The Normal Newborn:
Assessment, Care, Feeding
Presented by,
Joy Haskin, RN, MS
Joke for the day….
Should children witness
childbirth?
TERMS:
Neonatal Period:
Birth --> 28 days of life
Term Infant:
38 - 42 weeks of gestation
Transition Period: Phases of instability
during the first 6-8 hours after birth
Viability
Capacity to live outside of the uterus about 22 to 24 weeks since the last
menstrual period, or fetal weight greater
than 500 g.
In the past was 28 weeks - with
technology and advancements this is
becoming shorter and shorter…...
Physiologic Changes of the NB to
adjust to extrauterine life:
What happens during birth to the neonate?
Circulatory:
Transitional Circulation = acrocyanosis
Peripheral circulation = sluggish
High: RBC 4.8-7.1; Hgb 14-24; Hct 44-64
WBC 18,000 @ birth; 23-24,000 @ 1 day
Coagulation: Vit K dependent clotting
factors are decreased.
Platelet counts ok (150,000-350,000)
Respiratory
Before birth O2 needs met by placenta
L/S ratio should be > 2:1
After delivery need mature lungs that are
vascularized, have surfactant and sacules
- usually adequate by 32-35 weeksat term the lungs hold approx. 20 ml of fluid/kg
What initiates respiration?
Periodic Breathing -vsApnea
Apnea: no breathing for periods of
greater than 15 seconds should be
evaluated.
Periodic Breathing:
Notify MD if resp < 30 or > 60
Gastrointestinal System
Immature at birth, reaches maturity at 23 years of age
place food at back of tongue
sucking becomes coordinated @32 wks
little saliva until 3 months of age
bowel sounds after 1 hour of birth
Gastrointestinal
(continued)
NB have difficulty digesting complex
starches and fat
Abdomen becomes easily distended after
eating
Initial fecal material = meconium
No normal flora at birth in GI system to
synthesize Vit. K
Immune System
Limited specific and Non-specific
immunity at birth
passive immunity(from mom- IgG) for the
first 3 months of life ~ this will be
reduced if baby is born premature
breastfeeding = ^ passive immunity (IgA)
Temperature Regulation
Non-Shivering thermogenesis:
brown fat is the primary source of heat
production. Brown fat is broken down into
glycerol & fatty acids producing heat.
Brown fat is found @ the nape of the
neck, axillae, around the kidneys and in
the mediastinum.
Slightly warmer to touch than nml skin.
Cold Stress
An increase in the metabolic rate
associated with non-shivering
thermogenesis --> increased O2 demands
and caloric consumption
It’s important to provide a neutral
thermal environment to prevent
metabolic acidosis and prevent depleted
brown fat.
Kidneys and Urination
92% of all healthy infants void in the first
24 hrs of birth
initial urine:cloudy, scant amounts, uric
acid crystals-> reddish stain on diaper
Kidneys not fully functional until child is 2
years of age.
Hepatic Function
Liver produces substances essential for
clotting of blood.
Stores needed iron for the first few
months. Preterm & small infants have lower iron stores than
full term and heavier infants. (full term infants stores last 4-6 mo)
NB at risk for Physiologic Jaundice
after 24 hours of age, d/t increased
breakdown of RBC’s and immature liver
functioning.
Increased Bilirubin Levels
 Jaundice in the 1st day is NOT normal
Bilirubin level greater than 12 at any
time needs further attention
Maternal causes of increased bilirubin
levels in the NB: epidural use, oxytocin
induced labor, infection, hepatitis
Ethnic Influences: Asian infants levels
may be double other ethnic groups.
Kernicterus
Complication of neonatal
hyperbilirubinemia --> encephalopathy
basal ganglia and other areas of the brain
and spinal card are infiltrated w/ bilirubin
(produced by the breakdown of
hemoglobin -> levels of 20 - 25 or more).
Poor prognosis if untreated.
Neurologic
All neurons are present, but many are
immature:
uncoordinated movements
poor muscle control
startle easily
tremors in extremities
Weight Loss
It is normal for the newborn infant to
loose 5-10% of weight in the first 4 to 5
days of life.
Infants at Risk
“RED FLAGS” after birth include:
gagging --> turning blue (esp. after fdg)
generalized cyanosis
weak cry
grunting or respiratory distress
decreased or absent movements
excessive twitching or trembling
OTHERS>>>>>
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 to Meet NB
Needs
Prevent infection:
handwashing, stay away from large
groups or ill individuals, prophlactic
agents (EES, cord care, bathing)
Vernix
Breastfeeding
Warmth
Bath after temperature is stable
warmer/isolette/bundle
hat
keep out of drafts
skin to skin
Position of sleep/prevent
SIDS
Back to sleep
feet to foot of bed
no stuffed animals or excessive blankets
in bed
don’t cover head in stroller
don’t keep house too warm
No smoking around infant
Cleanliness
No tub baths until cord off and healed
clean around organs of elimination and
mouth after soiling to prevent skin break
down
daily head to toe bath not necessary
OK to clean and touch the “soft spot”
fold diapers away from umbilicus
NEVER leave child alone in tub!!
Research and Cord Care
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
–no alcohol used: 8.16 days
Carseats
“AS a condition for licensure, public and
private hospitals, birth centers, and clinics
must have a written policy on the
dissemination of child passenger restraint
system information to parents or the
person to whom the child is released”
(SB503 REQ)
Genital Care
Male Infant: if penis is uncircumcised
DO NOT RETRACT THE FORESKIN--“leave it alone”
Female Infant: wipe front to back. If
“smegma” has accumulated in the labial
folds it can be carefully removed
Infant Feeding
Why may a mother decide to Breast
Feed?
Discussion
Formula feeding
Why may a mother decide to formula feed
her infant?
Discussion
Frequency of Feedings
Breastfeeding: successful latch-on and
feeding should occur every 1.5 to 3 hours
daily.
Formula Feeding: 3-4 oz every 3-4
hours for full-term babies.
Baby should have 6-10 wet diapers/day
calculate amnt of formula mult. baby’s
wt in lbs by 2 then 3, this is oz per day.
 (EX: 8lb. Baby~ 8 X2 = 16; 8 x3 = 24 therefore 16-24oz of
formula per day is needed for adequate nutrition)
Nursing Diagnosis
Effective Breastfeeding
Risk for Altered Nutrition (more or less
than body requirements) R/T (insufficient
caloric intake or excessive caloric
intake)
Circumcision
Elective Procedure
Not pd for by medi-cal
Decision made based on tradition,
religion, culture, or personal factors
VALUE
OPPOSITION
Procedure
Usually delayed 12 to 24 hours until NB is
stabilized
Do not feed 1 hr prior to procedure
Consent required from one parent
Methods: Gomco or Plastibell
Restraint required
Anesthetic is physician dependent
After Care
Comfort measures
keep wound clean and dry (warm water)
ck urination w/in 12 hrs after procedure
monitor for bleeding
s/s of infection will not occur immediately
after procedure
Periods of Reactivity
REVIEW
1st period of reactivity:after birth of baby, bursts
of rapid movements. Quiet times during this
period are ideal for breastfdg & interacting
Deep Sleep - lasts 60-100 minutes
2nd period of reactivity: occurs 4-8 hrs after
birth lasts 10 min to several hours. Periods of
tachycardia & tachypnea. Increased muscle
tone, skin color, mucus production, pass
meconium
The end….