第一个小时：APGAR、保暖、Vitamin K 和血糖

🧠 为什么重要

APGAR 评分在出生后 1 分钟和 5 分钟时评估心率、呼吸努力、肌张力、反射应激性和肤色，每项 0 至 2 分；7 至 10 分令人安心，4 至 6 分为中度异常，0 至 3 分为低分。复苏绝不会为了等待评分而延误：当婴儿需要复苏时，复苏在 1 分钟评分之前就开始了。预期的新生儿生命体征：心率 110 至 160，呼吸 30 至 60（不规则，伴有短于 20 秒的短暂暂停），体温 36.5 至 37.5 °C。通过立即擦干、移除湿床单、皮肤接触、戴帽子，并让婴儿远离气流和寒冷表面（蒸发、传导、对流、辐射）来防止热量散失。在股外侧肌 IM 注射 Vitamin K 以预防出血，给予 erythromycin 眼膏以预防新生儿眼炎，并接种第一剂 hepatitis B 疫苗：AAP 推荐在 24 小时内为体重 2,000 g 或以上、医学上稳定的婴儿接种出生剂量，而自 2025 年末以来，当母亲 HBsAg 阴性时，CDC 时间表将出生剂量留给个人决定；如果母亲 HBsAg 阳性，则在出生后 12 小时内给予疫苗和 hepatitis B 免疫球蛋白。对有风险的婴儿（母亲患糖尿病的婴儿、大于或小于胎龄的婴儿、早产儿、受冷应激的婴儿）筛查低血糖；颤抖、无力、喂养不良和呼吸暂停是其征象，血糖低于约 40 至 45 mg/dL 时用早期喂养或 IV dextrose 治疗。出生后 24 小时内的黄疸是病理性的（溶血、ABO 或 Rh 不合）；24 小时后的黄疸通常是生理性的。光疗：戴上眼罩，遮盖生殖器，经常翻身，保持水分并注意体温。脐带护理保持干燥和清洁；脐带在 1 至 2 周内脱落。会让父母担心的预期表现：粟粒疹、先天性皮肤黑素细胞增多症（以前称为蒙古斑：良性的蓝灰色斑片，记录下来以免被误认为瘀伤）、出生后第一天的手足发绀、跨越颅缝的产瘤，以及吸吮、觅食、Moro、抓握和 Babinski 反射。

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: AAP recommends a birth dose within 24 hours for medically stable infants weighing 2,000 g or more, while since late 2025 the CDC schedule leaves the birth dose to individual decision-making when the mother is HBsAg-negative; 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.

🏥 真实场景

🧢 一名母亲患糖尿病的大于胎龄婴儿在出生 2 小时时出现颤抖。护士检查足跟血血糖：32 mg/dL。由于婴儿有症状，护士立即通知医生，并按规程准备 IV dextrose。如果婴儿能安全吸吮，可以给予喂养，但喂养绝不能延误 IV 治疗。单独喂养（或 dextrose 凝胶）适用于无症状的低血糖。治疗后复查血糖。母亲的高血糖使胎儿胰岛素升高，而出生时供应被切断了。考试将“母亲患糖尿病的婴儿”与“颤抖”配对，并每次都期望你“检查血糖”。

🧢 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. Because the baby has symptoms, the nurse notifies the provider immediately and prepares for IV dextrose per protocol. A feeding may be offered if the baby can suck safely, but it must not delay IV treatment. Feeding (or dextrose gel) alone is the approach for low glucose without symptoms. The glucose is rechecked after treatment. 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.

📌 要点总结

• APGAR 在 1 分钟和 5 分钟时评估；7 至 10 分为正常APGAR at 1 and 5 minutes; 7 to 10 is normal
• 热量散失：蒸发、传导、对流、辐射；擦干并覆盖Heat loss: evaporation, conduction, convection, radiation; dry and cover
• Vitamin K IM 注射、erythromycin 眼膏、hepatitis B 疫苗；24 小时内的黄疸是病理性的Vitamin K IM, erythromycin eyes, hepatitis B; jaundice under 24 hours is pathologic

✅ 自我测试