Care of Common Problems in the Newborn
Key Points
- Common newborn problems include hyperbilirubinemia, hypoglycemia-in-the-newborn, infections, and largely benign dermatologic conditions.
- Early recognition of feeding change, temperature instability, respiratory signs, and neurologic change is essential because newborn deterioration can be rapid.
- Hyperbilirubinemia and hypoglycemia are high-priority conditions due to potential neurologic injury if untreated.
- Family education on warning signs and prompt follow-up reduces avoidable morbidity.
Pathophysiology
Newborn physiology is vulnerable to metabolic and infectious imbalance during early adaptation. Bilirubin production from fetal red-cell turnover, immature hepatic handling, and feeding inadequacy can produce jaundice progression. Glucose instability may occur as placental glucose supply ends and neonatal regulation pathways activate.
Immature immunity and skin/mucosal barriers increase susceptibility to infection. Many skin findings are benign transitional phenomena, but clinicians must separate expected variants from pathology requiring intervention.
Classification
- Metabolic transition problems: Hyperbilirubinemia and hypoglycemia.
- Umbilical conditions: Granuloma, hernia, and omphalitis risk states.
- Dermatologic findings: Benign conditions (milia, erythema toxicum, transient pustular melanosis, cradle cap, diaper rash) versus concerning lesions.
- Infectious illness pathways: Viral respiratory syndromes and bacterial sepsis/meningitis risk.
Nursing Assessment
NCLEX Focus
Priority questions center on identifying subtle worsening trends that require urgent escalation rather than routine reassurance.
- Assess jaundice progression by age/pattern and correlate with bilirubin testing protocol.
- Assess glucose risk and symptoms in at-risk groups (SGA, LGA, IDM, preterm, cold-stressed newborns).
- Assess feeding quality, elimination, hydration, activity, cry quality, and temperature trends.
- Assess cord stump for bleeding, redness, drainage, odor, and delayed separation signs.
- Assess respiratory status and illness signs suggesting viral progression or possible bacterial sepsis.
Nursing Interventions
- Initiate protocolized treatment for jaundice (feeding optimization, phototherapy workflow, close bilirubin trend monitoring).
- Treat hypoglycemia promptly using feeding, oral dextrose approaches, or IV support per severity/protocol.
- Reinforce cord hygiene and urgent return precautions for omphalitis indicators.
- Provide practical skin-care guidance and distinguish benign rash patterns from infection.
- Escalate rapidly for fever, lethargy, respiratory distress, cyanosis, poor feeding, or suspected sepsis.
Neurologic Injury Risk
Severe untreated jaundice can progress to kernicterus, and prolonged severe hypoglycemia can cause brain injury.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| phototherapy | Bili-light treatment context | Requires eye/genital protection, temperature monitoring, and scheduled bilirubin reassessment. |
| dextrose | Oral glucose gel, IV glucose context | Timely correction of low glucose prevents neurologic compromise. |
| antibiotics | Ampicillin plus gentamicin context | Empiric treatment for suspected serious bacterial neonatal infection while cultures are pending. |
Clinical Judgment Application
Clinical Scenario
A 4-day-old breastfed newborn is increasingly sleepy, feeds poorly, appears more yellow to the chest, and has reduced wet diapers.
Recognize Cues: Worsening jaundice with intake/output concerns and lethargy. Analyze Cues: Hyperbilirubinemia risk is increasing, likely compounded by insufficient intake. Prioritize Hypotheses: Immediate priorities are bilirubin evaluation, feeding correction, and dehydration prevention. Generate Solutions: Obtain bilirubin level per protocol, intensify feeding support, and initiate treatment pathway. Take Action: Start ordered interventions and provide parent education with follow-up timeline. Evaluate Outcomes: Bilirubin trend improves and feeding/output normalize.
Related Concepts
- basic-newborn-care - Prevention-focused routine care lowers incidence of common newborn complications.
- newborn-discharge-planning-and-parent-education - Families need actionable warning-sign education before discharge.
- physical-assessment-of-the-newborn - Baseline exam supports early detection of evolving abnormalities.
- neutral-thermal-environment - Cold stress contributes directly to metabolic instability.
- postpartum-infections - Maternal infection and newborn infection risks can overlap in early postpartum care.
Self-Check
- Which timing and pattern findings help distinguish physiologic from pathologic jaundice?
- Which newborns require proactive glucose monitoring even when asymptomatic?
- Which cord findings indicate likely omphalitis and urgent provider notification?