Immediate care of the

newborn and newborn

assessment.
 IMMEDIATE CARE OF
THE NEWBORN
I. Care of the Newborn at the DELIVERY ROOM

>Establish and Maintain AIRWAY (Respiration)

A. Suctioning
>Turn the baby’s head to one side.

>Suction gently and quickly (5 to 10 seconds).

=bradycardia.
> Suction the MOUTH first before the nose.
ASPIRATION.

>REMEMBER: newborns are

NASAL BREATHERS.
C. TEMPERATURE REGULATION
(THERMOREGULATION)
 Maintain appropriate Body Temperature. Chilling
will increase the body’s need for O2.

 Wrap the newborn immediately

 Wrap him warmly

 Put him under a droplight

HEAT LOSS IN NEWBORN
 CONVECTION – flow of heat from body surface to
cooler surroundings
 RADIATION – transfer of body heat to a cooler solid
object not in contact with the body
 EVAPORATION – loss of heat through conversion of a
liquid to a vapor
 CONDUCTION – transfer of body heat to a cooler
solid object in contact with the body
 D. APGAR Scoring System – standard tool to
evaluate the condition of the neonate
 Done twice:
 1st minute: to determine general condition
(NEURO/RESPI/CIRCULATORY CHECK)
 5th minute: to determine if neonate can adjust to
extracellular life
 Appearance (color) – least important criteria
 Pulse rate (most important criteria)
 Grimace (reflex activity)- irritability
 Activity (muscle tone)
 Respiration

 *Lowest individual score is 0.

 *Highest individual score is 2.
 0 1 2
APPEARANCE BLUE/ PALE BODY PINK, Completely
PINK
EXTREMITIES BLUE,
(ACROCYANOSIS S- RUDDY SKIN
ST 0
NORMAL) 1 48 DUE
TO IMMATURITY OF
CIRCULATION
PULSE ABSENT < 100 BEATS / > 100 BEATS /
MIN MIN

GRIMACE NONE > WEAK CRY > SNEEZE, /

COUGH,LUSTY CRY
(GOOD, STRONG,
VIGOROUS)

ACTIVITY FLACID / LIMP > SOME EXT. WITHDRAWAL OF

FLEX FEET
EXT. FLEX
WELL
RESPIRATION ABSENT < 30 > 60
SCORE: 9 HIGHEST SCORE
10 PERFECT SCORE
ADD ALL SCORES AND INTERPRET:
0 – 3 = POOR, SERIOUS, SEVERELY
DEPRESSED, NEEDS CPR
4 – 6 = FAIR, GUARDED, MODERATELY
DEPRESSED
7 – 10 = GOOD, HEALTHY
I. Physical Assessment
1. Vital Signs
Temperature – axillary: 36.5º – 37ºC
(97.91-98ºF)/ rectal
Crying may increase body temperature
slightly.
Radiant warmer will falsely increase
axillary temperature.
RESPIRATION – normally RAPID, QUIET,
GENTLE, SHALLOW, IRREGULAR with
physiologic APNEA of less than 5
seconds

Largely diaphragmatic and abdominal

•60-80 breaths/min at birth
•30-60 breaths/min (stable)
BLOOD
PRESSURE
 not routinely
obtained except
for suspicion of
Coarctation of the
Aorta.
 BP at birth: 70/50
 At 10 days: 100/50
E. PROPER IDENTIFICATION IS DONE IN THE
DR BEFORE BEING BROUGHT TO THE
NURSERY.

BEST METHOD OF IDENTIFICATION:

** FOOTPRINTING – MOST RELIABLE
** ID BANDS – ( ANKLE & WRIST) ACCURATE &
RACTICAL
** BIRTHMARKS – LESS RELIABLE
 II. Care of the Newborn at the NURSERY

A. Check the ID bands of mother and baby

B. THERMOREGULATION
C. BATH – done if infant’s skin temperature
stabilizes at 36.5ºC (98.6ºF);
temperature stabilizes 6-8 hours after
birth
*VERNIX CASEOSA
*USE NON-ALKALINIC SOAP
*USE OF ANTISEPTIC SOLUTIONS
*WARM WATER
Maintain at 35.5ºC-36.5ºC
**Rectal route is preferred
**Passage of meconium should
be within 24 to 36 hrs
afterbirth.
No meconium
imperforate anus
D. Initial Cord Dressing
CORD: 2 A + 1 V
*Practice aseptic technique
* Use 70% Isoprophyl alcohol to prevent Tetanus
Neonatorum and Omphalitis infection of the cord
(streptococcal and staphylococcal)
Signs of Omphalitis:
*Reddening of the area
*Fever
*Discharge and foul smell
Application of sterile cord clamp
** The cord will fall off after – 7-10 days
E. CREDE’S PROPHYLAXIS
to prevent Opthalmia
Neonatorum or Gonorrheal
Conjunctivitis
(Neisseria gonorrhea)
which causes blindness if not
treated.
Infection can be acquired
during vaginal delivery from
mother with untreated
gonorrhea
Ophthalmic drops –
BEFORE: Silver Nitrate or
AgNO3 1% 1-2 drops
1-2 gtts into the lower
conjunctival sac
PRESENT:
Ointment – inner to outer canthus
Erythromycin – drug of choice of
Chlamydial Trachomatis
F. Vitamin K Injection
Vitamin K facilitates production of the clotting factor; thus,
prevents bleeding,

1 mg. Aquamephyton (generic: phytonadione)

Route: IM into the lateral anterior thigh (Vastus lateralis).
In children below 12 months of age who have not yet
learned how to walk.
G.Take Anthropometric
Measurements (Vital Statistics)

BL: 47–54 cm
HC: 33 – 35 cm
CC: 31 – 33 cm
AC: 31 – 33 cm
BW: 5.5-7.5 lbs

>Physiologic weight loss (reduction of

5-10% of BW) during the 1st 10 days of
life is normal.
 PHYSIOLOGIC WEIGHT LOSS (first 10
days of life)
Causes:
-Infant is no longer under the
influence of maternal hormones.
-Voids and passes out stools.
-Has relatively low nutritional intake
- Difficulty sucking
H. Initial Feeding – given 1-6 hours after birth.
1 oz of sterile water then glucose water

Purposes of breastfeeding:
*Primarily to promote bonding
*Facilitates uterine contraction
*Facilitates release of colostrums (contains
antibodies-IgA).
2. Skin
Dark red = prematurity
Acrocyanosis = body pink, extremities blue – normal
during the 1st 24-48 hours of life
Generalized mottling (cutis marmorata)
RUDDY – normal (stable)
Grayish – infection
Jaundice
Pallor due to anemia because of:
*Excessive blood loss when cord is cut
*Untimely cutting of the cord
* Inadequate iron stores-poor maternal
nutrition.
*Blood incompatibility
 Breastfed babies have longer physiologic
jaundice because human milk has
PREGNANEDIOL
Types:
1. Physiologic Jaundice – Icterus
Neonatorum
Causes:
*Begins from 2nd day – 7th day = TERM
2nd day – 10th day =
PRE- TERM
 2. Pathologic Jaundice
Causes:
Infection
Hemolytic disorders
Inability of the newborn to conjugate
bilirubin

Most accurate method of assessing the presence of

jaundice: Use natural light and blanch skin on the
chest or tip of the nose.
 Accumulation of bilirubin in the brain tissues
 SEIZURES
 MENTALRETARDATION
 EXCHANGE TRANSFUSION
Goal of treatment: to decrease the
bilirubin levels
Management:
Bililight(Phototherapy)
Nursing Care:
Cover eyes with an opaque mask
Distance of about 18-20 inches from
source of light.
Monitor V/S especially temp.
Cover the genitalia to prevent
(PRIAPISM)
Turning the baby q2hours.
Hydration.
 bluish
gray or dark nonelevated
pigmentation area over the lower back
and buttocks present at birth, primarily
nonwhite, disappear at SCHOOL AGE
Nevus vasculosus/Strawberry nevus
Nevus flammeus/PORTWINE STAIN
 Isthe fine downy, hair that covers a
newborn’s shoulder, back and upper arms
 Found also in the forehead and ears.
 Post-mature infants have rarely have
lanugo
 Disappears by 2 weeks of age.
 Within 24 hrs. of birth, the skin of most
newborns has become extremely dry
 The dryness is particularly evident on the
palms of the hands and soles of the feet.
 this is normal and needs no treatment.
 Normal mature infants’ newborn rash.
 Appears in the 1st to 4th day of life, may
appear up to 2 wks of age
 Also called Flea bite rash
 One of the chief characteristic of the rash is
the lack of pattern.
 There may be a circular or linear contusion
matching the rim of the blade of the forcep
on the infants cheek.
 The mark disappears in 1-2 days along with
the edema that accompanies it.
HARLEQUIN SIGN
- BECAUSE OF IMMATURITY OF
CIRCULATION, AN INFANT WHO HAS
BEEN LYING ON HIS SIDE WILL APPEAR
RED ON THE DEPENDENT SIDE & PALE
ON THE UPPER SIDE.
CUTIS MARMORATA
- TRANSITORY MOTTLING ON NB’S
SKIN WHEN IT IS EXPOSED TO COLD.
 Newborn sebaceous gland is immature.
 One pin-point white papule (a plugged or
unopened sebaceous gland)
 Found in the cheek or across the bridge of
the nose
 Disappears by 2-4 wks of age
 Avoid scratching or squeezing the papules
Head is the largest part of the infants’
body (1/4 of his total length);
forehead is large and prominent;
chin is receding when startled or
crying.

a. Symmetry of the Head

b. Fontanels
1.Anterior – diamond shape; closes at 12-18 months
between the 2 parietal bones and 2 fused frontal
bones.

Suture lines should never appear widely separated.

It indicates Hydrocephalus

2.Posterior – triangular in shape; between parietal and occipital

bones.
Closes by end of 2nd month.
CRANIOSTENOSIS/CRANIOSYNOSTOSIS
premature closure of the sutures
leading to mental retardation.
MOLDING
Cephalhematoma
collection of blood
under the
periosteum of the
cranialbone.
Disappears in weeks
to months
 Caput
succedaneum –
localized soft
swelling of the
scalp often
associated with a
long and difficult
birth; present at
birth; overrides
the suture line,
fluid is reabsorbed
within hours to
days after delivery
 Localized softening of the cranial bones
 It corrects itself without treatment after a
few months
 It is probably caused by the pressure of the
fetal skull against the mother’s pelvic bone in
utero.
 It is more common in 1st borne infants
EYES
•Eyelids of equal size
•Temporarily gray or brown in color
•Cry tearlessly during first 3 months
•Cornea should be round and adult sized
•Pupils should be round
•Eyes may appear cross-eyed (Strabismus)
V.A. of 20/200 to 20/500
d. EARS
•Top of ear should align with the inner
and outer canthus of the eye.
•If set of ears lower
>kidney malformation
or
>chromosomal defect
•Sense of Hearing – highly developed in
NB
e. NOSE
•Note for marked flaring of alae nasi,
•Causes of obstruction:
Secretions
Anatomical defect: septal
deviation
Sense of smell – least developed
f. MOUTH
•Should open evenly when crying.
•Palate should be intact; no breaks on the lip
•Epstein Pearls – small round glistening cysts seen
on palate and gums.
•If with tooth (NATAL TOOTH=not covered with gum
membrane) should be extracted to prevent
aspiration.
•Oral thrush – white gray patches usually on the
tongue and sides of cheeks due to Candida
albicans.
Bell's
Bell's(facial
(facialnerve)
nerve)Palsy
Palsy: :The
Theprognosis
prognosisfor
forfacial
facialnerve
palsies
nerve is
palsies
excellent,
is excellent,
and recovery
and recovery
usually usually
occurs in
occurs
the first
in the
month.
first month.
In theInmeantime,
the meantime,
prevention
prevention
of corneal
of corneal
dryingdrying
is is
essential.
essential.
g. NECK
•Thyroid gland is not palpable.
•Appears soft and palpable and creased with
skin folds
•Head should rotate freely on the neck and flex
forward and back.
•Rigidity of the neck
suspect CONGENITAL TORTICOLLIS
•In NB with nuchial rigidity suggests meningitis.
h. CHEST
•As large as or smaller than the head
•Symmetrically expands
•Breasts may be engorged (due to maternal
hormones)
•Passage of WITCH’S MILK.
i. Abdomen
•Normally dome shaped;
• If saphead, suspect DIAPHRAGMATIC HERNIA
(bowel sounds heard in the chest).
•Bowel sounds should be present within
1 hour after birth.
j. EXTREMITIES

•Symmetric and of equal length

•Fingers and toes in equal count.
•Supernumery = POLYDACTYLY;
•Fused or webbed = SYNDACTYLY
•Simean line – single palmar crease = DOWN’S
SYNDROM
•Observe for clubfoot deformities
POLYDACTYLY

SYNDACTYLY
Congenital Hip Dislocation
 k. SENSES
Sight – newborns can see at birth, cannot see
objects past the visual midline (not until 6-8 weeks).
The visual field is 9 inches.
Hearing – as soon as amniotic fluid has been
absorbed, the newborn can already hear
Taste – as soon as secretions have been suctioned,
newborns can already taste
Smell – as soon as the nose has been cleared of
mucus and fluid, newborns can smell
Touch – the most developed of all the senses
 Blood Coagulation
 Most newborn are born with a prolonged coagulation
or Prothrombin time.
 It takes 24 hrs. for flora to accumulate and vitamin K
to be synthesized
Increased pressure on the left side of the
newborn’s heart results in:

>Closure of the foramen ovale

>Change of the ductus arteriosus into a mere
ligament (ligamentum arteriosum)
>Ductus venosus becomes ligamentum
venosum
>Atrophy of the umbilical vein and arteries
 Within 10 minutes after birth, newborn has
establish a good residual volume.
 A baby born by CS have more lung fluid at
birth as one born vaginally, so they may have
more difficulty establishing effective
respiration (because of excessive fluid blocks
air exchange space)
 3 types of stools passed by NB:
1. Meconium – greenish-blackish viscous;
formed during fetal life from amniotic
fluid, intestinal secretions and cells shed
from mucosa; should be within 24 hours
2. Transitional – passed from 3rd to 10th day
•Milk stool
•Breast fed infant stool
•Bottle fed infant stool
 The average newborn voids within 24 hrs
after birth
 A single voiding in a newborn is only about 15
ml
 The daily urinary output for the 1st 1-2 days is
about 30-60 ml total.
 The 1st voiding may be pink or dusky because
of uric acid crystals that were formed in the
bladder in utero
 Epispadias -
urethral opening on
the dorsal surface of
the penis
 Surgical correction
 HYPOSPADIA
 Male urethral
opening on the
ventral surface of
penis, or female
urethral opening in
vagina
 Surgical
reconstruction
Female Genitalia – May have swollen labia and
“PSEUDOMENSTRUATION”

Male Genitalia – Scrotum may be edematous

CRYPTORCHIDISM – undescended testis

ORCHIOPEXY – repair for undescended testis.
HYDROCOELE INGUINAL HERNIA
 Care of the penis
 Uncircumcised – do not force retraction
of foreskin
>(complete separation of foreskin and
glans penis takes 3-5 y)
 Circumcised (surgical removal of
prepuce/foreskin)
 Ensure signed permission before
procedure.
 Postprocedure monitor for bleeding and
voiding, Teach parents to clean area
with warm water squeezed over penis
and dry gently; a whitish yellow
exudate.
PASSIVE NATURAL IMMUNITY – type of immunity
transferred from mother to newborn
(present in the infant for one year)
*Newborns have difficulty forming antibodies until 2
months of age (that is why immunizations are
started at 2 months).
 Reflexes
 Blink Reflex- to protect the eye from
any object coming near it by rapid
eyelid closure
• Rooting
Reflex– turns
toward any
object
touching/stro
king
cheek/mouth,
opens mouth,
and sucks
rhythmically
when
finger/nipple
is inserted
into mouth
(usually
disappears by
6 wks.)
• Sucking
Reflex-
when
newborn’s
lips are
touched, the
baby makes
a sucking
motion.
Disapears at
about 6
months
 Swallowing Reflex- food that reaches the
posterior portion of the tongue is automatically
swallowed.
 Extrusion Reflex- a newborn will extrude any
substance that is placed in the anterior portion
of the tongue.
 Protective reflex prevents the swallowing of inedible
substance
 Disappears at 6 wks to 3 mos.
 Palmar grasp –
pressure on
palm elicits
grasp (fades by
3-4 mo)
• Moro or
Startle Reflex –
elicited by sudden
disturbance in the
infant’s immediate
environment, body
will stiffen, arms in
tense extension
followed by
embrace gesture
with thumb and
index finger a “c”
formation
(disappears by 6
mo)
 Stepping
(walk)-in-place
reflex – when
held upright
with one foot
touching a flat
surface, with
alternating step
(fades 4-5 mo)
 Babinski’s sign – stroking the sole of the foot from heel
upward like an inverter “J” across ball of foot will cause all
toes to fan (reverts to usual adult response by 12 mo)
 Landau reflex- a newborn who is held in a prone
position with a hand underneath supporting the
trunk should demonstrate some muscle tone
 11. BACK
•On prone appears flat, (curves start to form
when child learns to sit or stand)
•Note: for mass, hairy nodule and a dimple
along axis. This may be indicative of
Spina Bifida.
 Discharge Instructions
Bathing – maybe given anytime as long as it is not within 30
minutes after a feeding.

>Sponge baths are done until the cord falls off

(7th to the 10th day).
Cord Care
Fold down diapers so that cord does not get wet during
voiding
Dab rubbing alcohol (70%) once or twice a day
Small pink granulating area may be seen on the day the
cord falls off. If it remains moist for a week, advise mother
to bring baby to the doctor’s clinic.
REPUBLIC ACT NO. 9288

“…ensure that every baby born in the Philippines is offered

the opportunity to undergo newborn screening and thus be
spared from heritable conditions that can lead to mental
retardation and death if undetected and untreated.”
 Thyroid hypofunction or enzyme defect
 reduced T3, T4
S/sx: excessive sleeping, enlarged tongue,
noisy respiration, poor suck, cold
extremities, slow pulse and respiratory rate,
lethargy and fatigue, short and thick neck,
dull expression, open mouthed, slow DTR,
obesity, brittle hair, delayed dentition, dry,
scaly skin
Dx: low T3 T4, inc TSH
Tx: synthetic thyroid hormone
Nsg Care: Assist parents administer drugs
- reduction in the levels of the enzyme G6PD
in RBC leads to hemolysis of the cell upon
exposure to oxidative stress

Dx: blood smear – heinz bodies

rapid enzyme screening test,
electrophoresis

Mx: avoid sulfonamides, antimalarials, fava

beans
- Deficient or absent phenylalanine hydroxylase
w/c converts phenylalanine to tyrosine

S/sx: mental retardation, musty odor of urine,

blond hair, blue eyes

Dx: Guthrie blood test

Tx: decrease phenylalanine (Lofenalac)

regulate diet
(-) enzyme that converts galactose to
glucose
S/sx: wt loss, vomiting,
hepatosplenomegaly, jaundice and
cataract

Dx: Beutler test

Tx: decrease lactose – soy based formula

regulate diet