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Category III patterns (absent baseline variability with recurrent late or variable decelerations or bradycardia, or a sinusoidal pattern) are abnormal and predict current or impending fetal acidemia. Expect an expedited delivery and prepare for full resuscitation.

Intra-amniotic infection is a leading risk factor for early-onset sepsis. The infant needs close monitoring of vital signs, tone, and feeding, plus sepsis evaluation or empiric antibiotics per protocol, even when he or she looks well at birth.

Late preterm is 34 0/7 to 36 6/7 weeks, early term 37 0/7 to 38 6/7, full term 39 0/7 to 40 6/7, late term 41 0/7 to 41 6/7, and post-term 42 0/7 or more. Late preterm infants look term-sized but still have immature feeding, thermoregulation, and bilirubin handling.

Symmetric IUGR, with head, length, and weight all proportionally small, points to an early insult such as a chromosomal disorder or congenital infection. Asymmetric IUGR spares head growth while weight suffers most, pointing to late placental insufficiency such as maternal hypertension.

Caput succedaneum is soft scalp edema present at birth that crosses suture lines and resolves in days. A cephalohematoma is a subperiosteal bleed that never crosses suture lines, often enlarges hours after birth, and adds to the hyperbilirubinemia risk as it resorbs.

One arm failing to abduct and extend points to injury on that side, most often a fractured clavicle or a brachial plexus injury such as Erb palsy. Palpate the clavicles, compare arm movement and grasp, and report the finding.

The umbilical artery carries blood away from the fetus and reflects fetal status; the vein reflects placental supply. An arterial pH below 7.0 with a base deficit of 12 mmol/L or more is the threshold ACOG links to acute intrapartum hypoxic injury.

A continuous machinery-like murmur at the left infraclavicular border, bounding peripheral pulses, a widened pulse pressure, and an active precordium, usually with rising oxygen or ventilator requirements and worsening apnea.

Pulses and blood pressure are stronger in the right arm than in the legs, with weak or absent femoral pulses. Systemic flow past the narrowing may depend on the ductus, so ductal closure causes shock; prostaglandin E1 reopens it until surgery.

Transposition of the great arteries creates two parallel circulations, so a hyperoxia test raises PaO2 very little. Survival depends on mixing across the foramen ovale or ductus until balloon atrial septostomy or arterial switch surgery.

RDS is surfactant deficiency in preterm infants, showing a diffuse ground-glass film with air bronchograms and worsening distress that may need CPAP or surfactant. TTN is retained lung fluid after a rapid or cesarean birth; tachypnea dominates and usually clears within 24 to 72 hours.

Herniated abdominal organs compress the developing lung, so the infant is born with pulmonary hypoplasia and pulmonary hypertension, not just a displaced lung. Intubate rather than mask-ventilate, decompress the stomach with a large orogastric tube, and ventilate gently to spare the hypoplastic lungs.

A preductal saturation on the right hand more than 10 percentage points above the postductal saturation on a foot shows right-to-left shunting across the ductus. Labile hypoxemia out of proportion to the lung disease is the classic picture.

Pneumatosis intestinalis, gas within the bowel wall, is diagnostic. Stop enteral feeds, place the infant NPO with gastric decompression, obtain cultures, start antibiotics, and follow serial abdominal films and girth measurements.

An orogastric tube cannot be advanced into the stomach and coils in the upper pouch on the film, with frothy oral secretions, choking, and coughing. A history of polyhydramnios supports it. Keep the infant NPO with the pouch suctioned and the head elevated.

An omphalocele herniates through the umbilical ring inside a membranous sac and carries a high rate of associated anomalies. Gastroschisis is uncovered bowel through a defect to the right of a normal cord, so evaporative heat and fluid losses are far greater.

Ortolani relocates an already dislocated femoral head into the acetabulum, producing a palpable clunk on abduction. Barlow attempts to push an unstable hip out of the socket. Either positive finding warrants hip ultrasound and orthopedic referral.

It is a benign, self-limited eruption of blotchy erythematous macules with small yellow-white papules that appears in the first days, spares palms and soles, and migrates from site to site. A smear shows eosinophils rather than bacteria, and no treatment is needed.

Bleeding starts in the fragile germinal matrix, which largely involutes by 34 to 36 weeks, so risk falls sharply with maturity. The AAP recommends screening ultrasound for infants born at 30 weeks or less: a first scan at 7 to 10 days, then repeats at 4 to 6 weeks and at term-equivalent age.

A subgaleal hemorrhage fills the space beneath the scalp aponeurosis, crosses suture lines, and can hold a large share of the infant's blood volume. It follows vacuum-assisted birth; track a boggy shifting swelling, serial head circumference, pallor, and tachycardia.

Infants of 36 weeks or more with moderate to severe hypoxic-ischemic encephalopathy are cooled to a core temperature near 33.5 degrees Celsius for 72 hours, started within 6 hours of birth, then rewarmed slowly to avoid rebound instability.

Jaundice that early signals hemolysis or another pathologic cause and requires an immediate total serum bilirubin, blood type, and direct antiglobulin test. Physiologic jaundice appears after 24 hours and peaks around days 3 to 5.

A type O mother with a type A or B infant: maternal anti-A or anti-B IgG crosses the placenta and coats fetal red cells. A positive direct antiglobulin (Coombs) test on cord blood confirms it, and unlike Rh disease it can affect a first pregnancy.

A central venous hematocrit above 65% raises blood viscosity and impairs perfusion, producing a plethoric infant with hypoglycemia, respiratory distress, poor feeding, or lethargy. Heel-stick values run higher than central samples, so confirm centrally before acting.

Usually in the first two weeks with vomiting, poor feeding, weight loss, and shock, alongside hyponatremia, hyperkalemia, and hypoglycemia. Female infants may show virilized genitalia while males look normal until the crisis, which is why newborn screening matters.

Hypotonia, a flat facial profile, upslanting palpebral fissures, a single transverse palmar crease, and a wide gap between the first and second toes. Atrioventricular septal defect is the most common associated heart lesion, so echocardiography is standard.

For most newborns who do not need immediate resuscitation, clamping is deferred at least 60 seconds, improving iron stores and transitional circulation. Intact cord milking is not recommended below 28 weeks because it raises the risk of severe intraventricular hemorrhage.

Give 30 to 60 assisted breaths per minute. The 9th edition starts peak inflation pressure at 25 cm H2O for infants of 32 weeks or more and 20 cm H2O below 32 weeks, within the guideline range of 20 to 30 cm H2O, then adjusts to achieve chest movement. A rising heart rate is the best sign ventilation is working.

Begin when the heart rate stays below 60 beats per minute after at least 30 seconds of ventilation that moves the chest, preferably through an endotracheal tube or laryngeal mask. Use a 3:1 ratio, delivering 90 compressions and 30 breaths per minute with oxygen increased to 100%.

At 1 and 5 minutes, then every 5 minutes through 20 minutes whenever the 5-minute score is under 7. The score documents transition and response to resuscitation; it never delays or dictates resuscitation, which follows respirations, heart rate, and oxygenation.

About 20 kcal per ounce, roughly 0.67 kcal/mL. Preterm infants need approximately 110 to 135 kcal/kg per day plus added protein, calcium, and phosphorus to grow 15 to 20 g/kg per day, so milk is fortified to about 22 to 24 kcal per ounce.

Suboptimal-intake jaundice appears in the first week from too few effective feeds, with dehydration and increased enterohepatic circulation; the fix is more frequent, better-latched feeding. Breast milk jaundice appears later, peaks around one to two weeks, and can persist for weeks in a thriving infant.

Loss of up to about 7% of birth weight is expected, and 10% is the usual ceiling before a formal feeding and dehydration evaluation. Weight should stop falling by about day 5 and return to birth weight by roughly 10 to 14 days.

A single 1 mg intramuscular dose within 6 hours of birth for infants over 1,500 grams; infants of 1,500 grams or less receive 0.3 to 0.5 mg/kg intramuscularly. It prevents vitamin K deficiency bleeding, including the late form that can present as intracranial hemorrhage weeks after discharge.

0.01 to 0.03 mg/kg; NRP suggests 0.02 mg/kg, which is 0.2 mL/kg of the 0.1 mg/mL concentration, through an umbilical venous catheter or intraosseous needle, repeated every 3 to 5 minutes while the heart rate stays under 60. The endotracheal dose is larger (0.05 to 0.1 mg/kg) and absorbs unreliably, so it only bridges until vascular access.

A loading dose of about 20 mg/kg followed by 5 to 10 mg/kg daily. It stimulates the central respiratory drive and improves diaphragm function, shortening time on support. Watch for tachycardia, jitteriness, and feeding intolerance.

Under AAP screening guidance, a value below 25 mg/dL in the first 4 hours or below 35 mg/dL from 4 to 24 hours means refeed and recheck in 1 hour, then IV glucose if it stays low; the goal is at least 45 mg/dL before routine feeds. Screen late preterm, small- and large-for-gestational-age infants, and infants of diabetic mothers.

Extreme prematurity, radiant warmers, phototherapy, low ambient humidity, and tachypnea all raise losses. Humidified incubators, polyethylene wrap or bags immediately after birth, and heated humidified respiratory gases reduce them.

The table now starts at 2 minutes: 65 to 70% at 2 minutes, 70 to 75% at 3, 75 to 80% at 4, 80 to 85% at 5, and 85 to 95% at 10 minutes. Measure on the right hand and titrate oxygen to the minute-specific target.

Respiratory acidosis pairs a low pH with a high PaCO2 and is a ventilation problem. Metabolic acidosis pairs a low pH with a low bicarbonate and a base deficit, pointing to perfusion, sepsis, or substrate problems. In mixed acidosis both move in the wrong direction together.

Newborns cannot shiver effectively and rely on nonshivering thermogenesis from brown adipose tissue. Cold stress raises oxygen and glucose consumption, producing hypoglycemia, metabolic acidosis, increased respiratory distress, and poor weight gain.

Evaporation from wet skin after birth, conduction to a cold scale or mattress, convection from drafts or cool airflow, and radiation to a cold window or incubator wall. Keep the axillary temperature between 36.5 and 37.5 degrees Celsius.

Cluster care around the infant's sleep-wake states, use cycled day-night lighting, shield the eyes from bright light, and keep sound low, following the long-standing AAP recommendation to stay under about 45 decibels. Support containment positioning, nonnutritive sucking, and skin-to-skin care.

Non-pharmacologic care comes first: rooming-in, skin-to-skin contact, low stimulation, swaddling, and small frequent feeds. The Eat, Sleep, Console approach judges severity by function, whether the infant feeds well, sleeps at least an hour, and can be consoled, adding medication only when function fails.

Early-onset appears within the first 72 hours from vertical transmission, most often group B streptococcus or E. coli. Late-onset appears after 72 hours and is usually healthcare- or community-acquired, with coagulase-negative staphylococci common in infants with central lines.

A universal vaginal-rectal culture at 36 0/7 to 37 6/7 weeks. Adequate intrapartum prophylaxis means penicillin, ampicillin, or cefazolin given at least 4 hours before delivery; anything shorter or a different agent means the newborn needs closer observation.

Place the infant fully supine for every sleep on a firm, flat, non-inclined surface in a crib or bassinet, with no pillows, bumpers, loose blankets, or soft toys. Parents should room-share without bed-sharing, ideally for at least the first 6 months.

Measure the right hand and either foot at 24 hours of age or later, or as late as possible before an earlier discharge. Passing requires 95% or more at both sites with no more than a 3-point difference; below 90% at either site fails immediately. A 90 to 94% reading or a gap over 3 points is rescreened once an hour later, and a second non-pass is a fail.

Parents are the surrogate decision-makers, and the clinician performing the procedure explains its purpose, risks, benefits, and alternatives. The nurse confirms the parents' understanding, witnesses the signature, and stops the process to bring the clinician back when understanding is incomplete.

Near-miss and error reports expose system defects such as look-alike labels, weight-based dosing steps, and staffing gaps, rather than assigning individual blame. Underreporting hides exactly the failures that quality improvement cycles are designed to correct.