Initial Evaluation of the Normal Newborn

Hand washing is critical for all personnel to prevent transmission of infection.

Active participation in the birth by the mother and her partner helps them adapt to parenting.

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 5 minutes after birth ( see Table: Apgar Score Apgar Score ). Apgar scores between 8 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. Many normal neonates have cyanosis 1 minute after birth that clears by 5 minutes. Cyanosis that does not clear may indicate congenital cardiopulmonary anomalies 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 should be done within 24 hours. Doing the examination with the mother and other family members present allows them to ask questions and the clinician to point... read more .)

Preventive interventions include administration into both eyes of an antimicrobial agent (eg, 0.5% erythromycin 1 cm ribbon, 1% tetracycline 1 cm ribbon, 1% silver nitrate solution 2 drops; in some countries, 2.5% povidone iodine drops) to prevent gonococcal and chlamydial ophthalmia Neonatal Conjunctivitis Neonatal conjunctivitis is watery or purulent ocular drainage due to a chemical irritant or a pathogenic organism. Prevention with antigonococcal topical treatment at birth is routine. Diagnosis... read more and administration of vitamin K 1 mg IM to prevent hemorrhagic disease of the newborn (see Vitamin K Deficiency Vitamin K Deficiency Vitamin K deficiency results from extremely inadequate intake or fat malabsorption. Risk of bleeding is increased by use of coumarin anticoagulants. Deficiency is particularly common among breastfed... read more ).

Subsequently, the neonate is bathed, wrapped, and brought to the family. The head should be covered with a cap to prevent heat loss. Rooming-in 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. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for a minimum of 6 months and introduction... 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 .)