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Care-of-the-Newborn

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									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
   acronym               Score of 0            Score of 1                 Score of 2

Appearance                             blue at extremities
Skin color                                                       no cyanosis
                      blue all over    body pink
                                                                 body and extremities pink
                                       (acrocyanosis)
Pulse rate            Absent           < 100                     >100

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

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.

								
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