Approach to the Newborn

Last updated: March 31, 2026
Table Of Contents
  1. Neonatal Biodata
  2. Maternal and Paternal Medical and Genetic History
  3. Maternal Obstetric and Antenatal History
  4. Antepartum and Intrapartum History
  5. Birth and Immediate Neonatal History
  6. Presenting Complaints
  7. History of Presenting Complaint
  8. Jaundice History (OPDEC)
  9. Neonatal Milestones
  10. Nutrition History
  11. Immunisation History
  12. Growth and Development
  13. Family History
  14. Socioeconomic History
  15. General Physical Examination
  16. Vitals (TABC)
  17. Anthropometry
  18. Head-to-Toe Examination
  19. Systemic Examination
  20. Central Nervous System Examination
  21. Screening
  22. Ballard Score
  23. Complications of Low Birth Weight

Neonatal Biodata

  • Baby of ______
  • Age (day of life)
  • Sex
  • Birth weight
  • Current weight

Maternal and Paternal Medical and Genetic History

  • Genetic history
    • Family history of congenital anomalies
    • Other inherited/genetic conditions (maternal and paternal)
  • Chronic medical conditions
  • Medications during pregnancy
    • Exposure to teratogens
    • Antiseizure medications are often continued (risk of seizures > teratogenic risk)
  • Dietary history
    • Adequacy of maternal nutrition
    • Special/restrictive diets
    • Calorie restriction
  • Substance use
  • Occupational/environmental exposure
    • Healthcare work
    • Radiation exposure
    • Industrial chemicals
    • Strenuous labour
    • Farming exposure
    • Cats (toxoplasmosis risk)
    • Veterinary exposure

Maternal Obstetric and Antenatal History

  • Maternal age
  • Gravida/Para
    • Gravida = total pregnancies
    • Para = pregnancies reaching viability
  • Blood group and Rh status
  • ANC care
    • IFAS and TT received
  • ANC profile
    • Hb
    • Maternal blood group
    • Paternal blood group
    • VDRL
    • HIV
    • Hepatitis B
    • Blood pressure range
    • Urinalysis
  • Current pregnancy history
    • Abnormal ultrasound findings
    • Screening tests (hCG, nuchal translucency, TORCH, Pap smear, quad screen, OGTT, GBS, Rh)
    • Amniocentesis results (if done)
  • Pregnancy complications
    • Pre-eclampsia/eclampsia
    • Gestational hypertension
    • Gestational diabetes
    • UTI
    • Preterm labour (and tocolysis)
  • Past obstetric history
    • Previous pregnancy outcomes
    • Previous complications

Antepartum and Intrapartum History

  • Rupture of membranes
    • Duration
  • Liquor/show
    • Clear
    • Blood-stained
    • Meconium-stained → fetal distress, MAS risk
  • Maternal fever
  • Fetal distress (FHR abnormalities)
  • Fetal presentation
    • Breech → risk of trauma
  • Mode of delivery
    • Vaginal vs Caesarean
    • Vacuum → subgaleal hemorrhage
    • Forceps → trauma
  • Anaesthesia use
    • May depress neonatal respiration

Birth and Immediate Neonatal History

  • Gestational age at birth
  • Birth weight
  • APGAR scores (1, 5, 10 minutes)
  • First cry (birth asphyxia if absent)
  • Need for resuscitation
  • Complications during delivery
  • Time of initiation of breastfeeding

Presenting Complaints

  • Jaundice
  • Fast breathing

History of Presenting Complaint

  • Onset and course of symptoms
  • ROM (spontaneous/artificial)
  • Liquor characteristics
  • Feeding history since birth
  • Associated symptoms

Jaundice History (OPDEC)

  • Onset
    • Physiological: >24 hrs, peaks day 3–5, resolves ≤1 week (term), ≤2 weeks (preterm)
    • Pathological: early onset, prolonged, rising after day 5, palms/soles involved
  • Progression
  • Duration
  • Etiology
  • Complications (BIND)
  • Associated features
    • Pale stool + dark urine → cholestasis
    • Fever
    • Fast breathing
    • Lethargy
    • Convulsions
    • High-pitched cry
    • Poor feeding
    • Vomiting (e.g. pyloric stenosis)
    • Delayed meconium/urine

Neonatal Milestones

  • First cry
  • First breastfeeding
  • First meconium (<24 hrs)
  • First urine (<48 hrs)

Nutrition History

  • Type of feeding
  • Frequency (8–10 times/day or on demand)
  • Urine output (6–8/day by the end of week 1)
  • Stool characteristics (golden yellow)
  • Sleep after feeds (1–2 hours)
  • Crying pattern

Immunisation History

  • BCG
  • OPV (zero dose)

Growth and Development

  • Birth weight
  • Current weight

Family History

  • Birth order
  • Siblings
  • Early neonatal deaths
  • Recurrent abortions

Socioeconomic History

  • Parents’ occupation
  • Living conditions
  • Insurance

General Physical Examination

  • Alertness
  • Activity
  • Feeding status
  • Tone/posture
  • Sick vs well baby

Vitals (TABC)

  • Temperature (36.5–37.5°C)
  • Airway patency
  • Breathing
    • RR 40–60
    • SpO₂
    • Retractions
  • Circulation
    • HR 110–160
    • Cap refill <3 sec
    • Pulses
    • BP (~½ adult)

Anthropometry

  • Birth weight classification
    • Normal ≥2500 g
    • LBW 1500–2499 g
    • VLBW 1000–1499 g
    • ELBW <1000 g
  • Gestational age classification
  • Growth chart interpretation
    • 10th–90th percentile = AGA
    • <10th = SGA
    • 90th = LGA
  • Length (~50 cm)
  • Head circumference (33–35 cm)
    • Macrocephaly >+2 SD
    • Microcephaly <-2 SD

Head-to-Toe Examination

  • Head
    • Caput succedaneum (crosses sutures)
    • Cephalohematoma (does not cross, jaundice risk)
    • Subgaleal hemorrhage (crosses, shock risk)
    • Fontanelles
  • Face
    • Dysmorphic features
    • Eyes (red reflex, cataracts)
    • Ear position
    • Nose patency
    • Oral findings
  • Skin
    • Milia
    • Miliaria
    • Erythema toxicum
    • Neonatal acne
    • Mongolian spots
    • Nevus simplex

Systemic Examination

  • Cardiovascular
    • Apex beat
    • Heart sounds
  • Respiratory
    • Work of breathing
    • Air entry
    • Added sounds
  • Abdomen and genitourinary
  • Musculoskeletal

Central Nervous System Examination

  • AVPU
  • Level of alertness
  • Cranial nerves
  • Tone
  • Passive movements
  • Primitive reflexes
    • Rooting
    • Sucking
    • Grasp
    • Moro
    • ATNR
    • Plantar
    • Crossed extensor

Screening

  • Jaundice assessment
  • Developmental dysplasia of the hip (Barlow, Ortolani)
  • Clubfoot (CTEV screening)

Ballard Score

Complications of Low Birth Weight

Reference Intervals ›
Biochemistry
ACTHP: <80 ng/L
ALTP: 5–35 U/L
AlbuminP: 35–50 g/L
AldosteroneP: 100–500 pmol/L
Alk. phosphataseP: 30–130 U/L
α-AmylaseP: 0–180 IU/dL
α-FetoproteinS: <10 kU/L
Angiotensin IIP: 5–35 pmol/L
ADHP: 0.9–4.6 pmol/L
ASTP: 5–35 U/L
BicarbonateP: 24–30 mmol/L
BilirubinP: 3–17 μmol/L
BNPP: <50 ng/L
CRPP: <10 mg/L
CalcitoninP: <0.1 mcg/L
Calcium (ionized)P: 1.0–1.25 mmol/L
Calcium (total)P: 2.12–2.60 mmol/L
ChlorideP: 95–105 mmol/L
CholesterolP: <5.0 mmol/L
VLDLP: 0.128–0.645 mmol/L
LDLP: <2.0 mmol/L
HDLP: 0.9–1.93 mmol/L
Cortisol AMP: 450–700 nmol/L
Cortisol MidnightP: 80–280 nmol/L
CK ♂P: 25–195 U/L
CK ♀P: 25–170 U/L
CreatinineP: 70–100 μmol/L
FerritinP: 12–200 mcg/L
FolateS: 2.1 mcg/L
FSHP: 2–8 U/L ♂; >25 menopause
GGT ♂P: 11–51 U/L
GGT ♀P: 7–33 U/L
Glucose (fasting)P: 3.5–5.5 mmol/L
Growth hormoneP: <20 mu/L
HbA1C (DCCT)B: 4–6%
HbA1C (IFCC)B: 20–42 mmol/mol
Iron ♂S: 14–31 μmol/L
Iron ♀S: 11–30 μmol/L
Lactate (venous)P: 0.6–2.4 mmol/L
Lactate (arterial)P: 0.6–1.8 mmol/L
LDHP: 70–250 U/L
LHP: 3–16 U/L
MagnesiumP: 0.75–1.05 mmol/L
OsmolalityP: 278–305 mosmol/kg
PTHP: 0.8–8.5 pmol/L
PotassiumP: 3.5–5.3 mmol/L
Prolactin ♂P: <450 U/L
Prolactin ♀P: <600 U/L
PSAP: 0–4 mcg/mL
Protein (total)P: 60–80 g/L
Red cell folateB: 0.36–1.44 μmol/L
Renin (erect)P: 2.8–4.5 pmol/mL/h
Renin (recumbent)P: 1.1–2.7 pmol/mL/h
SodiumP: 135–145 mmol/L
TBGP: 7–17 mg/L
TSHP: 0.5–4.2 mU/L
T4P: 70–140 nmol/L
Free T4P: 9–22 pmol/L
TIBCS: 54–75 μmol/L
TriglyceridesP: 0.50–2.3 mmol/L
T3P: 1.2–3.0 nmol/L
Troponin TP: <0.1 mcg/L
Urate ♂P: 210–480 μmol/L
Urate ♀P: 150–390 μmol/L
UreaP: 2.5–6.7 mmol/L
Vitamin B12S: 0.13–0.68 nmol/L
Vitamin DS: 50 nmol/L
Arterial Blood Gases
pH7.35–7.45
PaCO₂4.7–6.0 kPa
PaO₂>10.6 kPa
Base excess±2 mmol/L
Urine
Cortisol (free)<280 nmol/24h
Hydroxyindole acetic acid16–73 μmol/24h
Hydroxymethylmandelic acid16–48 μmol/24h
Metanephrines0.03–0.69 μmol/mmol cr.
Osmolality350–1000 mosmol/kg
17-Oxogenic steroids ♂28–30 μmol/24h
17-Oxogenic steroids ♀21–66 μmol/24h
17-Oxosteroids ♂17–76 μmol/24h
17-Oxosteroids ♀14–59 μmol/24h
Phosphate (inorganic)15–50 mmol/24h
Potassium14–120 mmol/24h
Protein<150 mg/24h
Protein/creatinine ratio<3 mg/mmol
Sodium100–250 mmol/24h
Haematology
WCC4.0–11.0 ×10⁹/L
RBC ♂4.5–6.5 ×10¹²/L
RBC ♀3.9–5.6 ×10¹²/L
Hb ♂130–180 g/L
Hb ♀115–160 g/L
PCV ♂0.4–0.54 L/L
PCV ♀0.37–0.47 L/L
MCV76–96 fL
MCH27–32 pg
MCHC300–360 g/L
RDW11.6–14.6%
Neutrophils2.0–7.5 ×10⁹/L (40–75%)
Lymphocytes1.0–4.5 ×10⁹/L (20–45%)
Eosinophils0.04–0.44 ×10⁹/L (1–6%)
Basophils0–0.10 ×10⁹/L (0–1%)
Monocytes0.2–0.8 ×10⁹/L (2–10%)
Platelets150–400 ×10⁹/L
Reticulocytes0.8–2.0% / 25–100 ×10⁹/L
Prothrombin time10–14 s
APTT35–45 s
Paediatric
Pulse Rate (bpm)
Neonate140–160
Infant <1yr120–140
1–5 years110–130
5–12 years80–120
>12 years70–100
Respiratory Rate (tachypnoea)
0–2 months≥60/min
2–12 months≥50/min
1–5 years≥40/min
>5 years≥30/min
Blood Pressure (mmHg)
Term65/45
1 year75/50
4 years85/60
8 years95/65
10 years100/70
Weight Formulas
3–12 months(a + 9)/2 kg
1–6 years2a + 8 kg
>6 years(7a − 5)/2 kg
Haemoglobin (g/dL)
Term newborn13–20
1 month11–18
2 months10–15
1–2 years10–13
>2 years11–14
MUAC (6 months–5 years)
Obese>17.5 cm
Normal13.5–17.4 cm
At risk12.5–13.4 cm
Moderate malnutrition11.5–12.4 cm
Severe malnutrition<11.5 cm
Developmental Milestones
Social smile1.5 months
Head control4 months
Sits unsupported7 months
Crawls10 months
Stands unsupported10–12 months
Walks12–13 months
Talks18 months
CSF WBC (/mm³)
Term newborn0–25
>2 weeks0–5
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