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
THERMOREGULATION
6. Infection Prevention
7. Infant Parent Bonding
8. Mental Stimulation and Rest

AIRWAY AND BREATHING

Nursing Alert:
•Breathing
•Initiation of breathing
•Most neonatal deaths
•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 (warm-
3. Precautions on oxygen administration 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 (cold-
premature. blooded)
-Abnormal blood vessels grow in the retina. 2. Inadequate subcutaneous tissue
2. Bronchopulmonary Dysplasia 3. Newborn are not yet capable of
a.k.a. chronic lung disease of prematurity. shivering.
-Rethink this order in premature infants 4. babies are born wet.
were the infants lungs become irritated, and
do not develop normally. SIGNS OF HYPOTHERMIA
1.Peripheral vasoconstriction
CIRCULATION 2. CNS depression
3. Increased Metabolism
4. Increased pulmonary artery pressure
 Nursing Alert: Circulation is initiated by
lung expansion or pulmonary EFFECTS OF HYPOTHERMIA
ventilation and is completed by the 1. Hypoglycemia
cutting of the umbilical cord. 2. Metabolic acidosis
-The psychomotor development. 3. High risk for kernicterus-jaundice
•Umbilical cord- AVA- 2 arteries and 1 4. Additional fatigue
vein
What are the Shunts in fetal circulations PROCESS OF HEAT LOSS
•Ductus venosus-a shunt from umbilical •1. Evaporation- eg. Evaporation of
vein to inferior vena cava water
•Foramen ovale-a shunt between the •2.Conduction- eg. friction
two aorta •3.Convection-eg. Boiling water
•Ductus arteriosus- shunt from •4.Radiation-eg. Heat from the sun,
pulmonary artery to aorta. microwaves from oven

PREVENTION OF COLD STRESS

1. Immediately after birth dry and wrap DISADVANTAGES OF BREASTFEEDING
newborns 1. Possibility of transfer of Hepa B,HIV
2. Mechanical measures 2. No iron hence prone to anemia
3. Prevent unnecessary exposure 3. the father cannot feed or bond as well
4. If power failure occurs, cover the baby
with tin foil STAGES OF BREAST MILK
5. Embrace the baby COMPOSITION
1. Colostrum (1-4 days)
BATHING THE BABY 2. Transitional (5-20 days)
3. Mature (20+)
1. Ensure that temperature is normal before
bathing baby. COWS MILK
2. Use warm room and warm water. 1. high in fat. Low in carbohydrates
3. Bathe quickly and gently. 2. high in protein called casein.
4. Dry quickly and thoroughly from head to 3. high in minerals
toe. 4. high in phosphorus
5. Wrap in dry, warm towel. * Evaluate Reflexes
6. Dress and wrap infant. •Rooting
7. Place close to the mother if roomed in. •Sucking
•Swallowing
HYPERTHERMIA •Extrusion/Protusion
•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
7. It contains the following: •The mother experiences after pains
•Antibody- IgA •The other nipple is also flowing with
•Lacto bacillus bifidus- lactose milk
intolerance -To prevent cracked nipples
•Interferon- treat viral infection such -for continuous production and proper
as hepa C emptying
•Lysozymes-natural antibiotic Problems experienced in breastfeeding:
•Macrophages-type of white blood cells 1. engorgement
2. Sore nipple
3. Mastitis
 •Contraindications in Breastfeeding
WASH ELIMINATION
Different types of newborn stools:
1. meconium-passed within 24-36 hours.
Blackish, green, sticky tar-like. Odorless
2. Transitional- 4-14 days. Green. Loose
and shiny
3. Breastfed stool- Golden yellow or orange
yellow. Soft mushy with sour milk smelling
odor
4. Bottlefed stool- Pale yellow, formed hard
with a typical offensive odor.
5. With supplementary foods added- brown.
Odorous stool
SIGNIFICANCE OF STOOL CHANGES
•Jaundice-light stool
•Undergoing Phototherapy – bright
green
•Milk allergy – Mucus mixed with the
stool
•Bileduct Obstruction – Clay-colored
•Undergone barium enema- Whitish
clay/chalk clay
•GIT Hemorrhage – Black stool
•Anal Fissure – Blood Flecked
•Intussusception – Currant Jelly
•Hirschsprungs Disease – Ribbon like
•Malabsorption Syndrome like Celiac
Disease and Cystic Fibrosis –
Steatorrhea- Fatty, bulky. Foul smelling
stool
NEWBORN ASSESSMENT
•Apgar Scoring-to determine general
condition of the baby which is done after
delivery of baby during:
-1 minute
-next 5 minutes
-Next 15 minutes
INTERPRETATION
RESPIRATORY DISTRESS SYNDROME:
1. Results from the absence or deficiency of
lung surfactant
2. It is a complication in about 1% of
pregnancies,
3. Occurs twice as often in males as in
females.
Factors associated with RDS:
1. Prematurity
2. Surfactant deficiency disease
* Pathophysiology
•Decrease in surfactant-decrease in lung
compliance-increased work of breathing-
decreased ventilation- hypercapnia-
respiratory acidosis-pulmonary and
peripheral vasoconstriction-increased
pulmonary
artery pressure,decreased pulmonary blood
flow and Poor peripheral perfusion-
formation of fibrin(hyaline membrane) –
atelectasis.
Complications of RDS
1. Hypoxia
2. Respiratory acidosis
3. Metabolic acidosis
Signs and symptoms
1. retraction
2. tachypnea/increased RR
3. Expiratory grunting
4. Pallor or mottling
5. Nasal flaring
6. edema and labored respirations
7. Rales, rhonchi and hypothermia
8. cyanosis
 circumference and gestational age.
(Anthropometric measurement).
Nursing management •Term Infant- are those born after the
1. monitor infant respiratory rate beginning of week 37 and before week
2. assess skin color 42 of pregnancy.
3. clear infants airway •Weight is the most sensitive indicator of
4. administer warm humid oxygen as growth. Doubles by 5 to 6 months,
ordered triples by 12 months and quadruples by
5. keep infant thermoregulated 2 to 2 1/2 years.
6. assess sucking, swallowing. Gag and •AGA- appropriate for gestational age,
cough reflex infants who fall between the 10thand
7. monitor IV fluids 90th percentiles of weight for their
8. provide nutrition via NGT gestational age whether preterm, term
9. surfactant replacement and rescue or post term.
•SGA- Small for gestational age, those
MECONIUM ASPIRATION SYNDROME who fall below the 10th percentile of
(MAS) weight for their gestational age.
-occurs when newborns aspirate meconium •LGA – large for gestational age, those
stained amniotic fluid into the who fall above the 90th percentile in
tracheobronchial tree or during the first few weight.
breaths of life. •LBW- Low birth weight- infant weighing
less than 2, 500 grams at birth.
Signs and symptoms •VLBW- Very Low Birth Weight- infant
1. fetal hypoxia weighing less than 1,500 grams at birth
2. slowing of heart rate •ELBW- Extremely Low Birth Weight-
3. Barrel chest infant weighing less than 1.000 grams at
4. pallor, cyanosis, apnea birth.
5. low apgar score
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 COMPLICATION OF PRETERM

tracheal suctioning is done by expert nurse 1. Anemia of prematurity
or doctor. 2. Acute bilirubin encephalopathy
 Pre-term babies and Post Term babies 3. Persistent Patent Ductus Arteriosus
 Pre-term babies- before or less than 36 4.
weeks Periventricular/ Intraventricular hemorrhage
 Post term babies- more than 40 weeks Intraventricular hemorrhage occurs most
often in VLBW.
NEWBORN AT RISK Classified vas.
ALTERED GESTATIONAL AGE
•After  •Grade 1-bleeding in the periventricular
OR BIDTH WEIGHT
birth, germinal matrix regions or germinal
the infant should be evaluated about the matrix occurring in one ventricle.
weight, height/length, head
 •Grade 2 – bleeding within the lateral
ventricle without dilation of the
ventricle.
 •Grade 3 – bleeding causing
enlargement of the ventricle
 •Grade 4- bleeding in the ventricles
and intraparenchymal hemorrhage
 •SGA is also known as Microsomia.
Birth weight is below the
10thpercentile.
SMALL FOR GESTATIONAL AGE INFANT
 •SGA infants are small for their age
because they have experiencing IUGR-
Intrauterine growth restrictions.
Etiology/ Causes.
 -lack of adequate nutrition
 -adolescent pregnancy
 -placental nutritional insufficient
 -intrauterine infection- rubella
 -women with systemic diseases
Appearance: poor skin turgor, large head,
skull sutures may be widely separated, hair
may be dull and lusterless, small liver,
abdomen may be sunken umbilical cord
often appears dry.
LARGE GESTATIONAL AGE INFANT
 LGA is also known as Macrosomia.
Birth weight is above 90th percentile.
Etiology.
 -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,
cardiovascular dysfunction and
hypoglycemia.
POST TERM INFANT
 - fetus begins to lose weight
(postterm syndrome)
Infant with postterm syndrome
demonstrate the following:
 -Characteristics of the SGA infant.
 -dry, cracked , almost leatherlike skin
from lack of fluid and an absence
of vernix.
 -meconium stained
 -fingernails will have grown well
 -more like a 2 week-old baby than
newborn
NEONATE IN THE NURSERY
 Immediate interventions
1. upon receiving
2. take anthropometric measurements
 -birth length
 -head circumference
 -chest circumference
 -abdominal circumference
3. Bathing the baby
4. Dressing the umbilical cord
BATHING THE BABY
  While most institutions used to
bathe babies within an hour or two of
birth, many are changing their
policies. The World Health
Organization (WHO) recommends
delaying baby's first bath until 24 hours
after birth—or waiting at least 6 hours if
a full day isn't possible for cultural
reasons.

 Post term infant born after the 41 week

of a pregnancy.
 -they are at risk because placenta
appears to function effectively for only
40 weeks.