Pediatrics
Neonatal Care
Neonatal care for MBBS and NEET-PG: newborn resuscitation, birth asphyxia, neonatal sepsis, hyperbilirubinemia and IMNCI danger signs, mapped to NMC PE20 codes.
MedNext Academy | 3 min read
Neonatal Care
Neonatal care for MBBS and NEET-PG: newborn resuscitation, birth asphyxia, neonatal sepsis, hyperbilirubinemia and IMNCI danger signs, mapped to NMC PE20 codes.
This chapter covers care of the newborn from delivery-room resuscitation and routine care through the recognition and management of the common neonatal emergencies that decide survival in Indian settings. It integrates IAP, NNF and IMNCI danger-sign pathways with international newborn guidance.
High-yield: Neonatal Care
- A neonate is an infant from birth to 28 completed days; the early neonatal period is birth to under 7 days and the late period is 7 to under 28 days.
- Term is 37 to under 42 weeks, preterm is under 37 weeks, and post-term is 42 completed weeks or more; low birth weight is under 2500 g, very low under 1500 g, and extremely low under 1000 g.
- Small for gestational age is below the 10th centile, appropriate for gestational age is 10th to 90th, and large for gestational age is at or above the 90th centile.
- In neonatal resuscitation the answer to most failures is ventilation corrective steps, not immediate drugs, and heart rate is the best marker of effective ventilation.
- No routine tracheal suctioning is recommended for meconium-stained liquor unless obstruction prevents ventilation; prioritise ventilation instead.
- Heart rate below 60 per minute after effective ventilation and compressions needs 3:1 compressions and epinephrine 0.01 to 0.03 mg/kg intravenous, repeated every 3 to 5 minutes.
- Apgar score is for documentation and trend, the Ballard score estimates gestational age, and the growth chart classifies the baby as AGA, SGA or LGA.
- Therapeutic hypothermia benefits eligible infants of at least 36 weeks and at least 1800 g, started within 6 hours, with moderate to severe hypoxic-ischaemic encephalopathy.
- Caput succedaneum crosses sutures and is benign, cephalohaematoma does not cross sutures and causes jaundice, and subgaleal haemorrhage crosses sutures and can cause shock.
- Vitamin K deficiency bleeding classically shows a prolonged prothrombin time with a normal platelet count, and late disease can present as intracranial haemorrhage in an unsupplemented breastfed infant.
- Symptomatic neonatal hypoglycaemia is treated with 10 percent dextrose 2 mL/kg intravenous bolus followed by a glucose infusion of 6 to 8 mg/kg/min.
- The phenobarbitone loading dose for neonatal seizures is 20 mg/kg intravenous over 20 minutes, given after checking glucose, calcium, magnesium and sodium.
- Neonatal sepsis can present as poor feeding or hypothermia alone; take a blood culture before antibiotics when feasible but never delay treatment in a sick neonate.
- Jaundice appearing within the first 24 hours is pathological until proven otherwise, and treatment decisions use bilirubin level by age in hours, gestation and risk factors.
- Bilious vomiting in a newborn is intestinal obstruction until proven otherwise, and bag-mask ventilation is avoided in suspected congenital diaphragmatic hernia.
Birth-weight and gestation groups
- **Low birth weight (LBW):** Birth weight less than 2500 g regardless of gestation.
- **Very / extremely low birth weight:** Very low is less than 1500 g and extremely low is less than 1000 g.
- **Preterm and late preterm:** Preterm is less than 37 completed weeks; late preterm is 34 to 36 weeks plus 6 days.
- **Growth for gestation:** SGA below the 10th centile, AGA 10th to 90th, LGA at or above the 90th centile.
NMC competencies in this chapter
- **PE20.3:** Neonatal Resuscitation on a Manikin: Neonatal Resuscitation Program Protocol
- **PE20.4:** Assessment of a Normal Neonate: Ballard Score, Apgar Score and Newborn Examination
- **PE20.7:** Birth Asphyxia and Hypoxic-Ischaemic Encephalopathy Staging
- **PE20.16:** Neonatal Sepsis
- **PE20.18:** Risk Stratification of a Sick Neonate Using IMNCI Guidelines
- **PE20.19:** Neonatal Hyperbilirubinemia
Frequently Asked Questions
What is the first step when a newborn's heart rate stays low during resuscitation?
Confirm effective ventilation before anything else, because heart rate is the best marker of ventilation. Most resuscitation failures are corrected by ventilation corrective steps, not by early drugs.
How do caput, cephalohaematoma and subgaleal haemorrhage differ?
Caput succedaneum crosses suture lines and is benign, cephalohaematoma does not cross sutures and can cause jaundice, and subgaleal haemorrhage crosses sutures and can cause life-threatening shock.
When is neonatal jaundice considered pathological?
Jaundice appearing within the first 24 hours of life is pathological until proven otherwise. Treatment is decided from the bilirubin level plotted against age in hours together with gestation and risk factors.
Which neonates are eligible for therapeutic hypothermia?
Infants of at least 36 weeks gestation and at least 1800 g with moderate to severe hypoxic-ischaemic encephalopathy, when cooling can begin within 6 hours of birth.
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