Two ways to facilitate closure of

NEWBORN ADJUSTMENT TO EXTRA UTERINE LIFE Foramen Ovale

Nursing Priorities in Newborn assessment 1. Tangential Foot slap
1. Airway and Breathing 2. Proper Positioning
2. Circulation Best position immediately after birth
3. Thermoregulation •CS: Supine or crib level position
4. Nourishment •NSD: Prone position
5. Waste Elimination
6. Infection Prevention
7. Infant Parent Bonding
8. Mental Stimulation and Rest

AIRWAY AND BREATHING

Nursing Alert:
•Breathing
•Initiation of breathing
•Most neonatal deaths THERMOREGULATION
•Lung function
HOW
Alert: Maintain it not less than 36.5
1. Remove secretions
degrees celsius
2. Proper suctioning with catheter or a bulb
-Maintenance of temperature
syringe
•Newborn baby is homeothermic
3. Precautions on oxygen administration
(warm-blooded)
•Brown Fat
Overdose of oxygen may lead to:
•Infection
1. Retrolental Fibroplasia or Retinopathy of
Factors leading to the Development of
Prematurity- retina develops new blood
Hypothermia:
vessels that are abnormal if baby is born
1. Preterms are born poikilothermic
premature.
(cold-blooded)
-Abnormal blood vessels grow in the retina.
2. Inadequate subcutaneous tissue
2. Bronchopulmonary Dysplasia
3. Newborn are not yet capable of shivering.
a.k.a. chronic lung disease of prematurity.
4. babies are born wet.
-Rethink this order in premature infants
were the infants lungs become irritated, and
SIGNS OF HYPOTHERMIA
do not develop normally.
1.Peripheral vasoconstriction
2. CNS depression
CIRCULATION
3. Increased Metabolism
 Nursing Alert: Circulation is initiated by 4. Increased pulmonary artery pressure
lung expansion or pulmonary ventilation
and is completed by the cutting of the EFFECTS OF HYPOTHERMIA
umbilical cord. 1. Hypoglycemia
-The psychomotor development. 2. Metabolic acidosis
•Umbilical cord- AVA- 2 arteries and 1 3. High risk for kernicterus-jaundice
vein 4. Additional fatigue
What are the Shunts in fetal circulations
•Ductus venosus-a shunt from umbilical PROCESS OF HEAT LOSS
vein to inferior vena cava •1. Evaporation- eg. Evaporation of
•Foramen ovale-a shunt between the water
two aorta •2.Conduction- eg. friction
•Ductus arteriosus- shunt from •3.Convection-eg. Boiling water
pulmonary artery to aorta. •4.Radiation-eg. Heat from the sun,
microwaves from oven
PREVENTION OF COLD STRESS DISADVANTAGES OF BREASTFEEDING
1. Immediately after birth dry and wrap 1. Possibility of transfer of Hepa B,HIV
newborns 2. No iron hence prone to anemia
2. Mechanical measures 3. the father cannot feed or bond as well
3. Prevent unnecessary exposure
4. If power failure occurs, cover the baby STAGES OF BREAST MILK
with tin foil COMPOSITION
5. Embrace the baby 1. Colostrum (1-4 days)
2. Transitional (5-20 days)
BATHING THE BABY 3. Mature (20+)

1. Ensure that temperature is normal before

COWS MILK
bathing baby.
1. high in fat. Low in carbohydrates
2. Use warm room and warm water.
2. high in protein called casein.
3. Bathe quickly and gently.
3. high in minerals
4. Dry quickly and thoroughly from head to
4. high in phosphorus
toe.
* Evaluate Reflexes
5. Wrap in dry, warm towel.
•Rooting
6. Dress and wrap infant.
•Sucking
7. Place close to the mother if roomed in.
•Swallowing
•Extrusion/Protusion
HYPERTHERMIA
•Fever above 37.5 degrees centigrade is
a sign of infection
•Do not use cold/ice water for sponge.
Tap water is enough.
•Overheating under warmers is the
cause of hyperthermia

NOURISHMENT

PROPER NUTRITION
Alert: Breastfeeding: best form of feeding.
•Best time to initiate breastfeeding
-NSD: immediately after birth/ASAP ,after
30 minutes
-CS: after 4 hours

Advantages of Breastfeeding
1. very economical
2. always available
3. facilitate bonding
4. helps in rapid involution of the uterus
5. decreases the incidence of breast cancer
6. breastfed baby has higher IQ than
bottle-fed babies
•The mother experiences after pains
7. It contains the following:
•The other nipple is also flowing with milk
•Antibody- IgA
-To prevent cracked nipples
•Lacto bacillus bifidus- lactose
-for continuous production and proper
intolerance
emptying
•Interferon- treat viral infection such
Problems experienced in breastfeeding:
as hepa C
1. engorgement
•Lysozymes-natural antibiotic
2. Sore nipple
•Macrophages-type of white blood cells
3. Mastitis
•Contraindications in Breastfeeding
 WASH ELIMINATION

Different types of newborn stools:

1. meconium-passed within 24-36 hours. INTERPRETATION
Blackish, green, sticky tar-like. Odorless
2. Transitional- 4-14 days. Green. Loose
RESPIRATORY DISTRESS SYNDROME:
and shiny
1. Results from the absence or deficiency of
3. Breastfed stool- Golden yellow or orange
lung surfactant
yellow. Soft mushy with sour milk smelling
2. It is a complication in about 1% of
odor
pregnancies,
4. Bottlefed stool- Pale yellow, formed hard
3. Occurs twice as often in males as in
with a typical offensive odor.
females.
5. With supplementary foods added- brown.
Odorous stool
Factors associated with RDS:
1. Prematurity
SIGNIFICANCE OF STOOL CHANGES
2. Surfactant deficiency disease
•Jaundice-light stool
* Pathophysiology
•Undergoing Phototherapy – bright
•Decrease in surfactant-decrease in lung
green
compliance-increased work of
•Milk allergy – Mucus mixed with the
breathing-decreased ventilation-
stool
hypercapnia- respiratory
•Bileduct Obstruction – Clay-colored
acidosis-pulmonary and peripheral
•Undergone barium enema- Whitish
vasoconstriction-increased pulmonary
clay/chalk clay
artery pressure,decreased pulmonary blood
•GIT Hemorrhage – Black stool
flow and Poor peripheral
•Anal Fissure – Blood Flecked
perfusion-formation of fibrin(hyaline
•Intussusception – Currant Jelly
membrane) – atelectasis.
•Hirschsprungs Disease – Ribbon like
•Malabsorption Syndrome like Celiac
Complications of RDS
Disease and Cystic Fibrosis –
1. Hypoxia
Steatorrhea- Fatty, bulky. Foul smelling
2. Respiratory acidosis
stool
3. Metabolic acidosis
Signs and symptoms
NEWBORN ASSESSMENT
1. retraction
•Apgar Scoring-to determine general
2. tachypnea/increased RR
condition of the baby which is done after
3. Expiratory grunting
delivery of baby during:
4. Pallor or mottling
-1 minute
5. Nasal flaring
-next 5 minutes
6. edema and labored respirations
-Next 15 minutes
7. Rales, rhonchi and hypothermia
8. cyanosis
 gestational age. (Anthropometric
Nursing management measurement).
1. monitor infant respiratory rate •Term Infant- are those born after the
2. assess skin color beginning of week 37 and before week
3. clear infants airway 42 of pregnancy.
4. administer warm humid oxygen as •Weight is the most sensitive indicator of
ordered growth. Doubles by 5 to 6
5. keep infant thermoregulated months, triples by 12 months and
6. assess sucking, swallowing. Gag and quadruples by 2 to 2 1/2 years.
cough reflex •AGA- appropriate for gestational age,
7. monitor IV fluids infants who fall between the 10thand
8. provide nutrition via NGT 90th percentiles of weight for their
9. surfactant replacement and rescue gestational age whether preterm, term or
post term.
MECONIUM ASPIRATION SYNDROME •SGA- Small for gestational age, those
(MAS) who fall below the 10th percentile of
-occurs when newborns aspirate meconium weight for their gestational age.
stained amniotic fluid into the •LGA – large for gestational age, those
tracheobronchial tree or during the first few who fall above the 90th percentile in
breaths of life. weight.
•LBW- Low birth weight- infant weighing
Signs and symptoms less than 2, 500 grams at birth.
1. fetal hypoxia •VLBW- Very Low Birth Weight- infant
2. slowing of heart rate weighing less than 1,500 grams at birth
3. Barrel chest •ELBW- Extremely Low Birth Weight-
4. pallor, cyanosis, apnea infant weighing less than 1.000 grams at
5. low apgar score birth.
6. diminished breath sounds on auscultation

Prevention of MAS
1. after the head is born, suction the
oropharynx and then the nasopharynx of the
baby with a bulb syringe or suction catheter.
2. No special resuscitation is needed if the
infant has good activity even if thickly
meconium stained
3. if there is absent or depressed
respiration.

Bradycardia and poor muscle tone direct

tracheal suctioning is done by expert nurse
or doctor.
 Pre-term babies and Post Term babies
 Pre-term babies- before or less than 36
weeks
 Post term babies- more than 40 weeks

NEWBORN AT RISK
ALTERED GESTATIONAL AGE OR BIDTH
WEIGHT

•After birth, the infant should be

evaluated about the weight,
height/length, head circumference and
 cardiovascular dysfunction and
COMPLICATION OF PRETERM hypoglycemia.
1. Anemia of prematurity
2. Acute bilirubin encephalopathy POST TERM INFANT
3. Persistent Patent Ductus Arteriosus  Post term infant born after the 41 week
4. of a pregnancy.
Periventricular/ Intraventricular hemorrhage  -they are at risk because placenta
Intraventricular hemorrhage occurs most appears to function effectively for only
often in VLBW. 40 weeks.
Classified vas.  - fetus begins to lose weight
 •Grade 1-bleeding in the periventricular (postterm syndrome)
germinal matrix regions or germinal
matrix occurring in one ventricle. Infant with postterm syndrome
 •Grade 2 – bleeding within the lateral demonstrate the following:
ventricle without dilation of the ventricle.  -Characteristics of the SGA infant.
 •Grade 3 – bleeding causing  -dry, cracked , almost leatherlike skin
enlargement of the ventricle from lack of fluid and an absence
 •Grade 4- bleeding in the ventricles of vernix.
and intraparenchymal hemorrhage  -meconium stained
 •SGA is also known as Microsomia.  -fingernails will have grown well
Birth weight is below the 10thpercentile.  -more like a 2 week-old baby than
newborn
SMALL FOR GESTATIONAL AGE INFANT
NEONATE IN THE NURSERY
 •SGA infants are small for their age
 Immediate interventions
because they have experiencing IUGR-
1. upon receiving
Intrauterine growth restrictions.
2. take anthropometric measurements
Etiology/ Causes.
 -birth length
 -lack of adequate nutrition
 -head circumference
 -adolescent pregnancy
 -chest circumference
 -placental nutritional insufficient
 -abdominal circumference
 -intrauterine infection- rubella
3. Bathing the baby
 -women with systemic diseases
4. Dressing the umbilical cord
Appearance: poor skin turgor, large head,
skull sutures may be widely separated, hair
may be dull and lusterless, small liver, BATHING THE BABY
abdomen may be sunken umbilical cord  While most institutions used to bathe
often appears dry. babies within an hour or two of birth,
many are changing their policies. The
LARGE GESTATIONAL AGE INFANT World Health Organization (WHO)
recommends delaying baby's first bath
 LGA is also known as Macrosomia. until 24 hours after birth—or waiting at
Birth weight is above 90th percentile. least 6 hours if a full day isn't possible
Etiology. for cultural reasons.
 -overproduction of nutrients and growth
hormone in utero
 -women who are obese or with diabetes
mellitus.
 - multiparous woman
Appearance:
 -immature reflexes, have extensive
bruising, birth injury such as broken
clavicle, head is large causing a
prominent caput
succedaneum, cephalohematoma,