NORMAL

NEWBORN CARE

DR.R.MARUTHAINAR
VISITING LECTURER IN PAEDIATRICS
UNIVERSITY OF JAFFNA
 NURSERY CARE OF THE WELL
NEWBORN

 ADMISSION TO THE NEWBORN
NURSERY
Healthy newborns should be remain in the
delivery room with the mother as long as
possible to promote immediate breast feeding
and early bonding.
A-CRITERIA FOR NURSERY ADMISSION
 Well appearing infant of at least 35weeks GA
or weighing 2kg
 ADMISSION TO THE NEWBORN
NURSERY

B- Ensure impeccable security in the nursery
to protect the safety of the families and to
prevent abduction of the babies.
 Electronic security system
 Identification badge/band to both mothers
and babies.
 All staff are required to wear identification
badge
 TRANSITIONAL CARE
( FIRST 4-6 HRS AFTER BIRTH)

A- During this period , the infant’s pul.vascular
resistance decreases, blood flow to the lungs
and overall oxygenation and perfusion
improve, and ductus arteriosus begins to
constrict or close

B-Interruption of normal transitioning ,usually

due to complication occurring in the
peripartum period, will cause signs of distress
in the newborn.
 TRANSITIONAL CARE


Common signs of disordered transitioning
are:
 Respiratory distress.

 Poor perfusion with cyanosis or pallor.

 Need for supplement oxygen.

Transitional care of the newborn can take place
in the mother’s room or in the nursery
 TRANSITIONAL CARE

1.

Infants are evaluated for problems that may
disqualify their admission to the normal
nursery ( gross malformations and disordered
transition)
2. The infant should be evaluated every 30 to 60
minutes( HR, RR,AXILL.TEMP,COLOR/TONE
and observe for signs of withdrawal from
maternal medications)
3. Infants with persistent signs of disordered
transitioning/haemo dynamically unstable
require transfer to a high level of care
ROUTINE CARE OF NORMAL
NEWBORN

Healthy newborns should be with their
mothers all or nearly all the time. When
possible , physical assessments,
administration of medication and bathing
should occur in mother’s room. Nursing ratio
for routine newborn care is 1: 6-8.

Upon admission to nursery, an assessment of

GA is performed (expanded Ballard score)
ROUTINE CARE OF NORMAL
NEWBORN

 The infant’s weight, length and OFC are recorded( ?
AGA, ?SGA, ?LGA, ?IUGR)
 The infant’s temperature is stabilized with one of
three modalities
1. Open radiant warmer on servo control

2. Incubator on servo control

3. Skin to skin contact with the mother-kangaroo care

 ROUTINE CARE OF NORMAL
NEWBORN

 Universal precautions should be used with all
patient contact
 The first bath is given with non medicated soap and
warm tap water (provided axillary temperature is >
97.5*F)
 Umbilical cord care- keeping the cord try promotes
earlier detachment of umbilical stump.
 ROUTINE MEDICATION

 A single intramuscular dose of vit.k should be given
to all newborns before 6 hours of age
 Administration of BCG vaccination is recommended
to all newborns
 SCREENING
 Congenital hypothyroidism- routine of specimen is
between 24 and 72 hours
 SCREENING

 Group B streptococcal disease.

 Glucose screening.

 Bilirubin screening.

 Routine hearing screening.

 ROUTINE ASSESSMENTS

 The infant’s physician should perform complete
physical examination within 24 hrs of birth.
 Vital signs(HR/RR/Ax.T) are recorded every 8-12
hrs
 Each urine and stool output is recorded in the baby’s
chart( 30hrs/ 48hrs respectively)
 Daily weights are recorded in the baby’s chart
 Weight loss in excess of > 7% need investigation
 FAMILY AND SOCIAL ISSUE

 Sibling visitation is encouraged. It is an important
element of family focused care.

 Social service involvement is helpful when there is

teen age mother, lack of prenatal care,H/O domestic
violence, maternal substance abuse, H/O previous
involvement with child protection service
 FEEDINGS

 The frequency, duration and the volume of each feed
depends on whether the infant is breast feeding or
bottle feeding.
 The breast fed infant should feed as soon as possible
after delivery, preferably in the delivery room and
feed 8-12 times/day ( 20-45 min )
( lactation centers referral SOS)
 Bottle fed infant- fed every 2-3 hrs (Feed chart)
 During the first few days, the well newborn should
consume at least 15-30 ml/ feed.
 DISCHARGE PREPARATION

Parental education on routine newborn care
should be initiated at birth and continued
until discharge.
The review of the following newborn issues
should be done at discharge:
 Observation for neonatal jaundice.
 Routine cord and skin care.
 Back to sleep position
 DISCHARGE PREPARATION

 Subtle signs of infant illness-report promply
 Adequacy of oral intake( UOP/ SOP/Wt
gain)
 Installation of baby car seat
 Lowering of hot water temperature
 Avoiding passive smoking
 Smoke detectors
Discharge examination
(heart,CNS,abd,skin,cord,infection,feeding,pare
ntal competence and follow up arrangements)
 DISCHARGE READINESS

Early discharge criteria( before 48hrs of age)
 Uncomplicated antepartum, intrapartum and
post partum courses for both mother and
infant.
 Normal vaginal delivery
 Stable vital signs in an open crib for at least
12 hours preceding discharge
 Passage of first urine and stool
 DISCHARGE READINESS
 Completion of at least two successful

feedings ( with proper breast feeding
technique)
 Unremarkable physical examination
 Assessment of risk for hyperbilirubinaemia
 Maternal competence in routine newborn
care
 Assessment of extended maternal support
 Assessment of family, environmental and
social risk factors
 Administration of BCG vaccine/metabolic
screen
 FOLLOW UP

Timing of review: for infant discharged
within 48 hrs of age, outpatient follow up-
within 48 hrs of discharge.
For newborn discharged between 48 and 72
hrs of age –within 2-3 days of discharge
The follow up visit is design to perform
 Assess the general state of the health(
Wt/hydration/ jaundice)
 FOLLOW UP

 Identify any new problem.
 Review the adequacy of oral feeding and
assess elimination patterns.
 Assess quality of mother –infant bonding.
 Reinforce parental education
 Review results of any outstanding lab.reports
 Provide anticipatory guidance and health
care maintenance (immuization, feeding,
weening, CHDR/FP)
 

THANKYOU