Newborn Care
The first hours and days
APGAR (1 and 5 minutes)
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| Heart rate | Absent | <100 | ≥100 |
| Resp. effort | Absent | Weak, irregular | Good cry |
| Muscle tone | Limp | Some flexion | Active motion |
| Reflex irritability | None | Grimace | Cry, cough, sneeze |
| Color | Blue/pale | Blue hands and feet | Pink all over |
7–10 normal · 4–6 moderate · 0–3 severe. Resuscitation never waits for the APGAR.
Normal values
| Heart rate | ~100–160/min (lower asleep, higher crying) |
| Respirations | 30–60/min; brief pauses <20 s normal |
| Temperature | 97.7–99.5°F (36.5–37.5°C) axillary |
| Weight loss | Up to ~7–10% in the first days; regained by 10–14 days |
Normal findings: acrocyanosis, molding, milia, erythema toxicum, Epstein pearls, small vaginal discharge or bleeding (maternal hormones). Caput crosses suture lines; cephalohematoma doesn't (and raises jaundice risk).
Routine newborn medications and screening
| Vitamin K | Single IM dose (0.5–1 mg) into the vastus lateralis within ~6 h: prevents vitamin K deficiency bleeding |
| Eye prophylaxis | Erythromycin 0.5% ophthalmic ointment within 1–2 h of birth (required by law in many states) |
| Hepatitis B | Birth dose within 24 h for medically stable newborns ≥2,000 g (AAP; what NCLEX tests). Mother HBsAg-positive: vaccine + HBIG within 12 h; status unknown: vaccine within 12 h. A Dec 2025 ACIP change (shared decision-making if the mother is HBsAg-negative) was blocked by a federal court in March 2026; check the current CDC schedule. Updated |
| RSV protection | Nirsevimab (or clesrovimab) IM for infants entering their first RSV season, unless the mother had the RSV vaccine ≥14 days before birth New |
| Screening | Newborn blood spot after 24 h of feeding; hearing; critical congenital heart disease pulse oximetry at ≥24 h (right hand and a foot) |
Hypoglycemia
At risk: infant of diabetic mother, small or large for dates, preterm, cold stress. Signs: jitteriness, poor feeding, floppy, apnea, high-pitched cry, temperature instability, seizures (or none). Check glucose early per protocol; feed; 40% dextrose gel to the cheek; IV dextrose if severe or persistent.
Jaundice
Within the first 24 h = pathologic: report now. Physiologic jaundice appears after 24 h and peaks day 3–5. Phototherapy: eye shields, maximum skin exposure, turn, feed often, monitor temperature and hydration. Treat by hour-specific bilirubin thresholds (AAP 2022).
Keeping baby warm and safe
- Dry immediately; skin-to-skin; hat; warm room. Heat loss: evaporation, conduction, convection, radiation.
- Safe sleep: on the back, firm flat surface, own sleep space in the parents' room, nothing soft in the crib, no smoking, avoid overheating.
- Cord: dry cord care: keep clean and dry, fold the diaper below the stump; falls off in ~10–14 days. Report redness, odor or drainage.
- Rear-facing car seat required for discharge; back seat, harness snug at the armpits.
Newborn reflexes
Moro (startle; gone by ~4–6 months) · rooting and sucking (~4 months) · palmar grasp (~3–4 months) · plantar grasp (~8–10 months) · tonic neck ("fencing", ~4–6 months) · stepping (~2 months) · Babinski (toes fan out: normal until ~1–2 years). An absent or one-sided Moro may mean injury (clavicle fracture, brachial plexus).