📚 Reading: ch. 18 — Exam 4, confirmed by the recording
APGAR never delays resuscitation.You do not wait a minute to act on a baby who is not breathing.Drying the baby is the first thing done at birth —
before weighing, before anything else.
💡 The one idea
A newborn loses heat four ways and cannot shiver. Cold stress drives up oxygen and
glucose use, so a cold baby becomes a hypoglycemic, acidotic baby fast.
Heat loss
How
Prevent by
Evaporation
Wet skin
Dry immediately — the first action at birth
Conduction
Cold surface
Warm blankets, pre-warm the scale
Convection
Draughts
Away from doors, vents, fans
Radiation
Nearby cold objects
Away from cold windows and walls
🖼️ APGAR scoring and newborn thermoregulation.Swipe it sideways if it is cut off, or tap to open it full size.
⭐ Newborn normals
Heart rate110–160
Respirations30–60, irregular, abdominal
Temperature36.5–37.5°C axillary
Glucose above 40–45 mg/dL
Weight loss up to 10% in the first days is normal; regained by 2 weeks
🗳️ APGAR — scored at 1 and 5 minutes
Appearance · Pulse · Grimace · Activity ·
Respirations. Each 0–2, total out of 10.
7–10 good · 4–6 moderate difficulty ·
0–3 resuscitate.
APGAR grades the transition. It never guides the resuscitation - you do not wait a minute to act on a baby who is not breathing.
🖼️ Feeding the newborn.Swipe it sideways if it is cut off, or tap to open it full size.
🚨 Jaundice — the timing decides everything
Within the first 24 hours = pathological. Usually hemolytic, often Rh or ABO
incompatibility. Always reported.
After 24 hours (day 2–3) = physiological. Common, from immature liver and rapid
breakdown of fetal red cells.
Feeding is treatment - it moves bilirubin out through the stool.
Phototherapy if levels rise; protect the eyes and monitor temperature and fluids.
✅ Normal findings that frighten parents
Milia, Mongolian spots, erythema toxicum, caput succedaneum
(crosses suture lines, resolves in days), acrocyanosis (blue hands and feet in the first
24–48 h), pseudomenstruation and swollen breasts from maternal hormones.
Cephalhematoma does not cross suture lines and takes weeks — it raises the
jaundice risk.
The four heat-loss mechanisms, and this is the way she asks it — Conduction: contact with a cold surface (mattress, scale, cold hands) → skin-to-skin and pre-warm the radiant warmer. Evaporation: wet skin → dry thoroughly. Radiation: a nearby cold surface or window → move the crib. Convection: drafts.
A cap addresses radiation and evaporation, not conduction. That is the trap.
Newborns use non-shivering thermogenesis via brown fat — they do not shiver to make heat.
Caput succedaneum CROSSES suture lines and resolves in days. Cephalohematoma does NOT cross sutures and raises jaundice risk.
Routine prophylaxis: erythromycin eye ointment and vitamin K IM in the vastus lateralis.
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Circumcision: petroleum jelly at every diaper change so the diaper does not stick · yellow crust is normal healing — do not remove it · continuous bleeding for 24 hours is a complication, not expected · never withhold feedings · verify he has voided before the procedure.
🖼️ Complications of prematurity.Swipe it sideways if it is cut off, or tap to open it full size.
📕 From your ATI review book
Covered by ch. 23 & 24.
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Apgar never dictates whether to start resuscitation — that begins on assessment, not on a score.
Respirations 30–60 counted a full minute; apnea over 20 sec is pathologic. Apical pulse 110–160, full minute. Axillary 36.5–37.5°C. Rectal temperatures are avoided.
Head circumference should exceed chest by 2–3 cm. Much larger suggests hydrocephalus; equal or smaller suggests microcephaly.
Four heat-loss mechanisms, one intervention each: conduction → prewarm the scale, warm the stethoscope · convection → out of drafts, hat on, room 22–26°C · evaporation → dry immediately, delay the first bath · radiation → move away from windows and outer walls. Skin-to-skin beats all of them.
Cold stress cascade: increased oxygen demand → hypoxia → metabolic acidosis → hypoglycemia. Brown fat is finite. Rewarm SLOWLY over 2–4 hours.
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Suction MOUTH before NOSE — nasal stimulation triggers a gasp and aspiration.
Vitamin K 0.5–1 mg IM into the vastus lateralis, because gut flora do not make it until ~day 7.Different thigh from the hepatitis B vaccine.
Erythromycin to both lower conjunctival sacs, inner to outer canthus, single-dose tube, within 24 h — may be delayed up to an hour for bonding.
Circumcision is deferred until after vitamin K and is contraindicated in hypospadias or epispadias.A yellow film over the glans by day 2 is healing — leave it alone.
Heel stick at 24 h, after at least 24 h of milk or formula, lancet no deeper than 2.4 mm, outer lateral heel, press with dry gauze not alcohol.
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CCHD pulse oximetry at 24–48 h: pass = over 95% in right hand or a foot with under 3% difference.
Normal and often mis-marked as abnormal: acrocyanosis, milia, Epstein's pearls, erythema toxicum, congenital dermal melanocytosis, telangiectatic nevi, molding, pseudomenses, breast hypertrophy, transient murmurs.
Real red flags: bulging fontanel · excessive drooling — think tracheesophageal fistula · a sacral dimple over 0.5 cm · low-set ears · asymmetric gluteal folds · jaundice before 24 hours · grunting, flaring, retractions.
Cord care: keep it clean and dry, fold the diaper below it, expect it to fall off in 1–3 weeks.
Stool progresses meconium → transitional → milk stool; wet diapers rise to about 6–8 a day by day 4.
Report: a temperature under 97.7°F or over 100.4°F, poor feeding, jaundice in the first 24 hours, no wet diapers, difficulty breathing, or a red or draining cord.
Never shake a baby. Teach the plan for inconsolable crying before discharge — put the baby down safely and step away.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Pediatrician or neonatal practitioner for the discharge examination.
Lactation consultant for feeding difficulty or weight loss beyond expected.
Audiology for a failed hearing screen; genetics for an abnormal metabolic screen.
Social work for housing, safe sleep equipment, or substance-exposed newborns.
Home visiting nurse for early follow-up, particularly for jaundice and weight checks.
⚠️ What goes wrongComplications
Complications
Airway obstruction from mucus: suction the mouth first, then the nose, with a bulb syringe to avoid aspiration
Hypothermia: keep axillary temperature at 36.5-37.5°C (97.7-99.5°F)
If temperature is unstable, use a radiant warmer or, better, skin-to-skin contact with the parent
Recheck axillary temperature hourly or per facility protocol until it stabilizes
Do exams under the warmer or during skin-to-skin contact
Hypothermia can be an early sign of sepsis; also watch for hypoglycemia
Inadequate oxygenation can stem from a blocked airway, poor cardiopulmonary function, or cold stress
ATI Active Learning Template — System DisorderNursing Care of Newborns
Filled from ATI chapter 24, row by row from that chapter’s own sections — 12 of 12 rows have content.
4 rows came from outside your ATI chapter — 4 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Newborn care focuses on a safe transition to life outside the uterus: airway management, thermoregulation, screenings, immunizations, feeding, elimination, and umbilical/circumcision care, plus family teaching for home care.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from CDC, 2024.
Nurses place newborns on their backs for every sleep period, including naps, starting with the first hospital sleep.
A firm, flat mattress with a fitted sheet is used, with no soft bedding, pillows, or bumper pads nearby.
Room-sharing without bed-sharing is encouraged, keeping the crib or bassinet in the same room as the caregiver, ideally until six months old.
Centers for Disease Control and Prevention (CDC) · Providing Care for Babies to Sleep Safely · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, 2023.
Babies sized either below or above the expected range for their gestation are more prone to low glucose.
Babies born to mothers with diabetes are also at increased risk, along with infants born late preterm, between thirty-four and thirty-six weeks.
Perinatal stress, sepsis, and a body temperature that drops too low can each add to a newborn's hypoglycemia risk.
Symptoms don't always match glucose readings, so an infant can be significantly hypoglycemic without showing obvious signs.
StatPearls (NCBI Bookshelf) · Neonatal Hypoglycemia · open the source →
Assessment — Expected Findings
Not in your ATI chapter — filled from StatPearls, 2023.
The Moro and palmar grasp reflexes both appear by about twenty-eight weeks gestation and fade around six months of age.
Light touch to the cheek triggers the rooting reflex, which is strongest at birth and lessens after about a month.
A sucking reflex is present as early as fourteen weeks gestation and helps nurses judge feeding readiness at birth.
StatPearls (NCBI Bookshelf) · Primitive Reflexes: Comprehensive Neurological Assessment Across the Lifespan · open the source →
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Check Hgb/Hct and blood glucose per policy or as ordered
State-mandated newborn screening catches metabolic, endocrine, hemoglobin, and genetic disorders early
Heel-stick screening is done at 24 hr after birth and needs 24 hr of feeding first for accurate results
Home birth, or discharge inside 24 hr: the family has to book the screen themselves with the provider
Every state screens for PKU; treating it within the first 2 months prevents developmental delay
Diagnostic Procedures
Hearing screening is required in most states to catch impairment early
CCHD screening by pulse oximetry at 24-48 hr: passing means SpO2 >95% in either extremity with <3% difference between limbs
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Confirm signed consent before circumcision; do a time-out to verify newborn, procedure, and site
Circumcision requires anesthesia: ring block, dorsal-penile nerve block, or topical numbing cream
Gomco/Mogen clamp or Plastibell is used; the Plastibell detaches on its own in 5-7 days
After circumcision, watch bleeding/voiding; give acetaminophen 10-15 mg/kg every 4-6 hr, up to 30-45 mg/kg/day
ID the newborn at birth with matching wrist and ankle bands plus footprint/thumbprint; recheck the match at every handoff
Prevent heat loss via conduction, convection, evaporation, and radiation — dry the newborn, cover the head, use skin-to-skin
Keep axillary temperature at 36.5-37.5°C (97.7-99.5°F); hypothermia is below 36.5°C
Start breastfeeding as soon as possible with skin-to-skin contact; feed on demand roughly every 2-3 hr
Formula-fed newborns get 30-60 mL every 2-3 hr; no extra water needed either way
Medications
Prophylactic erythromycin eye ointment is required to prevent ophthalmia neonatorum
Untreated exposure to gonorrhea or chlamydia during birth can cause blindness
Therapeutic Procedures
Circumcision removes the penile foreskin; the family decides based on health, religion, culture, and tradition
Avoid doing it right after birth — low vitamin K levels raise bleeding and cold-stress risk
Usually performed in the first few days of life; may be delayed for preterm or unstable newborns
Benefits: easier hygiene, lower STI risk (HIV, HPV), lower penile and partner cervical cancer risk
Avoid it with hypospadias or epispadias, since the foreskin may be needed for repair
💬 Around the patientClient Education · Interprofessional Care
Client Education
Change the diaper at least every 4 hr; clean the penis with warm water each time
Don't wrap the penis tightly — it can cut off circulation to the glans
No tub baths until the circumcision site has healed
Report redness, discharge, swelling, odor, tenderness, less urination, or excessive crying
A yellow mucus film by day two is normal — leave it in place
Skip alcohol-based wipes on the penis; they cause irritation
Expect fussiness or extra sleep for 24-48 hr; treat pain with acetaminophen
Interprofessional Care
Not in your ATI chapter — filled from CDC, 2024.
National benchmarks call for a hearing screen before one month, full audiology testing before three months if needed, and therapy enrollment by six months.
When a newborn does not pass the initial hearing screen, nursing staff arrange referral to an audiologist for complete testing.
Getting this diagnostic evaluation done quickly, no later than three months old, matters for the infant's long-term outcome.
Centers for Disease Control and Prevention (CDC) · Screening for Hearing Loss · open the source →
⚠️ What goes wrongComplications
Complications
Cold stress is a temperature below 36.5°C (97.6°F); can trigger hypoxia, acidosis, hypoglycemia
Newborns with respiratory distress face higher hypothermia risk
Watch for pallor, lethargy, hypoxia, fast breathing, slow heart rate, poor feeding, weak cry
Rewarm gradually over 2-4 hr; correct hypoxia, acidosis, and hypoglycemia as needed
Hypoglycemia: an initial glucose dip after birth is expected once the maternal supply stops
Healthy term newborns can tolerate glucose as low as 30 mg/dL without routine testing
Check glucose within the first hour for at-risk newborns (preterm, SGA/LGA, infant of a diabetic parent)
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Circumcision: petroleum jelly at every diaper change so the diaper does not stick · yellow crust is normal healing — do not remove it · continuous bleeding for 24 hours is a complication, not expected · never withhold feedings · verify he has voided before the procedure.
Apgar never dictates whether to start resuscitation — that begins on assessment, not on a score.
Respirations 30–60 counted a full minute; apnea over 20 sec is pathologic. Apical pulse 110–160, full minute. Axillary 36.5–37.5°C. Rectal temperatures are avoided.
Head circumference should exceed chest by 2–3 cm. Much larger suggests hydrocephalus; equal or smaller suggests microcephaly.
Four heat-loss mechanisms, one intervention each: conduction → prewarm the scale, warm the stethoscope · convection → out of drafts, hat on, room 22–26°C · evaporation → dry immediately, delay the first bath · radiation → move away from windows and outer walls. Skin-to-skin beats all of them.
Cold stress cascade: increased oxygen demand → hypoxia → metabolic acidosis → hypoglycemia. Brown fat is finite. Rewarm SLOWLY over 2–4 hours.
Vitamin K 0.5–1 mg IM into the vastus lateralis, because gut flora do not make it until ~day 7. Different thigh from the hepatitis B vaccine.
Erythromycin to both lower conjunctival sacs, inner to outer canthus, single-dose tube, within 24 h — may be delayed up to an hour for bonding.
Circumcision is deferred until after vitamin K and is contraindicated in hypospadias or epispadias. A yellow film over the glans by day 2 is healing — leave it alone.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
