‫الجمهورية اليمنية‬

‫جامعة صنعاء‬
‫كلية الطب والعلوم الصحية‬

‫‪NEWBORN CARE‬‬
• Contents:
1. Maintain respirations & Breathing
2. Provide and maintain warmth
3. Cord care
4. Breastfeeding
5. Apgar score
6. Physical assessment
7. Routine Exam of Newborn
8. Newborn identification
9. Facilitate attachment
The 1st 24 hours of Life:
- The first 24 hours of life is a very significant and a highly vulnerable time due
to critical transition from intrauterine to extra-uterine life.
Care of the Newborn immediately after birth:
1. Maintain respirations & Breathing
2. Provide and maintain warmth
3. Cord care
4. Apgar score
5. Vaccination BCG & O.P.V
6. Physical assessment
7. Newborn identification
8. Facilitate attachment

1. Respirations & Breathing:

▪ Suction gently & quickly using bulb syringe or suction catheter
▪ Starts in the mouth then, the nose to prevent aspiration
▪ Stimulate crying by rubbing
▪ Provide oxygen when necessary

2. Provide and maintain warmth:

A. Temperature:
▪ Dry immediately
▪ Place in infant warmer or use droplight
▪ Wrap warmly
 B. Newborn can lose heat in four ways:

Method of heat loss Prevention

▪ Evaporation: Wet baby ▪ Immediately after birth dry baby
with a clean, warm, dry cloth

▪ Conduction: Cold surface e.g ▪ Put the baby on the mother’s

weighing scale etc. abdomen or on a warm surface

▪ Convection: Cold draught ▪ Provide a warm, draught free

o
room for delivery at ≥25 C
▪ Radiation: Cold metallic ▪ Keep the room warm
surroundings

3. Immediate cord care

▪ Clamp and cut cord with a sterile instrument.
▪ Tie the cord between 2 to 3 cm. from the base and cut the remaining cord.
▪ Observe for oozing blood .
▪ DO NOT apply any substance to stump.
▪ DO NOT bind or bandage stump.
▪ Leave stump uncovered.

4. Breastfeeding
▪ Ensure ▪ Help mother to initiate
▪ Good position breastfeeding within first hour of
▪ Good attachment birth
▪ Effective sucklin ▪ Help mother at first feed

❖ Assess Breastfeeding:
- If infant has not fed in previous hour, ask mother to put her infant to breast.
5. APGAR Scoring:
▪ 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

INDICATORS 2 1 0
Activity Active, spontaneous Some flexion No movement
of extremities (flaccid, limp)
Pulse >100 bpm < 100 bpm Absent
Grimace Pulls away, sneezes, Facial grimace only No response
coughs with stimulation
Appearance Completely pink Acrocyanosis Bluish-gray or
pale all over
Respiration Good vigorous cry Slow, irregular Absent
Weak cry
Score Interpretation

6. Head to Toe Assessment of Newborn:

❖ Head: General appearance
▪ NOTE: Size: ¼ of body size [33-35 cm., 13-14 in. circumference].
▪ Molding: Asymmetry of skull.
▪ Cephalohematoma: collection of blood bet. skull bone & periosteum.
▪ Caput succedaneum: swelling over presenting part.

❖ Eyes
▪ Eyes: usually blue or gray
▪ Subconjunctival hemorrhage: from stress of vaginal delivery.
▪ First 6 weeks; transient strabismus; not able to focus.
▪ Constant strabismus < 6 weeks, further assessment needed. Strabismus > 6
weeks, referral needed.
▪ Scant purulent discharge > erythromycin ointment.
▪ Pupils round & equal; should constrict - normal response to light.
▪ “PERL” =pupils equal & reactive to light.
❖ Nose:
▪ Note size & shape, & presence of nasal discharge or stuffiness.
▪ Clean nose with bulb syringe; saline drops.
▪ Observe for nasal flaring.

❖ Mouth
▪ Mouth: Examine palate with index finger.
▪ Cleft lip and/or cleft palate.
▪ Note size & shape of tongue and length of frenulum membrane.
▪ Supranumery teeth aka natal teeth.
▪ Sucking reflex- evaluate.

❖ Ears/Neck
✓ Ears:
▪ Note position of ears in relation to eyes.
▪ Pinna should be fully formed and firm.
▪ Term infant: pinna recoils easily.
▪ Preterm infant, < 36 weeks - relatively shapeless and flat; little cartilage.
Slow recoil.
✓ Neck:
▪ Normal newborn neck short, chubby with creased skin folds. Head support
necessary. Inspect masses, limitation of movement & webbing.
▪ Clavicles: straight, palpate each clavicle for intactness; “crepitus”.

❖ Chest:
▪ Chest: Inspect shape, size, symmetry, position, development of nipples;
breast tissue.
▪ Breast engorgement – maternal hormones.

❖ Abdomen/Kidneys
▪ Abdomen: palpate for masses/organs
▪ Kidneys may be felt on right & left side of abdomen by deep palpation.
❖ Genitalia – Male
▪ Scrotum in full term infant swollen; + rugae; both R & L testes descended into
scrotal sac.
▪ Testes may be in process of descending. If one or both testes are
undescended = “cryptorchidism”.
▪ Agenesis [no testes] or closed scrotal sac.
▪ Assess for urethral opening as urinary meatus Abnormal placement on dorsal
surface *epispadias*; ventral surface *hypospadias*.

❖ Genitalia – Female
▪ Female: Vulva typically swollen. Labia minora & clitoris large with labia
majora covering both.
▪ Female infants have “pseudomenstruation”.

❖ Extremities
▪ Extremities: Assess for muscle tone
▪ Note length of arms/legs; should be symmetrical
▪ Limp arm may have nerve damage [birth injury] like brachial plexus palsy.
▪ Assess: syndactyly: webbing of fingers/toes & polydactyly: > than 10 fingers
or toes.

❖Skin
▪ Reddish in color; smooth and puffy.
▪ At 24 - 36 hours of age, skin flaky, dry and pink in color. Edema around eyes,
feet, genitals.
▪ Acrocyanosis: Bluish discoloration of hands and feet. Lasts for 24-48 hrs.
Mucous obstruction may cause central cyanosis.
▪ Milia: Pinpoint white papules; Disappear 2-4 wks.
▪ Vernix caseosa: white, cream cheese like substance; skin lubricant.

❖ Back/Anus/Rectum
▪ Spine: Assess for intact spine without masses or openings.
▪ Tuft of hair present at base of spine = Nevus pilosus.
▪ Anus & Rectum: Assess rectal patency with 1st temp; lubricated
thermometer. If rectum not patent, called imperforate anus.
7. Routine Exam of Newborn
• Vital Signs
• Daily:
▪ Weight: 2,500-3,500 gm, compare with previous day. 5-10 % weight loss
acceptable
▪ Assess feedings daily. # voids/stools in 24 hrs.
• Done once on admission to nursery:
▪ Length: 50 cm for male, and 49 for female
▪ Head: slightly larger than chest 35 cm
▪ Chest: 33 cm

8. Newborn identification:
1. Done immediately > delivery by same nurse assisting mother.
2. Prevent giving wrong infant to wrong mom, Identificant is 1 band on mom,
one significant other & 2 on baby.

9. Facilitate attachment:
✓ Skin to skin attachment.
10. Messages From Newborn:
1. I have come from an extremely warm, clean, quite and comfortable abode.
2. Protect me at birth from microbes & cold.
3. I am wet & nacked, dry me, cover me & place me under a heater.
4. I don’t know how to smile, let me announcemy arrival by a cry.
5. Don’t hurt me but gentle clean my windpipe to let me cry.
6. Don’t give me injection, but give me a breath to save my live.
7. I have been swimming all through in the womb. don’t be in a hurry to bathe
me in the labor room.