ESSENTIAL

NEWBORN
CARE

PRESENTED BY:-
Y.NATHALINA DEEPIKA,
MSc (N), OBG LECTURER,
GANGA CON.
 INTRODUCTION
 After the birth of the infant every
effort should be exerted to support
him in his first minutes, hours and
days of life. The quality of the
immediate care given to the newborn
will determine his later state of
health or well being.
Ten Essentials
of Immediate
Newborn
Care
I. ESTABLISH AIRWAY
 This is the top priority in the
immediate care of the newborn.
 Right after the extension of the
newborn’s head, before the chest is
delivered, the mouth and nose should
right away be cleared. This measure
is the best prevention to meconium
aspiration which results to lung
infection: aspiration pneumonia.
 Measures to promote patent air
passages are continued:
a) Position the baby in slight
trendelenburg (10-15 degree angle) in
order to drain secretions from oro-
naso-pharynx.
1. Avoid acute trendelenburg position
as this can cause abdominal
contents to exert pressure onto the
diaphragm causing more difficult
breathing.
2. The head down position is
contraindicated when there are
signs of increased intracranial
pressure.
b) Suction the newborn observing the
following conditions:
1. Start with the mouth then the nose
 To prevent stimulation of nerve receptors

present in the nose which can cause the

newborn to gasp for breath and aspirate
the oropharyngeal secretions (if nose is
suctioned first.)
2. Deflate the rubber ball of the syringe
before inserting its tip into the mouth and
nostrils of the newborn.
3. Suction slowly – by using the bulb syringe
and not a long catheter.
 Deep suctioning can cause vagal
stimulation, bradycardia and
laryngospasm in the the newborn.
 4. Suction briefly
Suction does not clear the air passages of
secretions, it also aspirates the much
needed air oxygen if done continuously.
 Observe correct and safe suctioning period:
 Preterm: less than 5 seconds per
suctioning time
 Full term: 5-10 seconds per suctioning time

c) Oxygenation is not a routine in the immediate

care of the newborn.
 Just ensure a patent airway and good supply
of atmospheric air and a normal newborn is
likely to breathe spontaneously.
 Injudicious use of oxygen can result to
damage of the retina causing neonatal
blindness known as Retrolental Fibroplasia.
 II. KEEP THE NEWBORN
WARM
A. The newborn’s temperature at birth
(37.3) drops quickly (35.5) owing to
mechanism of heat loss:
 Evaporation - loss of heat as liquid leaves
the newborn’s body
 Conduction – loss of heat from warm body to
cool surface indirect contact (e.g. weighing
scale, admitting table)
 Convection – loss of heat to cool air.
 Radiation – loss of heat to cool surface not
in contact (walls, floor, ceiling)
 Most of newborn’s heat is loss by
evaporation.
B. Dry the newborn right away after birth to
prevent heat loss by evaporation.
C. Wrap the body and promote flexion to
minimize the body surfaces exposed to cool
air and cool surfaces not in contact thus
preventing heat loss by convection and
radiation.
D. Never place newborn on cold and unlined
surface to prevent heat loss by conduction
 Weighing scale or examination table should first be
lined with dry and warn linen before placing the baby
on it.
 The warm abdomen of the mother can be a good
place to keep the newborn warm immediately after
birth.
E. The initial temperature of the newborn
is taken per rectum in order to detect
the most common congenital anomaly
that is not compatible with life:
Imperforate Anus
 Succeeding temperature taking should be per
axilla this route can detect core temperature of
the newborn faster as well as minimizes the
potential risk of traumatizing the rectum of the
newborn.
F. During the entire procedure to provide
immediate care to the newborn, he is
under the floor lamp (droplight) primarily
to keep him warm.
G. Subjecting the newborn to cold
stress can result to:
 Increased brown fat metabolism causing
an increase in fatty acids in circulation
thus resulting to metabolic acidosis.
 Increased metabolic rate causing
increased utilization of glucose and
oxygen thus resulting to low blood sugar
(hypoglycemia) and respiratory distress.
 III. DO APGAR SCORING
 APGAR Scoring is the initial evaluation of the
newborn during the first and the five minutes
of life after birth.
 The first scores determines the general
condition of the new and the need for
immediate resuscitation
 The second score measures how well the
infant in adjusting to the extra uterine life. It
is a useful index of the effectiveness of
resuscitation efforts and thus determines
prognosis. This is used to come up with the
nursing care plan for the newborn.
 The five adaptations scored in APGAR
Scoring are:
IV. IDENTIFY THE NEWBORN
PROPERLY
A. Identification is done as soon as possible
after birth before the newborn is
separated from the mother.
 In cases of birth of a high risk newborn,
proper identification must first be done
before transporting him to the nearest
hospital.
B. The best way to identify newborn is by
means of taking his footprints.
C. Proper identification of the newborn is
legal and moral responsibility of every
nurse.
 V. PROVIDE SKIN CARE
A. The immediate soap and water bath is
given to normal and full term newborns.
This is primarily to cleanse the skin of the
mucus, blood, at times meconium, in order
to prevent infection.
B. Oil bat is given to the pre terms and other
high-risk newborns.
C. Never give the newborn marine bath. This
is the bath someone gives as he holds the
newborn directly under the cold, running
water of the faucet and briskly bathes
him. This bath subjects the newborn to
cold stress.
 VI. CARE OF EYE
 The eyes should be cleaned at birth
and once every day using sterile
cotton swabs soaked in sterile water
or normal saline.
 Clean from medial to lateral canthus
 The practices of applying kajal in the
eyes is not recommended because it
may transmit infections like trachoma
or may even cause lead poisoning
VII. PERFORM CORD
DRESSING
A. A Cord Dressing must be performed under
strict aseptic techniques to prevent tetatnus
Neonatorum.
B. The Cord should be examined carefully for
the presence of three vessels:
1. Umbilical vein (left), and 2 smaller Umbilical arteries
(right and left)
 The presence of an incomplete number of vessels
warrants reporting to the physician so the newborn can
be thoroughly assessed for congenital defects.
C. Leave about 1 inch of the cord from the base
 The longer is left of the cord stump the longer is the
crying and dropping off time. This implies more risk to
local bacterial infection of the cord called Omphalitis.
D. In the first 24 hours, the cord should be
inspected for bleeding. (omphlangia)
18
 VIII. INJECT VITAMIN K
INTRAMUSCULARLY
A. Prohylactic Vitamin K is injected to
prevent bleeding or hemorrhagic
disease in the newborn by improving
blood coagulation.
B. The newborn’s gastrointestinal tract
is initially sterile – no E. coli to
synthesize vitamin K. (absence of
clotting factor)
C. The best site of intramuscular
injections in the newborn, infants and
young children is the thigh muscle,
specifically the vastus lateralis.
TAKE WEIGHT AND OTHER
ANTHROPOMETRIC MEASUREMENTS
A. Weight – the normal weight of the
newborns commonly ranges from 3000
grams to 3,400 grams with the lowest limit
normal of 2, 500 grams. A pre-term
newborn weighs less than 2,500 grams.
 The birth in the first weight is expected
to drop by 5% to 10 % (physiological
weight loss) in the first 7-10 days of life
owing to:
1. Urine and meconium passage
2. Drop in water-retaining maternal hormones
from newborn’s body
3. Inadequate intake.
 o Reassure mother of the normality of weight loss
and explain that gain weight is likely to be
observed after day
B. Height – the newborn height ranges
from 19-21 inches or an average of 50
cm. The heel-to-crown measurement is
to be taken.
C. Head cirmcumference – the head, the
biggest part is about ¼ of the body
length. It measures 33 to 35 cm ( 13-14
in)
D. Chest/Abdominal circumference – the
chest is almost equal to the abdomen in
measurement: 31-33 cm (12-13 in)
 ROOMING-IN AND
BREASTFEEDING
 Rooming-in is a hospital policy whereby the mother
has her new infant by her bedside, can take care of
him or her as she desires and as her condition
permits
 Check the baby’s chart if there’s an order for rooming-
in
 Bring baby to mother. Be sure to check the baby’s
identification with the mother.
 Give instructions to the mother regarding
breastfeeding and care of the baby.
 All roomed-in babies must be breastfed
 Breastfeeding on demand will be instructed to mother
during room-in.
 Newborn shall not be given prelacteal feeds such as sterile
water, glucose water or milk formula since breast milk can
provide for their needs.
Immunization