pediatrics
Initial Evaluation of the Normal Newborn
Introduction
Hand washing is critical for all personnel who provide newborn care to prevent transmission of infection. Immediately at delivery, the neonate’s respiratory effort, heart rate, color, tone, and reflex irritability should be assessed; all are key components of the Apgar score assigned at 1 minute and at 5 minutes after birth (see table Apgar Score ). Apgar scores between 7 and 10 indicate that the neonate is making a smooth transition to extrauterine life; scores < 7 at 5 minutes (particularly if sustained beyond 10 minutes) are linked to higher neonatal morbidity and mortality rates in population studies ( In addition to Apgar scoring, neonates should be evaluated for gross deformities (eg, Talipes Equinovarus (Clubfoot) and Other Foot Abnormalities , Score* Score* Criteria Criteria Mnemonic Mnemonic 0 0 1 1 2 2 Color Appearance All blue, pale Pink body, blue extremities All pink Heart rate Pulse Absent <100 beats/minute >100 beats/minute Reflex response to nasal catheter/tactile stimulation Grimace None Grimace Sneeze, cough Muscle tone Activity Limp Some flexion of extremities Active Respiration Respiration Absent Irregular, slow Good, crying * A total score of 7–10 at 5 minutes is considered normal; 4–6, intermediate; and 0–3, low. Preventive interventions include administration of the following: solution 2 drops; in some countries, 2.5% povidone iodine drops) to prevent Neonatal Conjunctivitis None (vitamin K) 1 mg IM for infants who weigh > 1500 g OR 0.3 to 0.5 mg/kg IM for infants who weigh ≤ 1500 g within 6 hours of birth to prevent hemorrhagic disease of the newborn (see Vitamin K Deficiency ) ( Hepatitis B (HepB) Vaccine None In addition, Screening Tests for Newborns are done. Subsequently, the neonate is bathed, wrapped, and brought to the family. The head should be covered with a cap to prevent heat loss. Keeping the newborn in the same room as the mother and early breastfeeding should be encouraged so the family can get to know the infant and can receive guidance from staff members during the hospital stay. Breastfeeding is more likely to be successful when the family is given frequent and adequate support. (See also 