NEW BORN CARE

IMMEDIATE CARE OF THE NEWBORN

•AIRWAY

•TEMPERATURE

•APGAR

•IDENTIFICATION

AIRWAY• Suctioning

Suction gently and quickly (5 to 10 seconds). Prolonged and deep suctioning of the nasopharynx during the first 5 to 10 minutes of life will stimulate the VAGUS NERVE (located in the esophagus) and cause bradycardia.

> Suction the MOUTH first before the nose. If the nose is suctioned first, the stimulation of the nasal mucosa will cause reflex inhalation of pharyngeal material into the trachea and bronchi, causing ASPIRATION.

>To test the patency of the airway, occlude one nostril at a time. (REMEMBER: newborns are

NOSE BREATHERS.) If a newborn struggles when a nostril has been occluded, additional suctioning is indicated.

POSITIONING OF THE NEWBORN

Right side lying

1. promote drainage secretion

2. promote closure of foramen ovale

3. fasten gastric emptying time

4. prevent an increase in intracranial pressure

> The position when suctioning should be one that promotes drainage of secretions – HEAD LOWER THAN THE REST OF THE BODY BUT head should be higher than the rest of the body if there are signs of increased ICP:

•Vomiting•Bulging, tense fontanels•Dilated scalp veins•Abnormally large head•Increased BP•Decreased PR and RR•Widening pulse pressure•Shrill, high-pitched cry

TEMPERATURE REGULATION (THERMOREGULATION)

• Maintain appropriate Body Temperature. Chilling will increase the body’s need for O2. The newborn suffers large losses of heat (cold stress) because he is wet at birth, the delivery room is cold, he does not have enough adipose tissue and does not know how to shiver.

• Wrap the newborn immediately

• Wrap him warmly

• Put him under a droplight

TEMPERATURE

36.5 – 37.4ºC Rectal thermometer check the patency of rectum passage of meconium after 24

hours (imperforate anus)

HEAT LOSS IN NEWBORN

• CONVECTION – flow of heat from body surface to cooler surroundings

• RADIATION – transfer of body heat to a cooler solid object not in contact with the body

• CONDUCTION – transfer of body heat to a cooler solid object in contact with the body

• EVAPORATION – loss of heat through conversion of a liquid to a vapor

convection

radiation

conduction

evaporation

APGAR

0 1 2

APPEARANCE BLUE/ PALE BODY PINK, EXTREMITIES BLUE, (ACROCYANOSIS S- NORMAL) 1ST 480 DUE TO IMMATURITY OF CIRCULATION

Completely PINKRUDDY SKIN

PULSE ABSENT < 100 BEATS / MIN

> 100 BEATS / MIN

GRIMACE NONE > WEAK CRY > SNEEZE, / COUGH,LUSTY CRY (GOOD, STRONG, VIGOROUS)

ACTIVITY FLACID / LIMP > SOME EXT. FLEX

WITHDRAWAL OF FEET

EXT. FLEX WELL

RESPIRATION ABSENT < 30 > 60

APGAR : AREAS OF ASSESSMENT

TOTAL SCORE INTERPRETATION

0-3• POOR,SERIOUS,SEVERELY

DEPRESSED; CPR4-6• FAIR,GUARDED, MODERATELY

DEPRESSED• NEEDS SUCTIONING & FURTHER

OBSERVATION7-10• GOOD, HEALTHY, ADAPTS WELL IN

THE EXTRAUTERINE LIFE

IDENTIFICATION

• Boy (blue), Girl (pink)

• Gender and Name of the mother

ex. baby girl Ingrid Garcia

• Bed number

• Room number

• Name of the Ob-Gyne/Pediatrician

ROUTINE NEW BORN CARE

• BATHING

• ANTHROPOMETRIC MEASUREMENT

• CREDE’S PROPHYLAXIS

• VITAMIN K INJECTION

• UMBILICAL CORD CARE

• PRINTS

BATHING

• Oil Bathspread or remove vernix caseosa

• Warm batha. foot ball holdb. check temp using the elbow(37-38ºC)c. from the cleanest the most soiled areasnof the body.

head eyes nose mouth ear neck chest axilla UE (arm, forearm & hands) abdomen back LE (thigh,leg & foot) genitalia anus

ANTHROPOMETRIC MEASUREMENT

• HEAD CIRCUMFERENCE :33-35cm

• CHEST and ABDOMEN : 31-33cm

• LENGTH : 47-54cm

• WEIGHT : 2500-4000 grams

• Note: A reduction of NB weight of about 5-10% of BW (6-10oz) or less known as Physiologic weight loss during the 1st 3-10 days of life is normal.

• Causes:•-Infant is no longer under the

influence of maternal hormones.•-Voids and passes out stools.•-Has relatively low nutritional intake•-Has beginning difficulty establishing

sucking

CREDE’S PROPHYLAXIS

To prevent Ophthalmia Neonatorum or Gonorrheal Conjunctivitis (Neisseria gonorrhea) which causes blindness if not treated.

Infection can be acquired during delivery from a mother with untreated gonorrhea

Ophthalmic drops

BEFORE: Silver Nitrate or AgNO3 1% 1-2 drops

1-2 gtts into the lower conjunctival sac

PRESENT:

Ointment – inner to outer canthusErythromycin – drug of choice of Chlamydial Trachomatis

VITAMIN K INJECTION

Vitamin K facilitates production of the clotting factor; thus, prevents bleeding, should be given within one hour after birth.

Full term (0.1 ml)Preterm (0.05 ml)

Aquamephyton (generic: phytonadione)Route: IM into the lateral anterior thigh (Vastus lateralis). In children below 12 months of age who have not yet learned how to walk, this is the preferred site of injection because the gluteal muscles are not yet fully developed.

UMBILICAL CORD CARE• Check two umbilical arteries, one umbilical vein

& wharton’s jelly• Milking (depends on hospital policy)• Disinfect the cord

– *Practice aseptic technique• Use povidoneiodine (Betadine); 70%

Isoprophyl alcohol to prevent Tetanus Neonatorum and Omphalitis infection of the cord (streptococcal and staphylococcal)

• Place the cord clamp

1-2 inches from the base• cut (1 cm or ½ inch from the cord clamp) and

disinfect– ** The cord will fall off after – 7-10 days• Application of sterile cord clamp to prevent

bleeding within the 1st 24 hours

• Signs of Omphalitis:• *Reddening of the area• *Fever• *Discharge and foul smell

•

PRINTS

• Foot prints of the baby (most reliable)

• Thumb mark of the mother

• Identification bracelet

Nursing Intervention

1. Meet physiologic needs

2. Meet psychological needs

3. Foster healthy family relationships

4. Provide education

THE END