A Typical Newborn  Flexed  Puffy  Molded  Nose breathers  Irregular HR and RR  Acrocyanosis  Periods of reactivity

Apgar score: What does it tells us?  HR, Resp. effort, tone, reflexes, color  1 min & 5 min  0-10  Good: 7-10

They do all kinds of weird things  Cross their eyes  Holes in their heads  Have dry skin (after the vernix absorbs)  They sneeze  Like being wrapped up tightly  Don ’ t get spoiled

Know your Patients history!  Prenatal: IDM?, GBS+?, mother ’ s bld type, significant labs or tests, gen. history  Intrapartum: length of labor, PROM, medications received, anoxia, assisted birth, FSE,

Determining Gestational Age  Neuromuscular  Physical skin lanugo plantar surface breast eye/Ear Genitals  Score: i.e. 30=36 wks

Gestational Age and Weight  AGA  LGA  SGA  LBW (<2500 g)  VLBW (<1500 g)  IUGR (<rate of growth)

Erythromycin, Hep B & and Vitamin K!

Newborn Screening  Hypothyroidism  PKU  Galactocemia  Sickle cell (most common)  CF  Congenital adrenal hyperplasia (CAH) 

Pulse Oximetry: CDC recommendation  Well newborn screening >24 hours old or at discharge if early discharge.  To detect asymptomatic critical heart defects  At least 95% in right hand or foot and < 3% difference between R hand and foot

Algo hearing test  50% congenital 50% environment  OAE: otoacoustic emissions testing  ABR: auditory brainstem response  They have to be calm and quiet!!!

On a scale of 1-10 rate your pain!  Obvious  Subtle Grimace, eye squeeze, brow contraction, nasolabial furrows Flexed and rigid Really quiet or restless  Pain scales for Infants: CRIES or NIPS

Newborn stools

Newborn Reflexes

Circumcision  Informed consent from parents  Pain medication for patient Before and after)  Post op care  Check for bleeding, voiding

Reasons for circumcision  Religious  Cultural  HIV Prevention?  Cleanliness?