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SCOPE

DISEASE/CONDITION(S)

Well newborn.

GUIDELINE/OBJECTIVE(S)

Review best practices in caring for the infants in the well newborn nursery.

BRIEF BACKGROUND

Newborns admitted to the well nursery often include term, late preterm, and stable infants with special diagnoses. Healthy infants may room-in with their parent(s) while they remain in the hospital. The hospital stay of the parent and the newborn allows identification of early problems, ensures that the family is prepared to care for the infant at home, and reduces the risk of readmission.

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Thorough history and physical examination should be completed within 24 hours of birth to determine if there are any risk factors or findings that may require further evaluation and management. Routine care of the well newborn also includes important screening and prevention measures. This chapter reviews practice recommendations for term infants, late preterm infants, and infants with Trisomy 21.

PRACTICE OPTIONS

Practice Option #1: Term Infant

History

Maternal history. Age, gravida, parity, medical or psychological issues, medications.

Pregnancy history. Prenatal labs (blood type, blood group sensitizations, hepatitis B, group B strep, rubella, gonorrhea, chlamydia, syphilis, HIV); fertility issues; ultrasound results or other screening results; prenatal consultations with specialists; tobacco, alcohol, or drug use; other complications (gestational diabetes, gestational thrombocytopenia, gestational hypertension, pre-eclampsia, thyroid abnormalities such as Graves disease).

Family history. Inherited diseases (genetic disorders, bleeding disorders, metabolic diseases); disorders that require follow up (congenital heart disease, developmental hip dysplasia, early hearing loss, sibling with jaundice).

Intrapartum history. Gestational age; mode of delivery (with or without assistance, such as vacuum); Apgar score and resuscitation needed; sepsis risk factors (fever, duration of rupture of membranes, intrapartum antibiotics, chorioamnionitis); appearance of amniotic fluid; multiple gestation; complications (shoulder dystocia).

Social history. Involvement of father, partner, or other support person; history of domestic violence; custody of other children; drug or alcohol use; cultural background of family; family stressors.

Physical Examination

General Examination

  • Infants should be examined whenever possible in the presence of their parents.

  • Infants should be fully undressed with proper lighting.

Vital signs

  • Temperature: Should be initially screened in the axilla. Normal axillary temperature is 97.7–99.3°F. If axillary temperature is outside of this range, temperature can be confirmed via rectal temperature. Normal rectal temperature is 98.1–99.9°F.

  • Respiratory rate: Normal respiratory rate is 30−60 breaths per minute.

  • Heart rate: Normal heart rate is 100−160 beats per minute (bpm). If resting heart rate is 80−100 bpm, heart rate should increase to the normal range with stimulation.

Measurements

  • Weight, length, and head circumference: Plot measurements on ...

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