CARE OF THE NEWBORN

Neonatal period – from birth to the first 28 days of life

I. Establish/maintain airway
II. Keep warm
III. Immediate assessment
IV. Care of umbilical cord
V. Birth record
VI. Vitamin K early immunization
VII. Eye care
VIII. Initial oil bath
IX. Physical assessment
X. Discharge instruction

Establish and maintain patent airway

- Never stimulate a baby to cry unless secretions have been drained out
- Mucus should be suctioned from the mouth by a bulb syringe as soon as the head is delivered
- Newborn is held for a few seconds with the head lightly lowered as soon as the infant is born for
further drainage of secretion
- Suction the newborn properly
- Record first cry

How to suction using bulb syringe

1. Compress bulb syringe before inserting in the mouth to prevent air from forcing mucus back into
the bronchi and alveoli
2. Suction mouth first then the nose to prevent aspiration
3. Insert bulb syringe on the side of the mouth
4. Inserting on the center of the mouth stimulates gag reflex

Suctioning using a machine and french tip #10

1. Turn the baby’s head to one side

2. Place thumb over the suction control and begin to apply suction
3. Without applying suction, insert the suction tube 3 to 5 inches
4. Suction the mouth first before the nose gently and quickly
5. Slowly remove the tube, rotating it slowly

*suction quickly and gently. Prolonged and deep of the naso-pharynx during the 5-1o mins stimulates
vagus nerve (located at the esophagus)

Oral mucus – cause choke, cough, or gag during the first 12-18 hours of life

Trendelenburg position - to drain secretions

Side lying position – to permit drainage of mucus from the mouth place pillow or small rolled towel at
the back to prevent neonate from rolling back to supine
Test the patency of the airway by occluding one nostril at a time. Newborns are nasal breathers

If it is necessary to pass the tube into the newborn’s stomach to remove meconium secretions that the
newborn swallowed before birth, insert the tube through the newborn’s mouth into the stomach. Apply
suction and continue to pass the suction tube through the mouth

Give oxygen as necessary if the infant remains cyanotic after initial suctioning and stimulation. Avoid
excessive oxygen administration as it can lead to retrolental fibroplasia (is a disease of the eye affecting
prematurely born babies generally having received neonatal intensive care, in which oxygen therapy is
used due to the premature development of their lungs)

A crying is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously or if baby’s
cry is weak. Do not slap the buttocks. Rub the soles of the feet or back.

Keep the newborn warm

- Chilling will increase the body’s need for oxygen

Methods of heat loss

1. Convection
- Flow of the heat from the body’s surface to cooler surrounding air. Eliminate drafts, such as
from windows or air conditioners to reduce convection of heat loss.
2. Conduction
- Transfer of body heat to a cooler solid object in contact with the baby
3. Radiation
- Transfer of body heat to a cooler solid object not in contact with the baby, such as cold window
or air conditioner. Move baby far from the cold surface.
4. Evaporation
- Loss of heat through conversion of a liquid to a vapor, dry newborns as soon as possible
especially face and hair. The head is the larger surface area in newborn responsible for great
amount of heat loss.

*newborns can conserve heat by constricting blood vessels and moving blood away from the skin

Brown fats – a special tissue found in mature newborns, apparently helps to conserve and produce body
heat by increasing metabolism. The greatest amount is found in the intrascapular region, thorax, and
perineal area. It aids in controlling newborn temperature

Effects of cold stress

It causes metabolic acidosis due to breakdown of brown fat as a result from the infant’s way of
increasing metabolism to produce heat and later on develops to hypoglycemia due to the use of glucose
stored as glycogen.

Newborns lose heat easily because:

1. They have immature temperature regulating system

2. Very little amount of subcutaneous fat to provide heat
 3. Have little ability to conserve heat by changing posture
4. No ability to adjust its own clothing in response to thermal stress

Nursing management to keep the baby warm

1. Dry the newborn immediately

2. Wrap him in a blanket but not too tight so as to not compromise respiratory effort
3. Lay infant on his side in a warmed bassinet or place under a droplight
4. Place a head cap to conserve heat especially if they are in an open crib
5. All nursing care should be accomplished as quickly as possible to minimize exposure of the
infant
6. Give the baby to the mother to hold. The warmth of her body can be a source of heat.

Immediate assessment of the newborn

- APGAR – Dr. Virginia Apgar

- Appearance, Pulse rate, Grimace, Activity/active muscle tone, Respiratory rate

APGAR

- Taken at first minute and five minutes at birth.

- First minute – neonates’ initial adaptation to extrauterine life and necessity for resuscitation
- Five minutes – more reliable picture of the neonate’s overall status, including neurologic
impairment or impending death
Points considered in obtaining APGAR
o Heart rate
o Respiratory effort
o Muscle tone
o Reflex irritability
o Color

Interpretation of APGAR result

0-3 = baby is in serious danger and needs immediate resuscitation

4-6 = the baby’s condition is guarded and may need more extensive clearing of the airway and
supplementary oxygen

7-10 = considered good and in the best possible health

Vital signs

1. Temperature – 36.5 to 37.2 C (97.7 to 99 F)

2. Pulse – 180 bpm after birth (apical heartbeat), average of 120-140 bpm an hour after birth
3. Respiration – 80 bpm after birth, 30-60 bpm when it stabilizes
Periodic respirations – respiratory depth, rate and rhythm are likely to be irregular and short
periods of apnea w/o cyanosis
4. Blood pressure – approx. 80/46 mmHg after birth, 100/50 mmHg by 10 th day BP cuff no more
than 2/3 length of the upper arm of thigh. A doppler can be used.

How to take an infant’s vital signs

1. Respiration
2. Heart rate
3. Temperature
4. Width
5. Length
6. Head size
7. Chest size

Vital statistics/anthropometric measurements

1. Weight – weighed nude and without blanket

- Average of 6.5 to 7.5 lbs or 3 to 3.4 kg
- 3,000 to 3,400 gms
- <2.5 kg = low birth weight
Causes of Physiologic weight loss (5-10% or 6-10 oz)
1. No longer under the influence of maternal hormones
2. Already voids and passes stools
3. If breastfed, intake is limited by the relatively low caloric content of colostrum until about
the third day of life
4. Time needed to establish effective sucking
2. Head circumference
- Average of 34-35 cm
3. Chest circumference
- Average of 31-33 cm or 2cm less than the head
4. Abdominal circumference
- Average of 31 to 33
5. Length
- Average of 50 cm (20 in) arbitrarily lower limit: 46 cm (18in)

Bathing the newborn

- Providing a complete bath to a newborn wash away vernix caseosa immediately after delivery
- Bath water should be approximately 37-38 C (98-100 F), a temperature that feels pleasantly
warm to the elbow or wrist
- Cleanest to most soiled area
 - From eyes, face, and head first, then to the trunk, extremities, and last to the perineum and
buttocks
- Wipe with dry towel and put on shirt and diaper
- Fold the diaper below the umbilical stump to prevent injury or irritation
- Provide warmth after bath to prevent hypothermia
- Wrap the newborn with blanket, place him under the droplight, put head cap or bonnet

Care of the umbilical cord

- Inspect for the presence of AVA (2 arteries, 1 vein)

- Clamp is applied ½ to 1 inch from the abdomen
- The cord and the area are cleansed with antiseptic solution
- Assess the cord for possible bleeding
- Cord clamp is removed after 2 days when the cord has dried
- The cord stump usually dries and falls off within 7 to 10 days leaving a granulating area that
heals on the next 7 to 10 days
- No tub bathing until cord falls off. Do not sponge bath to clean the baby
- Do not apply anything on the cord. Only 70% alcohol solution
- Avoid wetting the cord. Fold diaper below
- Leave cord exposed to air
- Signs and symptoms of infections:
1. Foul odor
2. Presence of discharge
3. Redness around the cord
4. Remains wet and does not fall within 7-10 days
5. Newborn fever

Rectal patency – using rectal thermometer

Checking for rectal patency:

1. Insert rectal temperature into the anus as far as 1-2 cm

2. Place baby in lateral position or lift the legs of the baby to expose the anal area

Proper identification of the newborn

1. Footprints
2. ID bracelets

Administration of Vitamin K

- Aquamephyton 0.5 mg to 1 mg (Phytonadione) injected IM into the lateral aspect of anterior

thigh (vastus lateralis) to prevent bleeding disorder hemorrhagic disease of newborn (HDN)
- Newborns are at risk for bleeding disorders during the first week of life because their
gastrointestinal tract is sterile at birth and unable to produce vitamin K which is necessary for
blood coagulation
- 25-gauge, 5/8-inch needle

Administration of BCG vaccine

 - Immediate after birth
- Prevents pulmonary and extra pulmonary tuberculosis
- Immune system is still immature
- Single dose of 0.05 ml through ID route at the left deltoid

Administration of hepatitis B vaccine

- First hour after birth

- Prophylaxis for hepatitis B
- Dose of 0.5 ml through IM route at the right vastus lateralis

Document birth record

1. Time of birth
2. Time the infant birthed
3. Whether respirations were spontaneous or added
4. APGAR score at 1 and 5 minutes
5. Whether eye prophylaxis and Vitamin K were given
6. General condition of the infant
7. Number of vessels in the umbilical cord
8. Whether cultures were taken (laboratory)
9. Whether the infant voided and passed stools