A guide to providing wide-ranging care to newborns
Here’s how to refine your care, which includes an assessment of neonatal feedings, the evaluation of jaundice and fever, and the prevention of SIDS.
PRACTICE RECOMMENDATIONS
› Include a full work-up and empiric antibiotics in the initial management of all febrile infants ≤28 days of age. A
› Recommend that newborns breastfeed exclusively (in the absence of contraindications) for 6 months and continue some breastfeeding until the baby is at least 12 to 24 months of age. A
› Screen all newborns for jaundice before discharge by 1) clinical assessment or 2) testing for total serum bilirubin (TSB) or transcutaneous bilirubin (TcB); measurement of TcB provides a reasonable estimate of the TSB level in healthy newborns at levels <15 mg/dL. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Numerous risk factors for SIDS have been identified, including maternal factors (young maternal age, maternal smoking during pregnancy, late or no prenatal care) and infant and environmental factors (prematurity, low birth weight, male gender, prone sleeping position, sleeping on a soft surface or with bedding accessories, bed-sharing (ie, sleeping in the parents’ bed), and overheating. In many cases, the risk factors are modifiable; sleeping in the prone position is the most meaningful modifiable risk factor.
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To minimize the risk for SIDS, parents should be educated on the risk factors—prenatally as well as at each infant well visit. Home monitors have not been proven to reduce the incidence of SIDS and are not recommended for that purpose.54-57 Although evidence is strongest for supine positioning as a preventive intervention for SIDS, other evidence-based recommendations include use of a firm sleep surface; breastfeeding; use of a pacifier; room-sharing with parents without bed-sharing; routine immunization; avoidance of overheating; avoiding falling asleep with the infant on a chair or couch; and avoiding exposure to tobacco smoke, alcohol, and drugs of abuse.55,56 A recent systematic review showed that large-scale community interventions and education campaigns can play a significant role in parental and community adoption of safe sleep recommendations; however, families and communities rarely exhibit complete adherence to safe sleep practices.57
Other concerns in the first month of life and immediately beyond
In TABLE 5,2 we list additional common newborn problems not reviewed in the text of this article and summarize evidence-based treatment strategies.
CORRESPONDENCE
Scott Hartman, MD, Associate Professor, Department of Family Medicine, University of Rochester Medical Center, 777 South Clinton Avenue, Rochester, NY 14620; scott_hartman@urmc.rochester.edu.
Acknowledgement
We thank Nancy Phillips for her assistance in the preparation of this article.
