Score Interpretation:

• 0–3: Critical condition; requires immediate resuscitation.

• 4–6: Moderate concern; may need airway management or oxygen.

• 7–10: Stable; healthy adaptation to life outside the womb.

Respiratory Assessment

Breathing is the highest priority in neonatal evaluation. The Silverman-Andersen index is often used to assess respiratory distress. It scores five parameters:

1. Chest movement

2. Intercostal retractions

3. Xiphoid retractions

4. Nasal flaring

5. Expiratory grunting

Each is scored 0 (normal) to 2 (severe distress), with:

• 0 = No distress

• 4–6 = Moderate distress

• 7–10 = Severe respiratory compromise

Unlike the Apgar score, higher Silverman-Andersen scores indicate worsening conditions.

Physical Examination

A prompt but thorough physical check helps detect anomalies or urgent health issues. Key aspects include:

• Height and weight: Helps assess gestational maturity and serves as a baseline.

• Daily weight monitoring: Identifies abnormal losses or gains.

• Heel-stick blood tests: Used for glucose levels and general screenings.

• Behavioral observations: Full-term babies are typically more alert and interactive than preterm infants.

Immediate Newborn Care at Birth

Once the baby is delivered, immediate care is performed in a designated area near the delivery room. Essential equipment includes:

• Radiant warmer

• Resuscitation tools

• Clean linens

• Suction and oxygen supplies

• Weighing scale

• Eye care materials

Identification procedures are critical to ensure safety and proper documentation:

• ID bands with key identifiers (mother’s name, time of birth, sex, hospital number)

• Footprint records

• Birth registration by attending healthcare providers

• Detailed charting of birth time, Apgar score, vaccinations, and general condition

Postpartum Newborn Care

Cultural practices influence newborn care routines, but general recommendations include:

Feeding

• Breastfed newborns can nurse immediately.

• Formula-fed infants typically begin feeding 2–4 hours post-birth.

Bathing

• First bath is done approximately an hour after birth to clean off vernix caseosa.

• Key bathing tips:

  • Use warm water in a warm room.

  • Bathe before feeding to prevent vomiting.

  • Clean from the eyes (cleanest) to the diaper area (dirtiest).

  • Avoid soaking the umbilical cord.

  • Don’t use soap on the face—only the body.

Bath items: washcloth, soap, towel, clean clothes, diaper, and a comb.

Sleep and Positioning

• Always place the newborn on their back to sleep, reducing the risk of Sudden Infant Death Syndrome (SIDS).

• Avoid putting pacifiers in the baby’s mouth during sleep.

Diapering

• Keep the area clean and dry to prevent rashes.

• Apply a light layer of petroleum jelly or ointment to protect the skin and ease cleaning of meconium.

Medications and Vaccines

• Vitamin K is administered to prevent bleeding disorders.

• Hepatitis B vaccine is given shortly after birth.

Transitioning Care to Parents

Healthcare providers play a vital role in initiating newborn care, but as the baby stabilizes, responsibility shifts to the family. Before discharge:

• Educate parents on newborn hygiene, feeding, safe sleep, and recognizing danger signs.

• Emphasize the importance of routine checkups and immunizations.

• Provide clear guidance on practices that promote safe and healthy infant development.

This foundational approach ensures newborns receive safe, evidence-based care both in the hospital and at home, enhancing their chances for a healthy start in life.