Updated for 2026
PNP-PC newborn care: neonatal assessment, screening, and common neonatal conditions
The Pediatric Nurse Practitioner — Primary Care (PNP-PC) exam places significant emphasis on newborn care and neonatal health. Certification tests include newborn assessment, Apgar scoring interpretation, universal newborn metabolic and hearing screening, neonatal jaundice management, breastfeeding support, and recognition and management of common neonatal conditions.
Educational purpose: This content is for exam preparation and professional development only. It is not intended for clinical decision-making. Always follow current guidelines, institutional policies, and scope of practice.
Newborn assessment and Apgar scoring
Apgar score: Assessed at 1 and 5 minutes (and 10 minutes if <7 at 5 minutes). Five criteria, each scored 0–2: Appearance (skin colour), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), Respiration. Total score 7–10 = normal; 4–6 = requires close monitoring/possible intervention; <4 = requires immediate resuscitation.
Normal newborn vital signs: HR 100–160 bpm (normal 80–100 sleeping, up to 180 crying — report if <80 or >200 at rest), RR 30–60 breaths/min (periodic breathing normal), temperature 36.5–37.5°C axillary, BP (systolic) 60–80 mmHg.
Newborn physical examination — key findings: Head: moulding (resolves within days), caput succedaneum (superficial, crosses sutures), cephalhaematoma (under periosteum, does not cross sutures). Eyes: transient subconjunctival haemorrhage (normal). Skin: vernix caseosa, lanugo, milia, Mongolian spots (blue-grey, sacral — benign, common in Asian and African infants), erythema toxicum (common benign pustular rash). Hips: Barlow (adduction to dislocate) and Ortolani (abduction to reduce) tests for developmental dysplasia of hip.
Newborn screening (RUSP — Recommended Uniform Screening Panel): All 50 states screen for 35+ conditions via heel-stick blood spot. Key conditions: phenylketonuria (PKU), congenital hypothyroidism (most common — levothyroxine prevents intellectual disability), congenital adrenal hyperplasia, galactosaemia, cystic fibrosis, sickle cell disease. Hearing screen: universal before hospital discharge. Critical congenital heart disease (CCHD): pulse oximetry screening at 24–48 hours.
Neonatal jaundice — physiological vs. pathological and phototherapy
Physiological jaundice: Appears after 24 hours (if present at <24 hours — pathological), peaks day 3–5, resolves by day 7–10 in term infants. Cause: increased bilirubin load from fetal haemoglobin breakdown + immature conjugation capacity.
Pathological jaundice features: Onset <24 hours (haemolysis until proven otherwise), bilirubin rising >5 mg/dL/day, total serum bilirubin above phototherapy threshold per Bhutani nomogram, jaundice persisting >3 weeks (evaluate for conjugated hyperbilirubinaemia — conjugated >2 mg/dL or >20% total = cholestasis, needs workup).
Management: Plot total serum bilirubin on age-specific (hour-of-life) Bhutani nomogram. Phototherapy when approaching action threshold; exchange transfusion for very high levels (15% above phototherapy threshold for exchange). Factors that lower phototherapy threshold: isoimmune haemolytic disease, G6PD deficiency, sepsis, asphyxia, prematurity, albumin <3 g/dL. Adequate feeding is essential — frequent breastfeeding (8–12 times/24h) supports bilirubin elimination.
Frequently asked questions
- What is the recommended approach to newborn breastfeeding support in the first 48 hours?
- AAP recommends exclusive breastfeeding for the first 6 months. PNP-PC support in the newborn period: (1) Initiate breastfeeding within 1 hour of birth — early skin-to-skin contact promotes latch and milk production. (2) Feed on demand 8–12 times per 24 hours (every 2–3 hours) in the first days. (3) Assess latch quality at each visit — proper latch: mouth wide, lower lip flanged out, areola visible above upper lip, no pain after initial latch. (4) Normal newborn weight loss: up to 7–10% in first 3–5 days; should return to birth weight by 10–14 days. Weight loss >10% or failure to return to birth weight warrants lactation consultation and evaluation for adequate milk transfer. (5) Formula supplementation indicated for: hypoglycaemia, severe weight loss, dehydration, severe hypernatraemia, or parental request. Vitamin D 400 IU/day supplement for all breastfed infants starting in first few days.
Clinically reviewed by NurseNest Clinical Review Team · Last updated 2026-06-10 · For educational purposes only · Review policy