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Newborn Initial Care
Chapter 24: pp. 620, 783, 826- 827, 832, 958-962
First Hour after delivery of infant:
First Priority is Respirations –
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Suction Mouth then Nose
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Assess color
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Signs of distress (see below)
Second Priority is Temperature-
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Dry Infant Off, Stimulate, and get rid of wet towel
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Continual temperature regulation to prevent heat loss
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Wrap Infant
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_______________________
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________________________
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Warm all Equipment
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___________________________
Third Priority is Apgar Score-
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Heart Rate – absent, above or below 100; count _____________ and add a zero
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Respiratory Effort- absent, irregular or good
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Reflex Irritability- absent, grimace or ____________________ when stimulated
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Muscle Tone- flaccid, some flexion, active motion
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Color- cyanotic, ____________________, pink
Good condition is _______________
4-7 needs stimulation
< 4 needs resuscitation
Fourth Priorities include-
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Infant Security
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Identification Bands: one to mother, one to significant other, two to newborn (one on wrist and one on ankle)
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Apply bands snuggly with one finger between
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Keep on until DC
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Some have alarms on band
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Staff must all wear Pink ID badges.
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Instruct all mothers to _____________________________ to anyone who does not have this badge and to keep infant away from door
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Umbilical cord cut and clamp
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Weight and length

Fifth Priority is Attachment-
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Dim lights
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_________________________
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_________________________
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Breast feeding or initiate feeding
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Alone time with infant
Infants Needing Stabilization
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________or LGA infants
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Heart Rate- < 110 or > 160
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First Period of Reactivity
• Lasts _________________
• Awake
• Active
• Hungry
• Respirations rapid with transient signs of distress
• Heart rate ___________ and ________________________
• Bowel sounds absent
Risks for Cold Stress
Who is at risk?
• Premature
• _________
• Hypoxemia in labor or in-utero
• Intracranial hemorrhage
• CNS abnormality
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• __________________________ (premature, LGA ,SGA, IUGR, mothers with GDM or HIP, males, respiratory distress, sepsis, anomalies, epidural anesthesia)
Prevention
• ____________________: Immediately dry infant at birth/after bathing.
• ____________________: Avoid placing infant on cold surface
• ____________________: Avoid cold drafts
• Radiation: Maintain warm environmental
• Unwrap only what is necessary
Signs of Cold Stress:
• Increased movement
• Increased respirations with episodes of ___________________________
• Decreased _____________________ or unstable
• Peripheral vasoconstriction
• Metabolic acidosis
• ________________________
• __________________________
• Hypoxia with decreased surfactant production and atelectasis
Thermoregulation: Don’t use the warmer read out for your assessment
97.2 to 97.6
• Temperature under _______________________
• Document both temps
• Skin to skin with hat on and warm blanket
• Breastfeed or radiant warmer (no blanket or hat on; use probe under warmer)
97.1 Or less
• Temperature under each arm
• Document both temps ___________________________
• Radiant warmer ________________________________
• Re-warm ___________________; about one degree per hour
• Check for hypoglycemia
Once temperature is achieved, wrap, recheck in __________________________ then hourly
Hypoglycemia: 0- 12 hours old
Who is at risk?
• Premature (< 37 weeks)
• LGA , SGA or IUGR
• Mothers with GDM, HIP, or Terbutaline
• Polycythemia (twins)
• _____________________
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• ______________________
• Anomalies
• Males
• Epidural anesthesia
Prevention
• _________________________________- Assess newborn for risk factors
• Check blood glucose as appropriate for infants at risk (preterm, mother DM, etc.)
• Provide early, frequent feedings.
• _________________________
• Ensure no respiratory distress
Hypoglycemia Signs
• Glucose of < 40 mg/dl
• Lethargy or limp or hypotonia
• __________________________
• Irritable
• High-pitched cry
• Poor feeding or vomit or loss of swallow reflex
• Hypothermia or _______________________
• Cyanosis or pale
• _______________ or irregular breathing
• Seizures or exaggerated moro
Steps of Heel Stick
ID infant
Medial or lateral aspect of heel
Pre-warm heel
Flex foot
Clean with alcohol
Dry with gauze
Puncture heel
Wipe first drop
Apply blood to glucometer; fill the strip
Apply pressure to site
Algorithm for Birth to Four Hours of Life
Blood Sugar Testing
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Normal BS (> 40 mg/dl glucose level)
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Test in the presence of risk factors or symptomatic
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Within the 30 minutes to one hour of life
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Breastfeed if no symptoms
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Monitor 24 hours if SGA, LGA, IDM
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Symptomatic
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Check immediately
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< 40m
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Serum level
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Notify Neonatologist
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Notify NICU
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Feed
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Recheck in one hour
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> 40
 Feed
 Notify pediatrician
Asymptomatic with High Risk Factors
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Initiate feeding within 30 to 60 minutes
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Screen 30 minutes after feeding or within 2 hours of birth
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>40
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Recheck before the next three feeding or within 3 hours of last check
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>30-39
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Serum level
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Feed
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Recheck in one hour
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Critical Value < 30 mg/dl or Symptomatic and < 40 mg/dl
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Notify Neonatologist
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Notify NICU STAT to determine if admitted to NICU
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Venous serum level
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Possible IV D10W 2 ml/kg
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Feed
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Recheck in one hour
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Continues < 30, transfer to NICU
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>30-39 or > 40 follow pathways above
Feeding
Skin to skin
Breast feed immediately (if not latching within 15 to 30 minutes, express mild and colostrum)
If continues to not eat, bottle feed 3-10 ml/kg by the first hour of life
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