PART 1: CARE OF NEONATES PO2 Saturation Normal Level – 95 to 100

Aligned with Essential Intrapartum Newborn

Care (EINC)
Position
1. Immediate Delivery Room Care
Promote drainage of secretion by gravity
a. Time Bound / Band Intervention
Supine with head turned to the side or
lie laterally
I. AIRWAY
Put on top of Mom’s belly (Skin to skin
Prevent aspiration! contact or SSC)

Suction with bulb syringe if with lots of mucus

greening amniotic fluid – not routine in EINC
2. Maintaining a Stable Temperature
Suction, if not necessary, should not be done.
Prevent Hypothermia
Extreme
Green amniotic fluid is green – presence of Hypothermia
meconium.
Extreme Burns brown fat for
Amniotic fluid should be clear/colorless.
Hypothermia Heat

Difference between choking and aspiration Extreme Ketones / Fatty Acids

Hypothermia
Choking – solid object
Low O2, High CO2 =
Aspiration – liquid object Acidosis
Acidosis

Prevent heat loss by:

II. NEONATES MUST BREATHE AFTER
Evaporation: dry immediately
BIRTH
Radiation: keep crib away from cold wall / use
Stimulate the neonate to cry to get his own O2
heating devices; radiant warmer, floor lamps,
(hypoxia causes acidosis causing CNS
drop lights
depression)
Conduction: use pre warmed padded crib,
Death due to asphyxiation
“unang yakap” skin to skin contact
Stimulate only after airways are clear.
Convection: avoid cold air currents; always
A crying baby is a breathing baby! regulate DR birthing room temperature.

Pulse Oximeter to measure O2 saturation

Attached at fleshy portion of sole of lower Identification and Registration

extremities of baby.
  Plastic bracelet placed on ankle and crib o BCG and HEP B1 at birth
card 4. Newborn Screening for Metabolic
 Footprints – no longer routine Problems
o Most ideal: DNA genotyping o RA9288 – Newborn Screening
Act
Safety While Rooming In
Done to diagnose inborn errors in metabolism:
 Local Civil Registrar then PSA for Birth
Congenital Adrenal Hyperplasia, Galactosemia,
Certificate
Phenylketonuria, G6PD, Cretinism, Maple Syrup
Urine Disease that may cause either Death or
Mental Retardation.
Non Time Bound
Done by heel prick when baby is at least 24
1. Eye Care (Crede’s Prophylaxis)
hours old but not more than 3 days.
o Prevents ophthalmia
neonatorum (neonatal 5. Universal Newborn Hearing Screen
conjunctivitis) due to maternal 6. Initial Bath
gonorrhea or chlamydia o Done best when vital signs
trachomatis especially temperature is
o Done to all babies – Normal stable.
Spontaneous Delivery (NSD) or o At least 6 hours after birth.
CS (Cesarian Section) after the o Do not remove excess vernix
first complete breastfeeding caseosa
o Eye antibiotic applied on lower o Use warm water
conjunctival sac, inner canthus 7. Initial Cord Care
to outer canthus o Strict Asepsis
o Antibiotic used: 5% o Clamped when no longer
erythromycin, 1% tetracycline, pulsating / don’t milk!
betadine eyedrops o Check for number of vessels (2
2. Vitamin K arteries & 1 vein). Abnormality
o Neonates cannot synthesize may mean cardiac or renal
vitamin K because of absent problem.
intestinal bacterial flora. Subsequent Cord Care
o Prevents bleeding o Soap and water only
o Given IM, Vastus Lateralis – o Air exposure is best to promote
biggest muscle mass and most drying (no dressings and binder,
developed fold diaper below the cord)
o 1mg o Observe bleeding (1st 24hours);
o Avoid using gluteal muscle infection (yellow discharge)
(buttocks) because of danger of o Cord should fall of 7-10 days
sciatic nerve trauma causing after birth.
paralysis

3. Immunization
 PART 2: CARE OF NEONATES Anthropometric Measurements:

Assessment of the Newborn Measuremen Norm Abnormality Implication

t al
1. APGAR SCORING Birthweight 3000g; Small for Intrauterine
o 1st – 1 minute 6.5 lbs Gestational Growth
o 2nd – 5 minutes Age (SGA) – Retardation
<10% in the = SGA
If 5 minutes AS is still below 7, do every 5
Intrauterine Macrosomia
minutes until score reaches 7. Growth =LGA
Determine Adaptation to Extrauterine Life Chart (IUGC) Maternal DM
Large for
Criteria Assess 0 1 2 Gestational
Pulse Cardiac Absent <100 >100 Age (LGA) -
rate >90%
Respirati Cry Absent Weak, slow, Strong, Birthlength 50cm;
on difficult vigorous 19-20
Activity Muscle Limp, Minimal Well inches
tone flaccid flexion, little flexed, Head 33- Microcephal Mental
movement brisk 35cm y Retardation
movem Macrocephal Hydrocephal
ent y us
Grimace Reflex No Grimace Cries Chest 31-
Irritabil respon when Circumferenc 33cm
ity se stimulat e
ed Abdominal 31- Smaller than Diaphragmati
Appeara Color Pale / Acrocyanosis Pink / Circumferenc 33cm chest c Hernia
nce blue (peripheral/d red all e
all istal over
over cyanosis)
Head should be biggest part.

Remember as PRAGA instead of APGAR Appropriate/Adequate for Gestational Age

(AGA)
Normal Heart Rate for Newborn: 120 minimum
140 midpoint 160 maximum

Interpretation: Assessment of Gestational Age

0-3: severe distress Term – born between 38-42 weeks

4-6: moderate difficulty Assessment of Maturity using Ballard or

Dubowitz
7-10: absence of difficulty adjusting to
extrauterine life, may room-in with mother Assessment of Appearance

Skin: color (ruddy - reddish), cyanosis, pallor,

birthmarks, jaundice, harlequin sign, mongolian
spot, lanugo, vernix caseosa, milia,
desquamation
Harlequin sign – one part is redder (dependent
sign) while other side is pale; poor or sluggish
circulation
Physiologic Jaundice Pathologic Jaundice
Mongolian spot – birthmark at buttocks;
Term babies – 3rd-7th If noticed at birth or
accumulation of melanin pigment (Common
day aby is less than 24
with dark skinned babies)
Preterm- 2nd-10th day hours old
Lanugo – fine hair at cheeks or back commonly Caused by normal Biliary atresia
found on premature babies accumulation of Blood incompatibility
bilirubin due to
Vernix caseosa – cheesy covering of baby’s skin expected hemolysis
after birth
Milia – white head on baby’s nose

Desquamation – peeling off process of skin

Biliary atresia – obstruction in flow of bile at
common bile duct.
RBC BREAKDOWN
Normal RBC for newborn: 6-8 million

HEME GLOBIN Normal Hemoglobin for newborn: 16-18%

hemoglobin
BILIRUBIN
IRON RBC: 5-6 million
(UNCONJUGATED)
Hemoglobin: 12-14g/dL or 12-14%

<anemic
Skin, icteric sclera = jaundice
>polyctemic

Phototherapy aids in RBC breakdown for babies.

Goes to liver (glucoronyl transferase)

Head Assessment
CONJUGATED BILIRUBIN
 Size: 33-35
Excreted through feces(stercobilin) & urine  Fontanels: Anterior and Posterior
(urobilinogen)  Sutures

o Molding Caput Succedanum

Indirect/unconjugated bilirubin is fat soluble
while conjugated or direct bilirubin is water  Enlargement of head is
soluble. equal, movable,
disappears after several
RBC lifespan 120 days. RBC breakdown through days
hemolysis. o Cephalhematoma
 One-sided
enlargement; fixed,
 disappears after weeks
or months
Epstein pearl look like milia (white heads/spots)
present in baby’s mouth more so on the palate.
Epstein pearl is a collection of calcium deposits.

 Craniotabes Assessment of the Rest of the Body:

o Ping pong ball head
o Depresses when poked but
returns when pulled back.
o Due to lack of vitamin D,
Secondary to rickets or early
descent of baby
Neck: short, no head control
Chest: same size as abdomen, 2cm smaller than
head, straight clavicle (r/o fracture during
birth), witch’s milk, RR at 30-60 bpm, quiet
breathing.

What to expect?

Cries but tearless There will be a time where chest, abdomen,

head are the same in size. This is expected to be
Sclera of eye is difficult to see due to large
at 1 year old.
pupils
Witch’s milk – engorged nipples of baby that
Opening of mouth should be even when baby
when applied with pressure there is white
cries
secretions.

Apnea in newborn is only normal only if it’s 20

PART 3: CARE OF NEONATES seconds per episode.

Assessment of the Face Babies are thoraco-abdominal breathers. Both

thorax and abdomen rise and fall at the same
Eyes: should be clear, tearless until 3 months, time when breathing.
gray iris, may have slight edema of eyelids

If eyes look cloudy, this may be a sign of

congenital cataract.
Ears: level of top part in line with outer canthus
of eye
If it does not line up, indication of chromosomal
abnormality (trisomy 21 or down syndrome)
Nose: check for blockage (choanal atresia)
Abdomen: protruberant (barrel shaped not
scaphoid, moves with breathing.
Anogenital area: note passage of meconium (1 st
24 hours), check for cryptorchidism, and
phimosis in males, pseudomentruation in
females.

A sign of choanal atresia is that baby refuses to Imperforate anus – no anal opening
close mouth as one uses mouth to breathe or
refuses breastfeeding Cryptorchidism – undescended testicles

Mouth: should open evenly, tongue tied, check Phimosis – foreskin is adherent to glans penis
intact palate, epstein pearl, thrush, neonatal causing smegma
teeth
Back: flat spine, no sac or dimpling 1st 24-48 hours, followed by transitional stool
then milk stool.

Presence of sac or deep dimpling on buttocks

indicate vertebral congenital defect.
Extremities: muscle tone, symmetrical
movement, finer and toes abnormality,
clubbing, and dislocations.
Urinary System: voids within 24 hours after
birth, odorless light-colored urine, pink urine is
indication of uric acid crystals, which means
baby is dehydrated.
Immune System: limited until about 2 months,
IgG and IgA

Neuromuscular System:
Polydactyly – excess finger
 Reflexes: blink, rooting, sucking,
Syndactyly – fused fingers swallowing, extrusion, palmar
grasp, step (walk)-in place, grasp,
Clubbing – curved inward or sometimes tonic neck reflex (TNR), Moro,
outward of digits Babinski, Deep Tendon Reflex (DTR)
o Above are primitive
reflexes. As baby matures,
Assessments of Systems: these reflexes disappear.
Cardiovascular: closure of foramen ovale and  Senses:
ductus arteriosus with normal murmurs, o Hearing – recognize
Cardiac rate 120-140-160 bpm, sluggish mother’s voice
circulation causing acrocyanosis 1st 24 hours, o Vision – pupillary reflex,
more RBC than adults, normal high WBC, blink reflex present
decreased blood coagulation ability o Touch – well developed at
birth
o Taste- can discriminate
There should be no abnormal heart sounds tastes, prefers sweets
when baby reaches 3 months old. o Smell – present as soon as
nose is cleared

Respiratory System: initial breath triggered by

cold receptor and low PO2 levels after cord PART 4: CARE OF NEONATES
clamping, normal periodic apnea lasting less
Provide Optimum Nutrition: RA7600 or
than 20 seconds per episode, thoraco-
Rooming In Breastfeeding Act of 1992;
abdominal breathers, obligate nasal breathers,
with coughing and sneezing reflexes already EO51 – Milk Code

Gastrointestinal System: 60-90mL stomach Breastfeeding – the best feeding for all babies
capacity, limited ability to digest starch and fat, (must be done 8x a day) on demand and is
immature cardiac sphincter, meconium during exclusive.

Teach proper handling of pumped breastmilk

 Emergency Baptism As Necessary

I baptize you, ___ in the name of the Father, the

Son and Holy Spirit.

B – best for baby

R – reduced allergy

E – emotional bonding

A – antibody presence (IgA)

S – stool not so offensive

T – temperature is always right

F – fresh always

E – economical

E – easy once established

D – digested well

I – immediately available

N – nutritious

G – gastroenteritis prevented

PART 5: NEONATE CARE

If mother has absolute contraindication to

breastfeeding

Give advice on the use of breastmilk

substitutes.

 Type (infant formula only), give

water in between
 Preparation (sterilization / boiling)
 Feeding method (do not prop)
o Aspiration may occur
o Otitis interna/media
o Otitis externa

If problems arise,