Nursing Care of The New
Born Infant
Retnayu Pradanie
01/04/09
Introduction
The neonatal periode is the time from
birth through the twenty day of life.
During this time the newborn must
accomplish a number of physiologic
and behavioral adjusments in order to
establish and maintain an
extrauterine life
Transition Period: Phases of
instability during the first 6-8 hours
after birth
Nurses play a vital role during the
transition periode
Help the newborn infant make a safe
transition to extrauterine life
Perform the initial assessment of the
newborn infant
Provide a physical environment
conducive to adaptation
Monitor the newborn infant’s condition
during the early adaptation phases
Immediate Care of
the Newborn
Start by congratulating the mother on
the arrival of her new baby and ask if
she has any concerns. The mother is
usually the first person to notice any
problems.
Doing initial newborn assessment
Initial Newborn assessment
Stimulate and dry infant
Asses ABCs
Encourage skin-to-skin contact
Assign APGAR score
Give eye prophylaxis & vit K
• sterile ophthalmic ointment
containing 1% tetracycline or 0.5%
erythromycin
• 1 mg of Vit K IM to prevent
hemorhagic
Initial assessment: Apgar Scoring
The most frequently used method to
assess the newborn's immediate
adjustment to extrauterine life.
The score is based on observation of :


Heart rate.

Respiratory effort.

Muscle tone.

Reflex irritability.

Color.
● Each item is given a score of 0, 1,or 2.
Apgar Scoring
SIGN
SCORE
0
1
2
Heart Rate
Absent
Slow (<100)
Over 100
Raespiratory
Rate
Absent
Slow, weak
cry
Good cry
Muscle Tone
Flaccide
Some flexion
of extremities
Well flexed
No response
Grimace
Cry
Blue, pale
Body pink,
extremities
blue
Completely
pink
Reflex
irritability
Color
Initial assessment: Apgar Scoring
Evaluation of all five categories are made
at 1 and 5 minutes after birth and repeated
until the infant's condition stabilized.
Total scores of 0-3 represent severe
distress.
Scores of 4-6 signify moderate difficulty.
Scores of 7-10 indicate absence of difficulty
in adjusting to extrauterine life
Initial assessment: Apgar Scoring
The Apgar score is affected by the
degree of :
- Physiologic immaturity.
- Infection.
- Congenital malformations.
- Maternal sedation or analgesia.
- Neuromuscular disorders.
Transitional assessment
Periods for reactivity:
First period of reactivity: For 6-8 hours after
birth.


Initial stage of alertness and activity:
- During the first 30 minutes.
- The infant is very alert, cries vigorously,
very interest in the environment.
- Neonate's eyes are usually open;
- The newborn has a vigorous suck; this is
an opportune time to begin breastfeeding
Transitional assessment
- physiologically, the resp rate is high as 80
breath/min, crackles may be heard, heart rate
reach 180 beat/min, bowel sound are active ,
mucus secretions are increased, and temp may
decrease.
2. Second stage:
- Lasts to 2-4 hours,
- Heart and resp rate decrease, temp continues to
fall, mucus production decreases ,and urine or
stool is usually not passed.
- The infant is in state of sleep and relative calm.
- Undressing or bathing is avoided during this time
Transitional assessment
-
The second period of reactivity: begins
when the infant awakes from this deep
sleep.
It lasts about 2-5 hours and
The infant is again alert and responsive,
Heart and resp rates increase.
The gag reflex is active gastric and
respiratory secretions are increased,
Passage of meconium frequently occurs.
This period is usually over when the
amount of respiratory mucus has
decreased.
Clinical assessment of gestational age
A frequently used method of
determining gestational age is the
simplifies Assessment of Gestational
Age by Ballard(1979):
- It assess six external physical and six
neuromuscular signs
- Each sign has a number score, and
the cumulative score correlate with a
maturity rating of from 20 to 44 weeks
of gestation.
Weight Related to Gestational Age:
● Birth weight alone is a poor indicator of
gestational age and fetal maturity .
● Maturity: functional capacity: the degree to
which the neonate's organ systems are
able to adapt to the requirements of
extrauterine life
● Classification of infants at birth by both
birthweight and gestational age provides
amore satisfactory method for predicting
mortality risks and providing guidelines for
management of the neonate than
estimating gestational age or birth weight
alone.
Clinical assessment of gestational age
● Appropriate for gestational age (AGA) :the
infant whose weight is between 10th and 90th
percentiles. Can be presumed to have
grown at a normal rate regardless of the
time of birth_ preterm, term, or post term.
● Large for gestational age (LGA): above
90th percentile can be presumed to have
grown at an accelerated rate during fetal life
● Small-for-gestational-age (SGA) infant
below 10th percentile can be assumed to
have intrauterine growth retardation or
delay.
Clinical assessment of the newborn
(General Examination)
Examine skin for prematurity or dismaturity
Thin,
transparent skin
in preterm
infants
Wrinkled peeling skin of
dysmaturity in an IUGR infant
Pale pink skin
of a term
infant (hair
shaved to site
IV line)
Skin: some common normal findings
Vernix caseosa: a cream/white cheesy
material on the skin at birth which cleans
off easily with oil.
Lanugo; fine downy hairs seen on the back
and shoulders especially in preterm infants.
Milia: pinpoint whitish papules on nose and
cheeks due to blocked sebaceous glands.
Mongolian blue spots: grey/bluish pigment
patches seen in the lumbar area, buttocks
and extremities in dark skinned
babies.They usually disappear by one year.
Skin: some common normal findings
Capillary heamangiomas (“stork bite”
naevi): red flat patches which blanch
with gentle pressure. Commonly
occur on upper eyelids, forehead and
nape of the neck.
Erythema toxicum: small white/yellow
papules or pustules on a red base
seen on face, trunk and limbs.
Develop 1 – 3 days after birth and
usually disappear by one week.
Colour
Note palor or plethora
Cyanosis: the baby should be uniformly
pink
Blueness of the hands and feet (peripheral
cyanosis) may be due to cold extremeties.
Blueness of the mucous membranes and
tongue is central cyanosis and is usually due
to lung or heart problems
Bruising (ecchymosis) is common after
birth trauma. Unlike cyanosis, bruising
does not blanch on gentle pressure.
Jaundice
Jaundice is common in the first
week of life and may be missed
in dark skinned babies
Blanch the tip of the nose or hold
baby up and gently tip forward
and backward to get the eyes to
open.
Teach mother to do the same at
home in the first week and report
to hospital if significant jaundice
is observed.
After general examination
After these general observations,
examine the infant starting with the
head and moving down the body
(Head to toe examination)
Count the respiratory rate
normal 30 – 40 breaths/min in term
infants
faster in preterms.
> 60 / minute abnormal
After general examination…
Measure:
Weight
normal 2.5 – 3.99 kg
Length
normal 48 – 52 cm
Occipitofrontal circumference (OFC)
normal 33 – 37 cm
Infants at Risk
gagging --> turning blue (esp. after
feeding)
generalized cyanosis
weak cry
grunting or respiratory distress
decreased or absent movements
excessive twitching or trembling
Nursing Diagnosis:
Ineffective Airway Clearance R/T excessive
oropharyngeal mucus
Ineffective Thermoregulation R/T newborn
transition to extrauterine life
High Risk for infection R/T maturational
factors, immature immune system
PC: Hypoxemia PC: Hyperbilirubinemia
(W) Beginning Integration of NB into Family
Unit
Nursing care of the newborn
The major elements of routine care:
Cord care
Thermal control
24 hour rooming in
Feeding
Immunization
Maternal education on hygiene
Cord Care
The umbilical stump needs particular
attention as there are risks of bleeding and
infection.
Good cord care includes:
Cutting cord with sterile equipment or a new
razor blade depending on the setting
Ligation with a sterile plastic clamp or clean
thread
Keeping cord stump exposed, clean (with 70%
alcohol, 4% chlorhexidine or simple soap and
water) and dry
Cord Care and Research
1,811 NB’s- 2 groups - one
receiving cord care with
alcohol and one group not:
equal # infections in infants
who received and did not
receive cord care
cord separation ~ alcohol
use: 9.8 days and no
alcohol use: 8.16 days
Thermal Control
The causes of heat loss at birth:

Evaporation: the lost of heat through
moisture (a major cause).
Radiation: the lost of heat to cooler solid
objects in the environment that are not in
direct contact with the infant.
Conduction: loss of heat from the body
because of direct contact of skin with a
cooler solid object
Convection is similar to conduction,
except that heat loss is aided by
surrounding air currents; as direct flow of
air from air conditioner vent.
Measures to prevent hypothermia
include:
Delivery in a warm environment
Immediate drying of the infant to
minimize heat loss by evaporation
Bath after temperature is stable
Keep out of drafts
Skin to skin contact with mother
Proper clothing and wrapping up
with linen including use of booties
and bonnets
Regular feeds
A well dressed baby
Rooming In
refers to the practice of nursing babies with
their mothers rather than keeping them in a
separate nursery
Advantages:

Promotes bonding

Makes exclusive breastfeeding easy

Mother is able to keep a close watch on her infant.
She should be encouraged to report any concerns
that she has to the health care staff.
Feeding
Breast feeding remains the best
method of feeding the newborn and has
the following advantages:
Breastmilk is nutritionally balanced
It reduces the risk of infection especially
in unhygienic situations
Protects against diarrhoea and other
infections in infancy
Promotes mother-child bonding
It is readily available
It helps in child spacing
Immunization
Example of an immunisation
schedule
At birth
6 weeks
10 weeks
14 weeks
9 months
BCG, Oral polio & HBV1
DPT1, Oral polio & HBV2
DPT2, Oral polio
DPT3, Oral polio & HBV3
Measles, yellow fever
Hygiene and prevent infection
Hand washing.
A common practice in many newborn nurseries is
the use of cover gowns to prevent infection.
Eye care, umbilical care, bathing, care of the
circumcision.
Vitamin K is administered to protect against
hemorrhage.
Proper identification.
No tub baths until cord off and healed
clean around organs of elimination and mouth
after soiling to prevent skin break down
fold diapers away from umbilicus
Questions and
Discussions
Thank You