Neonatal Care and Definitions

Fetus relies entirely on the placenta for circulation and oxygenation
Neonate is a newborn, after delivery
Extrauterine life begins when the umbilical cord stops pulsating, and the infant starts breathing independently
Neonate period is 0-28 days old
Infant period is up to 1 year of age

Dry, warm, position, and stimulate the newborn (suction only if needed)
Assess APGAR score at 1 and 5 minutes (7-10 is good, 4-6 needs stimulation, 0-3 requires resuscitation)
Maintain body heat and respiratory function
Minimize infection risk
Educate parents on infant care

Preterm: before 32 weeks gestation
- Increased risk of apnea and bradycardia
Premature: 32-34 weeks gestation
Late premature: 34-36+6/7 weeks gestation
Term: 37-42 weeks gestation
Post-term (postmature): after 42 weeks gestation
- Increased risk of placental dysfunction (fetal hypoxia, late decelerations).
- Increased risk of meconium aspiration

Chest Compression: during vaginal delivery, creates a vacuum, stimulating respirations
Cord Stop Pulsating: creates hypercarbia and hypoxia/acidosis, stimulating respirations
Stimulated Respirations: causes changes in pulmonary blood vessel pressure and blood volume in the lungs
Transitions from Fetal to Normal Circulation: the transition from intrauterine to extrauterine life.

Neonates attempt to regulate temperature via increased extremity movement, vascular constriction, and brown fat metabolism.
Premature infants are more vulnerable due to less brown adipose tissue and inability to shiver
To prevent cold stress (hypothermia): dry the infant, cover the head, skin-to-skin with mom, use warm blankets
To treat cold stress: check for dryness, cover the head, swaddle or pre-heated warmer, monitor temperature, check glucose levels, and treat hypoglycemia
Hypoglycemia (capillary glucose <40 mg/dl): monitor carefully

Infection prevention: E-mycin eye ointment to prevent gonorrhea or chlamydia
Bleeding prevention: Vitamin K injection in the vastus lateralis muscle
Routine Care: Assess vital signs (temperature, pulse, respirations, blood pressure) at regular intervals

General appearance, measurements (head, chest, height, weight), vital signs, skin, acrocyanosis, lanugo, vernix, jaundice, and pallor.
Assess head, symmetry, sutures, and fontanels
Inspect neck, chest, checking for breast tissue and auscultate lungs (looking for crackles)
Evaluate abdomen, identifying the umbilical cord and checking for patency and bowel sounds.
Evaluate the genitalia, checking for abnormalities in males (testicles in scrotum) or females (labia, discharge).
Assess extremities for symmetry and assessing the spine
Assess reflexes

Tachypnea (>60 breaths/min), tachycardia (>180 beats/min)
Accessory muscle use, retractions, see-saw/paradoxical breathing, nasal flaring, grunting, gray/dusky skin, hypotonia
Temperature less than 97.7°F (36.5°C), pale/gray/cool skin

Use a circumcision board and restraint to ensure infant safety, and employ sucrose and non-nutritive sucking.
Begin 2 minutes before the procedure.
Should last 5-7 minutes per dose
Give Tylenol one hour before the procedure and 24 hours later if needed

Crying, irritability, restlessness, frantic sucking, inability to be consoled, congestion, sneezing, yawning, hyperreflexia, tremors, poor feeding
Administer or teach the 5 S's (swaddle, sway, sideway position, shush) as appropriate for managing NAS

Group B Strep: screening at 35-37 weeks, with observation of 24 hours or 48 hours if not treated.
Meningitis: petechiae, rash, grunting, fever, tachycardia, and hypoglycemia
Septicemia: Petechiae/rash, grunting, fever, tachycardia, tachypnea, hypoglycemia, WBC, blood culture
Covid19 transmission and respiratory infection symptoms.

Jaundice: yellow discoloration of skin due to hyperbilirubinemia, associated with hypoxia, breastfeeding, ABO/Rh incompatibility, oxytocin, delayed cord clamping
NEC: inflammation and necrosis of the bowel (3-10 days after delivery), abdominal distention, bloody stools, vomiting; treat with ABCs, NPO, gastric decompression, IVF, surgery, ABX
Meconium Aspiration syndrome: dark green/pea soup stool in amniotic fluid, difficulty breathing, direct tracheal suction by a trained provider

Ensure needs are met (pain, position, toileting, hunger)
Education on individual needs for the newborn and parents
Topics include nutrition and hydration and newborn care, safety, abuse head trauma (shaken baby), and crying periods

Rash or sunken fontanels, signs of infection, cord/circumcision site problems, fever, tachypnea, grunting, tachycardia, see-saw or paradoxical breathing

Separation may be necessary if the mother is too ill or infant is medically unstable.
Newborn screening for PKU (phenylketonuria), a condition where the infant cannot metabolize phenylalanine.
Prematurity concerns include apnea and bradycardia (heart rate <60 bpm), hypoxia (decreased oxygen to tissues), and acidosis (decreased blood pH), which could lead to cardiovascular collapse