Care of the Well Newborn

Care of the Well Newborn

• Antenatal Care: Key to well-newborn care begins well before birth, optimizing maternal and fetal health.
• Prenatal Care: Anticipatory guidance, healthy lifestyle choices, medical history, substance use, family history, and mental health are important.
• Early Pregnancy Care: Focuses on risk assessment and mitigation, addressing maternal health and lifestyle factors.
• Maternity Care: Effective communication between providers (pediatricians and obstetricians).
• Prenatal Vitamins: Folic acid supplementation (400-800 µg) before conception and in first trimester crucial to prevent neural tube defects.
• Tetanus, Diphtheria, Acellular Pertussis (Tdap) Vaccination: Recommended in pregnancy (27-36 weeks) for maternal and fetal protection against pertussis.
• Influenza and COVID-19 Vaccination: ACOG recommends vaccination of all pregnant and lactating women due to demonstrated safety and efficacy.
• Delivery: Transition from intrauterine to extrauterine life.
• Maternal and Fetal Risk Factors: Factors influencing successful transition are crucial for clinicians to assess.
• Resuscitation: Necessary in up to 10% of deliveries, including 1% requiring aggressive resuscitation; emphasis on preparation and training.
• Newborn Assessment (Apgar Scores): Apgar scores (0-2) assessed at 1, 5, and subsequent 5-minute intervals if needed. Scores below 7 indicate need for re-evaluation.
• Apgar Score Components: Color, pulse, grimace, activity, respiration.
• Cord Clamping: 30-60 seconds of delayed cord clamping is recommended; improved hemoglobin and decreased risk of complications
• Postpartum Care: Direct skin-to-skin contact with mother for newborns, maximizes benefits to infant and mother.
• Skin-to-Skin Contact Benefits: Optimal nutrition, metabolic, cardiorespiratory, gastrointestinal, and neurologic outcomes, strengthened maternal-fetal bond. Important for breastfeeding initiation.
• Newborn Examination: Comprehensive head-to-toe evaluation; muscle tone, color, activity, disposition, and parent-infant interaction assessed initially; jaundice assessment is important.

Hospital Care of the Newborn

• Gestational Age: Assess gestational age (term, preterm, postterm) to guide care and interpretation.
• New Ballard Score: Useful for assessing neonatal maturity in cases of uncertain gestational age. This score considers physical signs linked to neuro-muscular maturation.
• Growth Parameters: Evaluate weight, length, and head circumference against standardized growth charts, which may be WHO (World Health Organization) based.
• SGA (Small for Gestational Age), LGA (Large for Gestational Age), AGA (Appropriate for Gestational Age). Infants outside of the 10th-90th percentile ranges for weight are considered atypical.
• Fetal Growth Restriction (FGR): Important to delineate if either symmetrical or asymmetrical
• Newborn Physical Examination: Comprehensive examination including assessing the head (molding, swelling), fontanelles, suture lines, symmetry, and eyes, ears, nose and throat.
• Cardiopulmonary Examination: Assessing respiratory effort, breathing pattern, breath sounds, and the heart.
• Extremities: Inspecting digits, palmar creases, and assessing for joint movement and range of motion. Hip dysplasia assessment using Barlow and Ortolani maneuvers should be performed.
• Genitourinary Tract: Visualizing genital area for anomalies, vaginal discharge, and testes descent in males.
• Neurologic Assessment: Assess for muscle tone, reflexes (suck, rooting, grasping, stepping, Moro) and Babinski reflexes.

Common Postnatal Complications

• Hypoglycemia: Infants at risk: gestational diabetes, large/small for gestational age, preterm infants; symptoms include jitteriness, floppiness, apneic episodes, tachypnea, lethargy and poor feedings.
• Jaundice: Physiologic jaundice is common. Pathologic jaundice appearing within 24 hours is critically important to identify and should prompt further investigation.
• Syphilis: Assess for congenital syphilis; possible transplacental antibody transfer; if high risk, mothers are screened and treated.
• Group B Streptococcus (GBS): Leading cause of neonatal morbidity/mortality; universal screening and intrapartum prophylaxis needed. Important to assess for early-onset sepsis.
• Hepatitis B: Screen all pregnant women; infants receive hepatitis B vaccine and immune globulin (HBIG) if needed to reduce risk; follow up and screening
• HIV: Formula feeding if mother known to be HIV positive. Zidovudine therapy started within 12 hours after birth.
• Neonatal Abstinence Syndrome (NAS): Infants born with maternal substance exposure; use specific scoring systems and supportive care.

Discharge and Anticipatory Guidance

• Newborn Screening: Screening newborns reduces morbidity with inborn errors of metabolism, congenital hypothyroidism, cystic fibrosis, hemoglobinopathies, immunodeficiencies, CCHD, and hearing loss; testing typically carried out shortly before discharge.
• Postnatal Care of the Newborn: Skin, cord, and circumcision care; feeding (breastfeeding vs formula, volumes).
• Car Seat Safety: Infants should ride rear-facing in a car seat, with appropriate precautions taken for safety.
• Postpartum Depression Screening: Vital for maternal mental health, which in turn effects the wellbeing of the infant; use standardized screening tools if possible.
• Vaccine Hesitancy: Address family/parental concerns, education, and motivation.
• COVID-19 Concerns: Manage with precautions and testing, while considering rooming-in, good hand hygiene, distancing, and masking when appropriate.

This quiz focuses on the essential aspects of care for well-newborns, including antenatal and prenatal care. It addresses the importance of maternal health, vaccinations during pregnancy, and effective communication between healthcare providers. Test your knowledge on these crucial topics to ensure the best outcomes for both mother and baby.