Neonatal Care

Birth demands rapid physiologic change. The lungs must clear fluid and inflate, pulmonary vascular resistance must fall, the ductal circulation must begin to close, and the infant must generate heat and maintain glucose without placental support. A healthy term newborn usually makes this transition quietly. A preterm or stressed infant may not. The newborn has little physiologic reserve. Small changes in temperature, oxygenation, feeding, or infection can produce a large clinical deterioration. That is why a newborn who is sleepy, cool, tachypneic, or feeding poorly deserves attention even when no single finding appears dramatic. Prematurity amplifies this vulnerability. Immature lungs have less surfactant, immature skin allows greater heat and water loss, glycogen stores are limited, and suck-swallow-breathe coordination may be incomplete. Care therefore focuses on protecting oxygenation, temperature, glucose, nutrition, and infection control while minimizing unnecessary stress. During initial stabilization, assess breathing, heart rate, tone, colour, and temperature. A vigorous newborn who is breathing or crying usually needs warmth, drying, skin-to-skin contact when appropriate, and ongoing observation. Apnea, gasping, persistent cyanosis, poor tone, or a heart rate below 100 beats/minute...