General Appearance

After collecting the history, it is important to observe the calm newborn. The normal term newborn rests with all extremities in some degree of flexion. Breathing should be quiet and effortless, but it can be very irregular. Episodes without breathing lasting 5 to 10 seconds are common and normal in newborns. Skin should be warm to the touch, soft, and smooth. Table 22-2 lists normal vital signs in the first days of life. Box 22-3 lists some common benign findings on the newborn examination. These are generally self-limited and require no further evaluation or treatment in the otherwise asymptomatic newborn.

Infants typically lose up to 10% of their birth weight in the first few days but should regain this weight by 2 weeks of age (Thureen et al., 2005). Excessive weight loss can indicate systemic disease or feeding difficulties and should be evaluated before discharge.

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