NCM 107 – Mother and Child Nursing ›Place the baby in a prone position on the mothers
abdomen or between her breasts
Unang Yakap Advocacy
› Unang yakap is a campaign launched by the DOH
with the support of WHO based on the Administrative
Order issued in December 2009 on the Guidelines on
Essential Newborn Care
› Philippines is 1 out of 43 countries accounting for
90% of all global death of under five children
› Every year 80,000 Filipinos die before their 5th
birthday
› Majority of newborn deaths occur in their first week
of life
› Essential intervention during labor and delivery and
immediately post-partum are needed to avert 70%
of newborn deaths
Essential Newborn Care
- Protocol adapted by DOH
- Saves lives with the right timing and step-by-step method
Essential Newborn Care Steps:
Step 1. Drying with Rapid Assessment of the baby’s breathing
 Immediate and thorough drying of the newborn
prevents hypothermia which is extremely important to
newborn survival
Step 2. Initiate immediate uninterrupted skin-to-skin contact
This promotes:
 Bonding between mother and child
 Improved breastfeeding initiation and exclusivity
 Stimulation of the Mucosa-associated lymphoid tissue
system
 Increased colonization with the protection Maternal
Skin Flora
 Protection from hypoglycemia, hypothermia and
sepsis
Step 3. Practice properly timed cord clamping
 Clamping and cutting until the umbilical cord pulsation
stops decreases anemia in 1 out every 7 term babies
and 1 out of every 3 preterm babies
 It also prevents brain (intraventricular) hemorrhage in
1 out of 2 preterm babies
Step 4. Initiate early breastfeeding
 Breastfeeding initiation within the first hour of life
prevents an estimated 19.1% of all neonatal deaths.
Carry out eye care and immunization procedures
Practice Rooming in
Practice exclusive per demand breastfeeding for 6 months
Continue breastfeeding until up to 2 years of age
Preparation for Labor and ENC Protocol
› Lay out 3 pairs of surgical gloves (2 for the obstetrician
and 1 for the pediatrician)
› 2 warm blankets
› 1 bonnet
› Cord Care Set (Includes umbilical clamps, kelly forceps,
umbilical scissors,
› Erythromycin for eye care
› Vitamin K and Hepatitis B shot
During the first 3 minutes within birth:
 Call out the time of birth, once the baby is delivered from
the perineum
 Use the first minute to towel dry the body of the newborn
› Dry the baby for at least 30 seconds, this will stimulate
the baby to baby to breath
› Do not wipe off the vernix (white, creamy, naturally
occurring biofilm covering the skin of the fetus during the
last trimester of pregnancy) as this will continue to
provide a natural protective cover for the baby
› Do not wash the baby within the first 6 hours of life
(may lead to hypothermia and infection)
› Do rapid assessment of breathing while drying the baby
 For the second minute, initiate skin-to-skin contact
› Cover the back and head of the baby, using the bonnet
and the second linen)
 Remove the first pair of gloves prior to handling of the
cord
› Do not cut the cord immediately, wait for at least 3
minutes, allowing the cord pulsation to stop without
milking the cord
› Clamp the cord at 2 cm from the umbilicus base and
apply the second clamp 5 cm from the umbilicus base
› Cut the cord
Ten minutes after birth:
› Inject 10 IU (1ml) of oxytocin into the mother’s arm
intramuscularly, to prevent uterine atony
› While still maintaining skin-to-skin contact, check on the
mother’s condition and deliver the placenta
› Check the heaviness of the mother’s bleeding and examine
the perineum, lower vagina and vulva for tears
› Clean the mother and keep her comfortable
30 minutes to an hour after birth:
› The baby will start licking, rooting and tonguing—cues
that the baby is ready for breastfeeding
› Encourage crawling reflex by telling the mother to nudge
her newborn towards the breast to seek out the nipple
› Council on positioning and attachment
After breastfeeding:
While the baby is still with the mother:
› Carry out the eye care procedure
› Administer vaccines
› Keep the infant in the mother’s arm while recovering from
giving birth
 The baby and the mother is roomed together in ward
 The baby may be washed after at least 6 hours
The Global Infant and Young Child Feeding Strategy Recommendation:
› Exclusive breast feeding from birth with colostrum up to 6
months
› At 6 months, appropriate complementary solids are
started while breastfeeding continues until two years old
or beyond
The Normal Newborn
Assessment and Care
Newborn Priorities in the 1st Day of Life
› Initiation and Maintenance of Respirations
› Establishment of extra-uterine circulation
› Control of body temperature
› Adequate nourishment
› Waste elimination
› Prevention of infection
› Infant-parent relationship
› Developmental care
Initiation and Maintenance of Respiration
Suctioning
› Turn head to one side
› Suction gently and quickly
› Suction the mouth first before the nose
› Test patency of airway
› Proper position
 Ensure open airway
 Do not hyperextend head
 Place neonate supine, head slightly extended
Made by: Mijelyn Bantigue
 Promote Early Bonding/ Attachment › Hypothermia can cause
 Allow parents to hold the newborn to promote bonding.  Hypoglycemia
Encourage breastfeeding right on the DR table  Increased oxygen needs
 Delay eye prophylaxis or crede’s prophylaxis for 1-2
hours after birth Four mechanisms of heat loss and corresponding interventions
 Implement early rooming-in › Evaporation
- Loss of heat through conversion of a liquid to a vapor
Profile of a Newborn  Dry infant immediately, covering head with cap after
drying
Vital Statistics › Conduction
› Weight (average 2.5-3.5 kg) - Transfer of body heat to cooler solid object in contact
› Length (male: 54 cm; female 53 cm. lowest 46 cm) with a baby
› Head circumference (34-35 cm)  Place on mothers body skin to skin
› Chest circumference (2cm less than the head) › Convection
- Flow of heat from the newborn’s body surface to
Vital Signs cooler surrounding air
› Temperature (37.2°C)  Cover with a blanket, wear a cap
› Pulse (120 to 160 bpm) › Radiation
› Respiration (30-60 breath/min) - Transfer of body heat to a cooler solid object not in
› Blood pressure (80/40 mmHg) contact with the baby
 Keep away from cold windows and cold objects
Respiratory System
› Reflex breath:
 Cold receptors
 Lowered pO2
 Increased pCO2
 Respiratory rate: 30-60 breaths per minute

Cardiovascular System
› Closure of ductus arteriosus and foramen ovale
 Heart rate: 120-160 beats per minute
› Easily palpable: femoral and brachial
› Acrocyanosis
 Cyanosis in the infant’s feet and hands
› Blood volume approx: 300mL
› High WBC 15,000-30,000mg/dL
› Prolonged coagulation and prothrombin time
› Vitamin K (AquaMEPHYTON) is usually administered
intramuscularly
 used to prevent and treat hemorrhagic disease in
newborns
› A newborn has difficulty conserving heat under any
circumstance.
› Newborns can conserve heat by constricting blood vessels
and moving blood away from the skin.
› Brown fat
 a special tissue found in mature newborns, apparently
helps to conserve or produce body heat by increasing
metabolism as well as regulating body temperature
similar to that of a hibernating animal.

Gastrointestinal System Routine Medications

› Accumulation of bacteria is necessary for digestion and › Erythromycin Eye Ointment
synthesis of Vitamin K › Aquamephyton (vitamin K)
› Can hold about 60-90 mL › First Hepatitis B vaccine
› Regurgitation
› Meconium Physical Characteristics
 Passed within the first 24 hours of birth During Phases Two and Three
 Sticky, tarlike, blackish-green, odorless material
formed from mucus, vernix, lanugo, hormones and Nervous System Reflex
carbohydrates
› Transitional stool
Reflex Description Purpose Disappear
 Green and loose stool that appears during the 2 nd to ance
3rd day of life Rapid eye closure Protect the Until adult
Blink
› Bright green stools appears because of increased bilirubin elicited by shining a eye from
excretion light on the eye or any object
› Clay-colored stool with bile duct obstruction sudden movement coming near
toward the eye it
Urinary System Rooting Newborn will turn the Help them 6 months
head in the direction find food
› Void within 24 hours of birth where the cheek is
› Light-colored and odorless urine brushed or stroked
near the corner of the
Immune System mouth
› Born with passive antibodies (IgG) Sucking Newborn makes Help 6 months
sucking motion when newborn find
 Newborns have limited immunologic protection at lips are touched food
birth because they are not able to produce antibodies Swallowing Food that reaches the Help them Until adult
until about 2 months. anterior portion of take in food
the tongue is
Maintaining thermoregulation automatically
› Referred to as maintaining a neutral thermal environment swallowed
 Heat loss is minimal
Gag, cough, Protecting airway Maintains Until adult
 Oxygen consumption needs are at their lowest sneeze mechanisms clear airway

Made by: Mijelyn Bantigue

 Reflex Description Purpose Disappea Senses Description
rance Hearing Begins in the utero and is acute after birth
Extrusion Newborn extrudes any Prevents 4 months Vision Blinking at strong light or following a bright light,
substance placed on the swallowing although they cannot follow the midline of vision
anterior portion of the indelible Touch Well-developed sense. Reacts to soothing touch and
tongue substances by sucking and rooting reflexes. Also reacts to painful
Palmar Newborn grasp an Helps hold 6 weeks stimuli.
grasp object placed in their on to certain Taste Taste buds are developed and functioning. Like sweets
palm by closing their objects better.
fingers on it Smell Present as soon as the nose is clear of secretions. They
Step-in Newborns who are held 3 months turn to mother’s breast out of recognition of the smell
Place in vertical position with of the breast milk
their feet touching hard
surface will take few
quick alternating steps
Period of Reactivity
Placing Elicited by touching the 6 weeks
anterior surface of the Assess First period Resting period Second period
newborn’s leg against a ment 15-30 mins 30-120 mins 2-6 hrs
hard surface Color Acrocyanosis Color Quick color
Plantar When an object touches Prepares for 8-9 stabilizing changes occur
grasp the soles of a newborn’s walking months with movement
foot at the base of the and crying
toes, the toes grasp Tempe Fall from Stabilized to Increases to
Tonic neck/ When newborn lies on Stimulate 2-3 rature intrauterine 37.2 37.6
Boxer/ their backs, their heads eye months temperature
Fencing turn to one side or the coordination (38.1)
other. The arm and the Heart rate 180 bpm 120-140 bpm Wide swings in
leg on the side towards rate and activity
which the head turns Activity Alert Sleeping Awakening
extend and the opposite Ability to Vigorous Difficult to Becomes
leg contract respond to reaction arouse responsive
Moro/ Newborns abduct and Stimulates 4-5
simulation
Startle extend their arms and action of months
Mucus Visible in Small amount Mouth full of
legs when startled by someone
mouth when sleeping mucus which
noise or allowing their trying to
causes gagging
heads to drop ward off an
Bowel Can be heard Present Passage of first
backward. Fingers attacker
sounds in the first 15 meconium
assume “C” position,
mins
and they swing their
arms into an embrace
position and pull their APGAR Assessment
legs against their › One and five minutes
abdomen - Meant to identify the need
Babinski Newborns fans the toes Immature 3 months
for neonatal resuscitation
when the side of the nervous
foot is stroked in an system › 1st minute
inverted “J” curve from development  General condition
the heel upward › 5th minute
Magnet Newborn pushed back Test for › Adjustment to
against the pressure spinal cord extrauterine life
when the pressure integrity
applied to the soles of
the feet when lying APGAR score
supine Criteria 0 1 2
Crossed If one leg of a newborn Pushing Color Blue or pale Acro-cyanotic Completely
extension lying supine is extended away the pink
and the sole of the feet hand Heart Rate Absent Slow >100/min
is irritated by being irritating the (<100/min)
rubbed with sharp leg Reflex No response Grimace Cough,
object, the infant raises irritability sneeze, cry
the other leg and Muscle Tone Limp Some flexion Active motion
extends it Absent Slow, irregular Good, crying
Respiration
Trunk When newborn lie in a
Incurvation prone position and are
Galant touched along the › 0-3
paravertebral area by  Needs resuscitation
probing finger, they › 4-6
flex their trunk and  Fair
swing their pelvis  May need suctioning and oxygenation
towards the touch  Condition guarded
Landau Newborn who is held in
a prone position with a › 7-10
hand underneath,  Good
supporting the trunk,  No signs of immediate distress
should demonstrate  Needs only admission care
some muscle tone. They
should be able to life Quick Assessment of Gestational Age
their head or arch their
back
Tapping the patellar › Skin › Breast tissue
Deep
Tendon tendon by the tip of the › Vernix › Genitalia
finger, the lower leg › Hair › Sole Creases
moves perceptibly › Ears › Resting Posture

Made by: Mijelyn Bantigue

 Cracked Skin Physical Maturity

Abundant
Lanugo

Ear of a
preterm
infant

Areola and
increased
lanugo

Comparison
of resting
posture
Appearance

Color
› Ruddy complexion due to increased concentration of RBC
› Cyanosis – Generalized mottling of the skin
Preterm and › Acrocyanosis – Blueness of the hands and feet
Term Male › Central cyanosis – Cyanosis of the trunk
Genitalia
Skin

› Jaundice
› Yellow coloring of an infant’s skin
Ballard Score › Caused by hyperbilirubinemia
› Test for newborn maturity › Common and is caused by the natural breakdown of RBCs
› Includes physical maturity and neuromuscular maturity in the infant after birth
› 2 types:
Neuromuscular Maturity Physiologic jaundice (2nd to 3rd day)
Pathologic jaundice (1st 24 hours)

Pallor
› Result of anemia
Excessive blood loss when the cord was cut
Inadequate flow of blood from the cord into the infant st
birth
Fetal-maternal transfusion
Low iron stores cause by poor maternal nutrition during
pregnancy
Blood incompatibility in which a large number of red
blood cells were hemolyzed in utero

Harlequin sign
› A newborn who has been lying on his side appears red on
the dependent side of the body and pale on the upper
side

Vernix Caseosa
› White, cream-cheese like substances that serves as skin
lubricant in utero

Lanugo
› Fine, downy hair that covers the newborn’ shoulders, back,
and upper arms. Maybe found on the forehead and ears

Made by: Mijelyn Bantigue

Desquamation › Dark Pupils
› Peeling of some areas of the skin similar to a sunburn due › Inspect the eye by laying the newborn supine and lift the
to dryness of the infant’s skin head

Milia Subconjunctival hemorrhage

› Pinpoint white papule found on the cheek or across the › Red spot on the sclera due to pressure during birth which
bridge of the nose of the newborn ruptures a conjunctival capillary

Erythema Toxicum Ears

› Newborn rash caused by the newborn’s eosinophils › Pinna bends easily
reacting to the environment as the immune system matures › Check overall response to sudden sound
Moro reflex
Forceps Marks › Check for placement of ears
› Circular or Linear contusion matching the rim of the blade Low set ears may indicate a congenital anomaly
of the forceps on the infant’s cheek
› Disappears 1-2 days Nose and Mouth
› Result of normal forceps use and does not denote unskilled › Nose appears large for the face
or too vigorous application of forceps › Test patency
› Tongue appears large and prominent
Turgor › Epstein’s Pearls
› Resilient if well hydrated Small round, glistening, well-circumscribed cysts
present on the palate
Birthmarks Extra load of calcium

Hemangioma (Vascular tumors of the skin) › Natal Teeth

Newborn teeth
Nevus Flammeus (port-wine stain)
› A macular purple or dark-red lesion that is present at birth Neck and Chest
› Neck is short and chubby with increased skin folds
Stork’s beak mark › Head should rotate freely
› Nevus flammeus lesion that are light and pink patches at the › Breasts may be engorged
nape of the neck (covered by hairline) › Witch’s milk
Thin, watery fluid secreted by the breast of newborn
Strawberry hemangioma baby
› Elevated areas formed by immature capillaries and
endothelial cells Abdomen
› Protuberant
Cavernous hemangioma › Umbilical stump appears white and gelatinous
› Dilated vascular spaces › Passage of meconium
› Resemble a strawberry hemangioma but does not › Abdomen should be soft and non-tender
disappear with time › Round but not distended
› Bowel sounds are present after first hour of birth
Mongolian Spots
› Umbilical cord inspection
› Collection of pigment cells that appear as slate-gray
patches across the sacrum or buttocks and possibly on the
arms and legs Anogenital
› Anus is present and patent
Head
Male
Sutures › Testes descended
› Separating lines of the skull › Cryptorchidism – undescended testes
› Cremasteric reflex – stroke the internal side of the thigh
Molding and the testis on that side moves
› Prominent and asymmetric head due to its engagement in › Proper placement of meatus
the cervix contours Epispadias – meatus on the dorsal surface
Hypospadias – meatus on the ventral surface
Caput Succedaneum
› Edema of the scalp at the presenting part of the head the Female
crosses the suture line › Vulva is swollen
› Disappears during the 3rd day of life › Pseudomenstruation
Mucus vaginal secretions which is sometimes blood-
Cephalhematoma tinged
› Collection of blood between the periosteum of the skull
bone caused by rupture of the periosteal capillary due to Back
pressure of birth › Spine appears flat in the lumbar and sacral areas
› Appears 24 hours after birth › Inspect the base to be sure there is no dimpling, opening

Craniotabes Extremities
› Localized softening of the cranial bones that is caused by › Five finger and five toes!!!
pressure of the fetal skull against the mother’s pelvic bone › Arms and legs appear short
in utero › Hands are plump and clenched
› Arms and legs move symmetrical
Eyes › Ankle ROM
› Tearless cry › Hips can be flexed and abducted
› Iris are blue or gray
› Sclera is blue

Made by: Mijelyn Bantigue

 › Infection
Hip Check › Metabolic/endocrine abnormalities
› Delayed defecation/intestinal obstruction
› Liver/biliary disease
› Spleen pathology
› Polycythemia

Phototherapy
- Treatment with a special type of light (not sunlight). It's
sometimes used to treat newborn jaundice by making it
easier for your baby's liver to break down and remove
the bilirubin from your baby's blood. Phototherapy aims to
expose your baby's skin to as much light as possible.

Care of Infant on Phototherapy

› Risk of injury to eyes
› Risk of injury to gonads
› Risk of impaired skin integrity
› Risk for fluid volume deficiency
› Risk for hyperthermia or hypothermia
› Risk of neurological injury
› Imbalance nutrition
› Check the hip skin folds › Parental anxiety

Assessment for Well-Being

Physiologic Jaundice
› Most jaundice in newborns is physiologic
› It peaks between 48-72 hours
› Usually disappears within a week
› Usually benign
› Can become elevated to a point of concern for the baby
› Infants have extra RBCs due to fetal life
› They need to be broken down by the body
› Bilirubin is a component of the degradation of the RBCs.
› The liver is immature and does not conjugate and get rid
of the bilirubin fast enough.

Significance of Jaundice
› Bilirubin is toxic to the brain.
› Bilirubin is prevented from entering the brain by blood
brain barrier under normal circumstances.
› However the blood brain barrier isn’t well developed in
the newborn. Unconjugated bilirubin (lipid soluble) could
cross to the newborn and would cause encephalopathy.
(Kernicterus)

More data on Physiologic Jaundice

› RBC/Hgb level is higher than required
 Neonatal RBC: 4.8-7.1 Infant: 4.2-5.2
 Neonatal Hbg 14-24 Infant 11-17
› Cells containing fetal hemoglobin have a shorter life span

Care to prevent hyperbilirubinemia

› Early feeding
› Frequent feeding
› Neutral thermal environment
› Prevention of hypoglycemia
› Prevention of hypoxia

Causes of Pathologic Jaundice

› Excessive hemolysis
 Rh incompatibility
 ABO incompatibility
 G6PD deficiency

Made by: Mijelyn Bantigue