Initial Evaluation of the Normal Newborn

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 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 (1 References 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,... read more ). Many normal neonates have cyanosis 1 minute after birth that clears by 5 minutes. Cyanosis (and, in particular, central cyanosis) that does not clear may indicate congenital cardiopulmonary anomalies Overview of Congenital Cardiovascular Anomalies Congenital heart disease is the most common congenital anomaly, occurring in almost 1% of live births ( 1). Among birth defects, congenital heart disease is the leading cause of infant mortality... read more or central nervous system (CNS) depression.

In addition to Apgar scoring, neonates should be evaluated for gross deformities (eg, clubfoot Talipes Equinovarus (Clubfoot) and Other Foot Abnormalities Talipes equinovarus, sometimes called clubfoot, is characterized by plantar flexion, inward tilting of the heel (from the midline of the leg), and adduction of the forefoot (medial deviation... read more , polydactyly Polydactyly Congenital limb defects involve missing, incomplete, supernumerary, or abnormally developed limbs present at birth. (See also Introduction to Congenital Craniofacial and Musculoskeletal Disorders... read more ) and other important abnormalities (eg, heart murmurs Murmurs Congenital heart disease is the most common congenital anomaly, occurring in almost 1% of live births ( 1). Among birth defects, congenital heart disease is the leading cause of infant mortality... read more ). The evaluation should ideally be done under a radiant warmer with the family close by. (See also Physical Examination of the Newborn Physical Examination of the Newborn A thorough physical examination of a newborn should be done within 24 hours of birth. Doing the examination with parents present allows them to ask questions and allows the clinician to point... read more .)

Preventive interventions include administration of the following:

In addition, routine neonatal screening tests Screening Tests for Newborns Screening recommendations for newborns vary by clinical context and regulatory requirements. In the United States, the Health Resources & Services Administration recommends screening for all... read more 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 Breastfeeding (See also Nutrition in Infants.) Breast milk is the nutrition of choice for young infants. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for a minimum of 6 months... read more is more likely to be successful when the family is given frequent and adequate support. (See also Care of the Normal Newborn Care of the Normal Newborn While in the hospital, new parents should be taught how to feed, bathe, and dress their newborn and become familiar with the newborn's activities, cues, and sounds. Before hospital discharge... read more .)