The Normal Newborn: Aimee Cristine Tan, MD, DPP S, DPSNBM

The Normal
Newborn
Aimee Crist
ine Tan, MD
, DPPS, DPS
Pediatrics - Neo NbM
natology
Routine Delivery Room and
Initial Care
Apgar Score
0 practical method of systematically assessing NB
infants immediately after birth
0 Assessed at 1 and 5 minute of life
0 If the 5 min score is <7, additional scores should be

assigned every 5 min up to 20 min
0 At one minute of age, an infant demonstrates
peripheral cyanosis, gasping respirations, heart rate
of 60, limp, and some grimacing
0 Based on these findings, the infant’s one minute

APGAR score is?
0 At five minute of age, infant has peripheral cyanosis,
shallow respirations, heart rate of 110, strong grimace
and active motion
0 Based on these findings, the infant’s five minute

APGAR score is?
Assessment of Gestational
Age at Birth (Ballard Score)
Ballard Score
0 To obtain a more accurate idea of the GA
0 Most accurate if performed within the 1st 12 hrs of life
0 Infant’s true GA can be estimated with an accuracy of
about 2 wks
0 If scored age is w/n 2 wks of the GA suggested by the
mother’s dates, then accept her dates as correct
0 Posture
0 Handle the infant and observe the position of the arms
and legs.
0 More mature infants have better flexion of their limbs
0 Square window
0 Gently press on the back of the infant’s hand to push the
palm towards the forearm
0 Observe the degree of flexion
0 More mature infants have greater wrist flexion
0 Arm recoil
0 Fully bend the arm at the elbow so that the infant’s hand
reaches the shoulder and keep it flexed for 5 seconds
0 Fully extend the arm by pulling on the fingers
0 Release the hand as soon as the arm is fully flexed and
observe the degree of flexion at the elbow
0 Popliteal angle
0 With your one hand hold the infant’s knee against the
abdomen
0 With the index finger of the other hand gently push
behind the infant’s ankle to bring the foot towards the
face
0 Observe the angle formed behind the knee by the upper
and lower legs
0 Scarf sign
0 Take the infant’s hand and gently pull the arm across the
front of the chest and around the neck like a scarf
0 With your other hand gently press on the infant’s elbow
to help the arm around the neck
0 Heel to ear
0 Hold the infant’s toes and gently pull the foot towards
the ear
0 Allow the knee to slide down at the side of the abdomen
0 The infant’s pelvis may be allowed to lift off the bed
0 Observe how the heel can be pulled towards the ear
Essential Intrapartum
Newborn Care (EINC)
0 4 CORE STEPS:
0 Immediate and thorough drying
0 Skin to skin contact
0 Properly timed cord clamping
0 Non-separation of the mother and the baby for a successful

breastfeeding
Newborn Care (EINC)
0 4 CORE STEPS: (Cesarean Section)

breastfeeding
Newborn Care (EINC)
0 4 CORE STEPS: (Cesarean Section)

breastfeeding
Anthropometric Measurements
Breastfeeding
0 Practices that encourage successful BF:
0 Antepartum education & encouragement
0 Immediate postpartum mother-infant bonding with
suckling
0 Demand feeding
0 Inclusion of maternal partners in BF education
0 Support from experienced women
0 Nursing at first for at least 5 min at each breast is
reasonable
0 Allows a baby to obtain most of the available breast
contents
0 Provides effective stimulation for increasing the milk
supply
0 Nursing episodes should be extended accoridng to the

comfort and desire of the mother and infant.
Mother Baby Friendly
Hospital Initiative
EO 51 (Phil. Milk Code)
Section 2.
“ The Code in effect aims to contribute to the provision
of safe and adequate nutrition of infants by the
protection and promotion of breastfeeding and by
ensuring the proper use of breastmilk substitutes
and breastmilk supplements when these are
necessary on the basis of adequate information and
through appropriate marketing and distribution;”
EO 51 (Phil. Milk Code)
0 Section 3: “The Code applies to the Marketing, and
practices related thereto, of the following products:
breastmilk substitutes, including infant formula;
other milk products, foods and beverages,
including bottle fed complementary foods, when
marketed or otherwise represented to be suitable,
with or without modification, for use as a partial or
total replacement of breastmilk; bottles and teats.
It also applies to their quality and availability, and to
information concerning their use.”
Proper Breastfeeding Position
0 Baby’s head and body in line
0 Baby held close to mother’s body
0 Baby’s whole body is well supported
0 Baby approaches breast, nose to nipple

Correct Attachment
0 More areola seen on top of baby’s top lip
0 Baby’s mouth wide open
0 Lower lip turned outwards
0 Baby’s chin touches breast
Immunization & Surveillance
0 Skin and cord care
0 Careful removal of amniotic fluid and blood from the
skin shortly after birth to reduce infection
0 To reduce colonization of S. aureus and other pathogenic
bacteria, umbilical cord may be treated daily with
bactericidal or antimicrobial agents (chlorehexidine)
0 Eye application with erythromycin or tetracycline
0 Vitamin K IM injection
0 Hep B immunization
0 Newborn screening
0 Hearing screen
0 Pulse oximetry screening
Thank You!

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The Normal

0 Assessed at 1 and 5 minute of life

0 If the 5 min score is <7, additional scores should be

0 Based on these findings, the infant’s one minute

0 Based on these findings, the infant’s five minute

0 Immediate and thorough drying

0 Skin to skin contact

0 Properly timed cord clamping

0 Non-separation of the mother and the baby for a successful

0 Immediate and thorough drying

0 Skin to skin contact

0 Properly timed cord clamping

0 Non-separation of the mother and the baby for a successful

0 Immediate and thorough drying

0 Properly timed cord clamping

0 Skin to skin contact

0 Non-separation of the mother and the baby for a successful

0 Nursing episodes should be extended accoridng to the

0 Baby held close to mother’s body

0 Baby’s whole body is well supported

0 Baby approaches breast, nose to nipple

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