Chapter 10
Nursing Care
of the Newborn
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
1
Phases of Newborn Care
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2
Objectives
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Define key terms listed.
Discuss the nursing responsibilities
concerning the care of the newborn infant.
Describe a neutral thermal environment.
Demonstrate three ways to hold a newborn.
Demonstrate the proper way to suction the
newborn with a bulb syringe.
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3
Three Phases
of Newborn Care
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Phases of Newborn Care
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Phase 1: birth to 1 hour
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Phase 2: 1 to 4 hours
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First period of reactivity; takes place in delivery
room
Assessment is completed; may take place in
newborn nursery or mother’s room
Phase 3: 4 hours to discharge

Second period of reactivity; takes place in
mother’s room; involves nursing interventions and
family teaching
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5
Phase 1 Nursing Interventions
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Clamping the Umbilical Cord
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Initially white and gelatinous
Two umbilical arteries and one vein (“AVA”)
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Begins drying within 1 to 2 hours after birth
Once newborn is stabilized, disposable
umbilical clamp applied
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Deviations should be reported immediately
Bleeding/foul odor should be reported immediately
Cord cut shorter in length
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Cord Care
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May include
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Cotton swab with isopropyl alcohol
Triple dye
Saline or other solution ordered by health care
provider
Clean around base of cord where it joins the
skin
Do at every diaper change
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8
Identification and Security
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Matching ID bands
placed on newborn
and mother
Newborn has two:
one on wrist, one on
ankle
Electronic sensor
may also be applied
to infant’s band
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Birth Certificates

Completed before discharge or within 48
hours of birth
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
Health care provider should review data on
certificate, because it increases accuracy of
information recorded
Need throughout life
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Thermoregulation

Maintain a neutral thermal environment
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Allows for minimal oxygen consumption but is
adequate to maintain body temperature
Room temperature should be maintained at 24°
to 25° C (75.2° to 77° F)
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Temperature Readings
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Rectal or axillary
Normal: 36.5°to 37.5°C (97.7°to 99.5°F)
Hypothermia
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Mild – 36° to 36.4° C (96.8° to 97.5°F)
Moderate – 32.0°to 35.9°C (89.6°to 96.6°F)
Severe – less than 32.6°C (90.7°F)
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Hypothermia
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Can cause
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Increased cell metabolism
Increased oxygen consumption
Hypoglycemia
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13
Kangaroo Care
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Newborn placed on
naked chest of
mother
Helps stabilize
newborn’s body
temperature
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Administering IM Injection
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Vitamin K (phytonadione [Aqua-MEPHYTON]
0.5 to 1 mg)
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Given to aid in blood clotting
Newborn cannot synthesize vitamin K without
the presence of bacterial flora
Administer in mid-anterior thigh
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Prophylactic Eye Care
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Erythromycin
ophthalmic ointment
placed in both eyes
Prophylaxis against
gonococcal
ophthalmia
neonatorum, which
can cause blindness
Also destroys
Chlamydia organisms
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End of Phase 1 Care
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17
Phase 2
Routine Nursing Interventions
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Weight
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Performed in birthing room or on admission to
newborn nursery
Normal full-term newborn weighs
approximately 3405 g (7 lbs, 8 oz)
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Scale zeroed with diaper in place; infant placed on
scale while nurse keeps hand above infant for
safety
Initially loses weight but after 1 week gains
about 200 g (7 oz) a week
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Measurements
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Measure
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Length
Head circumference
Chest circumference
Use disposable tape
Document measurements in centimeters (cm)
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Average Measurements
of Full-Term Infant
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Weight: 3405 (7 lbs, 8 oz)
Length: 48 to 53 cm (19 to 21 inches)
Head circumference: 33 to 35.5 cm (13 to 14
inches)
Chest circumference: 30.5 to 33 cm (12 to 13
inches)
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Audience Response System
Question 1
The nurse is bringing a newborn to her mother
for breastfeeding. What should the mother and
nurse do first?
A. The mother should go to the bathroom and then
wash her hands.
B. Have the mother and nurse verify the ID bands
between herself and the infant.
C. Observe the mother and infant interaction to see if
the infant is ready to be fed.
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22
Pain Assessment and Parent
Teaching
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Objectives
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Describe newborn bathing and cord care to
parents.
Interpret instructions for parents about
newborn stools and voiding patterns.
Discuss care of the circumcised and
uncircumcised penis.
Describe pain assessment and control in the
newborn.
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Objectives (cont.)
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Explain the discharge care plan.
Discuss five aspects of newborn care that the
mother should understand before discharge.
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Protection from Infection
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Cracks in skin increase vulnerability to
infection
Hands, feet, and umbilical cord most common
sites of infection
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Must perform hand hygiene before and after care
Many institutions require 3 minute hand to elbow
scrub at the beginning of each shift
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Signs of Newborn Infection
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Poor feeding
Lethargy
Periods of apnea
More obvious signs
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Drainage
Redness
Possible odor
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Hepatitis B Vaccination
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All newborns should receive first vaccine
within 12 hours of birth
Second injection at 1 month of age
Third injection at 6 months of age
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Assessing and Managing
Pain in the Newborn
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Untreated pain can have long-term effects
Pain pathways and structures required for
long-term memory are well-developed by 24
weeks gestation
Several pain assessment tools are available
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CRIES
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10-point scale used postoperatively
Newborn must be at least 32 weeks gestation
Assesses
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Facial expression
Cry
Movement of arms and legs
Consolability
Oxygen saturation
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CRIES (cont.)
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C: cry
R: requires oxygen
I: increased vital signs
E: expression on face
S: sleeplessness
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PIPP
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Premature infant pain profile
Based on scales similar to CRIES
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NIPS
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Neonatal infant pain profile
Based on scales similar to CRIES
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N-PASS
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Neonatal pain, agitation, and sedation scale
Considers CRIES as well as behavior
Very reliable and valid assessment tool

Especially of premature infants on a ventilator
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FLACC
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Face expression
Leg movements
Arousal and activity
Cry high-pitched
Consolability difficulty
Rated on a 2-point scale
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0 to 10 to rate newborn pain
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Unrelieved Pain
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Exhaustion
Irritability
Slow healing
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Pain Treatments
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Pharmacologic
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MSO4 or Fentanyl
acetominophen
Nonpharmacologic, including
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Touching
Stroking
Swaddling
Nonnutritive sucking (i.e., use of pacifiers)
• Avoid overstimulation
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Promotion of Safety
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Never leave infant unattended on table or
scale
Hold infant while bottle-feeding
Do not allow loss of body heat
Place on side after feeding
Placed on back for sleep
Extra linen and diapers are not to be stored in
infant’s bassinet or crib
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Facilitation of Parent-Newborn
Attachment
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Nurse teaches parents
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Newborn behaviors
How to identify cues and how to respond
Newborns respond positively to stroking,
massaging, and cuddling
Encourage mother to hold newborn en face
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39
Phase 3 Parent Education
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Call Health Care Provider

Instruct parents to call health care provider if
infant shows any of the following signs and
symptoms

Fever
 Lethargy
 Irritability
 Poor feeding
 Dehydration
 Yellowing of skin
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41
Bathing
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
Use to assess parent-infant interaction
Teach techniques on how to wake a sleepy
newborn or calm an active one
Important to maintain skin pH

Alkaline soaps, oils, powders, and lotion alter pH
of skin
 Provides medium for bacterial growth

Avoid just after feeding
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Positioning and Holding
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Support head
Firm mattress
Supine
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Ways to Hold an Infant
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Nasal and Oral Suctioning
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During the few days of life, the newborn has
increased amounts of mucus
Teach parents the correct method of use
Advise on how to clean the suction bulb
Ask for return demonstration to ensure
parents can perform this task safely
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Diapering
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

Fold diaper below umbilical stump to prevent
urine or feces from contaminating the stump
site
Clear water or premoistened wipes without
chemicals or fragrances are best
Mild soap with water may be necessary to
remove some stools
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Diaper Rash
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

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Results from ammonia irritation from the urine
Vitamins A&D ointment or zinc oxide cream
can be applied after genitalia and buttocks
have been cleaned
Some infants develop a rash where the
plastic from the diaper comes in contact with
the skin
Advise parents on what to observe for
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Clothing
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
Dress infant according to weather
Do not overdress or underdress infant,
because it may increase metabolic rate to try
to keep warm or cause dehydration and heat
stroke
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

T-shirts, diaper, light- to medium-weight stretch
sleeper
Hats in cool and hot weather
Wash clothing in mild soap, rinse thoroughly
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Circumcision
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

Surgical removal of the foreskin of the penis
Decision usually based on hygiene, religious
beliefs, culture, or social norms
If phimosis present, infant should be
circumcised, since the foreskin cannot be
retracted and can cause injury
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Circumcision Techniques
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
Yellen or Gomco clamp or Plastibell
Written consent from mother required
Infant placed on circumcision board
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
Nerve block, topical analgesia is given for pain relief
Pacifier with glucose for soothing infant
Sterile gauze with petroleum jelly or A&D
ointment is applied to penis once procedure
completed
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Complications of Circumcision
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

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Infection
Hemorrhage
Assess for pain, swelling, bleeding, voiding
If bleeding occurs, apply gentle pressure with
a sterile gauze pad or apply powdered
Gelfoam
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51
Caring for the
Uncircumcised Penis
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Avoid forceful retraction of foreskin
Wash penis with water only during infancy
For toddler, gentle retraction during bathing
and drying prevent moisture from
accumulating under foreskin
School-aged child is taught to retract foreskin
at least once a week during bathing
Full retraction of foreskin may not be possible
before puberty
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52
Cardiopulmonary Resuscitation

Parents are advised to learn basic CPR and
instructed on when to call 911 or emergency
assistance
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Cultural Beliefs and Practices
in Newborn Care
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Influence type of care given to newborns
Develop teaching plan around cultural beliefs
as much as possible
Demonstrate a nonjudgmental attitude
If practices are considered to be potentially
harmful, discuss concerns with family
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Discharge and Follow-Up Care
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Car Seats



Should not move
more than 1 inch in
any direction
Rear-facing position
for infants less than
9 kg (20 lb) or less
than 1 year of age
Newborns should be
placed in seat that
reclines 45 degrees
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56
Follow-Up Care After Discharge

American Academy of Pediatrics
recommends a follow-up office visit within 7
days of discharge from hospital or delivery
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“Safety Net” Numbers

Provide telephone numbers for the



Nursing unit
Lactation consultant
Health care provider
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Discharge Teaching

Should include

Breastfeeding or bottle-feeding
 Bowel and bladder patterns
 Cord care
 Skin care
 Signs of illness
 Car seat use
 Follow-up care
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59
Questions for Review
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Parent Education




Why is discharge planning integrated into all
phases of newborn care?
How do shorter hospital stays influence
discharge planning and its importance?
Why are support services important?
What written information should be provided
to parents? Why should written as well as
verbal information be provided?
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Parent Education (cont.)




What findings should parents report to a
health care provider after discharge?
How soon should a follow-up visit occur after
discharge?
What pain control methods can be used
during circumcision?
Is it recommended to use diaper wipes on a
healing circumcised penis? Describe
circumcision care. Describe care of the
uncircumcised penis.
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Parent Education (cont.)




Are car seats required for neonates? In what
position should they be placed?
Where should an infant car seat be installed?
Why?
How does infant CPR differ from adult CPR?
Why are repeat demonstrations valuable in
parent education?
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Review Key Points
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