# Newborn --- A **newborn** is a [[infant|baby]] that was just barely born up to about a month old. They require special care because they are getting used to not being a [[prenatal development|fetus]] any more. >[!science] Normal Values NEWBORN VITAL SIGNS: NORMAL RANGES • Respiratory Rate 30-60/min (irregular) • Heart Rate 110-160 bpm (irregular) • Temperature 97.7-99.5 F / 36.5-37.5 c ## Golden Hour The first hour of life. Birth to 2 hours: Navigating the Extrauterine Transition • Vital signs, Apgar scoring, neonatal resuscitation • Weights, measures, procedures • The Golden Hour Head-to-Toe Assessment Labs and Screening Tests Routine Care and Safety Discharge KEY ASSESSMENTS WITHIN 1 MINUTE OF BIRTH: TONE? BREATHING OR CRYING? HR >100? Timing is so important. You might often see the baby nurse unplug the fetal heart monitoring cord as soon as the head is delivered so that there is a very clear demarcation of when the birth happens. ![[neonatal resuscitation program.png]] Medications ("eyes and thighs") • Erythromycin ophthalmic ointment both eyes within first hour of life • Vitamin K (phytonadione), 0.5 mg 1M: required for blood coagulation • Hepatitis B Vaccination (if consent signed), 1M • If maternal HBsAg +, then also Hepatitis B IG (HBIG) 1M ASAP! ## APGAR score Apgars are a nursing function: memorize this chart Historical context: Virginia Apgar invented the score to get people to pay attention to babies Assess at 1 & 5 minutes of age If score is 7 or less at 5 minutes: perform again at 10 and 15 min A 10 is a perfect score, but you hardly ever see that at 1 minute because we expect to see some aconcyanosis or whatever it's called. You can see a 9 for a perfectly healthy baby Heartrate: must count for 1 minute, newborns heart rhythm is *regularly irregular* Respiratory effort: we're not looking at rate, just effort muscle tone: reflex irritability: babies should not be chilling, they were warm and happy in their dark little home. but now they get put through the ringer and it's bright and loud and cold here. Color: peripheral cyanosis is normal, central cyanosis is not (trunk or around the lips ) Best assessment is central part of body (lips, tongue, and torso) Acrocyanosis caused by poor neonatal circulation • Does not indicate decreased O2 the baby body is prioritizing the organs If baby requires resuscitation, an O2 saturation meter will be applied Resuscitation is started with room air inappropriate use of oxygen, even for adults, can be detrimental. too much oxygen can act as a [[antioxidant|free radical]]. when the red blood cells get oversaturated. If levels remain low and are not increasing-- add O2 ![[apgar score.png]] ## Newborn Transition The primary goal of care in the first moments after birth is to assist the newborn to successfully transition to extrauterine life - Spontaneous breathing • Clearing of lung fluid squeezing the fluid in the lung happens during a vaginal birth. • Establishing newborn circulation • Temperature regulation not just surface temps, but real core [[thermoregulation]] they have a high surface area to volume ratio they are also wet when they come out, so that's why it's important to dry them off and keep them covered. hospitals have to be well ventilated, so that makes it hard for babies too • Glucose regulation The best place to complete the neonatal transition is skin-to-skin on the parent's chest There is some connection to the brown-fat in babies. [[adipose tissue|brown fat]] BENEFITS OF UNINTERRUPTED SKIN-TO-SKIN CARE FOR NEWBORNS • Promotes physiologic stability • Thermoregulation • Glucose regulation Regulation of breathing and heart rate • Prevents the stress of separation • Facilitates self-attachment to breast/chest Improves long-term breastfeeding outcomes • Facilitates parent-infant bonding Bathing negates the benefits of vernix and lanugo ## Caput Succedaneum vs Cephalohematoma **Caput succedaneum** is a swelling on the top of the newborn's scalp. It's mostly seen during a head-down (vertex) delivery, and it's pretty harmless. It comes from the pressure coming out of the birth canal. **Cephalohematoma** is a hematoma, or a collection of blood, underneath the [[bone|periosteum]] of the scalp. A cephalohematoma is a bad sign. You can tell the difference between a cephalohematoma and caput because caput will cross the suture lines and cephalohematoma will be contained by the sutures. ![[caput.png]] ___