ISSUES UNIQUE TO THE NEWBORN

Rationale
Prerequisites
Competencies
Processes

Rationale
The transition from intrauterine life to extrauterine independent existence is a major event: physiologically for the baby, emotionally for the family, and medically for the health care team. Physicians must have an appreciation for the physiologic changes a newborn experiences. The newborn has unique needs and vulnerabilities that are distinct from other periods of infancy. Most of the information covered in this section is pertinent in the first few hours and days of life. However, the newborn period extends through to the first month of life.

Prerequisites

• Embryology
• Fetal physiology
• Knowledge of the basics of antepartum and intrapartum care, particularly maternal screening tests and common maternal complications that can affect the newborn.

Competencies

Knowledge

1. Describe the transition from the intrauterine to the extrauterine environment, including temperature regulation, cardiovascular/respiratory adjustment, glucose regulation, and initiation of feeding. (CP)
2. List the information from the history of pregnancy, labor, and delivery obtained from the parents or medical record that has implications for the health of the newborn. (CP)
3. Describe how gestational age can be assessed with an instrument such as the Ballard scale and identify key indications of gestational maturity. (CP)
4. Describe the challenges for parents adjusting to a new infant in the home. (CP)
5. List the differential diagnosis and complications for the following common problems that may occur in the newborn
   
   
   • jaundice (CP)
   • respiratory distress (CP)
   • poor feeding (CP)
   • large and small for gestation infants (e.g. congenital infection) (CP)
   • "state" abnormalities which includes tremulousness, irritability, lethargy from causes such as drug withdrawal, hypoglycemia, sepsis (CP)
   • prematurity (M)
     
     
6. Describe how gestational age affects risks of morbidity or mortality in the newborn period (for example lung disease, hypothermia, and glucose homeostasis) (M)

Skills

1. Perform a complete physical examination of the newborn infant. (CP)
2. Give parents of a newborn anticipatory guidance for the following issues: (CP)
   
   
   • the benefits of breast-feeding vs. formula for the newborn and mother
   • normal bowel and urinary elimination patterns
   • normal neonatal sleep patterns
   • newborn screening tests to include screens for metabolic and infectious conditions and hearing loss
   • appropriate car seat use
   • prevention of SIDS ("back to sleep"):
   • immunizations (e.g. HBV)
   • medications (e.g. eye prophylaxis and vitamin K)
   • the role of circumcision

Processes
All students on the Pediatric Clerkship should see one or more newborns and a newborn with jaundice.

Click here to link to the Clinical Case Scenarios.