A full-term newborn is a baby born at 37 weeks’ or more gestation. Term newborns are evaluated in the delivery room immediately after birth to assure that they do not require respiratory or circulatory support, have no birth-related trauma or congenital anomalies requiring immediate intervention, and are transitioning as expected to extrauterine life. Approximately 97% of newborns are healthy and require only routine care in the nursery after birth. In the nursery, newborns receive a thorough evaluation to determine maturity, evaluate growth and development, and identify those with signs of acute illness or underlying congenital disease.
At every delivery there should be at least 1 person whose primary responsibility is attending to the newborn. Although approximately 90% of the time no resuscitation will be required, the attendant must be able to recognize signs of distress in a newborn and carry out a skilled resuscitation.
After the umbilical cord is cut, newborns should be placed in a warm environment. They may be placed on the mother’s chest, skin-to-skin, or they may be brought to a radiant warmer. Early skin-to-skin contact increases the likelihood and duration of breastfeeding, decreases infant crying, and facilitates bonding and is therefore encouraged when possible. However, it should only be done when the newborn is crying/breathing and has good tone and when there are no risk factors that increase the likelihood that resuscitation will be required (eg, prematurity). The infant is dried with prewarmed towels to prevent heat loss and the airway is positioned and cleared to ensure patency. The airway may be cleared by suctioning the mouth and nares with a bulb syringe or a suction catheter connected to mechanical suction. If the newborn is well-appearing and not at increased risk, the airway can be cleared simply by wiping the mouth and nose with a towel.
During this initial postpartum period, the newborn’s respiratory effort, heart rate, color, and activity are evaluated to determine the need for intervention. If drying and suctioning do not provide adequate stimulus, it is appropriate to flick the soles or rub the back to stimulate breathing. It is important to note the presence of meconium in the amniotic fluid or on the newborn’s skin. Although not contraindicated, it is no longer recommended that the obstetrician routinely suction the oropharynx of an infant born with meconium-stained amniotic fluid upon delivery of the head. If a newborn is in distress or has depressed respiratory effort after delivery and there is evidence that meconium was passed in utero, it is appropriate to intubate and suction the trachea before stimulating the baby in any way. Meconium can block the airway, preventing the newborn lungs from filling with oxygen, a vital step in normal transitioning. However, if the attempted intubation is prolonged or repeatedly unsuccessful, it may be appropriate to omit tracheal suctioning in favor of initiating positive-pressure ventilation (PPV) in a ...