• eye prophylaxis
• prevention o fhemorrhagic disorders
• screening for PKU
• bathing
• cord care
• clothing
• circumcision care
• care of uncircumcised penis

• instruct mother that screeinging is done before hospital discharge and repeated in 7-14 days
• NB should be taking breast milk or formula for 24hrs prior to screening so there is sufficient protein intake

• keep clean and dry
• cord clamp may be removed after 24hrs
• triple dye and antimicrobial agents such as bacitracin or 70% alcohol
• fold diaper down below cord stump to avoid covering it
• use sponge baths and avoid sumberging cord in water until if falls off (7-14 days)
• assess for cultural practices r/t cord care

• assess for signs of hemorrhage q2hr
• observe first voiding to evaluate urinary obstruction from penile edema or injury
• apply petrolatum and gauze following procedure and for first few diaper changes to reduce further bleeding unless Plastibell is used
• Plastibell remians in place and hsould fall off within 8 days; no oitments or creams used while in place
• yellowish film indicates presence of normal granulation tissue
• monitor for signs of infection

• foreskin and glans are 2 layers of cells that separate fully btw 3 and 5 years of age
• teach mother not to force foreskin back over glans for cleansing
• teach that when separation does occur, foreskin may be gently retracted daily for gentle cleannsing with soap and water

• measured around forehead & occipital area
• 32-37 cm (12.5-14.5 in) or 2 cm >chest circumference
• symmetrical (unless birth trauma)

• Anterior fontanel closes by 18 months
• Posterior fontanel closes around 8-12 wks

• clear blue/slate gray or brown in color
• pupils equal and reactive to light, blink reflex present, sclera bluish white
• may have subconjunctival hemorrhage (disappears in few weeks)
• edematous eyelids
• lacrimal structures (tearing) functions at about 2 months 

• patent nares bilaterally
• no discharge
• may have flat bridge
• sneezing done to clear nostrils

• symmetrical when cries
• hard palate intact
• uvula midline
• rooting reflex and sucking reflex present
• may have epstein's pearls, tongue not protruding

• short
• freely moveable
• tonic neck reflex/fencer position present

when head is tunred to one side, extremities on same side extend and extremities on opposite side flex

* AKA fencer position

• clavicles straight and intact
• barel-shaped chest with bilateral expansion with inspirations
• heart rate auscultated at border of left sternum extending left to midclavicle; regular rate and rhythm 
• point of maximum impulse (PMI) lateral to midclavicular line at 3rd-4th intercostal space

• soft, dome-shaped, round, some laxness of muscles, moves with respirations 
• bowel sounds when relaxed
• umbilical cord is white, gelatinous with 2 arteries and 1 vein, clamped with no foul odor
• femoral pulses palpable and equal, no bulges or nodes along bilateral inguinal area

• pendulous scrotum with rugae
• testes descended into scrotum
• penis with urinary meatus at tip of glans on ventral surface of penile shaft

• labia minora may have vernix caseosa & smegma in creases
• labia majora normally covers labia minora and clitoris
• discharge may be present because of maternal hormones 

• short
• flexed
• synchronized movement
• Trunk incurvation (Galant reflex)

• stable with no clicks or snaps upon movement
• Barlow's maneuver
• Ortolani's maneuver

• equal in length and symmetrical movement
• grasp reflex
• five digits on each hand with normal palmar crease & nails present

• equal length
• bowed
• well-flexed
• symmetric skin folds
• peripheral pulses present

• creases on soles
• may have "positional" clubfoot caused by intrauterine position but should be able to turn toward midline
• Platar grasp
• Babinski reflex

• patent
• well-placed
• may have meconium stool

• color consistent with ethnic background, pink-tinged
• acrocyanosis
• may have mottling 
• may have milia
• may have mongolian spots
• may have lanugo
• may have Harlequin's sign

• evaluates 6 neuromuscular and 6 physical characteristics performed during first few hours after birth
• score of 1-5 assigned to each characteristic and total score correlates to gestational age
• rating is marked on graph along with NB weight, length, and head circumference
• overall rating below 10th percentile indicates SGA
• btw 10th & 90th percentile indicates AGA
• above 90th percentile indicates LGA

• PIH
• diabetes
• maternal analgesia and anesthesia 

• during first 24 hrs, NB NS is unstable
• reflexes & assessments dependent on brain centers
• results may be unreliable and need to be repeated in 24 hrs

• well-formed notch of ear on straight line with outer canthus of eye
• when top and bottom of pinna are folded over each other, pinna will spring back quickly when released (Ballard tool)
• upper 2/3 of pinna incurves

• male: testes descended, scrotum pendulous & covered with rugae
• Female: labia major increases as gestation increases and nearly covers clitoris at 36-40 wks, majora cover labia minora & clitors

• using forefinger and middle finger, gently measure breast tissue btw them in mm
• term gestation btw 5-10 mm & nipples raised above skin level

• reliable indicator of gestational age in first 12 hrs of life
• beginning at top of foot, creases should cover at least 2/3 of entire foot surface

• 90-120 kcal/24hr of nutrition
• 140-160 mL/kg/24hr of fluid intake
• weight gain is 4-8 oz/wk
• weight doubles by 6 mo and triples by 1 yr

• hold infant close with head elevated
• keep bottle tipped so nipple remains full of formula
• never prop bottle or put infant to bed with a bottle in his or her mouth; propping can cause aspiration and middle ear infections
• discard any formula left in bottle because of risk for bacterial growth

• nipple & areola drawn into mouth enough for lips to cover 1-1.5 inch of areola
• jaw should move up & down in rhythmic motion during milk transfer; ears may wiggle
• cheeks should be full & round, not sucked in
• upper and lower lips should be flanged
• tongue should be troughed (cup-shaped)
• audible milk swallowing (best indicator)

NB stomach capacity of about 30 mL, and breast milk is more easily digested than artificial milk (formula)

• rotting (sucking on fists, clenched fists); may be exhibited form 90 min-3 hrs after last feeding
• crying is last sign of hunger

• slowing of audible swallowing
• pauses btw sucking bursts
• infant takes himself/herself off breast
• hunger cues disappear
• infant is relaxed, drowsy, sleeping

• straight back
• pillows under arms (and under infant)
• feet touching floor or a foot stool beneath her feet

• infant is in chest-to-chest position, facing breast close enough to touch with nose and chin, with shoulder resting slightly lower on mother's forearm
• mother's hand supports infant's buttocks, opposite hand supports breast

• infant is lying alongside mother with a rolled-up blanket behind infant and a pillow behind mother to help maintain position
• suggested for nighttime feedings and mothers who had cesarean deliveries

• infant positioned in mother's arm with his or her head, back, & shoulders in palm of hand
• infant tucked up under mother's arm, lining up infant's lips with nipple

• opening that previously connected right to left atria in fetus
• functionally closes in about 1-2hr after birth
• anatomically closes in a few weeks-1year
• closure increases left atrial pressure
• some shunting may occur early in transition and with crying 

• shunts arterial blood into inferior vena cava in fetal circulation 
• closes and is thought to be r/t severance of cord, resulting in redistribution of blood and cardiac output
• closure forces perfusion of liver

1. Physical: effort required to expand lungs and fill collapsed alveoli; changes in pressure gradient
2. Sensory: temperature, noise, light, sound
3. Chemical: changes in blood (decreased O2 level, increased CO2, decreased pH as result of transitory asphyxia during delivery

• 30-60 min after birth
• awake and alert
• may display nursing and attachment behaviors with random diffuse movements

• activity diminishes, heart and respiratory rates decrease
• NB enters sleep phase lasting from a few minutes to 2-4 hrs
• difficult to awaken

• awakes from deep sleep
• lasting 4-6 hrs
• close observation is required for changes in heart rate, RR, and color

• Digestive enzymes are active at birth and can support extrauterine life by 36-38 wks
• necessary muscular and reflex developments for transporting food are present at birth
• digestion of protein and carbs is easily accomplished, but fat digestion and absorption are poor due to absence of pancreatic enzymes
• little saliva manufactured until 3 months
• immature lower esophageal sphincter often leads to regurgitation or spitting up
• meconium within 24 hrs in 90% of NB
• wide variation in interest of food

• functioning nephrons are complete by 34-36 weeks 
• glomerular filtration rate is low, which may tend to reabsorb sodium and excrete large amounts of water
• Decreased ability to excrete drugs and excessive fluid loss can lead to acidosis and fluid imbalance; uric acid crystals may cause a reddish stain in diaper