🤱 Maternity & Newborn · Lesson 5 of 6 · 7 min
The First Hour: APGAR, Warmth, Vitamin K and Sugar
👶 A newborn loses heat four ways in the first minutes of life, and a cold baby burns through its glucose and oxygen trying to stay warm. The first hour of nursing care is mostly about thermodynamics.
💡 Key idea
Dry, warm, skin-to-skin. APGAR 7 to 10 normal. Vitamin K soon after birth (within the first 6 hours), plus eye ointment. Jaundice before 24 hours is pathologic; check glucose in at-risk babies.
🧠 Why it matters
APGAR scores at 1 and 5 minutes rate heart rate, respiratory effort, muscle tone, reflex irritability and color from 0 to 2 each; 7 to 10 is reassuring, 4 to 6 is moderately abnormal, and 0 to 3 is low. Resuscitation is never delayed to wait for the score: when a baby needs it, it starts before the 1-minute score. Expected newborn vital signs: heart rate 110 to 160, respirations 30 to 60 (irregular, with brief pauses under 20 seconds), temperature 36.5 to 37.5 °C. Prevent HEAT LOSS by drying immediately, removing wet linen, skin-to-skin contact, a cap, and keeping the infant away from drafts and cold surfaces (evaporation, conduction, convection, radiation). Give VITAMIN K intramuscularly in the vastus lateralis to prevent bleeding, ERYTHROMYCIN eye ointment to prevent ophthalmia neonatorum, and the first HEPATITIS B vaccine as the current CDC schedule and AAP guidance direct; if the mother is HBsAg-positive, the vaccine and hepatitis B immune globulin are given within 12 hours of birth. Screen at-risk infants (of diabetic mothers, large or small for dates, preterm, cold-stressed) for HYPOGLYCEMIA; jitteriness, lethargy, poor feeding and apnea are signs, and a glucose below about 40 to 45 mg/dL is treated with early feeding or IV dextrose. JAUNDICE in the first 24 hours is PATHOLOGIC (hemolysis, ABO or Rh incompatibility); jaundice after 24 hours is usually physiologic. Phototherapy: eye shields on, genitals covered, turn frequently, maintain hydration and watch temperature. Umbilical cord care is dry and clean; it falls off in 1 to 2 weeks. Expected findings that alarm parents: milia, congenital dermal melanocytosis (formerly called Mongolian spots: benign blue-gray patches, documented so they are not mistaken for bruises), acrocyanosis in the first day, caput succedaneum crossing suture lines, and the sucking, rooting, Moro, grasp and Babinski reflexes.
🏥 In the real world
🧢 A large-for-dates infant of a diabetic mother is jittery at 2 hours of age. The nurse checks a heel-stick glucose: 32 mg/dL. The baby is fed immediately and rechecked, and the nurse notifies the provider: a newborn with symptoms of low glucose may need IV glucose per protocol, because feeding alone may not be enough. Maternal hyperglycemia drove fetal insulin high, and the supply was cut at birth. The exam pairs 'infant of a diabetic mother' with 'jittery' and expects 'check the glucose' every time.
📌 Takeaways
- APGAR at 1 and 5 minutes; 7 to 10 is normal
- Heat loss: evaporation, conduction, convection, radiation; dry and cover
- Vitamin K IM, erythromycin eyes, hepatitis B; jaundice under 24 hours is pathologic
📖 Terms in this lesson
APGAR score: A newborn score at 1 and 5 minutes for heart rate, breathing, tone, reflexes and color; 7 to 10 is normal.
APGAR (newborn score): Appearance (color), Pulse, Grimace (reflex irritability), Activity (muscle tone), Respiration: the five newborn signs scored 0 to 2 each at 1 and 5 minutes.
Newborn bilirubin: Physiologic jaundice appears after 24 hours and peaks around 5 to 6 mg/dL on days 3 to 5; jaundice in the first 24 hours is pathologic, phototherapy thresholds follow the hour-specific AAP chart, and levels near 20 to 25 risk kernicterus.
Newborn blood glucose: A newborn glucose below about 40 to 45 mg/dL is hypoglycemia; infants of diabetic mothers, large or small for dates, preterm or cold-stressed are screened, and jitteriness, poor feeding or apnea call for feeding or IV dextrose.
✅ Test yourself
A newborn has a heart rate of 120, a strong cry, good flexion, a grimace to suction and a pink body with blue hands and feet at 1 minute. What is the APGAR score?
- 7
- 10
- 6
- 8
Answer: D · 8
Heart rate 2, respiratory effort 2, tone 2, reflex irritability 1 (grimace), color 1 (acrocyanosis) = 8.
Which newborn finding requires immediate reporting?
- Blue-gray patches on the sacrum
- Yellow skin and sclera noted at 12 hours of age
- A respiratory rate of 48 with brief 5-second pauses
- Small white papules on the nose
Answer: B · Yellow skin and sclera noted at 12 hours of age
Jaundice within the first 24 hours is pathologic and suggests hemolysis; the other findings are normal variants.
Why does the nurse dry a newborn immediately and remove wet blankets?
- To prepare for the vitamin K injection
- To prevent heat loss by evaporation
- To improve APGAR color scoring
- To stimulate crying
Answer: B · To prevent heat loss by evaporation
Evaporative heat loss from wet skin is the largest source of cooling in the first minutes; cold stress raises oxygen and glucose demands.
NCLEX-style questions, XP and streaks in the app. No sign-up needed.