Immediate Nursing Care of the Newborn

Prepared by: Ms. Anafe B. Lanuzo RN

 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 birth an 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).

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.

Sign Appearance: Color

0 Pale, blue all over

1 Pinky body, blue extremities Less than 100 Grimace/feeble cry when stimulated

2 Pink all over

Pulse: pulse rate Grimace: reflex irritability

absent Non response to stimulation

More than 100 Sneeze/Coughs/Pull s away when stimulated; good strong cry

Activity: Muscle Tone

Limp, flaccid

Some flexion of extremities

Well-flexed extremities

Respiration: Breathing

Absent

Weak or irritable

Good, strong

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

Vital Statistic Average Low or arbitrary low Weight Length Head circumference Chest circumference 6.5 to 7.5 lbs 50 cms (20 in) 33 to 35 inches 31-33 cms or 2cms less than head circumference 31 to 33 cms Less than 5.5 lbs 46 cms (18 in)

Abdominal circumference

Vital signs
Vital sign Immediately at birth After birth Temp 36.5 to 37.2 celcius

Pulse

180 beats/min

120-140 beats/min

Respiration

80 breaths/min

30-50 breaths/min

Blood pressure

80/46 mmHg

100/50 mmHg (by 10th day)

Proper Identification and Charting

1. 2. 3. 4. 5. 6. Proper identification of the newborn and footprints must be taken and kept in the chart. Attach ID bracelet with a number that corresponds to the mothers hospital number, mothers full name, sex, date and time of birth. Inspect for the presence of 2 arteries and 1 vein. Suspect a congenital anomaly if blood vessels are not complete. Apply triple dye or Betadine for faster healing effect. This is to cleanse the baby of blood mucus and vernix, and then followed with sponge bath. Dry infant, wrap and keep him warm. 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 1. Wipe the face dry. 2. Shade the eyes from light and open one eye at a time by exerting gentle pressure on the upper and lower lids. 3. 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 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 Accomplish the form properly.

Continue Physical assessment

1. General Appearance position 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. 9. 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.

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