his virus is primarily spread by mosquito bites. Infection is asymptomatic in most people but can cause severe birth defects (Chap. 64, p. 1219). Screening begins with an interrogation for recent travel to endemic areas. For women at risk, serological screening is then completed. All newborns of mothers who have laboratory evidence of Zika virus infection during pregnancy should receive a comprehensive examination, a neurological assessment, postnatal head ultrasound, standard newborn hearing screen before hospital discharge, and Zika virus laboratory testing (Reynolds, 2017).
Supplemental vitamin K injection will prevent vitamin K-dependent hemorrhagic disease of the newborn (Chap. 33, p. 626). A single intramuscular dose of vitamin K, 0.5 to 1 mg, is given within 1 hour of birth (American Academy of Pediatrics, 2017b).
Numerous mass-screening tests are now available for 29 newborn conditions. Shown in Table 32-4, many are mandated by various state laws (American College of Obstetricians and Gynecologists, 2017 c). lost states require that all tests in the core panel be performed. Supplemental conditions-secondary targets-are also listed on the Maternal and Child Health Bureau website. Some states require some of these in addition to their mandated core panel. Each practitioner should be familiar with their individual state requirements, which are available at http:// genes-r-us.uthscsa.edu/resources/consumer/statemap.htm.
Newborn gestational age can be estimated very soon after delivery. The relationship between gestational age and birthweight can identiy neonates at risk for complications. For example, (cobalamin A, B) Propionic 3-Ketothiolase aDetermined by tandem mass spectrometry. bAdded after 2006.
From Centers for Disease Control and Prevention, 20r12; Watson, 2006.
The Newborn 61 5 neonates who are either small or large for gestational age are at greater risk for hypoglycemia and polycythemia, and measurements of blood glucose and hematocrit are indicated.
• Care of Skin and Umbilical Cord
All excess vernix, blood, and meconium is gently wiped of after delivery while keeping the newborn warm. Any remaining ver nix is readily absorbed and disappears within 24 hours. he first bath is postponed until the neonate's temperature is stable.
Aseptic precautions are observed in the immediate care of the cord. The American Academy of Pediatrics has concluded that keeping the cord dry is suicient care (Stewart, 2016). he umbilical cord begins to lose water from Wharton jelly shortly after birth. Within 24 hours, the cord stump loses its characteristic bluish-white, moist appearance and soon becomes dry and black. Within several days to weeks, the stump sloughs and leaves a small, granulating wound, which after healing forms the umbilicus. Separation usually takes place within the irst 2 weeks. The range is 3 to 45 days (Novack, 1988). he umbilical cord dries more quickly and separates more readily when exposed to air. Thus, a dressing is not recommended.
In resource-poor countries, local antimicrobial prophylaxis is reasonable (Salam, 2014). Triple-dye applied to the cord was reported to be superior to soap and water care in preventing colonization and exudate formation Qanssen, 2003). In a Nepalese study, cleaning the cord stump with 4-percent chlorhexidine reduced severe infection by 75 percent compared with soap and water (Mullany, 2006). Likewise, O.l-percent chlorhexidine powder was superior to dry cord care (Kapellen, 2009). he World Health Organization (2014) recommends cleansing with chlorhexidine.