NEWBORN CARE

As soon as the infant is born, the prior management is to establish, maintain and support
respirations, to provide warmth and prevent hypothermia, to ensure safety, prevent injury and
infection and 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 since the placenta has ceased to function as an organ of
gas exchange. It is in the maintenance of adequate oxygen supply through effective respiration
that the survival of the newborn greatly depends.

Newborns are obligatory nose breathers. The reflex response to nasal obstruction,
opening the mouth to maintain airway, is not present in most newborns until 3 weeks after birth.

To establish and maintain respirations:

1. Wipe mouth and nose of secretions after delivery of the

head.

2. Suction secretions from mouth and nose.

 Compress bulb syringe before inserting

 Suction mouth first, then, the nose
 Insert bulb syringe in one side of the mouth

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.

 Do not slap the buttocks rather rub the soles of the feet.
 Stimulate to cry after secretions are removed.
 The normal infant cry is loud and husky. Observe for the following abnormal cry:
o High, pitched cry – indicates hypoglycemia, increased intracranial pressure.
o Weak cry – prematurity
o Hoarse cry – laryngeal stridor

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.

 Trendelenburg position – head lower than the body

 Side lying position – If trendelenburg position is contraindicated, place infant in side
lying position to permit drainage of mucus from the mouth. Place a small pillow or rolled
towel at the back to prevent newborn from rolling back to supine position.
5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction.
Newborns are obligatory nose breathers until they are about 3 weeks old.

Care of the Eyes

It is part of the routine care of the newborn to give prophylactic eye treatment against
gonorrhea conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may
be passed on the fetus from the vaginal canal during delivery. This practice was introduced by
Crede, a German gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic
ointments are the drugs used for this purpose.

Erythromycin or tetracycline Opthalmic Ointment:

1. These ointments are the ones commonly used now a day for eye prophylaxis because they
do not cause eye irritation and are more effective against Chlamydial conjunctivitis.
2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over
the eyes.

Vitamin K or Aquamephyton

The newborn has a sterile intestine at birth, hence, the newborn does not possess the
intestinal bacteria that manufactures vitamin K which is necessary for the formation of clotting
factors. This makes the newborn prone to bleeding. As a preventive measure, .5 (preterm) and 1
mg (full term) Vitamin K or aquamephyton is injected IM in the newborn’s vastus lateralis
(lateral anterior thigh) muscle.

Care of the cord

The cord is clamped and cut approximately within

30 seconds after birth. In the delivery room, the cord is
clamped twice about 8 inches from the abdomen and cut in
between. When the newborn is brought to the nursery,
another clamp is applied ½ to 1 inch from the abdomen and
the cord is cut at second time. The cord and the area around
it are cleansed with antiseptic solution. The manner of cord
care depends on hospital protocol. What is important is that
the principles are followed. Cord clamp maybe removed
after 48 hours when the cord has dried. The cord stump usually dries and falls within 7 to 10
days leaving a granulating area that heals on the next 7 to 10 days.

The nurse must instruct the mother no tub bathing until cord falls off. Do not apply
anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution
which is 70% alcohol. Avoid wetting the cord. Leave cord exposed to air and not apply dressing
or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air.

If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose
and fasten. Report any unusual signs and symptoms which indicates infection.

 Foul odor in the cord

 Presence of discharge
 Redness around the cord
 The cord remains wet and does not fall off within 7 to 10 days
 Newborn fever

THE APGAR SCORING SYSTEM

The APGAR Scoring System provides a valuable

index for evaluating the newborn infant’s condition at birth.
Every nurse who is responsible for the care of the newborn
infants should be familiar with the principles set forth by
APGAR for infant evaluation because they provide a
simple, accurate and safe means of quickly appraising the
child condition. It is taken at one minute and five minutes
after birth. With depressed infants, repeat the scoring every
five minutes as needed. The one minute score indicates the
necessity for resuscitation. The five minute score is more
reliable in predicting mortality and neurologic deficits. The
most important is the heart rate, and then the respiratory
rate, the muscle tone, reflex irritability and color follows in decreasing order. A heart rate below
100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.
 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, Pink all over

Extremities blue

Score:

 7 – 10 Good adjustment, vigorous

 Moderately depressed infant, needs airway clearance
 Severely depressed infant, in need of resuscitation.

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

The Newborn Screening

Newborn Screening (NBS) is a simple procedure to find
out if your baby has a congenital metabolic disorder that
may lead to mental retardation and even death if left
untreated.

The goal of newborn screening is to give all newborns a

chance to live a normal life. It provides the opportunity
for early treatment of diseases that are diagnosed before
symptoms appear. Included in the panel of disorders
under the Philippine Newborn Screening Program are:
Congenital Hypothyroidism (CH), Congenital Adrenal
Hyperplasia (CAH), Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency, Galactosemia (Gal) and
Phenylketonuria (PKU).

Most babies with metabolic disorders look normal at birth. One will never know that the baby has the
disorder until the onset of signs and symptoms and more often ill effects are already irreversible.
Newborn screening is ideally done on the 48th hour or at least 24 hours from birth. Some disorders are
not detected if the test is done earlier than 24 hours. The baby must be screened again after 2 weeks for
more accurate results.

Expanded Program on Immunization (EPI)

The standard routine immunization schedule for infants
Provides maximum immunity against the seven vaccine preventable diseases in the country
before the child's first birthday. The fully immunized child must have completed BCG 1, DPT 1, DPT 2,
DPT 3, OPV 1, OPV 2, OPV 3, HB 1, HB 2, HB 3 and measles vaccines before the child is 12 months of age

Vaccine Minimum Number Dose Minimum Route Site Reason

Age at 1st of Doses Interval
Dose Between
Doses
Bacillus Birth or 1 0.05 -- Intradermal Right BCG given at
Calmette- anytime mL deltoid earliest
Guérin after birth region possible age
of the protects the
arm possibility of
TB meningitis
and other TB
infections in
which infants
are prone
Diphtheria 6 weeks 3 0.5 4 weeks Intramuscular Upper An early start
-Pertussis- mL outer with DPT
Tetanus portion reduces the
Vaccine of the chance of
thigh severe
pertussis
Oral Polio 6 weeks 3 2-3 4 weeks Oral Mouth The extent of
Vaccine drops protection
against polio
is increased
the earlier
the OPV is
given.
Keeps the
Philippines
polio-free
Hepatitis B At birth 3 0.5 6 weeks Intramuscular Upper An early start
Vaccine mL interval outer of Hepatitis B
from portion vaccine
1st dose to of the reduces the
 2nd dose, thigh chance of
8 weeks being
interval infected and
from becoming a
2nd dose carrier[6].
to third Prevents liver
dose. cirrhosis and
liver cancer
which are
more likely to
develop if
infected with
Hepatitis B
early in life[7]
[8]
.
About 9,000
die of
complications
of Hepatits B.
10% of
Filipinos have
Hepatitis B
infection[9
Measles 9 months 1 0.5 -- Subcutaneous Upper At least 85%
Vaccine mL outer of measles
portion can be
(not MMR) of the prevented by
arms immunization
at this age
Tetanus Toxoid Immunization Schedule for Women
When given to women of childbearing age, vaccines that contain tetanus toxoid (TT or Td) not
only protect women against tetanus, but also prevent neonatal tetanus in their newborn infants.

Vaccine Minimum Percent Protected Duration of Protection

Age/Interval
TT1 As early as possible -- --
during pregnancy
TT2 At least 4 weeks later 80%  infants born to
the mother will
be protected
from neonatal
tetanus
 gives 3 years
protection for
the mother

TT3 At least 6 months later 95%  infants born to

the mother will
be protected
from neonatal
tetanus
 gives 5 years
protection for
the mother

TT4 At least 1 year later 99%  infants born to

the mother will
be protected
from neonatal
tetanus
 gives 10 years
protection for
the mother

TT5 At least 1 year later 99%  gives lifetime

protection for
the mother
 all infants born
to that mother
will be protected
References:
1.) Adele Pillitteri, MATERNAL & CHILD HEALTH NURSING edition #6 “Care of the
Childbearing & Childrearing Family”(2009)

Newborn Period, Newborn Care, Apgar Scoring, Newborn Screening (pages, 448-483)

2.) Public Health Nursing in the Philippines 10th edition (2007)

Immunization (pages 177,239)

Perpetual Help College of Manila

1240 V. Conception St.

Sampaloc, Manila
Submitted by:

Bacual, Shaykh Norman E.

Submitted to:

Mrs. Marqueses