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.