NURSING CARE OF THE

NEWBORN
Prepared By:
Maria Lorena Araneta – Limbo RN, MAN
 OBJECTIVE
At the end of the class lecture/discussion, the students will be able to:

1. Identify the needs of the newborn

2. Assess a newborn to determine whether safe transition to extrauterine life has

occurred

3. Identify nursing care to assist the newborn to transition to extrauterine life

4. Review anticipatory guidance nurses provide to parents before discharge

 ESTABLISHMENT OF RESPIRATION
FOR NEWBORN

Establishment of Open Airway and Circulation

 As the fetal chest passes through the birth canal it is

compressed, squeezing excess fluid out of the lungs prior to the baby
taking its first breath

 Majority of babies cry at birth and take spontaneous respirations

FOR A WELL, TERM NEWBORN, USUALLY
WARMING, DRYING, AND
STIMULATING THE BABY BY RUBBING THE
BACK IS ENOUGH TO INITIATE RESPIRATIONS. 
q After birth, babies will cough and sneeze, mobilizing
additional fluid that may be in their lungs

 A crying infant is a breathing infant, because the sound of crying

is made by a current of air passing over the larynx. 

 The more lusty the cry, the greater the assurance the newborn is
breathing deeply and forcefully. 

 Vigorous crying also helps blow off the extra carbon dioxide that
makes all newborns slightly acidotic, so it helps to correct this
condition.   

 Ineffective respirations creates failure of fetal circulatory shunts,

particularly the ductus arteriosus, to close.
 HOW LONG DOES IT TAKE FOR A
BABY TO TAKE ITS FIRST
BREATH?
 The baby takes the first breath usually within ten seconds of birth. These first
few breaths, initiated by the newborn, are the most difficult.

 Most full-term infants will gasp spontaneously within seconds of birth.

 90-95% of newborns will complete this transformation without any help.

 WHAT STIMULATES A
NEWBORN’S FIRST BREATH?
 Taking the first breath is a primal reflex essential for keeping the baby alive
and is triggered by the change in air temperature and environment.

 Only 5-10% of babies require basic stimulation, such as drying and rubbing, to
initiate breaths

 3-6% require basic resuscitation steps (bag and mask ventilation)

 Less than 1% of babies require advanced resuscitation (cardiac compressions

or drugs)
 A newborn who does not breathe spontaneously or who takes a few quick, gasping breaths
but is unable to maintain respirations needs resuscitation as an emergency measure. An
infant with grunting respirations needs careful observation for respiratory distress
syndrome

 Common factors predisposing infants to respiratory difficulty in the first few days of life
 Low birth weight 
 Intrauterine growth restriction 
 Maternal history of diabetes 
 Premature rupture of membranes 
 Maternal use of barbiturates or narcotics close to birth 
 Meconium staining - poses a problem – a condition known as meconium aspiration syndrome and makes
breathing more difficult
 Irregularities detected by fetal heart monitor during labor 
 Cord prolapse 
 Lowered Apgar score (<7) at 1 or 5 minutes 
 Postmaturity (postterm) 
 Small for gestational age 
 Breech birth 
 Multiple birth 
 Chest, heart, or respiratory tract anomalies 
 The American Academy of Pediatrics (AAP) has instituted a Neonatal Resuscitation
Program updated at intervals that lists steps and rationales for newborn
resuscitation should follow an organized process: 
a) Establish an airway
b) Expand the lungs
c) Initiate and maintain effective ventilation

 If respiratory depression becomes so severe that a newborn’s heart begins to fail

(heart rate is less than 60 beats/min) despite effective positive pressure ventilation,
resuscitation should then also include chest compressions

 A rubber bulb syringe is a standard piece of equipment often used in the past to

suction infants’ noses and mouths, but because bradycardia can be associated with
bulb suctioning, routine suctioning of the nose and mouth is no longer recommended
unless there is concern that the airway is obstructed
  Mechanical suctioning should occur only if there is an obstruction such as a mucus plug
that is interfering with effective breathing; otherwise, it may cause bradycardia

 An infant who still makes no effort at spontaneous respirations after

mechanical suctioning steps may require insertion of an endotracheal tube to be certain
the airway is not obstructed so air can be effectively administered

 A healthcare provider skilled in laryngoscope and endotracheal tube insertion should be

present at the birth of all infants identified as high risk so a laryngoscope can be quickly
inserted into the airway as necessary

q If an infant needs air or oxygen by bag and mask to aid lung expansion, be certain the
mask covers both the mouth and the nose.  Make sure it doesn’t cover the eyes because
eye injury could occur from either pressure of the mask on the eyes or from drying of the
cornea from air or oxygen administration
q Air (or oxygen if needed) should be administered at a rate of 40 to 60 ventilations per
minute. To prevent unnecessary cooling or drying, the oxygen that is administered
should be both warmed (between 89.6° and 93.2°F [32° and 34°C]) and humidified
(60% to 80%).

q If the resuscitation has continued for over 2 minutes, insert an orogastric tube
(through the mouth to the stomach instead of through the nose to the stomach because
babies are obligate nose breathers)

q If heart rate continues to be inadequate (less than 60 beats/min), epinephrine 1:10,000
may be administered intravenously (IV) to stimulate heart action

q Preterm infants may receive surfactant to replace the natural surfactant that has not
yet formed in their lungs
 HELPING BABIES BREATHE AT
BIRTH
Please watch this

https://youtu.be/0clo9Lvpv7Y
 MAINTENANCE OF PATENT
AIRWAY
Promote Adequate Breathing Pattern and Prevent Aspiration

 To allow a newborn to adjust to and maintain the cardiovascular changes that occur at
birth, effective ventilation (continued respirations) must be maintained. Healthy
newborns accomplish this task on their own. 

 Use of pulse oximetry is crucial to be certain oxygen saturation remains adequate;

infants this young do not have dramatic skin color changes as do older infants and can
be mildly hypoxic (low in oxygen) without becoming cyanotic. 
THOSE WHO HAVE DIFFICULTY ESTABLISHING
RESPIRATIONS AT BIRTH NEED TO BE CAREFULLY
OBSERVED IN THE FIRST FEW HOURS AFTER BIRTH
TO BE CERTAIN RESPIRATIONS ARE MAINTAINED. 
 THE BABY WHO IS CRYING CAN
RECEIVE ROUTINE CARE  
KEEP WARM
 Position skin-to-skin with the neck slightly extended 
 Cover head and body 

CHECK BREATHING
 Listen, look at or feel movement of chest
 WHY DO PRETERM BABIES HAVE
TROUBLE BREATHING?
 Preterm babies haven’t had as much time produce surfactant – a substance that
keeps the air sacs in the lungs from sticking together when exhaling. Surfactant also
helps the lungs to inflate and prevents them collapsing in on themselves, which
makes breathing harder.
 A baby normally begins to produce surfactant from 24-28 weeks of pregnancy. Most
will produce enough to breathe normally by week 34
 Some babies born at this point, however, will still struggle to maintain breathing for
themselves and might require respiratory support from a breathing machine or
ventilator.
 The lungs aren’t considered mature until around 36 weeks. Generally the longer the
gestation, the better it is for the health of newborn babies, as they are better
equipped to deal with their new world.
 WHY IS THE FIRST BREATH OF A
NEWBORN THE MOST DIFFICULT? 
 The first breath immediately after birth is mechanically the most difficult for a
newborn because it’s the first time the lungs are being used.
 Within a couple of breaths, the baby’s lungs will inflate. They become filled with air,
and push out the fluid inside them.
 Only after this is done can the lungs effectively take in oxygen and eliminate carbon
dioxide.
 Imagine blowing up a balloon for the first time. The balloon is like the newborn’s
lungs. Your first attempt to blow up the balloon takes a lot of effort, but once you get
started it becomes easier. The next time you blow it up, it’s easier still.
 Once their lungs have begun working, the muscles involved in breathing don’t have
to work so hard to keep them inflated.
A STEADILY INCREASING RESPIRATORY
RATE, GRUNTING, AND NASAL
FLARING ARE OFTEN THE FIRST SIGNS
OF OBSTRUCTION OR RESPIRATORY
COMPROMISE IN NEWBORNS. 

IF THESE ARE PRESENT, UNDRESS THE

BABY’S CHEST AND LOOK
FOR INTERCOSTAL
RETRACTIONS (INWARD SUCKING OF THE
ANTERIOR CHEST WALL ON
INSPIRATION).

PULLING IN THE CHEST MUSCLE THIS

WAY REFLECTS THE DEGREE OF
DIFFICULTY THE NEWBORN IS HAVING
IN BREATHING IN AIR (TUGGING SO HARD
TO INFLATE THE LUNGS THAT THE
ANTERIOR CHEST MUSCLES ARE PULLED
INWARD).
IF A NEWBORN DOES NOT INITIATE
SPONTANEOUS BREATHING FOLLOWING GENTLE STIMULATION,
PLACE THE INFANT UNDER A RADIANT HEAT WARMER IN
A “SNIFFING” POSITION (HEAD SLIGHTLY TIPPED BACK) AND
RUB AND DRY HIS OR HER BACK AND HAIR AGAIN TO SEE IF THIS
ADDITIONAL STIMULATION INITIATES RESPIRATIONS.
A BABY WHO IS BREATHING WELL
 Crying or 
 Breathing quietly and regularly 

A BABY WHO IS NOT BREATHING WELL

 Gasping or 
 Not breathing at all Babies with shallow, irregular, slow or noisy breathing
or chest indrawing need continued monitoring
IF SECRETIONS ACCUMULATING IN THE RESPIRATORY TRACT APPEAR
TO BE CREATING INEFFECTIVE BREATHS, AN INFANT MAY NEED
ADDITIONAL SUCTIONING. “BAGGING” THE INFANT WITH A MASK AND
POSITIVE-PRESSURE VENTILATION BAG FOR A MINUTE BEFORE
SUCTIONING WILL USUALLY IMPROVE THE INFANT’S OXYGEN
LEVEL AND PREVENT IT FROM DESATURATING TO DANGEROUS LEVELS
DURING SUCTIONING. 
 VENTILATION WITH BAG AND MASK IS
THE MOST EFFECTIVE WAY TO HELP THE
BABY WHO IS NOT BREATHING OR IS
GASPING
BEGIN TO VENTILATE
 Follow your facility’s routine for when to clamp or tie and cut the cord 
 Place the baby on the area for ventilation 
• Beside the mother if the cord is not cut 
• A separate area if the cord is cut 
 Stand at the baby’s head 
 Check that the mask size is correct
A NEWBORN WHOSE AMNIOTIC FLUID WAS MECONIUM STAINED
AT BIRTH BUT IS BREATHING DOES NOT NEED SUCTIONING TO
CLEAR THE AIRWAY. IF THE NEWBORN WHOSE AMNIOTIC FLUID WAS
MECONIUM STAINED AT BIRTH PRESENTS WITH POOR MUSCLE
TONE AND INADEQUATE BREATHING, IT IS IMPORTANT TO
BEGIN THE INITIAL STEPS OF RESUSCITATION UNDER THE WARMER.
VENTILATE WITH BAG AND MASK

 Position the head slightly extended 

 Apply the mask to the face 
 Make a tight seal between the mask and face 
 Squeeze the bag to produce gentle movement of the chest 
 Give 40 ventilation breaths per minute If the chest is moving with  each
ventilation breath, continue ventilation for 60 seconds or until the baby begins
to breathe
IF THE CHEST IS NOT MOVING IMMEDIATELY
 Reapply the mask 
 Reposition the head

IF THE CHEST IS MOVING WELL, CONTINUE TO VENTILATE FOR ONE MINUTE OR

UNTIL THE BABY BEGINS TO BREATHE  
 Crying or
 Breathing quietly and regularly Stop ventilation and monitor with mother

IF THE BABY IS NOT CRYING OR BREATHING WELL THE BABY MAY BE

 Gasping
 Not breathing at all.  Continue ventilation with good chest movement

OR THE BABY MAY BE
 Taking fast, irregular, or shallow breaths 
 Grunting with chest wall indrawing. Monitor with mother and provide more help to breathe if
needed
 IF THE BABY IS NOT
BREATHING, CONTINUE VENTILATION
CALL FOR HELP
 Ask for a skilled helper, if available

IMPROVE VENTILATION IF THE CHEST IS NOT MOVING

 Reapply mask 
 Reposition head 
 Clear mouth and nose of secretions
 Open mouth slightly 
 Squeeze the bag harder.  Cut the cord if not already done
EVALUATE HEART RATE AFTER 1 MINUTE TO DECIDE IF VENTILATION
IS ADEQUATE
Feel the umbilical cord pulse 
OR 
 Listen to the heartbeat with a stethoscope 

 Decide quickly if the heart rate is normal or slow 

 Normal > 100 beats per minute 
 Slow < 100 beats per minute
IF THE HEART RATE IS NORMAL AND THE BABY IS NOT BREATHING OR
IS GASPING

 Continue ventilation 
 Re-evaluate breathing continuously and check heart rate every 3-5 minutes 
 Seek consultation to decide on advanced care

IF THE HEART RATE IS SLOW

 Improve and continue ventilation 
 Re-evaluate breathing continuously and check heart rate every 3-5 minutes 
 Seek consultation to decide on advanced care

IF THE HEART RATE IS SLOW OR THE BABY DOES NOT BREATHE AFTER

20 MINUTES
 Discuss with parents 
 Consider stopping ventilation
A BABY WHO RECEIVED VENTILATION NEEDS CONTINUED MONITORING
 Breathing
 heart rate 
 color 
 Temperature

IF A BABY NEEDED HELP TO BREATHE

 Prolong skin-to-skin care 
 Continue with immediate essential newborn care 
 Make a note of care provided in the clinical record
 IF REFERRAL IS NEEDED, TRANSPORT MOTHER AND BABY TOGETHER
 Continue skin-to-skin care
 Monitor the baby
 Communicate with the receiving facility
 Consider alternative methods of feeding 

SUPPORT THE FAMILY

 Communicate in a way appropriate for the culture and religion 

PREPARE FOR THE NEXT TIME A BABY NEEDS HELP TO BREATHE

 Review the actions taken with other team members (debrief)
 Disinfect the equipment used
 Store the equipment in a place where
 TEACHING POINTS FOR
NEWBORN RESUSCITATION
Please watsh this link

https://youtu.be/0480Zbkgt5M
Diaper Area Care CHANGING OF DIAPERS
 Preventing diaper dermatitis is a practice that parents need to start from the very
beginning with their newborns. 

 With each diaper change, the area should be washed with clear water and dried well, to
prevent the ammonia in urine from irritating the infant’s skin and causing a diaper rash. 

 After cleaning, a mild ointment such as petroleum jelly or A + D Ointment may be
applied to the buttocks. The ointment keeps ammonia away from the skin and also
facilitates the removal of meconium, which is sticky and tarry. 

 Wear gloves for diaper care as part of standard precautions.

 EYE PROPHYLAXIS 
Administer Eye Care.

  Although the practice may shortly become obsolete (as it is in

Europe), every U.S. state still requires that newborns receive
prophylactic eye treatment against gonorrheal conjunctivitis
(Raab,2007). 

  Such infections are usually acquired from the mother as the infant
passes through the birth canal. Formerly, eye prophylaxis was
applied immediately after birth. 

  Parents who know that they are free of agonococcal or

chlamydial infection can ask to have eyeprophylaxis omitted
entirely.
  Silver nitrate was exclusively used for prophylaxis in the past. 
Today, erythromycin ointment is the drug of choice. Erythromycin ointment
has the advantage of eliminating not only the organism of gonorrhea
but that of Chlamydia as well

  Always use a single-use tube or package of ointment, to avoid transmitting

infection from one newborn to another

  To instill the ointment, first dry the face of the newborn with a soft gauze square
so that the skin is not slippery
  The best procedure to open a newborn’s eyes is to
shade them from the overhead light and open one
eye at a time by pressure on the lower and upper
lids.  

  Squeeze a line of ointment along the lower

conjunctival sac, from the inner canthus outward

  Close the eye to allow the ointment to spread across

the conjunctiva
 CORD CARE
Inspect and Care for Umbilical Cord

 The umbilical cord pulsates for a moment after an infant is born as a last flow of blood
passes from the placenta into the infant

 Two clamps are then applied to the cord about 8 inches from the infant’s abdomen, and the
cord is cut between the clamps. Some fathers choose to do this as their responsibility. The
infant cord is then clamped again by a permanent cord clamp, such asa Hazeltine or a Kane
clamp

 The clamp on the maternal end of the cord should not be released after the cord is cut, to
prevent blood still remaining in the placenta from leaking out.  This loss is not important,
because the mother’s circulation does not connect to the placenta. It is messy, however, and
that is why the clamp is left in place
 Cords begin to dry almost immediately, and the vessels may be obscured by the time of
the infant’s first thorough physical examination in the nursery. 

 Wiping the cord with alcohol at each diaper change helps to hurry drying and possibly
reduce the development of infection.

 Until the cord falls off, at about day 7 to 10 of life, a newborn should receive sponge
baths rather than be immersed in a tub of water to keep the cord dry.

 Be certain that diapers are folded below the level of theumbilical cord, so that, when
the diaper becomes wet,the cord does not become wet also. 
 Remind parents to continue to keep the cord dry until it falls off after they return home.

 The use of creams, lotions, and oils near the cord should be dis-couraged, because they tend
to slow drying of the cord and invite infection.

 Some health care agencies recommend applying rubbing alcohol to the cord site once or twice
a day to hasten drying.   Others prefer the cord be left strictly alone, because manipulation
could invite infection.

 After the cord falls off, a small, pink, granulating area about a quarter of an inch in diameter
may remain. This should also be left clean and dry until it has healed (about 24 to 48
additional hours).

 If the ulcerous area has remained as long as 1 week, it may require cautery with silver nitrate
to speed healing
Observe for
z
the oozing
of blood. If
blood
oozes, place
a second tie
between the
skin and
the clamp
 z

Cord
clamping
and
cutting
 VITAMIN K
Vitamin K Administration

 Newborns are at risk for bleeding disorders during

the first week of life because their gastrointestinal
tract is sterile at birth and unable to produce vitamin
K, which is necessary for blood coagulation. 

 A single dose of 0.5 to 1.0 mg of vitmin K is

administered intramuscularly within the first hour of
life to prevent such problems. Infant born outside a
hospital also should receive this importantprotection
 REGULATION OF TEMPERATURE
Keep Newborn Warm

 Gently rub a newborn dry, remove the wet linen, then swaddle loosely with a clean,
warm, and dry blanket. Be certain to place a cap on the infant’s. These actions all help
to prevent heat loss. 

 Swaddling helps to mimic the tight confines of the uterus and appears to offer
a  sense of security as swaddled infants sleep for longer periods (Bregje et al., 2007)

 The period immediately after birth is an important time for parents to begin
interaction with their child. 
 Any extensive procedures, such as resuscitation, should be done under a radiant heat
source to reduce heat loss. 

 At the end of the first hour of life, reassess the newborn’s temperature.  

 If the temperature is subnormal and the baby is in a bassinet, he or she should be
placed in a heated bassinet or under a radiant warmer for additional heat. 

 During the first day of life, a newborn’s temperature is usually taken every 4 to 8
hours.  Thereafter, unless the temperature is elevated or subnormal, or the
infantappears to be in distress, measurement once a day while in the health
care facility is enough
The majority of heat loss occurs because of four separate
mechanisms:

 Convection is the flow of heat from the newborn’s body

surface to cooler surrounding air. Eliminating drafts, such
as from air conditioners, is an important way to reduce
convection heat loss. 

 Radiation is the transfer of body heat to a cooler solid

object not in contact with the baby, such as a cold window
or air conditioner. Moving an infant as far from the cold
surface as possible helps reduce this type of heat loss. 
 Conduction is the transfer of body heat to a cooler solid object
in contact with a baby. For example, a baby placed on the cold
base of a warming unit quickly loses heat to the colder metal
surface. Covering surfaces with a warmed blanket or towel is
necessary to help minimize conduction heat loss. 

 Evaporation is loss of heat through conversion of a liquid to a

vapor.  To prevent this type of heat loss, lay a newborn on the
mother’s abdomen immediately after birth and cover with a
warm blanket for skin-to-skin contact). In addition, drying the
infant especially the face and hair also effectively reduces
evaporation because the head, which is a large surface area in a
newborn, can be responsible for a great amount of heat loss.
Covering the hair with a cap after drying further reduces the
possibility of evaporation cooling
THE INITIAL FEEDING BREASTFEEDING 
 The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the
WHO and the United Nations Children’s Fund (UNICEF) to encourage and recognize
hospitals and birthing centers that offer an optimal level of care for infants that promotes
breastfeeding. 
To qualify as a Baby-Friendly–designated facility, a setting must:
1. Maintain a written breastfeeding policy that is routinely communicated to all
healthcare staff. 
2. Educate all healthcare staff in skills necessary to implement the written policy. 
3. Inform all pregnant women about the benefits and management of breastfeeding. 
4. Help mothers initiate breastfeeding within 1 hour of birth.
5. Show mothers how to breastfeed and how to maintain their milk supply, even if they
are separated from their infants. 
6. Offer breastfed newborns no food or drink other than breast milk unless medically
indicated. 
7. Practice “rooming in” or allow mothers and infants to remain together 24 hours a
day. 
8. Encourage unrestricted or “on-demand” breastfeeding. 
9. Give breastfeeding infants no pacifiers or artificial nipples. 
10. Foster the establishment of breastfeeding support groups and refer mothers to them
on discharge from the birth setting (UNICEF, 2016). 

After a first feeding in the birthing room, both formula-fed and breastfed infants do
best with an “on-demand” schedule (i.e., are fed when they are hungry). Many need
to be fed as often as every 1.5 to 2 hours in the first few days and weeks of life.
Chapter 19 discusses techniques of both breastfeeding and formula feeding. Nurses
can play an important role in helping new mothers establish breastfeeding during the
infant’s first weeks of life.
 z

Observe
the
newborn
for
feeding
cues
Breastfeeding
Attachment
z
 BURPING 
Why Should You Burp Your Baby?
 When a newborn or an infant swallows air during feeding, that air gets trapped in the
stomach. It can be uncomfortable, and it can make baby feel full. Burping helps to
remove that air. Once newborn burps and gets that air out of their belly, they will feel
better. They may even start breastfeeding again, since removing the air will make room
in their stomach for more breast milk.

When Should You Burp Your Breastfed Baby?

 Some babies don't take in very much air during feedings, so they don't need to burp as
much. However, if the mother has a strong let-down-reflex or an over abundant breast
milk supply, the fast flow of the breast milk can cause baby to swallow more air.  In
these situations, the baby need to burp more often.
• A good time to burp breastfed baby is after they stop nursing, or if they become fussy
during a feeding.  The newborn will often stop nursing and seem uncomfortable if they
need to burp. If mother breastfed from both sides at each feeding, burp baby in between
alternating breasts, and after each feeding.
• If breastfeed from just one side at each feeding, burp baby when they stop feeding. 
After burp of newborn, encourage mother to offer the same breast again to see if baby
wants more. Then, when the feeding is complete, burp baby again.
• Burping is also helpful if baby is sleepy.  If newborn falls asleep at the breast, burping
may help to wake them up and keep them breastfeeding a little longer.
• If baby is breastfeeding well and actively sucking, no need to stop for a burp. Wait until
they stop nursing on their own, and then burp them.
• Some babies need to be burped between feedings, too. If teh newborn is fussy and can't
sleep, a burp may be all that they need. Babies also swallow air when they cry. Because
some babies cry more than others, especially if they have colic, they will need to be
burped more often
How to Burp Your Baby
 Babies sometimes burp on their own without any help or special positioning.
However, it's natural to want to help the process along, and there are many ways to
do that. 

Here are three popular burping techniques. 

1. Over your shoulder: Hold your baby upright, in a vertical position with their head
over your shoulder. 
2. Lying on your lap: Place your baby on their belly across your lap and support their
head with your lap, arm, or hand. 
3. Sitting on your lap: Sit your baby on your lap, facing away from you. Lean them
forward and support his head, neck, and chest with your hand.3 
 First, place a burp cloth, bib, or cloth diaper under child's head before start
burping to protect clothing and catch anything that comes up. Then, when baby is in
position, gently rub or pat them on the back. Don't have to rub or pat hard.
Pounding harder on child's back will not make them burp better or faster. 
 ELIMINATION 
 Should void within 24 hrs (good renal function)

 Expected output for 1 to 2 days: 30 to 60 ml.   15 ml will stretch bladder resulting to as many as 20
voidings per day

 pink or dusky (uric acid crystals)

 The total volume of urine per 24 hours by 1st wk: 200 – 300 ml 

 Limited ability to concentrate urine, until about 3 months when kidneys mature

 Odorless & colorless

 Specific gravity: 1.001 – 1.020
 ELIMINATION 

   Change in Stooling Patterns

 Meconium – passed within 24-48 hours

  
  Transitional Stool (2nd or 3rd day)
Greenish brown to yellowish brown,  with some
milkcurds
  
 Milk Stools (4th day) 

 Breast-fed: 3 – 4 x/day
Light yellow to golden, soft consistency
or pasty, sour milk (lactic acid) odor or no foul
smell
  
 Formula-fed Infant: 2 - 3 x/day 
Pale yellow or bright yellow or light brown, soft
or firmer; offensive odor
 CUDDLING  
• It’s great if newborn cuddled often, especially in the three months after giving
birth. The first three months of your child’s life are known as the “fourth
trimester” This is because the newborn emerged from a dark, warm and
comfortable place. 
• Cuddling helps replicate the womb environment. The newborn feel safe and
warm. Cuddling helps baby develop a secure attachment. The bond developed
has effects later in your child’s life in terms of self-confidence, healthy
individuation and exploration, expression of empathy, social relationships and
ability to cope with life stressors. 
• Babies who don’t experience cuddling have been found to have markedly lower
levels of oxytocin and vasopressin. These two hormones are thought to play key
roles in stress and social behaviors. Lower levels may explain why these
children have difficulties forming attachments in adulthood.
Health benefits to child and parent include:

  Creating a healthy sense of personal boundaries

  Encouraging calmness and relaxation
  Improving muscle tone and circulation
  Improving pulmonary and immune functions
  Improving sleep patterns
  Lowering anxiety and stress
  Reducing discomfort from teething, congestion, colic and emotional stress
  Strengthening digestive, circulatory and gastrointestinal systems
Model Kangaroo Care
 skin-to-skin contact between baby’s front and mother chest. If baby is very small or
sick, parents may be afraid they'll hurt him or her, but they won't. Baby knows
parents scent, touch and the rhythms of parents speech and breathing. Holding the
baby also promotes breastfeeding because it helps develop the parent-child bond. 
Kangaroo care can help baby by:
 Encouraging successful breastfeeding and milk production
 Encouraging weight gaining (When your baby depends on your body to stay warm, they
use fewer calories to stay warm on their own)
 Maintaining their body temperature
 Regulating their heart and breathing rates
 Spending more time in deep sleep
 Spending more time being quiet and alert rather than crying (Brain wave patterns
associated with happiness have been shown to double when model Kangaroo care done
with newborn)
KANGAROO MOTHER CARE 
PLANNING AND INTERVENTION
 DISCHARGE PLANNING
 Before hospital discharge, nurses provide anticipatory 
guidance for parents regarding feeding and elimination 
patterns; positioning and holding; comfort measures; 
car seat safety; bathing, skin care, cord care, and nail 
care; and signs of illness.
 RECOMMENDATIONS FOR THE DISCHARGE
OF HEALTHY TERM NEWBORNS
It is recommended that the following minimum criteria be met before discharge of a
term newborn following an uncomplicated gestation and delivery:

 Healthy term newborns should not be discharged before 48 hours from birth if
delivered vaginally or 72–96 hours if delivered by caesarean section.

 Absence of evidence of abnormalities in the newborn during the hospital stay and
the routine physical examination. This examination must be performed by a
physician with a pediatrics specialty at least once, or by a physician with
documented experience in neonatal care and under the supervision of a pediatrics
specialist.
 It is recommended that the weight, hydration and nutritional status of
the newborn be assessed prior to discharge, especially in exclusively-breastfed
newborns or those delivered by caesarean section.

 Normal and stable vital signs for at least 12  hours prior to discharge; axillary
temperature between 36.5 and 37.4°C, respiratory rate below 60bpm and no other
signs of respiratory distress and an awake heart rate of 100–160bpm.  A resting
heart rate of up to 70bpm with no signs of circulatory compromise and adequate
responsiveness is also acceptable. A heart rate close to or above the upper bound of
the normal range requires further assessment.

 The newborn has urinated regularly and passed at least one stool spontaneously.

 The newborn has completed at least two successful feedings, with assessment to
verify that the newborn is able to coordinate sucking, swallowing and breathing
while feeding.
 Routine bilirubin measurement in all newborns is not indicated. If the newborn
presents with significant jaundice before discharge or is discharged before 48h
(early newborn discharge) the total serum bilirubin levels must be measured
and compared with risk charts to determine whether the newborn needs
phototherapy. Under these circumstances, an appropriate follow-up plan must
be instituted.

Newborns at risk of significant hyperbilirubinaemia must be identified and

assessed:

a. Gestational age of less than 38 weeks.

b. A previous sibling with neonatal jaundice requiring phototherapy.
c. Mother's intention to breastfeed exclusively.
d. Visible jaundice in the first 24h of life.
 The risk factors for infection have been assessed, and, when present, the
newborn has been evaluated appropriately and according to established
guidelines for the management of newborns with suspected early-onset
bacterial sepsis.

 The results of maternal blood tests, newborn blood type and direct Coombs test
have been reviewed.

 Due to the change in the vaccination calendar and delay in the first dose of the
Hepatitis B vaccine, a high level of cover must ensure a high coverage for the
prenatal screening of pregnant women, with vaccination and immune globulin
prophylaxis of newborns of HBsAg+ mothers in the first 24 hours post birth.

Newborn metabolic and hearing screenings have been completed according to

the specific protocols established for each.
 The mother has been given information and education on how to provide adequate
care for her infant, and the acquisition of this knowledge and competencies has been
confirmed.

 Instructions have been given in regard to the subsequent follow up of the newborn,
emphatically recommending a first visit in primary care within 72 hours
of discharge. Directions to follow in case of a complication or emergency must also be
given.

 It is advisable to ensure that there have been no misinterpretations of the provided

information on the part of the family due to language barriers or physical, psychical
or sensory impairments.

 Social risk factors have been assessed. When any are identified, discharge should be
delayed until they are resolved or a plan has been developed to guarantee the safety
of the newborn
 RECOMMENDATIONS FOR THE DISCHARGE
OF LATE PRETERM NEWBORNS
The minimum criteria for discharge are similar to those for healthy term newborns,
although the following points must be emphasised:

 Gestational age has been calculated through appropriate methods.

 The length of stay after birth must be determined on a case-to-case basis and be based
on feeding ability, adequate thermoregulation and the absence of disease and social
risk factors. Late preterm newborns may not have developed the abilities required for
discharge before 48 hours post birth.

 Medical follow up in primary care 24–48 hours after discharge must be arranged
prior to discharge. The recommended schedule of weekly check ups until 40 weeks’
postmenstrual age.
 Adequate breastfeeding or bottle feeding for a minimum of 24 hours has been verified,
with evidence of adequate coordination, suction and breathing during feedings. The
recommended weight loss during the hospital stay do not exceed 7% of the birth
weight.

 Feeding technique has been assessed thoroughly during the hospital stay following
birth.

 A feeding plan has been established, and the family understands it.

 The risk of developing severe hyperbilirubinaemia has been assessed. Combining the
findings of the medical examination with the total serum bilirubin measurement helps
predict the risk of severe hyperbilirubinaemia. In this regard, measurement of total
serum bilirubin prior to discharge is recommended in all late preterm newborns,
especially those that are exclusively breastfed.
 The physical examination of the newborn was conducted by a physician with a
pediatrics specialty and ruled out anomalies that could require a longer stay.

 Potential social risk factors have been assessed. When such factors are
identified, discharge should be delayed until they are resolved or social services
become involved.

 The mother and other potential caregivers have received sufficient information
and education to provide adequate care to the infant after discharge, with
particular emphasis on specific issues pertaining to late preterm newborns.

 Information on the prevention of sudden infant death has also been provided.
THE END

Q AND A