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OBSERVATION AND

NEWBORN CARE

SUBMITTED TO: SUBMITTED BY:


MRS. PRIYA.R UPASANA GARG
PROFESSOR (MAI M.SC (NSG) .
BHAGO COLLEGE
OF NSG)
NEWBORN CARE:
CARE OF NEWBORN

INTRODUCTION:
Essential care of the normal
healthy Neonates can be best
provided by the mothers under
supervision of nursing personnel
or basic/ primary health care
providers. About 80% of the
newborn babies should be kept
with their mothers rather than in a
separate nursery.
DEFINITION:
A healthy infant born at term b/w 38-42
wks should have average birth wt, cries
immediately following birth, establishes
independent rhythmic respiration &
quickly adapts to the changed
environment.

AIM:
The aim of the nursing management is
promotion and maintenance of the body
functions.
TYPES OF NEWBORN CARE

IMMEDIATE
NEWBORN
CARE

CARE AT CARE IN GENERAL


BIRTH NURSERY CARE
CARE AT BIRTH:

IMMEDIATE CARE
CARE AT BIRTH
Soon after the birth
Establish and maintaining airway
APGAR rating
Cord clamping and ligature
Maintainence of temperature
Screening
Identification tag
Transferring newborn
1. SOON AFTER THE BIRTH:
It should be placed on a tray covered
with clean dry linen with the head slightly
downwards.
It facilitates drainage of the mucus
accumulate in the tracheo- bronchial tree
of gravity.
The tray is placed between the legs of the
mother and should be at a lower level
than the uterus to facilitate gravitation of
blood from the placenta to the infant.
2. ESTABLISH AND
MAINTAINING AIRWAY:
Suctioning is done gently.
Suction the nose mouth as needed.
Have a bulb syringe to remove the
excessive secretions from the air
passage.
If the baby is not crying already by
this time, gentle tactile stimulation
are provided.
.
CONTINUE…………..

If the child does not cry after tactile


stimulation the other steps of
resuscitation should be followed.
Gentle suctioning helps to prevent
bradycardia, laryngospasm .and
cardiac - arrhythmias .
3. APGAR RATING:
The APGAR score is based on the
observation of the : heart rate
,respiration, muscle tone , reflex,
irritability and color of the neonate.
Each item is given 0, 1, 2 score.
RESULT:
NORMAL SCORE = 8 – 9
GOOD CONDITION= 8 – 10
MODERATE DIFFICULTY = 5-7
SEVERE DISTRESS = below 4. (need
resuscitation).
4. CLAMPING AND LIGATURE
OF THE CORD:

Then cord is clamped and ligated


following birth of the baby.
The cord is clamped by 2 kocher
forceps the near one is placed 2.5
cm away from the naval .
Squeezing the cord with fingers
prior to applying ligature prevent
accidental inclusion of embryonic
reminants.
CONTINUE…………
Side by side the presence of any
abnormality is to be noted.
Delay in clamping for 2- 3 minutes
or till cessation of the cord
pulsation facilitates transfer of 80-
100ml blood from the compressed
placenta to a baby when placed
below the level of uterus.
5. MAINTAINENCE OF
TEMPERATURE:
Immediate dry the infant under
radiant warmer or skin to skin
contact with the mother..
The maintenance of body
temperature can prevent the
potential problems of
hypoglycemia and
acidosis.
CONTINUE……..
The room temperature is maintained
between 28-30 degree centigrade. And
humidity 50% .
The bath can be postponed as per
hospital policy.
The neonate is cleaned , dressed, head
is covered, and body is wrapped in a
soft cloth and
blanket.
6. PREVENTION OF INFECTION:

The baby area should be


absolutely clean.
All equipments coming in contact
with newborn should be sterile .
The staff taking the care of the
newborn should be free from all
infections.
7. IDENTIFICATION TAG:

Newborn identification before a


baby leaves the delivery area,
identification bracelets with
identical number are placed on the
baby and mother.
Babies often have two
identification tags one on wrist and
one in ankle.
8. TRANSFERRING NEWBORN:

QUICK check is made to any gross


abnormality and the baby is rapped
in cotton and warm material .
After showing the baby to mother
the baby should transferred to
the nursery for further
observation and care.
B.CARE IN NURSERY
CARE:
CARE IN NURSERY:
1. Admission in nursery
2. Observation and routine care
3. Protection
4. Estimation of gestational age
5. Care of eyes
6. Care of umbilical cord
7. Medication .
1. ADMISSION IN NURSERY:
All healthy newborn are kept in the
delivery room with their mother to
promote immediate breast feeding and
early bonding.
Common indication for admission of the
newborn in the nursery are:
Respiratory distress
Poor perfusion or presence of pallor or
cyanosis.
Malformation.
Need for oxygen therapy.
2.OBSEVATION AND ROUTINE
CARE:
Close observation is done at least
4-8 hours after birth.
Observe for any excessive mucus
secretion fron the mouth.
Any bleeding from the umbilical
cord .
Hourly temperature until it stabilize
and remain above 36 degree
celsuis .
CONTINUE……….
The infant should be examined
systematically beginning from the
head followed by inspecting the
whole body to detect any
congenital abnormality..
The baby should be thoroughly
observed twice daily for early
detection of any abnormality.
3. PROTECTION:
Place the baby under a preheated radiant
warmer immediately following birth.
Cover the baby with a pre-warmer
towel.
Put the baby close to the mother
breast (kangaroo method) .
Wrap the mother and baby together
to prevent hypothermia.
Commence early breast feeding.
4. ESTIMATION OF
GESTATIONAL AGE:
Soon after delivery gestational age is
estimated.
A baby delivered at 39 weeks or more
present with following features:
Sole covered with creases.
Breast nodule diameter of 7mm.
Scrap hair –coarse and silky.
Ear lobule stiffened by thick cartilage.
In male scrotum is full with testes with
extensive rugae.
5. CARE OF EYES:
The eyes of the neonate are cleaned
immediately using sterile moist (normal
saline) swab one for each eye.
The eye is cleaned from inner canthus
to outer canthus .
The eye drops or ointment , as
prescribed ,is put in both eyes , to
prevent gonococcal conjunctivitis.
The are checked daily for any
discharge.
CONTINUE…………..
The eyes are cared properly to
prevent them from infections.
Gentamycin ophthalmic ointment or
erythromycin (0.5%) is applied in the
eyes every 6hourly as a prophylaxis.
6. CARE OF UMBILICAL CORD:
The cord is clamped or tied tightly with
the sterile ligature before the clamp is
removed
The oozing and bleeding is checked for
24hours.
The stump of the cord is observed for
three openings of the blood vessels,
one vein and two arteries.
It is kept exposed to air and allowed to
dry to promote early detachment
CONTINUE………….
Topical antibiotics or antibiotics
such as triple dye or Neosporin
powder may be applied to reduce
bacterial
7. CLOTHING:

The dress should be appropriate


for the climate
The extremities should be free for
movement.
A napkin is applied and should be
changed periodically.
8.MEDICATION:
A single intramuscular dose of (0.5) to
1 mg of vitamin K is given to all
newborn within 6 hours of birth.
Prophylactic antibiotics are given
B.C.G at birth.
C. GENERAL CARE:

Care of the skin


Care of the genitalia
Infection control
Adequate nutrition
Psychological bonding
with parents
1.CARE OF THE SKIN:
The neonate skin is delicate.
The neonate skin is cleaned in cephalo-
caudal direction.
First the face is cleaned.
The scalp is wiped
Carefully and wiped quickly.
While cleaning the head and the face
rest of the body is wrapped.
Then rest of the body is washed.
2. CARE OF GENITALIA:
The genitalia of the female and male
neonate require gentle cleaning.
Cleansing of the vulva is done with
front- to- back.
In the male neonate, smegma is
removed by cleansing around the glans.
The parents need explanation
about cleansing of the
genitalia.
3.INFECTION CONTROL:
The neonate defenses against infection
are not matured, thus, they are
susceptible to infection.
In preventing cross infection, the
practice of hand washing by all the
personnel in the nursery and delivery
room is very important.
The nurse and care taker wash their
hands before and after handling the
neonate.
4.ADEQUATE NUTRITION:
The food and feeding serve as a
nutritional requirement of the neonate.
The feeding situation also provide
opportunity for the neonate to explore
the environment and for the first
experience in the world .
Breast feeding
and artificial feeding
is provided to newborn
5.PSYCHOLOGICAL BONDING
WITH THE PARENTS:
During the first hour of age, the parents should
try to have eye-to- eye contact with the
neonate.
Whenever possible, both parents should
develop, emotional bond with the neonate, by
holding the baby close to the body, cuddling,
and through their touch.
The baby
should be kept at
side of mother to make
mother child bonding.
DAILY OBSERVATION AND
CARE OF NEWBORN
t
THE FOLLOWING SHOULD BE
OBSERVED DAILY:

1. Vital signs
2. Weight
3. General changes in
color and activity
1. Feeding status
2. Head and eyes
3. The mouth
CONTINUE……….

7. UMBILICAL CORD
8. ELIMINATION
9. BATH
10.PARENT- INFANT INTERACTION
11. VACCINATION AND
IMMUNIZATION
12.GROSS ABNORMALITY
CONTINUE…….

13. REFLEX BEHAVIOUR


14. SCREENING OF THE NEWBORN
15. DISCHARGE
16. FOLLOW UP
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