Oleh :

Ns. Nurfalah Setyawati, S.Kep

The Newborn
Newborn’s Immediate Needs
 Airway
 Breathing
 Circulation
 Warmth
The Newborn
 Neonatal transition: 1st few hours after birth
newborn stabilizes respiratory and circulatory
functions.
 When the cord is clamped, placental gas exchange
ceases.
 These changes stimulate carotid and aortic
chemoreceptors which send impulses to the
respiratory center in the medulla.
 A brief period of asphyxia stimulates respirations.
Apgar Score
 Assesses the infants cardiopulmonary adaptations
to extrauterine life
 Provides a quick evaluation on how the heart and
lungs are adapting
 5 items to be assessed 1 and 5 minutes after birth.
Apgar Score
 Heart rate, respiratory rate, muscle tone, reflex irritability and color
 Score of 0 – 2 for each item, then totaled.
 Apgar Score 8 or higher no intervention
 Apgar Score 4 – 8 gentle rubbing, oxygen
 Apgar Score 0 – 4 resuscitation
Points Given 0 1 2
A Activity/muscle Limp/flaccid Some Active motion/well
tone motion/flexion flexed
P Pulse Rate Absent <100 bts/min >100 bts/min
G Grimace/Reflex No Response Grimace Cry, cough,
Irritability sneeze
A Appearance/ Blue, Pale Body pink, Pink all over
Skin Color extremities Absence of
blue cyanosis

R Respiration Absent Slow weak cry Good Cry

I. PEMERIKSAAN SAAT LAHIR
 TUJUAN : 1. PENILAIAN ADAPTASI NEONATUS
2. MENCARI KELAINAN KONGENITAL
NILAI APGAR
TANDA 0 1 2

LAJU JANTUNG TIDAK ADA < 100 > 100

USAHA NAPAS TIDAK ADA LAMBAT MENANGIS

KUAT
TONUS OTOT LUMPUH EKSTREMITAS GERAKAN AKTIF
FLEKSI SEDIKIT
REFLEKS REAKSI (-) GERAKAN REAKSI
SEDIKIT MELAWAN
WARNA KULIT SELURUH TUBUH SELURUH
TUBUH KEMERAHAN, TUBUH
BIRU/PUCAT EKSTREMITAS KEMERAHAN
BIRU
 PENILAIAN ADAPTASI NEONATUS
DG NILAI APGAR
 PENILAIAN APGAR PADA MENIT KE-1 DAN MENIT
KE-5
 ADAPTASI NEONATUS BAIK : NILAI APGAR 7-10
 NILAI APGAR 4-6 (ASFIKSIA RINGAN)
 NILAI APGAR 0-3 (ASFIKSIA BERAT)
 PENILAIAN DIULANGI SETELAH 5 MENIT
UNTUK EVALUASI APAKAH TINDAKAN RESUSITASI
KITA SUDAH ADEKUAT ?
 NILAI APGAR 5 MENIT MEMPUNYAI NILAI
PROGNOSTIK-- BERHUB. MORBIDITAS NEONATAL
Prophylactic Care
 Vitamin K –to prevent hemorrhagic disorders – vit
k (clotting process) is synthesized in intestine
requires food for this process. Newborn’s stomach
is sterile has no food. aquaMEPHYTON
 Hepatitis B vaccination –within the first 12 hours
 Eye prophylaxis –(Erythromycin Ointment) to
prevent ophthalmia neonatorum –
gonorrhea/chlamydia
Newborn: Intramuscular injection
 aquaMEPHYTON (Vit.K)
 1 mg/0.5 ml IM lateral thigh
 Vastus lateralis
Vital Signs
 Temperature - range 36.5 to 37 axillary (97.7-98.6)
 Axillary vs Rectal about 0.2 to 0.5 difference
Common variations
 Crying may elevate temperature
 Stabilizes in 8 to 10 hours after delivery
 Heart rate - range 120 to 160 beats per minute
 Apical pulse for one minute
Common variations
 Heart rate range to 100 when sleeping to 180 when crying
 Color pink with acrocyanosis
 Heart rate may be irregular with crying
 Respiration - range 30 to 60 breaths per minute
 Blood pressure - not done routinely
 Ranges between 60-80 mm systolic and 40-45 mm diastolic.
Reflexes: indicate neurological integrity

 Rooting  Moro
 Sucking  Gallant
 Extrusion  Stepping
 Palmar grasp  Babinski’s
 Plantar grasp  Crossed extension
 Tonic neck reflex
 Placing
 Reflexes
 Tonic Neck Reflex (FENCING)  Moro Reflex
 EXTENDS arm & leg on the side
that the face points.  Birth to 4-6 months
 Flexes opposite arm & leg
 6-8 wks to 6 months
Rooting and Sucking Reflexes

 Birth to 3-4months  Birth to 10 months

Babinski and Palmer Grasping Reflex
 Babinski Reflex is (+)
 This is Normal
 Birth to after walking  Birth to 4 months
 12-18 months age
Skin
 Expected findings
 Skin reddish in color, smooth and puffy at birth
At 24 - 36 hours of age, skin flaky, dry and pink in
color
 Edema around eyes, feet, and genitals
 Vernix caceosa
 Lanugo (baby hair)
 Turgor good with quick recoil
 Hair silky and soft with individual strands
 Common Normal Variations
 Acrocyanosis - result of sluggish peripheral
circulation.
 Mongolian Spots: Patch of purple-black or blue-
black color distributed over coccygeal and sacral
regions of infants of African-American or Asian
descent.
 Milia: Tiny white bumps papules (plugged
sebaceous glands) located over nose, cheek, and
chin.
 Erythema toxicum: Most common newborn rash.
Variable, irregular macular patches. Lasts a few days.
PEMERIKSAAN SECARA
RINCI
 KULIT : NCB DISELIMUTI ZAT SPT LEMAK (VERNIKS
KASEOSA) SBG PELUMAS DAN ISOLASI PANAS
 LANUGO : RAMBUT HALUS PD PUNGGUNG BAYI,
BANYAK PD BY KURANG BULAN, MAKIN BERKURANG
SAMPAI HILANG PD NCB
 AMATI PETEKIE, EKIMOSIS AKIBAT TRAUMA LAHIR
 ADANYA TUMOR DI KULIT
 TURGOR KULIT JELEK : DEHIDRASI/ KURANG GIZI
 MILIA :BINTIK PUTIH KEKUNINGAN DI HIDUNG & PIPI
HILANG DL BBRP MINGGU (KISTA EPIDERMAL)
- MILIARIA KRISTALINA : VESIKEL JERNIH KRN
OBSTRUKSI KELENJAR KERINGAT
Erythema toxicum, acrocyanosis, milia and mongolian
spots
 Hyperbilirubinemia
 Physiologic Jaundice =Appears 24 hours after birth
peaks at 72 hrs.
 Bilirubin may reach 6 to 10 mg/dl and resolve in 5 to 7
days.
 Due to Unconjugated bilirubin circulating in the blood
stream that is deposited in the skin.
 Immature liver unable to conjugate bilirubin released by
destroyed RBC.
 Pathologic Jaundice =Not appear until after 24 hrs
leads to Kernicterus (deposits of bili in brain).
 Bilirubin >20mg/dl
 The most common cause is Rh incompatibility.
PEMERIKSAAN LANJUTAN

 WARNA KULIT : NORMAL KEMERAHAN, KADANG

SIANOSIS UJUNG JARI PD HR I
 SELURUH TBH SIANOSIS : PJB SIANOTIK
 PUCAT PD ANEMIA BERAT
 KUNING PD HIPERBILIRUBINEMIA

KUNING JINGGA : BILIRUBIN INDIREK MENINGKAT

KUNING KEHIJAUAN : BILIRUBIN DIREK NAIK

- KULIT BERWARNA : MONGOLIAN SPOTS
 The Head and Chest
 The Head: Anterior fontanel
diamond shaped 2-3 - 3-4
cms
 Posterior fontanel triangular
0.5 - 1 cm
 Fontanels soft, firm and flat
 head circumference is 33 – 35
cm
 The head is a few centimeters
larger than the chest!!!!
 The Chest: circumference is
30.5 – 33 cm
Anterior and Posterior Fontanelles

 Anterior diamond shaped 2-3 - 3-  Molding is shaping of

4 cms
 Posterior triangular 0.5 - 1 cm
fetal head to adapt to
 Fontanels soft, firm and flat the mothers pelvis
during labor.
Caput succedaneum
 Swelling of the soft tissue
of the scalp caused by
pressure of the fetal head
on a cervix that is not fully
dilated.
 Swelling is generalized.
may cross suture line and
decreases rapidly in a few
days after birth. Requires
no treatment
 2 – 3 days disappears
Cephalohematoma

 Collection of blood
between the periosteum and
skull of newborn.
 Does not cross suture lines
 Caused by rupturing of the
periosteal bridging veins
due to friction and pressure
during labor.
 Lasts 3 – 6 weeks
Bathing the Newborn
 No tub bath until after
the cord has fallen off
and healing is
complete.
 Newborn’s first bath-
the nurse needs to wear
gloves to prevent
infection.
 What is wrong with this
nursing action?
Gestational Age Relationship to Intrauterine Growth

 Normal range of birth weight for each week of

gestation.
 Birth weight is classified as follows:
 Large for gestational age (LGA): weight falls above
the 90th percentile for gestational age
 Appropriate for gestational age (AGA): weight falls
between the 90th and 10th percentile for gestational
age
 Small for gestational age (SGA): weight falls below
the 10th percentile for gestational age
Intrauterine Growth Grid
Circumcision
 Circumcision is considered an elective procedure
 Anesthesia should be provided.
 Parents must give written consent
 Full term health infants
 Aftercare: Check hourly for 12 hours
 Check for bleeding and voiding
 Before discharge:
 Newborn goes home within the first 12 hours after
procedure
 Bleeding should be minimal and infant must void
 Ensure that parents know how to care for the
circumcision.
Breastfeeding
 Colostrum is rich in immunoglobulins to protect
newborn GI tract from infection; laxative effect.
 Breast milk in 2 weeks sufficient nutrients 20 kcal/oz
(infant’s nutritional needs)
 To support Breastfeeding: Mother needs to consume
extra 500 calories per day.
 Feeding length: should be long enough to remove all
the foremilk (watery 1st milk from breast high in
lactose - skim milk & effective in quenching thirst)
 Hindmilk: higher in fat content leads to weight gain
and more satisfying.
 Breastfeeding time approximately 30 minutes
Infant Formula
 Formula 7.5 ml to 15 ml at feeding gradually
increase to 90 ml to 120 ml at each feeding in 2
weeks.
 Formula preparation: mixing must be accurate to
provide the 20 kcal/oz. (newborn nutritional
need)
 Burping: is needed to expel air swallowed when
infant sucks.
 Should be done about ½ way through feeding for
bottle feeders and when changing breasts for
breast feeders.
Respiratory Distress
 2 types: Respiratory Distress Syndrome (RDS) and Transient
Tachypnea of the Newborn (TTN)
 RDS: preterm infants/surfactant deficiency
 Hypoxia, respiratory acidosis and metabolic acidosis
 Surfactant is produced by alveoli - lung maturity
 L/S ratio 2:1 is a test done before birth to determine fetal lung
maturity
 TTN: AGA, near term infants
 Intrauterine or intrapartum asphyxia
 Newborn unable to clear airway of lung fluid, mucous or
amniotic fluid aspiration.
 Expiratory grunting nasal flaring, tachypnea with respirations
as high as 100 to 140 breaths/minute.
Neural Tube Defects
 3 types:
 Spina Bifida Occulta: failure of the vertebral arch to
close. Has dimple on the back with a tuft of hair. No
treatment required.
 Meningocele: saclike protrusion along the vertebral
column filled with cerebrospinal fluid and meninges.
Surgery required.
 Myelomeningocele: saclike protrusion along the
vertebral column filled with spinal fluid meninges,
nerve roots, and spinal cord = paralysis. Surgical repair
required.
 Sterile saline dressing.
 hydrocepalus
  meningocele
 Spina bifida occulta

 Spina bifida Occulta

 myelomeningocele
Infants of DM mothers (IDM) Complications
 Hypoglycemia: maternal glucose declines at birth.
Infant has high level of insulin production=
decreases infant’s blood glucose within hours after
birth.
 Respiratory Distress: less mature lungs due to
insulin
 Hyperbilirubinemia: hepatic immaturity, increased
hematocrit, bruising due to difficult delivery.
 Birth trauma: large size of infant
 Congenital birth defects: birth defects – Patent
Ductus Arteriosus, Ventricular Septal Defect and
more.
THE END