IMMEDIATE NEWBORN CARE Thermoregulation Immediately after delivery, the baby should be dried. Ideally, this is with a
warm, soft towel Babies, during the first few hours of life, have some difficulty maintaining their body heat and may develop hypothermia if not attended to carefully. This is particularly true true of premature infants. infants. Positioning The optimal position position for the baby is with the head head neither markedly flexed
against the chest, nor extended with the chin up in the air. Instead, the head should be in a "military" attitude, looking straight up. Airway • Neonates should maintain 30 – 60 breaths per minute 5 minutes after birth established as soon as head is delivered • suction the mouth (M) before the nose (N) • oxygenate in between suctioning • oxygen toxicity results results to retrolental retrolental fibroplasia: irreversible blindness blindness • NO DEEP SUCTIONING: SUCTIONING: bradycardia • Keep warm • • •
droplight is positioned 1ft away and at the foot part keep baby warm and dry 36.5-37.4 C (97.7-99.3 F)
APGAR Score • •
taken during the first 1 minute and 5 minutes Infant assessment at birth and baseline for further evaluation 7-10 GOOD; 4-6 FAIR (further suctioning and O2) 0-3 POOR (resuscitation)
Scoring Chart Sign
0 Point
1 Point
2 Points
A
Activity (Muscle Tone)
Flaccid
Arms and Legs Flexed
Well flexed
P
Pulse Rate
Absent
<100 bpm
Above 100 bpm
G
Grimace (Reflex Irritability)
No Response
Blue-gray, pale
A
Appearance (Skin Color)
R
Respiration
Absent
Grimace
Sneeze, cough, pulls away
Normal, Normal extremities skin blue coloring Slow, irregular
Good strong cry
Cord Care • •
note the number of blood vessels immediately after cutting; Keep cord dry until it falls off (7 – 10 days)
Eye Care
•
silver nitrate Erythromycin (DOC) Crede’s prophylaxis Ophthalmia Neonatorum
1 hour after birth tub bath is contraindicated until cord falls off bathe prior to feeding don’t soak the cord
• • •
Bathing
Vitamin K and Phototherapy Phototherapy 0.5 to 1 mg IM • to prevent hemorrhagic disease • overdosage can cause hyperbilirubinemia hyperbilirubinemia and thus kernicterus • Proper Identification
Identification band
footprint: best way to identify
Initial feeding may breastfeed immediately after birth • Formula feeding- 2 to 4 hours of age • Demand schedule • Mother's milk is the best food a baby can have in the first 6 months of life…
ADVANTAGES OF BREAST FEEDING 1. Enhances Enhances the infant infant’s ’s immune immune system system 1. IgA Lactofer Lactoferrin, rin, lysozyme lysozyme,, interferon, interferon, bifidus bifidus factor factor 2. It reduces the cost of feeding and preparation time 3. An excellent opportunity to enhance symbiotic bond 4. It is easy to digest. 5. It is clean and has the right temperature. 6. It contains the ideal electrolyte and mineral composition for infant growth Breastfeeding should start within 30 minutes after birth COLOSTRUM (first 2-3 days): good for babies and helps protect them against
infection When the baby is 6 months old, start giving other food in addition to breastmilk Continue to breastfeed sick babies Breastfeeding mothers should eat nutritious food to become stronger
NEWBORN ASSESSMENT
PROFILE OF THE NEWBORN Weight Normal birth weight 5.5–10 lbs; 3000-3400 g (Filipinos) LBW: < 2500 g Losses 5-10% of birth weight during the first few days Returns to birth weight at 10 days (breastfed)/ 7 days (formula fed) Length Female: 53 cm Male: 54 cm < 46 cm: Turner’s Syndrome Head Circumference Measured monthly until 2 yo 33-35 cm >2.5 cm/mo: hydrocephalus Chest Circumference 2 cm less than the head circumference 31-33 cm Abdominal Circumference
Vital Signs RPT BP Respiratory Rate ○ ○ ○
30-60 bpm Obligate nose breathers Periodic respiration
Pulse Rate
120-140 bpm Listen to the apical pulse in 1 full minute ○ Assess femoral pulses ○ Temperature 36.5 - 37.4 oC ○ Preferably Axillary ○ Rectal ○ ○
Blood Pressure ○ ○
Not routinely taken 80/40 – 90/50 mmHg
Physiologic Functions Cardiovascular System Closing of Fetal shunts with cold receptors High Erythrocyte Counts with Leukocytosis Prolonged Prothrombin and coagulation time Respiratory System First breath stimulated by the cold receptors 1/3 of fluids in the lungs is forced out by the pressure of vaginal birth Gastrointestinal Gastrointestinal System Culture of bacterial Flora in 24 hours 30 – 90 mL Limited ability to digest fats and starches Immature cardiac sphincters Immature liver
All about Stools
Green Stools Clay colored stools Blood flecked stools Black tarry stools Loose stools with mucus
NEWBORN REFLEXES Feeding Rooting Reflex – earliest; (-) Bell’s palsy diminishes at 6 mos Sucking Reflex – diminishes at 6 mos; disappears if not stimulated Swallowing Reflex – (-) TEF, BRENDA Extrusion Reflex – diminishes at 4 mos Protective Blink Reflex Coughing Yawning Neurological Tonic Neck Reflex – diminishes diminishes at 2-3 mos; “fencing “fencing reflex” -
One-sided: torticollis
Moro Reflex – diminishes at 4-5 mos; “startle reflex”
One-sided: brachial plexus palsy (Erb Duchenne) Two-sided: BRENDA BRENDA Non-disappearance: BRENDA Babinski Reflex – diminishes at 3 mos Non-disappearance: immature CNS Absence: paralysis APPEARANCE OF THE NEWBORN Skin Acrocyanosis: Normal for the first 24 hours Central cyanosis: decreased oxygenation Generalized mottling is common marks: lanugo, vernix caseosa, milia, mongolian spot, toxicum neonatorum, hemangioma, harlequin’s sign, pallor Head - posterior fontanel: 2-3 months - anterior fontanel: 12-18 months - tense, bulging: inc ICP - sunken: DHN -
Caput Succedaneum: few days
Cephalhematoma: Cephalhematoma: few weeks
Chest -
Witch’s milk: 3rd week normal due to withdrawal from maternal hormones
Abdomen barrel shape: normal protruding: necrotizing enterocolitis Hourglass / scaphoid: hernia
Diaphragmatic Hernia
Anal Area Imperforate anus Passes meconium for the first 24 hours Meconium: dark, tarry, sticky stool yellowish, soft stool Transition stool: yellowish, Back continuous fusion of spine Spina bifida Urogenital area Females: pseudomenstruation pseudomenstruation Males: cryptorchidism Musculoskeletal System Neurosensory Most sensitive: touch Least sensitive: smell Functional in utero: hearing
NORMAL CHANGES IN THE NEWBORN Weight loss – occurs in the 1st 7-10 days Weight gain – 2x: 6mos
3x: 1yo 4x: 2yo
Fever – 1st 24 hours: abnormal Jaundice
– NV: 2-6 mg/dl mg/dl
- 1st 24H: pathologic - sun exposure from 6am to 8am 4 H’s in Newborn Assessment 1. Hypoxia cyanosis retractions (intercostal mm, xiphoid) grunting nasal flaring, tachypnea and tachycardia 2. Hypoglycemia causes: DM mothers prematurity, post maturity low APGAR score signs: tremors / jitteriness poor sucking BG < 40 mg/dl Intervention: feed with breastmilk or milk formula to raise BG in 15 mins 3. Hypothermia causes: preterm (lack of SC) post-term (poorly developed muscle) NB exposed to cold stress signs: mottling cyanosis Interventions: keep baby warm, oxygenate when necessary, suction PRN 4. Hyperbilirubinemia
NV: 2-6 mg/dl, hyper: 12-10 mg/dl kernicterus: 20-35 mg/dl causes: prematurity polycythemia vera blood incompatibility drugs infection signs: pathologic jaundice yellowish amniotic fluid and vernix caseosa tea-colored urine dyspnea Interventions: phototherapy, exchange transfusion
