Routine Care of a Newborn (normal and abnormal) and how to document the findings and procedures

Routine Care of a Newborn

Table of Contents(toc)

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1. Immediate Care at Birth

• APGAR Score (at 1 & 5 min)

  • Appearance (color)

  • Pulse (HR)

  • Grimace (reflex irritability)

  • Activity (tone)

  • Respiration

• Drying and preventing hypothermia (warm, dry, stimulate)

• Clear airway only if obstruction/secretions present (avoid routine suctioning)

• Delayed cord clamping: 30–60 sec if no contraindication

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2. Routine Care in the First Hour (“Golden Hour”)

• Thermal protection

  • Skin-to-skin contact with mother

  • Warm environment, cap, blanket

• Airway, Breathing, Circulation (ABC)

  • HR >100, regular breathing, pink → continue routine care

  • HR <100, apnea, gasping → initiate resuscitation

• Early Initiation of Breastfeeding

  • Within first hour (promotes bonding, colostrum feeding)

• Vitamin K injection

  • 1 mg IM (0.5 mg in <1500 g babies)

• Eye prophylaxis

  • Erythromycin 0.5% or tetracycline 1% ointment to prevent ophthalmia neonatorum

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3. Ongoing Care in First 24–48 Hours

• Monitoring

  • Vitals: Temp, HR, RR every few hours

  • Urine and stool passage

  • Feeding adequacy (suck, swallow, satiety cues)

• Immunization

  • BCG, OPV-0, Hepatitis B (within 24 hrs as per national schedule)

• Anthropometry

  • Birth weight, length, head circumference

• Cord Care

  • Keep dry and clean, no antiseptic unless high-risk setting

• Parental Counselling

  • Breastfeeding techniques, hygiene, danger signs

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4. Routine Screening

• Metabolic / Endocrine

  • Hypoglycemia: esp. in preterm, IUGR, diabetic mother’s baby

  • Newborn screening (where available): congenital hypothyroidism, G6PD deficiency, PKU, CAH

• Jaundice

  • Clinical assessment, TcB or TSB if risk factors present

• Hearing Screening (OAE/ABR)

• Pulse Oximetry screening for congenital heart disease

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5. Abnormal / At-Risk Newborns

(Routine care + specific interventions)

Preterm (<37 weeks)

• Risk: hypothermia, hypoglycemia, apnea, sepsis

• Care:

  • Kangaroo mother care / incubator

  • Strict thermal regulation

  • Early and frequent feeding (NG tube if <34 wks)

  • Respiratory monitoring (CPAP if distress)

Low Birth Weight (<2500 g)

• Extra attention to:

  • Feeding support

  • Hypoglycemia prevention

  • Infection prevention (hand hygiene, minimal handling)

Asphyxiated newborn

• Routine → Resuscitation protocol (NRP)

  • Ventilation (bag & mask) if HR <100

  • Chest compressions if HR <60 despite ventilation

  • Consider medications (epinephrine) if persistent

Infant of Diabetic Mother (IDM)

• Early feeding within 30 min

• Monitor glucose (first 2 hrs then 6–8 hrly)

• Risk: hypoglycemia, hypocalcemia, polycythemia

Meconium-stained liquor

• If vigorous: routine care

• If non-vigorous: clear airway, positive pressure ventilation if needed

Sepsis risk (PROM >18 hrs, maternal fever, foul-smelling liquor)

• Close monitoring for danger signs

• Sepsis screen (CBC, CRP, cultures)

• Start empirical antibiotics if symptomatic

Jaundice (early or severe)

• Identify risk factors (ABO/Rh incompatibility, G6PD, sepsis)

• Phototherapy or exchange transfusion as indicated

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6. Danger Signs in Newborns (must educate parents)

• Poor feeding / not able to suck

• Lethargy / unconsciousness

• Seizures

• Fast breathing (>60/min) or severe chest indrawing

• Fever / hypothermia

• Jaundice in first 24 hrs or severe/progressive

• Bleeding from any site

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7. Summary Table – Routine vs Abnormal Newborn Care

Step	Normal Routine Care	Abnormal / At-Risk Adjustments
Thermal protection	Skin-to-skin, warm room	Incubator/KMC for preterm, strict monitoring
Feeding	Early breastfeeding, exclusive	NG feeds in preterm, early glucose monitoring in IDM
Vitamin K & Eye care	Universal	Same, no change
Immunization	Birth vaccines	Delay only if critically ill
Monitoring	Vitals, urine, stool	Add glucose, Ca++, sepsis screen as indicated
Screening	Jaundice, hearing, CHD	Expanded metabolic panels in high-risk
Resuscitation	Rarely needed	Asphyxia: follow NRP

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Key Point:

Routine newborn care aims at thermal protection, early feeding, infection prevention, and parental education. For abnormal newborns, routine care continues but with added monitoring, supportive interventions, and early detection of complications.

Clinical Note – Routine Newborn Care

Date / Time: _________

Name: Baby of _________

Sex: Male / Female

Age: ___ hours / days

Gestation: ___ weeks (Term / Preterm)

Birth Weight: ______ g

Delivery: Normal vaginal / LSCS / Instrumental

Apgar: ___ at 1 min, ___ at 5 min

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Review of Systems / Examination

• General: Alert, active / lethargic / irritable

• Color: Pink / jaundiced / cyanosed / pale

• Cry: Normal / weak / absent

• Vital Signs:

  • Temp: ___ °C

  • HR: ___ /min

  • RR: ___ /min

  • SpO₂: ___ %

• Anthropometry: Weight ___ g, Length ___ cm, HC ___ cm

• Respiratory: Clear / retractions / grunting / nasal flaring

• Cardiovascular: Normal S1, S2 / murmurs

• Abdomen: Soft, liver/spleen not palpable / distension

• Cord: Clean / oozing / foul smelling

• Genitalia: Normal male / female; anomalies?

• CNS: Tone, reflexes (Moro, rooting, sucking) present / absent

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Procedures Done

• Airway cleared, baby dried and kept warm

• Skin-to-skin contact initiated

• Delayed cord clamping performed (___ sec)

• Vitamin K 1 mg IM given

• Eye prophylaxis (erythromycin ointment) applied

• Immunization: BCG / OPV-0 / Hep B given

• Feeding initiated: Breastfed within 1 hr (Yes / No)

• Anthropometry recorded

• Cord care provided

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Review & Plan

• Baby stable / unstable

• Feeding well / requires NG tube feeding

• Passed urine and meconium (Yes / No)

• Screening planned:

  • Blood glucose (if preterm, IDM, LBW)

  • TcB/TSB for jaundice monitoring

  • Pulse oximetry (CHD screening)

• Monitoring: Vitals 4-hourly, urine/stool output

• Parental counselling done on:

  • Exclusive breastfeeding

  • Cord care & hygiene

  • Danger signs explained

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If Abnormal Findings (add here as needed)

• Preterm: incubator/KMC initiated

• Asphyxia: Resuscitation per NRP (document steps, duration, outcome)

• Jaundice: TcB ___, Phototherapy started

• Sepsis risk: Sepsis screen sent, antibiotics started

• Hypoglycemia: Blood sugar ___ mg/dl, managed with feeding / IV glucose

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Signature / Name / Designation