NURSING CAREOF NEWBORN

Neonate – first 28 days of life

• 1st 24 hours to first 28 days of life – most crucial period for the newborn
ASSESSMENT – should start immediately after birth and should be continued every co
ntact
I. PROFILE OF THE NEWBORN
A. Vital Statistics
1. Weight
- Average weight = 2.5 – 3.5 kg
• 4-7 kg – suspect of maternal illness such as DM
- Loses 5- 10 % of BW (6-10%) during the first few days after birth (sign
that newborn is adjusting)
- Additional weight loss as diuresis begins to remove a part of their high
fluid load during the 2nd to 3rd day of life
- Newborn voids and passes stool which is approximately 75- 90% of the new
born’s weight is fluid
• Regain weight gain within 10 days (breastfeeding) because of colostrums which ha
s laxative effect and relatively to caloric content
• Milk formula – regains within 7 days
- Begins to gain about 2lbs/ month (6-8 oz/wk) for the 1st 6 months of lif
e
- Birth weight doubles at 6 months and triples at 1 year
- Factors that influence birth weight:
a. Race
b. Nutritional intake of the mother during pregnancy
c. Intrauterine environment
d. Genetic factors
2. Length – 46- 54 cms.
3. Head circumference – 34- 35 cms (37 and above should be carefully investig
ated for neurologic involvement)
- Measured with tape measure drawn across the center of the forehead and a
round the most prominent portion of the posterior head (occiput)
• Birth weight, height and head circumference should fall within the same percenti
le for the same child
Example:
- Weight and height is 50% and head circumference is 90% will have abnorma
l head growth
- Weight and head circumference is 50% and height is 30- 35% will have gro
wth problem
4. Chest circumference – should be 2 cms (0.75- 1 inch) less than the head ci
rcumference
- Measured at the level of the nipples
5. Vital signs
a. Temperature
- Should be 37.2 C at the moment of birth
- There is a rapid fall of temperature because of heat loss, immaturity of
the thermoregulating mechanisms, temperature of the birthing room
- Subnormal body temperature (indications of infection)
- Site: axillary
Rectal (to test for the patency of anus; may cause rectal wall perforation)
- Mechanism of Heat Loss in Newborn:
1. Convection
2. Conduction
3. Radiation
4. Evaporation
- Prevention of Heat Loss:
1. Baby should be dried immediately
2. Any wet items should be removed and replaced with clean prewarmed linens
3. Dry the newborn’s face and hair. The head, a large surface area in newborn
can be responsible for a great amount of heat loss. Covering the hair with a ca
p after drying further reduce the possibility of evaporation
4. Placing them under a radiant heat source (droplight)
KANGAROO CARE
BROWN FAT
• Newborns exposed in cold environment usually kicks and cry to increase metabolic
rate to produce heat which in turn increase the need to oxygen thus increase in
RR
Immature newborn – with poor lung development
Unable to increase RR
Anaerobic catabolism of body cells
Release acid (newborn is slightly acidic)
New build up of acid
Acidosis (life- threatening)
b. Pulse
- Intrauterine (120- 160 bpm immediately after birth)
- Hour after- heart stabilizes to an average of 120- 140 bpm; usually irre
gular due to immaturity of the cardioregulating center in the medulla
- Transient murmur – results from incompetent closure of fetal circulation s
hunts
- Crying
- Sleep
- Femoral pulses should be palpated
c. Respiration
- Newborn in first few minutes of life maybe as high as 80 breaths per ave
rage of 30- 60 bpm when the child is at rest
- Respiratory depth, rate and rhythm are irregular at short periods of apn
ea (without cyanosis)
- Newborns are obligatory nose breathers
d. Blood Pressure
- Newborn’s BP is approximately 80/ 46 mmHg at birth
- 10th day- it rises to about 100.50 mmHg
II. PHYSIOLOGIC FUNCTION
1. Cardiovascular System – changes in the cardiovascular system are necessary
at birth because the lungs now must oxygenate the blood that was formerly oxyge
nated by the placenta
ACROCYANOSIS –

Circulatory events at Birth

Drying or clamping of the umbilical cord and stimulation of cold recepto
rs
 Increase CO2, decreased O2 and increasing acidosis
First breath
Decreased pulmonary artery pressure
Increase PO2 Closure of foramen ovale (pressure in left side of heart greater
than in right side)
Closure of ductus arteriosus
Closure of Ductus venosus and umbilical arteries and vein due to decreas
ed flow
Blood Values
- A newborn’s blood volume is 80-110 ml/kg of body weight or about 300 ml
- Fetal blood has greater quantity of oxygen bound to hemoglobin and parti
al pressure of oxygen than newborn resulting to:
a. Erythrocyte count around 6 million per cubic millimeter
b. Hemoglobin level has an average of 17-18 g/ 100 ml of blood
c. Hct level is between 45-50%
• Indirect bilirubin level at birth is1-4 mg/100 ml – increase over this amount refl
ects the release of bilirubin as excessive red blood cells begin the breakdown
d. WBC – at birth about 15,000 – 30, 000 cells/ cubic mm up to 40,000 cells/ cu
bic mm if birth was stressful
Blood Coagulation
- Vit.K is synthesized through the action of intestinal flora, which is ne
cessary for the formation of Factor II (prothrombin), factor VII (proconvertin),
factor IX (plasma thromboplastin component), and factor X (Stuart-Power Factor)
2. Respiratory System
- The first breath of a newborn is initiated by a combination of cold rece
ptors, a lowered PO2 and an increased PCO2
• Cold receptors, decrease PO2 and increase CO2
3. Gastrointestinal System
- GI tract is usually sterile at birth
- Newborn’s stomach holds about 60-90 ml
- Regurgitation of previously ingested milk is secondary to immature cardi
ac sphincter (between stomach and esophagus)
- Lowered glucose and CHON serum result from immature liver functions
STOOLS
Meconium
- 1st stool; passed within 24 hours after birth
- 2nd or 3rd day – newborn will have TRANSITIONAL STOOL characterized as gre
en in color and loose
- 4th day- breastfed babies pass 3 or 4 light yellow stools per day
- Milk formula fed – 2 to 3 bright yellow/ day with more noticeable odor
- Newborn under phototherapy light will have bright green stools because o
f increased bilirubin excretion (a treatment for jaundice)
- If with mucus or stools is watery or loose, milk allergy or lactose into
lerance or some other irritant should be suspected
- Bile duct obstruction will have a clay- colored (gray) stools because bi
le pigment do not enter the intestinal tract
- Blood- streaked
- Imperforate anus
- Stool is black and tarry
4. Urinary system
- The average newborn voids within 24 hours after birth
- If newborn does not void within this time, check for possibility of uret
hral stenosis or absent kidneys or ureters
- Kidneys do not concentrate urine well control over reabsorption of fluid
in tubules and concentration of urine occurs at 6 weeks of age
- Single voiding is about 15 ml, specific gravity ranges from 1.008 to 1.0
10
- Daily urine output for the 1st 1-2 days is 30- 60 ml
- By week 1 – total daily volume is 300 ml
- First voiding may be dusky
- Small amounts of CHON may be present during the first few days
5. Immune System
- Prone to infection for about 2 months of age
- Infant at birth has passive antibiotics (IgG) – polio, measles, diphtheria
, pertussis, chicken pox, rubella and tetanus
- Hepatitis B vaccine is given during the 1st 12 hours after birth
6. Neuromuscular System
- Newborn at term typically demonstrates several reflexes. If there is lim
pness or total absence of a muscular response to manipulation – it is never normal
and suggest narcosis, shock or cerebral injury
REFLEXES:
6.1 Blink reflex – serves the same purpose as in adult to protect the eye from any
object coming near it by rapid closure
6.2 Rooting Reflex – if newborn’s cheek is brushed or stroked near the corner of the
mouth, the child will turn the head in that direction
6.3 Sucking Reflex – when a newborn’s lips are touched, the baby makes a sucking mot
ion
6.4 Swallowing Reflex – if food reaches the posterior portion of the tongue is aut
omatically swallowed
6.5 Extrusion reflex – newborn will extrude any substance that is placed on the an
terior portion of the tongue
6.6 Palmar Grasp Reflex – newborn will grasp an object in their palm by closing th
eir fingers. It disappears at age 6 weeks to 3 months. Baby begins to grasp mean
ingfully at about 3 months of age
6.7 Step (Walk) in Place reflex – newborn who is held in upright or vertical posit
ion with feet touching a hard surface will take a few quick alternating steps
6.8 Placing Reflex – the placing reflex is similar to step- in place reflex except
it is elicited by touch, the anterior surface of a newborn leg against the edge
of a table. Newborn will make a few quick lifting motions as if to step onto th
e table
6.9 Plantar Grasp Reflex – when an object touches the sole of a newborn’s foot at th
e base of the toes, the toes grasp in the same manner as the fingers do.
6.10 Tonic Neck/ Boxing/ Fencing Reflex – when newborn’s lie on their backs their he
ad usually turn to one side or the other. The arm and the leg on the side to whi
ch the head turns extends and the opposite arm and leg contract.
6.11 Moro/ Startle reflex – initiated by startling the newborn with a loud noise o
r by jarring the bassinet. Newborn abduct and extend their arms and legs, finger
s assume a typical “C” position
6.12 Babinski Reflex – when side of the sole of the foot is stroked in an inverted
“J” curve from the heel upward, the newborn fans the toes
6.13 Magnet Reflex – if pressure is applied to the soles of the feet of a newborn
lying in a supine position, he/ she pushes back against the pressure
6.14 Crossed Extension Reflex – one leg of a newborn lying supine is extended and
the sole of the foot is initiated by being rubbed with a sharp object such as a
thumbnail
6.15 Trunk in Curvation Reflex – when newborn are in a prone position and are touc
hed along the parvertebral area by a probing finger, they will flex their trunk
and swing their pelvis toward the touch
6.16 Landau Reflex – a newborn is held in a prone position with a hand underneath
supporting the trunk should demonstrate some muscle tone
6.17 Deep Tendon Reflex – a patellar reflex can e elicited in a newborn by tapping
the patellar tendon with the tip of the finger. The lower leg will move percept
ibly if the infant has an intact reflex. Patellar reflex is a test for spinal ne
rve L2 through L4
6.18 Bicep Reflex – placing the thumb of the left hand on the tendon of the bicep
muscle on the inner surface of the elbow. Tap the thumb as it rest on the tendon
. You may feel the tendon contract then to observe movement – test for spinal nerv
e C5 and C6
7. The Senses
7.1 Hearing – a fetus is able to hear in utero. After amniotic fluid drain
or absorbed from the middle ear by way of the Eustachian tube – within an hour af
ter birth hearing becomes acute
7.2 Vision – newborn demonstrates sight at birth (blink reflex) or following a bri
ght light or a toy at short distance with their eyes. Focus best in black and wh
ite object at a distance of 9 to 12 inches
7.3 Touch – most developed sense. Reacts to painful stimuli
7.4 Taste – has the ability to discriminate taste because taste buds are well- dev
eloped and functioning before birth
7.5 Smell – present in newborn as soon as nose is clear from mucous and amniotic f
luid.
PHYSIOLOGIC ADJUSTMENT TO EXTRAUTERINE LIFE
Periods of Reactivity – first described by Desmond in 1963. It involves 3 periods
where the newborn move through periods of irregular adjustment in the first 6 ho
urs of life
1. First period of Reactivity – last about half an hour
2. Resting Period – heartbeat and respiratory rates slow
3. Second Period of Reactivity – between 2 and 6 hours of life, occurs when t
he baby wakes again, often gagging and choking on mucus that has accumulated in
the mouth. He or she is again alert and responsive and interested in surrounding
Assessment First Period (1st 15-30 min) Resting Period (30-120 min)
Second Period (2-6 hrs)
Color Acrocyanosis Color stabilizing Quick color changes occur with m
ovement or crying
Temperature Temp. begins to fall from intrauterine temp of about 100.6 F (38.
1 C) Temp. stabilized at about 9 F (37.2 C) Temp. Increases to 99.8 F (37.6 C)
Heart rate Raid as much as 180 bpm while crying Slowing to between 120 a
nd 140 bpm Wide swing in rate with activity
Respiration Irregular, 30-90 bpm while crying, some nasal flaring, occasiona
l retraction may be present Slowing to 30-50 bpm, barreling of chest occurs
Becoming irregular again with activity
Activity (ability to response to stimulation) Alert, watching vigorous reactio
n Sleeping, difficult to arouse Awakening, becoming responsive again
Mucus Visible n the mouth Small amount present while sleeping Mouth fu
ll of mucus causing gaggling
Bowel sound Ability to be heard after first 15 min. Present Often passage of
first meconium stool
APPEARANCE OF THE NEWBORN
SKIN – general inspection of the newborn’s skin reveals many characteristic findings
:
Color
a. Cyanosis
Acrocyanosis – appears as if a line is drawn across the wrist or ankles with usual
skin color on one side and blue on the other as if some stricture were cutting
off circulation
Central cyanosis or cyanosis of the trunk (generalized mottling of the skin)
Sudden cyanosis and apnea in newborn result from mucus obstructing the respirato
ry tract that had previously shown good color. Suctioning the mucus relieves the
 condition starting from the mouth following by the nose. If nose is suctioned f
irst, it may trigger a reflex grasp, possibly causing aspiration if there is muc
us in the posterior throat
b. Hyperbilirubinemia
- Leads to jaundice occurs on the second or third day of life in about 50%
of all newborn as a result of the breakdown of fetal red blood cell (physiologi
c jaundice)
RBC destruction
Heme Globin (CHON component that is reused by the body)
Iron Protoporphyrin

• Immature liver function cannot convert indirect to direct bilirubin, thus it rem
ain as indirect, when bilirubin rises above 7 mg/ 100 ml, bilirubin permeates th
e tissue outside the circulatory system causing jaundice
• Cephalhematoma – collection of blood under the periosteum of the skull
Serum bilirubin – requires treatment if the value is 10-12 mg/100 ml. about 20 mg/
100 ml – interferes with chemical synthesis of rain cells resulting in permanent b
rain cell damage termed as Kernicterus. It causes permanent neurologic effect in
cluding cognitive challenge may result
Treatment for physiologic jaundice in newborn is rarely necessary except for mea
sure such as early feeding – to speed passage of feces through the intestine and p
revent reabsorption of bilirubin from the bowel
Phototherapy – exposure of the infant to light to initiate maturation of liver’s en
yme
c. Pallor – result of anemia
Causes:
1. Excessive blood loss when cord was cut
2. Inadequate flow of blood from the cord into the infant at birth
3. Fetal- maternal transfusion
4. Low iron stores caused by poor maternal nutrition during pregnancy
5. Blood incompatibility in which a large number of RBC well hemolized in u
tero
6. Internal bleeding
7. Pale and cyanotic – CNS damage
Gray color in newborn – generally indicates infection
BIRTHMARKS
1. Hemangiomas
Types:
a. Nevus flammeus
- Appear on the face and also on the thighs, above the nose, tends to fade
- Removed by laser therapy or surgically removed
- Also occur as lighter, pink paches at the nape of the neck (storks beak
marks)
b. Strawberry hemangiomas
- Continue to enlarge after birth but usually disappear by age 10
- Formation is associated with the high estrogen levels of pregnancy
- Hydrocortisone ointment may speed their disappearance by interfering wit
h the binding of estrogen to the receptor site
c. Cavernous hemangiomas
- Dilated vascular spaces
- Usually raised and resemble a strawberry hemangioma in appearance
- They do not disappear in time
- Subcutaneous infusions of interferon alpha 2a can be used to reduce thes
e in size or are removed surgically
Mongolian spots
- Collection of pigment cells (melanocytes) that appear as state- gray pat
ches across the sacrum or buttocks and possibly the arms and legs
Vernix caseosa
- White, cream cheese-like substance that serves as a skin lubricants
- Can be removed by bathing the baby
Lanugo
- Fine, downy hair that covers a newborn’s shoulder, back and upper arm. Lan
ugo is rubbed away by the friction of bedding and clothes against the newborn’s sk
in. It disappears in 2 weeks
Desquamation
- Within 24 hours of birth, the skin of most newborn has become extremely
dry. Most evident on the palms of the hands and sole of the feet
Milia
- Newborn sebaceous glands are immature at least one pinpoint white papule
(a plugged or unopened sebaceous gland) can be found on the cheek or across the
bridge of the nose
Erythema toxicum
- Appears in the 1st to 4th day of life. It begins with papule, increase i
n severity to become erythema by the 2nd day and then disappears by the 3rd day.
Also called flea- bite rash
Forcep marks
- Appears in circular or linear contusion matching the rim of the blade of
the forceps in the infant’s cheek. It disappears in 1-2 days along with the edema
that accompanies it. It assess for facial nerve while the baby is at rest or cr
ying (facial nerve compression)
Skin Turgor – skin should feel resilient of the underlying tissue is well hydrated
. Grasp between the thumb and fingers. It should feel elastic. When it is releas
ed, it should fall back to form a smooth surface
HEAD
- Appears disproportionally large because it is about ¼ of the total length
- Head circumference – 34 to 35 cms. Forehead is large and prominent, chin a
ppears to be receding
- Well nourished have full bodied hair
- Poorly nourish or preterm have thin, lifeless hair
FONTANELLES
- Spaces or openings where the skull bone join
- Anterior fontanel is located at the junction of the two parietal bones a
nd measures 2-3 cm (0.8 to 1.2 inches) in width and 3-4 cm (1.2 – 1.6 inches) n le
ngth. It is diamond- shaped
- Posterior fontanel is located at the junction of the parietal and occipi
tal bone. It is triangular and measures about 1 cm (0.4 inch) in length
SUTURES
- May override at birth because of the extreme pressure exerted by the pas
sage through the birth canal
- Suture line should never appear widely separated in newborn
- Fused suture lines also are abnormal and need to be confirmed with x-ray
and further evaluation

MOLDING
- Part of the infant’s head that engages the cervix molds to fit the cervix
contours. After birth, the area appears prominent and asymmetry
CAPUT SUCCEDANEUM
- May appear in wide areas of the head and maybe the size of a large egg
- Gradually absorbed and disappear about the 3rd day of life
CEPHALHEMATOMA
- Occurs 24 hours after birth
- Appears dissolved (black or blue) because of presence of coagulated bloo
d
- Takes weeks to be absorbed
CRANIOTABES
- Condition corrects itself after a few months
- Probably is caused by pressure of the fetal skull against the mother’s pel
vic bone in uterus
EYES
- to assess the eyes – lay the newborn in supine position and lift the head
and this manner causes baby to open the eyes
- should appear clear, no redness or purulent discharge
- pressure during birth sometimes will rupture a conjunctival capillary re
sulting to small subconjunctival hemorrhage – no treatment
- will be absorbed in 2-3 weeks
- edema often is present around the orbit or on the eyelids. This will rem
ain for the 1st 2-3 days until the kidneys are capable of evacuating fluids effi
ciently
- cornea should be round
- pupils should be dark
EARS
- external ear is still not completely formed
- top of the external ear should be in line with the inner cantus of the e
ye
- hearing is tested by ringing a bell held about 6 inches away from each e
ar. Normal response will be the newborn momentarily stop when crying or blink hi
s eyes or may startle
NOSE
- may appear large for the face
- test for choanal atresia (blockage at the rear of the nose) by closing t
he newborns mouth and compressing one nares at a time – note any discomfort or dis
tress
MOUTH
- open evenly when the child cries. When one moves ore than the other, it
suggests cranial nerve injury
- palate should be intact, occasionally 1 or 2 glistening, well circumscri
bed cysts (Epstein’s pearls) are present on the palate, a result of the extra load
of calcium that is deposited in utero – this will disappear spontaneously on a we
ek
- tongue is usually large and prominent in the mouth and since the tongue
is short, the frenulum membrane is attached close to the tip of the tongue creat
ing the impression the infant is “tongue- tied”
NECK
- newborn’s neck is short and chubby with creased skin folds. The head shoul
d rotate freely on t
CHEST
- chest is smaller because the infant’s head is larger in proportion
- breast may be engorged which may occasionally secrete a thin, watery, fl
uid called “witch’s milk”. Once the hormones are cleared from infant’s system (about a w
eek) the engorgement or any fluid subsides
- chest circumference is 32-33 cm, about 2 cm less than head circumference
- clavicle should be straight
- chest should appear symmetric
- no retraction (drawing out of chest wall with inspiration)
- normal to hear sounds of rhonchi (harsh innocent sound of air passing ov
er mucus) for the first 24-48 hours
ABDOMEN
- contour is slightly protuberant
- a scaphoid or sunken appearance may indicate missing abdominal content o
r diaphragmatic hernia
- inspect the cord clamp to be certain it is secured
• first hour after birth the cord begins to dry and shrink and turn brown
• 2nd and 3rd day – turns black
• There should be no bleeding at cord site
• Moist and odorous cord suggests infection
ANOGENITAL AREA
- Anus- insert the tip of the little finger with gloves and lubricated
MALE GENITALIA
- Scrotum in male is edematous and has rugae
- Testes should be present in scrotum. Undescended (cryptorchidism) need r
eferral it may due to agenesis (absence of organ)
- CREMASTERIC REFLEX – this is to test the integrity of T8 through T10- usua
lly done 10 days and above
- Penis- appears small, approximately 2 cm long – less than should be referr
ed for evaluation. To see that the urethral opening is at the tip of the glans
- Dorsal surface - (epispadias)
- Dorsal surface – (hypospadias)
FEMALE GENITALIA
- Vulva maybe swollen because of the effect of maternal hormones
- Some have mucus vaginal secretions called PSEUDOMENSTRUATION
BACK
- Spine appears flat in the lumbar and sacral areas (curves will only appe
ar when the child is able to sit and walk)
- Inspect for any pinpoint opening or dimpling – suggest spina bifida occult
a
EXTREMITIES
- Arms and legs appear short and in flexed position
- Hands are clumped and clenched into fists
- Test for upper extremities for muscle tone – unflexing the arms for 5 seco
nds then release (the arm should return immediately to flexed position)
- Inspect palm for simean crease (a single palmar crease instead of 3) and
unusual curvature of the little finger (+) commonly associated with Down syndro
me
- Arms and legs should move symmetrically
- Unmoving suggest birth injury
- Assess fingers for webbing
- Extra toes or fingers
- Test for toenails blanching and refill after pressure
- Sole appears flat due to extra pad of fat in the longitudinal arch
- Creases of the foot for less than 2/3 of the foot or absent
- Put the ankle through a range of motion to evaluate the heel cord
- Observe for presence of clubfoot
- Flex and abduct the legs to determine for presence of hip abnormalities
NURSING CARE OF THE NEWBORN
1. Initial Feeding
A. Breastfeeding
Advantages:
1. Mother
a. May serve a protective function
b. The release of oxytocin promotes uterine involution
c. Has an empowering effect because it is a skill only woman can master
2. Baby
a. Contains secretory immunoglobulin A (IgA) which binds large molecules of
foreign proteins including viruses and bacteria, thus keeping them from being a
bsorbed through the GIT
Lactoferin
- an iron bonding CHON in breast milk that interferes with the growth of p
athogenic bacteria
- contains enzyme LYSOZYME which actively destroys by dissolving their cel
l membrane
Bifidus Factor
- is specific growth- promoting factor for the bacteria lactobacillus bifi
dus – which interfere with the colonization of pathogenic bacteria in the GIT redu
cing the incidence of diarrhea
- contains ideal electrolyte and mineral composition for human infant grow
th
- high in lactose – an easily digested sugar to provide ready glucose for br
ain growth
B. Formula feeding
1. Teach sterilization techniques if the water supply is located in areas w
here the purification process of the water is questionable
2. Remind the mother not to heat the bottle of formula in a microwave oven
3. Inform the mother that formula is a sufficient diet for the first 4 to 6
months
4. Assess the mother’s ability to burp the newborn
2. Bathing
- In most hospitals, newborn receives a complete bath to wash away vernix
caseosa within an hour after birth and once a day thereafter
- Room – should be 75 F or 24 C to prevent chilling
- Bath water is around 98 F to 100 F (37 to 38 C)
- Should be done prior to feeding to prevent spitting up or vomiting and p
ossible aspiration
3. Diaper Area Care
- With each diaper change, the area should be washed with clear water and
dried well
- Prevent the ammonia in urine from irritating the infant’s skin causing dia
per rash
4. Metabolic Screening Test (Newborn Screening)
It is stated in law that every infant must be screened for phenylketonuria (PKU,
a disease of defective protein metabolism and hypothyroidism)
A sample of blood about 3 drops from the heel are dropped into a special filter
paper. After the baby had received formula or breast milk for 24 hours (providin
g an intake of Phenylalanine, an essential amino acid formed in milk)
5. Hepatitis B Vaccination
- Should be administered within 12 hours after birth then 1 month after an
d 3rd dose is given at 6 months of age
- Mothers who are (+) of HbsAg, the baby will receive HB immune globulin (
HBIg) at birth
6. Vitamin K Administration
- Vitamin K stimulates the liver to produce factor II, VII, IX and X
- A single dose of 0.5 to 1.0 mg of Vitamin K given IM within the 1st hour
of life
7. Circumcision
- Is influenced by religion or culture like Jewish which is performed at t
he 8th day. Ceremony is called BRIS.
- US – routinely done for hygienic purposes
- Uncircumcised male have high incidence of penile cancer and cervical can
cer for their partners
PRETERM NEWBORN
1. A preterm neonate is one born before 37 weeks of gestation
2. The primary concern relates to immaturity of all body systems
Assessment
1. Respirations are irregular with periods of apnea
2. Body temperature is below normal
3. Newborn has poor suck and swallow reflexes
4. Bowel sounds are diminished
5. Urinary output is increased or decreased
6. Extremities are thin, within minimal creasing on soles and palms
7. Newborn extends extremities and does not maintain flexion
8. Lanugo, on skin and in the hair on the newborn’s head, is present in wooly
patches
9. Skin is thin, with visible blood vessels and minimal subcutaneous fat pa
ds
10. Skin may appear jaundiced
11. Testes are undescended in boys
12. Labia are narrow in girls
Interventions
1. Monitor vital signs every 2 to 4 hours
2. Maintain cardiopulmonary functions
3. Administer oxygen and humidification as prescribed
4. Monitor intake and output and electrolyte balance
5. Monitor daily weight
6. Maintain newborn in a warming device
7. Position every 1 to 2 hours, and handle newborn carefully
8. Avoid exposure to infections
9. Provide newborn with appropriate stimulation such as touch
POST TERM NEWBORN
1. A neonate born after 42 weeks of gestation
Assessment
1. Hypoglycemia
2. Parchment-like skin (dry and cracked)without lanugo
3. Fingernails long and extended over ends of fingers
4. Profuse scalp hair
5. Long and thin body
6. Wasting of fat and muscle extremities
7. Meconium staining possibly present on nails and umbilical cord
Interventions
1. Provide normal newborn care
2. Monitor for hypoglycemia
3. Maintain newborn’s temperature
4. Monitor for meconium aspiration
APGAR SCORING
- Developed by Dr. Virginia Apgar
- It is done in 1 minute and 5 minutes after birth
- Purposes:
1. To determine the degree of acidosis
2. How well the infant is adjusting in extrauterine life
Criteria 0 1 2
Appearance (color) Blue all over Body pink, extremities blue Pink all
over
Pulse (Heart rate) Absent Below 100 Above 100
Grimace(Reflex Irritability) No response Grimace Vigorous cry, sneeze
Activity (muscle tone) Flaccid, limp Some flexion Well flexed, active moti
on
Respiration Absent Slow, weak cry Good crying
BALLARD/ DUBOWITZ
- Examination for gestational age
- It consists of 2 parts:
1. Assessment of the newborn’s neuromuscular maturity by assessing 6 neurolog
ical features while the infant is in supine position
a. Posture – total muscle tone is reflected in the infant’s preferred posture a
t rest and resistance to stretch of individual muscle groups. (flexion of extrem
ities)
b. Square window flexion of the wrist. More mature infants have greater wri
st flexion
c. Arm recoil – fully bend the arm at the elbow so that the infant’s hand reach
es the shoulder and keep it for 5 seconds. Then fully extend the arm by pulling
on the fingers. Release the hand as soon as the arm is fully extended and observ
e the degree of flexion
d. Popliteal angle – with one hand hold the infant’s knee against the abdomen.
With the index finger of the other hand gently push the ankle to bring the foot
towards the face. Observe the angle formed behind the knee by the upper and lowe
r legs. More mature infants have less extension of the knee
e. Scarf sign – take the infants hand and gently pull the arm across the fron
t of the chest and around the neck like a scarf. With other hand gently press on
the infant’s elbow to help the arm around the neck. Mature infants arm cannot be
easily pulled across the chest
f. Heel to ear – hold infants toes and gently pull the foot towards the ear.
Mature infant have less flexion therefore you cannot bring the heel to the ear.
2. Assessing the Newborn’s Physical Maturity – this includes assessment of the
skin, lanugo, plantar creases, breast ear and genitals
a. Skin – more mature infants have thicker skin
b. Lanugo – amount of lanugo decreases with maturity
c. Breast – more mature infants have a bigger areola and breast bud
d. Ear- both the shape and thickness of external ear are considered. With i
ncreasing maturity the edge of the ear curls, the cartilage thickens with maturi
ty so that ear springs back into the normal position after it is folded against
the infant head
e. Genitalia
- male – with maturity the testes descend and scrotum becomes wrinkled
- female – labia majora increase in size with maturity