Care of Normal Newborn

Definition
Neonatal period/neonate/
newborn first 28 days of life

Perinatal period 22 weeks of gestation to 7

days after birth
 Definition
Early Neonate birth to first 7 days of life
Late Neonate after 7 days 28 days of lif
 Definitions
Term baby born after 37 completed weeks
upto 42 completed weeks of gestation
Preterm baby born before 37 completed
weeks of gestation
Post-term baby born after 42 completed
weeks of gestation
 Definitions
SFD / SGA : birth weight is <10TH CENTILE
FOR GESTATIONAL AGE
AFD/ AGA :Birth weight is 10TH - 90TH
CENTILES FOR GESTATIONAL AGE
LFD/ LGA :Birth weight is >90TH CENTILE
FOR GESTATIONAL AGE
 Classification of Newborn
A) Depending upon gestational age:
Term
Preterm
Post-term
 B) Depending upon Birth weight :

Normal birth weight (NBW) :2500-3999 g

Low birth weight (LBW) : <2500 g
Very low birth weight (VLBW) : <1500 g
Extremely low birth weight (ELBW) : <1000 g
Preemie : <750 g
Micropreemie : <500 g
Very Low Birth weight:
1000-1500g
Very Low Birth weight:
1000-1500g
Extremely low birth weight: 500-
1000g
 C) Depending upon Gestational Age &
B.WT
Preterm - SFD / SGA
AFD/ AGA
LFD/ LGA
Term -SFD / SGA
AFD/ AGA
LFD/ LGA
Post Term - SFD / SGA
AFD/ AGA
LFD/ LGA
Plotting Weight, Length, HC
 Component of Newborn care
1. Clean delivery & clean cord care
2. Maintanance of body temperature
room warm/cloths-cap, socks,oil
massage
3. Skin care- sponge, not to scrub vernix
4. Care of umbilical stump keep dry (fall
after 5-10days)
5. Care of eyes
 Component of Newborn care
6. Breast feeding
7. Weight record
8. Early detection of serious Ds
9. Immunization
10. Supplements and follow up
 Follow up
Well baby clinic evaluation
Exclusive breast feeding
Growth and development
Immunization
Nutrition advice
 Care at birth-DELIVERY ROOM CARE

Ensure clean and safe delivery

Delivery room - Clean, well
ventilated, adequately lighted, warm room
Temperature stabilisation
Suction - mouth and nostril
Cut the umbilical cord -2.5 inch from skin
Weigh and classify
Assess under warmth
 Basic care of the normal newborn

1.Rooming in
2. Receive the baby in sterile sheet
Cover adequately and dress
3. Check
color, respiration, temperature, and
umbilical cord
4. Record skin temperature
Basic care of the normal newborn

- Has instinct, concern, interest, love and affection

- Can involve in nursing care
- Recognition of early evidence of disease
 Basic care of the normal newborn

Breast feeding
- First feed within 1-2 hours
- No prelacteal feeds
- Colostrum to feed
- No need of water
- Demand feeding 2-3 hours -15-20min, Burp
- Adequacy of breast feeding
 Care of normal newborn
Maintenance of body temperature
- Avoid bath on first day
- Cover adequately and dress
Bath
- At birth - clean blood, mucus and meconium
- Bath can be given on next day, use unmedicated
soap and lukewarm water
- Sponging is sufficient
- Avoid dip bath
Skin care
- No need to clean all vernix, but clean blood and
meconium
- Skin abrasions - use topical antibiotics
 Care of normal newborn
Cord care
Clamp, inspect 2- 4 hourly for bleeding, no
dressing, spirit cleaning of tip and around
the base
Eye care
Sterile cotton swab cleaning, each eye
separately, no kajal application
Vitamin K - 1mg IM within 2 hours of life
Dresses
Loose, soft, preferably cotton, woolen, nappies
 Care of normal newborn

Routine care Supportive care

(Term, vigorous, crying, pink Warmth
good tone , no meconium) Position
Suction
Dry
Cover with dry linen
Dry
Skin to skin contact Stimulate
Clear airway Give O2
 Care during subsequent period
1.Weight recording - daily
- Weight loss during first 2-3 days, 5-8% of
body weight
- Stationary for next 1-2days
- Regain birth weight - at the end of first week
- Average weight gain thereafter- 30g / day
2. Immunisation - BCG
3. Discharge plan and future visits
 Grades of care of newborn
Level I care:
>89% require minimal care
Wt >2000gm

Care provided at home/subcenter/primary

health care
 Level II care :

10-15% require this care

Wt- >1500gm
Gest maturity 32-36 weeks
Needs specialized neonatal care supervised by
trained nurses /pediatrician
Equipments Et tube/Laryngoscope
- IV infusion, NG tube,
- Phototherapy
- Facility for exchange transfusion ect
 Level III care
3-5% require this care
Intensive neonatal care
< 1500 gm
Gest < 32 weeks
Skilled neonatologists/trained nurses
Equipments incubator, oxygen
- Suction apparatus
- Ventilator
- Infusion pump, trancutaneous
monitors
Early detection of serious disease

1. Bleeding from any site

2. Jaundice appearing <24 hours / Deep
jaundice / Physiological jaundice
3. Not passed meconium within 24
hours / urine within 48 hours
4. Regurgitation, vomiting / loose stools
5. Poor feeding / lethargy/ Excessive
sleepiness
 Early detection of serious disease
6. Excessive frothiness / drooling of
saliva
7.Cold to touch / fever / Dehydration
fever
8.Abdominal distension
9.Difficult / rapid breathing
10.Convulsions
 Common neonatal problems
11. Excessive cry- hunger, discomfort, full
bladder, colic, insect bite, soiling
12.Superficial infections - skin pustules,
umbilical, sepsis, conjunctivitis, oral
thrush
13.Blocked nasolacrimal duct
 Minor developmental pecularities
1. Erythema toxicum /urticaria neonatorum-
erythematous rash with central pallor
,appears on 2-3rd day in term baby, starts on
face & spreads to trunk & extremities in 24
hrs, disappears in 2-3 days
2. Peeling skin
3. Milia- retention sebum
4. Mongolian blue spot
 Minor developmental pecularities
5. Subconjunctival hge
6. Epstein pearl epithelial inclusion cysts
7. sucking callosities
8. Tongue tie
9. Hymenal tags/ non retractable prepuce
10.Prominent xiphisternum
11umbilical hernia
 Minor developmental pecularities
13. disorders due to transplacental passage of
hormones Mastitis neonatorum
- vaginal bleeing
- mucoid vaginal secretions
 Criteria of normal newborn
1. Gestation 37-42 completed weeks
2. Birth wt 2500 3999gm
3. Breathing spontaneous,regular,RR 30-
60/min
4. Color pink but slight peripheral cyanosis
soon after birth
5. Heart rate 100 -160/min
6. Temp ( axillary) 97.5-990 F
 Criteria of normal newborn
7. HC 33-35cm
8. Length 50 cm
9. Chest circumference 3 cm< HC
10.Upper segment : lower segment 1.7-1.9:1
11. Sucks soon after birth
12. Sleeps 18 hr/day
13.Physiological photophobia, sclera bluish
 Criteria of normal newborn
14. Ear cartilage firm with good elastic recoil
15. Breast nodule > 5 mm
16.Liver palpable 2 cm
17. Genitalia
Male -Testes in scrotum,deeply pigmented
scrotum/adequate rugae
Female -Labia minora covered by labia majora
18. Sloes >anterior 2/3rd show deep crease
 Criteria of normal newborn
19. Muscle tone increased by adult
standard/attitude of flexion
20. 95% term & preterm void within 24 hrs but
some pass in 48hrs
21. 99% term & 95% preterm pass meconium
within 24- 48 hrs of birth
22. No apparent cong anomalies
 Examination of newborn
Examined region by region
Soon after birth
At 24 hrs of life
Before discharge
Pre-requisites
Wash and dry hands
Good light
Warm environment
Concent
 Examination of newborn
1.Overall impression face,trunk,limbs,activity
2.Measurements wt/length/HC
3. Color pink,jaundice
4. Skin pallor /jaundice/erythema toxicum
5. Head fontanelles/ sutures/ cephalhematoma/
superficial injuries
6. Face dysmorphic features
 Examination of newborn
7.Ears low set/demormity
8. Eyes discharge/inflammation/cataract
9. Nose choanal atresia
10. Mouth cleft palate
/macroglossia/micrognathia/excessive
frothing
11. Neck sternomastoid tumour /branchial &
thyroglossal cysts/webbing neck/short
neck/neonatal goiter/ cystic hygroma
 Examination of newborn
12. Upper limbs
palsy/extra digits
13. Chest accessory nipples/wide apart
nipple/breast hypertrophy/lung field
14. CVS mumurs
15. abdomen organomegaly/distension
/bowel sound
16. umbilical cord single U. artery/signs of
sepsis
 Examination of newborn
17. Hip congenital dislocation of hip
18. Genitalia
19.Anus imperforated anus
20. Feet club feet/sole creases
21. Spine midline defect ( spina bifida)/
meningomyelocele
22. Primitive reflexes