Care of the Typical Newborn

Initial Steps: Warm, dry, and stimulate the newborn.
Assessment: Auscultate heart and lung sounds.
APGAR Score: Evaluate the newborn's status using the APGAR score.
Temperature: Assess and maintain the newborn's temperature.
Skin-to-Skin: Promote immediate skin-to-skin contact between parent and newborn.

Metabolic Screen (Newborn Screen):
- Tests for conditions like PKU (Phenylketonuria) and CF (Cystic Fibrosis).
- Results are typically available in $5-7$ days.
- Usually performed twice: one screen after $24$ hours of life, and a second at $2$ weeks of age.
Hearing Screen:
- Utilizes specialized computer equipment for assessment.
- If initial screening is inconclusive, it can be retested.
- Referral to an audiologist is made if retesting indicates a potential hearing issue.
CCHD (Critical Congenital Heart Disease) Screen:
- Measures pre-ductal SpO $<em>2$ (oxygen saturation on the right hand) and post-ductal SpO $</em>2$ (oxygen saturation on either foot).
- Both oxygen saturation numbers must be greater than $95\%$ .
- Additionally, the two numbers must be within $3$ points of each other.

ID Bands: Utilize identification bands for both the infant and parents/guardians to ensure proper identification.
Security Systems: Employ security measures like TOT guard and Hugs systems which are electronic tags that trigger alarms if an infant is moved beyond designated areas.
Footprints: Obtain the infant's footprints for identification purposes.
Staff Badges: Ensure all hospital staff wear appropriate identification badges (e.g., Bear badges for staff in direct infant care, Stork badges for other authorized personnel).

Timing: Administered within the first $24$ hours of life, though hospital policies may vary.
Parental Refusal: Parents have the right to refuse vaccination.
Weight Consideration: If the newborn weighs less than $2$ kg, the hepatitis B vaccination may be delayed until a later time.
Dosing Schedule:
- First Dose: At birth.
- Second Dose: At the $2$ month appointment.
- Third Dose: At the $4-6$ month appointment.
Parent Education:
- Transmission: The virus is found in blood and bodily fluids.
- Viability: It can survive on surfaces for up to $1$ month.
- Side Effects: Common side effects include soreness and redness at the injection site, and general irritability in the infant.

Parent Education:
- Do Not Pull Off: Advise parents not to forcibly pull off the umbilical cord stump, allowing it to detach naturally.
- Bathing: Recommend sponge baths instead of submersion until the cord has fallen off and the navel is healed.
- Keep Dry: Emphasize keeping the cord stump dry; cleansing solutions are generally not needed. If soiled with stool, it can be gently wiped clean.
- Diapering: Fold the diaper down below the cord stump to keep it exposed to air and prevent irritation.
- Signs and Symptoms of Infection: Educate parents to watch for:
  - Foul-smelling or yellow drainage from the stump.
  - Redness or swelling around the base of the cord.
  - A pink, moist bump (granuloma).
  - Poor feeding or decreased appetite.
  - Fever of $100.4^ ext{o}F$ ( $38^ ext{o}C$ ) or higher.
  - Lethargy or unusual sleepiness.
  - Poor muscle tone.

Recommendations: General guidelines for initiation and duration of breastfeeding.
Benefits: Explores the numerous health benefits for both the infant and the parent.
Breastmilk Characteristics: Discusses the dynamic composition and nutritional value of breastmilk.
Donor Milk: Information on the use and sourcing of donor human milk.
Successful Breastfeeding: Strategies and tips for establishing effective breastfeeding practices.
Positioning: Proper techniques for infant latch and comfortable feeding positions.
Supply Influences: Factors that can affect breastmilk supply, such as demand, frequency, and maternal health.
Cluster Feeding: Explanation of periods when infants feed more frequently than usual.

Preparation: Instructions on how to properly prepare infant formula.
Three Types: Overview of different types of formula available (e.g., milk-based, soy-based, hypoallergenic).
Safe Storage & Preparation: Guidelines for safely storing formula powder and prepared formula to prevent contamination and spoilage.
Pace Feeding: Techniques for feeding an infant formula at a slower, more controlled pace to mimic breastfeeding and prevent overfeeding.
Cues: Recognizing infant hunger and satiety cues.
Amount: Determining appropriate formula amounts based on infant age and weight.

Hand Hygiene: Wash hands well with soap and water.
Pump Kit Inspection: Inspect the pump kit and tubing for cleanliness; replace moldy tubing immediately.
Surface Cleaning: Clean pump dials, power switch, and countertops with a disinfectant wipe.

Labeling: Label milk with the date it was expressed and the child's name (if for childcare).
Storage Location: Store milk in the back of the freezer or refrigerator, not in the door.
Volume: Freeze milk in small $2$ to $4$ ounce amounts to avoid waste.
Expansion: When freezing, leave an inch of space at the top of the container as breast milk expands.
Travel Storage: Milk can be stored in an insulated cooler bag with frozen ice packs for up to $24$ hours when traveling.
Timely Freezing: If freshly expressed milk is not planned for use within $4$ days, freeze it right away.
Containers: Use breast milk storage bags or clean, food-grade containers made of glass or plastic with tight-fitting lids. Do not use disposable bottle liners or plastic bags not intended for breast milk storage.

Freshly Expressed or Pumped Milk:
- Countertop ( $77^ ext{o}F$ / $25^ ext{o}C$ or colder): Up to $4$ Hours
- Refrigerator ( $40^ ext{o}F$ / $4^ ext{o}C$ ): Up to $4$ Days
- Freezer ( $0^ ext{o}F$ /- $18^ ext{o}C$ or colder): Within $6$ months is best, up to $12$ months is acceptable.
Thawed, Previously Frozen Milk:
- Countertop: $1-2$ Hours
- Refrigerator: Up to $1$ Day ( $24$ hours)
- Freezer: NEVER refreeze human milk after it has been thawed.
Leftover from a Feeding (baby did not finish):
- Use within $2$ hours after the baby is finished feeding.

Prioritize Oldest Milk: Always thaw the oldest milk first.
Methods: Thaw milk under lukewarm running water, in a container of lukewarm water, or overnight in the refrigerator.
Avoid Microwave: Never thaw or heat milk in a microwave. Microwaving destroys nutrients and creates