Newborn Care

bY: J.Pitapit
a/y 1st term 2020-2021

Performing a Newborn Examination

•A detailed and systematic whole body

examination of a stabilized newborn during the early

hours of life.

PURPOSES:
•To determine the normalcy of
different body systems for healthy
adaptation to extrauterine life. •To
detect significant medical problems

for immediate management.

PURPOSES:
•To detect any congenital problems
present for early management and
parent education.
•It also provides a base line
against which an assessment can be
made at subsequent examination
General Instructions

•NEWBORN MUS T B E S TAB I L I Z ED B E FOR

E S TAR T ING THE AS S E S SMENT P ROC
EDUR E

•NORMAL BODY T EMP E RATUR E AND

COLOR

• EXAMINAT ION C AN B E CONDU C T ED

WI THOUT
AWAK ENING THE BABY.
•NUR S E ’ S HAND MUS T B E WASHED
THOROUGHLY
B E FOR E TOU C HING THE BABY.
General Instructions

• EXAMINAT ION SHOULD B E DONE

SYS T EMAT I C AL LY.

•A HEAD TO TOE AND SYS T EMS

AP P ROA C H TO B E
FOL LOWED FOR COMP L E T E
EXAMINAT ION.
Equipments

•Cordclamp
 •Sterile cotton balls with alcohol
•Measuring tape

Thermometer
•Baby cloth (frock)
,Bonette
•Baby sheet
•Identification tag
•Weighing Scales.
•Latex Gloves

Stethoscope
•1 cc syringe
Vitamin K (ampule)
•Eye ointment
 Diaper
The 1st 24 hours of Life is a very significant
and a highly vulnerable time due to critical
transition from intrauterine to
extrauterine
life
 Immediate

Care of the Newborn

•Airway

•Breathing
 •Temperature

Four Core Steps

of

Essential Newborn Care

••Immediate and thorough drying
 •Early skin-to-skin contact

•Properly timed cord clamping

•Non-separation of the newborn and mother

for early initiation of breastfeeding

 Specific Care of the Baby in
the Immediate Period after
Delivery
Time Band - 1st 30 seconds
•Dry the baby
•Check breathing
•Remove wet cloth
•Keep the baby warm

Time Band: Within 1st 30 seconds

Immediate and Thorough Drying
 •Do a quick check of breathing while
drying •During the 1st 30 secs:
–Do not ventilate unless the baby is
floppy/limp and not breathing
–Do not suction unless the mouth/nose
are blocked with secretions or other
material
Time Band 0 - 3 mins: Immediate, Thorough Drying
•Stimulates the newborn to breathe
normally
• Minimizes heat loss
Notes:
–Do not wipe off vernix
 –Do not bathe the newborn
–Do not do footprinting
–No slapping
–No hanging upside – down
–No squeezing of chest
Time Band: After 30 secs of drying
Early Skin-to-Skin Contact
•Skin-to-Skin Contact
–Provides warmth
–Improves bonding
– Provides protection from infection by
exposure of the baby to good bacteria of
the mother
 –Increases the blood sugar of the baby

AIRWAY'& BREATHING
•Stimulate crying by rubbing
•Position properly- side lying / modified t-
berg
•Provide oxygen when necessary

APGAR SCORING
Virginia Apgar
(1949)- developed the Newborn Scoring
System, later called the Apgar score. use in
deciding whether or not a newborn needed
resuscitation. -This score provides a uniform
method of observation and evaluation of
a newborn infant's need for
resuscitation
immediately
after delivery at
one minute and
again at five minutes.
•STANDARDIZED
EVALUATION OF THE NEWBORN
•PERFORM 1 MINUTE AND 5 MINUTES AFTER BIRTH
•INVOLVES(5) INDICATORS:
1.ACTIVITY
2.PULSE
3.GRIMACE
4.APPEARANCE
5.RESPIRATIONS

APGAR Scoring System A ctivity/Muscle Tone

P ulse/Heart Rate
G rimace/Reflex Irritability/ Responsiveness
A ppearance/Skin Color
R espiration/Breathing
APGAR Scoring System
APGAR Scoring System
APGAR Scoring System
COMPONENTS
•ANTHROPOMETRIC
MEASUREMENTS •BATHING
AFTER 24 HOURS
•CORD CARE
•DRESSING/ WRAPPING -
MUMMIFIED •EYE PROPHYLAXIS –
CREDE’S PROPHYLAXIS
•FOOT OR ANKLE TAG/
IDENTIFICATION •GET
APGAR SCORE – 1 & 5 MINS
•HR, RR, TEMP,
INJECTION OF VITAMIN K
 Proper Identification
•After delivery, gender should be
determined •Pertinent
records should be completed including
the ankle tag
•Before
transferring to nursery, ID tag should

be applied.
TIME BAND:WITHIN 90 MINUTES
 NON-SEPARATION OF NEWBORN FROM MOTHER
FOR EARLY BREASTFEEDING
•NEVER LEAVE THE MOTHER AND THE BABY
UNATTENDED
•MONITOR THEM EVERY 15 MINUTES IN THE 1ST 1-2
HOURS
–ASSESS BREATHING
: LISTEN FOR GRUNTING, LOOK FOR CHEST IN-
DRAWING AND FAST BREATHING

•WARMTH: CHECK TO SEE IF THE FEET ARE COLD

TO TOUCH, IF THERE IS NO THERMOMETER
Time Band: Within 90 minutes
Non-separation of Newborn from Mother for Early
Breastfeeding

•Start of breastfeeding

•Leave the newborn between the mother’s breasts in skin-to-skin

contact
•
•Every baby is different and the rest period may take from a 20
to 30 up to 120 minutes before the baby shows signs of wanting
to breastfeed.
Time Band:Within 90 minutes

Non-separation of Newborn from

Mother
for Early Breastfeeding

•Help the mother and baby

 into a
comfortable position

•Observe the newborn. Only once the

newborn shows feeding cues (e.g. opening

Congratulations on your
of mouth, tonguing, licking, rooting) make
verbal suggestions to the mother to
encourage her newborn to
move toward the breast e.g. nudging.
new baby!
Time Band: Within 90 minutesNon-separation of Newborn from
Mother for Early Breastfeeding

•Weighing, bathing, eye care, examinations, injections should

be done after the first full breastfeed is completed
•Postpone washing until at least 6 hours
 Weight and Anthropometric Measurements

Weight and Anthropometric Measurements

Weight and Anthropometric Measurements
NEWBORN ASSESSMENT
Assessment of the newborn is essential to ensure
a successful transition.
 Major Time Frames
1.Immediately after birth

2.Within the 1st 4 hours after birth

3.Prior to discharge
General Guidelines
•Keep warm during examination
•From general to specific
•Document ALL abnormal findings & provide nursing care

TEMPERATURE
•Site: Axillary NOT Rectal
•Duration: 3 mins
•Normal Range: 36.5 – 37.6 C
•Stabilizes within 8-12 hrs
•Monitor q 30 mins until stable for 2 hrs
then q 8 hrs
VITAL SIGNS
Pulse
•Awake: 120 – 160 bpm—120 – 140
bpm •Asleep: 90-110 bpm
•Crying: 180 bpm
•Rhythm: irregular,
immaturity of cardiac regulatory center in the
medulla
•Duration: 1 full minute, not crying
•Site: Apical
 Nursing

Considerations •Keep
warm
 •Take HR for 1 full minute

•Listen for murmurs

•Palpate peripheral pulses

•Assess for cyanosis

•Observe for CP distress

Respiration

•Characteristics:

Nasal breathers, gentle, quiet, rapid BUT shallow; may have short
periods of apnea
(<15 secs) and irregular without cyanosis—periodi

c respirations •Rate: 30-60 cpm

Duration: 1 full minute

Nursing considerations

•Position on side

•Suction PRN

•Observe for respiratory distress

•Administer oxygen via hood PRN and

as prescribed
Silverman-Anderson Index
Perform to observe for signs of respiratory
distress Chest lag
Retractions
Nasal flaring
Expiratory grunting
Silverman-Anderson Index
ANTHROPOMETRIC MESUREMENTS.
Length:
45 to 55 cm (18-22
inches) Average: 50 cm
Techniques: using tape
measure Supine with legs
 extended Crown to rump
Head to heel
Head Circumference (HC):
33 to 35.5 cm (13-14 inches)
Technique: using tape measure
From the most prominent part of the OCCIPUT to just above the EYEBROWS
1/3 the size of an adult’s head
Disproportionately LARGE for its body
HC should be = or 2cm > CC

Chest Circumference (CC):

30 to 33 cm (12-13 inches)
Technique: using tape measure
From the lower edge of the SCAPULAS to directly over the NIPPLE LINE anteriorly
CC should be = or < 2 cm than HC
 Crede’s
Prophylaxis
•Wipe the
eyes
•Apply an eye antimicrobial
within 1 hour of birth: –1%
silver nitrate drops
 or –2.5% povidone iodine drops
or
–1% tetracycline ointment or erythromycin eye drops
Vitamin K
Administration - it is
necessary in the
formation of certain
clotting factors
Bathing
•complete warm water bath
after 6 hours ( 24 hours)
•From cleanest to dirties part

•DO NOT remove vernix caseosa vigorously

 6 hours •Washing exposes to hypothermia
Washing should be delayed until after
•The vernix is a protective barrier to bacteria such as
E. coli and Group B Strep

•Washing removes the crawling reflex