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Women's Health and Education Center (WHEC)

Newborn Care

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  • Newborn Nutrition
    The landscape of breastfeeding has changed over the past several decades as more women initiate breastfeeding in the postpartum period and more hospitals are designated as Baby-Friendly Hospitals by following the evidence-based Ten Steps to Successful Breastfeeding. Human milk feeding supports optimal growth and development of the infant while decreasing the risk of a variety of acute and chronic diseases. The use of donor human milk is increasing for high-risk infants, primarily for infants born weighing <1,500 g or those who have severe intestinal disorders. Pasteurized donor milk may be considered in situations in which the supply of maternal milk is insufficient. Intramuscular vitamin K1 (phytonadione) at a dose of 0.5 to 1.0 mg should routinely be administered to all infants on the first day to reduce the risk of hemorrhagic disease of newborn. Vitamin D deficiency/insufficiency and rickets has increased in all infants because of decreased sunlight exposure secondary to changes in lifestyle, dress habits, and use of topical sunscreen preparations. Supplementary fluoride should not be provided during the first 6 months. From age 6 months to 3 years, fluoride supplementation should be limited to infants residing in communities where the fluoride concentration in water is <0.3 ppm. The Women's Health and Education Center (WHEC) strongly supports the national and international associations in endorsing the consumption of only pasteurized milk and milk products for pregnant women, infants and children.

  • Newborn Screening Program in the United States
    Newborn screening is the largest screening program in the United States with approximately four million newborns screened yearly. It is a mandated public health program designed for the identification of disorders in children. It is designed to provide rapid diagnosis and allow early therapy for specific metabolic, infections, and other genetic disorders for which early intervention reduces disabilities and death. This important practice typically occurs before the development of signs or symptoms of disease. Newborn screening programs are comprised of a complex, integrated clinical service of education, screening, diagnosis, follow-up, evaluation, and often long-term management. The list of recommended conditions for newborn screening programs is continually being evaluated. Integrating education about newborn screening into prenatal care allows parents to be prepared for having their child undergo screening as well as for receiving newborn screening test results. Furthermore, parents often view their care from prenatal management through pediatrics as a continuum of care without health care provider distinctions. This can be accomplished at different moments in prenatal care: 1) during the first-trimester new obstetric visit and include written or web-site information along with other patient education materials, 2) later in pregnancy with other educational information is routinely distributed, such as at the time of glucola or group B streptococcal screening in the third trimester, 3) during a discussion of past adverse pregnancy outcomes related to a positive newborn screening test result or birth defect, at the same time that options for prenatal or preimplantation genetic screening or diagnostic testing are considered.

  • The Apgar Score
    The purpose of this document is to place the Apgar score in its proper perspective. The Apgar score describes the condition of newborn infant immediately after birth, and when properly applied, it is a tool for standardized assessment. It also provides a mechanism to record fetal-to-neonatal transition. Apgar scores do not predict individual mortality or adverse neurologic outcome. However, based on population studies, Apgar scores of less than 5 at 5-minutes and 10-minutes clearly confer an increased relative risk of cerebral palsy, and the degree of abnormality correlates with the risk of cerebral palsy. Most infants with low Apgar score, however, will not develop cerebral palsy. The Apgar score is affected by many factors, including gestational age, maternal medications, resuscitation, and cardiorespiratory and neurologic conditions. If the Apgar score at 5- minutes is 7 or greater, it is unlikely that peripartum hypoxia-ischemia caused neonatal encephalopathy. The Neonatal Resuscitation Program (NRP) guidelines, Apgar score and subsequent neurological dysfunctions are also discussed. The review also examines the occurrence of 5-minute Apgar score of 0 and seizures or serious neurologic dysfunctions. Perinatal asphyxia is a major cause of neurologic sequelae in term newborns. Apgar score is useful for conveying information about the newborn’s overall status and response to resuscitation. However, resuscitation must be initiated, if needed, before the 1-minute score is assigned. Therefore, Apgar score is not used to determine whether the need for initial resuscitation steps are necessary, or when to use them.

  • Newborn Care: Initial Assessment & Resuscitation
    Approximately 10% of term and late-preterm infants require some assistance to begin breathing that includes stimulation at birth; less than 1% will need extensive resuscitative measures. Although the vast majority do not require intervention to make the transition from intrauterine to extrauterine life, because of the large total number of births a sizable number of babies will require some degree of resuscitation. Recognition and immediate resuscitation of a distressed newborn infant requires an organized plan of action that includes the immediate availability of proper equipment and on-site qualified personnel. Anticipated newborn problems should be thoroughly communicated by the obstetric care provider to the responsible lead member of the resuscitation team. Assessment and resuscitation of the infant at delivery should be provided in accordance with the principles of guidelines for neonatal resuscitation. Most of the principles are applicable throughout the neonatal period and early infancy. Each hospital should have policies and procedures addressing the care and resuscitation of the newborn infant, including the qualifications of physicians and other health care practitioners who provide this care. The Women's Health and Education Center (WHEC) with its partners has launched the series on Newborn Care to disseminate updated literature and guidelines to health care providers regarding newborn care and safety. Current guidelines are summarized in this section.

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