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Abdulmahdi A. Hasan*
*Ph,D, pediatric & psychiatric Mental Health Nursing
New Born
 DELIVERY PREPARATION
All needed equipment is available and working properly,
Warmer- head often is in a slight Trendelenburg position to help facilitate drainage of
airway secretions,
Pre-warmed blankets,
Cord clamp,
Wall suction with a mucous trap,
Bulb syringe,
Timer with alarms at 1 and 5 minutes,
Infant stethoscope,
Scale,
Erythromycin eye ointment,
Vitamin K,
and Identification bands.
 Emergency resuscitation equipment should be available,
including:
Oxygen
mask and tubing;
Ambu bag and mask;
laryngoscope with both 0 and 1 blades; Endotracheal tubes sizes 2.5,3.0, 3.5, and 4.0;
and resuscitation drugs including Narcan.
Narcan is used in newborns to reverse respiratory suppression resulting from
maternal pain medication.
 DELIVERY PREPARATION
Review information about the mother’s prenatal history and labor to assess for
potential risks during delivery.
 length of rupture of membranes, any meconium staining to the amniotic
fluid, any signs of maternal infections prenatally or during labor, fetal heart
monitoring such as decelerations, estimated gestational age, single or
multiple gestation, and any maternal pain medications and when they were
last dosed.
Nurses always adhere to standard precautions
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 TRANSITION OF THE NEWBORN
First 28 days of life, the baby is considered a newborn or neonate.
Newborns face the challenge of adapting to extra uterine life.
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 Circulatory Changes
Fetal circulation depends on patency of the foramen ovale (an opening between the
right and left atria) and ductus arteriosus (an opening that allows blood to flow
from the pulmonary artery into the aorta). These two openings allow most blood
volume to bypass the dormant lungs and instead to move through the fetal side of
the placenta, providing oxygen and eliminating carbon dioxide and wastes.
At birth, once the cord is clamped, these two communicating openings must close
for proper circulation.
 TRANSITION OF THE NEWBORN
Newborn color at birth is typically pale or even cyanotic.
As newborns begin breathing and circulation body color to become pinker.
Common to have acrocyanosis or mottling.
With acrocyanosis, the trunk remains pink, but the Extremities appear cyanotic.
Acrocyanosis usually resolves after the first 24 hours.
Mottling is a marbled appearance to the skin that often occurs when neonates are
chilled slightly, such as when being undressed.
Mottling also is related to circulatory labiality and dissipates over time.
 Thermoregulation
Babies are born with a substance in the upper back called brown fat, which is a
stored energy that they can use to generate heat.
Term infants have more brown fat than preterm babies -a finite amount, however,
and once they use it, they produce no more.
Therefore, keeping newborns warm and avoiding cold stressing them are essential .
 The Four Types of Heat Loss in Newborns
Evaporative, occurs immediately as they make contact with air temperature.
Therefore, drying newborns immediately after birth is critical
Conductive, heat from a warm object transfers to a cooler object through direct
contact- use pre-warmed blankets and equipment.
Radiant, occurs when heat is lost from a warm object to a cooler one not in contact
with each other.- radiant warmers,
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Convective, lose heat to cooler air- keep infants away from currents such as air
conditioners and fans.
 Heat Loss in Newborns
The surface area of head is very large compared to the surface area of the body.
Placing a hat on the head can reduce heat loss.
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 Immediate Nursing Care
Drying and Suctioning- mouth first, then nose-so you do not stimulate breathing
and meconium aspiration.
Meconium is the first stool that the neonate passes; it is very thick and sticky.
 Apgar Scoring
Appearance (color),
Pulse (heart rate),
Grimace (irritability to suctioning),
Activity (muscle tone),
Respiration (breathing efforts).
Each of these five items is scored as 0, 1, or 2 for a maximum total of 10.
Apgar scores are given 1 and 5 minutes after birth.
Never wait until 1 minute to decide if a neonate needs resuscitation.
 Immediate Nursing Care
Measurements and Weight
Eye Prophylaxis
Vitamin K Administration
Identification and Safety
Suctioning of Stomach Contents
Documentation
 Newborn Assessment
 Gestational Age
 Head-to-Toe Physical Assessment
 Assessment of Reflexes
 Ongoing Nursing Care
Assessment and Monitoring
Normal pulse rate ranges from 110 to 160 bpm,
Normal respiratory rate ranges from 30 to 60 breaths per minute.
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Take axillary temperature by placing the tip of the thermometer probe
firmly in the axilla and holding it there for 3 minutes.
Tympanic temperature probes, Hold the infant’s head still while performing
a tympanic temperature.
Blood pressure is normally low. Systolic readings from 50 to 80 mm Hg;
diastolic readings from 30 to 50 mm Hg.- usual site used is the leg.
blood glucose level-a heel stick or toe prick to obtain a drop of blood.
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Bathing
Cord Care
After 24 to 48 hours, putting rubbing alcohol on the cord with every diaper
change.
The cord will dry and usually fall off in 10 to 14 days.
Once it falls off, yellowish
or greenish drainage may appear from the umbilicus.
To help dry this drainage, continue to apply alcohol.
Elimination
6 to 10 wet diapers per day.
 Elimination
The first stool is meconium (discussed earlier).
Then greenish to yellow and often seedy.
Within a few days, the stool changes to mushy yellow or golden.
The stool of a breastfed infant is somewhat less offensive in odor than that of a
formula-fed infant.- Document
Change diapers fairly frequently to limit skin exposure to urine and stool to help
prevent diaper rashes.
Discourage use of powder, which can pose an aspiration risk, trap moisture, and
promote rashes.
 Screening Tests
phenylketonuria (PKU),
galactosemia,
maple syrup urine disease,
hypothyroidism,
biotinidase deficiency
hemoglobinopathy
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glucose-6-phosphate dehydrogenase deficiency,
and congenital adrenal hyperplasia.
sickle cell trait. should not be done before 24 hours of life, and
better after 48 to 72 hours of life.
 Circumcision
Circumcision is surgical removal of the foreskin of the penis.
Do not feed the infant right before the procedure, because feeding can
lead to possible regurgitation and potential aspiration.
Sterile gauze dressing remains in place for 24 hours or per doctor or
midwife order.
Inspect the site for bleeding often for the first few hours. And with
every diaper change.
Do not lay the infant on his abdomen for several hours after the
procedure.
Total healing takes approximately 1 week.
 Feeding
Some hospitals have protocols stating that the first thing an infant can
receive is sterile water.
Newborns are fed “on demand.”
Most newborns awaken every 2 to 4 hours to eat.
Most newborns eat 1 to 3 ounces per feeding, often
every 3 hours. Over a few weeks,
Burp the infant after he or she has taken approximately 0.5 to 1 ounce
of formula.
Colostrums, the first breast milk the woman produces after
delivery, is thick and yellowish. It contains many vitamins,
minerals, protein, and fats and is high in antibodies. 2- 4 days
Mothers may find that their breasts become larger, more firm, and
tender. This is referred to as engorgement and typically lasts 24
to 48 hours.
Sore Nipples. woman may rub some breast milk on the nipples
after breastfeeding and allow it to air-dry.
Women should wear cotton bras. They may use breast pads but must
change these frequently to prevent constant moisture against the skin.
should not use soap on the nipple because it is drying.
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They can rub vitamin E oil on the nipples; need to wash it off before
the infant feeds.
Mastitis: Symptoms include redness, swelling, tenderness, feeling
warm to the touch, and fever.
Cause is bacteria from the infant’s mouth entering the breast through
a crack on the nipple.
Treatment is with antibiotics; infant can continue to breastfeed.
 Explaining Infant Behavior
Involve fathers in the care of the infant.
Having a baby is a life-altering event. The parents will no longer have
the freedoms that they once had.
The mother usually sees her physician or midwife 6 weeks after
delivery.
 Promoting Bonding
Bonding refers to the initial attachment process between newborn and
parents. It should begin soon after delivery.
Face-to-face
Nurses also may choose to place the infant’s naked body against the
mother’s naked chest for skin-to skin contact. This provides warmth
for the infant and a sense of attachment between mother and child.
Observe infant–parent interactions and assess for positive attachment.
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