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Apgar Scoring (0-3 severe distress, 4-6 moderate, 7-10 no distress)

Sign	0	1	2
Heart rate	Absent	<100 bpm	>100 bpm
Respiratory effort	Absent	Slow, irregular	Good, crying
Muscle tone	Flaccid	Some flexion	Active motion
Reflex irritability	No response	Grimace	Cry
Color	Pale, blue	Body pink, extremities blue	Completely pink

Normal Newborn Vital Signs

• Temperature: 97.7-99.5°F (36.5-37.5°C) axillary
• Heart rate: 120-160 bpm (up to 180 during activity)
• Respirations: 30-60 breaths/min
• Blood pressure: 60-80/40-50 mmHg

Normal Measurements

• Weight: 2500-4000 g (5 lb 8 oz - 8 lb 13 oz)
• Length: 45-55 cm (18-22 inches)
• Head circumference: 33-35.5 cm (13-14 inches)
• Chest circumference: 30.5-33 cm (12-13 inches); 2-3 cm less than head
• Initial weight loss: 5-10% of birth weight (regained by 10-14 days)

Fontanels

• Anterior fontanel: Diamond-shaped; closes 12-18 months
• Posterior fontanel: Triangular; closes by 2 months

Newborn Reflexes

• Moro (startle): Sudden extension-adduction of arms with thumb/forefinger C-shape
• Rooting: Turns head toward stimulus when cheek touched
• Sucking: Sucks when palate stimulated
• Palmar grasp: Grasps when palm stimulated
• Plantar grasp: Toes curl when sole stimulated
• Babinski: Toes hyperextend with dorsiflexion of great toe
• Tonic neck (fencing): Arm and leg extend on side head turned to
• Stepping: Stepping movements when held upright

Newborn Skin

• Vernix caseosa: Cheeselike protective covering
• Lanugo: Fine hair on shoulders, back, forehead
• Milia: Pinpoint white spots on nose, chin (normal)
• Erythema toxicum: Newborn rash; benign
• Mongolian spots: Bluish-gray patches on sacrum/buttocks (common in dark-skinned infants)
• Cutis marmorata: Mottled appearance when cold (transient)
• Acrocyanosis: Blue hands/feet (normal first 24-48 hrs)

Umbilical Cord Care

• Clean with alcohol after each diaper change
• Keep dry and exposed to air
• Fold diaper below cord
• Report signs of infection: redness, drainage, odor, bleeding
• Falls off 10-14 days

Newborn Screenings

• Vitamin K (AquaMEPHYTON): IM within first hour to prevent hemorrhagic disease
• Erythromycin ophthalmic: Within first hour to prevent ophthalmia neonatorum (gonorrhea/chlamydia)
• Hepatitis B vaccine: First dose within 12-24 hours
• PKU test: After 24 hours of protein feeding (usually day 2-3)