THE NEWBORN

A. The Profile of a Newborn:

Physiologic Function and Appearance
Objectives:
 Describe the normal characteristics of a term newborn.
 Use critical thinking to analyze ways that the care of a term newborn can be more family
centered.
 Assess a newborn for normal growth and development.
 Formulate nursing dx r/t NB or the family of the NB
 Identify expected outcomes for a NB and family during the first 4 weeks of life
 Plan nursing care to augment development of a NB, such as ways to aid parent-child bonding
 Implement nursing care of a NB
 Evaluate outcome criteria for achievement and effectiveness of care
 Identify areas r/t NB assessment and care that could benefit from additional nursing research/
application of evidenced-based practice
 Integrate knowledge of NB G and D and immediate care needs with the nursing process to
achieve quality maternal and child health nursing care.

Newborn
 A.k.a “neonate”
 Undergoes profound/ intense physiologic changes at the moment of
birth
 Sudden change of environment (from the uterine env’t to the
outside env’t)
 Newborns undergo profound physiologic changes at the moment
of birth (and, probably, psychological changes as well), as they are
released from a warm, snug, dark, liquid-filled environment that
has met all of their basic needs into a chilly, unbounded, brightly lit,
gravity-based, outside world. Within minutes after being plunged
into this strange environment, a newborn has to initiate respiration
and adapt a circulatory system to extrauterine oxygenation.
 Within 24H: complete functioning: Neurologic, renal, endocrine, GI, and metabolic sustain life

Neonatal Period
 From the time the child was born to his/her 28 days of life

National Health Goals dealt directly with the NB period:

 Increase of at least 75% the proportion of mothers who breastfeed their babies in the early postpartal
period from a baseline of 64%
 Increase to at least 50% the proportion of women who continue breastfeeding until their babies are 5-
6 months old from a baseline of 29%
 Increase to 70% the percentage of healthy full-term infants who are put to sleep on their backs from a
baseline of 35%.
 Increase to 60% from a baseline of 43% the number of women who breastfeed exclusively until their
infant is 3 months of age; from 13% to 25% for those who breastfeed exclusively until 6 months.
 Increase to at least 75% the proportion of parents and caregivers who use feeding practices that
prevent baby-bottle tooth decay.
 Reduce the neonatal mortality rate to no more than 2.9 per 1000 live births from a baseline of 4.8 per
1000 live births (http://www.nih.gov)
Benefits of Breastfeeding
 Best for baby, best for mommy - bonding
 Reduces the incidence of allergies - because all the contents of the breast milk are natural
 Economical - do not have to buy
  Antibodies to protect baby against infection
 IgA - binds to large molecules of proteins that keeps baby away from microorganisms attacking
the GI tract
 lactoferrin - is an iron-binding protein that is found in breast milk w/c interferes w/ the growth of
pathogenic bacteria more particularly w/ staphylococcus aureus and E. coli
 Lysozyme in breast - actively dissolves the cell wall of the bacteria making it more effective as
an antibody
 Leukocyte in breast milk - provides protection against common respiratory infectious agents; for
low birthweight infant I who suffered hypoxia during delivery, provide additional protection against
acute necrotizing enterocolitis
 Macrophage - engulf and digest certain bacteria through phagocytosis; helps destroy polio,
influenza and diphtheria
 Interferon - will protect neonate by interfering with the viral growth; interferon (a protein that
protects against viruses), help interfere with virus growth. The bifidus factor is a specific
growthpromoting factor for the beneficial bacteria Lactobacillus bifidus. The presence of L. bifidus
in breast milk interferes with the colonization of pathogenic bacteria in the gastrointestinal tract,
reducing the incidence of diarrhea
 Sterile and Pure - always fresh and not need to be boiled
 Temperature is always ideal - resembles to temperature of the body of nsg mother
 Fresh milk never goes off - so long as there is continuous suckling of the nipple that there will be
continuous production of milk
 Prolactin - released from anterior pituitary gland and will stimulate the acini cells that is present in
the breast in order to produce milk also known as the “milk secretion reflex”
 Oxytocin - when nipples is suckled by neonate, it causes the contraction of myoepithelial cells
surrounding the milk glands w/c causes milk to flow towards the lactiferous sinuses or the
lactiferous ducts. Now this hormone is secreted from the posterior pituitary glands as the nipple
has been stimulated through suckling.
 Easy to prepare and to digest -
 Eradicates feeding difficulties -
 Develop mother and child bonding -
 Immediately available -
 Nutritionally optimal -
 Gastroenteritis greatly reduced -

Other Advantages of BF
 It contains ideal electrolytes and mineral composition for human infant growth
 It is high in lactose- an easily digested sugar (rapid brain growth)
 The ratio of cysteine to methionine in BM favors rapid brain growth in early months.
 It contains more linoleic acid- an essential acid for skin integrity
 It has less Na, K, Ca and P
 It has better balance of trace elements like Zn.
 BF helps prevent excessive weight gain in infants

Breastfeeding is contraindicated in only a few circumstances, such as:

 An infant with galactosemia (such infants cannot digest the lactose in milk)
 Herpes lesions on a mother’s nipples
 Maternal diet is nutrient restricted, preventing quality milk production
 Maternal exposure to radioactive compounds (e.g., during thyroid testing)
 Breast cancer
 Maternal active, untreated tuberculosis, hepatitis B or C, cytomegalovirus, or human
immunodeficiency syndrome
 Maternal active, untreated varicella. Once the infant has been given varicella zoster
immunoglobulin, the infant can receive expressed breast milk if there are no lesions on the breast.
Within 5 days of the appearance of the rash, maternal antibodies are produced, and thus
breastfeeding could be beneficial in providing passive immunity against varicella (Sadeharju et al.,
2007)
  Mothers receiving anti metabolites or chemotherapeutic agents
 Mothers receiving prescribed medications that would be harmful to an infant such as lithium or
methotrexate
 A mother lives in an area where environmental contaminants can be carried via breast milk to the
infant (AAP Committee on Drugs, 2002)
Advantages for a Mother
 Serve a protective function in preventing breast
cancer.
 Release of oxytocin from the posterior pituitary
gland aids in uterine involution.
 Successful BF can have an empowering effect,
because it is a skill only a woman can master.
 It reduces the cost of feeding and preparation time.
 It provides an excellent opportunity to enhance a
true symbiotic bond between mother and child.

Advantages for infant

 Breast milk contains more linoleic acid, an
essential fatty acid for skin integrity, and less
sodium, potassium, calcium,and phosphorus than
do many formulas. Breast milk also has a better
balance of trace elements, such as zinc. These
levels of nutrients are enough to supply the infant’s
needs, yet they spare the infant’s kidneys from having to process a high
renal solute load of unused nutrients. Women who have a familial history
of allergy are usually encouraged to breastfeed to try and eliminate the
possibility of exposing their infant to cow’s milk protein, which could be
allergenic this early in life (Hampton, 2008).
 Yet another advantage is that breastfed newborns appear to be able to
regulate their calcium/phosphorus levels better than infants who are
formula fed. Decreased calcium levels in a newborn can lead to tetany
(muscle spasm). The increased concentration of fatty acid in commercial
formulas may bind calcium in the gastrointestinal tract, increasing the
danger of tetany. Breastfeeding may also help prevent excessive weight
gain in infants (Box 19.3).
 A great deal of discussion about the benefits of breastfeeding has
centered on the effects of breastfeeding on the formation of the dental
arch, because babies suck differently from a breast than from a bottle
(Fig. 19.2). Babies pull their tongue backward as they suck from a breast.
They thrust their tongue forward to suck from a rubber nipple. That may
make breastfeeding the best preparation for forming common speech
sounds (Ferguson & Molfese, 2007).

Nursing Responsibilities:
a) Beginning Breastfeeding- should begin soon after birth (woman is still in
the birthing room while infant is in the first reactivity period)
 Let-down reflex:
 Called as milk ejection reflex
 Continuous or spontaneous flow of milk due to oxytocin’s action
 Oxytocin is released from the PPG as the NB infant sucks at the breasts causing the
collecting sinuses (lactiferous sinuses) of the mammary gland to contract milk moves
forward through the nipples.
 Oxytocin causes smooth muscle contraction (Uterine) prevents excessive bleeding; aids
in uterine involution
 Breastmilk Transition:
1. Colostrum: First 2 – 4 days:
  ↓ CHO, ↓ Fat, ↑ CHON, ↑ Fat-soluble vitamins
 thin, watery, yellow fluid composed of protein, sugar, fat minerals, vitamins and maternal
antibodies.easy to digest and capable of providing adequate nutrition
2. Transitional Milk: 4 – 14 days:
 ↑ lactose, ↑ minerals, ↑ water-soluble vitamins

3. Mature Milk:
 beyond 14th
day:
 ↑ CHO, ↑ Fats,
↓ CHON
 New milk, called hind milk, is
formed after the let-down reflflex.
Hind milk, higher in fat than fore
milk, is the milk that makes a
breastfed infant grow most
rapidly. Release of oxytocin has
a second advantage in that, by
causing smooth muscle
contraction, it helps contract the
uterus. As a result, a woman
may feel a small tugging or
cramping in her lower pelvis
during the fifirst few days of breastfeeding (afterpains) (Pavone & Purinton, 2007).
 Techniques of breastfeeding
 Physical preparation such as nipple rolling,
advised in the past as a way of making a woman’s
nipples more protuberant, is not necessary
because few women have inverted or
nonprotuberant nipples. In addition, oxytocin,
which is released by this maneuver, could lead to
preterm labor (nipple rolling is used to create
uterine contractions for stress tests). The
occasional woman who has inverted nipples may
need to wear a nipple cup (a plastic shell) to help
her nipples become more protuberant.
 Practicing breast massage to move the milk
forward in the milk ducts (manual expression of
milk) may be helpful. This can help a woman who
feels hesitant about handling her breasts grow
accustomed to doing so, and allows her to assist
with milk production in the first few days after birth.
Manual expression consists of supporting the
breast fifirmly, then placing the thumb and forefifinger on the opposite sides of the breast, just behind
the areolar margin, first pushing backward toward the chest wall and then downward until secretions
begins to flow (Box 19.4). During the last months of pregnancy and immediately after birth, the flfluid
obtained will be colostrum. By the third day of infant life, milk will be obtained. Teach women to wash
their breasts with clear water because soap tends to dry and crack
nipples.

b) Provide information regarding lactation and proper positioning

techniques.
 Breast milk looks like nonfat milk. It is thin and almost blue-
tinged in appearance. Some women may need assurance that
this color and consistency are normal; otherwise, they may
 think their milk is not nutritious enough.
 Before breastfeeding, recommend that a woman wash her hands to be sure they are free of
pathogens picked up from handling perineal pads or other sources. Washing her breasts is not
necessary unless she notices caked colostrum on the nipples. When she is first attempting to
breastfeed, lying on her side with a pillow under her head is a good position to use (Fig. 19.3).
This relieves fatigue because it allows her infant to rest on the bed.
 Shows a sitting position with a pillow under the
baby. Using a football hold with the baby
supported on a pillow also may be helpful,
especially if a mother had a cesarean birth.
 Brushing the infant’s cheek with a breast nipple
stimulates a newborn’s rooting reflflex. The baby
then turns toward the breast. Do not try to initiate
a rooting reflflex by pressing a baby’s face against
the mother’s breast; this will cause the child to
turn away from the mother and toward your hand.
Although not well documented as to effificiency or
reliable results, an assessment tool such as the
LATCH assessment (Table 19.2) can provide
measures to help evaluate a newborn’s
breastfeeding effectiveness (Howe et al., 2008).
 If a woman has large breasts, the infant may have
trouble breathing while nursing because breast
tissue presses against the nose. A woman can
prevent this happening by grasping the areolar margin of her breast between her thumb and
forefifinger, holding the bulk of the breast supported while her infant feeds. This also makes the
nipple more protuberant.
 During the first few days of life, because they are receiving only colostrum and need the nutrients
and fluid obtained by frequent sucking, babies should be fed as often as they seem hungry (every
2 to 3 hours). Frequent feeding also is advantageous to sustain a milk supply, because the more
often breasts are emptied, the more effificiently they fifill and continue to maintain a good supply
of milk.
 As important as making certain that infants grasp the breast areola is helping them to break away
from the breast when they are through feeding. Teach a woman to insert a fifinger in the corner of
the infant’s mouth or pull down the infant’s chin to release suction. Otherwise, the baby may pull
too hard on the nipple, causing cracking or soreness.

 Before BF- mother performs handwashing

  REPUBLIC ACT No. 10028
 AN ACT EXPANDING THE PROMOTION OF BREASTFEEDING, AMENDING FOR
THE PURPOSE REPUBLIC ACT NO. 7600, OTHERWISE KNOWN AS “AN ACT
PROVIDING INCENTIVES TO ALL GOVERNMENT AND PRIVATE HEALTH
INSTITUTIONS WITH ROOMING-IN AND BREASTFEEDING PRACTICES AND FOR
OTHER PURPOSES”
 Be it enacted by the Senate and House of Representatives of the Philippines in Congress
assembled:
 Section 1. Short Title. – This Act shall be known as the “Expanded Breastfeeding
Promotion Act of 2009”.
 Section 2. Section 2 of Republic Act No. 7600 is hereby amended to read as follows:
 Sec. 2. Declaration of Policy. – The State adopts rooming-in as a national policy to
encourage, protect and support the practice of breastfeeding. It shall create an
environment where basic physical, emotional, and psychological needs of mothers and
infants are fulfilled through the practice of rooming-in and breastfeeding.
 Observe proper position when BF
c) Provide immediate support if problems arise
 When handled intelligently by health care personnel, the common problems that arise with
breastfeeding usually pass and seem unimportant to a woman. Handled otherwise, they can
complicate breastfeeding and discourage a woman from continuing. It is unfortunate when
complications deter a woman from using the most natural and least complicated of all infant
feeding methods.
d) Provide information regarding techniques for burping the breast-
fed baby
 It is helpful to burp NB after they have emptied the first
breast and again after the total feeding
 Placing the baby over one shoulder and gently patting or
stroking the back; laying the baby prone across the lap
 Placing the baby over one shoulder and gently patting or
stroking the back is an acceptable position. However, this
position is not always satisfactory for a small infant, who
has poor head control. In addition, a parent may have
diffificulty supporting the baby’s head and patting the back
at the same time.
 Holding the baby in a sitting position on the lap, then
leaning the child forward against one hand, with the index
fifinger and thumb supporting the head, is often the best
position to use. This position provides head support but leaves the other hand free to pat the
baby’s back (Fig.19.5). Parents usually need to be shown this method, because it does not seem
as natural as placing a baby against the shoulder. Laying the baby prone across the lap is another
alternative position.
 Some infants seem to swallow little air when they breastfeed, whereas others swallow a great
deal. As a rule, it is helpful to bubble (burp) newborns after they have emptied the fifirst breast
and again after the total feeding
e) Support for a mother who is breastfeeding multiple infants.
 Provide support by ensuring that they drink adequate fluid and help them to organize their time.
 Assure women that the average woman can easily produce enough milk to feed multiple infants.
f) Prevent or relieve engorgement.
 Engorgement- breast distention, accompanied by hardness,
tenderness, and perhaps heat in their breasts. The skin
appears red, tense, and shiny.
 caused by vascular and lymphatic congestion
arising from an increase in the blood and lymph
supply to the breasts.
 Nursing interventions:
1) Empty the breasts of milk by having the infant suck
more often, or at least continue to suck as much as
before.
2) Good breast support from a firm-fitting bra helps
prevent a pulling, heavy feeling
3) Apply warm packs to both breasts or standing under a warm shower for a few minutes
before feeding, combined with massage to begin milk flow.
4) Manual expression or the use of a breast pump to complete emptying of the breasts after
the baby has nursed.
g) Promote healing of sore nipples.
 Painful nipples result from the strong sucking action of a newborn.
 It can be worsened by:
a. Improper positioning of an infant (failure to grasp the areola as well as the nipple)
b. Forcefully pulling an infant from a breast
c. Allowing an infant to suck too long at a breast after the breast is emptied
d. Permitting a nipple to remain wet from leaking milk
 Nursing interventions:
1) Encourage a mother to position her baby slightly differently for each feeding.
2) Advise to expose nipples to air by leaving her bra unsnapped for 10 to 15 minutes after
feeding.
3) Discourage the use of plastic liners that come with nursing bras; it is preferable to have air
always circulating around the breasts.
4) Apply vitamin E lotion after air exposure may toughen the nipples and prevent further
irritation
5) Applying a few drops of breast milk to the nipples after feeding and gently massaging it into
the areola.
6) Advise women not to use a hand pump with sore nipples, because the pressure may
cause fissures to worsen.
h) Anticipate potential problems and suggest methods for resolving them
 Women who do not remember to begin nursing the baby at the breast the infant finished on the
last time may find their milk supply decreasing in one breast. Although changing breasts may be
easy to remember in the hospital, distractions at home can make the sequence difficult to
remember. Pinning a safety pin to the bra strap on the side to start with at the next feeding is a
useful way to help remember this.
 Fatigue can be another problem on returning home if a woman
does not take adequate measures to conserve her energy.
Sitting relaxed in a comfortable chair with her feet elevated,
feeding her baby, and enjoying this time is an excellent way to
rest.
 Remind women that adequate maternal fluid intake is necessary
to maintain an adequate milk supply. Women who are
breastfeeding should drink at least four 8-oz glasses of flfluid a
day, and many need to drink six glasses. They need to increase
their calorie intake by about 500 calories a day (Table 19.4). A
daily diet plan for a lactating woman is given in Table 19.5.
 At one time, women were given a list of foods not to eat while
they were breastfeeding because it was thought they caused
diarrhea, constipation, or colic in infants. Today, there are no
rules other than to use common sense. A woman can eat
anything that agrees with her, is taken in moderation, and to
which she is not allergic.

i) Provide information on supplemental feedings.

 A breastfeeding woman may leave her child during the day or evening in the care of a babysitter or
another care provider, just as a formula-feeding woman may. She can express breast milk manually
and leave it in a bottle in the refrigerator or prepare a single bottle of formula for the time she is away.
 Bottles used for storage should be washed using normal dishwashing practice. Breast milk then may
be refrigerated for 24 hours, frozen for 30 days, or placed in a deep freezer for 6 months. Use of
commercially prepared formula or powder formula is appropriate and convenient to replace a single
feeding because one bottle at a time can be prepared. The bottle used should be glass or opaque,
nonshiny plastic as shiny types may contain polycarbonate, a compound that can leech into stored
milk and is associated with chromosomal aberrations (Raloff, 2007).
 Once breastfeeding has been established (after about 6 weeks), missing one feeding will not affect
milk production enough to make a difference at the next feeding. There is no need for a mother to
express milk manually to safeguard a supply while the infant takes a supplemental feeding, although
she may prefer to do so to reduce tension and discomfort.
 j) Provide information for a mother who works outside the home.
 Many women return to work while continuing to breastfeed by bringing
their infant with them to their workplace. Others express breast milk for a
caregiver to give by bottle while they work. As there are many
considerations to think about, women should review with an employer the
best way for them to continue breastfeeding at their worksite
(Abdulwadud & Snow, 2009) (Box 19.6).
k) Provide information on weaning
 It is best for infants if they are exclusively breastfed for at least 6 months
(Kramer & Kakuma, 2009). Women breastfeed for varying lengths of time,
however. Some do it for 1, 2, or 3 months and then wean their children
from breast to formula. Others continue until their children are 6 to 12
months of age and then wean directly to a small cup or glass. Some
continue to breastfeed until the child is of toddler or preschool age (Fig.
19.8). The AAP recommends that infants be breastfed for a full year; the
World Health Organization (2002) recommends exclusive breastfeeding
for 6 months and continuation for 2 years. Discontinuing breastfeeding
may make infants more susceptible to infection as infants are no longer
receiving immune protection (Akus & Bartick, 2007). Too lengthy a time of breastfeeding, however,
may lead to nutritional defificiencies if the child is taking in a large quantity of milk at the expense of
other foods (Ambruso, Hays, & Goldenberg, 2008).
 At any age, breastfeeding should be discontinued gradually to prevent engorgement and pain in a
mother’s breasts while still providing satisfaction for the infant. To do this, a woman could fifirst omit
one breastfeeding a day, substituting a formula feeding or milk from a glass or cup. Then she could
omit two breastfeedings, then three, and so on, until her infant is feeding entirely from a bottle, glass,
or cup. If breasts are not emptied by regular feedings, the resulting pressure leads to milk suppression
and natural, gradual discontinuance of milk secretion. If weaned before 12 months, infants should be
weaned to formula, not whole milk, so that they continue to receive the added vitamins and the low
solute load of commercial formulas.
 Urge women who have discontinued breastfeeding to explore whether there is a breast milk bank in
their community that would appreciate breast milk donors. Such milk is used to feed hospitalized
infants, especially preterm infants. Being fed breast milk can help prevent necrotizing enterocolitis, a
possibly fatal bowel infection.

Formula Feeding
a) Preparing for formula feeding
 Commercial Formulas
 TYPES:
 Milk based- formulas are used for the average newborn
 Soy based- devised for infants who are allergic to cow’s milk protein
 casein hydrolysate formulas have protein particles too small to be recognized by the immune
system
 Elemental (fat, protein, and carb hydrate content is modified, such as in lactose-free formula)
Reminders!
 Parents should be advised to purchase types with added iron to ensure that their newborn receives
enough of this element to prevent irondeficiency anemia (Marotz, 2009)
 Formulas for term newborns contain 20 cal/oz when diluted according to directions (the same number
of calories as breast milk).

4 forms of commercial formulas

 Powder that is combined with water
 Condensed liquid that is diluted with an equal amount of water
 Ready-to-pour type, which requires no dilution
 Individually prepackaged and prepared bottles of formula

b) Provide information regarding formula preparation

 Infant formula of any type must be prepared with careful attention to cleanliness to prevent pathogenic
microorganisms from growing in it.
 When using presterilized formula, the parent need only do the following to prepare a full day’s supply
of formula:
 Wash off the top of the can with warm, soapy water and rinse.
 Open the can and pour the desired amount of formula and water into each previously cleaned
bottle (cleaning a dishwasher is best).
 Put on the nipples, taking care not to handle the nipple projection.
 Place the bottle caps over the nipples and refrigerate.
 To prepare a single bottle, the parent simply combines clean water and liquid or powdered formula in
a previously cleaned bottle, caps the bottle, and shakes it to mix the ingredients.
c) Provide information regarding feeding techniques
 warm and cooled formula
 take precaution in warming the formula milk stored in bottles.
 Whether to warm formula or not is a parental decision: infants who are fed cooled formula
directly from the refrigerator thrive as well as those who are fed warmed formula. The best
method to warm formula is to stand the bottle in a bowl of warm water or hold it under a
faucet of running hot water for a few minutes. Caution parents not to use a pan on the stove
to warm formula because if the pan boils dry, the bottle of milk will burst. Disposable bottles
with plastic liners should definitely not be heated on the stove; the liner tends to melt and then
leak during feeding.
 It also is not recommended to warm bottles in a microwave oven, because the milk in the
center of the bottle can become hotter than that near the sides. If parents do not follow this
recommendation, caution them to heat no longer than 30 seconds for a 4-oz bottle and 45
seconds for an 8-oz bottle (Goldenring, 2007). After warming, they should add the nipple and
shake the bottle well to mix the cool and warm portions. Finally, with all warming methods.
parents should test the temperature of the formula by allowing a drop or two to fall onto the
inside of a wrist, to make sure it is not hot enough to burn the baby’s mouth.
 With any type of bottle, any contents remaining after a feeding should be thrown away, not
stored and reused. When sucking, an infant exchanges a small amount of saliva for milk.
Because milk is a good growth medium for bacteria and the baby’s mouth harbors many
bacteria, the bacterial content in reused formula is likely to be high.

d) Use a comfortable chair (as does a nurse who feeds babies) and adequate time (at least half an hour)
to enjoy the process and not rush the baby.
 Like breastfeeding, formula feeding an infant is a skill that must be learned. A parent needs a
comfortable chair (as does a nurse who feeds babies) and adequate time (at least half an
hour) to enjoy the process and not rush the baby.

e) Hold the baby with the head slightly elevated.

  Holding the baby with the head slightly elevated reduces the danger of aspirationand
retention of air bubbles.
f) Ensure the nipple is kept filled so that the baby is sucking milk, not air.
 A parent should be sure the nipple is kept filled so that the baby is sucking milk, not air. He or
she can be assured a baby is sucking effectively if small bubbles rise in the bottle.
g) Babies in the early weeks should be bubbled (burped) after every ounce of milk taken. The technique is
the same as that used for breastfed infants.
h) Do not to prop up bottles, because babies:
 Remind parents not to prop up bottles, because babies are in danger of aspiration if a bottle
is propped. In addition, an increased incidence of otitis media has been associated with
bottle-propping, because the infant’s head is not upright and formula may enter the
eustachian tube. Propping also can limit the amount of parent–child interaction.
i) Do not to put a baby to bed with a bottle of formula, because this can lead to “baby-bottle syndrome,” or
cavities of the lower teeth

Signs of a Well-fed Baby:

a) Steady weight gain of 150-240 g/ week during the 1st 6 months to120 g/week at the end of 1 year
b) Normal growth and development pattern
c) Happy, active and contented when awake
d) Regular and undisturbed sleep
e) Has normal bowel movements and elimination

VITAL STATISTICS: WEIGHT

 Varies among race, nutritional, intrauterine and genetic
fxs present during pregnancy
 The average birth weight (50th percentile) for a white,
mature female newborn in the United States is 3.4 kg (7.5
lb); for a white, mature male newborn, it is 3.5 kg (7.7 lb).
Newborns of other races weigh approximately 0.5 lb less.
Birth weight exceeding 4.7 kg (10 lb) is unusual, but weights as high as 7.7 kg (17 lb) have been
documented. Second-born children usually weigh more than fifirst-born. Birth weight continues to
increase with each succeeding child in a family.
 Arbitrary lower limit of normal for all races: 2. 5kg (5.5 lbs.)
 Normal Birth weight range: 2500 g- 4000 g (5 lbs 8 oz- 8 lbs 13 oz)
 Average: 3500 g
 Birth weight of 4.7 kgs: macrosomic; associated with DM
 Physiologic Weight Loss
 5- 10% of NB BW is lost for the 1st few days of life
 6-10 oz weight loss
 Causes:
a) No salt and fluid-retaining maternal hormone influence
b) Diuresis
c) Passing out of meconium
 Because approximately 75% to 90% of a newborn’s weight is flfluid, all three of these
measures reduce weight.

d) Limited caloric intake until about the 3rd day of life

 Breastfed NB: regains weight within 10 days
 Formula fed newborns: gains within 7 days
 Weight Gain among NB: about 2lbs per month (6-8 oz per week) for the 1st 6 months of life.
 Weight Gain:
 BW doubles at 5 to 6 mos and triples at 1 year.
 2 yrs of age: 4x the BW
 Infants generally gain approximately 20- 25 g/ day or 150- 210 g/ week during the 1st 5 months of
life
 3years: 5x BW
  5 years: 6x BW
 7 years: 7x BW
 10 years: 10x BW

 Abnormal Findings:
 Low birth weight/ SGA: <2,500 grams
 Very low birth weight: <1,500 grams
 Extremely low birth weight: <1,000 grams
 BW > 4000 g is known as Large for Gestational Age (LGA) infant.
 Weight loss of more than 10%
 Importance:
 Identify NB who are at risk because of their small size
 Separates small for gestational age (SGA- NB who have suffered IUGR) from preterm infants
 (infants who are healthy but small only because they were born early)
 Establishes a baseline for future evaluation.
 Good determinants of health and normal nutrition (together with height)

 Nursing Considerations in weighing NB:

 Undress NB infants before weighing.
 Keep a protective hand over an infant on an infant scale (hovering but not touching)
 Always cover scales with scale paper before weighing
 The same weighing scale should be used every time the infant’s weight is measured
 Plotting BW in a neonatal graph helps to identify NB at risk because of their small or too large size
 Weight should be compared with height and head circumference to see any disproportions that
indicates risk conditions

VITAL STATISTICS: LENGTH

 Average birth length (50th percentile): 53 cms (20.9
inches)
 Normal Range: 46-56 centimeters
 For mature males, the average birth length is 54 cm
(21.3 in).
 Nursing Considerations in taking NB length:
 Measure from top/ crown of the head to heel
using a tape measure.
 One person should hold the infant in place while
the other completes the measurement

VITAL STATISTICS: HEAD CIRCUMFERENCE

 Normal Measurement: 33-35 centimeters (13- 14
inches)
 The HC is usually greater than the chest
circumference by 2 centimeters.
 Head circumference is measured with a tape
measure drawn across the center of the forehead
and around the most prominent portion of the
posterior head
 It is ¼ of the total body length
 1 st 4 mos: HC increases by ½ inch a month and ¼
inch a month in the next 8 months.
 The ff are changes in the HC:
 At birth, HC may be equal or greater than the CC due to molding
 After 2-3 days, HC is greater than the CC by 2-3 cms
 After 6 months, HC is = to CC
 After 1 year, HC is < than CC
  Abnormal Findings:
 HC < 32 centimeters = microcephaly in term infants
 HC that is 4 centimeters and greater than CC or more than 37 centimeters = neurologic px
(Hydrocephalus)

VITAL STATISTICS: Chest Circumference

 Term newborn: about 2 cm (0.75 to 1 in) less than the head circumference measured at the level of
the nipples.
 A CC < than 30 cm indicates prematurity.
 An enlarged heart may make the left side of the chest larger.

VITAL STATISTICS: Abdominal Circumference

 Approximately the same as the CC
 Measured just above the umbilicus

VITAL STATISTICS: Vital Signs- TEMPERATURE

 The temperature of NB: about 99° F (37.2° C) at birth
 Temperature fluctuates during the first few hours post-birth
 The temperature of birthing rooms, approximately 68° to 72° F (21° to 22° C) adds to heat loss

 4 Mechanisms of heat loss among NB

a) Convection
 is the flow of heat from the
newborn’s body surface to
cooler surrounding air.
 The effectiveness of convection
depends on the velocity of the
flow (a current of air cools
faster than nonmoving air).
 Nsg Axn: Eliminate drafts from
windows or air conditioners
reduces convection heat loss.
b) Conduction
 transfer of body heat to a cooler
solid object in contact with a
baby.
 a baby placed on a cold
counter or on the cold base of a
warming unit quickly loses heat
to the colder metal surface.
 Nsg Axn: Covering surfaces with a warmed blanket or towel helps to minimize conduction
heat loss.
c) Evaporation
 loss of heat through conversion of a liquid to a vapor.
 Nsg Axn:
 dry newborns as soon as possible (face, hair, head)
 Covering the hair with a cap after drying it further reduces the possibility of evaporation
cooling.
 Be certain to remove any wet blankets used to dry the infant immediately place the infant
on a warm, dry blanket
 Drying and wrapping newborns and placing them in warmed cribs, or drying them and
placing them under a radiant heat source
d) Radiation
 transfer of body heat to a cooler solid object not in contact with the baby, such as a cold
window or air conditioner and examination tables near the NB.
 Nsg Axn:
  Move the infant far from the cold surfaces as possible helps reduce this type of heat loss.

NB loss heat easily because….

a) Immature temperature regulating system
b) Very little amount of subQ fats to provide heat in their body.
c) Little ability to conserve heat by changing posture and inability to adjust own clothes in response to
thermal stress.
d) They tend to take on the temperature of their environment

NB conserve heat by:

a) constricting blood vessels
b) moving blood away from the skin
c) Burning brown fat, a special tissue found in mature newborns, that helps to conserve or produce body
heat by increasing metabolism.

NB Produce Heat by:

a) Increasing muscular activity (kicking and crying) increase metabolic rates HEAT
b) Burning brown fat- present only in NB; forms at 17 weeks of gestation; the less mature the infant, the
less brown fat
HYPOTHERMIA
 Occurs when body temperature drops below 36.5 C
 The NB infant is most sensitive to hypothermia during the stabilization period
 Effects of Hypothermia
 Acidosis
 Hypoxemia - a below-normal level of oxygen in your blood, specifically in the arteries.
 Hypoglycemia
 Immediate interventions for hypothermia:
 Remove wet cloth
 Place the baby under heat source
 Encourage BF
 Start oxygen administration if the baby has respiratory distress or cyanosis
 Notify the physician

HYPERTHERMIA
 NB are also at risk of hyperthermia (T= >37. 5̊C)
 CAUSES:
 Too hot external environment
 Too many covers/ clothes on baby
 Infection
 S/Sx:
 Irritability/ fussy
 Abdomen and extremities are warm to touch
 Red, flushed skin
 Hot and dry skin
 Lethargy
 Stupor; at risk for convulsions (41 C)
 Interventions:
 Place NB in a cool environment (25-28 C)
 Keep away from sources of heat (direct sunlight)
 Undress the NB partially or fully, if necessary.
 Measure the T q 1̊until within the N range
 Sponge the baby if T > 39 C. Do not use cold/ ice water.
 If the NB has been under a radiant warmer, reduce the T setting until it becomes N
 Examine for signs of infection

Vital Signs- Heart Rate

  The heart rate of a fetus in utero averages 120 to 160 beats per minute (bpm).
 Immediately after birth, as the newborn struggles to initiate respiration, the heart rate may be as rapid
as 180 bpm.
 HR: determined by listening for an apical heartbeat for a full minute
 Within 1 hour after birth, as the newborn settles down to sleep, the heart rate stabilizes to an average
of 120 to 140 bpm
 HR of a newborn: often remains slightly irregular because of immaturity of the cardiac regulatory
center in the medulla.
 During crying: HR may rise to 180 bpm.
 Sleep periods: HR can decrease during sleep, ranging from 90 to 110 bpm.

Vital signs: Blood Pressure

 At birth: The BP of NB is approximately 80/46 mm Hg.
 By the 10th day of life : rises to about 100/50 mm Hg.
 BP tends to increase with crying (and a newborn cries when disturbed and manipulated by such
procedures as taking blood pressure).
 A Doppler method may be used to take blood pressure. Hemodynamic monitoring is helpful when
continuous assessment is necessary.

 AbN finding:
 Calf systolic pressure 6-9 mmHg less than the systolic pressure in the UE may be indicative of
coarctation of the aorta
 NOTE: For an accurate reading, the cuff width used must be no more than two thirds the length of
the upper arm or thigh.

Vital Signs: Respiration

 RR ranges to an average of 30 to 60 breaths per minute when the newborn is at rest.
 periodic respiration - Respiratory depth, rate, and rhythm are likely to be irregular, and short periods of
apnea (without cyanosis) which last less than 15 seconds are normal.
 RR: observed thru’ watching the movement of a newborn’s abdomen, because breathing primarily
involves the use of the diaphragm and abdominal muscles
 NB are obligate nose breathers.
 Signs of Respiratory Distress
 Nasal flaring
 Chest retraction, indrawing of the chest when breathing
 See-saw respiration
 Cyanosis other than the hands and feet
 Respiratory grunting- noisy respiration
 Adventitious breath sounds in NB
 Rhonchi - This is a low-pitched sound that resembles snoring.
 Rales - This is a fine, high-pitched crackling or rattling sound that can occur when you inhale.
 Stridor - This is a high-pitched, loud sound that sometimes sounds like a cough or bark.
 Wheezing - This is a high-pitched sound, almost like a long squeak, that can occur as you inhale
or exhale.
 Grunting
 Absent/ diminished breath sounds