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To establish, maintain and support respirations.

To provide warmth and prevent hypothermia.

To ensure safety, prevent injury and infection.

To identify actual or potential problems that may

require immediate attention.

Establish respiration and maintain clear airway

- The most important need for the newborn immediately
after birth is a clear airway to enable the newborn to
breathe effectively

To establish and maintain respirations

1.Wipe mouth and nose of secretions after delivery of the

2. Suction secretions from mouth and nose
3. A crying infant is a breathing infant. Stimulate the baby
to cry if baby does not cry spontaneously, or if the cry is

4. Oral mucous may cause the newborn, to choke,

cough or gag during the first 12 to 18 hours of
life. Place the infant in a position that would
promote drainage of secretions
5. Keep the nares patent. Remove mucus and
other particles that may be cause obstruction

Care of the Eyes

Neisseria gonorrhea- the causative agent for gonorrhea
conjunctivitis or opthalmia neonatorum, may be passed
on the fetus from the vaginal canal during delivery.
Drug of choice:

Erythromycin or tetracycline Opthalmic Ointment

This procedure is required by law in all states as

prophylaxis against gonorrhea. The medications
used are as follows:
a.Erythromycin Ophthalmic Ointment. This has become the
drug of choice and is received in a sterile syringe from the
pharmacy. It is injected into each eye from the inner to
outer canthus immediately after birth (see figure 8-10). It
does not appear to cause much eye irritation.
b.1% Silver Nitrate Solution. Two drops are applied in each
eye in the conjunctival sac, not the cornea. The infant eyes
may or may not be irrigated after instillation, depending on
local policy. The infant may get profuse discharge and
chemical conjunctivitis for a few days with no residual
damage.One percent silver nitrate solution is no longer
recommended for use.

Care of the cord


any unusual signs and symptoms which

indicates infection.
- Foul odor in the cord
- Presence of discharges
- Redness around the cord
- The cord remains wet and does not fall off
within 7 to 10 days
- Newborn fever


a. Inspect the cord frequently for signs of bleeding

immediately after it has been cut.
b. Apply triple dye (refer to local policy) to the cord after
the infant has had his bath and has been determined to
be stable. The dye prevents infection and helps the cord
to dry.
c. Swab the cord with alcohol at least three times per day
(refer to local policy). The alcohol aids in drying.
d. Observe for cord detachment. The cord detaches in ten
to fourteen days. The cord dries faster when left
uncovered. Have the parents roll the infant's diaper
down some in front initially so the cord is not covered.
e. Observe for signs of infection and report findings
immediately. The signs of infection are purulent
drainage, redness, and possible swelling (more than


Bactericidal substance


Antibiotic substance

3. Alcohol (70%)
4. Cleansed with mild soap solution
5. Air dry


-it was developed by Dr. Virginia Apgar

-it is a quick method of assessing the
newborn's adjustment to extrauterine life
and general condition.

- HR <100 signifies asphyxiated while > 160

signifies distress.
- should take 1-5 minutes after birth

Factors that affect the APGAR score are:

1. Degree of physiologic maturity
2. Fetal cardiorespiratory and neurologic
3. maternal perinatal therapy such as use of
analgesia during labor

a.Purpose. The APGAR scoring chart is used to

evaluate the conditions of the baby at birth,
determine the need for resuscitation, evaluate the
effectiveness of resuscitative efforts, and to
identify neonates at risk for morbidity and
b.Objective Signs Used for Evaluation.
(1) Heart rate.
(2) Respiratory effort.
(3) Muscle tone.
(4) Reflex irritability.
(5) Color.



at each of the five categories are initially

done at one minute after birth.
(2)Each item has a maximum score of two and a minimum
score of zero.
(3)The final APGAR score is the sum total of the five
items, with a maximum score of ten. The higher the
final APGAR score, the better condition of the infant.
(4)Evaluations at one minute quickly indicate the
neonate's initial adaptation to extrauterine life and
whether or not resuscitation is necessary.
(5)The five-minute score gives a more accurate picture of
the neonate's overall status, including obvious
neurologic impairment or impending death.


NORMAL: 7-10
Good adjustment; vigorous; No intervention required

Moderately depressed infant; newborns condition is
guarded and may need airway clearance and
supplementary oxygen

LOW- 0-3
Severely depressed infant; newborn is in serious
danger and id need of resuscitation.


Head Circumference

34 35 cm


36.5 C 37.5 C

Chest Circumference

32 33 cm

Heart Rate

120 140 bpm


30 60 bpm


2.5 to 3.4 kg


46 to 54 cm

Place the infant in an open warmer for the

remainder of the admission procedures to
maintain adequate temperature.


the infant

(a) Length (from top of head to the heel with the

leg fully extended).
(b) Head circumference - repeat after molding
and caput succedaneum are resolved.
(c) Chest circumference (at the nipple line).
(d) Abdominal circumference.

(2) Record measurements in inches and centimeters.

(3) Document the information in the appropriate
areas on, the delivery room record, and the
instant data card.
(4) Take infant's vital signs and document on the
delivery room record.
(a) Temperature-only the first one is done rectally,
the remainder are axillary.
(b) Heart rate and respirations-count a full minute
because of the irregularities in rhythm.


Crowning ready for suction

2. Expulsion of head wipe face and nose


Expulsion of newborn provide warmth, take

note of time and sex of baby

Heat Loss Mechanisms

The ability of controlled dissipation and production of

heat is a fundamental requirement for an organism to
be homeothermic.

Heat loss is a two-step process that ultimately results in

heat loss via:
1. radiation 39 %
2. convection 34 %
3. evaporation 24 %
4. conduction 3 %

Convective heat loss is the transfer of heat from a body to
moving molecules such as air or liquid

Evaporative heat loss is the vaporization of water from the
body or a mucosal surface, which uses the latent heat of
vaporization of water as its source

Conduction refers to heat transfer between two surfaces
that are in direct contact

Radiant heat loss refers to transfer of heat between two
objects of different temperatures that are not in contact
with each other (e.g., radiation is the mechanism by which
the sun warms the earth)

The first step in the heat dissipation process is

internal redistribution of heat, which refers to
the transfer of heat from the body core
(central compartment) to the periphery and
the skin surface.

The second step in the process is the transfer

of heat from the skin surface to the

Measures to Prevent Heat Loss

1.Dry the newborns head and body immediately after heat
loss from evaporation.
2. Wrap with dry and warm blanket before giving to the
mother to hold.
3. Place newborn in a preheated environment such as
radiant warmer or next to mother for about two hours after
4. Perform any extensive examination or procedure under
radiant heat to prevent heat loss.
5. Keep newborn away from air conditioning vents or fans
that can promote heat loss
6. Maintain ambiant temperature of the delivery and nursery
7. Delay initial bath for atleast 2 hours or until temperature
8. Warm all objects that will be used to examine or cover
newborn by placing them first under radiant warmer.

Varies depending on:
1. Race
2. Nutritional

3. Intrauterine factor
4. Genetic factor


1st few days after birth




Voiding and passage of stool

4. Breastfed newborns

Remove blood, amniotic fluid, and excessive

vernix caseosa as soon after birth as the
temperature is stable

It decreases exposure to maternal blood and

possible blood borne organism on the infants

e.g. Hep.B and HIV

Site: Vastus Lateralis

- fat soluble vitamin
- anti-hemorrhagic agent
-promotes the formation of factors II,VII,IX,X by
the liver for clotting factor, thus prevent
- Provides Vit.K which is not synthesized in the
intestine for the first 5 to 8 days after birth
because the newborn lacks intestinal flora
necessary for Vit.K production



Proper identification of the newborn and

footprints must be taken and kept in the chart.
Attach ID bracelet with a number that
corresponds to the mothers hospital number,
mothers full name, sex, date and time of birth.
Inspect for the presence of 2 arteries and 1


1. Respiratory

rate assess respirations at least once

every 30 mins. until stable for 2 hours after birth.

Observe for:
1. Periodic breathing
2. Apnea

2. Breath sounds auscultate anterior and

posterior lung fields for equal sounds which
should be present equally throughout

Sounds of moisture in the lungs during the 1st

hour or two after birth is NOT UNUSUAL
because fetal lung fluid has not been
completely absorbed.


1.Tachypnea respiratory rate above 60 bpm
2.Retractions due to infants weak chest wall
muscles that are used to help draw air into
the lungs
3. Flaring of Nares a reflexive widening of

4.Central cyanosis a purplish blue

discoloration due to insufficient oxygen
supply ( lips,tongue,mucous membrane and
trunks )

Peripheral cyanosis (acrocyanosis) due to

poor perfusion of blood to the periphery of
the body
Bruising of face due to tight nuchal cord or
pressure during birth and may look like
central cyanosis

How to check for Cyanosis?

1. apply pressure to the area

2. use of pulse oximeter
3. Color of mucous membrane

5. Grunting a noise made on expiration when

air crosses partially closed vocal cords
6. Seesaw respirations when the chest falls
the abdomen rises and vice versa
7. Asymmetry decreased on one side of the
lung may indicate a collapse of the lung
( atelectasis )

Blockage of one or both nasal passages by a

narrowed bone or membrane that protrudes
into the area

How to asses ?
1. By closing the infants mouth and occluding
one nostrils at a time and observe for
breathing while each nostril is occluded
2. Placing a cold metal object under the
nostrils and observe for fogging
3. Passing a catheter (fr.5 or 8) thru each nostril
to check for patency

1. Pallor indicates slight hypoxia or anemia
2. Ruddy color ( plethora) an excessive
number of RBC ( >65%)

Heart sounds
Auscultate for rate, rhythm and presence of
murmurs or abnormal sounds

Rhythm should be regular , the 1st and 2nd sounds

should be heard clearly, abnormalities should be
Murmurs abnormal sounds caused by abnormal
blood flow through the heart and may indicate
openings in the septum of the heart
- results from an incomplete transition
from fetal to neonatal circulation
- is common until the ductus arteriosus
functionally closed

Brachial and Femoral Pulses

Should be present equally and bilaterally
Blood pressure
Taken on all extremities if the infant has unequal
pulses or other signs of cardiac complications

1. Doppler UTZ
Average BP:
Systolic 65 95 mmHg
Diastolic 30 60 mmHg

Capillary Refill

Temperature should be assessed at least once

every 30 minutes until the infant has been
stable for 2 hours after birth

1. Axillary
2. Rectal

Types of Thermometer

1. Mercurial
2. Digital
3. Disposable
4. Tympanic

Plastic Strips


Head makes up one fourth of the length of
the body and is much larger in proportion to
the rest of the body
- should be palpated to assess the shape
and identify abnormalities

1.Molding caused by overriding of the cranial

bones at the suture and is common especially
a long second stage of labor
- parietal bones often override the
occipital and frontal bones and a ridge can
be felt at the areas

- a hard ridged area that is not a result of
molding due to premature closure of the
cranial sutures before or shortly after birth
which may impair brain growth and shape

a. Single Suture Synostosis Sagittal (SAJ-utul)/ Scaphocephaly

- The sagittal suture is located on the midline,
on top of the head and extends from the soft
spot towards the back of the head. When the
head is palpated, a ridge can be felt along
the suture.

Preoperations at age 5 months

7 months Post operation

2. Coronal(co-RO-nul)Suture Synostosis /
- The coronal suture is located on the side of
the head and extends from the soft spot to
an area just in front of the ear. It allows the
forehead and the frontal lobe to grow and
expand forward.

3. Metopic (mih-TOP-ick)
- This midline suture is located in the middle
of the forehead and extends from the soft
spot to the root of the nose. It allows both
frontal lobes to expand forward and sideways
as well as the eye socket to move to either

4. Lambdoidal (lam-DOID-ul) Suture

- Closure leads to posterior plagiocephalus
(PLAY-gee-o-SEF-a-lee) with flattening of the
back of the head on the affected side,
protrusion of the mastoid bone and lowering
of the affected ear. It may also cause the
skull to tilt sideways.

2. Fontanels are areas of the head where

sutures between the bones meet
2.1 Anterior
- is a diamond shape area
where the frontal and
parietal bones met
- Measures 2 to 4 cm
- Closes between 12 to
18 months of age

2.2 Posterior
- Is a triangular area where the occipital and
parietal bones meet
- Measures 0.5 to 1cm
- Closes by the time the infant is 2 to 3 months

3. Caput succedaneum
- Due to the pressure against the mothers
cervix and it interferes the blood flow in the
area causing localized edema which crosses
suture lines
4. Cephalhematoma
- Bleeding between the periosteum and the

assessed for:
- Symmetry
- Positioning of facial features
- Movement
- Expression

assessed for:

cleft lip/palate
Precocious teeth
Epsteins pearl

Neck assess visually and note the ease with which

the head turns from side to side
e.g. Turners syndrome

Turner syndromeorUllrich-Turner syndrome(also

known as "Gonadal dysgenesis") encompasses
several conditions, of whichmonosomyX
(absence of an entire sex chromosome, the
Barr body) is most common. It is a
chromosomal abnormalityin which all or part of
one of thesex chromosomesis absent (unaffected
humans have 46 chromosomes, of which two are
sex chromosomes). Typical females have two X
chromosomes, but in Turner syndrome, one of
those sex chromosomes is missing or has other
abnormalities. In some cases, the chromosome is
missing in some cells but not others, a condition
referred to asmosaicism[2]or 'Turner mosaicism'.

The syndrome manifests itself in a number of ways.

Characteristic :
1. physical abnormalities
- short stature, swelling,
- broad chest
- low hairline
- low set ears
- webbed necks.[5]Girls with Turner syndrome typically
experience gonadal dysfunction (non-workingovaries),
which results inamenorrhea(absence of menstrual cycle)

Concurrent health concerns are also frequently present,

- congenital heart
- hypothyroidism(reducedhormone secretion by the
- diabetes
- visionproblems
- hearingconcerns

Turner's syndrome is named afterHenry H. Turner.

Clavicle fracture are more likely to occur in large

e.g. shoulder dystocia
Shoulder dystociais a specific case ofdystociawhereby
after the delivery of the head, the anteriorshoulder
of theinfantcannot pass below thepubic symphysis,
or requires significant manipulation to pass below
thepubic symphysis. It is diagnosed when the
shoulders fail to deliver shortly after the fetal head.
In shoulder dystocia, it is the chin that presses
against the walls of theperineum. Shoulder dystocia
is an obstetrical emergency, and fetal demise can
occur if the infant is not delivered, due to
compression of theumbilical cordwithin the birth

Fracture a lump or tenderness over the area

Method of Detecting:
Moro Reflex a difference in the movement of the
Treatment :
- Immobilization of the affected part for a short time

C. Cord should contain three (3) vessels

arteries (2)
- are small and may stand up at the end cut

- (1)
- is larger than the arteries and resembles a slit

Thin cord the infant may have been poorly

nourished in utero
Yellow Brown or Green tinge cord
- indicates that meconium was released
sometime before birth
Patent urachus abnormal connection between
the umbilucus and bladder
Umbilical cord hernia - "Paraumbilical Hernias" develop in and
around the area of the umbilicus (belly button or navel).
- A congenital weakness (meaning present since birth)
exists in the naval area in the region where vessels of the
fetal and infant umbilical cord exited through the muscle of
the abdominal wall. After birth, although the umbilical cord
disappears (leaving just the dimpled belly-button scar), the
weakness or gap in the muscle may persist.

D. Extremities
- normally a term infant should remain sharply
flexed & resist extension during examination
Poor muscle tone results in a limp or floppy infant
Continued poor muscle tone may result from
prematurity or neurologic changes

All extremities are examines for signs of fracture:

3. Lumps or swelling
4. Lack of use /immobility

Erb-Duchenne paralysis- paralysis of the arm

resulting from injury to the brachial plexus (usually
during childbirth)
- Instead of the usual flexed position, the
affected arm is extended at the infants side with the
forearm prone
- exercise
- splinting or both

Are examined for extra digits which are often small

and may not have bones

Nails :
- in term infants it should extend to the end of the
fingers or slightly beyond
Creases :
- normally, two long transverse creases extend most of
the way across the palm

Polydactyly - is a condition in which a person has more

than five fingers per hand or five toes per foot.
Syndactyly - is a condition where two or more digits are
fused together. It occurs normally in somemammals,
such as thesiamangand kangaroo, but is an unusual
condition in humans.
Syndactyly can be complete or incomplete.
In complete syndactyly, the skin is joined all the way
to the tip of the finger
In incomplete syndactyly, the skin is only joined part
of the distance to the fingertip.
Syndactyly can be simple or complex.
In simple syndactyly, adjacent fingers or toes are
joined by soft tissue.
In complex syndactyly, the bones of adjacent digits
are fused. Thekangarooexhibits complex syndactyly.

Feet are assessed for club foot

Talipes equinovarus:The common ("classic") form of
clubfoot. Talipes is made up of the Latin talus (ankle)
+ pes (foot). Equino- indicates the heel is elevated
(like a horse's) and -varus indicates it is turned inward.
With this type of clubfoot, the foot is turned in sharply
and the person seems to be walking on their ankle.

Aclub foot, orcongenital talipes equinovarus(CTEV)is

a congenital deformity involving one foot or both.The
affected foot appears rotated internally at the ankle.
TEV is classified into 2 groups:
1. Postural TEV
2. Structural TEV

Are examined for signs of developmental dysplasia

which occurs more often on breech presentation

Normally both legs should abduct equally in normal

infants with click sound while in dysplasia is a
clunk sound

Dysplasia instability of the hip joint which occurs at the

head of the femur which can be moved in and out of the
Methods of Assessing:
1. TheBarlow maneuveris a physical examination
performed oninfantsto screen for
developmental dysplasia of the hip.
- It is named for T.G. Barlow, 1962 at Hope Hospital Salford,
- The maneuver is easily performed byadductingthe hip
(bringing the thigh towards the midline) while applying
light pressure on the knee, directing the force
posteriorly. If the hip is dislocatable - that is, if the hip
can be popped out of socket with this maneuver - the
test is considered positive. TheOrtolani maneuveris then
used, to confirm the positive finding (i.e., that the hip
actually dislocated).

2. TheOrtolani testorOrtolani maneuveris a

physical examinationfor
developmental dysplasia of the hip.

It is performed by an examiner firstflexingthe hips and

knees of a supine infant to 90 degrees, then with the
examiner's index fingers placinganteriorpressure on the
greater trochanters, gently and smoothlyabductingthe
infant's legs using the examiner's thumbs.

A positive sign is a distinctive 'clunk' which can be heard

and felt as thefemoral headrelocates anteriorlyinto the

This is part of the standard infant exam

performed preferably in early infancy; it usually
becomes negative after 2 months of age.

It is named forMarino Ortolani, who developed it

in 1937.[3

- palpate the entire length of the newborns vertebral

column to discover any defects in the vertebrae.

Check for:
Spina bifida - (Latin: "split spine") is a developmental
congenital disordercaused by the incomplete closing of the
embryonicneural tube. Somevertebraeoverlying the spinal cord
are not fully formed and remain unfused and open. If the opening
is large enough, this allows a portion of the spinal cord to
protrude through the opening in the bones. There may or may not
be a fluid-filled sac surrounding the spinal cord.

Other neural tube defects:

1.anencephaly, a condition in which the portion of the
neural tube which will become thecerebrumdoes not
2.encephalocele, which results when other parts of the
brain remain unfused.


Spina bifida occulta

OccultaisLatinfor "hidden". This is the mildest forms of

spina bifida.
In occulta, the outer part of some of the vertebrae are
not completely closed.The split in the vertebrae is
so small that the spinal cord does not protrude. The
skin at the site of thelesionmay be normal, or it may
have some hair growing from it; there may be a
dimple in the skin, or a birthmark.

2. Spina bifida cystica

In spina bifida cystica, a cyst protrudes through the
defect in the vertebral arch. These conditions can be
diagnosed in utero on the basis of elevated levels of
alpha-fetoprotein, after amniocentesis, and by
ultrasound imaging. Spina bifida cystica may result in
hydrocephalus and neurological deficits.

3. Meningocele
- The least common form of spina bifida is a
posteriormeningocele(ormeningeal cyst).

In aposterior meningocele, the vertebrae develop

normally, however the meninges are forced into the
gaps between the vertebrae. As the nervous system
remains undamaged, individuals with meningocele
are unlikely to suffer long-term health problems

A meningocele may also form through dehiscences in

the base of skull. These may be classified by their
localisation to occipital, frontoethmoidal, or nasal.
Endonasal meningoceles lie at the roof of thenasal
cavityand may be mistaken for anasal polyp. They
are treated surgically.

Encephalomeningoceles are classified in the same way

and also contain brain tissue.

4. Myelomeningocele
- In this, a serious and commonform, the unfused
portion of the spinal column allows the spinal cord to
protrude through an opening. The meningeal
membranes that cover the spinal cord form a sac
enclosing the spinal elements.

1.The protruding tissue should be covered with moist sterile

saline dressing immediately after birth
2. Intravenous antibiotics are started to prevent meningitis.
3. An adhesive plastic surgical field drape taped over the
buttocks deflects feces away from the back--"mud flap.
4. The most important words to say at the baby's birth are:
"Congratulations on the birth of your child!" These words
extend joy, optimism, reverence, respect, acceptance, and
nonabandonment. This simple step facilitates parental
interest, learning, and care provision.


Neurologic system



- assessment of the presence and strength of the

reflexes is important to determine the health of the
newborns central nervous system

Moro reflex is the most dramatic reflex

- startle reflex or infantile reflex
- It may be observed in incomplete form
inpremature birthafter the 28th week
ofgestation, and is usually present in
complete form by week 34 (3rd
- It is normally present in all
infants/newborns up to 4 or 5 months
of age, and its absence indicates a
profound disorder of the motor system

An absent or inadequate Moro response on one side is

found in infants with :

brachial plexus palsy
fractured clavicle.

Persistence of the Moro response beyond 4 or 5 months

of age is noted only in infants with severe neurological
* It was discovered and first described by
AustrianpediatricianErnst Moro(1874-1951).

The primary significance of thisreflexis evaluating

integration of thecentral nervous system(CNS), and
it involves 3 distinct components:

spreading out thearms(abduction)

- the reflex is initiated by pulling the infant up from
the floor and then releasing him;
unspreading the arms (adduction)
- spreads arms and pulls arms in

Palmar Grasp reflex - a flexion of the fingers caused by

stimulation of the palm of the hand. The reflex is
present at birth and usually disappears by 6 months of

Plantar Grasp reflex - a reflex characterized by the

flexion of the toes when the sole of the foot is stroked
gently. It is present in babies at birth but should
disappear after 6 weeks.

Babinski reflex - is obtained by stimulating the

external portion (the outside) of the sole. The
examiner begins the stimulation back at the heel
and goes forward to the base of the toes.
- Most newborn babies are not
neurologically mature and
therefore show a Babinski
- A Babinski response in an older
child or adult is abnormal. It is
a sign of a problem in
the(CNS), most likely in a part
called the pyramidal tract.

Rooting reflex - A reflex in infants in which rubbing or

scratching about the mouth causes the infant to turn
its head toward the stimulus.



assessed for :
1. Placement
2. Appearance
3. Maturity

Signs of potential distress or deviations from

expected findings:
Ear placement low
Clefts present
Cartilage absent
Preauricular sinus

Expected findings:
Slate gray or blue eye color
No tears
Fixation at times - with ability to follow objects to
Red reflex
Blink reflex
Distinct eyebrows
Cornea bright and shiny
Pupils equal and reactive to light

Opaque lenses
Absence of Red Reflex/Bruckner reflex
Epicanthal folds
Reflexes absent
"Doll's Eyes" Reflex(beyond 10 days of age):
When the head is moved slowly to the right or left, the
eyes do not follow nor adjust immediately to the position
of the head. This reflex should not be elicited once fixation
is present. The persistence of the Doll's Eyes Reflex
suggests neurologic damage.

1. Staphylococcus
2. Chlamydia
3. Neisseria


gram (-) bacteria

A. Newborns with hypoglycemia

low levels of blood sugar in the first days

following birth
Sugar levels in newborns may drop for a
number of reasons:
elevated insulin levels,
decreased glycogen levels,
low glucose production or overuse of glucose

1. Irritability high pitched cry
2. Lethargy
3. Seizure / jitteriness
4. Sweating
5. Poor sucking
6. Respiratory distress :
- Tachypnea
- Dyspnea
- Apnea
7. Discoloration / Cyanosis
8. Poor appetite
9. Excessive drowsiness

Causes of Hypoglycemia:
1. Maternal diabetes
2. Prematurity
3. Infection / Illness
4. Intrauterine growth retardation (IUGR)

Blood Sugar Level in Newborns

- should remain above 40 milligrams per
deciliter, or mg/dL.
Levels below 35 mg/dL indicate severe
levels under 50 mg/dL warrant close
A level between 54 and 72 mg/dL indicates a
more normal newborn blood glucose
At-risk infants need blood glucose monitoring
within the first two hours after birth.

If the baby can eat and the blood glucose
level is not too low, giving formula, sugar
water or breastmilkwill raise blood glucose
levels in most cases.
Babies who can't eat or those with very low
blood glucose levels need intravenous
infusion of dextrose, a type of sugar, to raise
their blood sugar.
Infants receiving glucose infusions may
develop temporary hyperglycemia, or blood
glucose levels over 125 mg/dL, which usually
requires no treatment,


At-risk infants require blood glucose

screening via heel stick or from blood drawn
from a central umbilical line.
The baby may need frequent blood tests in
the first 12 hours after birth to ensure that
levels don't drop.
Hypoglycemia most often develops within the
first 24 hours after birth,

B. Newborn Jaundice
Jaundice is a yellow discoloration of the skin and
the white part (thesclera) of the eyes. It results
from having too much of a substance
calledbilirubinin the blood.
Bilirubin is formed when the body breaks down
oldred blood cells. Theliverusually processes and
removes the bilirubin from the blood.
Jaundice in babies usually occurs because their
immature livers are not efficient at removing
bilirubin from the bloodstream.


Jaundice in newborns most commonly occurs

because their livers are not mature enough
to remove bilirubin from the blood. Jaundice
may also be caused by a number of other
medical conditions.

1. Physiologic

jaundice is the most common

form of newborn jaundice
2. Neonatal jaundice will be seen in cases of
maternal-fetal blood type incompatibility
3. hemolysis

4. Polycythemia
5. Cephalohematoma
6. Sometimes a baby swallows blood during birth
7. A mother who hasdiabetes
8. Crigler-Najjar syndrome
9. Lucey-Driscoll syndrome

Carotenemia - A condition that causes a yellowish

discoloration of the skin and tends to be a darker
orange than seen with jaundice.
Eating a lot of yellow vegetables causes this
Children with carotenemia have normal bilirubin
Unlike jaundice, carotenemia does not cause a
discoloration of the white part of the eyes.
This condition causes no harm and requires no

As a baby's bilirubin levels rise:
jaundice moves from the head to include the arms,
trunk, and finally the legs.
bilirubin levels are very high :
a baby will appear jaundiced below the knees and
on the palms of his or her hands.
How to Assess?
- One easy way to check for jaundice is to press a
finger against your baby's skin, temporarily pushing
the blood out of it. Normal skin will turn white when
you do this, but jaundiced skin will stay yellow.

Exams and Tests

Before a baby can be treated, the exact
cause of an infant's jaundice must be
determined. In some cases, a careful
examination by a pediatrician is all that is
needed. In other cases, blood tests may be

Laboratory Tests:
1. First, the total serum bilirubin level will be
checked. Based on this test, the doctor may
request that more tests be done.
2. A Coombs test checks for antibodies that
destroy an infant's red blood cells.
3. Acomplete blood count may be done.
4. Areticulocyte count checks to be sure your
baby is making enough new red blood cells.
5. Certainred blood celldiseases are found in
people of Mediterranean descent. In such
cases, it may be necessary to check blood
samples for a condition known asG6PD

Self-Care at Home
* Sunlight helps to break down bilirubin so that a
baby's liver can process it more easily.


a child in a well-lit window for 10 minutes

twice a day is often all that is needed to helpcure
mild jaundice. Never place aninfantin direct

If the bilirubin level is too high, the child may

need to be placed under a special type of

This treatment is called phototherapy

- These lights are able to penetrate a baby's
skin and affect the bilirubin within the child.
The light changes bilirubin into lumirubin,
which is easily handled by the baby's body.

If an infant's bilirubin levels are very high or if

the child appears ill, the baby will most likely
be admitted to the hospital for treatment.

Types of Jaundice
The most common types of jaundice are:
Physiological (normal) jaundice:occurring in
most newborns, this mild jaundice is due to the
immaturity of the baby's liver, which leads to a
slow processing of bilirubin. It generally appears
at 2 to 4 days of age and disappears by 1 to 2
weeks of age.

Jaundice of prematurity:occurs frequently

inpremature babiessince they are even less
ready to excrete bilirubin effectively. Jaundice
in premature babies needs to be treated at a
lower bilirubin level than in full term babies in
order to avoid complications.

Breastfeeding jaundice:jaundice can occur

when a breastfeeding baby is not getting enough
breast milk because of difficulty with
breastfeeding or because the mother's milk isnt
in yet. This is not caused by a problem with the
breast milk itself, but by the baby not getting
enough to drink.
Breast milk jaundice:in 1% to 2%
ofbreastfedbabies, jaundice may be caused by
substances produced in their mother's breast milk
that can cause the bilirubin level to rise. These
can prevent the excretion of bilirubin through the
intestines. It starts after the first 3 to 5 days and
slowly improves over 3 to 12 weeks.

Blood group incompatibility (Rh or ABO

problems):if a baby has a different blood type
than the mother, the mother might produce
antibodies that destroy the infant's red blood

The endocrine glands are considered better

organized than other systems. Disturbances are
most often related to maternally provided
hormones (estrogen, luteal, and prolactin) that
may cause the following conditions:

a. Vaginal

discharge and/or bleeding may occur in

female infants.
b. Enlargement of the mammary glands may occur
in both sexes

Physical AssessmentGenitourinary System

Important to note that infant is voiding

Keep record of number of voiding

A. Male infants
Assess for descended testicles.
Care following circumcision
Care of the uncircumcised infant

B. Female infants
Labia may be swollen.
May have blood-tinged discharge.
Teach peri-care.

SKIN is fragile and shows marked easily

especially for infants with fair color
Nsg. Responsibility:
1. Must examine every inch of the skin surface
carefully during the initial assessment and at
the beginning of the shift.

1. Harlequin coloration
- a clear color division over the body from the head
to the abdomen with one half deep pink or red
and the other half pale or of normal color
- indicate shunting of blood with cardiac problems
or sepsis. Redness may occur on the lower side
when the infant lies on the side

2. Mottling (cutis marmorata)

- Is a lacy pattern from dilated blood vessels
under the skin
May be a sign of:
- Cold stress
- Overstimulation
- Sepsis

- if persistent, may indicate chromosomal


3. Vernix caseosa
- A thick ,white substance that resembles cream
- Provides a protective covering for the fetal skin
in utero
4. Lanugo
- Fine hair that covers the fetus during
intrauterine life

5. Milia
- Are white cysts, 1-2 mm in size resulting from
distention of sebaceous glands that are not yet
functioning properly
6. Erythema toxicum
- A red, blotchy areas that may have white or
yellow papules or vesicles in the center
- Commonly called as fleabite or newborn rash

7. Birthmarks
- Assess the size and location and should be
carefully documented
7.1 Mongolian spots are bluish-black marks that
resembles bruises
- Usually found in sacral area but may appear in arm
7.2 Nevus simplex also called salmon patch, stork
bite or telangiectatic nevus
- a flat, pink or reddish discoloration from
capillaries that occur over the eyelids, just above
the bridge of the nose or at the nape of the neck.

7.3 Nevus flammeus (port-wine stain)

- is a permanent, flat dark, reddish-purple
mark and varies in size, location and
blanches minimally or not at all with
- located over the forehead and eyelid
7.4 Nevus Vasculosus (strawberry hemangioma)
- consists of enlarged capillaries in the outer
layer of the skin
- is a dark red and raised with a rough
surface giving a strawberry like appearance

7.5 Caf-au-lait spots

- are permanent,light brown areas that may
occur anywhere on the body. Although harmless,
the number and size are important.
8. Markings from Delivery
8.1 Petechiae pinpoint bruises that resembles a
rash, may appear over areas such as the back,
face and groin
- due to increase intravascular pressure during
the birth process such as in nuchal cord

8.2 Bruises may occur on any part of the body where

pressure occurred during delivery especially when
second-stage labor was difficult
8.3 Small puncture mark is present on the newborns
head if a fetal monitor scalp electrode was attached
8.4 Forceps mark occurs over the checks and ears
where the instrument applied
- size and location are carefully documented, lack
of movement or asymmetry of the face may indicate
injury of the facial nerve

Breasts note the placement of the nipple and

look for extra nipples which may appear on the
chest or axilla
Hair and Nails
hair should be silky and soft
- nails come to the end of finger or beyond



Is an examination of the newborns physical and

neurological characteristics to determine the number
of weeks from conception to birth

DUBOWITZ SCORING- is an in-depth, detailed
assessment tool that includes examination of
physical, neurological and behavioral; characteristics

NEW BALLARD SCORE- focuses on physical and

neuromuscular characteristics, eliminating the




Neuromuscular Characteristics
Posture posture and degree of flexion of the
extremities are scored
Square Window- is elicited by bending the hand at
the wrist until the palm is as flat against the
forearm as possible with gentle pressure
Arm recoil nurse hold the neonates arms fully
flexed at the elbows for 5 seconds, then extends
the am by pulling the hands straight down to the
sides and released quickly and the degree of
flexion is measured
Popliteal Angle newborns lower leg is folded
against the thigh, with the thigh on the abdomen
the lower leg is straightened just until resistance
is met

e. Scarf Sign the nurse grasps the infants head

and brings the arm across the body to the
opposite side, keeping the shoulder flat on the
bed and the head in the middle of the body

f. Heel to Ear the nurse grasps the infants foot

and pulls it straight up alongside the body
toward the ears while the hips remain flat on the
bed surface

II. Physical Characteristics

a. Skin
Assessed for:
- Color
- Visibility of veins
- Peeling and cracking
b. Lanugo

appears at 20 wks of gestation and increases in

amount until 28 wks and begins to disappear until little is


c. Plantar Surface- begins to appear at 32 wks of gestation

although the creases are only red lines near to toes at first,
they gradually spread down toward the heal and become

d. Breasts
- Nipple
- Areola
- Size of breast bud

e. Eyes and Ears

Eyes- are fused until 26 to 28 weeks of gestation
Ears the incurvation and thickness of pinna rated

f. Genitals
- Size of clitoris
- -labia majora and minora
Male: location of testes and rugae of scrotum

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