Care of the

Newborn
By:
Ruth V. Tianco, RN
Care of the newborn
 Care of the Normal Newborn Infant
• The nurse has a unique opportunity of closely
observing and providing care for the newborn infant
after delivery.
• Because of the newborn infant's helplessness, his
needs must be met initially by nursing personnel.
• Many nursing assessments and evaluations are
conducted for the well-being of the infant.
• Nursing care does not stop with the newborn infant.
• Interaction with the parents is also
important in the development of a
family unit.
 Establishing and Maintaining the
Newborn's Airway
• The physician suctions the infant
before it is completely born with a
bulb syringe or a DeLee trap.
• A DeLee trap is used if meconium
was present in the amniotic fluid.
• Once the infant is delivered, his head
is held slightly downward to promote
drainage of mucus and fluid.
• The infant's face is wiped thoroughly clean.
• If the infant doesn't breathe spontaneously, he should be
stimulated to cry by slapping his heels, lightly tapping
the buttocks, and/or rubbing his back gently.
• The infant is then positioned with his head slightly down
when placed in the radiant warmer. The bulb syringe is
used to remove mucus from his mouth and nose.
Position the Baby
• Keep the baby on its’ back or side, not
on its’ stomach
• Neither extend nor flex the head. Either
may obstruct the airway.
• Newborn babies normally make this
adjustment themselves. If depressed,
however, you may need to position the
head to get a good airway.
Suction the Airway
• Use a bulb syringe
• Use it gently
• The infant's mouth is suctioned first
and then his nose.
• May need to help them clear mucous
and amniotic fluid from the airway
• If bulb syringe is not available, use any
suction device.
How to use bulb syringe
 Common characteristics of newborn
respirations
• (a) Nose breathers. Sleeps with mouth closed, does
not have to interrupt feedings to breathe.
• (b) Irregular rate.
• (c) Usually abdominal or diaphragmatic in
character.
• (d) Ranges from 40 to 60 breathers per minute.
• (e) Breathing is quiet and shallow.
• (f) Easily altered by external stimuli.
 Common characteristics of newborn
respirations
• (g) Periods of apnea less than 15
seconds is normal.
• (h) Acrocyanosis may occur during
periods of crying. Acrocyanosis refers
to cyanotic look of the baby's hands
and feet when he is crying. When the
baby stops crying, his hands and feet
get pink again.
 Signs and symptoms of newborn
respiratory distress.
• (a) Increased rate or difficulty breathing-growing
and seesaw breathing. In normal respirations, the
infant's chest and abdomen rise. With seesaw
respirations, the infant's chest wall retracts and his
abdomen rises with inspirations. See fig. 8-3.
• (b) Sternal or subcostal retractions.
• (c) Nasal flaring.
• (d) Excessive mucus, drooling.
• (e) Cyanosis.
Signs and symptoms of newborn
respiratory distress.
 Identify the Infant After Delivery.
(1) The infant must be properly identified before leaving
the delivery room. An identification (ID) band is placed
on the infant's wrist and leg. An identical band matching
the infant's band is placed on the mother's wrist.
(2) The infant's footprints or palm prints placed next to
the mother's thumb print is rarely done in most facilities.
Each facility has its own instant identification method
 Maintaining Body Temperature.
(1) Dry the infant thoroughly
immediately after delivery.
The infant is extremely
vulnerable to heat loss
because his body surface area
is great in relation to his
weight and he has relatively
little subcutaneous weight.
(2) Place the
infant closely to
the mother's
skin. Skin-to-skin
contact with the
mother will help
prevent heat
loss.
 Oil Bath or Water Bath
What equipment is needed for water bathing
newborns?
• Thick towels or a sponge-type bath cushion.
• Soft washcloths.
• Basin or clean sink.
• Cotton balls.
• Baby shampoo and baby soap (non-irritating).
• Hooded baby towel.
• Clean diaper and clothing.
Vernix
• Cheesy-white
• Normal
• Antibacterial
properties
• Protects the
newborn skin
Sponge Bath
 Cont… Bathing of the newborn
• Make sure the room is warm, about (75° F).
• Check the water temperature by the use of your elbow.
• Gather all equipment and supplies in advance.
• Add warm water to a clean sink or basin (warm to the inside of
your wrist or between 90 and 100° F.).
• Place baby on a bath cushion or thick towels on a surface that is
waist high.
• Keep the baby covered with a towel or blanket.
 Cont… Bathing of the newborn
• NEVER take your hands off the baby, even
for a moment. If you have forgotten
something, wrap up the baby in a towel
and take him or her with you.
• Start with the baby's face - use one
moistened, clean cotton ball to wipe each
eye, starting at the bridge of the nose then
wiping out to the corner of the eye.
 Cont… Bathing of the newborn
• Wash the rest of the baby's face with a soft, moist
washcloth without soap.
• Clean the outside folds of the ears with a soft
washcloth.
• Wash the baby's head with a shampoo on a
washcloth. Rinse, being careful not to let water run
over the baby's face.
• Holding the baby firmly with your arm under his or
her back and your wrist and hand supporting his or
her neck, you can use a high faucet to rinse the
hair.
 Cont… Bathing of the newborn
• Add a small amount of baby soap to the water or
washcloth and gently bathe the rest of the baby from
the neck down.
• Rinse with a clean washcloth or a small cup of water.
• Be sure to avoid getting the umbilical cord wet.
• Scrubbing is not necessary, but most babies enjoy their
arms and legs being massaged with gentle strokes
during a bath.
 Cont… Bathing of the newborn
• Wrap the baby in a hooded bath towel
and cuddle your clean baby close.
• Follow cord care instructions given by
your baby's physician. This may include
alcohol or air drying.
• Use a soft baby brush to comb out your
baby's hair. DO NOT use a hair dryer on
hot to dry a baby's hair because of the
risk of burns.
 Anthropometric
measurements
• Head circumference (33-35 cm)-
repeat after molding and caput
succedaneum are resolved
• Chest circumference (31-33cm)- at
the nipple line
• Abdominal circumference
• Length (F=53, M=54)- from top of head
to the heel with the leg fully extended
• Weight 2.5- 4 kg
Anthropometric
measurements
Vital signs
 APGAR SCORING
• The Apgar score was devised in 1952 by
Dr. Virginia Apgar as a simple and
repeatable method to quickly and
summarily assess the health of newborn
children immediately after childbirth.
• Apgar was an anesthesiologist who
developed the score in order to ascertain
the effects of obstetric anesthesia on
babies.
 APGAR SCORING
• The Apgar score is determined by evaluating
the newborn baby on five simple criteria on
a scale from zero to two, then summing up
the five values thus obtained.
• The resulting Apgar score ranges from zero
to 10.
• The five criteria (Appearance, Pulse,
Grimace, Activity, Respiration) are used as a
mnemonic learning aid.
APGAR
 Color
• Most newborns have
Pink acrocyanosis (body is
centrally pink, but
hands and feet are blue
• Cyanosis requires
Acrocyanosis treatment:
– Oxygen
– Airway
– Ventilation

Cyanosis
 APGAR SCORING
• The test is generally done at one and five
minutes after birth, and may be repeated later if
the score is and remains low.
• However, the purpose of the Apgar test is to
determine quickly whether a newborn needs
immediate medical care; it was not designed to
make long-term predictions on a child's health.

•
Component of Score of 0 Score of 1 Score of 2
acronym

Appearance blue all over blue at extremities no cyanosis

Skin color body pink body and extremities
(acrocyanosis) pink

Pulse rate Absent < 100 >100

Grimace no response grimace/feeble cry sneeze/cough/pulls
Reflex irritabilit to stimulation when stimulated away when stimulated
y

Activity none some flexion active movement

Muscle tone

Respiration absent weak or irregular strong

Breathing
• Scores 3 and below are generally regarded
as critically low, 4 to 6 fairly low, and 7 to
10 generally normal.
• A low score on the one-minute test may
show that the neonate requires medical
attention but is not necessarily an indication
that there will be long-term problems,
particularly if there is an improvement by
the stage of the five-minute test.
• If the Apgar score remains below 3 at
later times such as 10, 15, or 30
minutes, there is a risk that the child
will suffer longer-term neurological
damage.
• There is also a small but significant
increase of the risk of cerebral palsy.
 CORD CARE
• Things needed for cordcare:
• Sterile gloves
• 2 sterile Clamp
• 1 sterile scissors
• 5 cotton balls
• Alcohol
• Betadine antiseptic solution
• Disposable cord clamp
• Sterile kidney basin
 CORD CARE
1. After the baby is born, leave the umbilical
cord alone until the baby is dried, breathing
well and starts to pink up.
 Cont… Cord Care
2. Once the baby is breathing, put two clamps on
the umbilical cord, about 5 to 8 inches from the
baby's abdomen and to the mother immediately
after delivery. Use scissors to cut between the
clamps.
 Cont… Cord Care
3. Milk the cord according to the hospital policy
4. Apply triple dye (refer to local policy). from, 1.
base, 2. cord. The dye prevents infection and helps
the cord to dry.
5. Put the disposable cord clamp on the umbilical
cord, about
an inch (3 cm) from
the baby's abdomen
6. Cut the cord above the cord clamp using the
sterile scissors.
 Cont… Cord Care
7. Inspect the cord frequently
for signs of bleeding
immediately after it has been
cut. Check for AVA
 Cont… Cord Care

8. Apply antiseptic solution to the stump

of the umbilical cord after checking the
AVA.
9. Eventually between 1-3 weeks the
cord will become dry and will naturally
fall off.
10. During the time the cord is healing it
should be kept as clean and as dry as
possible.
 Eye prophylaxis for the newborn

This procedure is required by law in

all states as prophylaxis against
gonorrhea. The medications used are
as follows:
• 1% silver nitrate
• 0.5% erythromycin ointment
 Eye prophylaxis for the newborn
• a. Erythromycin Ophthalmic Ointment.
This has become the drug of choice and is
received in a sterile syringe from the
pharmacy.
• It is injected into each eye from the inner
to outer canthus immediately after birth.
• It does not appear to cause much eye
irritation.
Administration of erythromycin
ophthalmic ointment.
 Eye prophylaxis for the newborn
• b. 1% Silver Nitrate Solution. Two drops are
applied in each eye in the conjunctival sac, not
the cornea.
• The infant eyes may or may not be irrigated after
instillation, depending on local policy.
• The infant may get profuse discharge and
chemical conjunctivitis for a few days with no
residual damage.
• One percent silver nitrate solution is no
longer recommended for use.
 Administration of Vitamin K
• Vitamin K is given as a
prophylaxis to prevent
hemorrhagic disease. Given few
hours after birth it is
administered intramuscular (IM)
in the vastus lateralis muscle
0.5- 1.0 mg.
 Clothing of the newborn
• Place the infant in a crib with droplight.
• Clothed the infant and place a
stockinette cap on the infant's head to
prevent heat loss through the head.
• Wrap the infant snugly in a warm
blanket.
 Neonate Reflexes
• This is sometimes referred to as the
startle reaction, startle response, startle
reflex or embrace reflex. It is more
commonly known as the Moro response or
Moro reflex after its discoverer,
pediatrician Ernst Moro.
• The Moro reflex is present at birth, peaks in
the first month of life and begins to
disappear around 2 months of age.
 Moro Reflex
• It is likely to occur if the infant's head suddenly shifts
position, the temperature changes abruptly, or they are
startled by a sudden noise.
• The legs and head extend while the arms jerk up and out
with the palms up and thumbs flexed. Shortly afterward
the arms are brought together and the hands clench into
fists, and the infant cries loudly.
• The reflex normally disappears by three to four months
of age, though it may last up to six months.
 Walking or stepping reflex
• The walking or stepping reflex is
present at birth; though infants this
young can not support their own weight,
when the soles of their feet touch a flat
surface they will attempt to 'walk' by
placing one foot in front of the other.
• This reflex disappears at 6weeks as an
automatic response and reappears as a
voluntary behavior at around eight
months to a year old.
 Rooting Reflex
• The rooting reflex is present
at birth and assists in
breastfeeding, disappearing
at around four months of age
as it gradually comes under
voluntary control.
• A newborn infant will turn
their head toward anything
that strokes their cheek or
mouth, searching for the
object by moving their head
in steadily decreasing arcs
until the object is found.
 Sucking Reflex
The sucking reflex is common to all
mammals and is present at birth. It is
linked with the rooting reflex and
breastfeeding, and causes the child
to instinctively suck at anything that
touches the roof of their mouth and
suddenly starts to suck simulating
the way they naturally eat.
 Sucking Reflex
There are two stages to the action:
• Expression: activated when the nipple is
placed between a child's lips and touches their
palate. They will instinctively press it between
their tongue and palate to draw out the milk.
• Milking: The tongue moves from areola to
nipple, coaxing milk from the mother to be
swallowed by the child.
 Palmar grasp reflex

• The palmar grasp reflex

appears at birth and
persists until five or six
months of age.
• When an object is placed
in the infant's hand and
strokes their palm, the
fingers will close and
they will grasp it.
 Palmar grasp reflex

• The grip is strong but unpredictable;

though it may be able to support the
child's weight, they may also release
their grip suddenly and without
warning.
• The reverse motion can be induced
by stroking the back or side of the
hand.
 Plantar Reflex
• A plantar reflex is a normal reflex that
involves plantar flexion of the foot
(toes move away from the shin, and
curl down. An abnormal plantar reflex
(aka Babinski Sign) occurs when
upper motor neuron control over the
flexion reflex circuit is interrupted.
This results in a dorsiflexion of the
foot (foot angles towards the shin, big
toe curls up).
 Babinski Reflex
• Often confused with the plantar reflex, the
Babinski reflex is also present at birth and
fades around the first year.
• The Babinski reflex appears when the side of
the foot is stroked, causing the toes to fan out
and the hallux to extend.
• The reflex is caused by a lack of myelination in
the corticospinal tract in young children.
• The Babinski reflex is a sign of neurological
abnormality, e.g. upper motor neurone lesion,
in adults
 Galant Reflex
• The Galant reflex, also known
as Galant’s infantile reflex, is
present at birth and fades
between the ages of four to
six months.
• When the skin along the side
of an infant's back is stroked,
the infant will swing towards
the side that was stroked.