Midwife Licensure Exam Newborn & Neonatal Care — Normal Newborn Assessment & CareConcept Map

Concept

APGAR Scoring System

Sub Concepts

• Five scoring components (Appearance, Pulse, Grimace, Activity, Respiration)
• Scoring interpretation (0-3 severely depressed, 4-6 moderately depressed, 7-10 good)
• Timing of assessment (1 minute and 5 minutes)
• Acrocyanosis as normal finding
• Distinction between APGAR scores and resuscitation initiation

Relationship To Central

Primary rapid assessment tool used immediately after birth to evaluate newborn's physiological transition

Concept

Gestational Age Assessment

Sub Concepts

• New Ballard Score components
• Physical maturity signs (skin, lanugo, plantar creases, breast tissue, ear/eye, genitalia)
• Neuromuscular maturity signs (posture, square window, arm recoil, popliteal angle, scarf sign, heel-to-ear)
• Classification by gestational age (preterm <37 weeks, term 37-42 weeks, post-term >42 weeks)
• Growth classification (SGA, AGA, LGA) based on percentiles
• Clinical implications for preterm/SGA and LGA infants

Relationship To Central

Determines newborn maturity level and risk stratification for appropriate care planning

Concept

Normal Newborn Vital Signs & Measurements

Sub Concepts

• Heart rate: 110-160 beats/min (apical count, full minute)
• Respiratory rate: 30-60 breaths/min (abdominal, irregular, periodic pauses normal)
• Axillary temperature: 36.5-37.5°C (preferred site)
• Blood pressure: 60-80/40-50 mmHg
• Weight: 2,500-4,000 g with normal 5-10% loss in first days
• Length: 45-55 cm
• Head circumference: 33-35 cm (2-3 cm larger than chest)
• Blood glucose: above 45 mg/dL (prevents hypoglycemia)

Relationship To Central

Establishes baseline normal parameters to identify deviations requiring intervention

Concept

Newborn Reflexes & Neurologic Assessment

Sub Concepts

• Rooting reflex (fades 3-4 months)
• Sucking reflex (fades 10-12 months)
• Palmar grasp (fades 3-4 months)
• Plantar grasp (fades 8 months)
• Moro (startle) reflex - asymmetry indicates injury (fades 6 months)
• Tonic neck (fencing) reflex (fades 4 months)
• Babinski reflex - toe fanning normal in infants
• Stepping/dancing and Galant reflexes

Relationship To Central

Evaluates intact neurologic system and developmental appropriateness

Concept

EINC/Unang Yakap Protocol

Sub Concepts

• Step 1: Immediate and thorough drying (within 30 seconds) for heat loss prevention
• Step 2: Early skin-to-skin contact (naked baby on mother's bare chest)
• Step 3: Properly timed cord clamping (1-3 minutes after pulsations stop)
• Step 4: Non-separation for early breastfeeding initiation (ideally within 90 minutes)
• Discouraged early routines (unnecessary suctioning, early bathing, footprinting)
• Delay first bath for at least 6 hours

Relationship To Central

Philippine DOH-standardized protocol for immediate newborn care ensuring evidence-based safe transition

Concept

Thermoregulation & Heat Loss Prevention

Sub Concepts

• Brown fat non-shivering thermogenesis mechanism
• Cold stress complications (hypoglycemia, respiratory distress, metabolic acidosis)
• Four heat-loss routes: evaporation, conduction, convection, radiation
• Prevention strategies for each heat-loss route
• Neutral thermal environment maintenance
• Cap placement and radiant warmer use

Relationship To Central

Critical physiologic maintenance preventing metabolic complications and cold stress effects

Concept

Prophylactic Medications & Immunizations

Sub Concepts

• Vitamin K (phytonadione): 0.5-1 mg IM in vastus lateralis - prevents hemorrhagic disease
• Erythromycin 0.5% ophthalmic ointment to both eyes - prevents ophthalmia neonatorum
• Hepatitis B vaccine: first dose within 24 hours
• BCG vaccine at birth per Expanded Program on Immunization
• Documentation and administration route requirements

Relationship To Central

Prevents serious infections and hemorrhagic complications in newborn period

Concept

Newborn Screening (RA 9288)

Sub Concepts

• Timing: heel-prick blood sample collection between 24-72 hours after birth
• Basic panel: CH, CAH, GAL, PKU, G6PD deficiency, MSUD
• Expanded panel: 28+ disorders
• Collection technique and specimen handling
• Parent consent and informed counseling
• Results follow-up and referral protocols

Relationship To Central

Legal mandate for early detection of treatable metabolic/endocrine disorders preventing intellectual disability

Concept

Normal Variations vs. Abnormal Findings

Sub Concepts

• Normal findings: acrocyanosis, milia, Mongolian spots, erythema toxicum, caput succedaneum, pseudomenstruation, physiologic peeling
• Concerning findings: central cyanosis, cephalohematoma, bulging/sunken fontanelle, single palmar crease with dysmorphism
• Respiratory distress indicators: grunting, flaring, retractions, RR >60/min
• Documentation importance for Mongolian spots (cultural consideration)

Relationship To Central

Differentiates benign newborn variations from pathologic findings requiring intervention

Concept

Patient & Family Education

Sub Concepts

• Cord care: keep clean and dry, fold diaper below umbilicus
• Safe sleeping position: back to sleep
• Breastfeeding on demand: 8-12 times/day
• Adequate intake indicators: 6+ wet diapers after day 4
• Jaundice monitoring and phototherapy indications
• Temperature maintenance strategies
• Follow-up appointments for screening, immunizations, well-baby checks

Relationship To Central

Empowers caregivers with knowledge for safe home care and recognition of warning signs

To

Resuscitation Initiation

From

APGAR Scoring System

Strength

strong

Relationship

APGAR guides ongoing observation and care level but does NOT determine timing of resuscitation; resuscitation begins immediately based on heart rate and breathing status regardless of APGAR timing

To

Normal Newborn Vital Signs

From

APGAR Scoring System

Strength

strong

Relationship

APGAR measures heart rate and respiratory effort components which are core vital signs; normal APGAR at 5 minutes correlates with stable vital signs indicating good transition

To

Normal Newborn Vital Signs

From

Gestational Age Assessment

Strength

strong

Relationship

Gestational age determines expected normal ranges for vital signs; preterm infants have different baseline parameters than term infants requiring adjusted interpretation

To

Blood Glucose Monitoring

From

Gestational Age Assessment

Strength

strong

Relationship

Growth classification SGA and LGA infants have specific hypoglycemia risks; SGA infants deplete stores quickly while LGA/maternal diabetes puts infant at high risk for neonatal hypoglycemia requiring frequent monitoring

To

Thermoregulation & Heat Loss Prevention

From

EINC/Unang Yakap Protocol

Strength

strong

Relationship

Immediate drying Step 1 of EINC is the single most critical heat loss prevention action; skin-to-skin contact Step 2 provides ongoing thermoregulation through maternal warmth

To

Early Breastfeeding

From

EINC/Unang Yakap Protocol

Strength

strong

Relationship

Step 4 of EINC mandates non-separation for early breastfeeding initiation ideally within 90 minutes supporting metabolic stability and reducing hypoglycemia risk

To

Blood Glucose Monitoring

From

Thermoregulation & Heat Loss Prevention

Strength

strong

Relationship

Cold stress increases glucose and oxygen consumption leading to hypoglycemia; maintaining neutral thermal environment prevents this complication and reduces need for interventions

To

Normal Newborn Vital Signs

From

Thermoregulation & Heat Loss Prevention

Strength

moderate

Relationship

Temperature is a vital sign with normal range 36.5-37.5°C; deviations indicate thermoregulation failure requiring intervention to prevent complications

To

Normal Variations vs. Abnormal Findings

From

Newborn Reflexes & Neurologic Assessment

Strength

strong

Relationship

Asymmetric Moro reflex is an abnormal finding suggesting fractured clavicle or brachial plexus injury; symmetric Moro and other normal reflexes reassure intact neurology

To

Vitamin K Administration

From

Prophylactic Medications & Immunizations

Strength

strong

Relationship

Vitamin K 0.5-1 mg IM at birth prevents vitamin K-deficiency bleeding hemorrhagic disease of newborn critical prophylaxis in immediate care

To

Eye Prophylaxis

From

Prophylactic Medications & Immunizations

Strength

strong

Relationship

Erythromycin 0.5% ophthalmic ointment to both eyes at birth prevents gonococcal and chlamydial ophthalmia neonatorum required immediate care

To

Early Detection Prevention

From

Newborn Screening RA 9288

Strength

strong

Relationship

Newborn screening at 24-72 hours detects treatable metabolic/endocrine disorders preventing intellectual disability and death through early intervention

To

Patient & Family Education

From

Normal Variations vs. Abnormal Findings

Strength

moderate

Relationship

Education must distinguish normal benign findings like acrocyanosis and Mongolian spots requiring only documentation from concerning findings requiring medical evaluation preventing unnecessary parental anxiety

To

Cord Care

From

Patient & Family Education

Strength

moderate

Relationship

Family must understand proper cord care keeping clean and dry folding diaper below umbilicus and recognizing redness/discharge as warning signs to prevent infection

To

Breastfeeding Support

From

Patient & Family Education

Strength

moderate

Relationship

Education on breastfeeding 8-12 times daily and adequate intake indicators 6+ wet diapers after day 4 supports successful feeding and infant nutrition

To

Gestational Age Assessment

From

APGAR Scoring System

Strength

moderate

Relationship

Together APGAR and gestational age provide comprehensive newborn status; preterm infants with low APGAR may need different interventions than term infants

To

Normal Newborn Vital Signs

From

Newborn Reflexes & Neurologic Assessment

Strength

moderate

Relationship

Normal reflexes combined with stable vital signs indicate successful physiologic transition and intact neurologic system

To

Early Breastfeeding

From

Blood Glucose Monitoring

Strength

strong

Relationship

Early breastfeeding within 90 minutes per EINC Step 4 provides glucose and reduces hypoglycemia risk particularly important for SGA and LGA infants

To

Infection Prevention

From

Prophylactic Medications & Immunizations

Strength

strong

Relationship

Prophylactic medications especially vitamin K and erythromycin eye ointment represent evidence-based infection and hemorrhage prevention in vulnerable newborn period

To

Delayed Cord Clamping Benefits

From

EINC/Unang Yakap Protocol

Strength

strong

Relationship

Step 3 of EINC recommends 1-3 minute delay in cord clamping to maximize placental blood transfusion improving iron stores and reducing anemia risk