Care of the Newborn

Nursing Care of the Newborn!

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 newborn’s 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 period—from birth through the first 28 days of life. (Adele Pillitteri, 2007)

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 newborn’s 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 baby’s 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 body’s 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 score—standardized evaluation of the newborn’s 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. Color—all infants appear cyanotic at birth and grow pink with or shortly after the first breath
2. Heart Rate—auscultation of the newborn’s heart
3. Reflex irritability—response to a suction catheter or having the soles of their feet slapped.
4. Muscle tone—newborn hold the extremity tightly flex. They should resist any effort to extend their extremities
5. Respiratory effort—a mature newborn usually cries spontaneously at about 30 seconds after birth. At one minute, the infant is maintaining regular although rapid respirations.

Immediate Assessment of the Newborn

Sign	0	1	2
Appearance: Color	Pale, Blue all over	Pinky body, blue extremities	Pink all over
Pulse: Pulse Rate	Absent	Less than 100	More than 100
Grimace: Reflex Irritability	No response to stimulation	Grimace/feeble cry when stimulated	Sneeze/Coughs/Pulls away when stimulated; good strong cry
Activity: Muscle Tone	Limp, flaccid	Some flexion of extremities	Well-flexed extremities
Respiration: Breathing	Absent	Weak or irregular	Good, strong cry

Scoring

• 0-3 points—the baby is serious danger and need immediate resuscitation.
• 4-6 points—the baby’s condition is guarded and may need more extensive clearing of the airway and supplementary oxygen.
• 7-10 points—are considered good and in the best possible health.

Vital Statistics/Anthropometric Measurements

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

Vital Signs

Vital Sign	Immediately At Birth	After Birth
Temperature	36.5 to 37.2 Celsius
Pulse	180 beats/minute	120-140 beats/minute ave.
Respiration	80 breaths/minute	30-50 breaths/minute
Blood Pressure	80/46 mmHg	100/50 mmHg (by 10th day)

1. Proper Identification and Charting
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 mother’s hospital number, mother’s full name, sex, date and time of birth.
3. Inspect for the presence of 2 arteries and 1 vein. Suspect a congenital anomaly if blood vessels are not complete.
4. Apply triple dye or Betadine for faster healing effect.
5. This is to cleanse the baby of blood mucus and vernix, and then followed with sponge bath. Dry infant, wrap and keep him warm.
6. Crede’s Prophylaxis—prophylactic 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
Administer Eye Care
Procedure

• Wipe the face dry.
• Shade the eyes from light and open one eye at a time by exerting gentle pressure on the upper and lower lids.
• 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

1. 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

1. Accomplish the form properly.