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Infant and Newborn Care

The goal of routine care for newborns and infants is to promote healthy development through proper nutrition, routine vaccinations, and early detection and prevention of disease.

Neonatal Period

Directly after delivery, neonates should be assessed using the APGAR score. The APGAR score is a method of assessment using five areas, scored on a scale of 0–2, to evaluate neonates after birth. The areas assessed include appearance (skin coloration), pulse (heart rate), grimace (reflex irritability), activity, and respirations (breathing rate and effort). Generally, an APGAR score above 7 is considered normal. The APGAR score determines the need for immediate medical care and is not a predictor of long-term development.

Within the neonatal period, preventative measures should be taken to guard against commonly acquired infections and conditions. This includes the administration of an antimicrobial agent such as erythromycin to both eyes and vitamin K given intramuscularly to prevent conjunctivitis of the newborn and hemorrhagic disease of the newborn, respectively. Neonates should be monitored for jaundice (elevated bilirubin levels in the blood) and screened for specific disease states and inherited conditions. Screening recommendations vary from state to state; however, at minimum, all states must screen for phenylketonuria (PKU) and congenital hypothyroidism. Most states also screen for additional inherited diseases such as sickle cell disease and congenital adrenal hyperplasia (CAH). Certain states participate in an expanded newborn screening. Human immunodeficiency virus (HIV) testing, while not routinely done, should be conducted if the mother is HIV positive or engaging in high-risk behaviors. Blood typing is done if the mother has type O blood or is Rh (Rhesus factor) positive to monitor the neonate for erythroblastosis fetalis which consists of anemia, jaundice, respiratory difficulties, and enlargement of the liver and spleen. Many, but not all, states require a hearing screen before the baby is discharged. The umbilical cord should be exposed to air and swabbed daily with rubbing alcohol to prevent infection. The umbilical cord stump detaches spontaneously in approximately one to three weeks. Circumcision of male neonates should be offered and, if desired, should be done within the first few days of life. The American Academy of Pediatrics’ policy regarding circumcision is that while newborn male circumcision has potential medical benefits, it also has disadvantages and risks; thus, parents should determine what is in the best interest of their child. Healthy neonates are usually discharged at 48 hours of life and should be followed up in approximately three days by a healthcare professional.

Nutrition

Both the World Health Organization and the American Academy of Pediatrics endorse breastfeeding as the optimal form of nutrition for infants and recommend exclusive breastfeeding for a minimum of six months. In addition to nutritional completeness, breastfeeding provides psychosocial and immunological benefits. Human milk supplies all of the fluid and nutrition an infant needs. However, iron-forti-fied rice cereals should be encouraged at the age of 6 months. Infants should not be given additional water for drinking due to the risk of hyponatremia (low sodium in the blood). Infants less than 1 year should not be given cow's milk. The only acceptable replacement for breast milk in the first year of life is commercially manufactured infant formula. Types of infant formulas include cow's milk-based, soy protein-derived, and specialized infant formulas, such as those for premature infants. Both breast milk and the typical infant formula contain 20 kcal/oz. Depending on age, infants should gain between three to eight ounces per week. Breastfed infants should be fed on demand or approximately every two hours, with a decreasing frequency as the infant ages. Bottle-fed infants can go approximately three to four hours between feedings, as formula is digested more slowly than human milk. At 1 year of age, whole cow's milk may be substituted for breast milk or formula.

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