THE NEONATE

 DEFINITION: The first 28 days of life of a newborn baby

 PRINCIPLES OF NEWBORN CARE

I. Establish & Maintain a Patent Airway

A. Never stimulate a baby to cry unless secretions have been drained out
B. The position should be head lower than the rest of the body, EXCEPT when there
are signs of increased intracranial pressure, in which case the head should be
higher than the rest of the body:
 Signs of ICP in a newborn
 Vomiting
 Bulging or tensed fontanelles
 Abnormally large head
 Increased BP, decreased PR & RR & widening pulse pressure
 Shrill, high-pitched cry
C. Suction the newborn properly:
1. Turn the baby’s head to one side
2. Suction gently & quickly – prolonged & deep suctioning of the nasopharynx
during the first 5-10 minutes of life will stimulate the vagus nerve & cause
bradycardia
3. Suction the mouth first before the nose – when suctioning the nose, the
stimulation of the nasal mucosa will cause reflex inhalation of the pharyngeal
material into the trachea & bronchi causing aspiration
4. Test the patency of the airway:
 Occlude one nostril at a time (remember: newborns are nasal breathers)
 If the newborn struggles when a nostril has been occluded, additional
suctioning is indicated

II. Maintain Appropriate Body Temperature

 Chilling will increase the body’s need for oxygen
 The newborn suffers large losses of heat (cold stress) because of the ff:
o He is wet at birth
o The delivery room is cold
o He does not have enough adipose tissues
o He does not know how to shiver
 Effects of Cold Stress:
o Metabolic Acidosis – one of the ways by which heat is produced in the newborn is
by increasing metabolism; when this occurs, fatty acids accumulate bec of the
breakdown of brown fat (seen only in newborns)
o Hypoglycemia – due to the use of glucose stored as glycogen
 Nursing Care:
o Dry the newborn immediately
o Wrap him warmly
o Put him under a droplight

III. Immediate Assessment of the Newborn

APGAR Scoring
 Standardized evaluation of the newborn’s condition
 Done at one minute after birth to determine the general condition & then
at 5 minutes to determine how well the newborn is adjusting to extrauterine life
 Interpretation:
 0 – 3: the baby is in serious danger & needs immediate resuscitation
 4 – 6: condition is guarded & may need more extensive clearing of the
airway
 7 – 10: baby is in the best possible health
 A – Appearance; P-Pulse; G-Grimace; A-Activity; R- Respiration
APGAR TABLE

SIGN 0 1 2
Heart Rate Absent < 100 >100
Respiratory Effort Absent Weak Cry Good, Strong Cry
Muscle Tone Limp; Flaccid Some Flexion of Well-Flexed Extremities
Extremities
Reflex Irritability No Response Grimace; Weak Cry Cough or Sneeze; Good
(catheter in nose or Strong Cry; Withdrawal
slap sole of foot) of Foot
Color/Appearance Pale, Blue Extremities Blue; Pink All Over
Body Pink

IV. Proper Identification

 Put the identification band in the delivery room before bringing the baby to the
nursery
 Footprints are said to be the best way by which we identify newborns

V. Nursery Care

A. Check identification band

B. Take anthropometric measurements
1. Length: Average – 47 to 54cm
2. Head Circumference: 33-35cm
3. Chest Circumference: 30-33cm.
4. Abdominal Circumference: 31-33cm

C. Take the Temperature

 At birth is around 37.2°C
 Due to evaporation from the moist skin & cool delivery room, it will stabilize in
8 hours
 Should be maintained at 35.5 to 36.5°C to prevent hypoglycemia & acidosis due
to hypothermia
 Axillary & rectal temperatures are approximately the same immediately
following birth
 Rectal route is preferred in order to check patency of the anus (imperforated
anus)

D. Specific Nursing Actions:

1. Give initial bath to cleanse the baby of blood, mucus & vernix
2. Dress the umbilical cord
 Inspect for the presence of 2 arteries & 1 vein (AVA)
 Suspect a congenital anomaly if blood vessels are not complete
 A more thorough physical assessment is indicated & closer observation in
an ICU is done
3. Crede’s Prophylaxis
 Prophylactic treatment of the newborn’s eyes against Gonorrheal
Conjunctivitis (Ophthalmia Neonatorum) which the baby may acquire as he
passes through the birth canal of his mother who has untreated gonorrhea:
 Procedure:
a. Wipe the face dry
b. Shade the eyes from light & open one eye at a time by exerting gentle
pressure on the upper lid & the lower lid
c. Instill 2 drops of 1% silver nitrate one at a time into the lower
conjunctival sac; be careful not to drop on the cheeks bec parents may
worry about the stain
d. Wash the silver nitrate away with sterile NSS after one minute to prevent
chemical conjuntivitis (inflammation, edema, purulent discharge)
 e. Ophthalmic ointments such as Penicillin/Chloromycetin/Terramycin may
be used since it does not irritate the eyes (although the baby may
develop sensitivity at an early age); apply from the inner to the outer
canthus of the eye

4. Vitamin K administration
 Rationale: Vitamin K facilitates the production of the clotting factor, thus
preventing bleeding but Vitamin K is synthesized in the presence of normal
bacterial flora in the intestines
 Since the newborn’s intestines are still relatively sterile, they will not be
able to synthesize Vitamin K
 Vitamin K is given to prevent hemorrhage
 Procedure:
o Phytomenadione (Aquamephyton) 1mg is injected IM
o Area of Injection: lateral anterior thigh (vastus lateralis)
o In children below 12 months who have not yet learned how to walk, this is
the preferred site of injection bec gluteal muscles are not yet fully
developed

5. Weight Taking
 Average Weight: 6.5-7.5 lbs
 Arbitrary lower limit below which the newborn is said to be of low birth
weight: 5.5 lbs
 Ideal Procedure in Weighing Newborn:
a. Weigh the clothes first
b. Put on the baby’s clothes
c. Weigh the baby with his clothes on
d. Subtract the weight of the clothes from the total weight of the baby & his
clothes
 Physiologic weight loss of 5-10% of birth weight (6-10oz) during the
first 10 days of life bec the newborn:
o Is no longer under the influence of mother’s hormones
o Voids & passes out stools
o Has limited intake
o Has beginning difficulty establishing sucking
6. Feeding
 Initial feeding – is a test feeding consisting of an
ounce of sterile water given to find out if the newborn can swallow without
aspirating
 Subsequent feedings – preferably given by demand

E. Physical Assessment
1. Pulse
 Normally irregular; normal range: 120 to 160 bpm
 Apical pulse (stethoscope below the left nipple) is recommended since the
radial pulse are not ordinarily palpable, in fact, may be a sign of congenital
heart anomaly
2. Respirations
 Are gentle, quiet, rapid but shallow
 Normally, 30-60 breaths per minute
 Largely diaphragmatic & abdominal (watch out for the rise & fall of the
chest & abdomen)
3. Blood Pressure
 Not routinely measured in newborns unless coarctation of the aorta is
suspected
 BP as part of VS routine: starts at 3yo
 Normal Values:
o At birth – 60/40 to 80/50 mmHg
 o After 10 days – 100/50 mmHg
 Size of the cuff in children must not be more than 2/3 the size of the
extremity (will result in false low BP) nor less than ½ the length of
extremity (will result in false high BP)

 Flush Method Procedure:

a. Cuff is applied to an extremity
b. Extremity is elevated & an elastic bandage is wrapped around the distal
portion of the extremity
c. Slowly inflate the cuff up to 100mmHg
d. Remove the bandage (extremity is expectedly pale)
e. Slowly deflate the cuff while watching the pale extremity
f. As soon as the extremity turns pink (flushes), read the manometer
g. Only one reading can be obtained, the average between the diastolic &
systolic pressures called flush pressure is normally 60
4. Skin
 Color:
o Usually ruddy or reddish bec of the increased concentration of RBCs &
decreased amount of subcutaneous fat
o Baby may present with:
 Acrocyanosis
 Body pink, extremities blue
 Normal during the first 24-48 hours of life
 Pallor
 Due to anemia which results from:
 Excessive blood loss when cord was cut
 Inadequate blood flow from cord to infant at birth
 Inadequate iron stores bec of poor maternal nutrition
 Blood incompatibility
 Generalized mottling is common due to an immature circulatory
system
 Gray Color – indicates infection
 Jaundice
 Yellowish discoloration of the skin & sclerae
 Cause: inability of the newborn to conjugate bilirubin
 Normal Values: Total Serum Bilirubin = 15 mg. (Direct: 1.7mg;
Indirect: 13.2mg)
 Most accurate method of assessing jaundice:
 Use natural light
 Blanch skin on the chest or tip of the nose
 Physiologic jaundice is normal from the 2nd to 3rd day of life
 Breastfed babies have longer physiologic jaundice bec human milk
has pregnanediol which depresses the action of glucoronyl
transferase (the enzyme responsible for converting indirect bilirubin
to direct bilirubin)
 Harlequin Sign – bec of immaturity of circulation, an infant who has
been lying on his side will appear red on the dependent side & pale on
the upper side
 Mongolian Spots – grayish/bluish/greenish patches seen across the
sacrum/buttocks; consist of collection of pigment cells (melanocytes);
disappear by school age
 Lanugo – fine, downy hair that covers the shoulders, back & upper
arms
 Desquamation – drying of newborn’s skin
 Petechiae – usually on face & neck; due to increased intravascular
pressure during delivery
 Milia – unopened sebaceous glands found on the nose, chin & cheeks;
disappear spontaneously by 2-4 weeks
5. Head
  It is the largest part of the infant’s body (1/4 of his total length)
 Forehead is large & prominent
 Chin is receding & quivers when startled or crying
 Fontanelles are neither sunken (a sign of dehydration) nor bulging (a sign of
↑ICP)
 Suture lines should neither be separated nor fontanelles prematurely closed
(“Craniosynostosis” – leads to mental retardation)
 Craniotabes
o Localized softening of the cranial bones; can be indented by pressure of a
finger
o Corrects itself without treatment after some months
o More common among first-borns bec of early lightening
 Caput Succedaneum & Cephalhematoma

INDICATORS CAPUT SUCCEDANEUM CEPHALHEMATOMA

Definition Edema of the scalp Collection of blood
Location Presenting part of the head Between the periosteum of skull
bone & the bone itself
Extent of Involvement Both hemispheres Confined to an individual bone;
does not cross suture lines
Cause Pressure (as in prolonged Rupture of capillaries due to
labor) pressure
Period of Absorption Third day Takes several weeks
Treatment None None; support anxious parents

6. Eyes
 Method of Assessment: Put the infant on an upright position
 Characteristics:
o Cry tearlessly during first 2 months bec of immature lacrimal ducts
o Cornea should be round & adult-sized
o Pupils should be round
7. Ears
 The level of top part of the external ear should be in line with outer canthus
of the eye
 If set lower, may be a sign of kidney malfunction or Down’s syndrome
8. Nose
 May appear large for the face
 There should be no septal deviation
9. Mouth
 Should open evenly when crying; if not, suspect cranial nerve injury
 Tongue appears large
 Palate should be intact; there should be no breaks in the lips
 Epstein Pearls – 1 or 2 small, round, glistening cysts seen on the palate due
to extra load of calcium while in utero
 A tooth may be seen; if loose, should be extracted to prevent aspiration
while feeding
 Oral thrush – white or gray patches on the tongue & sides of the cheeks due
to Candida Albicans acquired during passage of the baby through the birth
canal of the mother with untreated Moniliasis; also known as oral moniliasis
10. Neck
 Thyroid gland is not palpable
 Appears soft, chubby & creased with skin folds
 Head should rotate freely on the neck & flex forward & back
11. Chest
 As large as or smaller than the head
 Should be symmetrical
 Breasts maybe engorged – a result of the influence of maternal hormones
 Witch’s Milk – thin, watery fluid also due to maternal hormones
12. Abdomen
 Liver, spleen & kidneys are palpable at birth; liver is about 1-2cm below the
right costal margin
 Normally dome-shaped

13. Anogenital Area

 Take note of the time meconium is first passed; it should be within the first
24 hours of life
 Female genitalia: may have swollen labia & drops of blood due to maternal
hormones
 Male genitalia:
o Scrotum may be edematous – also due to maternal hormones
o Foreskin should be retracted to test for “Phimosis” (tight foreskin)
o Testes should be present; if not descended, the condition is called
“Cryptoorchidism” (repaired by “Orchidopexy”)
o Circumcision may be done prior to discharge from the nursery preferably
at the end of the first week
 Procedure:
 Vitamin K injected IM
 Infant is restrained; penis is cleansed with soap & water
 Yellen clamp is used
 Petrolatum gauze dressing is applied to prevent adherence of
circumcised site to the diaper while applying pressure to prevent
bleeding
 Nursing Care:
 Check hourly for bleeding during the first day
 If small amount of bright red blood is observed, apply gentle
pressure to the area with a sterile gauze pad
 Do not attempt to remove exudates which persist for 2-3 days; just
wash with warm water
 Diaper must be applied loosely during first 2-3 days when the base
of the penis is tender
14. Back
 On prone, appears flat
 Curves start to form only when sitting or walking has been
achieved

15. Extremities
 Arms & legs are short; hands are plump & clenched into fists
 Should move symmetrically
 Abnormalities:
 Erb-Duchenne Paralysis
o Aka “Brachial Plexus Injury”
o Causes:
 Lateral traction exerted on head & neck during delivery of the
shoulders in vertex position
 Excessive traction on the shoulders during breech extraction,
especially when the arms are extended over the head
o SX/SY:
 Inability to abduct arm from the shoulder, rotate arm externally or
supinate forearm
 Absent of Moro reflex on affected arm
o MGT:
 Abduct the affected arm in external rotation position with the elbow
flexed
 Congenital Hip Dislocation
o Aka “Hip Dysplasia or Subluxation”
 o SX/SY:
 Ortolani’s Sign – when holding the infant’s leg with the fingers on
the greater & lesser trochanter & then abducting the hip, a “clunk” of
the femur head striking the shallow acetabulum is heard
 Barlow’s Sign – the hip can be felt to actually slip out of the socket
 Galeazis Sign – assymetrical gluteal folds; extra gluteal folds
o MGT:
 Assist in replacing head of the femur into the acetabulum of the hip
bone by using 3 diapers instead of 1 or by putting pillow between the
thighs to maintain abduction of the thighs & flexion of the hip &
knee joints
 Infants preferably carried astride mother’s hip
 Hip spica cast is applied at a later age, before the infant starts to walk
 Cast extends from the waistline to below the knee of the affected
leg & above the knee of the unaffected leg
 If treatment is delayed (after the baby already learned how to
walk), the child will become lordotic & walk with a protective
limp at later age

F. Systemic Evaluation
1. Cardiovascular System
 Review of Fetal Circulation:
 Exchange of oxygen & carbon dioxide takes place in the placenta not in
the fetal lungs
 Because little blood goes to the fetal lungs, pressure in the left side of
the heart is less than the pressure in the right side of the fetal heart
 Presence of fetal accessory structures:
o Foramen Ovale – bypasses the pulmonary circulatory system since it is
the opening between the right & left atria
o Ductus Arteriosus – communication between the pulmonary artery &
the aorta
o Ductus Venosus – communication which bypasses the liver
o Umbilical Vein – carries the most highly oxygenated blood
o Umbilical Arteries – carry deoxygenated blood
 Neonatal/Adult Circulation:
 As soon as breathing has been initiated, oxygenation takes place in the
newborn’s lungs
 The change from fetal to neonatal circulation is therefore associated with
lung expansion causing the pressure in the left side of the newborn’s
infant heart to become higher compared to pressure in the right side of
the newborn’s heart
o Increased pressure on the left side of the newborn’s heart results in:
 Closure of the foramen ovale
 Change of the ductus arteriosus into a mere ligament
(ligamentum arteriosum)
o Decrease pressure on the right side of the newborn’s heart causes the
ductus venosus to become a ligament (ligamentum venosum)
o Since no more blood goes through the umbilical vein & arteries, these
blood vessels atrophy & degenerate
 Blood values are all high in the newborn period as a response to the
pulmonary circulation:
o RBC – 5-7 million/mm3
o Hemoglobin – 17-18 g/100cc
o Hematocrit – 48-63%
o WBC – 15,000 to 45,000 per mm3

2. Gastroinstestinal System
 Differences in Stools:
  Meconium
o Sticky, tarlike, blackish-greenish in color, odorless material formed from
mucus, vernix, lanugo, hormones & carbohydrates that accumulated
while in utero
 Transitional
o On the 2nd to the 10th day of life in response to the feeding pattern; are
slimy, green & loose resembling diarrhea to the untrained eye
 Breastfed
o Golden yellow, mushy, more frequent (3-4x/day) & sweet-smelling
because breastmilk is high in lactic acid which reduces the amount of
putrefactive organisms
 Bottlefed
o Pale yellow, firm, less frequent (2-3x/day) & with a more noticeable
odor

3. Urinary System
 Newborns should void within the first 24 hours of life
 Female newborns form a strong stream when voiding
 Male newborns form a small, projected arc when voiding; if not, suspect a
defect on the urethral meatus:
o Hypospadias – urethral opening located in the ventral (under) surface of
the penis
o Epispadias – urethral opening located in the dorsal (above) surface of the
penis
o MGT:
 Inspect for cryptoorchidism often found associated with hypospadias or
epispadias
 Meatotomy is done to establish better urinary function
 When the child is older (12-18 months), adherent chordae (fibrous bands
that cause the penis to curve downward) may be released surgically; if
repair will be extensive, surgery might be delayed until 3-4 years old
 Child should not be circumcised because at the time of repair, the
surgeon may wish to use a portion of the foreskin
 Surgical correction is done before school age so that the child appears
normal to his schoolmates

4. Autoimmune System
 Type of immunity transferred from mother to newborn: Passive Natural
Immunity
 Newborns have antibodies from mother against poliomyelitis, diphtheria,
tetanus, pertussis, rubella, measles; these are present in the infant for one
year
 There is little or no immunity against chickenpox that is why this disease is
often fatal in the newborn
 Newborns have difficulty forming antibodies until 2 months of age that is
why immunizations are started at 2 months

5. Neuromuscular System

 Blink Reflex
o Rapid eyelid closure when strong light is shone; always present
 Feeding Reflexes:
o Rooting Reflex
 Head will turn to the direction where cheeks is stroked near the corner of
the mouth
 Helps the infant find food
 Disappears by 6 weeks of age when infant is already capable of seeing
things past the visual midline
 o Sucking Reflex
 Anything placed between the lips will be sucked
 Disappears by 6 months
 Important: sucking reflex disappears immediately if not stimulated
regularly
 Implication: any infant who will be put on NPO should be given a
pacifier not only for psychological reasons but also to prevent premature
disappearance of the sucking reflex
o Extrusion Reflex
 Anything placed on the anterior portion of the tongue will be spitted out
 Disappears by 4 months of age when infant is about ready for semi-solid
foods
o Swallowing Reflex
 Anything placed at the back of the tongue will be swallowed
 Will never disappear
 Tonic-Neck Reflex
o Aka “Fencing Reflex” or “Boxer Reflex”
o When on his back, the infant’s arm & leg are extended on the side where
the head is turned while the arm & leg of the opposite side are flexed
o Disappears by 2-3 months
 Babinski Reflex
o When side of the sole is stroked with a “J” from heel upward, the infant
will fan out his toes
o Starts to disappear by 3 months of age
 Landau Reflex
o When on prone, the newborn should demonstrate some muscle tone
o A test of spinal cord integrity
 Palmar Grasp Reflex
o An accessory reflex; when something is placed in the hand of the infant,
he will hold on to it
  Plantar Reflex
o An accessory reflex; aka “Dancing or Stepping” reflex
o When infants foot are placed on flat surface, the infants makes steps
o Said to prepare the child for walking
 Moro Reflex
o Singular most important reflex indicative of neurological status
o Aka “Startle” reflex
o If the bassinet is jarred or the infant’s head is allowed to drop backward in
supine position, the infant will abduct & then adduct his arms
o Disappears by 4-5 months

6. Senses – all are functional at birth

 Sight
o All newborns can see at birth although they cannot see object past the
visual midline (not until 6-8 weeks)
o The visual field is 20-22cm or 9 inches
 Hearing
o As soon as amniotic fluid has been absorbed, the newborn can already
hear
 Taste
o As soon as secretions have been suctioned, newborns can already taste
 Smell
o As soon as the nose has been cleared off mucus & fluid, newborn can
smell
 Touch
o The most developed of all the senses

7. Newborn Screening (NBS)

 What is newborn screening?
Newborn screening (NBS) is a simple procedure to find out if your baby has
a congenital metabolic disorder that may lead to mental retardation and even
death if left untreated.
 Why is it important to have newborn screening?
Most babies with metabolic disorders look normal at birth. One will never
know that the baby has the disorder until the onset of signs and symptoms
and more often ill effects are already irreversible.
 When is newborn screening done?
Newborn screening is ideally done on the 48th hour or at least 24 hours
from birth. Some disorders are not detected if the test is done earlier than 24
hours. The baby must be screened again after 2 weeks for more accurate
results.
 How is newborn screening done?
Newborn screening is a simple procedure. Using the heel prick method, a
few drops of blood are taken from the baby's heel and blotted on a special
absorbent filter card. The blood is dried for 4 hours and sent to the Newborn
Screening Laboratory (NBS Lab).
 How much is the fee for newborn screening?
P550. The DOH Advisory Committee on Newborn Screening has approved
a maximum allowable fee of P50 for the collection of the sample.
 When are newborn screening results available?
Newborn screening results are available within seven working days to three
weeks after the NBS Lab receives and tests the samples sent by the
institutions. Results are released by NBS Lab to the institutions and are
released to your attending birth attendants or physicians. Parents may seek
the results from the institutions where samples are collected. A negative
screen mean that the result of the test is normal and the baby is not suffering
from any of the disorders being screened. In case of a positive screen, the
NBS nurse coordinator will immediately inform the coordinator of the
 institution where the sample was collected for recall of patients for
confirmatory testing.

 Who will collect the sample for newborn screening?

Newborn screening can be done by a physician, a nurse, a midwife or
medical technologist.
 Where is newborn screening available?
Newborn screening is available in participating health institutions (hospitals,
lying-ins, Rural Health Units and Health Centers). If babies are delivered at
home, babies may be brought to the nearest institution offering newborn
screening.
 What are the disorders included in the Newborn Screening Package?
1. Congenital Hypothyroidism (CH) - CH results from lack or absence of
thyroid hormone, which is essential to growth of the brain and the body.
If the disorder is not detected and hormone replacement is not initiated
within (4) weeks, the baby's physical growth will be stunted and she/he
may suffer from mental retardation.
2. Congenital Adrenal Hyperplasia (CAH) - CAH is an endocrine
disorder that causes severe salt loss, dehydration and abnormally high
levels of male sex hormones in both boys and girls. If not detected and
treated early, babies may die within 7-14 days.
3. Galactosemia (GAL) - GAL is a condition in which the body is unable to
process galactose, the sugar present in milk. Accumulation of excessive
galactose in the body can cause many problems, including liver damage,
brain damage and cataracts.
4. Phenylketonuria (PKU) - PKU is a metabolic disorder in which the body
cannot properly use one of the building blocks of protein called
phenylalanine. Excessive accumulation of phenylalanine in the body
causes brain damage.
5. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Def) - G6PD
deficiency is a condition where the body lacks the enzyme called G6PD.
Babies with this deficiency may have hemolytic anemia resulting from
exposure to certain drugs, foods and chemicals.

 What should be done when a baby is tested a positive NBS result?

Babies with positive results should be referred at once to the nearest hospital
or specialist for confirmatory testing and further management. Should there
be no specialist in the area, the NBS secretariat office will assist its
attending physician.

Effect if
Effects
Disorder Screened SCREENED and
SCREENED
treated
CH (Congenital Severe Mental
Normal
Hypothyroidism Retardation
CAH (Congenital
Death Alive and Normal
Adrenal Hyperplasia)
GAL (Galactosemia) Death of Cataracts Alive and Normal
Severe Mental
PKU (Phenylketonuria Normal
Retardation
Severe Anemia,
G6PD Normal
Kernicterus

VI. Discharge Instructions

A. Bathing
  Maybe given anytime convenient for the parents as long as it is not within 30
minutes after feeding bec the increased handling during bathing can cause
regurgitation
 Sponge baths are done until the cord falls off (7th to 14th day)

B. Cord Care
 Fold down diapers so that cord does not get wet during voiding
 Dab rubbing alcohol (70%) once or twice a day
 Small, pink granulating area may be seen on the day the cord falls off; if it
remains moist for a week, advise mother to bring the baby to the doctor’s clinic
where cautery with silver nitrate stick will be done to speed healing

C. Nutrition
 Recommended Daily Allowances
o Calories: 120 cal/kg body weight/day
o Proteins: 2.2grams/kbw/day
o Fluids: 16-20cc/kbw/day

 Vitamins
o Vitamins A, C & D are recommended for both bottlefed & breastfed babies
during the entire first year of life

D. Clothing the Newborn

 Rule of Thumb: If the mother feels warm, keep the baby cool; if the mother
feels cold, keep the baby warm

E. Sleep Patterns
 Babies sleep 16-20 hours a day

F. Common Health Problems

 Constipation
 More common among bottle-fed infants
 MGT:
o Add more fluids or carbohydrates/sugar
o If due to an unusually tight anal sphincter, dilate twice or thrice a day by
means of a gloved little finger
 Loose Stools
 Careful history should be taken; management depends on the cause

 Colic
 Paroxysmal abdominal pain common in infants below 3 months of age
 CAUSES:
o Overfeeding
o Gas Distention
o Too much carbohydrates
o Tense & unsure mother
 MGT:
o Feed by self demand; it is the best schedule bec it meets the individual needs
of the newborn
o Tell the mother to burp the infant at least 2x during the feeding
o Feed the baby in upright position
o May need to change the formula as per DR’s order
o Reduce sugar content of the formula

 Spitting Up
 Due to poorly developed cardiac sphincter
  More common among bottle-fed infants
 Will disappear when coordination with swallowing is achieved & digestion
improves
 MGT:
o Feed in upright position bec gravity will aid in gastric emptying
o Position on right side after feeding
o Bubble/burp more frequently

 Skin Irritation
 Maybe due either to poor hygiene or irritation from urine, feces or some
laundry products
 MGT:
o Expose to air – most important & effective
o Careful washing & rinsing away of irritating soap from the skin
o Starch bath in case of “Miliaria” or prickly heat

 Occasional “Cross-Eyes”
 Normal in many babies bec the eye muscle of coordination have not yet fully
developed
 Will disappear spontaneously

 Seborrheic Dermatitis/Cradle Cap

 Involves sebaceous glands; due to poor hygiene
 MGT:
o Apply mineral oil or Vaseline on scalp at night before washing with
shampoo in the morning