The Physiological (Healthy Term) Newborn

1. Define the physiological newborn:

Definition: A full-term infant born between the completion of 37 and 42 weeks of gestation, who is eutrophic (birth weight between the 5th and 95th percentiles for gestational age), shows no signs of disease or major congenital malformations, and adapts well to extrauterine life.
Classification by Weight: Hypotrophy (SGA), Eutrophy (AGA), Hypertrophy (LGA).
Characteristics of the Neonatal Period:
- Duration: From birth to the 28th day of life (Early: 0–7 days; Late: 8–28 days).
- Adaptation: Complex changes in respiratory, cardiovascular, thermoregulatory, metabolic, and hematological systems (e.g., physiological drop in Hb).
- Nutrition: Frequent breastfeeding; intake of colostrum initially, with lactation full developing by days 2–3. By one week, intake should be approx. 150 ml/kg/day.
- Elimination: First urination within 24 hours (subsequently 6+ times/day); first meconium (dark/sticky stool) passed within 48 hours, transitioning to typical "scrambled egg" appearance.

Vital Signs: HR: 100–160 bpm; RR: 30–40/min (rest) up to 60/min (active); Temp: 36.5–37.5 °C (rectal).
Skin: Pink (mild acrocyanosis is common); presence of vernix caseosa, lanugo, milia, and nevus simplex (stork bite).
Head: Palpable fontanelles (anterior/posterior), open sutures, facial symmetry. Common birth trauma: Caput succedaneum (soft tissue edema) or Cephalhematoma (subperiosteal hemorrhage—does not cross sutures).
Genitalia: Males: Testes descended into the scrotum. Females: Labia majora cover the labia minora.
Reflexes: Sucking, rooting, Moro, and palmar grasp reflexes.
Weight: Physiological weight loss (up to 10% is normal) should be regained by day 10–14.

Timing: Every physiological newborn must be systematically examined by a pediatrician within 6 hours of birth.
Head and Neck: Skull shape, fontanelles, palate integrity (rule out clefts), and "V" shaped nevus simplex on the forehead.
Chest: Heart sounds/murmurs, SpO2 (screening for CCHD), breath sounds, and respiratory effort.
Abdomen: Palpation for organomegaly (liver/spleen), umbilical cord assessment (3 vessels; mummifies and falls off in ~1 week).
Femoral Arteries: Palpate bilateral femoral pulses (rule out coarctation of the aorta).
Genitalia: Anatomy, urethral opening, and descent of testes. Note: Ambiguous genitalia can indicate life-threatening conditions like Salt-Wasting CAH.
Musculoskeletal: Hip stability (Ortolani/Barlow maneuvers), spine integrity (rule out spina bifida), limb length, polydactyly/syndactyly. Check for birth injuries: clavicle fracture or brachial plexus palsy.

Red Flags: Cyanosis, tachypnea, apnea, hypotonia (floppiness), hypoglycemia, or seizures. These require immediate stabilization or transfer to a Neonatal Intensive Care Unit (NICU).

Typical (Physiological):
- Physiological Jaundice: Appears no earlier than the 2nd day (unconjugated bilirubin).
- Transient hypoglycemia and thermolability.
- Transient Tachypnea of the Newborn (TTN): "Wet lung" syndrome.
- Halban's Reaction: Hormonal response (breast engorgement, pseudomenstruation).
Severe (Pathological):
- Early/Late-onset sepsis, meningitis, omphalitis (umbilical infection).
- Critical Congenital Heart Disease (CCHD).
- Inborn Errors of Metabolism (IEM).

Metabolic: Dried blood spot (Guthrie test) for various disorders.
Physical: Cataract (red reflex), hip ultrasound, hearing (OAE), and SpO2 (heart) screening.
Pulses: Mandatory palpation of femoral arteries.

Educate on warning signs (fever, poor feeding, lethargy, jaundice in first 24h).
Routine care: Breastfeeding, hygiene, and umbilical cord care.
Follow-up: Registering the child with a General Practitioner for Children and Adolescents (GPCA) for preventative care.