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NEWBORN

Ma. Elizabeth N. Jurado


DEVELOPMENTAL TASKS:

1.BIOLOGIC TASKS
a. establishing and
maintaining respiration
b. circulatory changes
c. regulation of body
temperature
d. ingesting, retaining and
digesting nutrients
e. elimination of waste
f. regulation of weight
2.BEHAVIORAL TASKS

a. establishing a regulated
behavioral tempo independent
of the mother
b. processing, storing, and
organizing multiple stimuli
c. establishing a relationship with
caregivers and the
environment
TRANSITION PERIOD
1. FIRST PERIOD OF REACTIVITY

A.FIRST STAGE – lasts up to


30 minutes after birth

B. SECOND STAGE – lasts 2 – 4


hours

2. SECOND PERIOD OF REACTIVITY


– lasts about 2-5 hours
PHYSIOLOGIC STATUS OF
SYSTEMS
Respiratory System

– Onset of breathing initiated by


chemical and thermal factors
– Tactile stimulation
– Fetal lung fluid is removed during
normal process of labor and
delivery
Circulatory System

- Transition from fetal circulation to


postnatal circulation through
functional closures of the fetal
shunts (foramen ovale, ductus
venosus, and ductus arteriosus)
Thermoregulation

– Most critical next to respiration


– Factors that predispose the NB in
heat loss
• Large surface relative to his
weight
• Thin layer of subcutaneous fats
• NB’s mechanism of producing heat
(NST)
Hemopoietic System

– Blood volume depends on placental


transfer
– 80-85 ml/kg BW
– Average blood volume = 300 ml
Fluid and Electrolyte Balance

– Fetus = 73% water


– Adult = 58% water
– Has more extracellular fluids than
adults
– More prone to dehydration, acidosis
and overhydration
Gastrointestinal System

– Enzymes are available to catalyze


proteins and simple carbohydrates
but not complex carbohydrates
– Liver is the most immature of all GI
organs ( jaundice, bleeding, edema,
hypoglycemia)
– Salivation at 2-3 months
– Stomach capacity =60-90 ml
– Changes in the stool pattern
Renal System
– Unable to concentrate urine and
cope with the fluid and electrolyte
imbalances
– Total UO = 200-300 ml by the end
of the first week
– Bladder involuntary empties with a
volume of 15 ml (20 voidings)
– Urine is colorless, odorless and has
specific gravity of 1.020
Integumentary System
– Epidermis and dermis loosely bound
and are very thin
– Eccrine glands functional at birth
– Apocrine glands remain small and
non-functioning
Musculoskeletal System
– The skeletal system contains larger
amounts of cartilage than ossified
bones
Defenses against infections
– Skin and mucus membrane
– Cellular elements of the immunologic
system
– Antibodies to an antigen
Endocrine System
– Effect of the maternal sex
hormones evident in newborns

Neurologic System
– Primitive reflexes
– Myelination follows the principles of
growth and development
Sensory Functions
Vision- Structurally incomplete; tear
glands do not begin to function until
2-4 weeks of age; visual acuity
between 20/100 and 20/400; RBW
Hearing- reacts to sound once the
amniotic fluid has been drained
from the middle ear
Smell-reacts to strong odors
Taste- prefers sweet taste
Touch-face, mouth, hands, soles
PRINCIPLES OF IMMEDIATE CARE

AIRWAY PATENCY
* most critical adjustment a
newborn must make at birth
TECHNIQUES to maintain patent
airway:
- wipe off mouth and nose with
sterile gauze
- suctioning with the use of rubber
bulb syringe or suction catheter
- positioning
PROVIDE OPTIMUM TEMPERATURE

FOUR PROCESS OF HEAT LOSS:

1. CONVECTION – flow of heat from


the body surface to cooler ambient
air

2. RADIATION – loss of heat from


the body surface to cooler solid
surfaces not in direct contact but
in relative proximity to each other
3. EVAPORATION – loss of heat that
occurs when a liquid is converted to
a vapor

4. CONDUCTION – loss of heat from


the body surface to cooler
surfaces in direct contact
POSSIBLE WAYS TO PRODUCE
HEAT:

1. NON-SHIVERING
THERMOGENESIS

2. METABOLISM OF BROWN FAT

3. GLUCONEOGENESIS
HOW TO PROVIDE WARMTH:

1. Dry newborn’s skin


2. Wrap using soft blanket
3. Use of pre heated bassinet
or crib, radiant warmer,
drop light or floor lamp
INITIAL ASSESSMENT OF
CONDITION

APGAR SCORING
- was developed by Dr. Virginia
Apgar in 1952
- done on the 1st minute, 5
and 10 minutes after
- based on 5 parameters, ranked
in order of importance
A. HEART RATE

- palpating the pulsation


of the cord

- listening to heartbeat
with a stethoscope
between the left nipple
and sternum @ 3rd – 4th
LICS for 60 secs.
B. RESPIRATORY EFFORT
- “ a crying baby is a
breathing baby ”

C. MUSCLE TONE

D. REFLEX IRRITABILITY
- tested through a gentle
slap on foot; passing
catheter thru nose

E. COLOR
- acrocyanosis
PROPER IDENTIFICATION

- through footprints and


nametag/bracelet
- done before leaving the
delivery room, to prevent
“switching” of babies
- done before cord is cut
PREVENTION OF INFECTION
AND INJURY

CORD CARE
Normal = 1 vein and 2
arteries ( AVA )
Abnormal =
2 A & 2 V – Mongoloid;
1 A & 1 V-kidney agenesis
CARE:
a. asepsis should be observed
- present care needs no dressing
after cord has been clamped
or ligated and cut. If left
exposed, will dry because
water is lost and separates
more quickly than when
covered.
b. frequently inspect for
bleeding
c. cord is clamped – 2.5cm (1inch)
from the skin. Using a
disposable clamp, ligature or
cord tie
d. cleansed with betadine
antiseptic during the initial
care. 70% ethyl alcohol can
be used in the succeeding
cord care.
SKIN CARE- done to prevent
skin infection

oil bath – high risk premature


soap/water bath – full term

- ideally given when body


temperature has stabilized
at 37°C
PROPHYLAXIS

EYE care (Crede’s prophylaxis)

> to prevent ophthalmia


neonatorum or gonorrheal
conjunctivitis caused by
Chlamydia trachomatis
> use of ophthalmic ointments like
terramycin, tetracycline,
erythromycin
TECHNIQUE:
- inner to outer canthus while
exposing the lower conjunctival
sac
- could be delayed for 1 hour
- might interfere with the
maternal and infant bonding
which should be established as
soon as possible after birth.
Hypoprothrombinemia prophylaxis

> prescribed with single dose


0.5-1 mg of Phytomenadione
solution (Aquamephyton) per
IM, vastus lateralis
> Aquamephyton, a Vit. K water
soluble preparation – acts as
preventive measure against
neonatal hemorrhagic disease
-most newborns are born with
prolonged coagulation or
prothrombin time due to ↓
blood levels of Vit. K.

-Vit.K is necessary for the


formation of clotting factors
VII, IX & X, which are
synthesized through the
action of intestinal flora.
MOTHER – CHILD BONDING

-an effective bond between


mother and infant that is
specific to them from which
both gain security

-first social relationship for the


infant
-research shows mother and
child need time immediately
after birth ( a sensitive
period when infant is awake,
need parental contact for
optimal development )

-interferences from bonding:


sickness, caesarian section,
difficult labor
NUTRITION

Purposes:

a. Bonding
b. Involution
c. Breast feeding stimulation
- Bottle feeding is postponed
until sucking and swallowing are
well coordinated, to prevent
possible aspiration.

- Once feeding is started, give


sterile water initially, to
check for coordination of
sucking, swallowing and
presence of gag reflex.
- Observe the neonate’s
reaction, if there seems to be
violent reaction elicited when
swallowing, stop the
feeding.
- Breastfeeding infants are
brought to their mothers as
soon as possible and are fed
on demand basis
- Bottle-fed babies are given
routine feeding of 2 – 3 oz /
4 hours
BAPTISM OF INFANT
- If there is a probability that the
infant is in imminent danger and
may not live, question of baptism
should be considered if family is
Roman Catholic.

- Is an essential duty, means a


great deal to the family.

- Should be reported to the family


after.
NORMAL
CHARACTERISTICS OF A
NEONATE

MA. ELIZABETH N. JURADO


ANTHROPOMETRIC
MEASUREMENT

( BODY MEASUREMENTS )
WEIGHT AND LENGTH

Americans – 48-53 cm
(19-21 inches )
- 6-9 lbs
(2.7-4 kg)
Filipinos - 47.5 – 52 cm
(19 – 20 inches)
- 6.5 lbs (3 kg)
Newborn loses 5 – 10% 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
will regain weight in 10 – 14 days of age
later on, he will be gaining
1lb/month for the 1st 6 months of
life thus:
2x @ 6 mos
3x @ 1 year
4x @ 2 years
HEAD CIRCUMFERENCE

- crown-to-rump circumference or
the sitting height
- 33 – 35 cm or 13 – 14 inches
- measured at the widest part,
which is the occipito-frontal
diameter, located across the
center of the forehead and
most prominent portion of the
posterior occiput.
- increases by 50% at one year
CHEST CIRCUMFERENCE

- 30.5 – 33 cm or 12 – 13
inches
- usually measures about
2-3 cm less than the HC
- tape measure placed at
the level of the nipple
ABDOMINAL CIRCUMFERENCE

- same as CC
- measured at level of umbilicus
- must be cylindrical in shape
and protrude slightly
VITAL SIGNS
-TPR are always obtained
-BP not routinely assessed
unless there is a potential
for cardiac, bleeding or
renal problems

A. TEMPERATURE
- 36.5 – 37 °C or 97.9 – 98 ° F
In the past, it is taken per
rectum to locate anal
opening; thus ruling out
imperforate anus.

Today, it is generally accepted


that passage of meconium is
enough to indicate patent
anus.
B.RESPIRATION

- 30 – 60 breaths per
minute
- Varies with state of
alertness; are shallow,
irregular and abdominal
in nature
-With periods of apnea
lasting for 5 – 15
seconds. Thus, count RR
for 1 full minute

- If ↑ 60 – place temporarily
on NPO because of
danger of aspiration
C.HEART RATE

- Fluctuates between 120 –


140 beats/minute
- Influenced by the NB’s
activity; irregular
- Taken between left nipple
line and sternum for
1 minute
E. BLOOD PRESSURE

-High immediately after


birth and falls to a
minimum within 3 hours
after birth

-65/41 mmHg – at 1 to 3
days of age
HEAD TO TOE
ASSESSMENT

GENERAL APPEARANCE

- generally flexed posture


SKIN

Pre term – thin, translucent,


ruddy skin; with easily seen
veins and venules esp. over
the abdomen
Term – thick, pinkish, mottled
because of temperature
changes ( Cutis Marmorata )

Post term – thick, parchment-like


with peeling and cracking;
few blood vessels over the
abdomen.
COLOR VARIATIONS

Gray

- indicative of infection
Pallor

- usually as a result of anemia, that


is due to the following:
i. excessive blood loss @ the time the
cord was cut
ii. inadequate flow of blood
from cord into infant @ birth
iii. fetal–maternal
transfusion
iv. low iron stores due to maternal
nutrition during pregnancy
v. others: incompatibility, bleeding
Cutis Marmorata
-transient mottling when infant
is exposed to decreased
temperature

Acrocyanosis
- bluish discoloration of the
hands and feet due to poor
peripheral circulation and
vasomotor instability.
Cyanosis
- may indicate disease state
- observed in crying / quiet state

a. cyanotic when quiet and grows


pink when cries → atelectasis
b. with normal color when quiet
then cyanotic when crying →
congenital heart disease,
“Blue Baby“
Harlequin sign

- clearly outlined color change as


infant lies on side; lower half
of body becomes pink, and
upper half is pale
Physiologic jaundice or Neonatal
hyperbilirubinemia

- appears in 50% of all newborns


as a normal process of the
breakdown of RBC → infant’s
skin and sclera becomes
yellowish in color
Full term = appears after 24°,
becomes definite bet 2 – 7
days; disappears after 7th
day

Pre term = appears after 18°,


becomes definite bet 3 – 10
days; disappears after the 9th
– 10th day
-If occurs less than 24° after
birth; could be due to
Rh/ABO or blood
incompatibility reaction,
congenital enzyme deficiency,
drug induced hemolytic
anemia.
-In fetal days, needs higher
levels of RBC, Hgb, Hct for
sufficient oxygenation. After
birth, the need no longer
arises since lungs are
functioning, → destruction of
excess RBCs.
-Serum unconjugated bilirubin
does not exceed 12mg/100cc
-Above 20mg/100cc, will cross the
blood brain barrier →
interfere with chemical
synthesis of brain →
permanent cell damage and
possible mental retardation,
epilepsy, cerebral palsy →
KERNICTERUS
OTHERS

LANUGO – fine downy hair,


common on pre-terms

VERNIX CASEOSA – whitish,


cheesy, odorless substances
covering the skin, usually on
folds of the skin, more in full
term. It protects skin /
prevents heat loss.
FORCEP MARKS – circular or
linear contusion matching
the rim of the blade of
forceps on infant’s
cheeks. It disappears in
2 – 3 days.
MILIA – distended
sebaceous glands that
appear as tiny white
papules on cheeks, chin
and nose
TELANGIECTATIC NEVI
(STORKBITES)

– flat deep pink spots


found at the back of
the neck and above
eyelids
MONGOLIAN SPOTS
- irregular areas of deep
blue pigmentation, usually
in sacral and gluteal
regions;seen predominantly
in newborns of African,
Native American, Asian,
or Hispanic descent
ERYTHEMA TOXICUM
NEONATORUM

– newborn rash; Pink papular


rash with vesicles
superimposed on thorax,
back, buttocks, and
abdomen; may appear in
24-48 hours and resolve
after several days
DESQUAMATION
– dry peeling of the skin
particularly on the palm
and soles, more in post
terms

HEMANGIOMAS
– vascular tumor of the
skin
HEAD
- proportionately large; ¼ of
total length
- cranium is large and face
relatively small
- has 6 bony plates, connected
by suture lines. Growth of
these bones along the sides
causes the head to ↑ in size
FONTANELS are opening at
points of union of skull
bones

Anterior – is diamond shaped,


closes @ 12 – 18 mos
(2.5-4 cm)
Posterior – is triangular in
shape, closes @ 2 – 3
months (0.5-1 cm)
-bulges when cries, coughs,but,
when prolonged and tense,
may indicate ↑ ICP,
hydrocephalus, subdural
hematoma

- sunken and depressed may


indicate dehydration
VARIATIONS IN THE HEAD

1. MOLDING – asymmetric
adjustment in the shape of
the head to fit the cervix
during delivery
2. CAPUT SUCCEDANEUM

– swelling or edema of the


presenting portion of the
scalp; usually the occiput
area; disappears after the
3rd day; no treatment
needed
3. CEPHALHEMATOMA

– collection of blood between


periosteum of the skull bone
and bone itself. Caused by
rupture of a blood vessel
during delivery. Will take
3-4 weeks for absorption.
4. CRANIOTABES – snapping
sensation along lambdoid suture
that resembles indentation of
Ping-Pong ball

-More common in first born


infants due to pressure of
fetal skull against mother’s
pelvic bone. No treatment
needed. Normal in newborn;
but, pathologic in older
children.
EYES
- slate gray or dark blue or brown;
do not assume normal color till
3 months; absence of tears
- should be clear, no redness, no
purulent discharges
Normal findings:

-subconjunctival hemorrhage –
due to pressure during
delivery causing rupture of
small capillaries; no treatment

-edema of eyelids for 2–3 days


till kidneys are able to
excrete urine efficiently
- pseudostrabismus or transient
strabismus – cross-eyed

- DOLL’S eyes – eyes do not


follow movement of the head.
Persists for 10 days, then
disappear
EARS

- top of pinna should be in line


with the outer canthus of
the eyes
- ears set lower are found in
those with chromosomal
aberrations like trisomy 18
and with mental retardation
NOSE

- appears large for his face


- should be patent, with
thin, white mucoid nasal
discharge
- sneezing
- abnormal: choanal atresia
MOUTH

- should open evenly when he


cries, tongue appears
large
- intact, high arched palate
- uvula in midline
- if one side moves more
than the other: cranial
nerve injury
VARIATION:

Epstein pearls – small


whitish-yellow
accumulation of epithelial
cysts on hard palate,
disappears in a week
Abnormal:
-Thrush ( Candida infection or
Moniliasis ) – whitish/ grayish
adherent patches on tongue,
palate and buccal surfaces
Acquired through passage
into the birth canal
-Cleft lip / palate
-Protruding tongue
-Drooling
-Inability to pass NGT
NECK
-short and chubby (thick)
surrounded by skin folds
with tonic neck reflex

Abnormal:
- Nuchal rigidity
- Congenital torticolis (wry
neck) – head held to one
side with chin pointing to
opposite side
CHEST
- anteroposterior and lateral
diameters equal
- clavicles should be
straight and symmetrical
- appears small since head
is large; but, @ 2 yrs,
CC is greater than HC
-breast engorgement both for
male and female, due to
mother’s hormone

-occasionally, breast secretes


thin watery fluid: Witch’s
milk ( due to lactating
hormone from mother )
Abnormal:
Funnel chest (pectus excavatum)
– depressed sternum

Pigeon chest (pectus carinatum)


– abnormal prominence of
sternum

Asymmetric chest expansion


LUNGS

- 30 – 60 breaths per
minute; chiefly abdominal

- Abnormal: apnea more than


20 secs., dyspnea, rate
above 60/min, grunting,
see-saw respiration
HEART

-120 – 140 beats / minute


-between left nipple and
sternum; 3rd -4th LICS
-Abnormal: cardiomegaly,
murmurs, persistent
cyanosis
ABDOMEN

- cylindrical in shape; liver,


spleen, kidneys are
palpable
- a sunken appearance may
indicate missing
abdominal contents
UMBILICAL CORD – appears as a
white gelatinous structure
during the first hour. Check
for AVA.
·After the first hour = begins to
dry, shrink and become
discolored
·2 – 3rd day = turns black
·6 – 10th day = sloughs off,
should have no bleeding at
site
ANO GENITAL AREA

FEMALE
- vulva may be swollen due to
maternal hormones
- urinates within 24 hours

Variation:
PSEUDOMENSTRUATION –
blood tinged or mucoid
discharge
Abnormal:

- enlarged clitoris with urethral


meatus at tip
- no vaginal opening
- fecal discharge per vaginal
opening
- no urination
MALE
-urethral opening at the tip of the
penis; testes palpable at
each scrotum
-scrotum usually large,edematous,
-deeply pigmented
-smegma (thick, cheesy,
odoriferous secretions under
the prepuce )
-urinates within 24 hours
Variations:

- Urethral opening covered by


prepuce
- Inability to retract the
foreskin or phimosis
- Erection or priapism
- Testes palpable at the
inguinal canal
Abnormal:
Hypospadia - urethral opening
under the penis

Epispadia – urethral opening @


dorsum of penis

Cryptorchidism

Inguinal hernia
BACK / RECTUM
BACK – spine intact; appears flat
in the lumbar / sacral
areas
- no openings, mass or
prominent curves
RECTUM – patent anal opening;
passage of meconium
within 24°
Abnormal:

Spina bifida (Spinal hernia)

Imperforate anus

No meconium within 36
hours
EXTREMITIES

- arms / legs appear short,


hands plump, fist
clenched, fingernails are
soft, smooth and long
- ten fingers and toes
- full range of motion
- nail beds pink with
transient cyanosis
-creases in anterior 2/3
of the sole
-symmetrical extremities
-bilateral muscle tone /
brachial pulse
Variations:

Webbing ( Syndactyly )

Extra toes and fingers


( Polydactyly )
Major Abnormalities:
- Persistent cyanosis of nail beds;
fractures; dislocations
- Short arms ( Achondroplastic
dwarfism )
- Clubfoot ( Talipes deformity )
- Absence of extremities
(Amelia )
- Short extremities, wherein
hands and feet appear to
adhere to the body
(Phocomelia)
SELECTED CONDITIONS
OF THE NEWBORN

Ma. Elizabeth N. Jurado


HYPOGLYCEMIA

– low blood sugar (<40 mg/dl)

- CHO stores are low, glucose


is the main source of the
energy for the first 4-6
hours
- Prematurity, post maturity,
inadequate intake, stresses
(cold stress, difficult
birth)

-Will fall rapidly then


stabilize: from 50 to 60
mg/dl to 60 –70 mg/dl
sx: jittery; apnea; tense,
bulging fontanels; absent
moro reflex

tx:
1. oral glucose
2. keep warm
3. monitor the VS
4. administer ordered 10%-
25% IV glucose
HYPOPROTHROMBINEMIA
(neonatal bleeding disorder)
ANEMIA
WEIGHT LOSS
PHYSIOLOGIC JAUNDICE OR
HYPERBILIRUBINEMIA
Treatment:
1. early feeding- to speed
passage of feces thus
preventing reabsorption of
bilirubin in the bowels
2. phototherapy- exposure to
light to initiate maturation
of liver enzymes
DESQUAMATION
Hepatitis B (HBV) vaccine
administration

@ birth
@ 6 weeks
@ 14 weeks
Newborn Screening test for
diseases

· early screening and detection


of genetic disorders such as
phenylketonuria (PKU),
hypothyroidism,
galactosemia, and sickle
cell
· educate the parents on the
importance of screening
and to collect appropriate
specimens at the
recommended time (after
24 hours of age)
Universal Newborn Hearing
Screening

 screens all newborn infants


before discharge for
hearing loss by auditory
brainstem response or
evoked oto-acoustic
emissions
DAILY CARE OF THE

NEWBORN
BATHING

 hygiene and excellent


time for observation of
the neonate
 performed after VS have
been stabilized
 involve the parents in the
care of the child
 preserve skin’s “acid
mantle”
 within an hour after
delivery to remove the
vernix caseosa
 then ONCE A DAY,
before feeding in AM
Materials:
1. bath water- 37-38 C or 98-
100 F, warm to the elbow
room temperature- 24 C
or 75 F
2. oil
3. soap- mild
4. basin, wash cloth towel,
comb, clean diaper/clothes
Techniques:

- cleanest to the most soiled


area
- wash hair daily
- each part should be
washed and rinsed well
- include cord care
CLOTHING

 cotton, simple, comfortable,


not restrictive, light
colored materials
 no snaps that may be
accidentally removed and
swallowed
 appropriate to the kind of
weather
SLEEP PATTERN

 sleeps most of the time;


wakes up for the
physiologic need
 averages 16-20 hours; 4
hours at a time
SKIN CARE

- meticulous skin care;


otherwise may lead to
infection
NUTRITIONAL

ALLOWANCES
1. CALORIE
 up to 2 mos of age=
120 calories/kg
body wt or 50-55
kcl/ lb every 24
hours for adequate
amount of food for
growth
beyond 2 months, decreases
=100 kcal/kg or 45
kcal/lb/day
2. CHON

 first 2 months is 2.2 g per


kg body wt
 cow's milk has more CHON
(18 %) content than human
milk (16%)
 both contains an amino acid,
HISTIDINE, necessary
for infant growth but not
necessary for adult
growth
 main protein content in cow’s
milk: CASEIN; human milk:
LACTALBUMIN; humans milk
easier to be digested
3. CHO

 LACTOSE, a disaccharide,
the most easily digested
carbohydrate
 Improves calcium absorption
and aids in nitrogen
retention
 It provides stools in which
gram positive microorganism
predominates
 Adequate CHO levels in formula
allows CHON to be used in
building new cells
 cow’s milk: 29%; human milk:
37%
4. FATS

 human milk has 3x


more content than
cow’s milk
5. FLUID
 needs sufficient fluid
intake because rate of
metabolism is high and
metabolism needs water
 NB uses 45-50 kcal/kg in
24 hours for metabolism
 30-35% of NB’s fluid is
extracellular and kidney’s
immaturity causes failure to
fully concentrate urine so
large amount of water is lost
 has larger surface of the
body in relation to body
mass, thus large amount of
water is lost during
evaporation

 Requirement: 160-200 ml/kg


or 2.5-3 oz /lb/ 24 hours
6. CALCIUM

 needed for bone growth


 human milk has more
than cow’s milk
7. IRON

 maternal iron supplied


to NB is enough to
last for 3 months, until
he starts to
produce adult HGB
TYPES OF FEEDING

a. breastfeeding
b. formula feeding
c. mixed feeding
Breastfeeding

 Human milk is the


preferred form of
nutrition for the
full-term infant
Physiology of Breastfeeding

A. Milk secretion reflex or


prolactin reflex
- total emptying of the
breasts is the best
stimulus to more milk
secretion
B. Milk ejection reflex or
letdown reflex

- relaxed and secured


maternal feeling best
stimulates letdown reflex
Prerequisite:

a) physiologic readiness
b) absence of emotional stress
c) sucking – stimulates let
down reflex
d) rest, exercise, diet
Maternal Contraindication

1. narcotic addiction
2. active PTB
3. acute contagious disease
4. cardiac disease
5. cancer
6. extensive surgery
Infant Contraindication

1. cleft lip
2. cleft palate
Essentials of Breastfeeding
A. To start:
 right on the delivery table
PRIMARILY to promote
bonding
 within 30 minutes after
birth in normal spontaneous
delivery
 within 4 hours after CS
B. Duration:

 5 minutes/ breast after


establishment of feeding
 the first 10 minutes= for
NOURISHMENT
 the 2nd 10 minutes= for
SUCKING PLEASURE
CARE OF THE BREAST

 daily bath towel dry


 clean bra
 use of nursing pads
 no soaping; no alcohols on
nipples
ADVANTAGES OF

BREASTFEEDING
Mother

 promotes bonding
 promotes uterine involution
 delays fertility (but not safe to
use as sole means of FP)
 economically saves time,
money, effort
 less incidence of breast
cancer
Baby

· contains antibodies that


protects NB from GI
infections
· always available in sterile
form and correct
temperature
· less incidence of colic,
constipation, diarrhea, allergy

· its protein, LACTALBUMIN, is


easy to digest

· contains TAURINE that


enhances brain development
ARTIFICIAL FEEDING

 recommended only if
breastfeeding is not
possible
ADVANTAGES:
1. provides an alternative to
breastfeeding
2. more accurate assessment of
intake
3. may meet the needs of
working mothers
4. maybe indicated in cases of
congenital deformities,
inborn errors of metabolism,
allergies
FACTORS TO SUCCESS:
1. pasteurization of the milk
2. sanitation in milk handling
3. adequate sterilization,
refrigeration, storage
4. to be equal with mother’s milk
in nutrients: ADD sugar to
increase energy value,
DILUTE with water to reduce
minerals and CHON
concentration
SPECIAL CONSIDERATIONS

1.observe aspiration
precaution
2.hold bottle in upright
position so that the nipple
is always filled with milk
3.burp
4.demand feeding is preferred
than scheduled
B- EST FOR BABY
R- EDUCES ALLERGY
E- MOTIONAL BONDING
A- NTIBODY PRESENT
S- TOOL INOFFENSIVE
T- EMPERATURE ALWAYS IDEAL
F- RESH
E- CONOMICAL
E- ASY ONCE ESTABLISHED
D- IGESTED EASILY
I- MMEDIATELY AVAILABLE
N- UTRITIOUS
G-ASTROENTERITIS PREVENTED
COMMON SKIN DISORDERS
A. DIAPER DERMATITIS

1. diaper dermatitis-
perianal irritation due
to accumulation of
moisture, heat, and
chemical substances
2. ammonia dermatitis-
diffuse erythema in
the perianal and gluteal
areas caused by
breakdown of urea in
the urine to ammonia
by bacteria in the
feces
3. intertrigo – maceration
of any two skin surfaces
in close opposition /
chafing of the skin
B. MILIARIA/ HEAT RASH/
PRICKLY HEAT

- “bungang-araw”
- due to overdressing, warm
weather
C. SEBORRHEA DERMATITIS
- “cradle cap”
- due to accumulation of sweat
and dirt causing flat,
adherent and greasy scales
with pruritus and crusting;
usually indicates a secondary
infection
D. IMPETIGO

- macules, papules, pustules,


crusts- infection caused
by bacteria due to poor
skin care, overcrowding,
malnutrition
E. BOILS/FURUNCLES
- bacterial infection of hair
follicles common in the
face, neck, axilla,
buttocks
treatment: personal hygiene;
no squeezing; topical
neomycin cream; diet high
in CHON, low in fats and
CHO
F. ORAL MONILIASIS

- “oral thrush”; fungi infection


of the mouth
- caused by Candida albicans
- seen as white patches on the
tongue
prevention: oral hygiene; care of
maternal nipples
treatment: mycostatin or
nystatin oral swab