NEWBOR

N CARE
Nursing Skills Laboratory

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 • Tremendous physiologic
adaptation begins to take
place in the newborn’s body
after birth. Beware of these
changes; newborns require
close observation and
special care to determine
how smoothly they are
making the transition to
extrauterine life.
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 PURPOSES:
1. To promote the physical well
being of the newborn
2. To assess and stabilize the
newborn
3. To initiate appropriate care
and intervention for any
signs of distress
4. To support the
establishment of a well
functioning family unit
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 Immediate
Care of the
Newborn
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 Equipment:
1. Rubber bulb syringe or
suction
apparatus/machine
2. Two receiving blankets
3. Cord Clamp
4. Radiant warmer
5. Bassinet
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 Therape
utic
Interven
On Immediate Care of the
tions
Newborn

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AIRWAY
1. Hold baby with head lowered
(10 to 15 degrees)
2. Suction oral pharynx with small
bulb syringe as soon as the
head is born
3. Suction nares next
4. Avoid deep suctioning with
catheter if possible
5. Avoid suspending neonate by
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ankles
 CORD CLAMPING
1.Immediately following birth,
neonate is kept at about the
same level as the uterus,
until cord clamp is applied or
until cord has stop pulsating
2.Without “milking” it, cord is
clamp close to umbilicus
approximately 30 secs after
birth if neonate appear
normal and mature
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 3. Cord is clamped 8 to 10
cm from umbilicus if
there is possibility for
exchange transfusion
4. Assess cord for 2 arteries
and one vein
5. Cleanse the umbilical
cord stump with betadine
solution
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ATTACHMENT &
WARMTH
1. Unless immediate
intervention is required,
dry infant and place on
mothers abdomen,
covering both; or wrap
infant in warm blanket
first.
2. Caution parents to keep
neonate’s head covered
3. Permit the mother to
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 PERFORM
ASSESSMENT
TEST

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 APGAR Scoring Chart
Sign 0 1 2

Heart Rate Absent Slow Over 100

(<100)
Respirator Absent Slow, Good
y Effort irregular Crying
Muscle Flaccid Some Active
Tone Flexion of Motion
Extremitie
Reflex No s
Cry Vigorous
Irritability Response Cry
Color Blue, Pale Body is Completely
pink, pink
Extremitie
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s are blue
• The Apgar is an excellent
method for assessing the
effectiveness of
resuscitation, however it
should not be used as the
sole basis for making
resuscitative decisions.
• One limitation of the Apgar
system is that it was
designed to assess normal
full term infants, not
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preemies, so it is less
 • For evaluating
premature neonates,
umbilical cord pH or
the Silverman-
Anderson scoring
system may be more
valuable than Apgar.

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Silverman-Anderson
Scoring System
• In order to assess the
degree of respiratory
distress in neonates,
practitioners often use the
Silverman-Anderson scoring
system.
• Like the Apgar system it
evaluates five parameters
and assigns a numerical
score for each parameter.
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 • However, unlike the Apgar
score, the lower the total
score the better the baby in
the Silverman-Anderson
system.
• The best score possible in
each category is a "0" the
worst is a "2". Parameters
assessed are: retractions of
the upper chest, lower
chest, and xiphoid, nasal
flaring, and expiratory
grunt.
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• Neonates with no retractions,
flaring or grunting with
synchronized respiratory
movements are scored with
"0s".
• Infants with visible
retractions of the lower chest
and xiphoid, with the upper
chest lagging compared to
the lower on inspiration,
receives a "1".
• Minimal nasal flaring and an
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expiratory grunt heard only
 • Marked retractions with a
"see-saw" movement of the
upper and lower chests
deserves a "2".
• Marked nasal flaring and
audible expiratory grunting
also deserve a "2".
• Normal babies have a
cumulative score close to
"0".
• Severely depressed babies
score close to "10".
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 Silverman-Anderson Scoring
System
Score 0 1 2
• Upper
lag on see-saw
Chest synchronized
inspiration movement
Retraction
• s
Lower
Chest none just visible marked
Retraction
s
• Xiphoid
none just visible marked
Retraction
s
• Nasal none minimal marked
Flaring
stethoscope naked eye
• Expiratory none
only and ear
Grunting
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Dubowitz Maturity Scale
- Assessment of the Gestational
Status
- Maturation level is rated
Categories :
1. External Characteristics – ear
cartilage , breast size, genitalia,
sole, creases, skin edema, amount
of lanugo
2. Neurological signs – posture , ankle
dorsiflexion, leg and arm recoil ,
popliteal ankle, heel to ear, scarf
sign, head lag and ventral
suspension
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 Ballard’s Assessment of
Gestational Criteria
– done within 3-4 minutes ;
determines SGA’s and
prematurity
Parts :
3. Physical maturity – skin
texture, color, lanugo, foot
creases, genitalia, ear, and
breast maturity
4. Neuromuscular maturity –
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observe and position the baby
 Crede’s Prophylaxis
• Instillation of a
prophylactic agent at the
eyes of all neonate is
mandatory as a precaution
against opthalmia
neonatorum.
Medication:
3. Erythromycin
4. Opthalmic ointment 0.5%
5. Tetracycline
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ophthalmic
ointment 1%
Prevention of
Hemorrhage
• To prevent bleeding, Vitamin K
( Aquamephyton, phytonadione)
is given intramuscularly in the
vastus lateralis or rectus
femoris muscle of the anterior
thigh.
• Dosage: Weight 2.5 – 3.5 kg
(1mg)
< 2.5 kg (0.5mg)
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 Identification:
Two Ways of Identification:
2. Use of pliable plastic tapes
which are applied to the
infants wrist and ankle ( it
contains the mothers name,
physician, date, time of birth
and sex of the infant and
hospital number)
3. Palm prints or foot prints
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 Anthropom
etric
Measureme
nts
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 Equipment:
2.Tape Measure
3.Weighing Scale

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 Implementation:
1. Weigh the newborn without
any dress
AGA= 2,500 – 4,000 gm
SGA= lower 10% of 2,500
gm
LGA= higher 10% of 4,000
gm
2. Put clean paper on the
scale
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3. Balance the scale at zero as
 4. Wash hands and put on
gloves if you haven’t
bath the neonate yet
5. Place the neonate in
the middle of the scale
tray without any dress.
Note the neonate’s
weight. Keep one hand
poise over him all times.
Work quickly.
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 6. Measure the
Newborn Using a
Tape Measure

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 Head circumference
2. Measure head at the
greater diameter or
occipitofrontal
circumference (33 – 35 cm)
3. Slide tape measure under
the neonate’s head at the
occiput and draw tape
snugly around, just above
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the eyebrow.
 Chest Circumference
• Measure the nipple line (30-33
cm which is lower in 1-2cm
than HC
• Place the tape under the back
and wrap it snugly around the
chest at the nipple line.
• Take the measurement after
the neonate inspires and
before it begins to exhales.
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 Length
• Measure from heel to
head of the infant
(normally 47-50 cm)
• Fully extend the
neonate’s legs with the
toes pointing up. Measure
the distance between the
marks.
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 7. Assess Vital
Signs
• RR= 32-60 bpm
• CR= 110 – 160 bpm
• Temp:
Oral= 36.4 – 37.4 C
Rectal= 36.2 – 37.8 C
Axillary= 35.9 – 36.7 C
• BP- varies in height and
weight
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 Assess Vital Signs
1.Assemble the equipment
beside the baby. If you are
using a mercury
thermometer, shake it until
the mercury drops under 96F
or 35.5C. If you have an
electronic thermometer,
apply the cover to the rectal
probe. Use water soluble
before taking rectal temp.
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 2. Observe respirations
first, before the neonate
becomes too active and
agitated. Watch and
count respiratory
movements for one
minute. Observe the
chest as it rises and
falls; normal movements
should be symmetrical.
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3. Place the stethoscope
over the apical pulse on
the fourth and filth
intercostal space of the
left mid clavicular line
over the cardiac apex.
4. To take temp rectally,
neonate lying supine,
firmly grasp his ankle with
finger between them
insert the lubricated
thermometer no more
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than 0.25 in to 0.5 in into
 5. Newborn’s legs
stabilized by the nurse’s
hand. Hold the
thermometer in place
for 3 minutes
6. Remove the
thermometer and read
the number on the scale
where the mercury
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 7. Although it is not
routinely measured at
birth, blood pressure is
assessed by Doppler UTZ.
8. Record V/S and related
measurements on your
notes. Include any
observation about the
neonate’s condition.
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 Cord Care
• The care of the umbilical cord
is the same as that for any
surgical wound. The goals of
care are prevention and early
identification of hemorrhage
and infection. Hospital
protocol directs the time and
techniques for routing cord
care.
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 Purpose:
•To prevent and
early identify
hemorrhage or
infection.

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 Equipments:
•Dry cotton balls
•Alcohol (70%)
•Forcep
•Betadine anticeptic
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Implementation with
Rationale
Initial Cord Care (Day 1) :
• Clamp 0.5 – 1 inch above
umbilical base. Milking the cord
towards the baby is not
allowed.
• Leave the umbilical stump
uncovered.
• With the use of forceps cleanse
the
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Cord stump with betadine
antiseptic or solution.
Suceeding cord care
( Day 2)
1. Assess for any odor,
discharge, bleeding, or skin
inflammation around the
cord.
2. Cleanse the cord and the
skin around the base of the
cord with cotton swabs and
prescribed preparation
( Alcoho 70%).
3. The clamp is removed when
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 Guidelines for the
mother:
1. Teach the mother to avoid
covering the cord with the
diaper for it may prevent drying.
2. Tech about the signs of tetanus
(weak sucking, foul smelling
discharge, fever and
convulsion).
3. Drops of blood can be seen
when the cord drops off. Assure
that this is not dangerous and it
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 Baby Bath
• Baby’s bath is
postponed until the
infant’s skin
temperature stabilizes
at 36.5 C (97.6 F) or
core temperature
stabilizes at 37 C
( 98.6 F) hours.
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 Purposes:
• It provides opportunities for
complete cleansing of the
infant.
• To observe the infant’s
condition.
• To promote patient’s
comfort and parent child
family socialization.
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 Equipment:
• Baby oil • Basin
• Baby soap • Mittens
• Reveiving • Warm
blanket water
• baby‘s
• Soft brush
clothing
or baby’s
• Diaper
comb
• Cotton
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balls • Gloves
Implementation and
Rationale
1.Assemble all equipment.
Do not leave the baby
alone on the bath area.
2.Wear gloves until initial
bath is completed.
3.A non medicated mild
soap or oil may be used.
Cotton balls not gauze
are used to cleanse the
nostrils and ears.
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 4. Bath the newborn
quickly exposing only a
portion of the body at a
time.
5. Checked the
temperature 30 minutes
after the completion of
the bath.

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 Daily bath
1. Supplies and clothing are made
ready.
2. Test temperature of the water.
3. Bring the infant to bathing area
when all supplies are ready.
4. Hold the baby in football
position, and head is washed
before unwrapping and
undressing. The scalp is washed
daily with water and mild soap.
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5. Cleanse the eyes from the
inner canthus outward, using
a clean washcloth.
6. Cleanse ears and nose with
twists made of moistened
cotton.
7. Creases under the chin and
arms and groin may be
exposed and cleansing the
creases under the chin could
be done by elevating the
infant’s shoulders 5 m (2in)
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 8. Undress the baby and
wash body arms and
legs. Baby may be tub
bathed after the cord
drops off.

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 TUB BATHING
1.Add 3 inches of comfortably
warm water into the basin at
98 F to 99 F pleasantly warm
to the inner wrist
2.Baby can be carefully placed
in to the warm water, the
bather’s arm.
3.Use towel and pat the baby
dry gently. Baby is dressed
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 Vernix Caseosa

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