Criteria for admission to the normal newborn nursery or couplet care with the mother vary among hospitals. The minimum requirement typically is a well-appearing infant of at least 35 weeks gestational age, although some nurseries may specify a minimum birth weight, for example, 2 kg.

Impeccable security in the nursery and mother’s room is necessary to protect the safety of families and to prevent the abduction of newborns.

The transitional period is usually defined as the first 4 to 6 hours after birth. During this period, the infant’s pulmonary vascular resistance decreases, blood flow to the lungs is greatly increased, overall oxygenation and perfusion improve, and the ductus arteriosus begins to constrict or close.

Interruption of normal transitioning, usually due to complications occurring in the peripartum period, will cause signs of distress in the newborn.

Common signs of disordered transitioning are (i) respiratory distress, (ii) poor perfusion with cyanosis or pallor, or (iii) need for supplemental oxygen.

Transitional care of the newborn can take place in the mother’s room or in the nursery.

Healthy newborns should be with their mothers all or nearly all the time. When possible, physical assessments, administration of medications, routine laboratory tests, and bathing should occur in the mother’s room. For familycentered maternity care, nursing ratios should not exceed 1:4 mother—baby couplets.

The infant’s temperature is stabilized with one of three possible modalities:

Universal precautions should be used with all patient contact.

The first bath is given with warm tap water and nonmedicated soap after an axillary temperature >97.5°F has been recorded.

Acceptable practices for umbilical cord care include exposure to air, or application of topical antiseptics, such as triple dye, or topical antibiotics, such as bacitracin. The use of topical antiseptics or antibiotics appears to reduce bacterial colonization of the cord, although no single method of cord care has proved to be superior in preventing colonization and disease. Keeping the cord dry promotes earlier detachment of the umbilical stump.

All newborns should receive prophylaxis against gonococcal ophthalmia neonatorum within 1 to 2 hours of birth, regardless of the mode of delivery. Prophylaxis is administered as a single ribbon of 0.5% erythromycin ointment or 1% tetracycline ointment bilaterally in the conjunctival sac (see Chap. 49).

A single intramuscular dose of 0.5 to 1 mg of vitamin K₁ oxide (phytonadione) should be given to all newborns before 6 hours of age to prevent vitamin K deficiency bleeding (VKDB). Oral vitamin K preparations are not recommended because late VKDB (2—12 weeks of age) is best prevented by the administration of parenteral vitamin K (see Chap. 43).

Administration of the first dose of preservative-free hepatitis B vaccine is recommended for all infants during the newborn hospitalization, even if the mother is hepatitis B surface antigen (HBsAg) negative (see Chap. 48).

Prenatal screening test results should be reviewed and documented on the infant’s chart at the time of delivery. Maternal prenatal screening tests typically include the following:

Cord blood is saved up to 14 to 21 days, depending on blood bank policy.