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4. Adequate nourishment
NEWBORN PRIORITIES IN THE FIRST DAYS OF LIFE
5. Waste elimination
6. Prevention of infection
7. Infant-parent relationship
8. Developmental care
ESSENTIAL NEWBORN CARE
Time bound – immed drying, SSC, cord clamping, non separation of NB fr mother,
breastfeeding
Non time bound – immunization, eye care, Vit K admin, weighing, washing
Preparing to meet
baby’s needs
2 clean and warm towels
NB size self inflating bag
Infant masks: normal and small
NB
Suction device
Rolled up piece of cloth
Clean, dry, warm surface
Warm delivery room
A. Time Bound Procedures
immed drying
SSC
cord clamping
non separation of NB fr mother
breastfeeding
1. Drying the NB
Dry body and head well
Provides warmth
Improves bonding
Protection from infection by
exposure of the baby to
good bacteria of the mother
Increases blood sugar of
the baby
* aseptic technique
* Povidone (Betadine); 70% Isoprophyl alcohol - prevent Tetanus Neonatorum and Omphalitis
(streptococcal and staphylococcal)
Signs of Omphalitis:
* Application of sterile cord clamp - prevent bleeding w/n 1st 24 hours (Omphalangia)
4. Kangaroo Mother Care
Provides NB w/ benefits of incubator care
Well small babies (preterm or lbw) may benefit
Once stable, KMC may begin
Head Position
Baby’s head should be turned to one side and slightly extended to keep airway open and allow
eye contact
Top of binder beneath baby’s ear
Radiation
Conduction
Evaporation
- special tissue
2. Hypoglycemia
- inc energy requirement to produce heat
5. Breastfeeding
1. bonding
2. uterine contraction
3. colostrum
4. Contraceptive
5. Cheap
6. Right temperature
7. Antibacterial – Lactoferrin, Lactobacillus bifidus, lysozyme, macrophage, T lymphocytes,
lactoperoxidase
Differences Between
Human and Cows Milk
SIGNS OF READINESS
- baby looking around
- mouth open
- searching
POSITIONING AND ATTACHMENT
Neck not flexed or twisted
NB facing mother, nose opposite nipple
Hold NB body close to body
Support whole body
Wait until mouth is wide open
Move NB quickly to breast, aiming lower lip below nipple
3.Vit K admin
4.Weighing
5. washing
1. Expanded Program on Immunization
2. Crede’s Prophylaxis
Medications:
Eye care:
Wipe eyes
Apply antimicrobial w/n 1 hr after birth
b. Ointment
Terramycin
Gentamycin
Chloramphenicol
Erythromycin
- pull eyelids downward
0.5-1 cm
Inner to outer canthus
Wipe excess away
3. Vitamin K Injection
- sterile GIT
Special Care
5. Initial Bath – temp stabilizes 36.5ºC 6-8 after birth
hexachlorophene (Phisohex)
– infected passageway
C. Unnecessary
1.routine suxning
3.prelacteal admin
4. footprinting
1. Suctioning
- Turn head to one side
- Suction gently and quickly
- Suction the MOUTH first before the nose
- Test patency of the airway
- proper position
Physical assessment
3. Initial Feeding
4. Proper Identification
– done in D.R. before being brought to the Nursery
c. Birthmarks
Immediate Assessment
of the Newborn
APGAR SCORE
Congenital Anomalies
1. Choanal Atresia
2. Tracheobronchial fistula
3. Cleft lip and cleft palate
Substances
1. drugs
2. smoking
3. alcohol
IUGR - Rate of growth does not meet expected pattern - growth restriction
DEFINING THE SMALL BABY
- SMALL BABY – 32-35 wks AOG OR
- 1-2 mos early OR
- BW bet 1500 g and 2,500g
Prematurity
Risk Factors:
1. Fetal
2. Placental
3. Maternal
4. Infection
Problems:
Respiratory adaptation
Susceptibility to infection
Hyperbilirubinemia
Cold stress
Hypoglycemia
anemia
Hypoglycemia
<40 mg/100 ml
dependent on maternal supply
Birth, continue to produce insulin
S/sx: limpness, jitteriness, apnea, twitching and hi pitched cry
CX: mental retardation
Tx: early feeding
D10W
Nsg: monitor blood glucose level
PE of the premature baby
Skin and SC tissue – thin, transparent
Inc lanugo
Dec plantar creases
Breast bud scarcely felt
Pinna flat and shapeless
Scrotum not pigmented
Testes not descended
Labia majora widely
separated
Management
Maintain patent airway
Incubator care
VS monitoring
O2 thearpy
Feeding
Infection precautions
Nursing Intervention
Meet physiologic needs
Meet psychological needs
Foster healthy family relationships
Provide education
Physiologic weight loss
- 5-10 % in 10 days
Causes
1. No longer under influence of maternal hormones
2. Voids and passes out stools
3. relatively low nutritional intake
4. beginning difficulty establishing sucking
Physical Assessment
Examination
After birth: at around 1 hr, before d/c from hosp (not less than 12 hrs of age), maternal concern
abt baby’s condition, danger sign during monitoring
After leaving hosp: 1st week of life at routine visit, ff up, sick visit
WHY DO WE EXAMINE?
Overall assessment, initial set of observations, provide appropriate care and tx
Before d/c and therafter: reassess and monitor, prov approp tx if condition changed, give
guidance to mother
>160-180 at birth
NORMAL: 30–60/minute
Babies < 2.5 kg or <37 wks AOG may have mild chest indrawing and periodically stop breathing
for a few sec
80–60/45–40 mm Hg at birth
100/50 mm Hg at day 10
d. Temperature
Axillary: 36.4C–37.2C
Skin: 36.0 C–36.5C
Rectal: 36.6C–37.2C
* Temperature 37.2 at birth
2. Skin
Acrocyanosis – up to 48 hours
Generalized mottling
Gray color - infection
* Blood incompatibility
Jaundice
Types:
1. Physiologic Jaundice / Icterus Neonatorum
2nd day – 7th day - TERM
2 day – 10th day - PRE-TERM
nd
Causes:
a.Hemolysis
b.Decreased conversion of bilirubin to urobilirubin
c.Decreased uptake of free bilirubin by
hepatic cells
2. Pathologic Jaundice
Normal total serum bilirubin = 15%
Direct bilirubin = 1.7
Indirect bilirubin = 13.2
Causes:
a. Infection
b. Hemolytic disorders
c.Inability of the newborn to conjugate bilirubin
Breastmilk jaundice
Pregnanediol
jaundice
Management
1. Early feeding
2. Phototherapy
· Cover eyes with opaque mask to prevent blindness.
· distance - 18-20 in from source of light.
· Monitor V/S especially temp
· Cover genitalia to prevent
PRIAPISM and sterility
· Adequate hydration
· Turn NB q 2º to expose all body surfaces
Common Marks
1. Harlequin Sign
3. Milia – unopened sebaceous glands; tip of nose and chin of the baby. (-) 2-4 weeks
4. Lanugo – fine downy hair on shoulders, upper arms, back; (-) 2 weeks.
6. Vernix Caseosa
7. Portwine Stain or Nevus Flammeus – birth; red to purple color; do not blanch on pressure nor
disappear; face
8. Strawberry Mark or Nevus Vascularis – 2nd most common type of capillary hemangioma.
elevated, sharply demarcated or bright or dark red, rough surface swelling. (+) school age
or even longer.
11. Nevi – stork bites or Telangiectasia Nevi; pink or red flat areas of capillary dilatation at upper
eyelids, nose, upper lip, lower occiput bone, nape and neck. (-) 1st and 2nd year.
Nevus flammeus
Strawberry hemangioma
Cavernous hemangioma
3. Head
– largest part of the human body (1/4 of his total length);
-forehead is large and prominent;
-chin is receding when startled or crying.
Fontanels
1. Anterior – diamond shape;
- closes 12-18 months; 3-4 cm long/2-3 cm wide
- junction of 2 parietal bones and 2 fused frontal bones
- not indented depressed
- suture lines - never appear widely separated
2. Posterior – triangular in shape
- junction of the parietal bones and the occipital bones.
- 1 cm
- closes by end of 2nd month
Sutures
Lambdoid (2)
Coronal (2)
Frontal (1)
Sagittal (1)
4. Eyes
- no discharge
- Eyelids of equal size
- temporarily gray or blue in color (d/t thinness)
- Cry tearlessly 1st 3 months
- Cornea round and adult sized
- Pupils round, not keyholed (Coloboma)
- cross-eyed (Strabismus)
- see object at 8 inches; V.A. of 20/200 to 20/500
5. Ears
-Top of ear should align with inner and outer canthus of the eye
6. Nose
- Nasal obligates
- Note for marked flaring of alae nasi, indicative of airway obstruction
Causes of obstruction:
1. Secretions
2. septal deviation
- Sense of smell – least developed
7. Mouth
- open evenly when crying. If not, suspect CN VII Paralysis (Bell’s Palsy).
- lips, gums, palate intact; no breaks on the lip - cleft palate; cleft lip
- Eptein’s Pearls – small round glistening cysts; palate and gums, due to extra load of
maternal Ca
- NATAL TEETH
- Oral thrush – white gray patches on the tongue and sides of cheeks due to Candida
8. Neck
- Thyroid gland not palpable
- soft, palpable and creased with skin folds
- Head - rotate freely on the neck and flex forward and back. (+) rigidity of the neck-
CONGENITAL TORTICOLLIS (injury to SCM)
-NB whose membranes ruptured 24 hours before birth, nuchal rigidity - meningitis.
9. Chest
- As large as or smaller than the head
- Symmetrical
11. Extremities
b. Bottle fed infant stool – formed, pale yellow with a typical odor; usually passed 1-2
times a day
13. Female Genitalia
Female– swollen labia and pass a slightly bloody vaginal discharge
-“PSEUDOMENSTRUATION” on day 2-3 up to day 7
Procedure:
1. Vitamin K injected IM
2. Infant is restrained; penis is cleansed with soap and water
3. clamp is used
4. Petroleum gauze dressing is applied to prevent adherence of circumcised site to the
diaper while applying pressure to prevent bleeding
Nursing Care:
- Do not attempt to remove exudates which persist for 2-3 days; just wash with warm
water.
- Diaper must be pinned loosely during the 1st 2-3 days when the base of the penis is
tender.
14. Back
- Note for mass, hairy nodule and dimple along axis - Spina Bifida.
- Cremasteric reflex – test for integrity of spinal nerves (T8 thru T10)
Systemic Evaluation
I.Cardiovascular System
Fetal Circulation
Oxygen exchange occurs in placenta
pressure on the left side of the heart < right side
(+) accessory structures
II. Neuromuscular system
Reflexes
blink reflex
Rooting reflex – (-) 6 wks old
Sucking reflex –(-) 6 mos
Extrusion Reflex – (-) 4 mos
Swallowing reflex
Tonic neck Reflex – (-)2-3 mos
Babinski reflex – (-) 3-12 mos
Landau reflex
Crossed extension reflex – (-) 1 mo
Palmar/Grasp (-) 3-4 mos
Plantar reflex – (-) 8 mos
Stepping reflex (-) 1 mo
Moro reflex- (-) 4-5 mos
Parachute reflex – (-) 8-9 mos
Trunk Incurvation reflex – (-) 2-3 mos
III. Gastrointestinal
IV. Urinary
Management
Feed by demand
Burp infant
Diaper Rash
Miliaria
Seborrheic Dermatitis
Clothing
Sleep Pattern
Newborn Screening
REPUBLIC ACT NO. 9288
Newborn Screening Act of 2004
“…ensure that every baby born in the Philippines is offered the opportunity to undergo
newborn screening and thus be spared from heritable conditions that can lead to mental
retardation and death if undetected and untreated.”
1. CONGENITAL HYPOTHYROIDISM
3. G6PD DEFICIENCY
- reduction in the levels of the enzyme G6PD in RBC leads to hemolysis of the cell upon
exposure to oxidative stress
4. GALACTOSEMIA
5. PHENYLKETONURIA (PKU)
- dec phenylalanine hydroxylase w/c converts phenylalanine to tyrosine