IMMEDIATE BASIC CARE

I. Establishment of Open Airway and Circulation

- Majority of babies cry at birth and take spontaneous respirations
- When the head is delivered, birth attendant immediately suction secretions, wipe
mucus from mouth, nose and face.
- As the fetal chest passes through the birth canal it is compressed, squeezing
excess fluid out of the lungs prior to the baby taking its first breath.
- After several seconds in this partly delivered position, fluid can be seen streaming
out of the baby’s nose and mouth.
- After birth, babies will cough and sneeze, mobilizing additional fluid that may be
in their lungs.
Assessment: APGAR
Appearance: bluish – acrocyanosis – pinkish
Pulse: 0 - > 100 – 100-120
Grimace: floppy – minimal – prompt response
Activity: Absent – flexed – active
Respiration: Absent – Slow and irregular – Vigorous cry
Total Score:
7-10: No Depression
4-6: Mild Depression
0-3: Severe Depression

II. Maintenance of Temperature

 Immediately dry the infant under a radiant warmer
 Skin to skin contact with the mother
 Keep neonates head covered with a bonnet
 Room in the neonate (the baby should not be separated from the mother).

Normal Temp : 37.2 upon birth (falls down to 36.5)

Modes of Heat loss:

1. Convection – air conditioned room, open window

2. Conduction – cold counter/ base
3. Radiation – near cold objects such as metals
4. Evaporation – drying of amniotic fluid

III. Identification of Newborn

 Newborn identification before a baby leaves the delivery area
 IDENTIFICATION BRACELETS with identical numbers placed in the baby and mother.
 Prevent from BABY SWITCHING.

IV. Vitamin K injection

Prevents neonatal haemorrhage during first few days of life before infant is able
to produce vitamin K.
Term: 1mg IM
Preterm: 0.5mg IM
Alternative Route:
• Oral Dose: 2mg orally at birth
• Repeat dose 2mg at 3-5 days and at 4-6 weeks of age.

V. Initiation of Breastfeeding
 Babies can be breastfed as soon as the airway is cleared and they are breathing
normally.
 Skin to Skin Contact
 Babies are placed on the abdomen of the mother

VI. Physical Assessment

CORD: AVA

VITAL SIGNS
RESPIRATION: 30-60 BREATHS
HEART RATE: 120-160 BPM
BLOOD PRESSURE: 80/46 – 100/50 mmHg
TEMPERATURE: 36.5 – 37.2 (AXILLARY)
rectal thermometer: check patency of anus

ANTHROPOMETRIC MEASUREMENT
1. Weight
Normal Birth Weight: 2,500 – 4,000 grams
Loses 5%-10% on the first week of life
Average weight gain:
• 30 gm/day in the first month of life
• 20 gm/day in the second month
• 10 gm/day afterwards during the first year of life
2. Length
From top of head to heel with the leg fully extended
Normal Length: 43-50 cm Filipino structure
Grows 1 inch/ month in 6 months
3. Head Circumference
Average range: 33-35 cm (13-14 inches)
Measure above eyebrows and stretch around fullest of the occipital at posterior
fontanel.
Normally 2 cms larger than chest
Measurement is repeated after molding and caput succedaneum are resolved.

Too small: microcephaly

Too large: macro/hydrocephaly
4. Chest Circumference
Average range: 30-33 cm (12-13 inches)
Measured across nipple line
Stretch tape around scapulae and over the nipple line
5. APPEARANCE
- Anterior Fontanel- Diamond; Closes By 12-18 Months
- Posterior Fontanel- Triangular; Closes By 2-3 Months
- Vernix Caseosa- White Cheesy Substance
- Lanugo- Fine Downy Hair
- Mongolian Spots- Dark (Blue Green Spots)
- Milia- Pearl White Spots On Nose And Forehead
- Erythema Toxicum- Newborn Rash
6. OTHERS:
- Meconium- First Stool; Greenish
- Caput Succedaneum- Edema Of Fetal Head Due To Labor
- Cephalhematoma- Accumulation Of Blood Between Cranial Bones And
Periosteum Following Delivery
- Jaundice
Physiologic – 1st To 3rd Day
Pathologic – < 24 Hours Of Life
- Breast- Slightly Enlarged Due To Maternal Hormones
- Genitals
Female: Vaginal Blood At 2-3 Days After Birth
Male: Left Scrotum Lower Than Right; Right Slightly Bigger Than Left
 Cryptorchidism
Phimosis

VII. MEDICATIONS
1. Crede’s Prophylaxis – prevent ophthalmia neonatorum
2. Vitamin K – prevent bleeding
3. BCG
4. Hepatitis B

VIII. Other Physiologic Functions

A. Cardiovascular System
Blood Values:
blood volume: 80 – 110 ml / kg body weight
hemoglobin: 17 – 18mg / 100ml
hematocrit: 45 – 50%
indirect bilirubin: 1 – 4mg / 100ml
WBC: 15,000 – 30,000 /mm3 at birth

B. Respiratory System
FIRST BREATH:
cold receptors
lowered PO2 (from 80 to 15 mmHg)
increased PCO2 (70 mmHg)
- 40 – 70 cm H2O pressure
- Breathing normalizes at 6 – 8 cm H2O

C. Gastrointestinal System
• Sterile at birth
• Stomach capacity: 60 – 90 ml
• Meconium: blackish green odorless matter formed from mucus, vernix,
lanugo hormones, carbohydrates
• Transitional stool : loose green, 2nd – 3rd day
• Breastfed: 3 -4 golden - colored stools
• Formula-fed: 2 – 3 bright yellow stools
• Jaundice: bright green stools
• Bile obstruction: gray-colored stools
 D. Urinary System
Single voiding: 15 ml
Daily urinary output: 30 – 60 ml ( first 1 – 2 days)
300 ml by week 1
- Pinkish urine – uric acid crystals

E. Neuromuscular System
Stepping reflex: disappears by 3 months
Moro (startle): disappears by 4 to 5 months
Rooting: disappears at 6th week 
Palmar grasp: disappears at 3 months
Tonic neck: disappears by 2 to 3 months
 Plantar grasp: disappears at 8 to 9 months
Sucking: disappears at 10 to 12 months
 Babinski: disappears by 12 months

IX. Daily Newborn Care

 The majority of complication of the normal newborn may occur during first
24 hours or within 7 days.
 Close observation and daily essential routine care is important for health
and survival of the newborn.
Major Goals:
 Establish and maintain homeostasis
 Stability of the normal physiologic status

WARMTH
 Keep the baby dry
 Wrapping the baby with adequate clothing – Layette
 Ensure head and extremities are well covered