Care Of The Newborn

The 1 st 24 hours of Life The first 24 hours of life is a very significant and a highly
vulnerable time due to critical transition from intrauterine to extrauterine life

IMMEDIATE CARE OF THE NEWBORN

A irway

B reathing

T emperature

Airway & Breathing

Suction gently & quickly using bulb syringe or suction catheter

Starts in the mouth then, the nose to prevent aspiration

1.
2. . Airway & Breathing
3. Stimulate crying by rubbing
4. Position properly-
5. side lying / modified t-berg
6. Provide oxygen when necessary

Temperature

7. Dry immediately
8. Place in infant warmer or use droplight
9. Wrap warmly

APGAR Scoring

Standardized evaluation of the newborn

Perform 1 minute and 5 minutes after birth

Involves (5) indicators:

Activity

Pulse

Grimace

Appearance

Respirations
Neonatal Care

9. Care of the Newborn in the Nursery

10. 10. Components <ul><li>

11. A nthropometric Measurements </li></ul><ul><li>
12. B athing – Oil bath/ warm water bath </li></ul><ul><li>
13. C ord Care </li></ul><ul><li>
14. D ressing/ Wrapping - mummified </li></ul><ul><li>
15. E ye prophylaxis – Crede’s </li></ul><ul><li>
16. F oot printing / Identification </li></ul><ul><li>
17. G et APGAR score – 1 & 5 mins </li></ul><ul><li>
18. H R, RR, Temp, BP </li></ul><ul><li>
19. I njection of Vitamin K
20. Proper identification –tag/bracelet </li></ul><ul><li>
21. 23. Daily Care <ul><li>
22. Nutrition/ Feeding </li></ul><ul><li>
23. Elimination </li></ul><ul><li>Weight </li></ul><ul><li>
24. Bathing & Hygiene/ Grooming </li></ul><ul><li>
25. Obtain vital signs </li></ul><ul><li>
26. Rooming-in </li></ul><ul><li>
27. Note for any abnormalities
28. 30. GENERAL APPEARANCE
29. 31. Posture <ul><li>Full term: </li></ul><ul><ul><li>
30. Symmetric </li></ul></ul><ul><ul><li>
31. Face turned to side </li></ul></ul><ul><ul><li>
32. Flexed extremities </li></ul></ul><ul><ul><li>
33. Hands tightly fisted with thumb covered by the fingers 33. VITAL SIGNS
34. 34. TEMPERATURE <ul><li>
35. Site: Axillary NOT Rectal </li></ul><ul><li>
36. Duration: 3 mins </li></ul><ul><li>
37. Normal Range: 36.5 – 37.6 C </li></ul><ul><li>
38. Stabilizes within 8-12 hrs </li></ul><ul><li>
39. Monitor q 30 mins until stable for 2 hrs then q 8 hrs
40. 38. Pulse <ul><li>
41. Awake: 120 – 160 bpm—120 – 140 bpm </li></ul><ul><li>
42. Asleep: 90-110 bpm </li></ul><ul><li>
43. Crying: 180 bpm </li></ul><ul><li>
44. Rhythm: irregular, immaturity of cardiac regulatory center in the medulla
</li></ul><ul><li>
45. Duration: 1 full minute, not crying </li></ul><ul><li>
46. Site: Apical
47. 41. Respiration <ul><li>
48. Characteristics: </li></ul><ul><li>
49. Nasal breathers, gentle, quiet, rapid BUT shallow; may have short periods of apnea
(<15 secs) and irregular without cyanosis—periodic respirations
50. Rate: 30-60 cpm
51. Duration: 1 full minute
52. 47. Blood Pressure <ul><li>
53. NOT routinely measured UNLESS </li></ul><ul><li>i
54. n distress or CHD is suspected </li></ul><ul><li>
55. At birth: 80/46 mmHg* </li></ul><ul><li>
56. After birth: 65/41 mmHg* </li></ul><ul><li>Using Neonatal Care
57. ANTHROPOMETRIC MESUREMENTS
58. 54. SKIN
59. Neonatal Care
60. 94. Neurofibromatosis 051104 Neonatal Care
61. 95. HEAD
62. 96. What to assess
63. For symmetry, shape, swelling, movementSoft, pliable, moves easilyWith some
molding (if VSD); round & well-shaped (if CS)Measure HC; HC = or > CC

. Fontanelles “soft spot99. Caput Succeedaneum <ul><li>Swelling of soft tissues of

the scalp </li></ul><ul><li>Due to pressure </li></ul><ul><li>Crosses the suture
lines </li></ul><ul><li>Presenting part </li></ul><ul><li>3 days after birth
</li></ul>051104 Neonatal Care

64. 100. Cephalhematoma

65. 101. Molding
66. 103. Forcep Marks
67. 104. Craniotabes
68. 105. Craniosynostosis 106.
69. Face/Eyes/Ears/ Nose /Mouth
70. 107. What to Assess <ul><li>Facial movement & symmetry
</li></ul><ul><li>Symmetry, size, shape and spacing of eyes, nose and ears
</li></ul>051104 Neonatal Care
71. 108. Eyes <ul><li>Color: white sclera Slate gray, brown or dark blue Final eye color:
after 6-12 months Symmetrical Pupils equal, round, reactive to light (+) Blink reflex
</
72.
73. 113. Ears <ul><li>Soft and pliable; with firm cartilage Pinna should be at the level of
outer canthus of the eye </li></ul><ul><li>(+) Low set ears = renal or chromosomal
abnormalities </li></ul><ul><li>May be congested and hear well after few days
</li></ul>051104 Neonatal Care
74. 114. 051104 Neonatal Care Low set ears
75. 115. 051104 Neonatal Care Accessory tragus: remnant of 1 st branchial arch
Congenital preauricular sinus: ends blindly risk for infection <ul><ul><ul><ul><li>
</li></ul></ul></ul></ul>
76. 116. Mouth
77. Pink, moist gums
78. Intact soft & hard palates Epstein’s pearls Uvula midline
79. Tongue moves freely, symmetrical with short frenulum
80. Extrusion & Gag reflexes

. Small mouth or large tongue =

chromosomal problems </li></ul><ul><li>(+) white patches on tongue or side of the

cheek = Oral thrush </li></ul>051104 Neonatal Care

81. 118. Neck

 82. Short, thick, in midline
83. Able to flex and extend but cannot support the full weight of head
84. Creased with skin folds
85. Trachea midline
86. Thyroid gland not palpable
87. Intact clavicle
88. 119. ChestCC = or < 2cm than HC Cylindrical; equal AP:T diametSymmetrical
Abdominal breathers

Bronchial sounds Breast engorgement ; subsides after 2 wks Prominent/ edematous nipple (+)
Accessory nipples (+) “Witch Milk

Abdomen

Umbilical Cord 2 arteries; 1 vein

White & gelatinous immediately after birth

Begins to DRY between 1-2 hrs following birth

Blackened or shriveled between 2-3 days

Dried & gradually falls off by 7 days

122. Daily Cord Care

Keep cord dry and clean &

Anus Check patency First stool (Meconium) – within 1 st 24 hrs Sticky, tarlike, blackish-
green, odorless material

89. 126. Transitional Stool Within 2- 10 days after birth Breastfed: golden yellow,
mushy, more frequent 3-4x and sweet smelling Bottlefed:Pale yello, firm, less
frequent 2-3x, with more noticeable odor
90. 128. GenitalsFemale: Labia: edematous Clitoris: enlarged (+) Smegma
91. 131. Back Spine
92. Straight, posture flexed
93. Supports head momentarily
94. Arms & legs flexed </li></ul></ul><ul><ul><li>Chin flexed on upper chest
</li></ul></ul><ul><ul><li>Check for protrusion, excessive or poor muscle
contractions = CNS damage </li></ul></ul>051104 Neonatal Care
95. 132. Extremities <ul><li>Flexed, full ROM, symmetrical
</li></ul><ul><li>Clenched fists; flat soles </li></ul><ul><li>With 10 fingers and
toes in each hand </li></ul><ul><li>Legs bowed </li></ul><ul><li>Even gluteal
folds </li></ul>051104 Neonatal Care
96. 133. <ul><li>(+) Creases on soles of feet </li></ul><ul><ul><li>(-) Creases =
prematurity </li></ul></ul><ul><li>Check for hip fractures or dysplasia
</li></ul><ul><ul><li>(+) Ortolani’s click & uneven gluteal folds = Hip dysplasia
</li></ul></ul>051104 Neonatal Care click !
97. 134. 051104 Neonatal Care

98. 135. 051104 Neonatal Care

99. 136. <ul><li>(+) inward turning of the foot = club foot or talipes equinovarus
</li></ul>051104 Neonatal Care
100. 137. <ul><li>(+) extra digits = Polydactyly </li></ul><ul><li>(+) web fingers
= Syndactyly </li></ul>051104 Neonatal Care <ul><ul><li>
</li></ul></ul>
101. 138. Neurologic System
102. 139. Reflexes
103. 140. Sucking/ Rooting <ul><li>Touch the lip, cheek or corner of the mouth
</li></ul><ul><li>Turns head toward the nipple, opens mouth, takes hold of the
nipple and sucks </li></ul><ul><li>Disappears after 3-4 mos up to 1 year
</li></ul>051104 Neonatal Care
104. 141. Extrusion <ul><li>Anything place on the anterior portion of the tongue
will be “spit out’ </li></ul><ul><li>To prevent swallowing of inedible substances
</li></ul><ul><li>Disappears after 4 months </li></ul><ul><li>Disappearance
indicates readiness for semi-solid to solid foods </li></ul>051104 Neonatal Care
105. 142. Swallowing <ul><li>Occurs spontaneously after sucking and obtaining
fluids </li></ul><ul><li>NEVER disappear </li></ul><ul><li>Newborn swallows
in coordination with sucking without gagging, coughing or vomiting
</li></ul>051104 Neonatal Care
106. 143. Tonic Neck/ Fencing <ul><li>While the baby is falling asleep or
sleeping, gently and quickly turn the head to one side </li></ul><ul><li>As the baby
faces the left side, the left arm and leg extend outward while the right arm or leg flex
and vice-versa </li></ul><ul><li>Disappears within 3-4 mos </li></ul>051104
Neonatal Care
107. 144. Palmar(Grasping)/ Plantar <ul><li>Place a finger in the palm of the
baby’s hand, then place a finger at the base of the toes </li></ul><ul><li>Fingers
will curl or grasp the examiner’s finger and the toes will curl downward
</li></ul><ul><li>Palmar: fades within 3-4 mos </li></ul><ul><li>Plantar: fades
within 8 mos </li></ul>051104 Neonatal Care
108. 145. Moro <ul><li>Hold baby in a semi sitting position then allow the head
and trunk to fall backward to at least a 30-degree angle
</li></ul><ul><li>Symmetrically abducts and extends the arms; fans the fingers out
and forms a C with the thumb and the forefinger; and adducts the arms to an
embracing position & returns to a relaxed state </li></ul>051104 Neonatal Care
109. 146. <ul><li>Present at birth; complete response at 8 weeks
</li></ul><ul><li>MOST significant singular reflex indicative of CNS problem (>6
mos) </li></ul><ul><li>Disappears after 4-5 mos. </li></ul>051104 Neonatal Care
110. 147. Startle <ul><li>Best elicited if baby is 24 hrs old
</li></ul><ul><li>Make a loud noise or claps hands </li></ul><ul><li>Baby ‘s arms
adduct while elbows flex with fists clenched </li></ul><ul><li>Disappears within 4
mos </li></ul>051104 Neonatal Care
111. 148. Babinski <ul><li>Gently stroke upward along the lateral aspect of the
sole, starting at the heel of the foot to the ball of the foot
</li></ul><ul><li>Dorsiflexion of big toe and fanning of little toes
</li></ul><ul><li>Disappears starts a 3 mos to 1 year
</li></ul><ul><li>Disappearance indicates maturity of CNS </li></ul>051104
Neonatal Care
112. 149. Stepping/ Walking/ Dancing <ul><li>Hold baby in a standing position
allowing one foot to touch a surface </li></ul><ul><li>Simulates walking by
alternately flexing and extending feet </li></ul><ul><li>Disappears after 3-4 mos
</li></ul>051104 Neonatal Care
113. 150. Assessment of Gestational Age <ul><li>Dubowitz Maturity Scale
</li></ul><ul><ul><li>Gestational rating scale </li></ul></ul><ul><ul><li>NB are
observed and tested according to the criteria </li></ul></ul><ul><ul><li>Help
determine whether the NB needs immediate high-risk nursery intervention
</li></ul></ul>051104 Neonatal Care
114. 151. Usher’s Criteria 051104 Neonatal Care FINDINGS 0-36 WKS 37-38
WKS 39 WKS AND OVER Sole creases Anterior transverse crease only Occl
creases in ant 2/3 Sole covered with creases Breast nodule diameter (mm) 2 4 7 Scalp
hair Fine and fuzzy Fine and fuzzy Coarse and silky Ear lobe Pliable; no cartilage
Some cartilage Stiffened by thick cartilage Testes and scrotum Testes in lower canal;
scrotum small; few rugae Intermediate Testes pendulous, scrotum full; extensive
rugae
115. 152. Ballard’s Scoring <ul><li>Completed in 3-4 min </li></ul><ul><li>2
portions: physical maturity and neuromuscular maturity </li></ul>051104 Neonatal
Care
116. 153. 051104 Neonatal Care Physical maturity
117. 154. 051104 Neonatal Care Neuromuscular Maturity
118. 155. 051104 Neonatal Care Scoring
119. 156. 051104 Neonatal Care Physical maturity 19
120. 157. 051104 Neonatal Care Neuromuscular Maturity 17
121. 158. 051104 Neonatal Care Scoring 19+17=36 36 39
122. 159. Other Nursing Responsibilities <ul><li>Identification band
</li></ul><ul><li>Birth Registration </li></ul><ul><li>Birth record and
</li></ul><ul><li> documentation </li></ul>051104 Neonatal Care
123. 160. Newborn Screening <ul><li>The Newborn Screening Reference Center
(NSRC) is an office under the National Institutes of Health (NIH), University of the
Philippines Manila created under RA 9288– The Newborn Screening Act of 2004
</li></ul><ul><li>Performed after 24 hours of life up to 3 days except for patient in
intensive care, must be tested by 7 days </li></ul>051104 Neonatal Care
124. 161. <ul><li>Congenital Hypothyroidism (CH) </li></ul><ul><li>Congenital
Adrenal Hyperplasia (CAH) </li></ul><ul><li>Galactosemia (GAL)
</li></ul><ul><li>Phenylketonuria (PKU) </li></ul><ul><li>Glucose-6-Phosphate-
Dehydrogenase Deficiency (G6PD Def) </li></ul>051104 Neonatal Care
125. 162. 051104 Neonatal Care Disorder Screened If not screened If screened
Congenital Hypothyroidism Severe mental retardation Normal Congenital Adrenal
Hyperplasia Death Alive and Normal Galactosemia Death or Cataracts Alive and
normal PKU Severe mental retardation Normal G6PD Deficiency Severe Anemia,
Kernicterus Normal
126. 163. Infant Care Skills <ul><li>Holding the baby
</li></ul><ul><ul><li>Football Hold </li></ul></ul><ul><ul><li>Cradle Hold
</li></ul></ul><ul><ul><li>Shoulder Hold </li></ul></ul>051104 Neonatal Care
127. 164. Football Hold <ul><li>Purpose: to carry on one hand free
</li></ul><ul><li>A holding technique in bathing a baby </li></ul><ul><li>Use for
small babies </li></ul><ul><li>Procedure: </li></ul><ul><li>1. slide forearm under
his back </li></ul><ul><li>2. support neck and head with your hand
</li></ul><ul><li>3. press his arm firmly against your side </li></ul><ul><li>4. his
 head faces you </li></ul><ul><li>5. infant’s feet tucked under your elbow
</li></ul>051104 Neonatal Care
128. 165. Cradle Hold <ul><li>Purpose: use for feeding and cuddling a baby
</li></ul><ul><li> </li></ul><ul><li>Procedure: </li></ul><ul><li>support head
in the crook of your arm </li></ul><ul><li>encircle the body with your arm
</li></ul><ul><li>press baby firmly against your side </li></ul><ul><li>use other
hand to support bottom and thigh </li></ul>051104 Neonatal Care
129. 166. Shoulder Hold <ul><li>Purpose: use for burping </li></ul><ul><li>
</li></ul><ul><li>Procedure: </li></ul><ul><li>draw baby towards your chest with
one forearm </li></ul><ul><li>bracing his back and your hand cradling his head
</li></ul><ul><li>support your baby’s bottom and thighs with your other arm
</li></ul><ul><li>gently press his head against shoulder </li></ul>051104 Neonatal
Care

1. ESSENTIAL NEWBORN CAREPRESENTED BY:A.PRIYADHARSHINI, M.Sc

(N),LECTURER,DEPT. OF PAEDIATRICS,JAI INSTITUTE OF NURSING AND
RESEARCH,GWALIOR.
2. 2. INTRODUCTION: Essential care of the normal healthy neonates can be best
provided by the mothers under supervision of nursing personnel or basic/ primary
health care providers. About 80% of the newborn babies should be kept with their
mothers rather than in a separate nursery.
3. 3. HEALTHY NEWBORN A healthy infant born at term b/w 38-42wks should have
average birth wt, criesimmediately following birth, establishesindependent rhythmic
respiration & quicklyadapts to the changed environment.
4. 4. Establishment of open airway Maintenance of temperatureIMMEDIATE
BASIC CARE & Initiation of breastfeeding. Vitamin K injection Identification of
newborncirculation
5. 5.  Immediately dry the infant under a radiant warmerMaintenance of temperature:
Skin to skin contact with the mother. Rooming in (The baby should not be
separated from the mother)Keep neonates head covered.
6. 6. Establishment of open airway: (Majority of babies cry at birth & When the head is
delivered birth attendant immediately suction the secretions, wipe mucus from face
and mouth and nose.take spontaneous Respiration)
7. 7. Position the Baby on their backs or tilted to the side, but not on their
stomachs.Keep head slightly lower than the bodySuction the mouth and nose by
using bulb syringe
8. 8. After several seconds in this "partly delivered" position, fluid can be seen
streaming out of the babys nose and mouth. As the fetal chest passes through the
birth canal it is compressed, squeezing excess fluid out of the lungs prior to the baby
taking its first breath.Importance of suctioning: Several natural mechanisms help
with this:
9. 9. After birth, babies will be cough and sneeze, mobilizing additional fluid that may
be in their lungs.Contd…
10. 10. APGAR SCORING CRITERIA 0 1 2Respiration Absent Slow, irregular Good,
cryingHeart rate Absent Slow (Below 100) More than 100Muscle tone Flaccid Some
flexion of Active body extremities movementsReflex response No response Grimace
CrySkin color Blue, pale Body pink, Completely pink extremities blue
11. 11. Severe depression: 0-3Mild depression: 4-6 No depression: 7-10TOTAL
SCORE = 10
12. 12. Newborn Identification: Newborn Identification Before a baby leaves the delivery
area, identification bracelets with identical numbers are placed on the baby and
mother. Babies often have two, on the wrist and ankle.
13. 13. Vitamin K: Preterm infants (0.5mg) – IM Term infants (1mg) - IMVitamin K
Prevent neonatal hemorrhage during first few days of life before infant is able to
produce Vitamin K administration:
14. 14. Repeat dose (2mg) at 3-5 days and at 4- Oral Dose: 2mg orally at birth;•
Alternative Route: 6 weeks of age.
15. 15. Initiation of breastfeeding: Babies can be breast-fed as soon as the airway is
cleared and they are breathing normally.
16. 16. DAILY ROUTINE CARE OF NEONATES The majority of complication of the
normal newborn may occur during first 24 hours or within 7 days. So close
observation & daily essential routine care is important for health & survival of the
newborn baby.
17. 17. EstablishThe major goals: & Stability of normal physiological
status.maintain homeostasis
18. 18. The daily routine care of the neonates are as follows: Warmth Breastfeeding
Skin care & baby bath Care of umbilical cord Care of the eyes Clothing of the
baby
19. 19. Follow upImmunizationTaking anthropometric
measurementObservationGeneral care & advice
20. 20. WARMTH Warmth is provided by keeping the baby dry & wrapping the baby
with adequate clothing in two layers, ensuring head & extremities are well covered.
Baby should kept by the side of the Mother.BREAST FEEDING Breastfeeding The
baby should be put to the mother’s breast within half an hour of birth or as soon as
possible the mother has recovered from the exertion of labour.
21. 21. Skin care & baby bath: The skin should be cleaned off blood, mucus & meconium
by gentle wiping before he/she is presented to the mother. Baby bath can be given at
the hospital or home by using warm water in a warm room gently & quickly. First
Bath: Once a babys temperature has stabilized, the First bath can be given.
22. 22. CORD BLOOD COLLECTION Make sure cord blood is collected for analysis
and sent to laboratory for checking of: Rh Blood type, Hematocrit & possible cord
blood gases.
23. 23. Topical application of antiseptics is usually not necessary unless the baby is
living in a highly contaminated area. Keep the cord stump clean and dry.CARE OF
THE UMBILICAL CORD
24. 24. Care of the eyes. : Eyes should be clean at birth & once in every day using sterile
cotton swabs soaked in sterile water or normal saline. Separate swabs for each eye.
25. 25. The baby should be dressed with loose, softClothing of the baby: & Large
button, synthetic frock and plastic or nylon napkin should be avoided.cotton cloths.
The frock should be open on the front or back for easy wearing.
26. 26. tendersensory stimulation Aseptic technique gentle approach Rooming –
inGeneral care:& loving care.
27. 27. Observation: The baby should be kept in continuous observation twice daily for
detection of any abnormalities.
28. 28. Chest circumferenceHead circumferencelengthMeasure weight•
Anthropometric measurement:
29. 29. Average range: 18-22 inches (46-56 cm)10gm per day afterwards during the first
year of life.LENGTH: (from top of head to the heel with the leg fully extended) It is
 about 20gm/day in second monthThe average daily wt gain for healthy term babies
is about 30gm/day in the first month of lifeWEIGHT:
30. 30. Head circumference:Head circumference (repeat after molding and caput
succedaneum are resolved). Average range: 33 to 35 cm (13-14 inches) Normally, 2
cm larger than chest circumference Place tape measure above eyebrows and stretch
around fullest part of occipital at posterior fontanel.
31. 31. Chest circumference (at the nipple line): Average range: 30-33 cm (12-13 inches)
Normally, 2 cm smaller than head circumference Stretch tape measure around
scapulae and over nipple line.Immunization: Newborn should be immunized with
BCG vaccine & ‘0’ dose of ‘OPV’. Hepatitis ‘B’ vaccine can be administered at birth
as first dose & other two doses in one month & 6 months of age.
32. 32. Follow up & Advice: Each infant should be followed up, at least once every
month for first 3 months & subsequently 3 month interval till one year of age.
33. 33. HARMFUL TRADITIONAL PRACTICES FOR THE CARE OF NEONATES
use of unclean substance such as cow instillation of oil drops into earsapplication of
kajal in the newborn eyes,use of prelacteal feeds, immediate bathing,dung, mud
on umbilical card, & nostrils,
34. 34. giving opium introduction of artificial feeding with diluted milk, use of
pacifiers,during bathing the baby use of unhygienic herbal water, & use of
readymade expensive formula foods.brandy to neonates
35. 35. Nursing Diagnoses:• Ineffective airway clearance related to nasal and oral
secretions from delivery.• Ineffective thermoregulation related to environment and
immature ability for adaptation.• Risk for injury related to immature defenses of the
newborn.• Risk for infection related to immature immune system
36. 36. Bibliography• Adele Pillitteri (2010), Maternal and Child Health Nursing, 6th
edition, Lippincott Williams and Wilkins Publications.• Lowdermilk Perry (2007),
Maternity and Womens Health Care, 9th edition, Mosby Elsevier Publications.• Wong
Perry, Hockenberry and Lowdermilk Wilson (2006), Maternal Child Nursing Care,
3rd edition, Mosby Elsevier Publications.• Emily Wone Mckinney, Sharon Smith
Murray, Jean Weiler Ashwill (2009), Maternal Child Nursing, 3rd edition, Saunders
Elsevier Publications.• Susan A. Orshan (2008), Maternity, Newborn and Womens
Health Nursing, 1st edition, Lippincott Williams and Wilkins.
37. 37. • D.C. Dutta (2011), Text book of Obstetrics, 7th edition, New Central Book
Agency (P) Limited.• Meharban Singh (2004), Care of the Newborn, 6th edition,
Sagar Publications.• B.T. Basavanthappa (2006), Textbook of Midwifery and
Reproductive Health Nursing, 1st edition, Jaypee Publications.• Susan Scott Ricci,
Terri Kyle (2009), Maternity and Pediatric Nursing, 1st edition, Lippincott Williams
and Wilkins.

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