Newborn metabolic and respiratory complications

Newborn complication items reward pattern recognition: who crashes glucose, who is cold, which tachypnea story fits TTN vs RDS vs meconium, and what families must hear about jaundice lights and metabolic screens. Broader transition and fluid assessment sits in Paediatric fluid and newborn.

Hypoglycemia and hypothermia

After birth the newborn must make glucose without a continuous placental supply. Infants of diabetic mothers had fetal hyperinsulinism in response to maternal hyperglycemia; once the cord is cut, that insulin keeps working and blood glucose falls. Preterms, SGA babies, and stressed/cold infants also burn through stores fast. Jitteriness, lethargy, poor suck, apnea, and seizures are classic — do not wait for a dramatic look if the risk group is named.

Cold stress raises oxygen and glucose demand. Evaporative heat loss from wet skin is the usual culprit in the first minutes. Warmth is treatment and prevention: dry thoroughly, cover the head, use skin-to-skin when appropriate, and keep the environment draft-free. Fixing cold often helps the glucose and respiratory picture together.

TTN, RDS, and meconium aspiration

All three can present with tachypnea and work of breathing, so exams force you to use gestational age, timing, and fluid history. Transient tachypnea of the newborn is delayed clearance of fetal lung fluid, more often in term or near-term infants, sometimes after cesarean without labor. Distress appears early and typically improves over hours with oxygen and observation as ordered.

Respiratory distress syndrome is a preterm surfactant problem. Alveoli collapse, compliance falls, and you see progressive grunting, nasal flaring, retractions, and cyanosis. Warmth, respiratory support, and ordered surfactant are the spine. Meconium aspiration hits more mature infants who passed meconium in utero; chemical irritation and ball-valve obstruction produce patchy distress and higher risk of severe hypoxemia — suction/resuscitation follow current NRP cues in the stem, then supportive care.

1. Count respirations a full minute; note grunting and retractions.
2. Keep NPO or limited feeds as ordered when work of breathing is high — aspiration risk.
3. Position for open airway; report rising O2 need promptly.

Jaundice phototherapy and newborn screening

Physiologic jaundice is common; pathologic patterns rise earlier or higher and need a cause hunt. Phototherapy converts bilirubin into excretable forms. Nursing is practical: cover the eyes, expose as much skin as ordered, monitor temperature so the baby does not overheat or cool under the lights, maintain hydration with feeds, and expect looser stools as bilirubin clears. Remove eye shields for feeds and bonding when protocol allows, then replace them before lights resume.

• Report poor feeding, high-pitched cry, or arching — kernicterus concern is rare but tested as escalate-now.
• Do not apply lotions that can burn under lights unless ordered.
• Parents need the why: lights lower bilirubin; feeding helps excretion.

Newborn metabolic screening catches treatable conditions before damage shows. For PKU, once confirmed, dietary phenylalanine restriction protects the developing brain — teach that “a little protein cheat” is not harmless. Congenital hypothyroidism needs early, lifelong thyroid hormone replacement; missing doses risks intellectual disability. Your job on stems is usually teaching urgency and follow-up, not inventing lab cutoffs.

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