The document discusses the newborn period, which begins at birth and lasts through the first month of life. During this time, marked physiological transitions occur across all organ systems as the infant learns to respond to external stimuli. A thorough history and physical exam are important to assess any medical issues in the mother, pregnancy, delivery, or infant. The exam should check temperature, pulse, breathing, color, tone and activity. Breastfeeding is recommended but some medical conditions like HIV or active tuberculosis may contraindicate it until treatment. Certain medications may also affect breast milk safety.

1. The Newborn Period
By Rayan Hejazi

2. Outline
 Definition
 History taking
 Physical exam
 Breast feeding precautions

3. Definition
 The newborn (neonatal) period begins at birth (regardless of gestational age) and includes the 1st mo of life. During this time, marked
physiologic transitions occur in all organ systems, and the infant learns to respond to many forms of external stimuli.
 Because infants thrive physically and psychologically only in the context of their social relationships, any description of the new- born’s
developmental status has to include consideration of the parents’ role as well.
 The annual rate of deaths during the 1st yr is unequaled by the rate in any other period of life until the 7th decade.

4. History taking
• Demographic and social data: socioeconomic status, age, race
• Past medical illnesses in the mother and family, including previous siblings: cardiopulmonary disorders, infectious diseases, genetic disorders, anemia, jaundice, diabetes mellitus
• Previous maternal reproductive problems: stillbirth, prematurity, blood group sensitization
• Events occurring in the present pregnancy: preterm labor, fetal assessments, vaginal bleeding, medications, acute illness, duration of rupture of membranes
• Description of the labor (duration, fetal presentation, fetal distress, fever) and delivery (cesarean section, anesthesia or sedation, use of forceps, Apgar scores, need for resuscitation)

5. Physical exam
 The initial examination of a newborn infant should be per- formed as soon as possible after delivery. Temperature, pulse, respiratory rate, color, type of respiration, tone, activity, and level of consciousness of infants should be monitored frequently until stabilization.
 For high-risk deliveries, this examination should take place in the delivery room and should focus on congenital anomalies, maturation and growth, and pathophysiologic prob- lems that may interfere with normal cardiopulmonary and meta- bolic adaptation to extrauterine life. Congenital anomalies of varying degrees of severity may be present in 3-5% of infants.
 After a stable delivery room course, a 2nd and more detailed examination should be performed within 24 hr of birth.
 If an infant remains in the hospital longer than 48 hr, a discharge examination should be performed within 24 hr of discharge.
 For a healthy infant, the mother should be present during this exami- nation; even minor, seemingly insigni? cant anatomic variations may worry a family and should be explained.
 Head to toe examination

6. Breast feeding precautions
 Medical contraindications to breast-feeding in the USA
include infection with HIV, human T-cell leukemia virus
types 1 and 2, cytomegalovirus (preterm infants), active
tuberculosis (until appropriately treated 2wk and not
considered contagious), and hepatitis B virus (until an
infant receives hepatitis B immune globulin and
vaccine)

7. Breast feeding precautions
 Maternal medications may affect the production and safety of breast milk (Table 88-7). Although most
commonly used medica- tions are safe, the safety of any new drug to be used while a woman is breast-
feeding must be con?rmed before the drug is initiated and/or breast-feeding is continued. Maternal sedatives
may result in sedation of the infant. Maternal drugs that are weak acids, composed of large molecules,
plasma bound, or poorly absorbed from the maternal or neonatal intestine are less likely to affect a neonate.

8. Breast feeding precautions

9. Resource
 Nelson’s textbook of pediatrics, 19 edition