CARE OF INFANT AND FEEDING
STUDY GUIDE
Three types of newborn:
1. Preterm
2. Term
3. Post term
Immediate care of newborn
1. Establishment of respiration and maintain clear airway
2. Provision of warmth and maintenance of body temperature
3. Prevent infection
4. Prevent haemorrhage
5. Infant’s identification
6. Initial feeding
7. Bonding
8. Immunization
Normal Adjustment o Extrauterine Life
 First period of reactivity- first 15 to 30 mins
 Resting period- 30 to 120mins
 Second period of reactivity
Physiologic function
1. Respiratory System
The most critical and immediate change required of the newborn is the onset of breathing.
2. Cardiovascular System
Equally important as the initiation of respiration are the circulatory changes that allow blood flow through
the lungs.
3. Gastrointestinal System
The ability of the newborn to digest, absorb, and metabolize foodstuff is adequate but limited in certain
functions.
4. Renal System
The first voiding should occur within 24 hours. The urine is colorless and odourless.
Kidneys cannot sufficiently concentrate urine to conserve body water.
5. Integumentary System
Plugging of sebaceous glands causes milia. Retention of sweat may cause milliaria.
6. Musculoskeletal System
At birth the skeletal system contains larger amounts of cartilage that ossified bone.
7. Defences against infection
Infants are generally not capable of producing their own immunoglobulins until the beginning of 2nd month of
life but they receive considerable passive immunity from maternal circulation and from human milk. They are
protected against major diseases provided the mother developed antibodies to these illness.
8. Endocrine System
Adequately developed but its function are immature. The effect of maternal sex hormone in newborn is
evident. The labia are hypertrophied and the breast are enlarged and secrete milk (witch’s milk) from the first
days until 2 months. Female newborns may have pseudomensration (milky secretion than actual blood) from
sudden drop of progesterone.
9. Neurologic System
At birth the nervous system is incompletely integrated but sufficiently developed to sustain extrauterine life.
Most neurologic functions are primitive reflexes.
10. Sensory Functions: Vision, Hearing, Smell, Taste, Touch
AGPAR Scoring –
Sign
0
1
2
Heart Rate
absent
slow, <100
>100
Respiratory
absent
irregular, slow, weak cry
good strong cry
Muscle tone
limp
some flexion of extremities
well reflex
Reflex irritability
no response
grimace
cry, sneeze
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Color
blue, pale
body pink, extremities blue
completely pink
Score
o 0-3 severe distress
o 4-6 moderate difficulty
o 7-10 absence of difficulty in adjusting to extrauterine life.
Silverman and Anderson scoring system
Sign
0
1
2
Chest movement
synchronized lag on inspiration
see-saw respiration
Intercostals retraction none
just visible
marked
Xiphoid retraction
none
just visible
marked
Nares dilatation
none
minimal
marked
Respiratory grunt
none
audible by
audible by ear stethoscope
Score
o No respiratory distress
o 4-6 moderately depressed
o 7-10 severely depressed
Physical assessment of the newborn
Assessment Area
General Measurements:
Head circumference
Chest circumference
Crown to rump length
Head to heel length
Birth weight
Abdominal cir.
Vital Signs:
Temperature
Heart rate (Apical pulse)
Respirations
Blood pressure
General Appearance:
Posture
Skin
Hydration
Cry
Head
Anterior Fontanel
Posterior Fontanel
Sutures
Face
Eyes
Ears
Nose
Mouth and throat
Neck
Chest
Lungs
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Usual findings
33-35 cm
31-33 cm
31-35 cm
48-53 cm
2500-3000g (Fil) 6-9lbs
29-30 cm
36-37
120-160 beats/min
30-60 breaths/min., quiet and shallow, diaphragmatic, occasional
periods of rapid breathing, alternating with short periods of apnea
65/41mm Hg in arm and calf
Flexed
At birth, bright re, puffy, smoot to third day pink, flaky, dry, vernix
caseosa, lanugo, Accrocyanosis, cutis marmorata, milia, milliaria,
erythema toxicum, monglian spot, stork bites, harlequin color change
Good skin turgor
lusty
Elongated
Flat, soft, firm, diamonds shaped, 2-3 cm W, 3-4 cm L
Triangular in shape, 1-2 cm, almost closed
Sagittal, Lambdoid, coronal, frontal
Small, round, symmetrical fat pads in cheeks, receding chin
Lids edematous, usually closed, colo (slate grey, dark blue brown),
absence of tears, presence of red reflex, pupils equal
Positio (top of pinna on horizontal line with oute cantus of eye),
startle reflex, pinna flexible, patent
Patent, sneezing, white nasal discharge
Intact lips, gums, palate, sucking reflex, Epstein pearls, rooting reflex,
gag reflex, extrusion reflex, vigorous cry, absent of salivation
Short, thick surrounded by skin folds, TNE, torticollis
Equal, slight sternal retractions, breast engorgement
Respiration abdominal, equal breath sounds
Heart
Abdomen
Umbilical cord
Genitalia
Female
Male
Anus
Back
Reflexes
Eyes
Blinking or corneal
Pupillary
Doll’s eyes
Nose
Sneeze
Mouth
Sucking
Gag
Rooting
Extrusion
Yawn
Cough
Extremities
Grasp
Babinski
Mass
Moro
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Apex (4th to 5th inercostal space)
Cylindrical, slightly protuberant, no masses, femoral pulses equal
No extensive protrusion or herniation, no discharges, 3 blood vessels,
whartons jelly
Appropriate for gender
Labia and clitoris usually edemaous, urethral meatus behind clitoris,
vernix caseosa between labia, urination within 24 hours
Urethraloping at tip of glans penis
Scrotum usually large, edematous, pendulous, covered with rugae,
deply pigmented, smegma
Urination within 24 hours
Patent, passage of meconium within 24 hours, anal reflex
Spine intact, no openings, masss or prominent curves
Ten fingers and toes
Full range of motion
Nails bedspink, with transient cyanosis, immediately after birth
Creases on anterior 2/3 of sole, sole usually fat
Symmetry of extremities, equal muscle tone
Expected Behavioral Responses
Infant blinks at sudden appearance of a bright light or at an approach of an object
toward conea: persists throughout lie
Pupil constricts when a bright light shines toward I; it persists throughout life
As head is moved slowly to right or left, eyes lag behind and do not immediately adjust
to know position of head; disappears as fixiation develops; of indicates neurologic
damage
Spontaneous response f nasal passages to irritation or obstruction; persists
throughout life
Infant begins strong sucking movements of circumolar area is response o stimulation;
persists throughout infancy even without stimulation, such as during sleep
Stimulation of posterior pharynx by food, suction, or passage of a tube causes infant
to gag; persists throughout life
Touching or stroking the cheek alongside mouth causes infant to turn head toward
that side and begin to suck; should disappear at about 3-4 months; but may persist
for upto 12 months
Wen tongue is touched or depressed, infant responds by forcing it outward;
disappears by age 4 months
Spontaneously response to decreased oxygen by increasing amount of inspired air;
persists throughout life
irritation of mucus membrane of larynx or tracheabronchial tree causes coughing;
persists throughout life; ususlly present after first day of life
Touching palms of hands of soles of feet near base of digits causes reflexion of hands
and toes; palmar grasp lessens after age 3 onths to be repaced by voluntary
movement; plantar grasp lessense by 8 months of age
Stroking outer sole of foot upward from heel and across ball causes toes to
hyperextend and hallux to dorsiflex; disappears after age 1 year
Sudden jarring or change in equilibrium causes sudden extension and abduction of
extremities and fanning of fingers, withindex finger and thumb orming a C shape,
followed by reflexion and abduction of extremities; legs may weakly flex; infant may
cry; disappears after 3-4 months, usually strongest during 2 months
Startle
Asymmetric
Dance or step
A sudden loud noise causes abduction of the arms with reflexion of elbows; hands
remain clenched; disappears by 4 months
When infant’s head is turned o one side, arm and leg extend on that side, and opposite
arm and leg Tonic neck flex; disappears by age -4 months, to e replaced by symmetric
positioning of both sides of body
If infant is held so that sole of foot touches hard surface, there is a reciprocal flexion
and extension of leg, stimulating walking; disappears after age 3-4 weeks, to be
replaced by deliberate movement
Nutrition
1. Breast-milk is the most complete diet during the first 6 months
2. The addition of solid foods before 4-6 months is not recommended
3. During the second half of the first-year, BF or formula is the primary source of nutrition
4. Iron fortified cereal is generally introduced first because of its high protein content
5. The addition of other foods is arbitrary
6. Weaning should be gradually by replacing one bottle or BF at a time
Health Problems of Newborn
1. Birth Injuries
o Caput succedaneum – edema of scalp
o Cephallematoma- accumulation of blood between periosteum
o Fracture of clavicle – assymetric moro reflex, cry when arms are moved
o Facial paralysis – drooping corners of mouth
o Brachial palsy – arms hangs limp alongside of the body
2. Hemolytic disease of the newborn erythroblast
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