What are the critical recommendations for newborn care in neonatology?

Critical Recommendations for Newborn Care in Neonatology

All newborns require immediate attention to delayed cord clamping, temperature maintenance, assessment of transition, and early glucose monitoring to prevent morbidity and mortality.

Immediate Delivery Room Management

Umbilical Cord Management

• Delay cord clamping for at least 60 seconds in term infants to reduce anemia and improve neurodevelopmental outcomes 1.
• For preterm infants (<35 weeks), delay cord clamping for at least 30 seconds to reduce transfusion needs, intraventricular hemorrhage, and necrotizing enterocolitis 1.
• Position the infant on the maternal abdomen, legs, or hold close to placental level during the delay period 1.
• Clamp immediately only if the infant requires urgent resuscitation or placental circulation is compromised 1.
• Monitor for hyperbilirubinemia risk, as delayed clamping increases phototherapy needs 1.

Temperature Management

• Maintain operating room temperature between 21-25°C to prevent hypothermia, which increases neonatal morbidity and mortality across all gestational ages 1.
• Immediately dry and cover the infant's head while awaiting cord clamping 1.
• For preterm infants, use plastic wraps/bags, transwarmer mattresses, exothermic heaters, and caps to maintain normothermia 1.

Initial Assessment and Resuscitation Readiness

• Document Apgar scores at 1,5, and 10 minutes as critical health indicators 1.
• Ensure equipment, staffing, and skills are immediately available for neonatal resuscitation in all cesarean delivery settings 1.
• Heart rate is the most sensitive indicator of successful resuscitation response 1.
• Establishing effective ventilation remains the most critical step, as neonatal arrest is almost always asphyxial 1.

Safe Positioning and Skin-to-Skin Care

Preventing Sudden Unexpected Postnatal Collapse (SUPC)

• Ensure the infant's face is visible and uncovered during skin-to-skin care 2.
• Position the infant's head in "sniffing" position with a straight neck 2.
• Cover the infant's back with blankets while maintaining proper positioning 2.
• Provide continuous monitoring during the first 2 hours of life, the highest-risk period for SUPC 2.

Oxygen Management for Preterm Infants

Initial Resuscitation Strategy

• Initiate resuscitation of preterm infants (<35 weeks) with low oxygen (21-30%), not high oxygen (≥65%) 1.
• Titrate oxygen concentration to achieve preductal saturation approximating healthy term infant ranges 1.
• High oxygen provides no survival or morbidity benefit and exposes preterm infants to unnecessary oxidative stress 1.

Postresuscitation Metabolic Management

Glucose Monitoring and Management

• Initiate intravenous glucose infusion as soon as practical after resuscitation to avoid hypoglycemia 1.
• Maintain vigilance for both hypoglycemia and hyperglycemia, as both are associated with harm 1.
• Use protocols for blood glucose management to avoid large swings in glucose concentration 1.
• For infants on TPN, monitor blood glucose during interruptions, especially in young infants at risk for hypoglycemia 3.

Fluid Management

• Maintain perioperative euvolemia to optimize maternal and neonatal outcomes, as fluid overload causes newborn weight loss in the first 3 days 1.
• Adequate uterine perfusion optimizes fetal oxygenation and prevents acidosis 1.

Infection Prevention and Screening

Group B Streptococcus (GBS) Management

• All well-appearing newborns born to mothers with chorioamnionitis require limited evaluation (blood culture and CBC) before empirical antibiotics 1.
• For term infants with adequate maternal intrapartum antibiotic prophylaxis (IAP), routine care with 48-hour observation is sufficient 1.
• Discharge at 24 hours is acceptable if the infant is term, meets discharge criteria, and has ready access to medical care with follow-up within 48-72 hours 1.
• Well-appearing term infants with inadequate IAP and rupture of membranes ≥18 hours require limited evaluation and 48-hour observation 1.
• All preterm infants with inadequate IAP require limited evaluation and 48-hour observation 1.

Newborn Screening

• Mandate screening for all core panel conditions including metabolic, hearing, and pulse oximetry screening 1, 2.
• Verify completion of all screenings before discharge 2.
• Report all secondary target conditions and clinically significant abnormal results 1.

Jaundice Monitoring

Bilirubin Assessment

• Evaluate any infant jaundiced after 2 weeks of age for cholestasis with total and direct bilirubin measurement 4.
• Direct bilirubin >1.0 mg/dL (>17 μmol/L) warrants timely referral to pediatric gastroenterology/hepatology 4.
• Monitor for hyperbilirubinemia following delayed cord clamping and ensure phototherapy capability 1.
• Early detection through bilirubin screening and prompt phototherapy are critical to preventing kernicterus 5.

Discharge Planning

Comprehensive Assessment Before Discharge

• Assess feeding patterns thoroughly before discharge 2.
• Verify appropriate bilirubin measurement protocols are in place 2.
• Confirm completion of metabolic screening, hearing screening, and pulse oximetry 2.

High-Risk Infant Discharge

• Identify and prepare in-home caregivers for high-risk infants 2.
• Develop a specific nutritional care plan 2.
• Coordinate equipment and supply sourcing 2.
• Establish communication with the primary care physician 2.
• Assess home physical facilities for safety and adequacy 2.

Special Populations

Epidermolysis Bullosa (EB)

• Use the side-roll technique for lifting: hold under neck and diaper area, never under the arms 1.
• Apply emollient or padding between gloved hands and skin to reduce friction 1.
• Use axillary temperature probes with emollient, or digital infrared thermometers if available 1.
• Place soft cotton or silicone dressing between oxygen monitors and skin 1.
• Use padding or clothing between blood pressure cuffs and skin 1.
• Consider hospital transfer to EB specialist centers based on severity, monitoring requirements, and local resources 1.