Care of the Newborn

The care of a normal newborn is a balance between facilitating maternal-infant bonding and successful transition to extra-uterine life while providing interventions to prevent disease and screening to allow for the early identification of rare conditions. Ideally, evidence-based interventions and monitoring of the newborn infant should be provided as unobtrusively as possible. In this chapter, we examine the evidence surrounding the most commonly recommended interventions, screening, monitoring, and assessment in the care of the newborn. Normal and abnormal adaptation to extra-uterine life including vital signs, temperature regulation, weight loss, stool and urine patterns, and glucose homeostasis are described and suggested management of common newborn problems is provided. The evidence for the benefits of interventions such as intramuscular vitamin K, newborn metabolic, hearing, and pulse oximetry screening is weighed against their potential risks. For controversial topics such as male circumcision and maternal HIV-positive breastfeeding, balanced information is provided that can be used by clinicians for discussions with parents. Finally, two of the central concerns during the newborn stay are jaundice and possible sepsis. While clinicians are most concerned with under-diagnosis of either condition, the effects of overtreatment are considerable. The evidence underlying recommended management guidelines for these conditions is presented, and methods for screening for jaundice and sepsis that limit invasive testing and unnecessary treatment while maximizing the chance of identifying newborns likely to benefit from intervention are offered.