First 28 days of life

PRINCIPLES OF NEWBORN CARE

1. 2.

Stimulation Position should promote drainage

4.

Suctioning Airway patency
3.

B. Maintain appropriate body temperature.
 Chilling will increase the body’s need for oxygen.  COLD STRESS
 Metabolic acidosis  Hypoglycemia

 Dry the newborn immediately.  Wrap warmly  Put under a droplight

C. Immediate assessment of the newborn
APGAR SCORING – standardized evaluation of the newborn’s condition and serves as a baseline for future evaluations
• Performed at 1 minute and 5 minutes after birth

APGAR SCORING
SIGN
Heart rate

0
Absent

1
<100

2
>100

Respiratory effort Muscle tone
Reflex irritability

Absent Limp, flaccid
No response

Weak cry Some flexion of extremities
Grimace; weak cry

Good, strong cry Well-flexed extremities
Sneeze; good, strong cry

Skin color

Pallor or cyanosis

Extremities blue, body pink

Pink all over

APGAR SCORING
• Interpretation:
•0–3
• Serious danger and needs resuscitation

•4–6
• Condition is guarded and needs clearing of airway and supplementary oxygen.

• 7 – 10
• Good

BALLARD SCORING
• A revised assessment of Dubowitz scale (Maturity scale). • Assessment for gestational age • The total score of both portions is compared with the standard scale. • cit different parameters • Numeric scores from 0-5 is given

BALLARD SCORING
• Two portions:
1. PHYSICAL MATURITY
• Series of observation about skin texture, color, lanugo, foot, creases, genitalia, ear and breast maturity. • The body part is inspected, and given a score 0-5. • Should be done as soon as possible after birth

2. NEUROMUSCULAR MATURITY
• Observe and position the body to elicit different parameters

BALLARD SCORING
PHYSICAL MATURITY SIGN
SKIN

-1
sticky, friable, transparent

0
gelatinous, red, translucent

1
smooth pink, visible veins

SCORE 2
superficial peeling &/or rash, few veins thinning anterior transverse crease only stippled areola 1-2 mm bud well-curved pinna; soft but ready recoil testes descending, few rugae majora & minora equally prominent

3
cracking, pale areas, rare veins

4
parchment, deep cracking, no vessels mostly bald creases over entire sole

5
leathery, cracked, wrinkled

LANUGO
PLANTAR SURFACE

none
heel-toe 40-50 mm: -1 <40 mm: -2 imperceptable

sparse
>50 mm no crease

abundant
faint red marks

bald areas
creases ant. 2/3

BREAST

barely perceptable
lids open pinna flat stays folded scrotum empty, faint rugae prominent clitoris & small labia minora

flat areola no bud
sl. curved pinna; soft; slow recoil testes in upper canal, rare rugae prominent clitoris & enlarging minora

raised areola 3-4 mm bud
formed & firm instant recoil testes down, good rugae majora large, minora small

full areola 5-10 mm bud
thick cartilage ear stiff testes pendulous, deep rugae majora cover clitoris & minora

EYE / EAR

lids fused loosely: -1 tightly: -2 scrotum flat, smooth clitoris prominent & labia flat

GENITALS (Male) GENITALS (Female)

BALLARD SCORING

BALLARD SCORING
MATURITY RATING
SCORE WEEKS -10 20 -5 22 0 24 5 26 10 28 15 30 20 32 25 34 30 36 35 38 40 40 45 42 50 44

D. Proper identification
Must be done the DR. Use of identification band with permanent locks
case/hospital number the mother’s full name sex, date , and time of birth of the newborn.

Footprints are said to be the best way to identify newborns.

E. Nursery Care
Check identification of the newborn. Take the temperature
At birth is 37.2 °C Must be maintained at 35.5-36.5 °C Rectal route is preferred in order to check the patency of the anus

E. Nursery Care
• Take anthropometric measurements
• • • • Length Head circumference Chest circumference Abdominal circumference

• Weigh-taking
• Average birth weight
• 3000 – 3400 g

• Lower limit - 2500 g (5.5 lbs) • Physiologic weight loss

E. Nursery Care
• Vitamin K administration
• Facilitates production of clotting factors • 0.5 – 1.0 mg IM into the vastus lateralis

• Dress the umbilical cord.
• Check for the presence of 2 arteries and 1 vein • If not complete, suspect a congenital anomaly • Fall-off at 7-10 days

E. Nursery Care
• Crede’s prophylaxis
• Prophylactic treatment against ophthalmia neonatorum • Drugs used:
• Silver Nitrate 1% • Erythromycin ophthalmic ointment

• Feeding
• Initial feeding – test feeding consisting of an ounce of sterile water • Subsequent feedings – per demand

F. Physical Assessment
Pulse
120-140 bpm Irregular

Respiration
30-60 cpm Irregular and with periodic respirations Gentle, quiet, rapid but shallow, diaphragmatic and abdominal

Blood pressure
Not routinely measured in newborns unless cardiac anomaly is suspected. Normal values
At birth – 80/46 mmHg By tenth day – 110/50 mmHg

F. Physical Assessment
• Head
• Largest part of the infant’s body • Forehead is large and prominent • Chin is receding and quivers when startled or crying

F. Physical Assessment
• Fontanelles
• Spaces or openings where the skull bones join • Anterior fontanelle
• Diamond shaped • Measures 2-3 cm in width and 3-4 cm in length • Closes at 12-18 mos • Abnormal findings:
• Indented or sunken • Bulging

• Posterior fontanelle
• Triangular in shape • Measures 1cm in length • Closes 2-3 months

F. Physical Assessment
• Sutures
• Separating lines of the skull • Overriding is normal at birth • Should never appear separated or fused.

• Molding • Craniotabes
• Localized softening of the cranial bones. • The condition corrects itself without treatment after a few months.

F. Physical Assessment
INDICATORS Definition Location CAPUT SUCCEDANEUM Edema of scalp Presenting part CEPHALHEMATOMA Collection of blood Between periosteum of the skull bone and the bone itself Does not cross suture lines

Involvement

Both hemispheres

Cause
Period of absorption Treatment

Pressure
1 – 3 days None

Pressure
Several weeks Support parents

F. Physical Assessment
• Eyes
• Tearless • Should appear clear • Small Subconjuctival Hemorrhage
• Appears as a red spot on the sclera • Bleeding is slight and needs no treatment • Completely reabsorbed in 2-3 weeks.

• Edema around the orbit or on the eyelids
• Remain for the first 2-3 days

• Cornea should be round and proportionate to that of an adult. • The pupil should be dark.

F. Physical Assessment
• Ears
• The level of the top part of the external ear should be on a line drawn • Small tags of skin • Test hearing by ringing a bell 6 inches from each ear.

• Nose
• Appear large for the face. • Test for choanal atresia. • Presence of milia – small pinpoint white or yellow dots usually found in the nose, forehead & cheeks.

F. Physical Assessment
• Mouth
• • • • Epstein’s pearls Thrush Blowing bubbles of mucus Natal teeth

• Neck
• Short and often chubby with creased skin folds. • Head should rotate firmly on the neck and should be able to flex forward and back.

F. Physical Assessment
• Chest
• • • • • Should be symmetrical. Breast may be engorged. Witch’s milk Retraction should not be present Abnormal sounds:
• Grunting – suggestive of respiratory distress syndrome • High, crowing sound –suggestive of stridor or immature tracheal development

F. Physical Assessment
• Skin
• Color
• Normally with ruddy complexion • Generalized mottling • Cyanosis:
• Acrocyanosis • Central cyanosis

• Gray color indicates infection

F. Physical Assessment
• Jaundice • Due to inability of the newborn to conjugate bilirubin • Pathologic jaundice • Physiologic jaundice • Breastfed babies have longer periods of physiologic jaundice • Kernicterus. • Pallor - due to anemia • Harlequin Sign

F. Physical Assessment
• Birth marks
• Hemangiomas - Vascular tumors of the skin
• Nevus flammeus
• A macular purple or dark red lesion - “port-wine stain” • May appear lighter, pink patches at the nape of the neck – “stork’s beak marks”

• Strawberry hemangiomas
• Elevated areas formed by immature capillaries and endothelial cells • Formation is due to high estrogen levels of pregnancy. • Tend to be absorbed and shrink in size after 1 year.

• Cavernous hemangiomas
• Dilated vascular spaces • Raised and resemble strawberry hemangiomas

• Mongolian spots

F. Physical Assessment
• Vernix caseosa
• A white, cream cheese-like substance that serves as a skin lubricant. • Takes color of the amniotic fluid

• • • •

Lanugo Desquamation Milia Erythema toxicum
• Newborn rash • “flea bite rash”

• Skin turgor
• Resilient, feel elastic, fall back to form smooth surface after being grasped.

F. Physical Assessment
• Abdomen
• Slightly protuberant • Bowel sounds should be present within an hour after birth

• Anogenital Area
• Passage of meconium • Male Genitalia
• Scrotum may be edematous and has rugae • Testes should be present; if not descended, the condition is called cyrptorchidism • Elicit cremasteric reflex • Urethral opening should be open at the tip of the glans

• Female Genitalia
• Vulva may be swollen • Psudomenstruation

F. Physical Assessment
• Back
• Spine of newborn appears flat in the lumbar and sacral areas

• Extremities
• • • • • Arms and legs are short Hands are clenched to fists Unusually short arms may signify achondroplastic dwarfism Note for simian crease Arms and legs should be symmetrical • Erb-Duchenne paralysis • Congenital hip dislocation • Assess for finger abnormalities • Syndactyly • Polydactyly • Assess for talipes deformity (clubfoot)

G. Physiologic Function
• Gastrointestinal System
• Regurgitates if stomach is overfull • Meconium
• Sticky, tarlike, blackish-green, odorless material formed from mucus, vernix, lanugo, hormones, and carbohydrates that accumulated during intrauterine life.

• Transitional stool
• Second or third day of life • Green and loose, and may resemble diarrhea to the untrained eye

• Breastfed babies’ stool
• Golden yellow, mushy, sweet smelling, more frequent

• Bottle-fed babies’ stool
• Pale yellow, firm, slight more noticeable odor, less frequent

G. Physiologic Function
• Urinary System
• Must void within the first 24 hours • First voiding may be pink or dusky because of uric acid crystals that were formed in the bladder in utero.

• Immune System
• Prone to infection • Passive natural immunity • May have antibodies from the mother

G. Physiologic Function
• Neuromuscular System
• Should demonstrate general neuromuscular function by
• moving their extremities, attempting to control head movement, and exhibits a strong cry.

• Limpness – total absence of a muscular response to manipulation. • Senses:
• All are functional at birth • Touch is the most developed of all senses

G. Physiologic Function
• Reflexes
• • • • • • • • Blink Rooting Sucking Extrusion Swallowing Palmar Grasp Step-in Plantar Grasp • • • • • • • •

Tonic Neck Neck Righting Moro Babinski Magnet Trunk Incurvation Landau Parachute

NURSING CARE OF NEWBORN

A. FEEDING


Term newborn  Breastfed - may be fed immediately.  Formula fed – first feeding at 2-4 hours of age Feed by demand Feed by schedule Should be burped at least twice during feeding.

B. BATHING
Initial complete bath Bathed once a day. Best done by parents under nurse’s supervision. The room should be warm and water temperature should be 37 – 38 °C. Should be done before feeding. Should proceed from the cleanest to the most soiled areas. Talcum powder is not advisable.

 


  

C. SLEEPING

Should be positioned on the back for sleeping. Newborn sleeps an average of 16 hours of every 24 hours in the first week. By 4 months of age, the child sleeps an average of 15 hours of every 24 hours and through the night.

D. CORD CARE

Fold down diaper so that cord does not get wet during voiding. Dab rubbing alcohol (70%) once or twice a day

E. DIAPER AREA CARE

With each diaper change, the area should be washed with clean water and dried well. Wear gloves for diaper care as part of standard precautions.

F. CLOTHING

Cover newborn’s head to prevent heat loss

As a rule, to be comfortable, the infant should be dressed in one more layer of clothing than what the parents are wearing.