IMMEDIATE CARE OF THE NEWBORN

Rationale: Assessment of the newborn allows recognition of the abnormalities requiring intervention.

The student will be able to describe: A. Perform techniques for assessing newborn status B. Immediate care of the normal newborn C. Identify situations requiring immediate intervention in newborn care

this is with a warm. prevent injury and infection. maintain and support respirations. soft towel. Directly after birth there should be attention to the condition of the newborn. Ideally. To provide warmth and prevent hypothermia. To ensure safety. This would include: y Shirts y T-shirts y Gloves y Jackets y Socks . any dry. Immediate care involves: Drying the Baby Immediately after delivery. As much as labor and the birth of a new life can be tiring and overwhelming for new parents the nursing care needs to begin immediately whilst still being able to enjoy the first few moments of life. Taking care of an immediate newborn can be done with a little knowledge and patience to ensure that she starts off life healthy and happy. as well as starting the process of breastfeeding. In an emergency. soft towel. Taking care of a newborn immediately following her birth includes ensuring that the newborn can breathe and maintaining her temperature. To identify actual or potential problems that may require immediate attention. but don't delay in drying the baby while searching for a warm. the baby should be dried. For many first time moms and dads the experience of the first few moments with a much awaited baby can be overwhelming. absorbing material will work well for this purpose. which is why immediate nursing care of the newborn can be delivered with the assistance of the delivering nurse of midwife.Immediate Care of the Newborn Objectives: y y y y To establish. There are also some items that need to be administered to the newborn to prevent disease and eye infection. The World Health Organization (WHO) states that such attention is an integral part of care in normal birth.

is not present in most newborns until 3 weeks after birth. The reflex response to nasal obstruction. Babies. This is particularly true of premature infants.Replace the Wet Towels Babies can lose a tremendous amount of heat very quickly. By removing the wet towels and replacing them with dry towels. particularly if they are wet. you will reduce this heat loss. It is in the maintenance of adequate oxygen supply through effective respiration that the survival of the newborn greatly depends. 2. cough or gag during the first 12 . pitched cry ± indicates hypoglycemia. to choke. y Compress bulb syringe before inserting y Suction mouth first. The normal infant cry is loud and husky. increased intracranial pressure . Observe for the following abnormal cry: . Wipe mouth and nose of secretions after delivery of the head of the baby . have some difficulty maintaining their body heat and may develop hypothermia if not attended to carefully.Hoarse cry ± laryngeal stridor 4. Suction secretions from mouth and nose. Do not slap the buttocks rather rub the soles of the feet. opening the mouth to maintain airway. To establish and maintain respirations: 1. the nose y Insert bulb syringe in one side of the mouth 3. Stimulate to cry after secretions are removed. Stimulate the baby to cry if baby does not cry spontaneously. Oral mucous may cause the newborn.High. or if the cry is weak. Newborns are obligatory nose breathers. then.Weak cry ± prematurity . Establish respiration and maintain clear airway The most important need for the newborn immediately after birth is a clear airway to enable the newborn to breathe effectively since the placenta has ceased to function as an organ of gas exchange. y y A crying infant is a breathing infant. during the first few hours of life.

Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine position. sputter and sneeze. Newborns are obligatory nose breathers until they are about 3 weeks old. fluid can be seen streaming out of the baby's nose and mouth. Place the infant in a position that would promote drainage of secretions: . Bulb syringes are commonly used for this purpose. they may need some assistance in clearing their airway of the mobilized fluid. When babies are born. Several natural mechanisms help with this: y y y y As the fetal chest passes through the birth canal it is compressed. After birth. babies cry loudly and repeatedly. While babies will. place infant in side lying position to permit drainage of mucus from the mouth. After birth. 5. clearing fluid and opening air sacs in the process. This will require suctioning. including a hypodermic syringe without the needle. mobilizing additional fluid that may be in their lungs. any suction type device may be used. Crying is a reassuring event and does not indicate distress. If a bulb syringe is not available.Side lying position ± If trendelenburg position is contraindicated. After several seconds in this "partly delivered" position. Remove mucus and other particles that may be cause obstruction. they need to clear the mucous and amniotic fluid from their lungs. This is noticed most often after the fetal head is delivered but prior to delivery of the shoulders. babies cough. bring the amniotic fluid out of the lungs on their own. keep the baby in a slight Trendelenburg position (head slightly lower than the feet) and turn the baby to its' side to allow the fluids to drain out by gravity. suctioning both the nose and mouth of the baby. for the most part. Keep the nares patent. . squeezing excess fluid out of the lungs prior to the baby taking its' first breath.to 18 hours of life.Trendelenburg position ± head lower than the body . in addition to opening the air sacs in the lungs. Newborn grunting actions may further mobilize fluid. If no suction device is available.

Babies are not slapped on their buttocks for this purpose.6 F axillary 32 ± 33 cm 120 ± 140 bpm 30 ± 60 bpm 2. particularly the hands and feet. Central cyanosis is not normal and indicates the need for treatment. although flicking the soles of the feet with a thumb and forefinger can provide enough noxious stimulation. many have some degree of "acrocyanosis. are blue or purple." This means that the central portion (chest) is pink. Although some newborn infants are uniformly pink in color. . It is due to relatively sluggish circulation of blood through the peripheral structures. additional drying with a towel may provide enough tactile stimulation to cause the baby to gasp and recover. but the extremities. color and heart rate.5 to 3. disappearing over the next day.4 kg 46 to 54 cm Evaluate the Baby Evaluate the baby for breathing.6 ± 98. Acrocyanosis is normal for a newborn during the first few hours. If the baby is not breathing well or is depressed. It is due to the accumulation of desaturated (oxygen-depleted) hemoglobin. Cyanosis due to airway obstruction is treated by opening the airway.Assessing the average newborn Head Circumference Temperature Chest Circumference Heart Rate Respirations Weight Length 34 ± 35 cm 97. related to immaturity or inexperience of the newborn blood flow regulatory systems. Color Asses the pinkness of the fetal skin.

If the pulse is less than 100 BPM. the baby is not making significant respiratory efforts. You will feel a strong tapping sensation if you feel the cord next to the baby with your thumb and forefinger. but palpating the newborn pulse is easy to do and requires no special equipment. bag. 100% oxygen. Even if the umbilical cord has been clamped and cut. In other than ideal circumstances. If you blow too forcefully or use too large a volume of air. This hand will make the small adjustments necessary to keep the airway open. flowmeter and flow control valve. Position one hand behind the newborn head and neck. you risk over expanding the lungs. In mild cases. . causing a pneumothorax. after a brief period of tactile stimulation. you should begin ventilating the baby artificially. Check the Heartbeat The normal newborn heart rate is over 100 BPM. using whatever materials you have available to you. cyanosis may be resolved by providing 100% oxygen to the baby. Alternatively. you can feel the brachial artery pulse. using whatever equipment and skills that are available. the umbilical arteries can still be palpated.Cyanosis due to inadequate ventilations is treated by ventilating the baby. pressure gauge. Pediatric stethoscopes can be used to listen to the heartbeat. Use puffs of air to expand the baby's lungs. which courses down the medial aspect of the upper arm. you should begin artificial ventilation. In ideal circumstances. Ventilate if Necessary If. this equipment would include a newborn mask. Cover the newborn's nose and mouth with your own mouth. mouth-to-mouth ventilation may be the only available resource.

The presence of meconium is significant because is indicates the need to thoroughly clear the airway of meconium. In operational settings. With depressed infants. repeat the scoring every five minutes as needed. About 6 hours or so after birth. Babies subjected to intrauterine stress often pass meconium before delivery. this is due to the presence of meconium and is found in as many as one in five deliveries. cheesy coating on their skin called "vernix. as it helps protect against infection. Virginia Apgar as a method of assessing the newborn¶s adjustment to extrauterine life. this is often accomplished with endotracheal visualization or intubation. but the vernix caseosa (whitish greasy material that covers most of the newborn's skin) is tried to be preserved. If the amniotic fluid is green colored. It is taken at one minute and five minutes after birth.Vernix Babies are usually born with a white. In a hospital setting. The one minute score indicates the ." This is a combination of skin secretions and skin cells. While excess vernix can be cleaned from the baby. endotracheal intubation of the newborn may not be an option and careful suctioning with any available device will be performed. it is not necessary to remove all of it as it has a protective effect on the baby's skin. Meconium Meconium is the dark green fecal material that babies pass after delivery and sometimes before delivery. Assign Apgar score THE APGAR SCORING SYSTEM The APGAR Scoring System was developed by Dr. but so do many non-stressed fetuses. the baby is bathed.

Cord clamp maybe removed after 48 hours when the cord has dried. The total score is the sum of the points from each category. ASSESS HEART RATE RESPIRATION MUCLE TONE REFLEX IRRITABILITY COLOR 0 Absent Absent Flaccid No response Blue all over 1 Below 100 Slow Some flexion Grimace Body pink. Extremities blue 2 Above 100 Good crying Active motion Vigorous cry Pink all over Score: y y y 7 ± 10 Good adjustment. Topical application of antiseptics is usually not necessary unless the baby is living in a highly contaminated area. vigorous Moderately depressed infant. The manner of cord care depends on hospital protocol. . The cord and the area around it are cleansed with antiseptic solution. Keep the cord stump clean and dry. needs airway clearance Severely depressed infant. The five minute score is more reliable in predicting mortality and neurologic deficits. the cord is clamped twice about 8 inches from the abdomen and cut in between. another clamp is applied ½ to 1 inch from the abdomen and the cord is cut at second time. In the delivery room. the muscle tone. Points are assigned according to each of five categories. What is important is that the principles are followed. reflex irritability and color follows in decreasing order. The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days. then the respiratory rate. A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress. Care of the cord The cord is clamped and cut approximately within 30 seconds after birth. When the newborn is brought to the nursery. in need of resuscitation The Apgar score is a commonly-used method to assess the newborn status and need for continuing treatment. The most important is the heart rate. Daily wiping of the cord with alcohol and leaving it open to the air facilitates drying and discourages bacterial growth.necessity for resuscitation.

4. As a preventive measure. Do not apply dressing or abdominal binder over it. 2. 5. Do not apply anything on the cord such as baby powder or antibiotic. hence. Vitamin K is also administered to prevent haemorrhagic disease of the newborn. 3.5 (preterm) and 1 mg (full term) Vitamin K is injected IM in the newborn¶s vastus lateralis (lateral anterior thigh) muscle. If you notice the cord to be bleeding.Instruction to the mother on cord care: 1. The cord dries and separates more rapidly if it is exposed to air. Leave cord exposed to air. . Report any unusual signs and symptoms which indicates infection. . the newborn does not possess the intestinal bacteria that manufactures vitamin K which is necessary for the formation of clotting factors. This makes the newborn prone to bleeding. Avoid wetting the cord. except the prescribed antiseptic solution which is 70% alcohol.      Foul odor in the cord Presence of discharge Redness around the cord The cord remains wet and does not fall off within 7 to 10 days Fever Vitamin K The newborn has a sterile intestine at birth. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine. apply firm pressure and check cord clamp if loose and fasten.

Care of the Eyes It is part of the routine care of the newborn to give prophylactic eye treatment against gonorrhea conjunctivitis or opthalmia neonatorum. erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose. manipulate eyelids to spread medication over the eyes. Keep the Baby Warm Newborn hypothermia can occur quickly and depress breathing. a German gynecologist in1884. . In sub-optimal circumstances. It is very important to keep the newborn warm. Silver nitrate. This can be accomplished by covering the baby with clothing as soon as it is dried. the causative agent. This practice was introduced by Crede. nearly any cloth material can be used keep the baby warm. Erythromycin or tetracycline Opthalmic Ointment: These ointments are the ones commonly used now a days for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis. Pay particular attention to keeping the head covered (but the airway open) as heat loss from the newborn head can be substantial. Apply over lower lids of both eyes. then. soft blankets and a head covering put in place. Neisseria gonorrhea. may be passed on the fetus from the vaginal canal during delivery. Typically. the baby is wrapped in warm.

Baby will get used to familiar smells very soon and to have that tactile contact with mom will provide those smells that will offer comfort and reassurance to baby. armpits. and cover both of them with blankets or clothing. Early sucking/breast-feeding should be encouraged within the first hour after birth and of nipple stimulation by the baby may influence uterine contractions. with windows closed. wash cloths. till the cord falls off. If the mother is available. Check the baby's temperature several times during the first few hours of life. the baby can be attached to the breast almost immediately. particularly if used in airtrapping layers. As previously mentioned. even if not getting much milk the feeling of closeness to mom is something that is essential. Bathing the newborn It is now common practice not to bathe the baby on the first day. to avoid accidental use of very hot water. & neck y Take the baby wrapped in a blanket away from the bathing area before dressing up.7-99. It is unwise to try to breast-fed babies with respiratory difficulties until the breathing problems are resolved. y Hold the baby firmly at all times supporting her / his neck properly.. y The room or bathroom should warm. y Wash the baby¶s face carefully with minimum of soap. Remember to fill cold water first in the tub. This helps to keep the cord dry. towels and change of clothes).Non-cloth material can also be effective in keeping the baby warm. The mother's body heat will help keep the baby warm. if breastfeeding.5-37. Breast-feeding Babies can be breast-fed as soon as the airway is cleared and they are breathing normally. back of knees.3F). y Avoid getting water in the ears. The normal range of newborn axillary temperature is about 36. place the baby on the mother's chest. y Always test the water first. y Dry the areas of creases and skin folds ± groin. then add hot water till the temperature is right. but is more time-consuming Keep all bath items ready (soap. you may prefer to give a sponge bath rather than a full tub bath to the baby. . dry the baby. Aluminum foil or Mylar reflective blankets provide satisfactory heat retention. cotton.4C (97. using swabs or a washcloth to clean the eyes. Often.

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