Issues Unique to the Newborn
Rationale
The transition from intrauterine life to extrauterine independent existence is a major event: physiologically for the baby, emotionally for the family, and medically for the health care team. The events before, during and after delivery can have profound and lifelong effects on the baby, and, therefore, physicians, whether as primary care providers or as specialists, must have an appreciation for the physiologic changes a newborn experiences. The newborn has unique needs and vulnerabilities which are distinct from those of other periods of infancy and which may extend to the end of the first month of life. Most of the information covered in this section is pertinent in the first few hours and days of life, but must be considered for infants up to one month of age.
Objectives
- Recognize factors in the maternal and newborn
history which may put a neonate at risk for medical
problems.
- Describe and interpret the Apgar score. Explain
the relationship between the Apgar score and
morbidity, mortality and prognosis.
- Perform a complete physical examination on a
newborn infant and describe the special aspects of the
examination (e.g. assessment of hip dysplasia, eye
exam, neurological examination).
- Outline the key features of the gestational age
assessment.
- Use weight and gestational age to categorize
potential clinical problems.
- Identify the medications routinely given to all
newborns (e.g. vitamin K, Hepatitis B vaccine,
ophthalmological prophylaxis).
- Identify the diseases detected by neonatal
screening.
- Develop a reasonable differential diagnosis and
evaluation scheme for newborns with the following
clinical problems:
- Jaundice
- Respiratory distress
- Lethargy or poor feeding
- Cyanosis
- Vomiting, bilious and nonbilious
- Hypoglycemia
- Jitteriness or seizure
- Sepsis
- Demonstrate knowledge of the risks of transmission of Human Immunodeficiency
Virus (HIV) from mother to fetus and explain prevention strategies and the
indications for newborn HIV screening.