IMMEDIATE NEWBORN CARE

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

To establish and maintain respirations

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





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

5. Keep the nares patent. Remove mucus and other
particles that may be cause obstruction
Care of the Eyes

Neisseria gonorrhea- the causative agent for gonorrhea
conjunctivitis or opthalmia neonatorum, may be passed on
the fetus from the vaginal canal during delivery.


Drug of choice:
- Erythromycin or tetracycline Opthalmic Ointment
Care of the cord

Report any unusual signs and symptoms which
indicates infection.

- Foul odor in the cord
- Presence of discharges
- Redness around the cord
- The cord remains wet and does not fall off within 7
to 10 days
- Newborn fever

It may be treated with:
1. Bactericidal substance

2. Antibiotic substance

3. Alcohol (70%)

4. Cleansed with mild soap solution

5. Air dry

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
COLOR Blue all over Body pink
Extremities blue
Pink all over
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
REMEMBER:
1. Crowning ready for suction

2. Expulsion of head wipe face and nose

3. Expulsion of newborn provide warmth, take
note of time and sex of baby
4 Mechanisms of Heat Lose
1. Convection

2. Conduction

3. Radiation

4. Evaporation
Other Means of Heat Loss:
1. Insulation

2. Constriction of blood vessels and moving blood
away from skin

3. Brown fat

4. Drying and wrapping newborns

WEIGHT

Varies depending on:

1. Race
2. Nutritional status
3. Intrauterine factor
4. Genetic factor
REASONS for Wt.Loss
1. 1
st
few days after birth

2. Diuresis

3. Voiding and passage of stool

4. Breastfed newborns
Bathing
- Remove blood, amniotic fluid, and excessive
vernix caseosa as soon after birth as the
temperature is stable

- It decreases exposure to maternal blood and
possible bloodborne organism on th infants
skin
e.g. Hep.B and HIV

Administer Vitamin K
Site: Right Vastus Lateralis
Classification:
- fat soluble vitamin
- antihemorrhagic agent
Action:
-promotes the formation of factors II,VII,IX,X by the liver
for clottingfactor,thus prevent bleeding
- Provides Vit.k which is not synthesized in the intestine
for the first 5 to 8 days after birth because the
newborn lacks intestinal flora necessary for Vit.K
production
DOCUMENT birth record
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.
ASSESSMENT OF CARDIORESPIRATORY
STATUS
AIRWAY

1. Respiratory rate assess respirations at least
once every 30 mins. until stable for 2 hours after
birth.

Observe for:
1. Periodic breathing
2. Apnea



2. Breath sounds auscultate anterior and
posterior lung fields for equal sounds

- Sounds of moisture in the lungs during
the 1
st
hour or two after birth is NOT
UNUSUAL because fetal lung fluid has
not been completely absorbed.





SIGNS OF RESPIRATORY DISTRESS
1.Tachypnea respiratory rate above 60
bpm
2.Retractions due to infants weak chest
wall muscles that are used to help draw
air into the lungs
3. Flaring of Nares a reflexive widening
of nostrils


4.Central cyanosis a purplish blue
discoloration due to insufficient oxygen
supply ( lips,tongue,mucous membrane
and trunks )

Peripheral cyanosis (acrocyanosis) due
to poor perfusion of blood to the
periphery of the body
Bruising of face due to tight nuchal
cord or pressure during birth and may
look like central cyanosis


How to check for Cyanosis?

1. apply pressure to the area

2. use of pulse oximeter

3. Color of mucous membrane

5. Grunting a noise made on expiration
when air crosses partially closed vocal
cords

6. Seesaw respirations when the chest
falls the abdomen rises and vice versa

7. Asymmetry decreased on one side of
the lung may indicate a collapse of the
lung ( atelectasis )


Choanal atresia
- Blockage of one or both nasal passages by a
narrowed bone or membrane that
protrudes into the area

How to asses ?
1. By closing the infants mouth and
occluding one nostrils at a time and
observe for breathing while each nostril is
occluded
2. Placing a cold metal object under the
nostrils and observe for fogging
3. Passing a catheter (fr.5 or 8) thru each
nostril tto check for patency

Color
1. Pallor indicates slight hypoxia or
anemia
2. Ruddy color ( plethora) an excessive
number of RBC ( >65%)

Heart sounds
- Auscultate for rate, rhythm and
presence of murmurs or abnormal
sounds


Rhythm should be regular , the 1
st
and 2
nd

sounds should be heard clearly,
abnormalities should be noted.

Murmurs abnormal sounds caused by
abnormal blood flow through the heart
and may indicate openings in the septum
of the heart
- results from an incomplete
transition from fetal to neonatal circulation
- is common until the ductus
arteriosus functionally closed
Brachial and Femoral Pulses
- Should be present equally and bilaterally

Blood pressure
- Taken on all extremities if the infant has unequal
pulses or other signs of cardiac complications

Method:
1. Doppler UTZ

Average BP:
Systolic 65 95 mmHg
Diastolic 30 60 mmHg

Capillary Refill
Capillary Refill
- assessed to help determine if
perfusion is
adequate
B. Assessment of Thermoregulation
- Temperature should be assessed at least once
every 30 minutes until the infant has been
stable for 2 hours after birth

Method:
1. Axillary
2. Rectal


Types of Thermometer

1. Mercurial
2. Digital
3. Disposable Plastic Strips
4. Tympanic
C. PHYSICAL ASSESSMENT
A. HEAD & NECK

Head makes up one fourth of the length
of the body and is much larger in
proportion to the rest of the body
- should be palpated to assess the
shape and identify abnormalities




Note for:
1.Molding caused by overriding of the
cranial bones at the suture and is
common especially a long second stage
of labor
- parietal bones often override
the occipital and frontal bones and a
ridge can be felt at the areas
Craniosynostosis
- a hard ridged area that is not a result
of molding due to premature closure of
the cranial sutures before or shortly
after birth which may impair brain
growth and shape
Types:
a. Single Suture Synostosis Sagittal (SAJ-
ut-ul)/ Scaphocephaly

- The sagittal suture is located on the
midline, on top of the head and extends
from the soft spot towards the back of
the head. When the head is palpated, a
ridge can be felt along the suture.

Preoperations at age 5 months
7 months Post operation
2. Coronal (co-RO-nul) Suture Synostosis /
Plagiocephaly
- The coronal suture is located on the side
of the head and extends from the soft
spot to an area just in front of the ear. It
allows the forehead and the frontal lobe
to grow and expand forward.

3. Metopic (mih-TOP-ick)
SutureSynostosis/
Trigonocephaly
- This midline suture is located in the
middle of the forehead and extends
from the soft spot to the root of the
nose. It allows both frontal lobes to
expand forward and sideways as well as
the eye socket to move to either side.

4. Lambdoidal (lam-DOID-ul) Suture
Synostosis
- Closure leads to posterior plagiocephalus
(PLAY-gee-o-SEF-a-lee) with flattening of
the back of the head on the affected
side, protrusion of the mastoid bone
and lowering of the affected ear. It may
also cause the skull to tilt sideways.
2. Fontanels are areas of the head where
sutures between the bones meet

2.1 Anterior
- is a diamond shape area
where the frontal and
parietal bones met
- Measures 2 to 4 cm
- Closes between 12 to
18 months of age
2.2 Posterior
- Is a triangular area where the occipital
and parietal bones meet
- Measures 0.5 to 1cm
- Closes by the time the infant is 2 to 3
months
3. Caput succedaneum
- Due to the pressure against the
mothers cervix and it interferes the
blood flow in the area causing localized
edema which crosses suture lines

4. Cephalhematoma
- Bleeding between the periosteum and
the skull




Face
assessed for:
-Symmetry
-Positioning of facial features
-Movement
-Expression




Mouth

assessed for:

- cleft lip/palate
- Precocious teeth
- Epsteins pearl
B. Neck and Clavicles
Neck assess visually and note the ease with
which the head turns from side to side
e.g. Turners syndrome


Turner syndrome or Ullrich-Turner syndrome (also
known as "Gonadal dysgenesis") encompasses
several conditions, of which monosomy X
(absence of an entire sex chromosome, the Barr
body) is most common. It is a chromosomal
abnormality in which all or part of one of
the sex chromosomes is absent (unaffected
humans have 46 chromosomes, of which two
are sex chromosomes). Typical females have
two X chromosomes, but in Turner syndrome,
one of those sex chromosomes is missing or has
other abnormalities. In some cases, the
chromosome is missing in some cells but not
others, a condition referred to as mosaicism
[2]
or
'Turner mosaicism'.
The syndrome manifests itself in a number of ways.
Characteristic :
1. physical abnormalities
- short stature, swelling,
- broad chest
- low hairline
- low set ears
- webbed necks.
[5]
Girls with Turner syndrome typically experience
gonadal dysfunction (non-working ovaries), which results
inamenorrhea (absence of menstrual cycle) and sterility.

2. Concurrent health concerns are also frequently present,
- congenital heart
- hypothyroidism (reduced hormone secretion by the thyroid)
- diabetes
- vision problems
- hearing concerns

Turner's syndrome is named after Henry H. Turner.
Clavicle fracture are more likely to occur in large
infants
e.g. shoulder dystocia
Shoulder dystocia is a specific case
of dystocia whereby after the delivery of the head,
the anterior shoulder of the infant cannot pass
below the pubic symphysis, or requires significant
manipulation to pass below the pubic symphysis. It
is diagnosed when the shoulders fail to deliver
shortly after the fetal head. In shoulder dystocia, it
is the chin that presses against the walls of
the perineum. Shoulder dystocia is an obstetrical
emergency, and fetal demise can occur if the infant
is not delivered, due to compression of
the umbilical cord within the birth canal.





Fracture a lump or tenderness over the area

Method of Detecting:
Moro Reflex a difference in the movement of
the arm

Treatment :
- Immobilization of the affected part for a short
time

C. Cord should contain three (3) vessels

arteries (2)
- are small and may stand up at the end cut

vein - (1)
- is larger than the arteries and resembles a slit


Thin cord the infant may have been poorly
nourished in utero
Yellow Brown or Green tinge cord
- indicates that meconium was released
sometime before birth
Patent urachus abnormal connection between
the umbilucus and bladder
Umbilical cord hernia - "Paraumbilical Hernias" develop in and
around the area of the umbilicus (belly button or navel).
- A congenital weakness (meaning present since birth)
exists in the naval area in the region where vessels of the fetal
and infant umbilical cord exited through the muscle of the
abdominal wall. After birth, although the umbilical cord
disappears (leaving just the dimpled belly-button scar), the
weakness or gap in the muscle may persist.
D. Extremities
- normally a term infant should remain sharply
flexed & resist extension during examination

Poor muscle tone results in a limp or floppy
infant

Continued poor muscle tone may result from
prematurity or neurologic changes
All extremities are examines for signs of fracture:

1.Crepitus
2.Redness
3. Lumps or swelling
4. Lack of use /immobility

Erb-Duchenne paralysis - paralysis of the arm
resulting from injury to the brachial plexus
(usually during childbirth)
- Instead of the usual flexed position, the
affected arm is extended at the infants side with
the forearm prone

Treatment:
- exercise
- splinting or both
A. Hands and Feet
- Are examined for extra digits which are often
small and may not have bones

Nails :
- in term infants it should extend to the end of
the fingers or slightly beyond

Creases :
- normally, two long transverse creases extend
most of the way across the palm
Polydactyly - is a condition in which a person has more
than five fingers per hand or five toes per foot.

Syndactyly - is a condition where two or more digits
are fused together. It occurs normally in
some mammals, such as the siamang and kangaroo,
but is an unusual condition in humans.
Syndactyly can be complete or incomplete.
In complete syndactyly, the skin is joined all the way
to the tip of the finger
In incomplete syndactyly, the skin is only joined
part of the distance to the fingertip.
Syndactyly can be simple or complex.
In simple syndactyly, adjacent fingers or toes are
joined by soft tissue.
In complex syndactyly, the bones of adjacent digits
are fused. The kangaroo exhibits complex
syndactyly.


Feet are assessed for club foot

Talipes equinovarus: The common ("classic") form
of clubfoot. Talipes is made up of the Latin talus
(ankle) + pes (foot). Equino- indicates the heel is
elevated (like a horse's) and -varus indicates it is
turned inward. With this type of clubfoot, the
foot is turned in sharply and the person seems to
be walking on their ankle.

A club foot, or congenital talipes
equinovarus (CTEV) is a congenital deformity
involving one foot or both.The affected foot
appears rotated internally at the ankle.

TEV is classified into 2 groups:
1. Postural TEV
2. Structural TEV
2. Hips
- Are examined for signs of developmental
dysplasia which occurs more often on breech
presentation

- Normally both legs should abduct equally in
normal infants with click sound while in
dysplasia is a clunk sound
Dysplasia instability of the hip joint which occurs at the head of
the femur which can be moved in and out of the acetabulum

Methods of Assessing:

1. The Barlow maneuver is a physical examination performed
on infants to screen for developmental dysplasia of the hip.

- It is named for T.G. Barlow, 1962 at Hope Hospital Salford,
Manchester

- The maneuver is easily performed by adducting the hip
(bringing the thigh towards the midline) while applying light
pressure on the knee, directing the force posteriorly.

If the
hip is dislocatable - that is, if the hip can be popped out of
socket with this maneuver - the test is considered positive.
The Ortolani maneuver is then used, to confirm the positive
finding (i.e., that the hip actually dislocated).


2. The Ortolani test or Ortolani maneuver is a physical
examination for developmental dysplasia of the hip.

It is performed by an examiner first flexing the hips and knees of a
supine infant to 90 degrees, then with the examiner's index
fingers placing anterior pressure on the greater trochanters,
gently and smoothly abducting the infant's legs using the
examiner's thumbs.

A positive sign is a distinctive 'clunk' which can be heard and felt
as the femoral head relocates anteriorly into the acetabulum:



This is part of the standard infant exam
performed preferably in early infancy; it
usually becomes negative after 2 months of
age.


It is named for Marino Ortolani, who
developed it in 1937.
[3


3. Vertebral Column

- palpate the entire length of the newborns
vertebral column to discover any defects in the
vertebrae.

Check for:

Spina bifida - (Latin: "split spine") is a developmental congenital
disorder caused by the incomplete closing of the embryonic neural tube.
Some vertebrae overlying the spinal cord are not fully formed and remain
unfused and open. If the opening is large enough, this allows a portion of
the spinal cord to protrude through the opening in the bones. There may
or may not be a fluid-filled sac surrounding the spinal cord.

Other neural tube defects:

1. anencephaly, a condition in which the portion of
the neural tube which will become
the cerebrum does not close,
2. encephalocele, which results when other parts
of the brain remain unfused.
Classification:

1. Spina bifida occulta

Occulta is Latin for "hidden". This is the mildest forms
of spina bifida.


In occulta, the outer part of some of the vertebrae are
not completely closed. The split in the vertebrae is
so small that the spinal cord does not protrude. The
skin at the site of the lesion may be normal, or it
may have some hair growing from it; there may be
a dimple in the skin, or a birthmark.

2. Spina bifida cystica
In spina bifida cystica, a cyst protrudes through
the defect in the vertebral arch. These
conditions can be diagnosed in utero on the
basis of elevated levels of alpha-fetoprotein,
after amniocentesis, and by ultrasound
imaging. Spina bifida cystica may result in
hydrocephalus and neurological deficits.
3. Meningocele
- The least common form of spina bifida is a
posterior meningocele (or meningeal cyst).

- In a posterior meningocele, the vertebrae
develop normally, however the meninges are
forced into the gaps between the vertebrae. As
the nervous system remains undamaged,
individuals with meningocele are unlikely to
suffer long-term health problems



- A meningocele may also form through dehiscences in the
base of skull. These may be classified by their localisation to
occipital, frontoethmoidal, or nasal. Endonasal
meningoceles lie at the roof of the nasal cavity and may be
mistaken for a nasal polyp. They are treated surgically.

- Encephalomeningoceles are classified in the same way and
also contain brain tissue.

4. Myelomeningocele
- In this, a serious and common form, the unfused
portion of the spinal column allows the spinal
cord to protrude through an opening. The
meningeal membranes that cover the spinal cord
form a sac enclosing the spinal elements.

Nsg. Responsibility
1.The protruding tissue should be covered with moist sterile saline
dressing immediately after birth

2. Intravenous antibiotics are started to prevent meningitis.

3. An adhesive plastic surgical field drape taped over the buttocks
deflects feces away from the back--"mud flap.

4. The most important words to say at the baby's birth are:
"Congratulations on the birth of your child!" These words extend
joy, optimism, reverence, respect, acceptance, and
nonabandonment. This simple step facilitates parental interest,
learning, and care provision.

D. Assessment of Body Systems
I. Neurologic system

a. Reflexes

- assessment of the presence and strength of the
reflexes is important to determine the health
of the newborns central nervous system
Moro reflex is the most dramatic reflex
- startle reflex or infantile reflex
- It may be observed in incomplete form
in premature birth after the 28th week
of gestation, and is usually present in
complete form by week 34 (3
rd

trimester)
- It is normally present in all
infants/newborns up to 4 or 5 months
of age, and its absence indicates a
profound disorder of the motor system
An absent or inadequate Moro response on one side is
found in infants with :

- hemiplegia,
- brachial plexus palsy
- fractured clavicle.

Persistence of the Moro response beyond 4 or 5
months of age is noted only in infants with severe
neurological defects.

* It was discovered and first described by
Austrian pediatrician Ernst Moro (1874-1951).
The primary significance of this reflex is
evaluating integration of the central nervous
system (CNS), and it involves 3 distinct
components:

spreading out the arms(abduction)
- the reflex is initiated by pulling the infant up
from the floor and then releasing him;
unspreading the arms (adduction)
- spreads arms and pulls arms in
crying (usually)





Palmar Grasp reflex - a flexion of the fingers
caused by stimulation of the palm of the hand.
The reflex is present at birth and usually
disappears by 6 months of age.




Plantar Grasp reflex - a reflex characterized by the
flexion of the toes when the sole of the foot is
stroked gently. It is present in babies at birth but
should disappear after 6 weeks.






Babinski reflex - is obtained by stimulating the
external portion (the outside) of the sole. The
examiner begins the stimulation back at the
heel and goes forward to the base of the toes.
- Most newborn babies are not
neurologically mature and
therefore show a Babinski
response
- A Babinski response in an older
child or adult is abnormal. It is
a sign of a problem in
the (CNS), most likely in a part
called the pyramidal tract.
Rooting reflex - A reflex in infants in which rubbing
or scratching about the mouth causes the infant
to turn its head toward the stimulus.






Sucking reflex - sucking movements of the lips of an infant
elicited by touching the lips or the skin near the mouth.
Stepping reflex - movements of progression elicited when the infant is
held upright and inclined forward with the soles of the feet touching a
flat surface.
Tonic Neck reflex - extensions of the arm and sometimes
of the leg on the side to which the head is forcibly
turned, with flexion of the contralateral limbs; seen
normally in the newborn.
II. Sensory Assessment
A. Ears

assessed for :
1. Placement
2. Appearance
3. Maturity
Expected findings:
* Loud noise elicits Startle Reflex
* Flexible pinna with cartilage present
* Pinna top on horizontal line with outer
canthus of eye


Common variations:

* Skin tags on or around ears

Signs of potential distress or deviations from
expected findings:

Ear placement low

Clefts present

Malformations

Cartilage absent

Preauricular sinus
b. Eyes
Expected findings:

Slate gray or blue eye color

No tears

Fixation at times - with ability to follow objects to

midline

Red reflex

Blink reflex

Distinct eyebrows

Cornea bright and shiny

Pupils equal and reactive to light

Common variations:
* Edematous Eyelids
* May focus for a few seconds
* Uncoordinated movements
Signs of potential distress or deviations from expected findings:
Discharges
Opaque lenses
Absence of Red Reflex
Epicanthal folds in newborns not of Oriental descent
Reflexes absent
"Doll's Eyes" Reflex (beyond 10 days of age):
When the head is moved slowly to the right or left, the eyes do
not follow nor adjust immediately to the position of the head.
This reflex should not be elicited once fixation is present. The
persistence of the Doll's Eyes Reflex suggests neurologic damage.

Chemical conjunctivitis
* Subconjunctival hemorrhage
Causative Agent:

1. Staphylococcus
2. Chlamydia gram (-) bacteria
3. Neisseria gonorrhoea
Assessment on hepatic system
A.Newborns with hypoglycemia
- a medical condition referred to as
neonatal hypoglycemia
- have low levels of blood sugar in the
first days following birth.
- Sugar levels in newborns may drop for a
number of reasons, including elevated
insulin levels, decreased glycogen levels,
low glucose production or overuse of
glucose stores.
Signs:
1. Irritability high pitched cry
2. Lethargy
3. Seizure / jitteriness
4. Sweating
5. Poor sucking
6. Respiratory distress :
- Tachypnea
- Dyspnea
- Apnea
7. Discoloration / Cyanosis
8. Poor appetite
9. Excessive drowsiness



Causes of Hypoglycemia:
1. Maternal diabetes
2. Prematurity
3. Infection / Illness
4. Intrauterine growth retardation (IUGR)
Blood Sugar Level in Newborns
- should remain above 40 milligrams per
deciliter, or mg/dL.
Levels below 35 mg/dL indicate severe
hypoglycemia
levels under 50 mg/dL warrant close
observation.
A level between 54 and 72 mg/dL indicates
a more normal newborn blood glucose
At-risk infants need blood glucose
monitoring within the first two hours after
birth.


Treatment
If the baby can eat and the blood glucose
level is not too low, giving formula, sugar
water or breast milk will raise blood
glucose levels in most cases.
Babies who can't eat or those with very
low blood glucose levels need intravenous
infusion of dextrose, a type of sugar, to
raise their blood sugar.
Infants receiving glucose infusions may
develop temporary hyperglycemia, or
blood glucose levels over 125 mg/dL,
which usually requires no treatment,

Prevention

- At-risk infants require blood glucose
screening via heel stick or from blood
drawn from a central umbilical line.
- The baby may need frequent blood tests
in the first 12 hours after birth to ensure
that levels don't drop.
- Hypoglycemia most often develops
within the first 24 hours after birth,

B. Newborn Jaundice
Jaundice is a yellow discoloration of the skin
and the white part (the sclera) of the eyes. It
results from having too much of a substance
called bilirubin in the blood.
Bilirubin is formed when the body breaks
down old red blood cells. The liver usually
processes and removes the bilirubin from the
blood.
Jaundice in babies usually occurs because
their immature livers are not efficient at
removing bilirubin from the bloodstream.

Causes:

Jaundice in newborns most commonly
occurs because their livers are not mature
enough to remove bilirubin from the
blood. Jaundice may also be caused by a
number of other medical conditions.

1. Physiologic jaundice is the most common
form of newborn jaundice
2. Neonatal jaundice will be seen in cases of
maternal-fetal blood type incompatibility
3. hemolysis
4. Polycythemia

5. Cephalohematoma

6. Sometimes a baby swallows blood during birth

7. A mother who has diabetes

8. Crigler-Najjar syndrome

9. Lucey-Driscoll syndrome
Carotenemia - A condition that causes a
yellowish discoloration of the skin and tends
to be a darker orange than seen with
jaundice.
Eating a lot of yellow vegetables causes this
condition.
Children with carotenemia have normal
bilirubin levels.
Unlike jaundice, carotenemia does not cause a
discoloration of the white part of the eyes.
This condition causes no harm and requires no
treatment.

Symptoms:
As a baby's bilirubin levels rise:
jaundice moves from the head to include the arms, trunk,
and finally the legs.
bilirubin levels are very high :
a baby will appear jaundiced below the knees and on the
palms of his or her hands.

How to Assess?
- One easy way to check for jaundice is to press a finger
against your baby's skin, temporarily pushing the blood
out of it. Normal skin will turn white when you do this,
but jaundiced skin will stay yellow.

Exams and Tests

Before a baby can be treated, the exact
cause of an infant's jaundice must be
determined. In some cases, a careful
examination by a pediatrician is all that
is needed. In other cases, blood tests
may be required.

Laboratory Tests:
1. First, the total serum bilirubin level will be
checked. Based on this test, the doctor
may request that more tests be done.
2. A Coombs test checks for antibodies that
destroy an infant's red blood cells.
3. A complete blood count may be done.
4. A reticulocyte count checks to be sure
your baby is making enough new red
blood cells.
5. Certain red blood cell diseases are found
in people of Mediterranean descent. In
such cases, it may be necessary to check
blood samples for a condition known
as G6PD deficiency.

Treatment
Self-Care at Home

* Sunlight helps to break down bilirubin so
that a baby's liver can process it more
easily.


Placing a child in a well-lit window for 10
minutes twice a day is often all that is
needed to help cure mild jaundice. Never
place an infant in direct sunlight.

If the bilirubin level is too high, the child may
need to be placed under a special type of light.

This treatment is called phototherapy
- These lights are able to penetrate a baby's skin
and affect the bilirubin within the child. The light
changes bilirubin into lumirubin, which is easily
handled by the baby's body.

If an infant's bilirubin levels are very high or if the
child appears ill, the baby will most likely be
admitted to the hospital for treatment.

Assessment in gastrointestinal system
Assessment on endocrine system
The endocrine glands are considered
better organized than other systems.
Disturbances are most often related to
maternally provided hormones (estrogen,
luteal, and prolactin) that may cause the
following conditions:

a. Vaginal discharge and/or bleeding may
occur in female infants.
b. Enlargement of the mammary glands
may occur in both sexes

Physical AssessmentGenitourinary System

Important to note that infant is voiding
Keep record of number of voiding

A. Male infants
Assess for descended testicles.
Care following circumcision
Care of the uncircumcised infant
B. Female infants
Labia may be swollen.
May have blood-tinged discharge.
Teach per-care.


Integumentary system
SKIN is fragile and shows marked easily
especially for infants with fair color

Nsg. Responsibility:
1. Must examine every inch of the skin
surface carefully during the initial
assessment and at the beginning of the
shift.

ASSESS for:
1. Harlequin coloration
- a clear color division over the body from the
head to the abdomen with one half deep
pink or red and the other half pale or of
normal color

- indicate shunting of blood with cardiac
problems or sepsis. Redness may occur on
the lower side when the infant lies on the
side
2. Mottling (cutis marmorata)
- Is a lacy pattern from dilated blood vessels
under the skin

May be a sign of:
- Cold stress
- Overstimulation
- Sepsis

- - if persistent, may indicate chromosomal
abnormality
3. Vernix caseosa
- A thick ,white substance that resembles
cream cheese
- Provides a protective covering for the fetal
skin in utero

4. Lanugo
- Fine hair that covers the fetus during
intrauterine life


5. Milia
- Are white cysts, 1-2 mm in size resulting
from distention of sebaceous glands that
are not yet functioning properly

6. Erythema toxicum
- A red, blotchy areas that may have white
or yellow papules or vesicles in the center
- Commonly called as fleabite or newborn
rash
7. Birthmarks
- Assess the size and location and should be
carefully documented

7.1 Mongolian spots are bluish-black marks that
resembles bruises
- Usually found in sacral area but may appear in arm
andshoulder

7.2 Nevus simplex also called salmon patch, stork bite or
telangiectatic nevus
- a flat, pink or reddish discoloration from capillaries that
occur over the eyelids, just above the bridge of the nose
or at the nape of the neck.
7.3 Nevus flammeus (port-wine stain)
- is a permanent, flat dark, reddish-purple mark
and varies in size, location and blanches
minimally or not at all with pressure.
- located over the forehead and eyelid and may be
associated with Sturge-Weber syndrome

7.4 Nevus Vasculosus (strawberry hemangioma)
- consists of enlarged capillaries in the outer layer
of the skin
- is a dark red and raised with a rough surface
giving a strawberry like appearance


7.5 Caf-au-lait spots
- are permanent,light brown areas that may occur
anywhere on the body. Although harmless, the number
and size are important.

8. Markings from Delivery

8.1 Petechiae pinpoint bruises that resembles a rash,
may appear over areas such as the back, face and groin
- due to increase intravascular pressure during the
birth process such as in nuchal cord

8.2 Bruises may occur on any part of the body
where pressure occurred during delivery
especially when second-stage labor was difficult

8.3 Small puncture mark is present on the
newborns head if a fetal monitor scalp electrode
was attached

8.4 Forceps mark occurs over the checks and ears
where the instrument applied
- size and location are carefully documented, lack
of movement or asymmetry of the face may
indicate injury of the facial nerve
Breasts note the placement of the nipple
and look for extra nipples which may
appear on the chest or axilla

Hair and Nails
hair should be silky and soft
- nails come to the end of finger or beyond
ASSESSMENT OF GESTATIONAL AGE
- Is an examination of the newborns physical and
neurological characteristics to determine the number of
weeks from conception to birth

TOOLS:
1. DUBOWITZ SCORING- is an in-depth, detailed
assessment tool that includes examination of physical,
neurological and behavioral; characteristics

1. NEW BALLARD SCORE- focuses on physical and
neuromuscular characteristics, eliminating the behavioral
I. Neuromuscular Characteristics
a. Posture posture and degree of flexion of the
extremities are scored
b. Square Window- is elicited by bending the hand at the
wrist until the palm is as flat against the forearm as
possible with gentle pressure
c. Arm recoil nurse hold the neonates arms fully flexed
at the elbows for 5 seconds, then extends the am by
pulling the hands straight down to the sides and
released quickly and the degree of flexion is measured
d. Popliteal Angle newborns lower leg is folded against
the thigh, with the thigh on the abdomen the lower leg
is straightened just until resistance is met

e. Scarf Sign the nurse grasps the infants
head and brings the arm across the body to
the opposite side, keeping the shoulder flat
on the bed and the head in the middle of
the body


f. Heel to Ear the nurse gasps the infants
foot and pulls it straight up alongside the
body toward the ears while the hips remain
flat on the bed surface


II. Physical Characteristics
a. Skin
Assessed for:
- Color
- Visibility of veins
- Peeling and cracking

b. Lanugo appears at 20 wks of gestation and increases in
amount until 28 wks and begins to disappear until little is left

c. Plantar Surface- begins to appear at 32 wks of gestation
although the creases are only red lines near to toes at first, they
gradually spread down toward the heal and become deeper
d. Breasts
Assess:
- Nipple
- Areola
- Size of breast bud
e. Eyes and Ears
Eyes- are fused until 26 to 28 weeks of gestation
Ears the incurvation and thickness of pinna rated

f. Genitals
Assess:(Female)
- Size of clitoris
- -labia majora and minora
Male: location of testes and rugae of scrotum
THANK YOU!!!!!!!!!!!


and



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