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  • Heat loss: Evaporation, radiation, conduction, convection.
  • Heat production: Mainly through nonshivering thermogenesis (lipolysis of brown adipose tissue).

Gas Exchange

  • From placenta to lungs.
  • Fetal Hb allows fetus to maintain lower arterial oxygen tension (greater affinity for oxygen binding than adult Hb).

Effective Breathing and Pulmonary Inflation

  • From sporadic breathing to continuous breaths.
  • Replacement of fetal lung fluid with air (decreased production and increased absorption).


  • In fetus: ↑ PVR, ↓ SVR.
  • At birth: SVR increases with removal of placenta; PVR decreases with replacement of fetal lung fluid with oxygen and endogenous nitric oxide production, causing vasodilation.
  • Mixed circulation persists during this “transition” secondary to ductus arteriosus (closes within 2 wk, but flow decreases within a few hours of birth) and foramen ovale (right-to-left flow reverses soon after birth).

Vital Signs

  • Temperature (36.5°C–37.4°C)
  • Respirations (<60 breaths/min with no signs of respiratory distress)
  • HR (100–160 beats/min)

Head Circumference, Length, Weight, and Assessment of Gestational Age

General Appearance

  • Activity, color, abnormalities


  • Color, normal rashes (erythema toxicum, pustular melanosis), mongolian spots, abnormalities (nevi, hemangiomas)

  • Swelling (caput, cephalohematoma, subgaleal hemorrhage), trauma (forceps marks, scalp electrode marks), scleral hemorrhage, symmetric pupillary response, presence of red reflex, choanal atresia, cleft lip/palate, ear pits/tags, facial symmetry


  • Clavicles, cysts, webbing, masses


  • Equal breath sounds, respiratory distress (grunting, retracting)
  • Nipples (supernumerary), sternal abnormalities (ie, pectus excavatum or carinatum)


  • S1/S2 , rate, murmur, PMI, brachial and femoral pulses


  • Bowel sounds, defects, organomegaly, masses, appearance, cord vessels (two arteries, one vein)


  • Patent anus, ambiguous genitalia, abnormal anatomy (hypospadias, epispadias)
  • Boys: Descended testicles, penile length
  • Girls: Perforate hymen, clitoral length


  • Tone, equal movement, perfusion, digits, Barlow and Ortolani maneuvers for hip dysplasia

eFigure 28-1.

New Ballard score for assessment of fetal maturation of newly born infants. (Reproduced with permission from Ballard JL, et al: New Ballard score, expanded to include extremely premature infants. J Pediatr 1991;119:417. New York: McGraw-Hill. Copyright © The McGraw-Hill Companies. All rights reserved.)

eFigure 28-2.

Infant evaluation at birth—Apgar score. (Reproduced with permission from Hay WW Jr, Levin MJ, Sondheimer JM, Deterding RR: Current Diagnosis & Treatment: Pediatrics, 19th ed. New York: McGraw-Hill. Copyright © The McGraw-Hill ...

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