Neonatal Care Guidelines

Initial Assessment and Vital Signs

The American Academy of Pediatrics recommends that the vast majority (85%) of term newborns require only routine care, while approximately 10% need stimulation and only 5% require active resuscitation interventions, with heart rate and respirations guiding management 1
Newborns meeting all three criteria (term gestation, breathing or crying, and good tone) should remain skin-to-skin with mother for routine care rather than being moved to a radiant warmer 2
Approximately 60 seconds are allotted to complete initial assessment and establish effective ventilation 1

The American Academy of Pediatrics recommends maintaining axillary temperature between 36.5°C to 37.4°C 3
Respiratory rate should be less than 60 breaths per minute without signs of distress 3
Heart rate ranges from 100-190 beats per minute when awake, as low as 70 beats per minute when sleeping 3
Weight, length, and head circumference must be plotted on appropriate growth charts 3

Palpate fontanelles for size, tension, and abnormalities to detect increased intracranial pressure or dehydration 3
Perform red reflex testing bilaterally—normal findings show symmetry without opacities, white spots, or dark spots 3
Assess pupillary reactivity, fixation, and following behavior 3
Evaluate ear position, as low-set ears should prompt evaluation for genetic conditions 3
Assess patency and response to auditory stimuli 3

Auscultate lungs bilaterally for breath sounds and abnormalities 3
Assess respiratory rate and pattern systematically 3
Auscultate heart for rate, rhythm, and murmurs—benign murmurs are often present in the first hours of life representing transition from fetal to neonatal circulation 3

Palpate for masses (often renal in origin), organomegaly, or tenderness 3
Assess cord site for healing and signs of infection 3
Document any bilious or repetitive vomiting, which may indicate pyloric stenosis or gastrointestinal obstruction 3
Examine external genitalia for abnormalities or ambiguous features 3
Document first void if possible or confirm it has occurred 3
Assess urinary stream in males and genital appearance in females 3

Perform Ortolani and Barlow maneuvers—abnormal findings require further evaluation for developmental hip dysplasia 3
Assess extremities for symmetry, range of motion, and deformities 3

Assess muscle tone, posture, and symmetry of movement 3
Evaluate primitive reflexes: Moro, rooting, sucking, palmar and plantar grasp, stepping, and placing reflexes 3

Assess for jaundice and quantify with transcutaneous bilirubin or total serum bilirubin if present 3
Measure total and direct bilirubin levels in jaundiced newborns 3
Evaluate for signs of infection or poor perfusion 3

Complete newborn metabolic screening per hospital protocol and state regulations 3
Perform hearing screening or review results if previously completed 3
Complete pulse oximetry screening before discharge 3
Document successful feeding (breastfeeding or bottle-feeding) with proper coordination of sucking, swallowing, and breathing 3
Identify a source of continuing healthcare for post-discharge follow-up 3
Educate parents on signs of illness, feeding patterns, and when to seek medical attention 3

Correct anthropometric measurements for gestational age for at least the first 24 months of life for infants born before 36 weeks gestation 3