IMMEDIATE CARE OF THE

NEW BORN
Objectives;
Gentleness and prevention of infection
Establishment and maintenance of respiration
Care of the umbilical cord
Care of the eyes
Stabilization of the baby’s temperature
Identification of the infant
Maintaining a record of observations on baby’s
temperature
 Gentleness and prevention of infection

Sterility must be maintained using aseptic techniques

during and after delivery to prevent cross infection from
either the mother or the delivery room.

Using gentle pressure during and after delivery, prevents

the likelihood of injuries or wounds that can ease the
entry of pathogenic micro-organism.
 Establishment and maintenance of
respiration
The infant’s respiration must be established and
maintained; the baby should cry lustily periodically to
create full expansion of the lungs that provides oxygen for
the blood which until birth was supplied through the
placental circulation.

Any infant who does not breathe within 30 seconds after

birth is considered to be in danger; this suggests close
observation and resuscitation measures.
 Cont’
A method of scoring the amount of retraction, respiratory
rate and absence or presence of cyanosis present indicates
the degree respiratory difficulty in the new born;
resuscitation with an ambubag is essential.

Failure of the baby to cry suggests obstruction of the air

passage with mucus; mucus drainage with the help of a
bulb syringe is necessary.
 2 POINTS 1 POINT 0 POINT

AApgar score
Complete pink
body and face
pink body, blue limbs, pale or blue
pale body and face body and face

P more than 100b/m, 100b/m or less, WHR

SHR
NHR, or
response
Crying, coughing Grimace or puckering No response
G or sneezing of face

Active mov’t Some response to No mov’t of

A waving arms or stimulation legs, arms,
legs palm

R Strong cry Slow irregular No cry or

breathing or weak cry breathing
 Cont’
Classification according to total score;
Apgar 7 – 10 = normal
Apgar 4 – 6 = moderate asphyxia
Apgar 0 – 3 = severe asphyxia
 Care of the umbilical cord

• The cord felt for, around the neck during delivery when it is
slipped over the baby’s head and if it is tight around the baby’s
neck pressure increases at the baby’s neck, which calls for
clamping of the cord with two cord clamps and then cut to
relieve pressure as the head adverse or turns during restitution.

• Instruments used should be sterile to prevent infections. In case

it is not around the neck, it is clamped after delivery, 8-10cm
from the umbilicus.

• Application of gauze over the cord while cutting it with scissors

will prevent blood from splashing on the delivery place.
 Care of the eyes

As the baby’s head is born eyes are swabbed using sterile
swab; one swab per wipe, inwards to outwards and
discarded to prevent transmission of infections like
gonorrhoea (ophthalmia neonotorum).

In additional, application of tetracycline eye ointment is

helpful in preventing and treating the suspected eye
infection on the new born.
 Stabilization of the baby’s temperature

Since the delivery room temperature is lower than that of

utero, drying and wrapping the baby in a dry, warm, sterile
flannel blanket immediately after birth is helpful in
preventing the drop in baby’s temperature.
 Identification of the infant

The baby must be labeled with identification arm band or

tapes, marked with identification numbers of both the
mother and the baby or the foot or thumb print of the
baby before leaving the delivery room.
Maintaining a record of observations on baby’s
temperature

Three hourly frequent observations should be made on

the baby to ensure regular respiratory rate, colour and
exclude minor haemorrhage from the cord, but if the
bleeding is serious, tightening of the cord with a new
ligature is helpful.
 Purpose of immediate care of the new
born
Purpose of immediate care of the
new born

1To establish, maintain and support respirations.

2To provide warmth and prevent hypothermia.

3To ensure safety, prevent injury and infection

4To identify actual or potential problems that may require

immediate attention
Purpose of immediate care of the new
born
1 To establish, maintain and support respirations, Ensuring that
the airway is clear, removing mucus and other material from
the mouth, nose and throat with a suction pump. Immediately
after birth, the infant is quickly examined for respiratory
problems and abnormality The most important need for the
newborn immediately after birth is a clear airway to enable the
newborn to breathe effectively since the placenta has ceased to
function as an organ of gas exchange.. The nurse determines
whether resuscitation and other immediate interventions are
necessary
Con’t…
 2 To provide warmth and prevent hypothermia Drying the
baby with warm towels or cloths, while being placed on the
mother's abdomen or in her arms. This mother-child skin-to-
skin contact is important to maintain the baby's temperature to
ensure no metabolic problems associated with exposure to the
cold arise.
3 Clamping and cutting the umbilical cord with
sterile instruments, thoroughly decontaminated
by sterilization. This is importance for the
prevention of infections
4 4 To prevent infection prophylactic eye treatment
against gonorrhea conjunctivitis, may be passed on
the fetus from the vaginal canal during delivery,
Erythromycin or tetracycline Ophthalmic Ointment is
usually placed into the eyes to prevent infection
5
Vitamin K is also administered to prevent
haemorrhagic disease of the newborn because
The newborn has a sterile intestine at birth,
hence, the newborn does not possess the
intestinal bacteria that manufactures vitamin
K which is necessary for the formation of
clotting factors.
6Promotion of early maternal-infant attachment.
Immediately after birth and for some time thereafter the
mother and newborn form what is called the maternal-
child dyad. Formation of the dyad seems to be an
important factor in the continued process of parent-
child attachment. Historically, formation of the new
family has been believed to depend to a large extent on
the integrity of this dyad. Maternal- infant bonding, is a
vital component of the attachment process that occurs
in the postpartum period.
. Bonding is any one necessary component of the
parent-child attachment process. The outcome of
these processes will be the individuation of the
child and mother into two independent,
autonomous individuals, a parent and child who
have health and love.
7 To evaluate the gestational maturity of the
newborn.
The gestational age assessment of the
newborn’s physical and neurologic characteristics
to determine the number of weeks from
conception to birth. It is important because neonates
born before or after term and those whose sizes are
not appropriate for gestational age are at high risk to
premature related complication.
8 To determine the health of the newborn’s central
nervous system through the assessment of the
presence and strength of the reflexes. Assessment of
the presence and strength of the reflexes is
important to determine the health of the newborn’s
CNS. The nurse notes the strength of the reflexes
and whether both sides of the body responds
symmetrically,
A diminished overall response occurs in preterm
and ill infants. Absence of reflexes may indicate a
serious neurologic problem. Asymmetric response
may indicate that trauma during birth caused
nerve damage, paralysis or fracture.
Prior to transferring the baby from the labour suit
the midwife must undertake a detailed examination
of the baby checking for obvious abnormalities.
The birth weight of the baby is taken at the end of
the first hour time of birth and sex of the baby are
noted and recoded.
• The initial cord clump is replaced with a more
permanent plastic clamp
• Sample of blood is obtained from the cord then I.M
vitamin K is administered to the baby to prevent
haemorrhage, since vitamin K is synthesized in the GIT
is sterile supplement vitamin K is necessary to
produce prothrombin in the liver until the baby 3-4
days of life. Apply TEO in baby’s eyes then dress up
the baby in dry, soft cotton clothes.
• Ensure environmental temperature remains warm,
25oc. Then transfer the baby to postnatal unit at
the mother’s side or in her arms to avoid heat loss
and also promote mother – baby bonding.
Provide support for initiation of breast feeding
observes the new born when he/she shows
feeding cues (opening of the mouth, tonguing,
licking etc). Then make verbal suggestions to
the mother to encourage her new born to
move towards the breast. Counsel mother on
positioning and when the baby is ready advise
her to:
• Make sure the new born’s neck is not flexed or
twisted, and he is facing the breast, nose opposite
the nipple and chin touching the breast.
• Hold the new born’s body close to her mother by
supporting the whole baby not just the neck and
shoulders.
• Wait until baby’s mouth is open wide.
• Move the new born onto her breast aiming the
infant’s lower lip well below the nipple.
• Baby’s chin touching the breast
• Sucking should be slow, deep with some causes
• Remove the air from the baby’s upper GI when he
has completed breast feeding, and then put him in
his cot to sleep, or even leave him at the mother’s
side.
.
• Make sure the applied TEO is not wiped off baby’s
eyes.
• Therefore within the first 90 minutes to 6 hours of
life after birth, eroute:
• Baby has an identification band
• He is breathing well
• Has been examined by the midwifery
• Weighed
• Sex is known by the mother
• He / she is warm
• If possible immunised with polio O and BCG
• Cord well clamped and not bleeding
• Baby is able to suckle the breast
• Tetracycline eye ointment is not wiped off baby’s
eyes
• The baby’s 1st bath should be given a t least after
13 hours after birth, when the baby has warmed
up to an axillary temperature of 36.5oc. The bath
aims at removing blood and other secretions from
the baby.
• Bath should be performed from head to toe using
warm water and a mid soap.
• Female genitalia should be cleaned in a front to
back manner to prevent UTIs
• In male neonates any smegma around the glans
should be wiped away but the foreskin should not
be forcefully retracted.
• The umblicus provides an excellent medium for
infection therefore it should be cleaned using saline
water and sterile swabs after every clamper change.
Fold the top of the diaper back after cleaning to expose
the umbilical area thus enhance drying.
• Do it for the mother as she watches so that she learns
to do it herself when discharged
• N.B Do not apply anything on the baby’s cord
after cleaning, it will just dry and drop off by
itself after some days.
• If the baby is stable after 12 hours of birth,
continue reviewing the above mentioned aspects
at least every 2 hours.
• Emphasis on nutrition, cord care, hygiene and
keeping the baby warm, promote parent-infant
bonding, and prepare for discharge, by doing
the pre-discharge counselling concerning
baby’s care:
• However, if after 30 seconds of thorough drying
the new born is not breathing or crying even
after stimulation, remain calm, do first things
first:
• Call for help
• Inform the mother that the new born has difficulty
in breathing, reassure her and keep her informed
of whatever is happening to her baby.
• Start the resuscitation protocol ( chest
compression and bagging), remember first give
two rescue breaths by use of an ambulg then
using 2 fingers do chest compressions thus 15
times followed by 2 breaths.
• If the baby is non – vigorous (floppy and not
breathing and meconium stained) and:
• Health worker not skilled at advanced resuscitation,
or skilled but not equipped with intubation needs,
• Clear the mouth
• Cont bag / mask ventilation
• Refer and transport
• Health worker with advanced skills at resuscitation.
• Intubate the new born and provide positive
pressure ventilation
• Refer and transport as necessary
• If in a setting that is equipment with advanced life
support machine, transfer the new born to neonatal
intensive care unit, do not leave the mother alone,
reassure her, keep her informed each step you are
concerning her baby and let her family members
who are around sat with her preferable the
husband.
OBJECTIVES
• Identify the requirements used in general
examination of the new born baby
• Prepare the mother physically and
psychologically for baby examination
• Demonstrate how to carry out baby
examination systematically
• Document the finding following examination
of the new born
• Its carried out before the first bath,
• It begins with a series of measurements ,
including
• Weight
• the average weight at birth is 2.5kg
• Length
. Head circumference
• AIMS
• To determine maturity of the baby
• To exclude congenital abnormalities and
assess the baby’s condition
• To exclude birth injuries
• To assess baby’s condition generally
• REQUIREMENTS
• Thermometer, tape measure,
• PROCEDURE
• Explain the procedure to the mother
• Close the nearby windows
• Wash hands
• Un dress the baby and expose the part to be
examined only
• Position the baby in a supine position
• When caring out physical assessment of the
new born, you will need to be able to
communicate effectively with another, father
and family to assess how the new born is doing,
you need to provide practical guidance and
support for breast feeding as well as information
on cord care and other care in the home for the
baby.
• As you question the mother try to maintain
simple and appropriate language. Treat any
concern she raises about her baby or her role as a
mother with respect even if her worries might
appear unnecessary to you.
• You should maintain her first at this time so that
she can come again. All mothers specially first
time mothers need a lot of support and
reassurance that may lead to good care. You can
explain some by active demonstration for example
how to lift.
 AT BED SIDE
ATRAY CONTAINING
Gall pot with cotton swabs Weighing scale

A bottle of normal saline or boiled cooled water Adequate light

Tape measure Stethoscope

Rectal thermometer Baby’s linen

Apron Baby’s chart

Receivers

Gloves, Vaseline lubricant,

Cord ligatures, cord scissors

Temperature
• indicate whether oral or axillary(is usually 1degree
lower than rectal)
Rectal –is usually 1 degree higher than oral
• Respiration normal,40-60breath/min
• Blood pressure-correlates directly with gestational
age, postnatal age of infant, and birth weight.
• Pulse rate ranges 120-160 but in normal healthy
babies the heart rate increases with stimulation.
HEAD
Molding:
• A normal head -first delivery leaves the head
slightly molded for several days,
This should go untouched
Caput succedaneum
T he bones that form the skull overlap, which allows
the head to become compressed for delivery , Some
swelling and bruising of the scalp is typical
Cephhalhematoma
Is asubperioteal hemorrhage that never extends
across the suture line, this is due to traumatic or
forceps delivery
Sometimes bleeding from one of the bones of the
skull and its outer covering causes a small bump on
the head that disappears in a few weeks.
• When breech delivery, the head is usually not mis
shapen, however , the buttocks, genital , or feet
may be swollen and bruised
1. Circumference ;
• Place the measuring tape around the front of the
head and the occipital area , the tape should be
above the ears. this is known as the occipito frontal
circumference which is normally32-37cm at term.
LENGTH
The length is measured into two stages using a non
stretcheable tape measure from the crown (top part of
head) to the base of the spine, and from the base of
the heel. A second person may be required to
straighten the legs
The weight of the baby should taken in kilograms,
this can be taken at the beginning or end of the
examination provided the baby is warm.
Assessment of gestational age .
 THE FONTANELLES
• Are two in number, a fontanelle is a space
between the bones of an infant skull where the
sutures intersect and are covered by tough
membranes
1. ANTERIOR FONTANELLE (SOFT SPOT)
The junction where the two frontal and two parietal
bones meet.
The anterior fontanelle remains soft until about 9-
12months
2. POSTERIOR fontanelle
The junction of the 2parietal bones and the
occipital bone. It usually closes first before the
anterior fontanelle.(2-4months)
A bulging fontanelle is seen in hydrocephalus,
infections, newborn with dehydration have
depressed fontanelles, a small anterior fontanelle
may be associated with hyperthyroidism or
craniosynotosis.( premature closure of 1or more
sutures)
• Note the appearance of the face , nose, mouth,
chin, to exclude possible paralysis
• Compression through the birth canal may make
the face initially appear asymmetrical
( never compress to organize it , it goes slowly )
• This a symmetrical sometimes results when one
of the nerves supplying the face muscles is
damaged during delivery, recovery is gradual over
next few week
• Pressure during vaginal delivery may bruise
the newborn’s face
• Examine the eyes to ensure all the two are present,
assess their size and shape and any slanting,
CATARACTS
• may be noticeable by a study and be noted. This is
not normal and could be indicative of infection. The
presence of conjunctival haemorrhage, usually
acquired during the second stage of labour, should
be noted
check and note any discharge ( to rule out neonatal
opthalmia) setting of the eyes, color and opening
The pupils should be examined and should appear
round. Occasionally , a key hole shape is present
(colobomal) which could be indicative of an
underlying refine defect
• The shape of the nose and width of the bridge
should be observed, this should be greater than 2.5
cm in the term baby. It is not unusual for the nose
to be squashed at birth, if so this should be noted,
particularly if is affecting the baby’s ability to
breath. The nostrils should be flare, if they do, this
is usually indicative of respiratory illness.
• Examine the nose for discharge, patency of the
nares and any congenital abnormality( cleft palate,
additional openings, malposition)
• Observe the mouth, the lips should be formed
symmetrical. A symmetrical could be indicative of
fiscal palsy. A small mouth may be due to
micrognathia. Often associated with underlying
abnormality.
• Examine the tongue for size and any congenital
abnormalities, Oral thrush.
Areas between lips and nose should be examined for
the presence of a cleft lip. The inside part of the
mouth should be visualised using a good light
source achieved when baby is crying, observe
palate for Cleft palate, length of frenulum and
colour of white spots.
• Examine the ears to ensure two are present and
they are fully formed in the correct position. The
ears of the term baby should contain enough
cartilage to allow the ears to spring into position
when move of forward quantity. The pinna should
be well formed, and correct positioning is
determined by tracing an imaginary line from the
outer canal thus of the eyes horizontally back to
the ears, the top of the pinna should be above this
line.
(Trisomy 92) is an underlying chromosomal
abnormally (rose 1994)
look for unusual shapes or mulposition
• Assess for firmness, presence of cartilage,
placement and hearing .
• Hairy ears, is seen in babies of diabetics mothers,
• Look for discharge
• Babies have short necks, which should be
examined for symmetry. Move the fingure around
the neck to detect the presence of any swelling for
example cystic hygroma, sternomastoid tumour,
hematoma, webbing is
unusual and could be an indicative of turners
syndrome or reduced skin fold at the back of the
neck.
• Eliciting rooting reflex ,causes the infant to turn
the head and allows easier examination of the
neck.
• Palpate thyroid for enlargement and check for
throglossal duct cyst
• Turn the neck gently and palpate for masses, and
palpate the clavicles to rule out fractures that
could have occurred at delivery and also
dislocations.
• Using the index finger, feel along the clavicles to
ensure that are intact particularly if there was a
breech presentation or shoulder dystocia both
increase the risk of fracture of the clavicle,
resulting in little or no movement in the associated
arm.
Both arms should be available, same length, rule out
neurological impairment. Poor motor control by
determining the movement.
• HANDS
• The flexibility and mobility of arms , legs , and hips,
are checked for dislocation
• Note the size and length of the hands , to rule out
deformity,
• Examine the axilla, elbows and note the flexion and
rotation of the wrist and elbow joints
• Count the number and formation of fingers
• Examine the palmer creases
• Note abnormal features like extra digits
• Look at the nails for the presence of paronychia as
may become infected or get caught on bedding
causing them to tear and bleed.
• Examine the chest for symmetry , movement with
respiration. Respiratory rate .. can be counted if
needed and any signs of respiratory distress for
example sternal recession, intercostals recession
report to the paediatricians immediately. The
breast may appear enlarged, this is normal and of
little significance unless there are signs of
infection
• THE CHEST
• Take the chest circumference with tape measure.
Normal range is 30-33cm
• Count respirations, normal-
Apex beat , note regularity. Normal range is 120-
160B/M
• Breasts, note the size and location of nipples, extra
nipples, and discharge
• The breast may appear enlarged, this is normal
and of little significance unless there are signs of
infection
• HEART BEAT AND BREATH SOUNDS
• Listen to the heart and lungs through a
stethoscope to detect any abnormality
• Newborn babies have faster heart rates than adults
HEART BEAT RANGES
• Between130-160 beats per minute,
this usually slows down as the child
gets older to about 100beats
• per minute in new born babies to
six months old.
• Observe skin for the following
• Rashes
• Swelling
• Colour
• Birth mark
• Bruising
• Spots
The general condition of skin for any sign of
problem
Plethora( deep, rosy red/ruddy color.)
is more common in babies with polycythermia but
can also be seen in an overoxygenated or
overheated babies.
Erythemaneonatorum-an overall brush to reddish
color, it occurs in the transitional period and can
occur when a baby is stimulated , its normal and
JAUNDICE
Yellowish color if secondary to indirect
hyperbilirubinemia, greenish color if secondary to
direct hyperbilirubinemia.
Its abnormal in babies less than 24 hours and may
signify Rh
incompatibility,sepsis, and TORCH(Toxoplasmosis
other
Rubella, cytomegalovirus, and herpes simplex virus)
after 24hrs it may be due to these diseases or
from ABO. INCOMPATIBILITY or physiologic causes
• It is vital to determine discoloration days after birth
to know mongolian blue sport or Asian or balck
ancestry appearance,
• PULSE
• The strength of pulse is checked.
BREATHING EFFORT No breathing-0 Slow or irregular respiration-1 Infant cries well-2

Heart rate , use a stethescope, No heartbeat-0 Heart rate less than 100beats Greater than 100b/min-2
it’s the most important per minute-1
Muscle tone Muscles are loose and floppy-0 Some muscle tone-1 Active motion -2

Grimace or reflex No reaction-0 There is grimacing-1 Grimacing ,cough, sneeze or

irritability( response to vigorous cry-2
stimulation such as mild pinch
Skin color Pale-blue-0 Baby is pink but extremities are Entire body pink-2
blue-1
• NORMAL RESULTS:
• The Apgar rating is based on a total score of I to
10 ,
• The higher the score the better the baby is doing
after birth
• A score of 7,8, nor is normal and is assign that the
newborn is in good health
• A score of 10 is unusual, since almost all newborns
lose 1 point for blue hands and feet, which is
normal for after birth.
• Fluid in the baby’s airway
• This baby may receive oxygen and clearing airways
to help the baby breath
• A lower score does not mean that the baby will
have a serious or long term health problem
• Its not designed to predict future health of the baby
• Examine the mouth for color, presence of thrush,
palpate the hard palate and soft palate, exclude
false teeth, Cleft palate, macroglossia(enlargement
of the tongue –abnormal or acquied) oral thrush,
Observe/Inspect the abdomen which should appear
rounded and move in synchromy with the chest
during respiratory, inspecting the area to ensure it is
intact, The umbilical cord should be securely
clampled. This should be inspected to ensure there
are no signs of haemorrhage
• ABNORMAL RESULTS
• Any score lower than 7 is assign that the baby
needs medical attention,
• This could be due to difficult birth
• c-section
• Auscultate for bowel sounds
• Palpate for the liver and spleen, and kidney
• General shape of the abdomen, size, and position
of those organs
• E NLARGED KIDENYS may indicate an obstruction
to the outflow of urine
• The passage of urine or meconium should be
recorded as it indicates patency of the Renal and
lower gastrointestinal tract respectively
 Examine the anus to make sure the opening is
not sealed shut.
• Pass a rectal thermometer into the rectum to
exclude imperforate anus.
• Note if the baby has passed meconium(first
stool the baby passes)
• GENITALS
• Determine the sex of the baby and note any
abnormality
• Examine the genitals to ensure the urethra is
open, and in proper location.
• With boys, the length of the penis should be
assessed, this is usually about 3 cm and the
position of the urethral meatus confirmed. the
fore skin should be retracted as it is adherent to
the glans penis and physically retracting it at this
stage can lead to phimoisis. The scrotum should
be gently palpated for the presence of two tests.
• For girls, the vulva should be examined by parting
the labia gently to ensure the presence of the
clitoris, and the urethral and vagina orifices. A
mucoid discharge may be present which is normal.
• the labia are prominent because of exposure to
the mother’s hormones and they remain swollen
for the first few weeks
• BACK
• Turn the baby gently and make the baby lie on its
abdomen and examine the vertebral column( for
congenital abnormality, skin color , scars)
This may be easier to do by standing the baby over
one hand, while using the other hand to feel the
spine. Gently part the cleft of the buttocks, look for
any Dimples or sinuses and confirm the presence
of the anal sphincter.
looking for any obvious abnormality such as spina
bifida and also for any swelling, dimpling or hairly
patches, these could be indicatives of an
abnormality of spinal cord or veterbral column by
 LIMBS
• Examine the arms and legs paying close attention
to the digits and palmar creases
FINGURES
• Syndactyly or abnormal fusion of the digits most
commonly involves the 3and 4thFingures and the
2and 3 rd toes
• Poldactyly –is supranumerary digits on the hand
or feet(associated with family history)
• Note any fractures, paralysis, flex the thigh and
abduct them to
exclude congenital dislocation of the hip,
(Barlow/Ortlon’s test)
• Note the size, length and exclude talipes
• Identify any other abnormality
• Examine the legs and feet to assess symmetry size,
shape and posture. Both legs should be freely
movable, any difficulty should be due to fracture
or nerve damage, toes should be counted,
polydactyly or syndactlyly should be noted.
Camptodactyly
• It involves the little finger and is a flexion
deformity that causes it to bent.
• Arachnodactyly- spider like fingers that can be
seen in Marfan syndrome and homocystinuria
• Simian crease-a single transverse palmar crease
is most commonly seen in Down syndrome but is
normally a normal variant
• Talipes equinovarus(club finger) is more common in
males, the foot is turned outward and inwards and
the sole is directed medially
• If this problem can be corrected with gentle force, it
will resolve spontaneously,if not orthopedic
treatment and follow- up are necessary.
• Metatarsus varus is adefect where the forefoot
rotates inward, it usually corrects spontaneously
• Metatarsus valgus-the forefoot rotates outwards.
• Rocker bottom feet-usually seen with trisomy
13and 18, it involves an arch abnormality that
causes aprominent calceneus with arounded
bottom of the sole.
• Tibial torsion- inward twistin of the tibia bone that
causes the feet to turn in due to position in the
uterus but can resolve spontaneously.
• Genu recurvatum-knee able to bent backwards.
NEROUS SYSTEM
• NEURAL ASSESSMENT
• Of reflexive actions that indicate neurological
wellbeing
• Nerve abnormalities can test the newborn’s
reflexes
• Muscle tone
1., hypotonia floppiness and head lag are seen
2.hypertonia-inreased resistance is apparent when
the arms and legs are extended
THREE COMMON REFLEXES OF NEWBORN

• MORO REFLEX
• ROOTING REFLEX
• SUCKING REFLEX

OTHERS
• GRASP REFLEX
• STEP REFLEX
• BABISNKI SIGN
• 1. MORO REFLEX
• When newborn are startled, their arms and legs
swing out and forward in a slow movement with
• Fingers outstretched.
• 2. ROOTING REFLEX
• When either side of their mouth is touched
newborns turn their head toward that side,
• This reflex enables newborn to find the nipple
• 3. SUCKING REFLEX.
• When an object is placed in their mouth,
newborns begin sucking immediately
*Many serious disorders that are not apparent at
birth be detected by blood tests
• GRASP
• A finger in the baby’s palm, the baby responds by
grasping the finger symmetrically
• STEP REFLEX
• Hold the baby upright with feet touching the flat
surface , the baby should make stepping motions
5.Shallow,irregular respiration
6.Apnea.
7.Apathy
8.Staring
9.Seizures activity(sucking or chewing of the tongue,
blinking of the eyelids , eye rolling and hiccups
10.Absent,depressed, or exagerated reflexes
11.Asymmetric reflexes.
• Keep baby warm if cold put a cap Sweaters, and
extra closes according the weather.
• Care of umbilical cord, do not put anything on
it.
• Keep baby clean, wash face and neck daily
• Make follow ups and visit health worker 1 week - 6
months after birth ( for immunisation)
• Let baby, sleep on back or side.
• Keep baby away from smoke
• Do not expose baby to direct sun.
• Do not put baby on cold surface
• Difficult to breath
• Fits
• Fever, cold, bleeding
• Stops feedig
• Diarrhoea
• Feels less than every 5 hours
• Dust from eyes, irritated cord
• Yellow eyes or skin.
• Also remind families about child registration,
consider making a list of strainer when and where
to go.
 Length of stay and discharge.
After vaginal birth with no complications 24_48hours.
After a cesarean birth with no complications 48_72hours

CRITERIA TO BE MET BEFORE DISCHARGING A

NEWBORN
.
•The infant has urinated regularly and passed atleast
1 stool spontaneously.
•The infant has completed atleast 2 successful
consecutive feeding with assessment to verify that
the infant is able to coordinate sucking , swallowing
and breathing while feeding.
•There is no bleeding at the circumcision site
•The clinical risk of development of subsequent
hyperbilirubinaemia has been assessed and
appropriate management and follow up plans have
been instituted.
•The infant has been adequately evaluated and
monitored for sepsis on the basis of maternal risk
factors and in accordance with current guidelines for
prevention of perinatal group B streptococcal
disease
•Maternal blood tests and screening results are
available and have been reviewed for example
maternal syphilis and hep B surface antigen status,
screening tests including HIV test
•Infant blood tests have been taken and the
results are available e.g cord blood type
•Initial hep B vaccine as been administered
according to the current immunization schedule
•Family, environment and social risk factors have
been assessed and the mother and her family
members have been educated about safe home
environmment.incase of risks discharge should be
delayed until its safe.
•Barriers to adequate follow up care for the new
born, such as lack of transportation to health services,
lack of easy access to telecommunication and non
english speaking parents have been assessed and
wheneva possible assistance has been given to the
family .
•The mothers knowledge, ability and confidence to
provide adequate care for the infant have been
assessed for competency. Therefore achecklist to
facilitate discussions with new parents before
discharging a healthy new born from the hospital
should be given to the mother and it includes the
following:
Breastfeeding benefits both the mother and the
baby. Teach the mother proper positioning and
attachment of the baby to the breast and
techniques for expressing breast milk, caution the
mothers on taking any over the counter medication
because anything she ingests potentially can be
transmited to the new born through the breast milk.
Parents who choose to bottle feed their newborns
should use a formula that contains iron and should
not change formulas without consulting their
physicians .
Bottles should be thoroughly cleaned with hot
soapy water.
 Formula need to be heated to room temperature.
 Incase the child chokes or turns blue during the
feeding the mother should stop and immediately
rush to the clinic.
Parents should not give children who r less than
12months honey because it increases the risk of
neonatal botulism, and solid foods should not be
introduced before 4 or 6 months.
Breastfed infants have more than 3 bowel
movements per day and are rarely constipated
,watery stools normal unless its too much that it
runs out of the diaper.
Formula fed babies have less frequently bowel
movements than breastfed babies.
Mother should report if their infant has had fewer
than 5 bowel movements per week over a 2 weeks
period.tell parents to increase the fluid intake of the
Breastfed babies always have 6 or more wet
diapers per day after they begin feeding bottle fed
babies should have a similar number of voids.
It should be cleaned with normal saline and
allowed to dry naturally in order for it to separate
sooner. It will fall off within 2 weeks of life. If the
skin around the cord becomes red or if pulurent
discharge is present, notify the nurse.
Neonaal skin rashes are extreamely comon and are
commonly caused by arternal hormones if an infant
has neonatal acne ,erythema, toxicum neonatorum,
parents should be reassured that these rashes are
comon and will fade away mostly within the first 4
months of life. incase of fever or dehydration or
lethargy report immeiately.
If a child was circumcised always apply petroleum
jelly at the front of the diaper to moisten it and
prevent the penis from sticking to it. If the penis starts
to bleed or swell inform the physician.
For the uncircumcised child avoid forcibly
retracting the foreskin of the penis because it may
cause phimosis.
Genitals of the new born girls should be washed
gently with warm water.
A bloody vaginal discharge may be a normal
response to martenal homones.
This means the infant is only wearing a diaper and
s placed on the mothers bare chest and both are
covered with the blanket.
Holding your infant skin to skin benefits both the
mother and the child ie there is less crying, better
breathing, better blood sugar levels,less stress and
breastfeeding sooner longer and better.
It also promotes bonding between the infant and
he mother therefore this practice should be
continued at home.
Fever of 38 but also stress the fact that a child can
also be sick without a fever.
Lethargy, difficulty in feeding,irritability.
Dehydration, an infant will show decreased tears
and dry mucous membrane.
Distinguish normal crying from an inconsolable
infant.
For example use of an appropriate car safety seat,
supine positioning for sleeping.
Maintaining a smoke free environment and room
sharing.
Incase of cramps and pain from stitches,
medications for pain may be given and mother
taught how to self administer them.
THANKS YOU FOR
LISTENING>
GROUP TWO MEMBERS

OSANYA COLEEN

MUSINGUZI AMOS

TEKLE ARIAM

NYENDE ASHA

NALWOGA PHIONA

DANMUSA SAFIA