NEWBORN SCREENING
- Using the heel prick method, a few
RA 9288
Newborn Screening
- a simple procedure to find out if a
baby has a congenital metabolic
disorder that may lead to mental
retardation or even death if left
untreated.
- To assess for genetic and metabolic
abnormalities, hearing problems,
specific heart problems, and other
conditions that can hinder their
development.
Importance
- Most babies with metabolic disorder
look normal at birth.
- One will never know that the baby
has the disorder until the signs and
symptoms are manifested. By this
time, irreversible consequences are
already present.
- helps us find babies who have certain
serious medical conditions so that
they can begin treatment right away.
When is newborn screening done?
- Ideally done on the 48th to 72nd hour
of life (first 2 to 3 days of life).
- May also be done 24 hours from birth
since some disorders are not detected
if the test is done earlier than 24 hours
from birth.
PARTS of NBS
● Blood
● hearing
● heart screening.
How is newborn screening done?
drops of blood are taken from the
baby’s heel
- Blotted on a special absorbent filter
card
- Blood is dried for 4 hours and sent to
the Newborn
Blood spot collection
- Blood spot collection can be
performed by trained perspnnel such
as hospital nursery staff, laboratory
staff or out of hospital birth providers
- TIMING OF COLLECTION: blood spots
drawn too early or too late may yield
false results
- Best collected between 24 and 48 hrs
of age ( at least 24 hrs old)
- Blood spots collected before 24 hrs
generates an unsatisfactory results
that require another blood spot
collection
- Avoid touching the area within the
circles on the filter paper section
before, during and after collection of
th specimen since oils and other
materials from the hands might affect
or contaminate the card or specimen
- Do not allow water, feeding formulas,
antiseptic solutions, glove powder,
hand lotion or other materials to
come into contact with the specimen
card before of after use
- Blood collection from the heel is the
standard for newborn screening
- The medial and lateral parts of the
underfoot are preferred
Blood should NEVER be collected from:
● The arch of the foot
● The fingers
● The earlobes
● a swollen or previously punctured site
● IV lines containing other substances (TPN,
blood, drugs)
- Warm the heel with a warm
dampcloth or commercially available
heel warmer and position the leg
lower than the heart to increase
venous pressure before collecting the
blood spots.
- The infant should be swaddled in a
blanket with only one foot exposed.
- Powder free gloves are bestworn
while collecting the blood spots
- Lotion, vaseline and other substances
which can interfere with bloodspot
analysis should be kept off the infant’s
skin
- Wipe the skin clean with an alcohol
wipe and allow to thoroughly air dry
- Use a sterile lancet or heel incision
device to make an incision 1mm
deep and 2.5 mm long ( shallow
incision is more safer)
- Wipe away the first drop of blood with
a sterile gauze pad
- Allow a large drop of blood to form
using the thumb to intermittently
apply gentle pressure to the heel may
be helpful in encouraging the drop to
coalesce
- Touch the first circle on the newborn
screeningcare gently against the
large blood drop and in one step,
allow the blood to soak through the
filter paper and fill the circle.
- Do not press the paper directly
against the baby’s heel. Each of the
five/four circles need to be filled and
saturated through
- Apply the blood to any one side of
the filter paper
- Do not apply multiple layers of blood
drops to the same circle
- The circles are measures and should
contain a set volume of blood.
Layering can interfere with the
accuracy of the test by providing
non-standard amount of blood on
non-uniform analyte concentration
- Excessive milking or squeezing of the
puncture site can result in an
unsatisfactory specimen because of
hemolysis breaking down the blood
cells to be analyzed or mixing tissue
fluids in the specimen which can
dilute the blood
- Allow the specimen to dry flat at room
temperature for at least 3 hours ( this is
essential in maintaning the integrity of
the blood spots)
- Keep them out of direct sunlight and
way from other heat sources
- Avoid stacking the cards
- Do not close the biohazard flapover
the spots until they are completely dry
- Once the blood spots have dried
completely, the biohazard flap can
be closed and the newborn screening
card can be sent to the Newborn
screening program
When are newborn screening results
available?
- Seven (7) working days from the time
the newborn screening samples are
received parents should claim the
results from their physician, nurse,
midwife or health worker.
- Any laboratory result indicating an
increased risk of a heritable disorder
(i.e. positive screen) shall be
immediately released, within twenty-
 four (24) hours, so that confirmatory - Accumulation of excessive galactose
testing can be immediately done. in tha body can cause many
- A positive screen means that the problems including liver
newborn must be referred at once to damage,brain damage and
a specialist for confirmatory testing cataracts
and further management.
- An inherited disorder that lacks an
enzyme (Galactose-1-phophate uridyl
FIVE (5) DISORDERS CURRENTLY INCLUDED IN
transferase/Gal-1-PUT) which helps the
THE NEWBORN SCREENING PACKAGE
body break down the galactose

Screened Effect if NOT Effect if SCREENED

SCREENED and TREATED Management of Galactosemia
- Avoid milk and milk products
Congenital Severe Mental Normal substituted with Lactose free or
Hypothyroidism Retardation
Galactose Free milk such as Soy-
(CH)
based milk formula
Congenital Death Alive and Normal - Galactose restricted diet must be
Adrenal followed for life and requires close
Hyperplasia supervision and monitoring
(CAH)
CONGENITAL ADRENAL HYPERPLASIA
Galactosemia Death or Alive and Normal
(GAL) Cataracts
- An endocrine disorder caused by
abnormalities in specific enzyme of
Phenylketonuri Severe Mental Normal the adrenal gland that causes severe
a (PKU) Retardation salt lose, dehydration and abnormally
high levels of male sex hormones in
G6PD Severe Anemia, Normal
Deficiency Kernicterus
the both boys and girls.
- If not detected and treated early,
babies may die within 7-14 days

PHENYLKETONURIA (PKU)
GALACTOSEMIA (GAL)
- PKU is an autosomal recessive
metabolic disorder in which the body
cannot properly use one of the
building blocks of protein called
phenylalanine, an essential amino
acid that converts into tyrosine
causing elevation of phenylalanine in
the blood.
- Screening of newborns for PKU entails
- -GAL is a condition in which the bdy is
simple heel stick blood sampling test
unable to process gaactose, the
called Guthrie test
sugar present in milk.
 - Phenylalanine is neurotoxic
- Excessive accumulation of
phenylalanine in the body causes
brain damage
- Phenylalanine hydroxylase (PAH) is
either missing or not working properly
- The first effects are usally seen arounf
6 months of age
- Untreated infants may be late in
learning to sit, crawl and stand. They
may pay less attention to things
around them.
- Without treatment, a child with PKU
will become mentally retarded
CLINICAL Manifestations:
- Severe intellectual impairment
- Microcephaly
- Eczema
- Seizures
- Hypopigmentation
- Hyperactivity
- Autistic behavior
Management:
- Should start as soon a possible but no
later than 7 to 10 days
- Protein diet restriction
G6PD DEF
- G6PD deficiency is an X-linked
hereditary disease, which means it is
caused by a defective gene and
effects males almost exclusively and is
transmitted by the mother only to son
or daughter who will become another
carrier.
- Glocuse-6-Phosphate Dehydrogenase
Deficiency
- An inherited condition in which the
body lacks the enzyme glucose-6
phosphate dehydrogenase which
helps red blood cells function normally
- This deficiency can cause hemolytic
anemia usually after exposure to
certain medications, foods or even
infections
- G6PD is one of many enzymes that
help the body process carbohydrates
and turn them into energy
- G6PD also protects RBC from
potentially harmful byproducts that
can accumulate when a person takes
certain medications or when the body
is fighting an infection
- Without G6PD to protect the blood,
RBC can be damaged or destroyed
- Hemolytic anemia is a disorder in
which the RBCs are destroyed faster
than the bone marrow can produce
them
Kids with G6PD deficiency typically do not
show any symptoms of the disorder until
their RBC are exposed to certain triggers
which are:
● illness (bacterial and viral infections)
● certain painkillers and fever
reducing dtugs like aspirin
● certain antibiotics( especially those
that have”su;f” in their nameslike
sulamethoxazole- bactrim)
● certain antimalarial drugs ( those
that with “quine” in their names like
chloroquine(
● Soya foods-taho, tokwa, soy sauce
- Red wine
- Legumes- monngo, garnazos,
abitsuelas
- Vitamin K
- Naphthalene (moth balls)
- blueberries
- s/s: anemia like symptoms
● Paleness ) in darker-skinned children
paleness is sometimes best seen in the
 mouth, especially on the lips or
tongue)
● Extreme tiredness
● rApid heartbeat
● Rapid breathing or shortness of
breath
● Jaundice or yellowing of the skin
and eyes particularly on newborns
● Enlarged spleen
● Dark-tea-colored urine
- Prevention/treatment
● Limit exposure to the triggers
● Folic acid
● Phototherapy
● Blood transfusion

CONGENITAL HYPOTHYROIDISM
HYPOTHYROIDISM
- is a condition in which the person does not
make enough thyroid hormone.
APGAR SCORE and 10, it will receive normal care
from there on out
● if the newborn scores between a 4
and 6, they may need help breathing
● anything lower than a 4, would
What is the APGAR SCORE? mean that the infant needs extreme
- The Apgar score is a scoring system measures to save it's life
doctors and nurses use to assess
newborns one minute and five
A is for Activity
minutes after they’re born.
- How is your baby’s movement?
- Dr. Virginia Apgar created the system
● 0 point - no movement. Almost “limp’’
in 1952, and used her name as a
● 1 point - some flexing in the arms an/or
mnemonic for each of the five
legs
categories that a person will score.
● 2 points - active. Arms and legs flex resist to
Since that time, medical professionals
extend
across the world have used the
scoring system to assess newborns in
P is for Pulse
their first moments of life.
- How fast is baby’s heart rate? (in 1
- Medical professionals use this
minute)
assessment to quickly relay the status
● 0 point - no pulse
of a newborn’s overall condition. Low
● 1 point - less than 100 beats per minute
Apgar scores may indicate the baby
● 2 points - higher or equal to 100 beats per
needs special care, such as extra help
minute
with their breathing.

G is for Grimace
What is the Apagar Score?
- How does your baby react when
● the first test given to a newborn to
being irritated?
determine it's physical condition
● 0 point - no response
(occurs right after birth)
● 1 point - only facia; expression
● recorded at 1 and 5 minutes after
● 2 points - pulls away, cries, sneezes etc
birth
● calculated by adding points, either
2,1, or 0
A is for Appearance
● best possible score is out of 10
- What color is your baby?
● points given for muscle tone, skin
BLUE (WHERE)
color, heart rate, respiratory effort,
● 0 point - Everywhere
and response to stimulation
● 1 point - everywhere but the torso
● 2 points - normal (PINK)
What do the Apgar Scores mean?
R is for Respirations
● after the 1 minute Apgar evaluation,
- What is the baby’s breathing like?
if the newborn scores between a 7
● 0 point - absent
● 1 point - slow,weak.irregular
● 2 points - strong cry, normal effort and rate

APGAR SCORE
SCORE OF 0 SCORE OF 1 SCORE OF
2
ACTIVITY absent Flexed arms and active
legs
(muscle tone)

PULSE RATE absent Below 100 bpm Above

100 bpm
(heart rate)

GRIMACE floppy Minimal Prompt

response to response
(reflex irritabilty) stimulation to
stimulatio
n
APPEARANCE blue/pale Pink body wih pink
blue
(skin color)
extremities

RESPIRATION absent Slow and Vigorous

irregular cry
(breathing)
DUBOWITZ/BALLARD SCORING PHYSICAL MATURITY

 Based on the neonate's physical and

neuromuscular maturity

 can be used up to 4 days after birth

 evaluates a baby's appearance, skin

texture, motor function, and reflexes.

 The physical maturity part of the

examination is done in the first 2 hours
of birth.

 The neuromuscular maturity

examination is completed within 24 NEUROMUSCULAR MATURITY
hours after delivery.

 This scoring allows for the estimation of

age in the range of 26 weeks-44
weeks.

 an extension of the above to include

extremely pre-term babies i.e. up to
20 weeks.

 The scoring relies on the intra-uterine

changes that the fetus undergoes
during its maturation.

POSTURE

 Total body muscle ton is reflected in

the infant’s preferred posture at rest
and resistance to stretch of individual
muscle group
 To elicit the posture item, the infant is
placed supine (if found prone) and
the examiner waits until the infant
settles into relaxed or preferred
posture.

SQUARE WINDOW
 Wrist flexibility and/or resistance to
extensor strethching are responsible
for the resulting angle of flexion at the
wrist.
 The examiner straightens the infant’s
fingers and applies gentle pressure on
the dorsum of the hand, close to the
fingers. From extremely pre-term to
post-term, the resuling angle between
the palm of the infant’s hand and
forearm is estimated at; >90 degrees,
90 degrees, 45 degrees, 30 degrees, 0
degree
 The appropriate square on the score
sheet is selected.
ARM RECOIL
 This maneuver focuses on passive
flexor tone of the biceps muscle by
measuring the angle of recoil
following very brief extension of the
upper extremity.
 With the infant lying supine, the
examiner places one hand beneath
the infant’s elbow for support. Taking
the infant’s hand, the examiner briefly
sets the elbow in flexion, then
momentarily extends the arm before
releasing the hand.
POPLITEAL ANGLE
 This maneuver assesses maturation of
passive flexor tone about the knee
joint by testing for resistance to
extension of the lower extremity. With
the infant lying supine, and with the
diaper re-moves, the thing is placed
gently on the infant’s abdomen with
the knee fully flexed. After the infant
has relaxed into this position, the
examiner gently grasps the foot at the
sides with one hand while supporting
the side of the thigh with the other.
SCARF SIGN
 This maneuver tests the passive tone
of the flexors about the shoulder
girdle.
 The examiner nudges the elbow
across the chest, felling for passive
 flexion or resistance to extension of
posterior shoulder girdle flexor
muscles.

HEEL TO EAR

 The examiner supports the infant’s

thigh laterally alongside the body with
the palm of one hand. The other hand
is used to grasp the infant’s foot at the
sides and to pull it toward the
ipsilateral ear.
NEWBORN ASSESSMENT
ANTHROPOMETRIC MEASUREMENT
Weight
 2.5-4.5 kg
Length
-measured from the top of the head to the
bottom of one of their heels
 Female – 53 cm (20.9 in)
 Males – 54 cm ( 21.3 in)
Head circumference
-Wrap a flexible, non-stretchable measuring
tape around their head at the widest part –
just above the eyebrows( 1-2 fingers) and
ears, and around the back where the head
slopes up prominently from the neck
 34-35cm
Chest circumference
-measured at the level of the nipple, at the
end of expiration
-2 cm less than the head circumference
 30-33 (12-13 inches)
Vital signs
1. TEMPERATURE
 99F ( 37.2 C) at the moment of
immature temperature regulating
mechanisms
 birth bec they have been confined in
an internal body organ.
 Falls immediately because of heat loss
 Convection – flow of heat to body
surface to cooler surrounding air.
 Conduction- transfer of heat to a
cooler solis object in contact with the
baby.
 Radiation – transfer of heat to a cooler
solid/object not in contact with the
baby.
 Evaporation – loss of heat through
conversion of a liquid to a vapor.
 loses heat easily
 has difficulty conserving heat under
any circumstances.
INSULATION
–effective for adults but not for newborns
because they have little subcutaneous fats
to provide insulation
-Constricting blood vessels
BROWN FAT
–a special tissue found in a mature
newborns helps to conserve or produce
body heat by increasing metabolism.
-Found in the intrascapular region, thorax,
perineal area
-Because newborns have difficulty 3. RESPIRATION
conserving heat, exposure to cold is
 1st few minutes of life - 80 breaths/min
detrimental, newborns tends to kick and cry
to increase metabolic rate to produce more  Average- 30-60 breaths/min
heat.
 Respiratory depth, rate and rhythm
 newborns tends to kick and cry to are irregular and short periods of
increase metabolic rate to produce apnea sometimes called PERIODIC
more heat. RESPIRATIONS which are normal.

 Coughing and reflexes are present at

birth to clear the airway.
HOW TO CONSERVE HEAT:
 Nose breathers
 Drying and wrapping newborns

 Placing them in a warmed crib

4. BLOOD PRESSURE
 Placing them in a radiant heat source
 at birth - 80/46 mm Hg
 KANGAROO CARE– placing the
newborn against the mother’s skin  10th day - 100/50 mmHg
and covering the newborn to help
transfer heat from the mother to the
newborn.
APPEARANCE OF A NEWBORN

SKIN
2. PR
A. Color
 Transient murmurs - incomplete
- ruddy/red ( term)- RBC and less SQ fats
closure of fetal circulation shunts
- cyanosis- decrease oxygenation
 Immediately after birth - 180bpm
- hyperbilirubinemia- yellow /jaundice
 Within an hour after birth- 120-140bpm
- pallor- pale( anemia)
 Irregular because of the immaturity of
the cardiac regulatory center in the B. Birthmarks
medulla.
C. Vernix caseosa
 Femoral pulses can be felt readily in a
D. Lanugo
newborn. If absent = suggest possible
coarctation ( narrowing) of the aorta. - fine downy hair

 Radial and temporal pulses are - disappears by 2 weeks

difficult to palpate
- covers NB’s shoulders, back, upper arms,
forehead and ears
E. Desquamation -localized softening of cranial bones

-dryness ( palms of the hand soles of the -Common in 1st born infants
feet)
-Cranium – skull
-No need treatment
-Tabes- wasting
-seen on postmature babies
F. Cephalhematoma
F. Milia
-collection of blood between the
-Pinpoint white papule foundon the cheeks periosteum of the skull
and on the bridge of the nose

-Disappear by 2-4 weeks( maturation of

EYES
sebaceous glands)
-no tears until 3 month
-Don’t squeeze or scratch
-subconjunctival hemorrhage
G. Erythema Toxicum
-periorbital edema( 2-3 days)
-Newborns rash

-Appears in the 1st to 4th day of life-2 weeks

of age EARS
H. Forcep Marks -not completely formed
-Disappears 1-2 days -term – pinna recoils

-visualizing tympanic membrane is difficult

HEAD

A. Fontanelle- shd not ne indented NOSE

B. Sutures -large
-Wide separation( increased ICP,
hydrocephalus, accumulation of blood from
birth injury) MOUTH

C. Molding opens evenly

D.Caput succedaneum -large tongue

-edema of the scalp -Epstein pearls (palate)

- disappear- 3rd day

E. Craniotabes NECK

-short and chubby, rotates freely

CHEST Swallowing reflex

-witch’s milk  Food that reaches the posterior

portion of the tongue is automatically
-rhonchi
swallowed.
-location of nipples
 Gag,cough and sneeze reflex are also
present to maintain a clear airway in
the event that normal swallowing
ABDOMEN does not keep the pharynx free of
obstructing mucus.
-slightly protuberant, umbilicus
Extrusion Reflex

 Extrude any substance that is placed

ANOGENITAL AREA
on the anterior portion of the tongue.
EXTREMITIES
 This protective reflex prevents the
swallowing of inedible substances.

NEWBORN REFLEXES  Disappears about 4 months of age-

until then, an infant may seem to be
Blink Reflex
spitting out or refusing solid food
 to protect the eye from any object placed in the mouth.
coming near it by rapid eyelid closure.
Palmar Grasp Reflex
Rooting reflex
 Grasp an object placed in their palm
 Serves to help the baby find food. by closing their fingers on it.

 Newborn’s cheek is brushed or  Mature newborns grasp so strongly

stroked near the corner of the mouth, they can be raised from a supine
the child will turn the head in that position and be suspended from the
direction. examiner’s fingers.

 Disappears abt the 6th week of life. -  Disappears at 6 weeks to 3 months

at this time, the eyes can already
focus and can already see.
Sucking Reflex
 When a newborn’s lips are touched,
the baby makes a sucking motion.
 Diminish at 6 months of age
 Disappears immediately if
stimulated.
 A baby begins to grasp meaningfully
at about 3 months of age.
Step (Walk) in place Reflex
 Newborns who are held in A vertical
position with their feet touching a
hard surface will take a few quick
alternating steps.
not
 Disappears by 3 months of age
Tonic neck Reflex Babinski Reflex

 When newborn’s lie on heir backs,  When the side of the sole of the foot is
their head usually turn to one side of stroked in an inverted “J” curve from
the other. the heel upward.

 The arm and the leg on the side to
which the head turns extend, and the
opposite arm and leg contract
 Movement is evident in the arms
 This reaction occurs because nervous
system development is immature.
 Remains positive until 3 months of age

 Also called the Boxer or fencing reflex

 Disappears between the 2nd and 3rd

month of life.

Moro / Startle Reflex

 Can be initiated by startling the

newborn with a loud noise or by
jarring the bassinet

 The most accurate method to elicit

reflex is to hold newborns in a supine
position and allow their heads to drop
backward an inch .

 They abduct and extend their arms

and legs.

 Fingers assume a typical “C” position

 The reflex stimulates the action of

someone trying to ward off an
attacker, then covering up to protect
himself.

 Strong for the 1st 8 weeks

 Disappears at the end of 4th or 5th

month when the infant can roll from
danger.
ESSENTIAL INTRAPARTUM - Monitoring the progress of labor
with the use of partograph
NEWBORN CARE
Unnecessary interventions eliminated

● DURING LABOR AND DELIVERY

- enemas and shavings
Essential Intrapartum and Newborn Care - fluid and food intake restriction
- routine insertion of intravenous
(EINC) Evidence-based Standard Practices
- The EINC practices are fluids
- Fundal pressure to facilitate
evidenced-based standards for
second stage of labor is no
safe and quality care of birthing
mothers and their newborns, longer practiced, because it
resulted to maternal and
within the 48 hours of
Intrapartum period (labor and newborn injuries and death.
delivery) and a week of life for
the newborn. Unnecessary interventions eliminated
- EINC distinguishes the necessary ● FOR NEWBORN CARE
- routine suctioning
practices in the delivery and
- early bathing
care for the newborn and the
- routine separation from the
mother, from the unnecessary.
mother
- In December 2009, the
Secretary of the Department of - foot printing
- application of various
Health Francisco Duque signed
substances to the cord
Administrative Order 2009-0025,
- and giving pre-lacteals or
which mandates
artificial infant milk formula or
implementation of the EINC
Protocol in both public and other breast-milk substitutes.
private hospitals. Likewise, the
WOMAN ALREADY IN THE DR
Unang Yakap campaign was
- Checked temperature in DR
launched.
area to be 25-28C, eliminated
PRIOR TO WOMAN’S TRANSFER TO THE DR air draft
- Asked woman if she is
- Continuous maternal support,
comfortable in the semi upright
by a companion of her choice,
during labor and delivery position
- Ensured the woman’s privacy
- Mobility during labor – the
mother is still mobile, within - Non-drug pain relief, before
offering labor anesthesia
reason, during this stage
- Episiotomy will not be done,
- Ensured that mother is in her
position of choice while in labor unless necessary
- Asked mother if she wishes to
PROCEDURE:
eat/drink or void
- Removed all jewelry then
Communicated with the
mother – informed her of washed hands thoroughly
progress of labor, gave observing the WHO 1-2-3-4-5
procedure
reassurance and
- Prepared a clear, clean
encouragement
newborn resuscitation area.
 Checked the equipment if - Applied perineal support and
clean, functional and within did controlled delivery of the
easy reach. head
- Called out time of birth and sex
NURSING ACTION of the baby
- Arranged materials/supplies in a linear - Informed the mother of
sequence
outcome
RATIONALE
- To facilitate easy access of the materials
FIRST 30 SECONDS
according to the order of use.
● Gloves • Thoroughly dried baby for at least 30
● dry linen seconds, starting from the face and
● Bonnet
head, going down to the trunk and
● oxytocin injection
● plastic clamp extremities while performing a quick
● instrument clamp check for breathing
● Scissors/ surgical blade
● 2 kidney basins.
● In a separate sequence for after the 1st 1-3 MINUTES
breastfeed:
● eye ointment, • Removed the wet cloth
● (stethoscope to symbolize PE),
• Placed baby in skin-skin contact on
● vit K,
● hep B and the mother’s abdomen and chest
● BCG vaccines
• Covered baby with the dry cloth and
● ( plus cotton balls)
the baby’s head with a bonnet
NURSING ACTION
• Excluded a 2nd baby by palpating the
-Cleaned the perineum with antiseptic
solution abdomen in preparation for giving
RATIONALE oxytocin.
- To prevent infection
• Used wet cloth to wipe the soiled
gloves. Give IM Oxytocin within one
NURSING ACTION minute of baby’s birth. Disposed of
- Washed the hands and put on 2 pairs of wet cloth properly
sterile gloves aseptically ( if same worker
handles perineum and cord) • Removed 1st set of gloves and
RATIONALE decontaminated them properly
- To prevent contamination.
• Palpate umbilical cord to check for
AT THE TIME OF DELIVERY pulsations
- Encouraged the woman to
push as desired • After pulsations stopped, clamp cord
- Draped the clean, dry linen using the plastic clamp or cord tie at
over the mother’s abdomen or 2cm from the base
arms in preparation for drying
the baby
• Place the instrument clamp 5 cm from 15-90 MINUTES
the base
• Advised mother to observe for
• Cut near plastic clamp feeding cues

• Performed the remaining steps of the • Supported mother, instructed her on

AMTSL: positioning and attachment

0Waited for strong uterine • Waited for full breastfeed to be

contractions then applied controlled completed
cord traction and counter traction on
• After a complete breastfeed,
the uterus, continuing until placenta
administered eye ointment ( first) did
was delivered
thorough physical examination, then
• Massage the uterus until it is firm did vit K, hep B and BCG injections(
simultaneously explained purpose of
• Inspected the lower vagina and
each rationale)
perineum for lacerations and repaired
lacerations/tears as necessary • Advised OPTIONAL/DELAYED bathing
of baby ( AND was able to explain the
• Examined the placenta for
rationale)
completeness and abnormalities
• Advised breastfeeding per demand
• Cleaned the mother. Flushed
perineum and applied perineal • In the first hour: checked baby’s
pad/napkin breathing and color; and checked
mother’s vital signs and massaged
• Checked baby’s color and breathing;
uterus every 15 minutes
checked that mother was
comfortable, uterus is contracted • In the second hour; checked mother
baby dyad every 30 minutes to 1
• Disposed of the placenta in a leak
hour
proof container or plastic bag
• Completed all records
• Decontaminated instruments before
cleaning, decontaminated 2nd pair of
gloves before disposal, stating that
VACCINATION
decontamination lasts at least 10
mins. • Eye Ointment- erythromycin- to
prevent pink eye in the first month of
• Advised mother to maintain skin-skin
life” ophthalmia neonatorum”.
contact. Baby should be prone on
Common cause is chlamydia, a
mother’s chest between the breasts
sexually transmitted infection.
with head turned to one side.
• Hepatitis B- given to newborn baby’s
“insurance policy” against being
 infected with the hepatitis virus. Within • Initiates immediate skin-to skin
12 hours contact.

• Vitamin K- given to form blood clots • Positions the newborn prone on the
and to stop bleeding. Vitamin mother’s abdomen.
deficiency bleeding(VKDB). (0.5mg-
• Covers the newborn’s back with a dry
weighing below 1,500g & 1.0mg-
blanket.
weighing above 1,500mg).
• Covers the newborn’s head with a
• BCG-Bacille Calmette-Guerin-
bonnet.
vaccine given to baby to protect
them from serious forms of • Removes the 1st set of gloves prior to
tuberculosis(TB) such as TB cord clamping and cutting.
meningitis(infection of the brain).
• Clamps and cuts properly timed cord
between 1-3 minutes.
ANTHROPOMETRIC MESAUREMENTS • Injects oxytocin 10 IU to the mother’s
deltoid.
• LENGTH-48CM-50 CM
• Checks the mother’s condition and
• WEIGH- 2.5KG- 3.5KG
delivers the placenta.
• HEAD CC- 33 CM-35 CM
• Initiates breastfeeding for the 1st 30-60
• CHEST CC-30CM-33CM minutes.

• ABDOMINAL CC-33CM-35CM • Administer ointment, Vit K, Hep B and

BCG after the baby completes her
• THIGH CC-12-16CM
breastfeeding.
• ARM CC-8-9CM
• Performs anthropometric
measurements.

PROCEDURE (PORTFOLIO)

• Lays out material in linear manner.

• Wears sterile gloves. (Double gloving)

• Supports the perineum.

• Calls out the time of birth and sex of

the baby.

• Dries throrougly the baby for full 30

seconds using the 1st towel.

• Performs a rapid assessment of the

baby’s breathing.
NOTES NURSING CARE PLAN

ASSESSMENT

 Subjective- patient only

PHYSICAL ASSESSMENT  Objective-observed, parents, relatives
GENERAL ASSESSMENT

-Vital signs NURSING DIAGNOSIS

-Anthropometric measurements PLANNING
-Cry  SMART
SKIN, HAIR, NAILS  State the exact nursing intervention

HEAD AND NEACK RATIONALE

-assess shape of head, movement of neck EVALUATION

EYES AND EARS

MOUTH, THROAT, NOSE, SINUSE FDAR

-assess opening of mouth, moisture, check FOCUS

palate, assess tounge, check potency, nasal DATA
falring, respiratory distress, check sinuses
-assess positioning and attachment
HEART AND NECK VESSEL
-describe mouth of newborn
-indicate heart rate
-describe the position of baby
ABDOMINAL
-related to problem
-assess bowel sound
-there should be introduction (received
EXTREMITIES baby boy
-assess movement of extremities ACTION
GENITALIA -past tense
-assess scrotum RESPONSE
NEUROLOGIC -state interventions
-describe mental assessement

RESPIRATORY RATE- first vital sign to be

monitored
DRUG STUDY VITAMIN K

HEPATITIS B VACCINE  0.1 ml

 Use to prevent further bleeding
 Intamuscular
 Neweborn does not have the
 0.5 ml
bacteria to produce vitamin k
 Vastus lateralis- first dose
 Intramuscular
 Engerix-a
 Vastus lateralis
 Contraindication-hypersensitivity to
 Given ate left thigh when hep in on
yeast
right
 Side effect- dizziness, inflammation
 Monitor for bleeding episodes, assess if
 Given after delivery
there is darkening of skin, assess for
 Second dose- after 1 month (left
gengival bleeding, check platelet
thigh)
count, check if there is a presence of
 3rd dose- after 2 months
blood in urine
 Given after delivery

BCG VACCINE

 Bacillus Calmette Guerin

 .05 ml
NEWBORN ASSESSMENT
 Given only at birth
 Intradermal-perpendicular, deltoid, 15  Dry from head to toe
degrees angle, insert the bevel not  Skin to skin
the needle, and observe bleb or  Place bonnet
wheel  Place towel
 Class- immunological,  Wait 2-3 mins before cutting umbilical
antisera/antiserum cord
 Use to prevent tuberculosis among  Inject oxytocin to mother
newborns  Observe, initiate breastfeeding
 Treat tb  Do anthropometric measurements
 Contraindication- severe illness, seve  Give eye ointment to baby (inner to
fever, malnourished outer canthus), do not touch eyes, do
 Side effect- small swelling in injection not remove excess
site, absessforsome, fever, rashes  Give hepa b, bcg, and vitamin k
 Responsibilities- advise parents not to vaccines
scratch it, assess if there is fever, assess  Rest the baby
allergic reactions

ANTHROPOMETRIC MEASUREMENTS

 Weight- undress, consider time, done

at the same time (at morning, then
another morning), no diaper
  Length- head to heels, side lying,  Average- 30-60 bpm
female- 53 cm (20.9 inches), males- 54  Irregular and shallow for newborn,
cm(21.3 inches) they also cough to clear airways
 Head circumference- place tape  Remove secretion on mouth and nose
measure around occiput, above
eyebrows, 34-35 cm, <33 is
microcephaly BLOOD PRESSURE
 Chest circumference- at level of niple,
taken at end of expiration, bigger  At birth- 80/46 mmHg
head-smaller chest  10th day- 100-50 mmHg

VITAL SIGNS SEQUENCE OF GETTING VITAL SIGNS

TEMPERATURE 1. RR
2. PR
 99 farenheit (37.2 degree celcius)- 3. TEMP
they have this temp. because they 4. BP
are in uterus
 drop in temp. (hypothermia, no
clothing)
 newborn have no brown fat,
especially immature, but term baby APPEARANCE OF NEWBORN
have which warm their bodies
SKIN
 brown fat (thorax, perineal)
 they are crying and kicking to Color
produce metabolism for heat
 ruddy/red- RBC, less subcutaneous
fat- grade of 2
 cyanosis- decrease oxygen
PULSE RATE
 yellow/jaundice
 180 beats per min., but after 3 mins or  pallor- pale (grade of 0)
1 hour, it becomes 120-140 bpm
Birth marks
 Transient murmurs is normal
 When palpating femoral pulse, you  vernix caseosa- skin folds, provides
can feel it, but if you can’t, there is a warmth, acts as a thermoregulator,
contraction of aorta do not remove
 Radial and tempral pulse are hard to  lanugo
palpate  desquamation- leather-like skin
 milia- bridge of nose, cheeks, related
to immature sebaceous glands, just
RESPIRATORY RATE like white heads, do not scratch
because it causes infection
 1 min- 80 bpm
 erythema toxicum
  forcep marks- assisted forcep delivery  open evenly, if not, there is a problem
in CN 7, tounge is large, epstein pearls
HEAD
(palate)- calcium
Fontanelle

 when palpated, not intended, but if, it

NECK
is abnormal condition
 baby should not be crying and eating  short and chubby, rotates freely

Sutures

Molding CHEST

 head is deformed- caused by  nipples (inflamed) and secretions

mother’s pushing, disappears in how  witch’s milk related to maternl
many days hormones
 caput succedaneum- pressure during
delivery
 craniotabes- palpate head (soft)- ABDOMEN
related to pressure
 cephalhematoma  slightly protuberant, umbilicus (check
color, 6-7 days will fall off)

ANOGENITAL AREA
EYES
 testes (pendulous)
 no tears until 3 months because of  female (big labia)
immature sweat glands
 presence of blood on conjunctiva
related to pressure
EXTREMITIES

 check for extra toes

EARS  check palms/soles for creases

 not completelt formed

 preterm- stays that way
 ears are still occupied with vernix and
amniotic fluid

NOSE

 large

MOUTH