IMMEDIATE NEWBORN CARE

Thermoregulation

 Immediately after delivery, the baby should be dried. Ideally, this is with a
warm, soft towel
 Babies, during the first few hours of life, have some difficulty maintaining
their body heat and may develop hypothermia if not attended to carefully.
This is particularly true of premature infants.

Positioning

 The optimal position for the baby is with the head neither markedly flexed
against the chest, nor extended with the chin up in the air. Instead, the head
should be in a "military" attitude, looking straight up.

Airway
• Neonates should maintain 30 – 60 breaths per minute 5 minutes after
birth
• established as soon as head is delivered
• suction the mouth (M) before the nose (N)
• oxygenate in between suctioning
• oxygen toxicity results to retrolental fibroplasia: irreversible blindness
• NO DEEP SUCTIONING: bradycardia

Keep warm

• droplight is positioned 1ft away and at the foot part

• keep baby warm and dry
• 36.5-37.4 C (97.7-99.3 F)

APGAR Score

• taken during the first 1 minute and 5 minutes

• Infant assessment at birth and baseline for further evaluation

7-10 GOOD;
4-6 FAIR (further suctioning and O2)
0-3 POOR (resuscitation)
Scoring Chart

Sign 0 Point 1 Point 2 Points

A Activity (Muscle Flaccid Arms and Well

Tone) Legs Flexed flexed

P Pulse Rate Absent <100 bpm Above

100 bpm

Sneeze,
G Grimace (Reflex No Response Grimace cough,
Irritability) pulls
away
Appearance (Skin Blue-gray, pale Normal, Normal
A Color) extremities skin
blue coloring

R Respiration Absent Slow, Good

irregular strong
cry

Cord Care
• note the number of blood vessels immediately after cutting;
• Keep cord dry until it falls off (7 – 10 days)
Eye Care
• silver nitrate
• Erythromycin (DOC)
• Crede’s prophylaxis
• Ophthalmia Neonatorum
Bathing
 1 hour after birth
 tub bath is contraindicated until cord falls off
 bathe prior to feeding
 don’t soak the cord

Vitamin K and Phototherapy

• 0.5 to 1 mg IM
• to prevent hemorrhagic disease
• overdosage can cause hyperbilirubinemia and thus kernicterus

Proper Identification

 Identification band

 footprint: best way to identify

Initial feeding
• may breastfeed immediately after birth
• Formula feeding- 2 to 4 hours of age
• Demand schedule

Mother's milk is the best food a baby can have in the first 6 months of
life…
ADVANTAGES OF BREAST FEEDING
1. Enhances the infant’s immune system
1. IgA Lactoferrin, lysozyme, interferon, bifidus factor
2. It reduces the cost of feeding and preparation time
3. An excellent opportunity to enhance symbiotic bond
4. It is easy to digest.
5. It is clean and has the right temperature.
6. It contains the ideal electrolyte and mineral composition for infant
growth

 Breastfeeding should start within 30 minutes after birth

 COLOSTRUM (first 2-3 days): good for babies and helps protect them against
infection
 When the baby is 6 months old, start giving other food in addition to
breastmilk
 Continue to breastfeed sick babies
 Breastfeeding mothers should eat nutritious food to become stronger

NEWBORN ASSESSMENT
PROFILE OF THE NEWBORN

 Weight
 Normal birth weight 5.5–10 lbs; 3000-3400 g (Filipinos)
 LBW: < 2500 g
 Losses 5-10% of birth weight during the first few days
 Returns to birth weight at 10 days (breastfed)/ 7 days (formula fed)
 Length
 Female: 53 cm
 Male: 54 cm
 < 46 cm: Turner’s Syndrome
 Head Circumference
 Measured monthly until 2 yo
 33-35 cm
 >2.5 cm/mo: hydrocephalus
 Chest Circumference
 2 cm less than the head circumference
 31-33 cm

 Abdominal Circumference
Vital Signs

 RPT BP

 Respiratory Rate
○ 30-60 bpm
○ Obligate nose breathers
○ Periodic respiration

 Pulse Rate
○ 120-140 bpm
○ Listen to the apical pulse in 1 full minute
○ Assess femoral pulses
 Temperature
○ 36.5 - 37.4 oC
○ Preferably Axillary
○ Rectal

 Blood Pressure
○ Not routinely taken
○ 80/40 – 90/50 mmHg

Physiologic Functions

 Cardiovascular System
 Closing of Fetal shunts with cold receptors
 High Erythrocyte Counts with Leukocytosis
 Prolonged Prothrombin and coagulation time
 Respiratory System
 First breath stimulated by the cold receptors
 1/3 of fluids in the lungs is forced out by the pressure of vaginal birth

 Gastrointestinal System
 Culture of bacterial Flora in 24 hours
 30 – 90 mL
 Limited ability to digest fats and starches
 Immature cardiac sphincters
 Immature liver
All about Stools

 Green Stools
 Clay colored stools
 Blood flecked stools
 Black tarry stools
 Loose stools with mucus

NEWBORN REFLEXES

 Feeding
 Rooting Reflex – earliest; (-) Bell’s palsy diminishes at 6 mos
 Sucking Reflex – diminishes at 6 mos; disappears if not stimulated
 Swallowing Reflex – (-) TEF, BRENDA
 Extrusion Reflex – diminishes at 4 mos

 Protective
 Blink Reflex
 Coughing
 Yawning
 Neurological
 Tonic Neck Reflex – diminishes at 2-3 mos; “fencing reflex”
- One-sided: torticollis

 Moro Reflex – diminishes at 4-5 mos; “startle reflex”

- One-sided: brachial plexus palsy (Erb Duchenne)
- Two-sided: BRENDA
- Non-disappearance: BRENDA
 Babinski Reflex – diminishes at 3 mos
- Non-disappearance: immature CNS
- Absence: paralysis
APPEARANCE OF THE NEWBORN
 Skin
 Acrocyanosis: Normal for the first 24 hours
 Central cyanosis: decreased oxygenation
 Generalized mottling is common
 marks: lanugo, vernix caseosa, milia, mongolian spot, toxicum
neonatorum, hemangioma, harlequin’s sign, pallor
 Head
- posterior fontanel: 2-3 months
- anterior fontanel: 12-18 months
- tense, bulging: inc ICP
- sunken: DHN

Caput Succedaneum: few days

Cephalhematoma: few weeks

 Chest
- Witch’s milk: 3rd week
- normal due to withdrawal from maternal hormones

 Abdomen
 barrel shape: normal
 protruding: necrotizing enterocolitis
 Hourglass / scaphoid: hernia
Diaphragmatic Hernia

 Anal Area
 Imperforate anus
 Passes meconium for the first 24 hours
 Meconium: dark, tarry, sticky stool
 Transition stool: yellowish, soft stool

 Back
 continuous fusion of spine
 Spina bifida

 Urogenital area
 Females: pseudomenstruation
 Males: cryptorchidism

 Musculoskeletal System

 Neurosensory
 Most sensitive: touch
 Least sensitive: smell
 Functional in utero: hearing

NORMAL CHANGES IN THE NEWBORN

 Weight loss – occurs in the 1st 7-10 days

 Weight gain – 2x: 6mos

3x: 1yo
4x: 2yo
  Fever – 1st 24 hours: abnormal

 Jaundice – NV: 2-6 mg/dl

- 1st 24H: pathologic

- sun exposure from 6am to 8am

4 H’s in Newborn Assessment

1. Hypoxia
 cyanosis
 retractions (intercostal mm, xiphoid)
 grunting
 nasal flaring, tachypnea and tachycardia

2. Hypoglycemia
causes:
DM mothers
prematurity, post maturity
low APGAR score
signs:
tremors / jitteriness
poor sucking
BG < 40 mg/dl

Intervention: feed with breastmilk or milk formula to raise BG in 15 mins

3. Hypothermia
causes:
preterm (lack of SC)
post-term (poorly developed muscle)
NB exposed to cold stress
signs:
mottling
cyanosis
Interventions: keep baby warm, oxygenate when necessary, suction PRN

4. Hyperbilirubinemia NV: 2-6 mg/dl,

hyper: 12-10 mg/dl
kernicterus: 20-35 mg/dl
causes:
prematurity
polycythemia vera
blood incompatibility
drugs
infection
signs:
pathologic jaundice
yellowish amniotic fluid and vernix caseosa
tea-colored urine
dyspnea
Interventions: phototherapy, exchange transfusion