KRISHNA INSTITUTE OF MEDICAL SCIENCES

AND DEEMED TO BE UNIVERSITY

KRISHNA INSTITUTE OF NURSING SCIENCES,

KARAD

SUBJECT: OBSTETRIC AND GYNECOLOGY

NURSING

SEMINAR ON

THE TERM NEWBORN

SUBMITEED TO, SUBMITTED BY,

DR.MRS. JYOTI SALUNKHE MISS. SHWETALI BHAVAKE

MSC NSG PhD OBGY NURSING MSC. NSG 1 ST YEAR

PROFESSOR, DEAN ACADEMICS KINS, KARAD

KINS KARAD
General Objectives

At the end of this session students will be able to understand all about the
newborn.

Specific Objectives

At the end of this session students will be able to

 Define neonate
 Explain physiological adaptation of newborn
 Explain essential newborn care
 Explain breastfeeding
 Explain immunization schedule
 The Term Newborn

As the birth of the baby takes place, the assessment has to be done
afterwards to look for the normal features present in the baby. Any abnormality
can be treated properly with the timely assessment.

Normal Neonate

A newborn is considered as healthy when the infant is born at term, cries

almost immediately at birth, is having the adequate birth weight according to
the country (around 2.7 kg in India), and establishes satisfactory rhythmic
pulmonary respiration.

 Physiological adaptation

Respiratory Adaptation

At birth, respiratory rate is around 40-60 per minute. The breathing is

diaphragmatic, chest and abdomen rising and falling synchronously. There is
combination of biochemical changes and other physical stimuli such as cold,
gravity, pain, light, noise etc. which stimulates the neonate to take the first
breath.

Physiology of first breath

Respiratory centre is stimulated by mild hypoxia and carbon dioxide

retention. During delivery baby takes the first gasp due to elastic recoil of the
chest, one third of the lung liquid gets squeezed out through the nose during
vaginal birth. Respiratory centre gets further stimulated by surface stimuli from
skin, joints, cord clamping. Majority of babies cry at this time due to negative
pressure of water created by elastic recoil of the chest. Lung alveoli gets filled
with air and lung liquid is pushed to periphery of alveoli and gets absorbed to
pulmonary circulation. With crying, lungs expand and infant breathes twice the
rate of an adult. The normal cry of the baby is loud and medium pitched.
Transient cyanosis mayarise in the first few days when the baby is crying.

Circulatory changes

The heart rate of the baby is around 120-160 per minute. Peripheral
circulation is sluggish. Blood pressure ranges from 80-85/50-55 mm Hg during
first few days. The hemoglobin levels are high i.e., 18-20 gm/dl. In the first
week of life, jaundice may appear in the baby because of the breakdown of the
excess red blood cells in the liver and spleen. With the clamping of the
umbilical cord and first breath taken by the baby, fetal circulation alters to the
mature circulation. There is closure of ductus arteriosus, converting into
ligamentum arteriosum and closure of foramen ovale. The ductus venosus
becomes occluded and is known as the ligamentum venosum. The umbilical
vein becomes obliterated and is known as the ligamentum teres. There is
decreased pulmonary vascular resistance and increased aortic blood pressure

Gastrointestinal system

The mucus membrane of the term baby is moist and pink, and the sucking
pads give the full appearance of the cheek of the baby. After around one hour of
the birth, bowel sounds are present. The meconium containing bile, mucus, fatty
acids and epithelial cells, is passed for 2-3 days. The stool of the breast fed baby
is loose, bright yellow and inoffensive. On the other hand, stool of the bottle fed
baby is paler, semiformed and have sharp smell. During the first few days,
cardiac sphincter of the baby is weak which may lead to regurgitation.
Physiological jaundice generally appears in the newborns due to low production
of glucuronyl transferase enzyme along with the red cell breakdown.

Thermal regulatory system

As there is immaturity of hypothalamus at birth, the neonate is inefficient

to maintain the optimum temperature and is at the risk of hypothermia. The
baby will try to maintain thermo regulation by adopting flexed posture and by
peripheral vasoconstriction. The neonate has to be dressed properly and the
environment should not be cold, so that the baby can maintain temperature of
36-37 degrees Celsius. The neonate is capable of producing heat through both
general and brown fat metabolism.

The neonate can lose heat from the body through four specific ways

 Evaporation-If the skin is not cleaned properly and remains wet in a dry
room. To maintain temperature, avoid evaporation in newborns by
keeping them dry by adequately drying with towel.
 Radiation- The heat is transferred from the body to the other cooler
objects in the surrounding which are not in direct contact with the body.
To maintain temperature of new born baby, the temperature of nursery
should be maintained to avoid loss of heat by radiation.
 Conduction-Whenever the heat is lost from the body to the other objects
which are in direct contact with the skin. To avoid loss of heat in
newborn babies, the babies should not be kept on wet surface Leon wet
towel, wet cradle sheet,wet mattress etc.
 Convection- The heat is lost with the movement of the cool air passing
over the surface of the body. To avoid loss of heat, the windows,holes
and apertures should be closed to prevent entry of cooled air in nursery
to prevent cooled air coming in contact with the body of baby.

Musculoskeletal system

The bones are not completely ossified, though the muscles are complete
at birth. The skull bones are also not ossified completely which is mainly for the
growth of the brain and for helping in the moulding during labour. The neonate
is having two fontanelles which can be palpated at birth; namely, anterior
fonatanelle (closes at around. 18 months of age) and posterior fontanelle (fuses
at around 6-8 weeks).

Renal system

Kidneys of the neonate are not adequately mature. GFR is low along with
restricted tubular resorption capabilities. The bladder can be palpated
abdominally as the pelvis of the baby is small. The urine of the baby is straw
colored, dilute and odor less, and is passed for the first time at birth or within 24
hours of birth.

Immunological system

There are mainly three main immunoglobulins; IgG, IgA and IgM. IgG is
small and can cross the placental barrier and gives immunity to certain viral
infections in the neonate; whereas IgA and IgM do not cross the placental
barrier. Newborn is prone to infections. Passive immunity is provided by breast
milk, especially colostrum.

Reproductive system

In both the ovaries of the female, primordial follicles are present. In

males, there is no spermatogenesis till the puberty. After the birth there is
withdrawal of the maternal hormones which can result in breast engorgement
and secretion of milk in both males and females. Pseudomenstruation may occur
in girls.

Neurological system

Like other systems, nervous system is also not fully mature at birth. The
braingrows rapidly after birth. If the brain is not developed properly and
remains immature, there occurs temperature instability and uncoordinated
muscle movements in the baby. Following reflexes are found in the baby:
 Blink reflex- When a bright light is shone into the infant's eyes suddenly,
there is a quick closure of the eyes.
In the case of impaired light perception, this reflex is absent.
 Corneal reflex- With a piece of cotton, cornea is touched lightly. The
infant closesthe eyes in response.
In the case of lesions of the fifth cranial nerve, this response is absent.
 Rooting reflex- With a finger, the corner of the baby's mouth is touched
with the finger. The head turns towards the stimulated side, the infant
opens the mouth and tries to suck on the stimulating object.
In case, the baby is not hungry, the head will turn away from stimulation.
 Palmar grasp reflex- When the fingers of the examiner are placed in the
infants hands and the palms are pressed. In response, there is flexion of
all the infant's fingers tightly around the examiner's hands.In case of brain
damage, there is absence of the reflex.
 Traction reflex-The infant is pulled with the wrists to a sitting position.
While doing so, initially the head lags, then becomes straight and finally
falls forward onto the chest.
 Tonic neck reflex- To elicit this reflex, infant is placed on his back and
the head is turned to the side. In response, arms and legs on the same side
extend and arms and legs of the opposite side flex. The infant assumes a
fencing position.
In case of neurological dysfunction, this reflex persists beyond 2-3
months.
 Moro reflex- To elicit this response, baby is held in hands and suddenly
head is dropped 1-2 cms; or a sudden loud noise or hand is clapped near
the baby; the table of the baby is struck near the head end. In response,
the infant abducts and extends his arms and there is fanning of the
fingers. The legs also extend and flex onto the abdomen.
 In case of brain damage, this reflex is absent.
 Swallowing reflex-food reaching the posterior portion of tongue is
automatically swallowed. Extrusion reflex-newborn extrudes any
substance placed on anterior portion oftongue.
 Stepping reflex- When the baby is held upright and the soles of the feet
of the baby are made to touch the ground, there is stepping movement of
both the legs. Plantar reflex- When the examiner presses the balls of the
infant's feet with histhumbs, there is flexion of the toes.
In case of the defect of the lower spinal cord, this response is absent.
 Babinski's reflex- In this, the examiner scratches the lateral aspect of the
sole of the infant's foot from heel to toes. In response, there is
dorsiflexion of the big toe. In case of the defect of the lower spinal cord,
this response is absent.

 Essential Newborn Care

 Clean childbirth - Child birth is performed in a clean, hygienic, sterile

way. Unclean delivery room predisposes to the infections. Baby is
handled gently after birth and sex is noted.
 Cord care- Clamps are applied on the umbilical cord and cut in between
to separate the baby from the placenta. After cutting and clamping the
cord, it is checked for any redness, tenderness or oozing. In hospital
deliveries, cord care is performed daily in which the base, stump and cord
is cleaned.
 Initiation of breathing and resuscitation - Breathing starts
spontaneously in the baby after the first cry, if not, resuscitative measures
are to be followed.
  Prevent newborn infection - Prevention of infection is an essential
aspect. As the immunity of the baby is not so well developed, so he is
prone to infections.
 Thermal protection-Baby has to be kept warm. The baby is wiped and
dried so that heat loss is minimized. Baby can be kept under the radiant
warmer orthe warm blankets. Skin to skin contact with the mother is
helpful in maintaining the temperature of the baby.

Hypothermia prevention

 Deliver in a warm room- To prevent the hypothermia, the delivery

room's temperature should be maintained. The windows and doors
must be closed. A warm delivery room is the first step to prevention
of hypothermia
 Dry newborn thoroughly and wrap in dry, warm cloth - As soon
as the babyis born, he should be dried thoroughly with a clean cloth
to wipe off the secretions. After proper cleaning, baby is wrapped in
a clean, dry, warm clothes.
 Keep out of draft and place on a warm surface - Baby should be
protectedfrom cold, in the nursery, while transferring or at the home.
 Give to mother as soon as possible-Baby should be given to the
mother soon as:
 Skin-to-skin contact first few hours after childbirth
maintains the temperature.
 Promotes bonding between the mother and the baby.
 Enables early breastfeeding.
  Bathe when temperature is stable (after 24 hrs) - Generally babies
are not given bath in the hospital to prevent the chances of infection.
In the home, alsobaby should be given bath after 24 hours when the
temperature stabilizes.
 Early and exclusive breastfeeding - Breast feeding should be started as
soon as possible or within 1 hour after the child birth. Breast feeding
should be continued for 6 months exclusively, and afterwards
complementary feeding may be started along with the breast feeding.
 Eye care - Eye care is performed by wiping the eyes from inner to
outercanthus with a sterile saline swab.
 Immunization - At birth: bacilleCalmette-Guerin (BCG) vaccine, oral
poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine.

INCIDENCE

The first month of life is the most vulnerable period for child survival.
The majority of all neonatal deaths (75%) occurs during the first week of life,
and about 1 million newborns die within the first 24 hours. The most common
causes of neonatal death are preterm birth,low birthweight, intrapartum-related
complications (birth asphyxia or lack of breathing at birth), infections and birth
defects cause most neonatal deaths

Globally 2.4 million children died in the first month of life in 2020.

In 2020, neonatal mortality rate for India was 20.3 deaths per thousand
live births. Neonatal mortality rate of India fell gradually from 83.6 deaths per
thousand live births in 1971 to 20.3 deaths per thousand live births in 2020.

The current NMR is 28 per 1000 live births. Given the infant and under-
five child mortality rates of 40 and 49 per 1000 live births, respectively, 70% of
total infant deaths and more than half of under-five deaths fall in the neonatal
period.

In 2018, the state of Madhya Pradesh, with 52 infant deaths per 1,000 live
births, recorded the highest rural infant mortality rate in India.

An infant that appears well but has any of the following features should
be regarded as high risk and, therefore, likely to develop a problem during the
newborn period: Infants that are born preterm or postterm. All low birth weight
infants. Infants who are underweight or overweight for gestational age.

The world has made substantial progress in child survival since 1990.
Globally, the number of neonatal deaths declined from 5.0 million in 1990 to
2.4 million in 2019.

Infant mortality rates are often used as an indicator of the health and well-
being of a nation. Monaco, Iceland and Japan are among the top three countries
with the lowest infant mortality rates with around 2 infant deaths per 1,000
infants within their first year of life.

Newborn care in a skilled way is very important as each year, 98% of

these deaths are in developing countries - most in the home without any skilled
care and newborns who lack appropriate care are at high risk of poor health and
reduced productivity in child hood and later life. At least, following three
actions have to be undertaken by the health care facilities to improve the
newborn's health status.

Firstly, essential care needs to be provided during pregnancy. Tetanus

toxoid immunization, proper nutrition including iron/folate supplements, and
treatment of maternal infections, such as malaria and sexually transmitted
infections, have a strong influence on newborns' health and survival.
 Second, two priority interventions during labor and delivery are critical,
in addition to managing obstetric complications: reducing the risk of infection
to mothers and newborns by keeping the birth attendant's hands and all contact
with the umbilical cord clean, and resuscitating newborns who are not breathing
normally.

Third, certain actions can make the postnatal period safer for newborns.
Immediate and exclusive breastfeeding and keeping the baby warm and the
umbilical cord clean contribute to the health and survival of newborns. Since
most newborn deaths occur during the first hours or days after birth, contact
with an appropriately trained health provider is key to newborn health and
survival. In addition to counseling on newborn care practices, particularly
careful management of low birth weight babies, and timely recognition and
antibiotic treatment of infections such as pneumonia, sepsis, meningitis are the
key.

 Breast Feeding

Composition of breast milk

Fat

Total (g/100 ml)4.2

Fatty acids- length 8C (%)trace

Polyunsaturated fatty acids (%)14

Protein (g/100 ml)

Total1.1
Casein 0.40.3

a-lactalbumin0.3

Lactoferrin0.2

IgA0.1

IgG0.001

Lysozyme0.05

Serum albumin 0

B-lactoglobulin

Carbohydrate (g/100 ml)

Lactose 7

Oligosaccharides 0.5

Minerals (g/100 ml)

Calcium0:03

Phosphorus0.014

Sodium0.015

Potassium0.055

Chlorine0.043

Breast- Feeding has been shown to be beneficial for the both mother and infant.
Breast milk is species specific and changes with the baby's developmental
needs. Formulas have failed to duplicate the content of breast milk. Breast milk
meets all the nutritional requirements of the new baby.
Fat-The proportion of the fat in the breast mlk increases during the course of
the feed. The fat provides the baby with more than 50 percent of his caloric
requirement.

Protein-As compared to the mature milk, colostrum contains around three times
more amount of the protein. Human milk is less in the protein content and so it
is thin. Whey protein is more because of which the milk forms soft flocculent
curdsafter getting acidified in the stomach.

Lactose - The enzyme lactase converts the lactose in the breast milk into
galactose and glucose. This provides rapid energy. Lactose also enhances the
absorptionof calcium.

Vitamins - All the fat soluble and water soluble vitamins are present in
thebreast milk in the adequate amount. Vitamin K is required for blood clotting
and thebaby's gut flora synthesizes adequate amount only after 2 weeks after the
birth, soall the babies are given vitamin K soon after the birth.

Minerals and trace elements - Iron content is less in the breast milk as
compared to the formula feeds, but on the other hand, around 70 percent of iron
found in the breast milk is absorbed whereas only 10 percent is absorbed from
the formulas. Breast milk also contains small quantities of calcium,
phosphorous, zinc, sodium and potassium.

Anti-infective factors - Certain anti-infective agents are found in the breast

milk such as secretory IgA and interferon. Immunoglobulins IgA. IgG, IgM and
IgD are found in the breast milk. These protect the intestinal epithelium against
the entry of pathogenic organisms. Leucocyte present in the milk destroy the
harmful bacteria. Lactobacillus bifidus discourages the multiplication of
pathogens. Breast milk also contains lactoferrin and a general anti-infective
agent, lysozyme
Benefits for baby

During breastfeeding nutrients and antibodies pass to the baby while it

helps to strengthen the maternal bond. There are many benefits to breastfeeding.
These include:

Proper nutrition: Breast milk has just the right amount of fat, sugar, water, and
protein that is needed for a baby's growth and development.

Ideal composition: There is ideal composition of the required nutrients in

thebreast milk for easy digestion.

Greater immunity: Breast milk contains several anti-infective factors such as:
lysozyme, lactoferrin (which binds to iron and inhibits the growth of intestinal
bacteria) and immunoglobulin A protecting against microorganisms.

Higher intelligence: Few studies have suggested that breast fed babies
havehigher intelligence. Breast milk affects the metabolism of fatty acids, such
as DHAand AA, which are known to be linked to early brain development.

Long term health effects: Infants exclusively breastfed have less chance of
developing diabetes mellitus than peers with a shorter duration of breastfeeding
and an earlier exposure to cow milk and solid foods. Breastfeeding appears to
reduce the risk of extreme obesity in children. Some studies have shown that
breastfeeding resulted in lowered the risk of asthma, protect against allergies
and provide improved protection for babies against respiratory and intestinal
infections.

Fever infections and allergies: It has been noticed that breastfeeding reduces
the risk of acquiring urinary tract infections. Breastfeeding appears to reduce
symptoms of upper respiratory tract infections also. A longer period of
breastfeeding associated with a shorter duration of some middle ear infections
Another study found that breastfed babies had half the incidence of diarrheal
illness.In children who are at risk for developing allergic diseases can be
prevented or delayed through exclusive breastfeeding.

Benefits for mothers

Breastfeeding has so many benefits for the mother. It is a cost effective

way of feeding an infant, and provides the best nourishment for a child. The
benefits are discussed below:

Act as contraceptive: Breastfeeding act as acontraceptive for a short time.

Lactation suppresses the ovulation and can delay the return of fertility through
lactational amenorrhea.

Increased bonding: During breastfeeding beneficial hormones are released into

the mother's bond and the maternal bond can be strengthened. When the mother
is supported by the partner and the family members during breastfeeding, it
increases the family bond.

Uterine involution: As the baby takes breastfeeding, there is increase in

ofhormones the mother's oxytocin levels, making the uterus of the mother
contractmore quickly and reducing the postpartum bleeding.

Weight loss: As the fat accumulated during pregnancy is used to produce milk,
extended breastfeeding-at least 6 months-can help mothers lose weight.

Long-term health effects: Certain ling term benefits are, there is less risk of
breast cancer, ovarian cancer, and endometrial cancer. Breastfeeding diabetic
moth ers require less insulin and there is reduced risk of postpartum bleeding

Breastfeeding difficulties
 Though breastfeeding is a natural human activity, difficulties may be
found. Many breastfeeding difficulties can be resolved with proper hospital
procedures, properly trained midwives, doctors and hospital staff, and lactation
consultants

Difficulties related to mother

Inadequate supply of milk- Some mothers complain of not having

adequatemilk supply. Such mother may be instructed to nurse the baby often.
The milk supply is directly related to the frequency of nursing.

Breast engorgement- A warm cloth should be applied to each breast before

breast feeding to promote milk flow. Manual expression of milk may also be
done to emptythe breasts after feeding the baby.

Poor attachment of breast- In this, the areola remains outside the mouth of the
baby which causes quick, shallow sucks. So, the baby should be placed properly
sothat much of the arolar space is in the baby's mouth.

Stress and anxiety- If there is an anxiety or emotional trauma to the mother, it

affects the milk ejection and her milk will not let-down. In this case she should
bemade to divert her mind and concentrate on relaxing her baby.

Short or very large nipples- Short nipples may cause problem for the baby
while feeding. In case of large nipples, baby's mouth may not be able to get
beyond thenipple.

Difficulties related to the baby

Low birth-weight baby- A low birth weight baby is too small to suck, so
artificial feeding may be given to this baby.
Cleft palate- In case of this disorder, baby cannot form the vaccum and thus
form the teat out of the breast and nipple. Baby is fed with a special device or a
spoon.

Illness of the baby- Any temporary illness of the baby such as, oral thrush,
respiratory infections, jaundice etc may lead to improper sucking.

Overdistention of the stomach- While feeding, baby swallows some air also. It
can be prevented by burping the baby several times during feeding.

Additional Informations:

Infant weight gain

Breastfed infants generally gain weight according to the following guidelines:

0-1 months: 170 grams per week

4-6 months: 113-142 grams per week

6-12 months: 57-113 grams per week

The Baby-Friendly Initiative

The Baby-Friendly Initiative (BFI) is an international programme

developed by the World Health Organization and UNICEF. The main goal of
the programme is to protect, promote and support breastfeeding. The BFI
encourages and recognizes hospitals and community health services that offer
an optimal level of care for all mothers and babies, and their families.

Goals of the Baby-friendly Hospital Initiative

1. Transformation of hospital and maternity facilities all the way through
implementation of the "TenSteps

2. To end the practice of distribution of free and low-cost supplies of breast

milk substitutes tomaternity wards and hospitals.

Every facility providing maternity services and care for newborns/infants

should follow the following Ten Steps to successful breastfeeding:

1. Have a written breastfeeding policy, which is routinely communicated to all

health care staff

2. Train all health care staff in relevant skills to implement this policy.

3. Inform all pregnant women about the advantages and management of

breastfeeding.

4. Help mothers start breastfeeding within half an hour of childbirth.

5. Demonstrate mothers how to breastfeed, and how to maintain lactation even

if theyare requiredto separate from their infants,

6. Give the newborn/infant no food or drink other than breast milk, unless it is
medicallyindicated

7. Implement rooming-in-allowing mothers and infants to remain together - 24

hoursa day.

8. Encourage breastfeeding on demand.

9. Do not give artificial teats or pacifiers (dummies or soothers) to breastfeeding

infants

10. Support the establishment of breastfeeding support groups and refer mothers
to them ondischarge from the hospital or clinic.
  Immunization

Immunization is a process of protecting an individual from a disease by

introducing live/killed or attenuated organisms in individual system. It gives
resistance to an infectious disease by producing/augmenting the immunity,
hence reduces child mortality morbidity and handicapped condition.
Immunization is a way of producing artificially acquired immunity

Vaccine-preventable disease:

 Six killer vaccine-preventable diseases: Poliomyelitis, tuberculosis,

diptheria, pertussis, tetanus and measles.
 Other vaccine-preventable diseases: Hepatitis A. hepatitis B, mumps,
rubella, Haemophilusinfluenzae type B infections, typhoid, encephalitis,
yellow fever, cholera, malaria, plague, rabies.
 National Immunization Schedule (NIS) for Infants, Children and Pregnant
Women

Vaccine When to Give Dose Route Site

For pregnant women

TT-1 Early in pregnancy 0.5 mL Intramuscular Upper arm

TT-2 4 weeks after TT-1" 0.5 ml. Intramuscular Upper arm
TT booster If received two TT doses 0.5 mL Intramuscular Upper arm
in a pregnancy within the
last3 years
For infants

BCG At birth of as early as 0.1 mL Intradermal Left upper arm

possible till 1 year of age (0.05 mL until
1 month age)

Hepatitis At birth or as early as 0.5 mL Intramuscular Anterolateral

B-birth dose possible within 24 hours side of
midthigh

OPV-0 At birth or as early as 2 drops Oral Oral

possible within the first 15
days
OPV 1, 2 and 3 At 6 weeks, 10 weeks and 2 drops Oral Oral
14 weeks
(OPV can be given till 5
years of age)
Pentavalent At 6 weeks, 10 weeks and 0.5 mL Intramuscular Anterolateral
1, 2 and 3 14 weeks side of
(can be given till 1 year of midthigh
age)
Rotavirus At 6 weeks, 10 weeks and 5 drops Oral Oral
14 weeks (can be given till
1 year ofage
JE-1 9 completed months to 12 0.5 mL Subcutaneous Left upper arm
months
Vitamin A At 9 completed months 1 mL (1 lakh Oral Oral
(first dose) with measles, rubella IU)
For children

DPT booster-1 16-24 months 0.5 mL Intramuscular Anterolateral

side of
midthigh
Measles/MR second 16-24 months 0.5 mL Subcutaneous Right upper
dose Arm
OPV booster 16-24 months 2 drops Oral Oral
JE-2 16-24 months 0.5 mL Subcutaneous Left upper arm
Vitamin A 16-18 months 2 mL Oral Oral
(Second to ninth Quarterly (every 6 (2 lakh IU) Oral Oral
dose) months) up to the age of 5
years
DPT booster-2 5-6 years 0.5 mL Intramuscular Upper am
TT 10 years and 16 years 0.5 mL Intramuscular Upper arm
IPV Two fractional doses at 6 0.1 mL Intradermal Intradermal:
and 14 weeks of age two fractional Right upper
doses arm
Measles/MR first 0.5 mL Subcutaneous Right upper
dose 9 completed months to Arm
12 months (can be given
till 5 years of age)

Nursing Responsibility For Child Immunization

Nurses play the key role for administration of immunization and its related
activities in collaboration with other team members. Nursing responsibilities at
various levels can be summarized as follows:

 Motivation of people about the importance and benefits of immunization

 Information, health education and communication about immunization
sessions, immunization camps, outreach and home-based services.
 Arrangement and maintenance of required amount of articles and
vaccines for a particular immunization centre/clinic.
 Maintenance of cold chain system at immunization centre/during
transportation of vaccines fromclinics/homes with necessary protection to
preserve the potency and efficacy of the vaccines.
 Nurses should follow the basic nursing skills during administration of
vaccination such as following aseptic technique, checking the vaccine
before administration, selection of proper site, positioning of the child,
maintaining the rights of medication.
  Observation of possible reactions after vaccination and providing
necessary instructions to theparent and family members.
 Information about the next scheduled visit.
 Maintenance of documentation (immunization card, clinic records,
stocks, number of attendance for vaccination, vaccine used, etc.)
 Reporting about immunization coverage and problems in particular area.
 Participating in research activities and new approaches related to
immunization programme toupdate own knowledge and skills regarding
advancement of immunization practices.

SUMMARY

Observing the adaptation in newborn is very important for knowing the

proper further development. And newborn care is to be done properly for babys
good health and overall development. It is also a nurses responsibility to
examine and provide proper care and immunization for the newborn.

CONCLUSION

Routine newborn care is essential to aid babies in the transition period

right after birth. While most babies are born with minimal difficulties requiring
little or no support, a small number of them necessitate some intervention at the
time of delivery.

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 Konar H. DC Dutta's Textbook of Obstetrics. 9th ed. New Delhi: The

Health Science Publisher; 2018.
 Podder L. Fundamentals Of Midwifery & Obstetrical Nursing. 5th ed.
Haryana: Elsevier; 2019.

 Posner G, Dy J, Black A, Jones G. Oxorn Foote Human Labor& Birth.

6th ed. Noida: McGraw Hill Education; 2013.

 Rao K, Kashyap C. Textbook of Midwifery & Obstetrics For Nurses. 1st

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