The majority of full-term newborns have an uneventful postnatal course. Once the newborn transitions from the intrauterine to extrauterine environment, management centers on routine care and parental anticipatory guidance. However, certain clinical conditions may not manifest in the immediate newborn period, and their early detection may prevent long-term morbidity or even death. Therefore, proper parental education not only makes the mother’s and father’s transition into parenthood easier but also prevents potential adverse outcomes for the infant.
Assessment of the newborn begins with review of the maternal history, the pregnancy, and the delivery (Table 124-1). A physician must perform a thorough head-to-toe examination of the newborn infant within 24 hours of birth and daily while the infant is in the hospital. Every examination should start with a review of the vital signs; the range of normal values for newborns is provided in Table 124-2. The initial examination should also include measurements of birth weight, length, and head circumference. These are plotted on standard growth curves to determine whether they are proportional and appropriate for the gestational age.
TABLE 124-1Perinatal History Assessment |Favorite Table|Download (.pdf) TABLE 124-1 Perinatal History Assessment
|Maternal ||Fetus ||Labor |
|Illnesses (current or past) ||CVS or amniocentesis ||Gestational age at delivery |
|Medications ||Prenatal ultrasonography ||Progression of labor (e.g. duration of rupture of membranes, maternal fever) |
|Drug, alcohol, or tobacco use ||In utero interventions (e.g. surgery, infusions, selective reductions) ||Delivery (induced, spontaneous, vaginal, forceps or vacuum assisted, cesarean, presentation) |
|Prenatal care || ||Medications (analgesia, antibiotics) |
|Prenatal testing (CVS, amniocentesis, hepatitis B, HIV, RPR, other STIs, PPD, GBS, blood type) || ||Fetal distress, presence of meconium or urine, evidence of chorioamnionitis |
|Complication of this pregnancy (e.g. premature labor, bleeding) || ||Resuscitation |
|Complications of previous pregnancies || ||Apgar scores |
|Disorders in other children or family members || ||Complications |
TABLE 124-2Vital Signs in Full-Term Newborns |Favorite Table|Download (.pdf) TABLE 124-2 Vital Signs in Full-Term Newborns
|Vital Sign ||Normal Range |
|Temperature ||Rectal: >36.5°C and <38°C* |
|Heart rate ||90-150 beats/min |
|Respiratory rate† ||30-60 breaths/min |
The infant should be completely undressed and observed for any signs of distress, dysmorphology, asymmetry, or abnormal color. Pertinent findings of the newborn examination are summarized in Table 124-3. Abnormalities, including vital signs outside the normal range, often require further investigation or follow-up.
TABLE 124-3Newborn Examination