Newborn Assessment and Care (Apgar, Transition, Thermoregulation)

Most newborns need routine care, not resuscitation. Dry them and keep them warm. Skin-to-skin contact is part of it. Wait for a stable baby before you clamp the cord. Score the Apgar for the record. Check glucose when the baby is at risk. This page covers that routine care for the first 28 days of life. Ventilation, compressions and epinephrine live on Neonatal Resuscitation (NRP 9th Edition).

Never let routine care delay help for a newborn who is not breathing well. Where a step depends on protocol, this page says so.

Vitamin K, the hepatitis B vaccine, eye prophylaxis and newborn screening are routine hospital items, and this page leaves them out. Newborn screening includes pulse oximetry for critical congenital heart disease.

Why Kids Are Different

• Heat: a large surface area for its body mass, thin skin, little fat and weak shivering. Wet in a cool room, the baby loses heat fast.
• Glucose: energy stores are small. Late-preterm, small and stressed infants face a higher risk of low glucose. Its signs are easy to miss.
• Transition: over the first minutes, the baby shifts from placental to lung circulation. Routine care supports that shift. It does not force it.
• Breathing: the lungs are full of fluid at birth and clear over the first hours. Fast breathing that won't settle, or grunting that keeps going, is not routine care.

1. Dry and cover: for a term or late-preterm newborn, dry at once, remove wet linen, and cover the head and body. Heat protection starts here, before any other step. A very preterm infant is not dried first; wrap it instead (see Special Populations).
2. Keep warm: skin-to-skin on the caregiver's chest in a draft-free space is the warmest option for a stable baby. Use a pre-warmed radiant warmer when the baby needs hands-on assessment.
3. Clamp late if stable: for a baby who does not need immediate help, wait at least 60 seconds before clamping the cord. If life-saving interventions are needed, clamp and cut within 30 seconds.
4. Check breathing, heart rate and tone: look at breathing or crying, muscle tone and color. Decide quickly whether this is routine care or resuscitation.
5. Score the Apgar at 1 and 5 minutes: record the score and the time, and note any resuscitation given at the same time.
6. Check glucose when at risk: use the local protocol for late-preterm, small or unwell newborns.

The Apgar rates five signs, each at 0, 1 or 2 points. Think of it as a record of how the newborn looks and responds after birth. It does not measure cause or outcome.

• Totals: 7 to 10 is the conventional reassuring range. 4 to 6 is moderately abnormal, and 0 to 3 is low. Score at 1 and 5 minutes. A 5-minute score below 7 means you repeat it every 5 minutes, for up to 20 minutes.
• Scores during resuscitation: a score given mid-resuscitation does not mean the same as one for a baby breathing on its own. Write the interventions next to the number.

Hold the target at 36.5 to 37.5 °C (97.7 to 99.5 °F). The ERC 2025 guideline asks that temperature be monitored regularly or continuously after birth.

Newborns lose heat four ways. A large surface area makes it worse in preterm infants. Each route has a simple fix.

Keep the delivery room warm: about 23–25 °C for larger infants, and above 25 °C for infants at or below 28 weeks.

An unplanned birth outside the hospital is associated with higher neonatal morbidity and mortality. Hypothermia is common there too. The ERC 2025 guideline makes prevention or treatment of hypothermia the main focus for out-of-hospital providers.

Newborn care needs very few drugs. Routine vitamin K is a hospital item. For EMS, ED and transport teams, dextrose is the drug they are most likely to give.

Vitamin K is given as a single dose to prevent vitamin K deficiency bleeding. Two sources differ, and the page shows both above. The Hospira label (DailyMed) says 0.5 to 1 mg within one hour of birth. It prefers the subcutaneous route and carries a boxed warning against IV and IM injection unless SC is not feasible. The AAP 2022 statement says 1 mg IM within 6 hours of birth for infants over 1500 g. That is standard US newborn practice. For infants of 1500 g or less, it says 0.3 to 0.5 mg/kg IM. The Canadian Paediatric Society also recommends one IM dose within 6 hours. This page does not pick a winner. Route and timing follow your local neonatal protocol or the order. The neonatal product is 1 mg/0.5 mL (2 mg/mL), so confirm the strength before you draw up a newborn dose.

Low glucose in a newborn is commonly treated with 10% dextrose at 2 mL/kg (200 mg/kg) IV, given slowly. Then recheck glucose (AHA/AAP neonatal resuscitation guidance). A bolus alone may not hold glucose, which is why a continuous dextrose infusion is usually needed, per NICU protocol. Point-of-care meters are less accurate in neonates, so confirm a low reading per protocol. For asymptomatic infants, feeding or buccal dextrose gel is an option where the protocol allows. This page gives no fixed threshold. The NICU or local protocol decides when to treat.

Doses vary by protocol; follow local protocols and medical direction.

Late-Preterm and Small Newborns

• Late-preterm and term infants at risk of low glucose need early identification. Prophylactic measures follow the protocol, per the AAP 2011 report.
• The 2025 Cochrane review looked at healthy full-term and late-preterm infants. Immediate or early skin-to-skin raised infant blood glucose, with a mean difference of 10.49 mg/dL and moderate certainty.

Preterm Under 32 Weeks

• Do not dry first. Place the body in a plastic bag or wrap, with the head covered, under a pre-warmed radiant warmer, per current guidelines and NICU protocol. Where that cutoff sits varies. Commonly it is under 32 to 34 weeks.
• Monitor temperature regularly or continuously, aiming for 36.5 to 37.5 °C. Avoid overheating from the wrap or warmer.

Unplanned Birth Outside the Hospital

• Associated with higher neonatal morbidity and mortality.
• For out-of-hospital providers, the ERC 2025 guideline makes hypothermia prevention the main priority.

Scope varies by state and agency. Read this table as typical roles, not scope-of-practice statements.

• Vehicle and stretcher: warm the cab and the stretcher before loading the newborn. Keep the doors closed to limit drafts.
• Caregiver: keep skin-to-skin going with the caregiver when it is safe and per local protocol. When it is not, use a warmed, securely fastened infant carrier or incubator, per protocol.
• Documentation: time of birth, cord clamp time, Apgar scores at 1 and 5 minutes, temperature and any glucose result.
• Destination: a receiving hospital with newborn care, chosen per regional protocol.
• Handoff: give a structured report (IMIST-AMBO or MIST). Include the birth details and the warming steps already taken.