Care of the term (≥ 37 0/7 weeks of gestation) newborn involves rapid assessment of transition to extrauterine life, using the Apgar score and other aspects of the initial evaluation to identify infants who require resuscitation or closer monitoring. Care of most neonates includes supportive measures (skin-to-skin contact, thermoregulation, early feeding) and preventive care (ocular antibiotic, vitamin K, and hepatitis B vaccine as indicated).
Apgar Score and Additional Newborn Evaluation
The neonate’s respiratory effort, heart rate, color, tone, and reflex irritability should be assessed immediately after delivery; all are key components of the Apgar score assigned at 1 minute and again at 5 minutes after birth (see table ) (1).
The Apgar score itself is not directly used to guide resuscitation (especially the initial steps of resuscitation, which occur before 1 minute has passed), but several of its components (muscle tone, respiratory effort, and heart rate) are. Apgar scores are generally considered normal when between 7 and 10 at 5 minutes, and indicate that the neonate is making a smooth transition to extrauterine life (2); scores < 7 at 5 minutes (particularly if sustained beyond 10 minutes) are linked to higher neonatal morbidity and mortality rates in population studies (3). However, even within the "normal" range there is variation; study of more than 1.5 million infants showed that a score of 7 to 9 at 5 minutes was associated with a poorer prognosis than a score of 10 (4).
Acrocyanosis is extremely common at 1 minute, but can last for 24 to 48 hours (and may be observed intermittently for many months). Central cyanosis may also be seen initially in normal newborns as they transition to extrauterine life, but central cyanosis that persists beyond 5 to 10 minutes may indicate airway or breathing problems, congenital cardiopulmonary anomalies, or CNS depression.
include respiratory, cardiovascular, or neurologic issues. Neonatal resuscitation is discussed in detail separately.
In addition, neonates should be evaluated for obvious malformations (eg, clubfoot, polydactyly) and other important abnormalities (eg, heart murmurs). The initial evaluation should ideally be performed under a radiant warmer with the family close by. (See also Physical Examination of the Newborn.)
Apgar Score
Score* | ||||
|---|---|---|---|---|
Criteria | Mnemonic | 0 | 1 | 2 |
Color† | Appearance | All blue pale | Pink body, blue extremities | All pink |
Heart rate | Pulse | Absent | < 100 beats/minute | > 100 beats/minute |
Reflex response to nasal catheter/tactile stimulation | Grimace | None | Grimace | Sneeze, cough |
Muscle tone | Activity | Limp | Some flexion of extremities | Active |
Respiration | Respiration | Absent | Irregular, slow | Good, crying |
* A total score of 7–10 at 5 minutes is considered normal; 4–6, intermediate; and 0–3, low. † The color (appearance) component as originally described may be less useful prognostically for non-White newborns; modifications to the scoring system have been suggested. Central cyanosis may be evaluated more reliably in the lips, mucous membranes, and tongue in non-White newborns. See Tillman D, Guillory C, Raphael JL. Color outside the lines: rethinking Apgar scores for equity. Pediatr Res. Published online November 11, 2024. doi:10.1038/s41390-024-03701-7 and Fair FJ, Furness A, Higginbottom G, Oddie SJ, Soltani H. Systematic review of Apgar scores & cyanosis in Black, Asian, and ethnic minority infants. Pediatr Res. 2025;97(3):939-952. doi:10.1038/s41390-024-03543-3. | ||||
Apgar score and additional newborn evaluation references
1. APGAR V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-267.
2. Committee Opinion No. 644. The Apgar Score. Obstet Gynecol. 2015;126(4):e52-e55. doi:10.1097/AOG.0000000000001108
3. Chen HY, Blackwell SC, Chauhan SP. Association between apgar score at 5 minutes and adverse outcomes among Low-Risk pregnancies. J Matern Fetal Neonatal Med. 2022;35(7):1344-1351. doi:10.1080/14767058.2020.1754789
4. Razaz N, Cnattingius S, Joseph KS. Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden. BMJ. 2019;365:l1656. Published 2019 May 7. doi:10.1136/bmj.l1656
Initial Newborn Care
Vigorous newborns not requiring resuscitation should establish skin-to-skin contact with a parent as soon as possible. Skin-to-skin contact has significant benefits, including breastfeeding promotion, thermoregulation, and glucose homeostasis (1).
The neonate is usually 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 parent and early breastfeeding (chestfeeding) should be encouraged so the family can begin to bond with the infant. Breastfeeding is more likely to be successful when the family is given frequent and adequate support (2, 3). (See also Care of the Normal Newborn.)
General preventive interventions recommended for newborns include administration of the following:
A topical antimicrobial ointment applied to both eyes to prevent ophthalmia neonatorum caused by Neisseria gonorrhoeae (4). Erythromycin 0.5% ointment is recommended in the United States. If erythromycin ointment is unavailable, infants at risk for N. gonorrhoeae infection may be administered ceftriaxone IM or IV (4). Tetracycline and tobramycin ointment, silver nitrate solution, and povidone-iodine drops are used in some countries (5).
Phytonadione (vitamin K) 1 mg IM for infants who weigh > 1500 g OR 0.3 to 0.5 mg/kg IM for infants who weigh ≤ 1500 g, within 6 hours of birth, to prevent hemorrhagic disease of the newborn (see Vitamin K Deficiency) (6). Alternative oral regimens exist for parents who decline intramuscular injection (7, 8).
Hepatitis B vaccination (prevention of hepatitis B) in neonates is discussed in detail separately.
In addition, routine neonatal screening tests (described separately) are performed.
Initial newborn care references
1. Moore ER, Brimdyr K, Blair A, et al. Immediate or early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2025;10(10):CD003519. Published 2025 Oct 22. doi:10.1002/14651858.CD003519.pub5
2. Gavine A, Shinwell SC, Buchanan P, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev. 2022;10(10):CD001141. Published 2022 Oct 25. doi:10.1002/14651858.CD001141.pub6
3. Patnode CD, Senger CA, Coppola EL, Iacocca MO. Interventions to Support Breastfeeding: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2025;333(17):1527-1537. doi:10.1001/jama.2024.27267
4. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. Published 2021 Jul 23. doi:10.15585/mmwr.rr7004a1
5. Kaštelan S, Anić Jurica S, Orešković S, et al. A Survey of Current Prophylactic Treatment for Ophthalmia Neonatorum in Croatia and a Review of International Preventive Practices. Med Sci Monit. 2018;24:8042-8047. Published 2018 Nov 10. doi:10.12659/MSM.910705
6. Hand I, Noble L, Abrams SA. Vitamin K and the newborn infant. Pediatrics. 149(3):e2021056036, 2022. doi: 10.1542/peds.2021-056036
7. Mihatsch WA, Braegger C, Bronsky J, et al. Prevention of Vitamin K Deficiency Bleeding in Newborn Infants: A Position Paper by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2016;63(1):123-129. doi:10.1097/MPG.0000000000001232
8. Ng E, Loewy AD. Position Statement: Guidelines for vitamin K prophylaxis in newborns: A joint statement of the Canadian Paediatric Society and the College of Family Physicians of Canada. Can Fam Physician. 2018;64(10):736-739.
Drug Information for the Topic
