Neonatal Care
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Skin-to-skin contact established
Baby is cleaned and dried, first APGAR score taken
Cord cut, blood taken for lactate
2nd APGAR and brief newborn exam after 5 minutes
Breast-feeding (colostrum) within first hour
Baby weighed and measured
Obs hourly for first 4 hrs (Temp, RR, HR), 3-hourly BSLs if GDM
 “pink, warm & sweet”
Vitamin K injection <6 hrs
Passage of meconium (<24/48 hrs)
Full newborn exam and Hep B immunisation 48 hrs
Discharge (48 hrs NVB/96 hrs LUSCS)
Newborn Screening Test (heel-prick) 48-72 hrs
 CF, PKU, congenital hypothyroidism, galactosaemia, others
Sign
Colour
Appearance
Heart rate
Pulse
Reflex irritability
(stimulation to sole of
foot)
Grimace
Muscle tone
Activity
Respiratory effort
Respiration
0
Blue/pale
2
Pink
Absent
1
Body pink/
periphery blue
Slow (<100 bpm)
No response
Grimace
Cry/pulls away
Limp
Some flexion of
extremeties
Weak cry/
hypoventilation
Active motion/
extremities well flexed
Good, strong cry
Absent
Neonatal resuscitation
In infants, cardiac arrest is almost always caused by respiratory failure.
Specialised bag and mask system for neonates – on wards.
Needs two people for CPR – one on compressions, one on bag/mask
Head in sniffing position
Bag and mask should cause a chest rise, no more
3 compressions to one breath, cycle over 2 seconds
Compressions can be two-handed or one-handed – 1/3 of chest
See attached file
Fast (≥100 bpm)
Neonatal Examination
1. General inspection
 Colour
 Activity – spontaneous,
symmetrical, tone
 Respiratory effort
i. Intercostal recession
ii. Audible respiration
(eg. mewling)
 Signs of systemic
developmental disability
i. Small, low set ears
ii. Distance between
eyes
iii. Epicanthal fold etc.
iv. Distinctive fascies
 Birthmarks
2. Head and Neck
 Anterior fontanelle, sutures
 Cephalhaematoma/chignon
 Patent ears
 Red reflex
 Patent nostrils
 Cleft lip/palate (feel and look)
 Branchial cyst
3. Chest
 Auscultation
i. Heart rate/murmurs
ii. Breath sounds
4. Abdomen
 Masses
 Umbilicus
5. Legs/limbs
 Femoral pulses
 Supranumerary digits
 Clubfeet
 Palmar creases
6. External genitalia
 Boys
i. Scrotal contents
ii. Hypospadias
iii. Phimosis
 Girls
i. Imperforate hymen
ii. Fused labia
 Indeterminate gender
 Imperforate anus (meconium
is a giveaway)
7. Back
 Check for NTD’s
8. Hips
 Clicky hips (DDH)
i. Barlow’s test
ii. Ortelani’s test
 Leg length
 Symmetrical creases
9. Reflexes/development
 Moro
 Rooting
 Stepping
 Palmar grasp
 Cremasteric
 Glabellar tap
 Head lag
General pointers:
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Needs full exposure, but undressing
will cause crying
Technique needs to be fluid
Fundoscopy when quiet, palate when
unsettled
Hips ALWAYS last
Always wash hands
Always dress/wrap baby
Change nappy if necessary