Newborns undergo profound physiologic changes at the moment of birth, as they are

released from a warm, snug, dark liquid-filed environment that has met all of their basic
needs, into a chilly, unbounded, brightly lit, gravity based outside world.
Within minutes after being plunged into this strange environment, a newborns body must
initiate respirations and accommodate a circulatory system to extrauterine oxygenation.
How well the newborn makes these major adjustments depends on his or her genetic
composition, the competency of the recent intrauterine environment, the care received
during the labor and birth period, and the care received during the newborn or neonatal
periodfrom birth through the first 28 days of life. (Adele Pillitteri, 2007)
Two thirds of all deaths that occur during the first year of life occur in the neonatal period.
More than half occur in the first 24 hours after birthan indication of how hazardous this
time is for an infant. Close observation of a newborn for this indication of distress is
essential during this period (National Center for Health Statistics, 2005).
For the new Guidelines regarding Newborn Care. Please read the Essential Newborn Care
or the Unang Yakap Program here.

Establish and Maintain a Patent Airway

1. Never stimulate a baby to cry unless secretions have been drained out.
2. Mucus should be sustained from a newborns mouth by a bulb syringe as soon as
the head is delivered.
3. As soon as an infant is born, he/she should be held for a few seconds with the
head lightly lowered for further drainage of secretion.
4. Suction the newborn properly:
1. Turn the babys head to one side
2. Suction gently and quickly.
3. Suction the mouth first before the nose.
4. Occlude one nostril at a time when testing for airway patency.
5. Record the first cry.
6. Maintain appropriate body temperature as chilling will increase the
bodys need for oxygen.

7. Newborn suffers large losses of heat because he is wet at birth, the

delivery room is cold he does not have enough adipose tissues and
does not know how to shiver.

Keep Newborn Warm

Effects of Cold Stress

Metabolic acidosis

Hypoglycemia

1. Dry the newborn immediately

2. Wrap him with a warm blanket but not too tight as not to compromise respiratory
effort
3. Lay infant on his side in a warmed bassinet or place under a droplight
4. Place a head cap to conserve heat especially if they are in an open crib.
5. All nursing care should be accomplished quickly as possible to minimize exposure
of the infant.
6. Apgar scorestandardized evaluation of the newborns condition. Done at one
minute after birth to determine the general condition and then at 5 minutes to
determine how well the newborn is adjusting to extrauterine life.
1. Colorall infants appear cyanotic at birth and grow pink with or shortly
after the first breath
2. Heart Rateauscultation of the newborns heart
3. Reflex irritabilityresponse to a suction catheter or having the soles
of their feet slapped.
4. Muscle tonenewborn hold the extremity tightly flex. They should
resist any effort to extend their extremities
5. Respiratory efforta mature newborn usually cries spontaneously at
about 30 seconds after birth. At one minute, the infant is maintaining
regular although rapid respirations.

Immediate Assessment of the Newborn

Sign

Appearance: Color

Pale, Blue all

Pinky body, blue

Pink all over

over

extremities

Pulse: Pulse Rate

Absent

Less than 100

More than 100

Grimace: Reflex

No response to

Grimace/feeble cry

Sneeze/Coughs/Pulls

Irritability

stimulation

when stimulated

away when stimulated;

good strong cry

Activity: Muscle Tone

Limp, flaccid

Some flexion of

Well-flexed extremities

extremities
Respiration: Breathing

Absent

Weak or irregular

Good, strong cry

Scoring

0-3 pointsthe baby is serious danger and need immediate resuscitation.

4-6 pointsthe babys condition is guarded and may need more extensive
clearing of the airway and supplementary oxygen.

7-10 pointsare considered good and in the best possible health.

Vital Statistics/Anthropometric Measurements

Low or Arbitrary

Vital Statistic

Average

Weight

6.5 to 7.5 lbs

less than 5.5 lbs.

Length

50cms (20in)

46cms (18in)

Head Circumference

33 to 35 inches.

Chest Circumference

Abdominal
Circumference

Low

31-33cms or 2cms less than head

circumference

31 to 33 cms

Vital Signs
Vital Sign

Immediately At Birth

Temperature

36.5 to 37.2 Celsius

Pulse

180 beats/minute

After Birth
120-140 beats/minute
ave.

Respiration

80 breaths/minute

Blood Pressure

80/46 mmHg

30-50 breaths/minute
100/50 mmHg (by
10th day)

1. Proper Identification and Charting

1. Proper identification of the newborn and footprints must be taken and
kept in the chart.
2. Attach ID bracelet with a number that corresponds to the mothers
hospital number, mothers full name, sex, date and time of birth.
3. Inspect for the presence of 2 arteries and 1 vein. Suspect a congenital
anomaly if blood vessels are not complete.
4. Apply triple dye or Betadine for faster healing effect.
5. This is to cleanse the baby of blood mucus and vernix, and then
followed with sponge bath. Dry infant, wrap and keep him warm.
6. Credes Prophylaxisprophylactic treatment of the newborns eyes
against gonorrheal conjunctivitis aka opthalmia neonatarum, which the
baby acquires as he passes through the birth canal of the mother who
has untreated gonorrhea.

Care of the Umbilical Cord

Give Initial Oil Bath
Administer Eye Care
Procedure

Wipe the face dry.

Shade the eyes from light and open one eye at a time by exerting gentle pressure
on the upper and lower lids.

Apply Erythromycin/Terramycin Opthalmic ointment from the inner to outer

canthus of the eye. The antibiotic will eliminate gonorrhea and Chlamydia as well.

Administration of Vitamin K
1. Vitamin K facilitates production of the clotting factor, thus preventing bleeding.

Method: Aquamephyton 1mg (Phytonadione), a synthetic Vitamin K is injected IM into the

lateral aspect of the anterior thigh (vastus lateralis).

Document Birth Record

1. Accomplish the form properly.
Continue Physical Assessment

Characteristics of a Newborn
1. General Appearanceposition and activity
2. Skin
1. a. Colorruddy complexion due to increased RBC concentration and decreased
subcutaneous fat which makes blood vessels more visible.
1. Acrocyanosis
2. Physiologic Jaundice
3. Textureslight desquamation for the first 2 to 4 weeks of life
4. Skin Turgorgood elasticity
5. Vernix Caseosawhite cream-cheese like that serves as a skin
lubricant
6. Miliapinpoint size white spots seen on the nose and chin due to
obstruction of the sebaceous glands.
7. Erythema Toxicumnewborn rash. It begins with a papule and
eventually to an erythematic appearance.
8. Lanugois the fine downy hair that covers a newborns shoulders,
back and upper arms. Immature newborns have more lanugo than
mature infant.
9. Birthmarks
1. Hemangiomasare vascular tumors of the skin.
1. Nevus flammeusmuscular purple or dark red
lesion. Generally appear on the face and thighs.
2. Strawberry hemangiomaselevated areas formed
by immature capillaries and endothelial cells.

3. Cavernous

hemangiomasthese

are

dilated

vascular spaces.
4. Mongolian spotsslate gray patches across the
sacrum or buttocks and consist of a collection of
pigment cells.
5. Forceps marksthese are circular or linease
contusion matching the rim of the blade forceps on
the infants cheeks.
3. Headnewborns head is disproportionately large
1. Fontanellesspaces or opening where the skull bones join
2. Moldingthe part of the infants head that engages the cervix. It is molded to fit
the cervix contours.
3. Caput Succedaneumis edema of the scalp at the presenting part of the head.
4. Cephalhematomais a collection of blood between the periosteum of the skull
bone and the bone itself caused by rupture of the periosteum capillary due to the
pressure of birth.
5. Craniotabesis a localized softening of the cranial bones.
4. Eyesvision is present as evidence of blinking reflex
5. Earshearing is present as soon as amniotic fluid is drained or is absorbed from the
middle ear.
6. Nosemay appear large for the face.
7. Mouthshould open evenly when the baby cries.
8. Neckis short and chubby, creased with skin folds and head rotate freely.
9. Chestappear small in proportion to infants head.
1. Abdomencontour is slightly protuberant (sticking out from the surroundings)
2. Anogenital Areaanus should not be covered by a membrane. Take note of the
time meconium is first passed.
1. Backthe spine appears flat in the lumbar and sacral areas
2. Extremities

1. Arms and legs appear short

2. Hands are plump and clinch into fists
3. Should move symmetrically
4. Fingernails are soft, smooth
5. Good muscle tone, arms always in flexed position
6. Palm of hands should have three creases.
7. Legs are bowed as well short
8. Soles of the feet appears to be flat
9. Presence of crisscrossed lines on the soles of the foot.
3. Feeding

Provide Discharge Instructions

1. Breast-fed babies are fed immediately after birth and can be fed on demand or at
least every 2 hours for the first few days of life. Advice to alternate both breast at
10-15 minutes each.
2. Bottle-fed babies routinely received an initial feeding of about 1oz of sterile water
at 4-6 hours of age to be certain the infant can swallow without gagging and
aspirating. The newborn is then fed every four hours.
1. Sleep patternsnewborns sleep 16-20 hours a day
2. Bathingmay be given anytime convenient as long as it is not within 30
minutes after feeding as handling might cause regurgitation. Sponge
baths are done until cord falls off.
3. Cord Care
1. Dab rubbing alcohol (70% soln) two or three times a day for faster
drying.
2. Fold down diapers so that cord does not get wet during voiding.
3. Small, pink granulating area may be seen on the day the cord falls off. If
it remains moist or with foul discharge, advise mother to bring baby to
the doctors clinic.
4. Car Safety. Until a child reaches a weight of 20lbs, the best type of car seat is an
infant only seat that faces the back of the car.

References

Pillitteri, A. (2007). Maternal and Child Health Nursing:Care of the Childbearing and
Childrearing Family. Winsconsin: Lippincott Williams & Wilkins.