What Is the Neonatal Period?

The First Four Weeks of a Child's Life

The neonatal period is the first four weeks of an infant's life, whether the baby was carried to term or born prematurely. It's a time of rapid change and development where patterns for infancy, like feeding and bonding, are developed. It's also the period when there are the most risk for post-birth complications or when birth defects or congenital conditions may first be detected. The neonatal period includes the perinatal period, which is the initial period after the birth.

mother's hands holding newborn boy's head

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Importance of the Neonatal Period

Newborns, also called neonates, are observed closely in the first few hours of life. This is particularly true for premature births, which occur before the 37th week of pregnancy, or if there were any complications during the delivery. A developing baby goes through important growth throughout pregnancy, including in the final months and weeks. Premature babies can have immature lungs, difficulty regulating body temperature, poor feeding, and slow weight gain. In 2018, preterm birth and low birth weight accounted for about 17% of infant deaths (deaths before 1 year of age).

Immediately after birth, a medical team quickly checks the baby's vital signs, alertness, and overall health. Supplemental oxygen and other emergency care may be provided if the baby has breathing difficulties. You may hear the baby assigned an Apgar score, which is based on:

  • Color
  • Heart rate
  • Reflexes
  • Muscle tone
  • Breathing

Numerical scores are added for each category and reevaluated every five minutes for the baby's first 20 minutes of life. Low scores or problems in any of these areas may result in the need for additional care for the baby. The goal is for the infant and their parent to be together in this period and begin feeding and bonding.

Risks and Complications

The neonatal period is the riskiest period after birth. Worldwide, 2.4 million infants died in the first month of life in 2019. Death rates in this period have decreased over the past few decades, but complications during pregnancy and delivery remain significant, with 75% of infant deaths occurring in the first week of life.

With proper prenatal care, some complications or conditions may be identified before delivery, and infants could be labeled as high risk before they are even born. This gives medical teams adequate warning and time to make sure the tools necessary to care for the infant are in place at the time of birth.

Even for infants who aren't labeled as high-risk before birth, healthcare providers will watch the baby closely after birth, ideally noting any illness or complications within the first two hours of life.

Possible complications or problems during the delivery process and neonatal period include:

  • Birth defects
  • Birth injuries
  • Breathing problems
  • Infection
  • Jaundice
  • Low birth weight
  • Low blood sugar
  • Neurological problems like cerebral palsy or seizures
  • Feeding difficulties
  • Pneumonia from breathing in fluids during birth
  • Temperature control problems
  • Developmental delay
  • Vision problems
  • Hearing problems

Infants who require extensive care from premature birth or other neonatal complications may need to receive treatment in a neonatal intensive care unit after birth. If no complications occur, the delivery team begins to make plans to transition babies to postnatal care hours after delivery. Hospitals in the United States are required to offer at least a 48-hour hospital stay after birth for a vaginal delivery and 96 hours for a cesarean delivery.

What Happens in the Neonatal Period

A lot happens during the neonatal period—especially immediately after delivery. While each baby moves at a different pace, here are some general milestones to expect during this time.

In the Hospital

Your baby will undergo a number of tests and screenings for common diseases, hearing problems, and more. They will also receive a number of vaccinations. You may be asked to select a pediatrician before delivery, or the medical team will help you find one. Before you leave the hospital, you should have a follow-up care plan for your baby established.

Week 1

In the first week after birth, you and your baby will be getting to know each other. Bonding and feeding are the primary tasks in this first week. Whether you are breastfeeding or using a formula, urination and stooling patterns will signal to you whether your baby is receiving enough nutrition.

It's common for infants to lose weight after birth. Don't be alarmed if your baby sleeps a lot this first week also. It's not unusual for newborns to sleep for 14 to 17 hours a day in the first weeks of life. But they will also wake up every two to four hours for feeding. Expect to have your first follow-up visit with a pediatrician outside of the hospital three to five days after birth.

Week 2

Sleep and feeding are erratic at this stage. Your baby may be having their first growth spurt, having returned to their birth weight and then some. Most babies will consume 16 to 24 ounces of breastmilk or formula each day during this time. Talk to your doctor immediately if you are having trouble feeding or if you notice a decrease in wet or soiled diapers.

Week 3

Feeding and sleeping schedules are still inconsistent, but your baby will begin to refine its muscle control at this point. Most babies begin to lift their head and should have regular "tummy time" to help develop strength. Your pediatrician will closely monitor your infant's weight and growth in the first few weeks of life to identify any early feeding problems.

Week 4

You've officially reached the end of the neonatal period. For many parents, feeding and sleeping become more routine at this stage. Your baby may be responding to you more as their senses like hearing and vision develop. You may even begin to recognize patterns in the sounds and cries your baby makes. Expect another visit with your pediatrician at this point to review the baby's growth, discuss care for the next stages, and receive additional vaccinations.

Coping

Coping with the challenges of the neonatal period can be difficult. If you gave birth to your newborn, you will experience hormonal and physical challenges from the birth and any complications you may have had. Even parents who didn't give birth to their infants may struggle with sleep and feeding schedules or even bonding.

Talk to your doctor if you are struggling to care for your baby. Be sure to establish a good support system before the birth, and don't be afraid to ask for help. Be aware of the signs of postpartum depression. Your pediatrician and the hospital should review basic newborn care with you and help you and your baby stay on track with growth and development.

A Word From Verywell

The neonatal period is an exciting time when your baby starts to grow and you begin to bond with them, but it can also be challenging with the erratic sleeping and feeding schedules. Caring for a newborn while navigating new parenthood, feeding and sleep schedules, and life in general can be difficult. Don't be afraid to ask for help and support from family, friends, community services, and even your pediatrician.

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Article Sources
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  1. MedlinePlus. Neonate. Updated May 4, 2021.

  2. Centers for Disease Control and Prevention. Preterm birth. Updated October 30, 2020.

  3. American Academy of Pediatrics/American College of Obstetricians and Gynecologists. Guidelines for perinatal care. Updated 2017.

  4. World Health Organization. Newborns: Improving survival and well-being. Updated September 19, 2020.

  5. University Hospitals Rainbow Babies & Children's. Newborn complications we treat.

  6. National Conference of State Legislatures. Maternity length of stay rules. Updated April 23, 2018.

  7. American Academy of Pediatrics. AAP schedule of well-child care visits. October 26, 2018.