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Historical Perspectives

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Care of the Fetus

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Fetal Disorders

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Neonatal Mortality and Morbidity

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Delivery Room Resucitation

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Transitional Changes in the Newborn

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Examination of the Newborn Infant

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Postnatal Care and Observation of Low-Risk Newborns

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GENERAL CONSIDERATIONS

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This chapter will describe the care of hospital-born low-risk newborn infants between birth and discharge home. Routine care usually begins with an initial assessment of the infant in the newborn nursery.

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The goals of postnatal neonatal care for low-risk newborns are to

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  1. ensure transition to extra-uterine life,

  2. prevent or treat neonatal conditions arising from maternal or infant medical and social risk factors, and

  3. ensure a successful transition to home care.

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PHYSICAL ASSESSMENT

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The infant should be examined by the primary provider within the first 24 hours after birth. Generally, immediately after birth, healthy infants will remain with their mothers for a period of transition, skin-to-skin contact, breastfeeding, and bonding. This time together helps maintain the infant’s body temperature and facilitates successful breastfeeding. Guidelines suggest that the newborn’s condition should be evaluated after birth every 30 minutes until it has been stable for 2 hours. Thereafter, observations can be less frequent if the infant appears well. Nursing staff, medical staff, or a midwife in the postpartum area should perform a full assessment of the infant to identify potential problems.

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Body Temperature

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In the first few hours after birth, the infant’s body temperature should be measured on a regular basis. Skin temperature is usually lower than central body or core temperature, but it is still a reliable indicator of optimal temperature. Rectal temperature is a good indicator of core temperature, but insertion of a rectal temperature probe carries with it a risk of large bowel perforation. Measurement of axillary temperature is the preferred and safe alternative, and the normal range is 36.5°C to 37.4°C.

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At delivery, the skin is wet and covered with amniotic fluid; the infant is usually exposed to low ambient temperature in the delivery room and frequently is kept unclothed to allow adequate initial observation. Therefore, heat is lost by evaporation, radiation, and convection. If measures are not taken to prevent heat loss in the newborn, body temperature can fall precipitously. Drying the infant immediately after birth, wrapping the infant in a warm, dry towel, and placing a knit cap on the head all help to reduce heat loss. Delivery room assessments and resuscitation should be performed under a radiant warmer, ideally with a servo-controlled feedback device that attaches to the infant’s skin. Infants may also be placed in an incubator for observation in a neutral thermal environment of 31°C to 34°C at 50% humidity. In this range of ambient temperature and humidity, ...

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