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Published by: josephine on May 02, 2010
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10/19/2013

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PRINCIPLES OF IMMEDIATE CARE
I. AIRWAY PATENCY
* Most critical adjustment a newborn must make at birth
TECHNIQUES to maintain patent airway:

\ue000wipe off nose and mouth with sterile gauze
\ue000suctioning with the use of rubber bulb syringe or suction catheter
\ue000positioning

i. if NSD without problem = TRENDELENBURG
ii. traumatic delivery = FLAT
\u2022
with head turned towards the side
\ue000stimulating the newborn to cry
II. PROVIDE OPTIMUM TEMPERATURE
POSSIBLE WAYS TO PRODUCE HEAT:
1. SHIVERING
2. METABOLISM OF BROWN FAT
3. GLUCONEOGENESIS

HOW TO PROVIDE WARMTH:
1. Dry, newborn\u2019s skin
2. Wrap, using soft blanket

3. Use of pre heated bassinet or crib, radiant warmer, drop light or floor lamp
III. INITIAL ASSESSMENT OF CONDITION
APGAR SCORING

\ue000was developed by Dr. Virginia Apgar in 1952
\ue000done on the 1st minute, 5 and 10 minutes after
\ue000based on 5 parameters, ranked in order of importance

A. HEART RATE
B. RESPIRATORY EFFORT
C. MUSCLE TONE
D. REFLEX IRRITABILITY

E. COLOR
IV. PROPER IDENTIFICATION
V. PREVENTION OF INFECTION AND INJURY

A. ASEPTIC TECHNIQUE
1. CORD CARE
- Check:

Normal = 1 vein and 2 arteries (AVA)

Abnormal = 2 A & 2 V \u2013 Mongoloid
2. SKIN CARE
oil bath \u2013 high risk premature
soap/water bath \u2013 full term
* use mineral oil to remove vernix caseosa on the body
* use skin antiseptic or any mild soap for a regular bath

B. PROPHYLAXIS

1. EYE (Crede\u2019s prophylaxis)
> to prevent ophthalmia neonatorum or gonorrheal conjunctivitis
> use of ophthalmic ointments like terramycin,

tetracycline
TECHNIQUE:
- inner to outer canthus while exposing the lower conjunctival sac

2.HYPOPROTHROMBINEMIA prophylaxis
> prescribed with single dose (1 mg /0.1ml) of Phytonadione solution
(Aquamephyton) per IM, vastus lateralis

1
> Aquamephyton, a Vit. K water-soluble preparation \u2013 acts as preventive
measure against neonatal hemorrhagic disease
VI. MOTHER \u2013 CHILD BONDING
VII. NUTRITION
Purposes:
a. Bonding
b. Involution
c. Breast feeding stimulation
VII. BAPTISM OF INFANT
NORMAL CHARACTERISTICS OF A NEONATE
1.
ANTHROPOMETRIC MEASUREMENTS
A. WEIGHT AND LENGTH
Americans -
53 cm (21 inches)
7.7 lbs.
Filipinos - average weight = 6.9 lbs (2500 \u2013 4000gms.)
average length = 48 \u2013 53cm (19 \u2013 21inches)
Newborn loses 5 \u2013 10% or 6 \u2013 9% of his body weight during the first few days of life due to:

a. withdrawal of hormones
b. voiding and passing out of stool
c. limited intake

\u2022
will regain weight in 10 \u2013 14 days of age
\u2022later on, he will be gaining 1 lb/month for the 1st 6 mos. Of life thus:

2x @ 6 mos.
3x @ 1 year
4x @ 2 years

B. HEAD CIRCUMFERENCE
-
33 \u2013 35 cm or 13 \u2013 14 inches
C. CHEST CIRCUMFERENCE
-
31 \u2013 33 cm or 12 \u2013 13 inches
D. ABDOMINAL CIRCUMFERENCE
-
same as CC
2. VITAL SIGNS
A. TEMPERATURE
-
36.5 \u2013 37 \u00b0C or 97.7 \u2013 98 \u00b0 F
B. RESPIRATION
-
30 \u2013 60 breaths per minute
C. HEART RATE
-
Fluctuates between 120 \u2013 180 beats/minute
E. BLOOD PRESSURE
-
High immediately after birth and falls to a minimum within 3 hours after birth.
-
67/41 mmHg \u2013 80/40
2. HEAD TO TOE ASSESSMENT
I.
GENERAL APPEARANCE
2
II.
SKIN
\u2022Pre term \u2013 thin, translucent, ruddy skin; with easily seen veins and venules esp. over the
abdomen.
\u2022Term \u2013 thick, pinkish, mottled
\u2022Post term \u2013 thick, parchment-like with peeling and cracking; few blood vessels over the
abdomen.
III.
COLOR
VARIATIONS:
1. Gray - indicative of infection
\u2022
Pallor- usually as a result of anemia
2. Cutis Marmorata
3. Acrocyanosis
4. Cyanosis
\u2022cyanotic when quite and grows pink when cries \u2192 atelectasis
\u2022
with normal color when quite then cyanotic when crying \u2192 congenital
heart disease, \u201c Blue Baby \u201c
5.Harlequin sign
6. Physiologic jaundice or Neonatal hyperbilirubinemia
\u2022Full term = appears after 24\u00b0, becomes definite bet 2 \u2013 7 days;
disappears after 7th day
\u2022Pre term = appears after 18\u00b0, becomes definite bet 3 \u2013 10 days;
disappears after the 9th \u2013 10th day
-
Serum unconjugated bilirubin does not exceed 12mg/100cc
-

Above 20mg/100cc, will cross the blood brain barrier \u2192 interfere with chemical synthesis
of brain \u2192 permanent cell damage and possible mental retardation, epilepsy, cerebral
palsy \u2192 KERNICTERUS

7. OTHERS:
\u2022
LANUGO
\u2022
VERNIX CASEOSA
\u2022
FORCEP MARKS
\u2022
MILIA
\u2022NEVI (STORKBITES)
\u2022
MONGOLIAN
\u2022
ERYTHEMA TOXICUM NEONATORUM
\u2022
DESQUAMATION
\u2022
HEMANGIOMAS
IV.
HEAD
FONTANELS are opening at points of union of skull bones
\u2022
Anterior \u2013 is diamond shaped, closes @ 12 \u2013 18 mos.
\u2022
Posterior \u2013 is triangular in shaped, closes @ 2 \u2013 3 mos
VARIATIONS IN THE HEAD:
1. MOLDING
2. CAPUT SUCCEDANEUM
3. CEPHALHEMATOMA
4. CRANIOTABES
EYES
-
Normal findings:
\u2022
subconjunctival hemorrhage
\u2022
edema of eyelids for 2 \u2013 3 days till kidneys are able to excrete urine efficiently
\u2022
pseudostrabismus or transient strabismus \u2013 cross-eyed
\u2022
DOLL\u2019S eyes \u2013 eyes do not follow movement of the head. Persists for 10 days,
then disappear
EARS
-
shld. be in line with the outer canthus of the eyes
-
ears set lower are found in those with chromosomal aberrations like trisomy18 and with
mental retardation
3

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