Immediate Care of the Newborn

BY DAISY JANE ANTIPUESTO RN MN · JUNE 25, 2009

Goals:
 To establish, maintain and support respirations.
 To provide warmth and prevent hypothermia.
 To ensure safety, prevent injury and infection.
 To identify actual or potential problems that may require
immediate attention.
Establish respiration and maintain clear airway
The most important need for the newborn immediately after
birth is a clear airway to enable the newborn to breathe
effectively since the placenta has ceased to function as an organ of gas exchange. It is in the maintenance of
adequate oxygen supply through effective respiration that the survival of the newborn greatly depends.

Newborns are obligatory nose breathers. The reflex response to nasal obstruction, opening the mouth to maintain
airway, is not present in most newborns until 3 weeks after birth.

To establish and maintain respirations:

1. Wipe mouth and nose of secretions after delivery of the head.
2. Suction secretions from mouth and nose.

 Compress bulb syringe before inserting

 Suction mouth first, then, the nose
 Insert bulb syringe in one side of the mouth
3. A crying infant is a breathing infant. Stimulate the baby to cry if baby
does not cry spontaneously, or if the cry is weak.

 Do not slap the buttocks rather rub the soles of the feet.
 Stimulate to cry after secretions are removed.
 The normal infant cry is loud and husky. Observe for the following abnormal cry:
 High, pitched cry – indicates hypoglycemia, increased intracranial pressure.
 Weak cry – prematurity
 Hoarse cry – laryngeal stridor
4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant
in a position that would promote drainage of secretions.
  Trendelenburg position – head lower than the body
 Side lying position – If trendelenburg position is contraindicated, place infant in side lying position to permit
drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from
rolling back to supine position.
5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are
obligatory nose breathers until they are about 3 weeks old.

Care of the Eyes

It is part of the routine care of the newborn to give prophylactic eye treatment against gonorrhea conjunctivitis or
opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed on the fetus from the vaginal canal
during delivery. This practice was introduced by Crede, a German gynecologist in1884. Silver nitrate, erythromycin
and tetracycline ophthalmic ointments are the drugs used for this purpose.

Erythromycin or tetracycline Opthalmic Ointment:

1. These ointments are the ones commonly used now a days for eye prophylaxis because they do not cause eye
irritation and are more effective against Chlamydial conjunctivitis.
2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes.
Vitamin K or Aquamephyton
The newborn has a sterile intestine at birth, hence, the newborn does not possess the intestinal bacteria that
manufactures vitamin K which is necessary for the formation of clotting factors. This makes the newborn prone to
bleeding. As a preventive measure, .5 (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the
newborn’s vastus lateralis (lateral anterior thigh) muscle.

Care of the cord

The cord is clamped and cut approximately within 30 seconds after
birth. In the delivery room, the cord is clamped twice about 8 inches
from the abdomen and cut in between. When the newborn is brought to
the nursery, another clamp is applied ½ to 1 inch from the abdomen and
the cord is cut at second time. The cord and the area around it are
cleansed with antiseptic solution. The manner of cord care depends on
hospital protocol. What is important is that the principles are followed. Cord clamp maybe removed after 48 hours
when the cord has dried. The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that
heals on the next 7 to 10 days.
Instruction to the mother on cord care:
1. No tub bathing until cord falls off. Do not sponge bath to clean the baby. See to it that cord does not get wet by
water or urine.
2. Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution
which is 70% alcohol.
3. Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the
diaper soaks with urine.
4. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and separates
more rapidly if it is exposed to air.
5. If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten.
6. Report any unusual signs and symptoms which indicates infection.
 Foul odor in the cord
 Presence of discharge
 Redness around the cord
 The cord remains wet and does not fall off within 7 to 10 days
 Newborn fever

THE APGAR SCORING SYSTEM

The APGAR Scoring System was developed by Dr. Virginia Apgar as a
method of assessing the newborn’s adjustment to extrauterine life. It is
taken at one minute and five minutes after birth. With depressed infants,
repeat the scoring every five minutes as needed. The one minute score
indicates the necessity for resuscitation. The five minute score is more
reliable in predicting mortality and neurologic deficits. The most
important is the heart rate, then the respiratory rate, the muscle tone,
reflex irritability and color follows in decreasing order. A heart rate below
100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.
ASSESS 0 1 2
HEART RATE Absent Below 100 Above 100

RESPIRATION Absent Slow Good crying

MUCLE TONE Flaccid Some flexion Active motion

REFLEX IRRITABILITY No response Grimace Vigorous cry

Body pink,
COLOR Blue all over Pink all over
Extremities blue

Score:

 7 – 10 Good adjustment, vigorous

 Moderately depressed infant, needs airway clearance
 Severely depressed infant, in need of resuscitation.

ASSESSING THE AVERAGE NEWBORN

Head Circumference 34 – 35 cm
Temperature 97.6 – 98.6 F axillary

Chest Circumference 32 – 33 cm

Heart Rate 120 – 140 bpm

Respirations 30 – 60 bpm

Weight 2.5 to 3.4 kg

Length 46 to 54 cm