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 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). 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 or central nervous system (CNS) depression.

In addition to Apgar scoring, neonates should be evaluated for gross deformities (eg, clubfoot, polydactyly) and other important abnormalities (eg, heart murmurs). The evaluation should ideally be done under a radiant warmer with the family close by. (See also Physical Examination of the Newborn.)

Preventive interventions include administration of the following:

• gonococcal ophthalmia

• Vitamin K Deficiency) (2)

• Hepatitis B vaccination

In addition, routine neonatal screening tests 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 is more likely to be successful when the family is given frequent and adequate support. (See also Care of the Normal Newborn.)