Clinical Preparation for Infant Care
Read chapters in textbook Part 6, The Newborn.
Nursing care of the newborn involves careful planning, modeling behaviors, and patient education for
families.
Review the following:
https://www.merckmanuals.com/professional/pediatrics/perinatal-problems/gestationalage#:~:text=Newborn%20physical%20examination%20findings%20also,in%20the%20first%2024%20hou
rs).
Circumcision
The nursery nurse also assists with circumcision. Please be prepared for this on your nursery clinical day.
Parents also ask about the procedure and aftercare. Discharge instructions for “circ care” are the
responsibility of the nurse. Baby will not be able to be bottle fed for up 2-3 hr prior to the procedure to
prevent vomiting and aspiration. Newborns can be breastfed up until the procedure. The newborn will
be restrained on a board during the procedure. Keep the area clean. Change the newborn’s diaper at
least every 4 hr and clean the penis with warm water with each diaper change. With clamp procedures,
apply petroleum jelly with each diaper change for at least 24 hr after the circumcision to keep the diaper
from adhering to the penis. Avoid wrapping the penis in tight gauze, which can impair circulation to the
glans. Do not give a tub bath until the circumcision is healed. Until then, trickle warm water gently over
the penis. Notify the provider f there is any redness, discharge, swelling, strong odor, tenderness,
decrease in urination, or excessive crying from the newborn. A film of yellowish mucus can form over
the glans by day 2. Do not wash it off. Avoid using premoistened towelettes to clean the penis because
they contain alcohol. The newborn can be fussy or can sleep for several hours after the circumcision.
Provide comfort measures for 24-48 hr, to include acetaminophen as prescribed. The circumcision
should heal completely within a few weeks. Report any frank bleeding, foul-smelling drainage, or lack of
voiding to the provider.
Remember that circumcision requires informed consent from the parent. Read about the medical
benefits of circumcision and be prepared to discuss pros and cons. Pros: easier hygiene, decreased risk
of STIs (HIV, HPV), decreased risk of penile cancer and cervical cancer in female partners. Cons/Risks:
hemorrhage, infection, inflammation or stenosis of the urinary meatus, urethral fistula, adhesions or
dehiscence of the skin, concealed peins.
#Circumcision #Plastibel #BabyCircumcision
SIDS – review online and in textbook/ATI
We must always teach patients how to decrease SIDS risks during discharge planning. Remember “Back
to Sleep”!
Be familiar with how to prevent SIDS and explain/educate your new parents: place your baby on his or
her back for all sleep times-naps and at night. Use a firm, flat sleep surface, such as a mattress covered
by a fitted sheet. Keep your baby’s sleep area in the same room where you sleep until your baby is at
least 6 months old, or ideally until your baby is one year old. Keep soft bedding such as blankets, pillows,
bumper pads, and soft toys out of your baby’s sleep area. Do not cover your baby’s head or allow your
baby to get too hot, signs your baby may be getting too hot include sweating or his or her chest feels
hot.
Review Apgar scoring in text and on YouTube
Appearance (skin color): 2 normal color all over (hands and feet are pink), 1 normal color (hands and
feet are bluish), 0 bluish-gray or pale all over
Pulse (heart rate): 2 normal (above 100 bpm), 1 below 100 bpm, 0 absent (no pulse)
Grimace (“reflex ability”): 2 pulls away, sneezes, coughs, or cries with stimulation, 1 facial movement
only (grimace) with stimulation, 0 absent (no response to stimulation)
Activity (muscle tone): 2 Active, spontaneous movement, 1 arms and legs flexed with little movement, 0
no movement “floppy” tone
Respiration (breathing rate and effort): 2 Normal rate and effort, good cry, 1 slow or irregular
breathing, weak cry, 0 absent (no breathing)
Prepare yourself to administer cord care: The cord will dry out and eventually fall off within 1-3 weeks
after birth. Prior to it falling off you should: keep the stump dry by keeping the baby’s diaper folded
down to avoid covering the stump and letting the stump be exposed to air to help dry out the base.
Sponge bath your baby while the stump is still attached, this will make it easier to keep the stump dry,
although it is ok to get the stump wet it is not recommended that it sits or soaks in water while bathing
your baby. Let the stump fall off on its own, resist the temptation to pull the stump off before it is ready.
List uses and dosages for the following frequently used medications:
Review the rationale for administering Hep B, vitamin K and antibiotic for eye prophylaxis.
Hepatitis B vaccine
Vitamin K
Erythromycin
NICU CLINICAL PREPARATION
Review Chapters in Text on Newborn Complications Part 8
Define these pathologies and be familiar with etiology, symptoms, diagnosis, medical treatment, and
nursing care for each:
1. ABO Incompatibility: Most common maternal-fetal blood group incompatibility and most
common cause of hemolytic disease of baby. Common in type A over type B. Diagnosed by cord
blood testing, CBC, elevated bilirubin levels. Treated with light therapy. Full recovery usually
occurs with no lasting repercussions. Signs and symptoms: pale, jaundice, splenomegaly,
hepatomegaly, swelling.
2. Rh Incompatibility: occurs when mother and baby have different blood types. Mom is Rh- and
baby is Rh+. Blood can cross during delivery. Does not affect mom. Can cause hemolytic anemia
in baby. Treated with Rh immune globulin
3. NEC (necrotizing enterocolitis): Serious GI problem mostly affects premature babies.
Inflammation of intestine tissue causing it to die. A perforation may form in intestines. Bacteria
can leak into abdomen or blood. Signs and symptoms: abnormal gas patterns. Stop all feedings,
NG tube, antibiotics, check for blood in stool.
4. ROP (retinopathy of prematurity): Abnormal blood vessels grow and spread through retina. Can
cause scarring of retina and retinal detachment. Usually resolves without treatment. Advanced
ROP can cause vision problems or blindness.
5. IVH (intraventricular hemorrhage): Low O2 levels, changes in BP breathing problems can cause
IVH. Can damage blood vessels. Low birth weight can also cause IVH. Treatment: supportive
care, fluid and O2. Signs and symptoms: swelling of head, seizures, abnormal BP. Diagnosed with
head ultrasound
6. Respiratory Distress Syndrome: Breathing disorder caused by immature lungs. Usually develops
within first 24 hours after birth. Usually in premature 6 weeks or more. Treatment: O2 therapy,
breathing support, surfactant replacement
7. Gastroschisis & Omphalocele: Birth defect of the abdominal wall, intestines outside of the body.
Signs and symptoms: lump in abdomen. Treatment with surgery
8. Neonatal Abstinence Syndrome: Infant withdrawal from drugs they were exposed to in utero.
Signs and symptoms: shakes, overactive reflux, excessive crying, poor feeding, breathing
problems, fever, blotchy skin. Can last up to 6 months.
9. Microcephaly: Baby’s head is significantly smaller than expected. Causes: infections,
malnutrition, exposure to toxins. Can cause speech defect, intellectual disabilities. No cure,
supportive care
10. Patent Ductus Arteriosus / Cardiac Defects: Heart defect caused by problem in heart
development. Opening between 2 blood vessels leading from the heart. May be asymptomatic if
small but can cause poor eating, breathlessness
11. Sepsis (early signs of neonatal infection): In infant <90 days old signs and symptoms: body temp
changes, diarrhea, decreased bowel movements, decreased blood sugar, seizures, changes in
HR, reduced feedings, sucking
12. Hyperbilirubinemia: Liver condition. Signs and symptoms: jaundice. Treatment: light therapy,
supportive care, IV fluids, monitor labs
Review the following aspects of NICU care:
1. Kangaroo Care (k-care): skin to skin care that can help regulate heart rate, breathing pattern,
and temperature, can enhance breastfeeding, can decrease pain perception during heel stick.
Often used with premature babies.
2. Gavage feedings: method to provide nourishment to an infant who is compromised by
respiratory distress, an infant who is too immature to have coordinated suck and swallow reflex,
or an infant who is too fatigued by sucking. The infant is fed through a nasogastric or orogastric
tube.
3. Phototherapy: Use of visible light to help treat jaundice
4. Mechanical Ventilation: used for infants who have apnea with bradycardia, ineffective
respiratory effort, shock, asphyxia, infection, meconium aspiration syndrome, RDS syndrome, or
congenital defects that affect ventilation. Goal is to oxygenate baby and remove CO2 &
minimize damage to lungs. Positive pressure is most common in neonates.
5. PICC lines: Can last 2-3 weeks. Usually given for long term IV meds. Placed in arm, leg, or scalp
6. Oxygen therapy: Heart or lung problems can be treated with O2 therapy.
List uses and dosages for the following frequently used medications:
Prevacid: not used often. (PPI) decreased acid reflux, healing of duodenal ulcers. Children 1-11 y/o
greater than or equal to 30 kg give 15 mg daily.
Reglan: not used often. Antiemetic. Facilitation of SBO intubation. IV <6 y/o: 0.1 mg/kg over 1-2 min
Gentamycin: anti-infective. IM/IV neonates: 2.5 mg/kg/dose Q 18-24 hr
Ampicillin: anti-infective. GBS neonates: 200 mg/kg/day divided Q 8 hr
Surfactant: Pulmonary surfactant - prevention of RDS in premature infants. 5.8 mL/kg. Repeated nomore
than Q 6 hr, do not exceed 4 doses in first 48 hr
Caffeine: respiratory stimulant. Short term treatment of idiopathic apnea of premature infants between
28- <33 weeks gestational age. Loading dose 20 mg/kg. Maintenance dose starting at 24 hr after loading
dose, 5 mg/kg Q 24 hr
AZT: anti-retrovirus. Reduction of maternal/fetal transmission of HIV, decreases transmission of HIV to
infants. IV neonates: 1.5 mg/kg Q 6 hr until 6 weeks. PO: 2 mg/kg Q 6 hr until 6 weeks