Neonatal Care

At birth, the newborn must replace placental gas exchange with pulmonary ventilation within minutes. The first effective breaths expand fluid-filled alveoli, lower pulmonary vascular resistance, and increase pulmonary blood flow. Clamping the cord raises systemic vascular resistance. These pressure changes reverse the direction of flow through the foramen ovale and begin constriction of the ductus arteriosus. Surfactant reduces alveolar surface tension. A preterm infant with insufficient surfactant may develop respiratory distress syndrome because alveoli repeatedly collapse, increasing the work of breathing and impairing oxygenation. A cold infant also consumes more oxygen and glucose, so hypothermia can worsen respiratory distress and precipitate hypoglycaemia. The first clinical question is not the Apgar score. It is whether the newborn is breathing effectively and has an adequate heart rate. A vigorous newborn can usually remain skin-to-skin after drying and assessment. A newborn who is apnoeic, gasping, persistently bradycardic, or showing increasing respiratory effort needs immediate support according to the neonatal resuscitation algorithm. When resuscitation is not required, dry the newborn thoroughly, replace wet linens, maintain warmth, and support uninterrupted skin-to-skin contact. If there is...