MCN WEEK 6:

THE HEALTHY NEWBORN

TIME BAND: 1-3 MINS PROPERLY – TIMED CORD CLAMPING
ESSENTIAL INTRAPARTAL AND NEWBORN CARE (EINC)  Remove the first set of gloves
 After the umbilical pulsations have stopped, clamp the
Immediate Essential Newborn Care cord using a sterile plastic clamp or tie at 2cm from the
OBJECTIVES: To describe and carry out the evidenced-based routine umbilical base
care of a newborn baby at the time of birth and prevent  Clamp again at 5 cm from the base
complications.  Cut the cord close to the plastic clamp
 NOTES:
BASIC NEEDS OF A BABY AT BIRTH: - Do not milk the cord towards the baby
st
1. To breathe normally. - After the 1 lamp, you may “strip” the cord of blood
nd
2. To be warm. before applying the 2 clamp
3. To be protected. - Cut the cord close to the plastic clamp so that there is
nd
4. To be fed. no need for a 2 “trim”
- Do not apply any substance onto the cord
FOUR CORE STEPS OF ESSENTIAL NEWBORN CARE
 Immediate and thorough drying TIME BAND: WITHIN 90 MINS NON-SEPARATION OF NEWBORN
 Early skin-to skin contact FROM MOTHER FOR EARLY BREASTFEEDING
 Properly timed cord clamping  Leave the newborn in skin-to-skin contact
 Non-separation of the newborn and mother for early  Observe for feeding cues, including tounging, licking,
initiation of breastfeeding rooting
 Point these out to the mother and encourage her to
nudge the newborn towards the breast
TIME BAND: AT PERINEAL BULGING PREPARE FOR THE DELIVERY
 Check temperature of the delivery room TIME BAND: WITHIN 90 MINS NON-SEPARATION OF NEWBORN
o
- 25-28 C FROM MOTHER FOR EARLY BREASTFEEDING
- Free of air drafts (use tissue paper to check for air  Counsel on positioning
drops) - Newborn’s neck is not flexed nor twisted
 Notify appropriate staff - Newborn is facing the breast
 Arrange needed supplies in linear fashion - Newborn’s body is close to the mother’s body
 Check resuscitation equipment - Newborn’s whole body is supported
 Wash hands with clean water and soap
 Double glove just before delivery  Counsel on attachment and suckling
- Mouth wide open
ST
TIME BAND: WITHIN 1 30 SECS IMMEDIATE AND THOROUGH - Lower lip turned outwards
DRYING - Baby’s chin touching breast
 Do a quick check breathing while drying - Suckling is slow, deep with some pauses
Tinuyo for hypothermia
 Notes:  Notes:
-
st
During the 1 secs - Minimize handling by health workers
 Do not ventilate unless the baby is floppylimp - Do not give sugar water, formula or other prelacteals
and not breathing - Do not give bottles or pacifiers
 Do not suction unless the mouth are blocked - Do not throw away colostrum
with secretions or other material
 Weighing, bathing, eye care, examinations, injections
TIME BAND 0-3 MINS: IMMEDIATE, THOROUGH DRYING (hepatitis B, BCG) should be done after the first full
 Notes: breastfeed is completed
- Do not wipe off vernix  Postpone washing until atleast 6 hours
- Do not bathe the newborn
- Do not do footprinting CONTINUATION OF EINC CHECKLIST
- No slapping 15 to 90 Minutes:
- No hanging upside-down 38. Advise mother to observe feeding cues.
- No squeezing of chest 39. Support mother and instruct her on positioning and
attachment.
TIME BAND: AFTER 30 SECS OF DRYING EARLY SKIN-TO SKIN 40. Wait for full breastfeed to be completed.
CONTACT 41. After a complete breasfteed:
 If newborn is breathing or crying A. Administer eye ointment. Retracting right lower
- Position the newborn prone on the mother’s eyelid outward with forefinger, then instil ¼ inch
abdomen or chest strand of ointment along the lower conjunctival
- Cover the newborn’s back with a dry blanket surface from inner to outer canthus. Repeat
- Cover the newborn’s head with a bonnet procedure on the other eye. (prophylaxis for eye
infection)
 B. Do thorough physical examination. Take weight and
measure head, chest, and abdominal circumference
C. Administer vitamin K. Inject at right upper, outer
thigh. (IM; use cotton balls soaked in cool boiled
water)
D. Administer hepatitis B vaccine. Inject at left upper,
outer thigh. (IM; use cotton balls soaked in cool
boiled water)
E. Administer BCG vaccine. Inject at right upper arm.
(intradermal)
42. Advise optional or delayed bathing of the baby. (6 hours)
43. Advise exclusive breastfeeding per demand.
(world renowned protocol which is the mother baby
friendly hospital originated by the Philippines in Baguio
General Hospital by dr. clavario) 8 – 10 feedings per day
small frequent feeds. 1.5 cm of stomach only. First 3 days
they need protection. Prolactin is high produce more milk
by sucking in 3-5 days. Lactogenesis will come out in a
matter of 3-5 days. If asleep, it it okay since they need 5
hours uninterrupted sleep for brain growth. RA 128
lactation stations. EO 51. Milk Code. RA 10354 Responsible
parenting
44. In the 1st hour:
A. Check baby’s breathing and color.
B. Check mother’s vital signs.
C. Massage mother’s uterus every 15 minutes.
45. In the 2nd hour, check mother-baby dyad every 30
minutes to 1 hour.
46. Complete all records.
- Most accurate is rectally but the vagus nerve might be
stimulated and might increase the rr. Pwede
magkaron ng bradycardia. Not recommended to get
routinely.
- It can check if there is intestinal obstruction.
- All newborns are prone to hypothermia
- 1. Premature hypothalamus
- 2. Inadequate subcutaneous fats
- 3. There is no shivering mechanism among newborns
- 4. Body surface area is greater than their body
weight.
- COMPLICATIONS:
- 1. HYPOGLYCEMIA – they will use glucose as a source
of heat
- 2. ACIDOSIS – fat as source of body heat
- 3. RESPIRATORY DISTRESS – metabolic demand is
increased
Ways of losing heat:
- convection
 Transfer of heat into a colder surrounding air
- Conduction
 Transfer of air into a surrounding cold air into
a thing
- radiation
 transfer of heat into a colder object without
touchng the baby
- evaporation

PROFILE OF THE NEWBORN 2. Heart Rate (120 to 160 beats per minute)
I. Vital Statistics - PMI or point of maximum impulse is at the apical.
th
II. Vital signs Between the 3rd and 4 intercoastal space left mid
III. Physiologic Function clavicular line. Do not get the pulse rate but get pulse
IV. Physiologic adjustment to extrauterine life rate
3. Respiratory rate (30 to 60 breaths per minute)
- Normally in the first few hours of life, tachypnea and
I. VITAL STATISTICS apnea mught be evident. Physiologic Tachypnea
1. Weight ž (2.5 to 3.5 kg) should not increase in 20 seconds. Dahan dahan
- Done 90 minutes ideally before during skin-to-skin niyang inaabsorb ung amniotic fluid sa lungs niya.
- No metal clamp - Physiologic apnea should be below 20 seconds.
- 2.5 – 3.5 kg normal 4. Blood Pressure (60/40 mmHg)
2. Length ž (47 to 51 cm) - Not routinely observed
- 47-51 cm normal
- Bumbunan hanggang sole of the feet III. PHYSIOLOGIC FUNCTION
- Newborn’s knees are flexed 1. Cardiovascular System ž
3. Head circumference (33 to 35 cm)
- Point of circumference is temporal
- 33-35 cm normal
- If bigger head circumference there might be an
increase of intracranial pressure. Or hydrocephalus.
- Should be done everyday
4. Chest circumference ž (31 to 33 cm)
- 31-33 cm normal
- Normally 1-3 cm smaller than the head circumference
- Nipple line is point of reference
5. Abdominal circumference (29 to 31 cm)
- 29-31 cm normal
- 1-2 cm smaller than the chest - The fetal circulation is different of that is the newborn
- Point of reference is above or below umbilicus primary reason is because the baby do not use her lungs to
get oxygen intrauterine life. The oxygen is from placenta.
II. VITAL SIGNS - Artery - movement of blood away from baby;s heart
o
1. Temperature (36.5 to 37.4 C) - Vein - Movement of blood into the heart
 - Violet because of mixed blood combined oxygenated and I. Swallowing Reflex
unoxygenated J. Extrusion Reflex
- Foramen ovale opening of right and left atrium K. Foot Placing Reflex
L. Trunk Incurvation Reflex
STRUCTURE APPROXIMATE STRUCTURE M. Landau Reflex
TIME OF REMAINING N. Crossed Extension Reflex
OBLITERATION O. Deep tendon
1. Foramen Ovale 1 year Fossa Ovalis - To check how well the brain is developed
2. Ductus arteriosus 1 month Ligamentum
Arteriosum A. MORO REFLEX (STARTLE REFLEX)
3. Ductus Venosus 2 months Ligamentum - Strong for the first 8 weeks of life and fades by the
Venosum end of the fourth or fifth month.
4. Umbilical Arteries 2 to 3 months Lateral Umbilical - Nagulat with strong sound, extend upper extremities,
Ligament flex lower extremities.
Interior Illiac Artery - Intrauterine life
5. Umbilical Vein 2 to 3 months Ligamentum Teres B. GRASP RESPONSE
PALMAR - disappears 6 weeks to 3 months.
2. Respiratory System ž - Kamay
 First is breath initiated by lowered PO2 and increased PLANTAR - disappears at about 8 to 9 months
PCO2 with a pressure of 40 to 70 cm H2O. - Paa
- Enough surfactant C. WALKING REFLEX (STEP IN REFLEX)
3. Gastrointestinal System ž - Disappears by 3 months of age
- Pag talampakan nakaramdam n g flat surface, parang
 Vitamin K injection
naglalakad a siya in place
within 24 hours:
D. TONIC-NECK REFLEX (BOXER, FENCING REFLEX)
meconium = sticky, tarlike, blackish-green, odourless
- Disappears by 2 or 3 months.
2nd to 3rd day:
- Kung saan nakaharap ung face, the same extremity is
transitional stool = green, loose, resemble diarrhea
4th day onwards: extended, the opposite is flexed.
breast-fed = light yellow, sweet-smelling E. BABINSKI REFLEX
formula-fed = bright yellow, noticeable odor - Remains until 3 months of age.
 To help prevent bleeding synthesizes using the - Fetal life
normal flora in the intestines. GI tract is - Fanning of the finger toes with stimulation of the
sterile. talampakan
4. Urinary System ž F. SUCKING REFLEX
- Diminishes by 6 months of age.
 kidneys do not concentrate urine well, thus urine is
usually light in color, and odorless
G. SWIMMING REFLEX
 specific gravity is 1.008 to 1.01
- Ikakampay yung kamay at paa when in a pool
 daily urine output:
- first 1 to 2 days - 30 to 60 ml by first week - 300 ml –
H. ROOTING REFLEX
 small amount of protein is normally present - Disappears about 6 weeks of life.
- Hahabulin nila ung kamay mo in the cheeks
5. Autoimmune System ž
I. SWALLOWING REFLEX
- Nailulunok ung kung ano man napunta sa bibig
- Posterior part nilulunok
J. EXTRUSION REFLEX
- Disappears about 4 months of age
- Anterior part, naluluwa nila
K. FOOT PLACING REFLEX
- Pag may natapakan na hard surface, tatapak sila

L. TRUNK INCURVATION REFLEX

- Pag naka lie prone ung baby, if stimulated on the right
it will curve

M. LANDAU REFLEX
6. Neuromuscular System ž - Among older infants. There is no head lag
A. Moro Reflex
B. Grasp Reflex N. CROSSED EXTENSION REFLEX
C. Walking Reflex - Right leg stimulated, right leg will remove stimulation
D. Tonic Neck Reflex in the left leg
E. Babinski Reflex
F. Sucking Reflex O. DEEP TENDON REFLEXES
G. Swimming Reflex - Only remained in the adults.
H. Rooting Reflex - Normal score is plus 2
 II. Hyperbilirubinemia
- jaundice, normal if it happened 24 hours after
birth; pathologic jaundice if discoloration happen
within 24hrs due to blood circulation or descresia
- Newborns are at risk for physiologic jaundice due
to heme breaks into iron and protoporphyrin. RBC
breakdowns; (adult rbc contains 2 alpha and 2
beta chains - 120 days) fetal RBC; 90 days,
contains 2 alpha and 2 gamma chains which the
life is shorter than adult RBC. Heme breakdowns
faster into iron (reused not involved in jaundice)
and protoporphyrin (into indirect bilirubin or
unconjugated bilirubin - a fat-soluble and cannot
- Positive 3 is heightened reflex be excreted by the kidneys)
 For the removal from the body, it is converted
by the liver enzyme glucuronyl transferase
7. The Senses into direct bilirubin which is water-soluble
- hearing incorporated in stool and then excreted in
 first to have and go feces
- vision - Jaundice babies undergo fluorescent lighting; eyes
 black and white and genitalia are covered to avoid direct exposure
 12 inch and infertility
- touch  Light allow faster development or producing
 some do not want to be cuddled (check for liver enzyme glucuronyl transferase
signs of autism)  Can cause dehydration to the babies
- taste  Requires phototherapy if bilirubin is between
 sweet 8-12 dL; 20 deciliters = toxic to brain causes
- smell kernicterus
III. Pallor
IV. PHYSIOLOGIC ADJUSTMENT TO EXTRAUTERINE LIFE - Lack of blood or anemic or may be due to
-
Reactivity Periods bleeding hemorrhage
1. first period of reactivity IV. Harlequin Sign
- dapat gising at umiiyak because there is a - right side is pale, left side is pinkish; this is due to
sudden change in the environment. the left side-lying position as blood circulation
Nasanay sa masikip at dark na environment manifests more on the left side
- first 30 mins B. BIRTHMARK
2. resting period of reactivity I. HEMANGIOMAS
- warm dapat Strawberry Hemangioma
- nagaadjust na sa exrauterine life
3. second period of reactivity
- panahon na gigising na ulit, nakaadjust na
sa extrauterine life
APPEARANCE OF THE NEWBORN
NEONATAL PHYSICAL ASSESSMENT
1. SKIN
2. HEAD - - macular; purple or dark-red lesions, may or may
3. EYES not fade; port wine stain
4. EARS Nevus Flammeus
5. NOSE
6. MOUTH
7. NECK
8. CHEST
9. ABDOMEN
10. ANOGENITAL AREA
11. BACK
12. EXTREMITIES
- elevated areas formed by immature capillaries
and endothelial cells; fade usually at the age of 10
1. SKIN
Cavernous Hemangioma
A. COLOR
I. Cyanosis
- insufficient oxygen supply; acrocyanosis (pink and blue)
is normal for the first few hours of life adjusting to the
extrauterine life
 - dangerous; dilated vascular spaces, do not - not found in the full term or mature babies; sign
disappear; surgically remove as it cause internal of prematurity
bleeding H. DESQUAMATION

II. MONGOLIAN SPOTS

- pigmentation usually found in the buttocks

coming from utero - “nagbabalat”, sign of post-maturity, placenta is a
C. VERNIX CASEOSA good moisturizer and if it exceeds from the
effectivity of the placent this happens
I. MILIA

- For easy passage of baby through birth canal;

helps thermoregulation
D. ERYTHEMA TOXICUM (NEWBORN RASH)
- unopened sebaceous glands; looks like white
heads and fades in a matter of months
2. HEAD
A. MOLDING

- due to exposed sensitive skin in the surroundings

as it adopts in the extrauterine life
E. FORCEPS MARK
- the head is similar to the shape of the pelvic canal
B. CAPUT SUCCEDANEUM

- edema of the scalp; left and right side of the head;

- bruises when forceps are used during deliver
may resolve in a matter of days
F. SKIN TURGOR
C. CEPHALHEMATOMA

- signs of dehydration or for nutritional assessment

G. LANUGO
- collection of blood between the periosteum of a
skull bone and the bone itself; one side
D. FONTANELLES
 - Tongue appears large and prominent palate
should be intact, with presence of epstein’s
pearls
- All newborns have some mucus in their mouth
- Unusual to have teeth, but sometimes 1 or 2 are
present
 If suctioning, mouth first before the nose; not
more than 10-15 seconds as it can stimulate
- anterior (diamond shape) and posterior (triangular shape) vagus nerve
 Increased ICP, it intends to bulge
 If dehydrate, it is sunken (soft spot) 7. NECK
E. SUTURES - Short, chubby, and with skin folds
- Head should rotate freely
 congenital torticollis (damaged
sternocleidomastoid muscle)
 meningitis (meningeal irritation)
- congenital torticolis - meningitis
- Not strong enough to support total weight of the
head

8. CHEST
- Breasts may be engorged
- Presence of witch’s milk - (estrogen; released in
- allow overlapping of bone scalp; smaller the better for the breast of the baby)
vaginal birth - Chest should be symmetric
F. CRANIOTABES - Breath sounds may reveal presence of ronchi -
amniotic fluid were absorb in the alveoli, not the
meconium

9. ABDOMEN
- Slightly protuberant
- Bowel sounds must be heard within an hour after
birth
- Meticulous cord care (no more substance; dry,
- localized softening of the cranial bones clean, odorless and not bleeding)
3. EYES - Palpate for internal organs
- Newborns cry tearlessly (UNTIL 2 MONTHS)
- Irises are color gray or blue 10. ANOGENITALAREA
- In a supine position, lifting the head will open a A. MALE GENITALIA
newborn’s eyes - Scrotum is edematous and rugated
- Subconjunctival hemorrhage - (pressure during - Both testes must be present
vaginal birth)  Undescended testes - cryptorchidism
- Edema until the 3rd day - Cremasteric reflex
- Cornea is round and proportionate in size to that - Examine penis and prepuce
of an adult
B. FEMALE GENITALIA
4. EARS - Vulva is swollen
- Pinna bends easily - Has mucus vaginal secretions
- Normoset ears (outer canthus of the eyes is  Normal and expected coming from mother’s
aligned in the tip of the ears, superior part; down hormones. It will be faded in a matter of days
syndrome) C. ANUS
- Visualizing the tympanic membrane is difficult and  No imperforate anus
generally not attempted  No obstruction in the intestinal obstruction
- Test the hearing by ringing a bell about 6 inches  Easiest way to check this is through insertion of rectal
from each ear thermometer

5. NOSE
- May appear large for the face
- Milia is present
- Test for choanal atresia - breathing from the
mouth due to respiratory distress

6. MOUTH
- Open evenly when the baby cries
BACK One minute after birth, your newborn patient is actively crying in
 Spine appears flat response to your bulb syringe. His body is pink, and he is moving his
 Inspect skin to be certain there is no pinpoint openings extremities which are blue. His heart rate is 110. What is the
along the spinal cord area; check it with penlight newborn’s APGAR score? 9/10 score first minute
A - pink, blue = 1
 A newborn normally assumes the position in the uterus; in P - 110 bpm = 2
fetal position G - actively crying = 2
A - moving extremities = 2
EXTREMITIES R - actively crying = 2
 Arms and legs appear short
 Hands are clenched into fists
 Test the upper extremity muscle tone by unflexing the Ballard’s assessment of gestational age criteria.
arms for about 5 seconds
 Legs are bowed and short, and can be flexed and abducted (A) Physical maturity assessment criteria.
to such an extent that they touch or nearly touch the
surface of the bed

Assessmentfor Well-being
 APGAR
Scoring - by Virginia Apgar
 Maturity Testing Tool

(B) Neuromuscular maturity assessment criteria.

Posture: With infant supine and quiet, score as follows: arms and
legs extended # 0; slight or moderate flexion of hips and knees # 2;
legs flexed and abducted, arms slightly flexed # 3; full flexion of arms
and legs # 4.

Square Window: Flex hand at the wrist. Exert pressure sufficient to

get as much flexion as possible. The angle between hypothenar
eminence and the anterior aspect of the forearm is measured and
scored. Do not rotate your wrist.

Arm Recoil: With infant supine, fully flex the forearm for
5 sec, then fully extend by pulling the hands and releasing. Score as
follows: remain extended or random movements # 0; incomplete or
partial flexion # 2; brisk return to full flexion # 4.

Popliteal Angle: With infant supine and pelvis flat on examining

AS: (First minute, 5th minute)
surface, flex leg on thigh and fully flex thigh with one hand. With the
 8-10 score: Good and healthy condition, vital organs adapt
other hand, extend leg and score the angle attained according to the
well to extrauterine life
chart.
 5-7 score: Moderately depressed, needs
intervention and monitoring
Scarf Sign: With infant supine, draw the infant's hand across the
 0-4 score: Severely depressed, needs immediate neck and as far across the opposite shoulder as possible. Assistance
resuscitation to the elbow is permissible by lifting it across the body. Score
according to location of the elbow: elbow reaches opposite anterior
axillary line # 0; elbow between opposite anterior axillary line and
midline of the thorax # 1; elbow at midline of thorax # 2; elbow does
not reach midline of thorax # 3; elbow at proximal axillary line # 4.

Heel to Ear: With infant supine, hold infant’s foot with one hand and
move it as near to the head as possible without forcing it. Keep the
pelvis flat on the examining surface.

(C) Scoring for a Ballard

assessment scale. The point total from
assessment is compared to the left
column. The matching number in the
right column reveals the infant’s age in
gestation weeks.

REPUBLIC ACT 9288

NEWBORN SCREENING ACT
Institutionalized a comprehensive, integrative, and sustainable
national newborn screening system to ensure that every newborn
baby in the Philippines have the chance to undergo newborn
screening, which will ultimately spare them from either mental
retardation, serious health complication, or death from heritable
diseases that are left untreated or undetected.

● These are hard to detect unless newborn screening is

applied.