Care of the Normal Newborn
Laedwig Chapters 23, 24, 25, 26
Mary Jane Hopkins, ARNP
The Newborn Assessment
General appearance—flexed position
Weight and measurements
Average birth weight—3405 g= 7 lb, 8 oz
2500-400G= 5 lb. 8 oz- 8 lb. 13 oz
Can lose 5-10 % of weight in first 3-4 days due to small fluid intake, and fluid loss
(meconium loss& urine)
Will regain 1 oz/ day after loss over
Usually regains in second week
Average length is 50 cm=20 in
range 48 to 52 cm =18 to 22 in
Head circumference—32 to 37 cm =12. 5 to 14.5 in
Chest circumference—32 cm =12. 5 in
range 30 to 35 cm =12 to 14 in
Heart rate, 120 to 160 beats per minute
Count AP for 1 full minute
AP may increase to 180 when crying or go as low as 80 when resting
Respirations, 30 to 60 respirations per minute
Count for 1 full minute
May be irregular with short periods of apnea
May be slightly elevated with crying
>60 tachypnea and < 30 bradypnea
Blood pressure at birth, 80–60/45–40 mm Hg
Should be measure when infant is resting
ALWAYS REPOT THE FOLLOWING IN THE NEWBORN
Signs of Respiratory Distress
Temp 100 or 97
Apical Pulse 160 or 120
Respirations 60 or 30
B/P cuff can be applied to the upper arm or thigh.
Thermoregulation in newborn is closely related to rate of metabolism and oxygen consumption
Neutral thermal environment (NTE) zone exists when rates of oxygen consumption and
metabolism are minimal.
Characteristics affecting thermoregulation
Newborn has decreased subcutaneous fat and thin epidermis
Blood vessels closer to skin than adult
Flexed posture of term newborn decreases surface area exposed to environment,
reducing heat loss
preterm or small-for-gestational-age (SGA) newborn has less adipose tissue and is
hypoflexed requiring higher environmental temperatures to achieve an NTE
Thermogenesis—Physiologic mechanisms that increase heat production. Include
increased basal metabolic rate
chemical thermogenesis or Nonshivering thermogenesis (NST) stimulates sympathetic
nervous system to metabolize newborn's stores of brown adipose tissue (BAT) or brown
fat to provide heat.
Oxygen consumption and metabolic rate increase in response to cold environment. If prolonged
glycogen stores will be depleted and acidosis can occur
Methods of heat loss
Characteristics of Newborn
Head—newborn's head is disproportionately large for its body
Approximately one fourth of body size
Molding-overriding of cranial bones
Fontanelles ="soft spots"
Palpated on newborn’s head
Should be flat and smooth may bulge when crying
Depressed may indicate dehydration
Bulging may indicate Increase ICP
Anterior fontanelle= diamond shaped
Between Frontal and parietal bones
Posterior fontanelle= triangular
Between the occipital and pariental bones
swelling of soft tissue under the scalp
Usually from Birth Trauma
Will resolve 1 week
Hair—term newborn's hair is smooth with texture variations depending on ethnic background.
Lanugo- fine downy hairy seen on body between 20 weeks and birth
Should be symmetrical
Color established at 3 months, may change any time up to 1 year
Small subconjunctival hemorrhages may appear on sclera.
Transient strabismus caused by poor neuromuscular control of eye muscles.
Absence of red reflex occurs with cataracts.
No tears until 2 months
Nose breathers for first few months of life
Remove obstructions by sneezing
Lips of newborn should be pink.
Touch on lips should produce sucking motions.
On hard palate and gum margins
Small glistening white specks (keratin-containing cysts)
Will disappear 2-3 months
Soft and pliable
Recoil readily when folded and released
Low-set ears may indicate chromosomal abnormalities.
Trisomies 13 and 18
Internal organ abnormalities
A short neck, creased with skin folds
Evaluate clavicles for evidence of fractures
Lung sounds clear
Engorged breasts occur frequently in both males and females.
Result of maternal hormonal influence
last up to 2 weeks
Supernumeray= extra nipple
Should be strong, lusty, and of medium pitch
A high-pitched, shrill cry may indicate neurological disorders or hypoglycemia.
Cylindrical and protrude slightly
Bowel sounds present
Laxness of the abdominal muscles is normal.
White and gelatinous in appearance
Two umbilical arteries and one umbilical vein
Term Newborns Usually Pass Meconium within 8 to 24 Hours
Formed in utero from amniotic fluid and its constituents, intestinal secretions, and shed mucosal
Thick, tarry black or dark green appearance.
Physiologic Factors of Newborn Kidney function
Term newborn's kidneys have full complement of functioning nephrons by 34 to 36 weeks'
Glomerular filtration rate of newborn's kidney is low compared with adult rate; newborn's
kidney unable to dispose of water rapidly when necessary.
Full-term newborns less able than adults to concentrate urine because tubules are short and
Reduced ability to concentrate urine caused by limited tubular reabsorption of water and
limited excretion of solutes (principally sodium, potassium, chloride, bicarbonate, urea, and
phosphate) in growing newborn
Decreased ability to excrete drugs
First 2 days newborn voids two to six times daily, with urine output of 15 mL/day
Newborn subsequently voids 5 to 25 times every 24 hours, with volume of 25 mL/kg per day
Record # of wet diapers
Rule of thumb
day 1 of life= 1 wet diaper
day 2 of life =2 wet diapers……
after day 6= 6 or more wet diapers daily
Vaginal discharge of thick, whitish mucus
Can become tinged with blood, called pseudomenstruation, caused by withdrawal of
Vernix caseosa, a white substance, is often present between labia.
Scrotum is inspected for size and symmetry and presence of both testes.
Hypospadias—urinary meatus located on ventral surface of penis
Phimosis—opening of foreskin (prepuce) is small and foreskin cannot be pulled back
over glans; may interfere with urination
Gross deformities, extra digits, webbing, clubfoot, and range of motion
Arms and hands
Brachial palsy, paralysis of portions of arm
Erb-Duchenne paralysis (Erb's palsy)
damage to upper arm (fifth and sixth cervical nerves)
Unable to move arms or they may be assymetical
Assymetry of the gluteal folds may indicate hip dysplasia
Legs and feet
Talipes deformity (clubfoot)
The asymmetry of gluteal and thigh fat folds seen in infant with left developmental dysplasia of
Barlow’s (dislocation) maneuver. Baby’s thigh is grasped and adducted (placed together) with
gentle downward pressure.
Ortolani’s maneuver puts downward pressure on the hip and then inward rotation. If the hip is
dislocated, this maneuver will force the femoral head back into the acetabular rim with a
The nurse moves the foot to the midline. Resistance indicates true clubfoot.
Spine should appear straight and flat.
Lumbar and sacral curves not developed until the newborn begins to sit
Should be patent
Skin color varies with genetic background, pink tinge
bluish discoloration of hands and feet may be present in first 2 to 6 hours after birth.
lacy pattern of dilated blood vessels under the skin occurs as result of general
Harlequin sign (clown)
transient—deep red color develops over one side of body while other side remains pale,
color change results from vasomotor disturbance in which blood vessels on one side
dilate while vessels on other side constrict
Acrocyanosis= bluish discoloration of hands and feet
Assessed to determine hydration status
Whitish, cheeselike substance
Covers fetus while in utero
Lubricates skin of the newborn
Post-term newborn has less vernix.
Exposed sebaceous glands
Appear as raised white spots on the face, especially across the nose
Clear spontaneously within the first month
Forceps marks—present after a difficult forceps birth
Telangiectatic nevi (stork bites)
Seen on Asian, African , and hispanic babies
Nevus flammeus (port-wine stain)
Nevus vasculosus (strawberry mark)
Erythema toxicum on leg.
Jaundice—first detectable on face
First appears where skin overlies cartilage= bridge of nose, mucous membranes of
mouth and has head-to-toe progression.
noted before newborn is 24 hours of age, it should be reported to
Serious blood incompatability
Begins after the first 24 hours
Normal complication caused by
Accelerated destruction of fetal RBCs
Impaired conjugation of bilirubin
Increased bilirubin reabsorption from intestinal tract
Bilirubin peaks in 3-5 days
Bilirubin levels should not excede 13 mg./ dl.
Breast Milk Jaundice
Bilirubin level begins to rise after first week of life.
Level peaks at 5 to 10 mg/dL at 2 to 3 weeks of age
Level declines over first several months of life
Related to milk composition
Associated with poor feeding practices
If bilirubin becomes too high may need to D/C breastfeeding
Prevention of early breastfeeding jaundice:
Encourage frequent breastfeeding,
Access maternal lactation counseling
Conjugation of Bilirubin
Definition: Conversion of yellow lipid soluble pigment into water-soluble pigment
Unconjugated (indirect) bilirubin is breakdown product
Derived from hemoglobin
Released primarily from destroyed RBCs
Unconjugated bilirubin not in excretable form
Total serum bilirubin is sum of conjugated (direct) and unconjugated (indirect) bilirubin.
Fetal unconjugated bilirubin crosses placenta to be excreted, so fetus does not need to
Total bilirubin at birth usually less than 3 mg/dL unless abnormal hemolytic process has been
present in utero
After birth newborn's liver must begin to conjugate bilirubin by itself.
Produces normal rise in serum bilirubin levels in first few days of life
Bilirubin formed after RBCs are destroyed
Direct bilirubin excreted into tiny bile ducts, then into common duct and duodenum.
In the intestinals bacteria transform it into urobilinogen (urine bilirubin) and
stercobilinogen and excreted.
Stercobilinogen is not reabsorbed but is excreted as yellow-brown pigment in stools.
About 50% of full-term and 80% of preterm newborns exhibit physiologic jaundice on about
second or third day after birth.
Yellow color results from increased levels of unconjugated (indirect) bilirubin,
Normal product of RBC breakdown
Reflect body's temporary inability to eliminate bilirubin
Serum levels of bilirubin about 4 to 6 mg/dL before yellow coloration of skin and sclera appear.
Newborn Care Procedures to Decrease Probability of High Bilirubin Levels
Maintain newborn's skin temperature at 36.5°C (97.8°F) or above
Monitor stool for amount and characteristics
Encourage early feedings
Clinical Gestational Age Assessment Tools
Gestational Age can be determine by
maternal menstrual dates
External physical characteristics
Ballard and Dubowitz Assessment tools
Neurological or neuromuscular development
Gestational age testing done soon after birth
Helps to determine possible neonatal complications arising from pre or post term maturity
Square window sign
Amount of breast tissue
Amount of lanugo/ Vernix
Cartilaginous development of the ear
Testicular descent and scrotal rugae or labial development
Correlation of Gestational Age and Birth Weight
Gestational age score, birth weight, length, head circumference are marked on a graph to
determine maturity and Intrauterine growth
Appropriate for gestational age (AGA)= when the newborn is between the 10th and 90th
Small for gestational age (SGA)= Below the 10th percentile,
Large for gestational age (LGA)= Above the 90th percentile
Major Reflexes Present at Birth
elicited when object placed in newborn's mouth or anything touches lips
Disappears by 12 months
Elicited when side of newborn's mouth or cheek is touched.
In response, newborn turns toward that side and opens lips to suck (if not fed recently).
Disappears 4-7 months
Elicited by stimulating newborn's palm with a finger or object
Newborn grasps and holds object or finger firmly enough to be lifted momentarily from crib.
Disappears 3-4 months
Moro or Startle reflex. Elicited when newborn startled by loud noise or lifted slightly above crib
and then suddenly lowered
In response, newborn straightens arms and hands outward while knees flex, slowly arms return
to chest, as in embrace. Fingers spread, forming C, and newborn may cry. Disappears by 6
The Babinski reflex (response) Fanning of toes occurs when lateral aspect of sole is stroked from
heel upward across the ball of foot.
Disappears by 12 months
The stepping reflex disappears after about 4 to 8 weeks.
Tonic neck “Fencer position”
Elicited when newborn is supine and head is turned to one side
In response, extremities on same side straighten, whereas on opposite side they
Disappears by 3-4 months
Trunk incurvation—stroking spine when newborn is prone causes pelvis to turn
to stimulated side.
Prone crawl—When placed on stomachs, they push up and try to crawl.
Newborns can blink, yawn, cough, sneeze, and draw back from pain (protective reflexes).
Behavior during first hours Periods of Reactivity/ inactivity
First period of reactivity
Lasts approximately 30 minutes after birth
Awake and active
Strong sucking reflex
Bursts of random, diffuse movements alternating with relative immobility
Respirations are rapid, may be retraction of the chest, transient flaring of nares, and
Heart rate is rapid and rhythm may be irregular.
Bowel sounds are usually absent.
Period of inactivity to sleep phase
After approximately half an hour
Activity gradually diminishes
Heart rate and respirations decrease as newborn
May last from a few minutes to 2 to 4 hours
Difficult to awaken
Show no interest in sucking
Bowel sounds become audible
Cardiac and respiratory rates return to baseline values
Second period of reactivity
Awake and alert
Lasts 4 to 6 hours
Physiologic responses are variable.
Heart and respiratory rates increase.
Production of respiratory and gastric mucus increases, and newborn responds by
gagging, choking, and regurgitating.
Gastrointestinal tract becomes more active; first meconium stool is frequently passed
and initial voiding may also occur.
Interventions during second period of reactivity
Nurse must be alert for apneic periods, may cause a drop in heart rate.
Newborn is stimulated to continue breathing during such times.
Newborn may develop rapid color changes and become mildly cyanotic or mottled
during these fluctuations.
Continued close observation and intervention may be required to maintain clear airway.
Newborn will indicate readiness for feeding by such behaviors as sucking, rooting, and
swallowing. If feeding was not initiated in first period of reactivity, it is done at this time.
Characterized by closed eyes with no eye movements
Regular, even breathing
Jerky motions or startles at regular intervals
Behavioral responses to external stimuli delayed
Startles rapidly suppressed
Changes in state not likely to occur
Heart rate may range from 100 to 120 beats per minute
Any disturbance of sleep-wake cycle can result in irregular spikes of growth hormone.
REM sleep stimulates highest peaks of growth hormone and growth of neural system.
Drowsy or semi-dozing
Alert and follows
Fixates on attractive objects, faces, or auditory stimuli
Eyes are open
Motor activity is intense
Thrusting movements of extremities
Environmental stimuli increase startles or motor activity
May be distraction from disturbing stimuli such as hunger and pain
Fussiness allows discharge of energy and behavior reorganization
Elicits an appropriate response of help from parents
Behavioral-Sensory Capacities of Newborn
Hand to mouth movements
Sucking on fist
The ability of the newborn to ignore repetitive disturbing stimuli
Ability to be alert to, follow, and fixate on complex visual stimuli
Optimum state for interaction between baby and parents
Newborn prefers human face and eyes and bright shiny objects
Becomes familiar with family, friends, and surroundings
Responds with definite, organized behavior repertoire
Cardiac rate rises
Minimal startle reflex observed
All birthing centers in Florida Screen Newborn hearing
Select people by smell
Taste and Sucking
Sugar increases sucking
Sucking pattern variations
rubber nipple and breast
Sensitive to being touched, cuddled, and held
Settled newborn is able to interact with environment.
Definition: The first few hours of life when the newborn stabilizes respiratory and circulatory
Fetal lung development
Surfactant mixture of surface-active phospholipids (lecithin and sphingomyelin)
Fetal breathing movements
Initiation of breathing
Pulmonary ventilation must be established through lung expansion following
Marked increase in pulmonary circulation must occur
Chemical stimuli = elevated CO2
Thermal stimuli=Change in temperature at birth
Sensory stimuli= light, sounds, drying and wrapping
Greater blood volume to lungs contributes to conversion of fetal circulation to newborn
Shunting of blood is common in early newborn period
Oxygen saturation in newborn's blood is greater than adult's
Amount of oxygen available to tissues is less
Airway resistance is increased in newborn as compared to adult
Onset of respiration triggers increased blood flow to lungs after birth
Major areas of change occur in cardiopulmonary adaptation
Increased aortic pressure and decreased venous pressure
Increased systemic pressure and decreased pulmonary artery pressure
Closure of foramen ovale ( R to L atria)
Closes in 1-2 hours. Blood now flows from aorta to Pul. artey
Closure of ductus arteriosus
Closure of ductus venosus
Closure forces perusion to the liver
90% of all murmurs in newborns are transient.
Hematocrit may rise 1 to 2 g/dL above fetal levels
due to placental transfusion, low oral fluid intake, and diminished extracellular fluid
Hemoglobin level declines progressively over first 2 months of life.
Due to decrease in red cell production and increase in loss.
Leukocytosis is normal finding, because stress of birth stimulates increased production of
neutrophils during first few days of life.
Coagulation factors II, VII, IX, and X are synthesized in liver and activated under influence of
Absence of normal flora needed to synthesize vitamin K in newborn gut results in low levels of
Creates transient blood coagulation alteration between second and fifth day of life
Coagulation factors rise slowly.
Vitamin K =Aquamephyton 0.5- 1mg. given IM prophylactically at birth to combat potential
clinical bleeding problems
25 gauge ½ inch needle
Other Lab Tests on the Newborn
Blood type and Rh
Presence of antibodies(direct Coombs)
May have blood glucose if mom had DM
Metabolic Screening ( In Florida)
Done after 24 hours of protein feedings
For multiple disorders including
Hemoglobinopathies- sickle cell, thallasemia
Congenital Adrenal Hyperplasis
Proteins well digested and absorbed from newborn intestine
Air enters stomach immediately after birth.
Newborn's stomach has capacity of about 50 to 60 mL
Bowel sounds present within first 30 to 60 minutes of birth and newborn can successfully feed
during this time.
Immature Cardiac Sphincter
Regurgitation may be noted
Term newborn requires 120 cal/kg/day to gain weight
Immune Function in Newborn
Limitations in newborn's inflammatory response result in failure to recognize, localize, and
destroy invasive bacteria
There is a poor hypothalamic response to pyrogens
fever is not reliable indicator of infection
Active Acquired Immunity
IgG crosses placenta
Pregnant woman forms antibodies in response to illness or immunization
Passive Acquired Immunity
IgG antibodies are transferred to fetus in utero
Fetus does not produce antibodies itself
Period of resistance varies:
Immunity against common viral infections such as measles may last 4 to 8 months.
Immunity to certain bacteria may disappear within 4 to 8 weeks.
Normal newborn produces antibodies in response to antigen.
Immunize at 2 months of age to develop active acquired immunity.
105-108 kcal/ kg./day
50-55 kcal. /lb/ day
140-160 ml/kg/day of fluid
Increase fluid need in hot weather and during illness
Formula fed babies tend to regain their weight faster- 10 days. Breast fed babies by day
Formulas are made to meet these requirements =20cal/oz.
First feeding is usually 15-30 ml. of water to assure swallow ability.
May regurgitate mucous first few feedings
Stomach capacity= 50-60 ml.
Emptying time about 2-3 hours
Bottle feeding should be at least 1 oz. Q 2-4 hrs
Instruct mother to notify nurse if <30ml/ feeding
Burp at frequent intervals- every 1/2- 1 oz. or between breasts
allows baby to eat more
Breast feeding meets all the nutritional and fluid requirements and should be done q 1-3
Hunger is usually manifested by crying, restlessness, sucking
Parents need to be taught to use bulb syringe to clear nasal/oral secretions
Need to clear nares before feeding ( nose breathers)
Yellowish or creamy-appearing fluid
Thicker than mature milk
Contains more protein, fat-soluble vitamins, and minerals
Contains high levels of immunoglobulins or antibodies
Source of passive immunity for the newborn
2 to 4 days after birth until approximately 2 weeks postpartum
Contains lactose, water-soluble vitamins, elevated levels of fat
More calories than colostrum
10% solids (carbohydrates, proteins, fats)
Water—vital for maintaining hydration
Composition of mature milk varies according to time during feeding
Obtained at beginning of the feeding
High in water content
Contains vitamins and protein
Released after initial letdown of milk
Higher fat concentration
Maure Breast Milk and formulas provide 20kcal/ oz
Nutritional Advantages of Breast Milk
Composed of lactose, lipids, polyunsaturated fatty acids, amino acids
Whey-to-casein protein ratio that facilitates digestion, absorption
High concentration of cholesterol and polyunsaturated fatty acids
Balance of amino acids best for myelination and neurologic develops
Provides minerals in more appropriate doses than formulas
Concentration of iron in breast milk
Lower than that in prepared formulas
Much more readily and fully absorbed
Sufficient to meet iron needs for the first 6 months
Component delivered to the infant in an unchanged form
Vitamins not lost through processing and heating
Protein metabolism produces less nitrogen waste—positive effect on the infant's immature
Immunologic Advantages of Breastfeeding
Protection from respiratory and gastrointestinal infections, otitis media, meningitis,
sepsis, and allergies
Secretory IgA has antiviral, antibacterial effect
Psychosocial Advantages of Breastfeeding
Oxytocin increases with breastfeeding
Even mood responses
Increased feelings of maternal well-being
Other Advantages to Breastfeeding
Milk always perfect temperature
No preparation time needed
Contraindications and Disadvantages of Breastfeeding
Diagnosis of breast cancer
Maternal Human Immunodeficiency Virus (HIV)/ AIDS
Maternal medications may or may not be contraindication
Newborn jaundice may include a brief suspension of breastfeeding.
9 to 12 feedings every day may be considered inconvenient and stressful.
Exclusion of the father from nurturing involved in feeding infant
Maternal smoking – nicotine in breast milk
Breastfeeding after returning to work may be difficult.
Cow's milk proteins
Enriched with tyrosine, phenylalanine, iron, vitamins
Soy protein-based formulas
Isomil, Prosobee, Gerber So
Substitute soy protein supplemented with methionine protein
Used for primary lactase deficiency or galactosemia
Specialized or therapeutic formulas
Casein-hydrolysated or whey-hydrolysated formulas
Allergy or intolerance to cow's milk protein
Use iron-fortified formulas or supplements to prevent iron deficiency anemia
Parents can share equally in the nurturing, caring experience.
Positive parent-infant interaction
Father or anyone can feed baby.
Formula-fed babies gain weight faster because of higher protein.
Potential allergies to formula
Risk for infection in preparation
Need for refrigeration
Establishing a Feeding Pattern
"On-demand" feeding program
Facilitate each baby's rhythm
Assists mother in establishing lactation
Nurse 8 to 10 times in a 24–hour period
Awaken for feedings every 2 to 5 hours
Satisfied with feedings every 3 to 4 hours
Digest more slowly, go longer between feedings
Observe newborn closely
Positioned on right side to aid drainage and facilitate gastric emptying
Social Cultural Influence and Infant Care
Mothers identify modesty and embarrassment as reasons why they may not breastfeed
Consider it indecent to expose breast
Believe that too much handling spoils children
Regard weaning as sign of infant development
Mexican American, Navajo, Filipino, and Vietnamese
Colostrum is not offered to newborn.
Breastfeeding begins after milk flow is established.
Breastfeed because Koran encourages it
Breastfeed until child is 2 years old
Japanese women—breastfeed for baby's first year
African American culture
Emphasize plentiful feeding
Solid foods introduced early and added to infant's formula
Frequent feeding—positive behavioral characteristic
Traditional Mexican women
A fat baby is considered healthy.
Infants fed on demand
To Facilitate Successful Breastfeeding
Position baby comfortably close to mother
Position baby so nose is at level of the nipple
Nose is at level of the nipple
Gums are on areola
both breasts offered at each
Feeding to stimulate supply demand
Stimulate early feedings supply
Burp between feedings on each breast
and at end of feeding
Encourage a Sleepy Baby to Breastfeed
Provide skin-to-skin contact between mom and baby
Have mom rest with baby near her breast
Encourage mom to watch for feeding cues
Vocalization but not necessarily crying
Mother should be taught the signs of milk transfer to infant
Milk appearing in baby's mouth
Breast feeling soft after feeding
Milk leaking from opposite breast
Newborn gains weight
Has six or more wet diapers per day.
Storing Breast Milk
Breast milk can be pumped and stored
Refrigerated milk used within 3 days
Store in clean plastic containers
Can be frozen for up to 2 weeks
The father or other partner is the most important support person.
Baby provides support in form of positive feedback
La Leche League International
Provide education about breastfeeding
Assistance to women who are breastfeeding
Provides printed materials
Offers one-to-one counseling
Local lactation consultants
Drugs and Breastfeeding
Observe infant for
Signs of drug reaction
Changes in sleeping habits or feeding patterns
Most drugs cross into breast milk.
< 1% of maternal dose
Tell physician who may prescribe medications that client is breastfeeding.
Foods can also affect newborn
Caffeine, chocolate can stimulate
Gaseous foods can cause gas
Infant's Nutritional Status Assessed at Each Well-Baby Visit
Weight gain since the last visit
Formula-fed infant—30 g (1oz)/ day for first 6 months of life
Breastfed infant—0. 5 oz/day for first 6 months
Breastfed infant—15 g (0. 5 oz) per day for the second 6 months
Growth chart percentiles
Identify any nutritional disorders
Bathing the newborn and teaching parents
1st Bath after VS and temperature are stabilized
Recheck temp after bath
Sponge bath initially while under warmer
Mild or no soap
Girls clean peri area front to back
Boys be sure foreskin is not left retracted
Triple dye initially, avoid getting wet
alcohol to cord with each diaper change
Will fall off within 10 days- then tub bath OK
Monitor for S & S of infection
Circumscision- surgical removal of foreskin
Religious, parents preference, controversial?
Use of anesthetic or analgesic recommended
Requires parents consent, separate cost
Keep clean, apply petroleum ointment
Observe for bleeding
apply pressure if bleeding occurs
Do not remove yellow exudate or crust
Observe for S&S of infection, decreased urination
Position baby on back to sleep to prevent SIDS
Parents need to have a thermometer and know how to take baby’s axillary temperature &
Call MD for sudden fever, rash, excessive vomiting, abdominal distension,
Car Seat Law all children under 4
Will not be discharged from hospital without seat
Parents should know CPR/ airway clearing
Prevention of Eye infections
Erythromycin opthalmic ointment
Tetracycline opthalmic solution
Prophylaxis for Opthalmia Neonatorum
possible exposure to gonorrhea or chlamydia
May cause irritation or imflammation
Will resolve in 24-48 hours
Hepatitis B Immunization
Administered at birth if Hep B Positive mom or if Hep B status is unknown.
If Mom negative dose can be delayed