1. Maternal and Child Health Nursing
Care of the Newborn
PRINCIPLES IN IMMEDIATE NEW BORN CARE
1st day of life
1. Initiation and maintenance of respiration (used
bulb syringe)
2. Establishment of extra uterine circulation
3. Control of body temp
4. Intake of adequate nourishment
5. Establishment of waste elimination
MATERNAL and CHILD HEALTH NURSING 6. Prevention of infection
7. Establishment of an infant parent relationship
CARE OF THE NEWBORN 8. Care that balances rest and stimulation or mental
Development
Lecturer: Mark Fredderick R. Abejo RN, MAN
______________________________________ Immediate care of the newborn.
Objectives: A-airway (most neonatal deaths with in 24 h caused by
inability to initiate airway, lung function begins after
 Describe the normal characteristics of a term birth only)
newborn. B-body temperature
 Assess a newborn for normal growth and C-check/asses the newborn
development. D-determined identification
 Formulate nursing diagnoses related to a newborn or
the family of a newborn.
 Identify expected outcomes for a newborn and family I. Establish and maintain a patent airway
during the first 4 weeks of life.
 Plan nursing care to augment normal development of
A. Never stimulate a baby to cry unless secretions
a newborn, such as ways to aid parent-child bonding
have been drained out.
 Implement nursing care of a normal newborn, such as
“A crying infant is a breathing infant. Effective
administering a first bath or instructing parents on
cry means effective breathing”
how to care for their newborn.
 Do not slap the buttocks but rub the
 Evaluate expected outcomes to determine
soles of the feet
effectiveness of nursing care and outcomes
 The normal infant cry is loud & lusty.
achievement.
Observe for the ff. abnormal cry:
 Use critical thinking to analyze ways that the care of
a term newborn can be more family centered.
High-pitched cry : hypoglycemia, increased ICP
 Integrate knowledge of newborn growth &
Weak cry: prematurity
development and immediate care needs with the
Hoarse cry: laryngeal stridor
nursing process to achieve quality maternal and child
health nursing care.
B. The position should be one that promotes
drainage of secretions (head lower than the rest
Goals
of the body) EXCEPT when there are signs of
To establish, maintain and support respirations.
increased intracranial pressure
To provide warmth and prevent hypothermia.  Vomiting
To ensure safety, prevent injury and infection.  Bulging
To identify actual or potential problems that may  Tense fontanelles
require immediate attention.  abnormally large head
 Increased B
 Decreased PR and RR
 Widening pulse pressure
 Shrill, high-pitched cry
Oral mucus may cause the NB to choke, cough or
gag during the first 12 to 18 hours of life. Place the
neonate in a position that would promote drainage
of secretions
 Trendelenburg (contraindicated to
Increased ICP)
 Side lying position – If trendelenburg
THE NEONATE position is contraindicated, place infant
 From birth through the first 28 days of life in side lying position to permit drainage
 Also called “the newborn period” of mucus from the mouth. Place a small
 2/3 of all deaths that occur during the 1st year of pillow or rolled towel at the back to
life occur during this period; more than half prevent newborn from rolling back to
occur in the 1st 24 hours after birth---an supine position.
indication of how hazardous this time is for an
infant
 How well a NB makes major adjustments
depends on his or her: C. Suction the newborn properly:
 Genetic composition 1. Turn the baby’s head to one side
 The competency of the recent intrauterine 2. Compress the suction bulb and insert in
environment one corner.
 The care received during the neonatal
period
Care of the Newborn Abejo

2. Maternal and Child Health Nursing
Care of the Newborn
3. Suction gently and quickly – prolonged Effects of cold stress
and deep suctioning of the nasopharynx Cold stress metabolic acidosis CNS
during the first 5-10 minutes of life will depression Coma Death
stimulate the vagus nerve (located in the  Metabolic Acidosis – one of the airways by
esophagus) and cause bradycardia. which heat is produced in the newborn is by
increasing metabolism. When this occurs,
fatty acids accumulate because of the
breakdown of brown fat (seen only in
newborns)
 High risk for kernicterus- bilirubin in brain
leading to cerebral palsy
 Additional fatigue to allergy stressful heart
 Hypoglycemia – due to the use of glucose
stored as glycogen
o Every NB is born slightly acidotic. Any new
build-up of acid may lead to life-threatening
metabolic acidosis, which can be lethal even
to normal newborn infants.
o The average NB temp.@ birth is around
4. Suction the mouth first before the nose 37.2°C.
– when suctioning the nose, the o NB lose heat easily because:
stimulation of the nasal mucosa will  They have immature temp.-regulating
cause reflex inhalation of pharyngeal system
material into the trachea and bronchi,  Of very little amount of subcutaneous
causing aspiration. fat to provide heat
5. To test for patency of the airway,  They have a larger body surface area
occlude one nostril at a time that results in more heat loss
(REMEMBER: Newborns are nasal  They have little ability to conserve heat
breathers). If the newborn struggles by changing posture and no ability to
when a nostril has been occluded, adjust its own clothing
additional suctioning is indicated
Methods of Heat Loss in Newborn
D. Keep the nares patent. Remove mucus and other • Convection – the flow of heat from the NB’s
particles w/c can cause obstruction as newborns body surface to cooler surrounding air; ex:
are “obligatory nasal breathers” until they are windows, air conditioners
about 2-3 weeks old. • Conduction- the transfer of a body heat to a
cooler solid object in contact with a baby; ex:
E. Give O2 as needed. Oxygen should be given for baby placed on a cold counter
20-30 minutes when the neonate remains • Radiation – the transfer of body heat to a cooler
cyanotic or tachycardic after initial suctioning solid obj. not in contact with a baby; ex: cold
and stimulation. window or air con
* asphyxiation → hypoxia → hypercapnia • Evaporation – loss of heat through conversion
(↑ CO2) → acidosis → coma → death of a liquid to a vapor; ex: after delivery,
• Observe precaution in giving oxygen newborns are wet, with amniotic fluid on their
• Do not give more than 40% O2 as skin, tsb
this may lead to retrolental
fibroplasia (blood vessels of the eyes
become spastic leading to blindness)
• Use pulse oximeter and monitor O2
concentration every hour
F. If the heart rate falls below 60 bpm, cardiac
massage may need to be carried out.
II. Maintain appropriate body temperature.
Chilling will increase the body’s need for
oxygen. The newborn suffers large losses of heat (cold
stress) because he is wet at birth, the delivery room is
cold, he does not have enough adipose tissues and does
not know how to shiver.
Temp Regulation
 Goal in temp regulation is to maintain it not less
than 97.7% F (36.5 C)
 Maintenance of temp is crucial on preterm and
SGA (small for gestational age) - babies prone to
hypothermia or cold stress
o Neonates have “physiologic resilience”
wherein they tend to adopt or take
temperature of their own environment.
(poikilothermic)
“cold stress (hypothermia) is more
dangerous than hyperthermia”
Care of the Newborn Abejo

3. Maternal and Child Health Nursing
Care of the Newborn
To Prevent Hypothermia
1. Dry and wrap baby
2. Mechanical pressure – radiant warmer pre-heated
first isolette (or square acrylic sided incubator)
3. Prevent is necessary exposure – cover baby
4. Cover baby with tin foil or plastic
5. Embrace the baby- kangaroo care
6. Delay initial bath until temp. has stabilized for at
least 2 hours.
7. Maintain ambient temp. of nursery at 24°C or
75°F.
8. Perform any extensive examination or procedure
under radiant heat to prevent heat loss and The Silverman & Anderson Scoring System
expose only the part of the body to be examined. o Devised in 1956 and is a test used to
9. Note the presence of any cyanosis: evaluate or estimate the degrees of
2 types of cyanosis: respiratory distress in newborns or the
a.) central cyanosis respiratory status of premature infants.
b.) peripheral cyanosis hands & feet o A NB is observed and then scored on
are cyanotic, due to cold each of five criteria ---0,1 or 2. The
environment and poor circulation scores are then added. (the scores of this
system are interpreted as opposite of the
Apgar)
The Silverman & Anderson Scoring System
0 1 2
Chest Synchronized Lag on Seesaw
Movement respirations inspiration respirations
Axillary temperature measurement. The thermometer Intercostal none Just visible Marked
should remain in place for 3 minutes. The nurse presses Retraction
the newborn’s arm tightly but gently against the Xiphoid none Just visible Marked
thermometer and the newborn’s side, as illustrated Retraction
Nares none minimal Marked
Dilatation
III. Perform Initial Assessment Expiratory none Audible by Audible by
Grunt stethoscope unaided ear
APGAR Scoring System
o Developed by Dr. Virginia Apgar in 1958
Silvermann and Anderson Scoring Interpretation
o It is a standardized method for evaluation of  0 : no respiratory distress
the newborn and serves as a baseline for  4-6 : moderate respiratory distress
future evaluations.  7-10 : severe respiratory distress
o It is taken twice: initially @ 1 minute, and
then @ 5 minutes after birth
IV. Proper Identification of the Newborn
 Proper Id is made in the delivery room before
Special Considerations: mother and baby are seperated.
1st 1 min – determine general condition of baby o Identification Band
Next 5 min- determine baby’s capabilities to adjust extra o Footprints
uterine o Others – fingerprints, crib card, bead
Next 15 min – dependent on the 5 min bracelet
 Birth certificate
APGAR Scoring System  A final identification check of the mother and
infant must be performed before the infant can
0 1 2 be allowed to leave the hospital upon discharge
to ensure that the hospital is discharging the right
Appearance Pale or Body pink, Pink all over
infant.
(Color) blue all extremities blue
over
Pulse/♥ rate absent Below 100 Above 100 V. Preventing Infection
Principles of cleanliness at birth:
Grimace/ No grimace Sneezes,gags,
 Clean hands
Reflex response coughs,vigorous
 Clean perineum
Irritability cry and foot
 Nothing unclean to be introduced into the vagina
withdrawal
 Clean delivery surface
A ctivity / Limp, Some flexion of Active motion/
 Cleanliness in cutting the umbilical cord
Muscle Tone flaccid the extremities well-flexed
 Cleanliness for cord care of the newborn baby
Respiratory absent Slow,irregular, Good,
Effort weak cry strong,lusty cry Handwashing
 Before entering the nursery or caring for a baby
APGAR result  In between newborn handling or after the care of
0 – 3 = severely depressed, need CPR, admission NICU each baby
4 – 6 = moderately depressed, needs add’l suctioning &  Before treating the cord
oxygen  After changing soiled diaper
7 - 10 = good/ healthy  Before preparing milk formula.
Care of the Newborn Abejo

4. Maternal and Child Health Nursing
Care of the Newborn
Credes Prophylaxis – Dr. Crede  Aspirate, then slowly inject the solution to
 -prevent opthalmia neonatorum or gonorrheal distribute the medication evenly and minimize
conjunctivitis the baby’s discomfort.
- how transmitted – mom with gonorrhea  Remove the needle and gently massage the site
drug: erythromycin ophthalmic ointment with an alcohol swab.
(inner to outer)
*It is part of the routine care of the NB to give
prophylactic eye treatment against gonorrheal
conjunctivitis or ophthalmia neonatorum within the first
hour after delivery.
* Neisseria gonorrhea, the causative agent,maybe passed
on to the fetus when infected vaginal and cervical
secretions enter the eyes as the baby passes the vaginal
canal during delivery. This practice was introduced by
Crede, German gynecologist in 1884. Silver Nitrate, VII. Care of Cord
erythromycin and tetracycline ophthalmic ointments are
the drugs used for this purpose.
Ophthalmia neonatorum
 Any conjunctivitis with discharge occuring during
the first two weeks of life. It typically appears 2-5
days after birth, although it may appear as early as
the first day or as late as the 13th.
Administering Erythromycin or Tetracycline
Ophthalmic Ointment  The cord is clamped and cut approximately
 These ointments are the ones commonly used within 30 seconds after birth.
nowadays for eye prophylaxis because they do not  In the delivery room, the cord is clamped twice
cause eye irritation and are more effective against about 8 inches from the abdomen and cut in
Chlamydial conjunctivitis. between.
 Apply over lower lids of both eyes, then,  When the newborn is brought to the nursery,
manipulate eyelids to spread medication over the another clamp is applied ½ to 1 inch from the
eyes. abdomen and the cord is cut at second time.
 Wipe excess ointment after one minute Č sterile  The cord and the area around it are cleansed with
cotton ball moistened Č sterile water. antiseptic solution.
 The manner of cord care depends on hospital
protocol. What is important is that the principles
are followed. Cord clamp maybe removed after
48 hours when the cord has dried.
 The cord stump usually dries and fall within 7 to
10 days leaving a granulating area that heals on
the next 7 to 10 days.
Instruction to the mother on cord care:
1. No tub bathing until cord falls off. Do not
VI. Preventing Hemorrhage sponge bath to clean the baby. See to it that cord
 As a preventive measure, 0.5mg (preterm) to 1 does not get wet by water or urine.
mg (full term) Vit. K or Aquamephyton is 2. Do not apply anything on the cord such as baby
injected IM in the NB’s vastus lateralis (lateral powder or antibiotic, except the prescribed
anterior thigh)muscle antiseptic solution which is 70% alcohol.
 Vit-K – to prevent hemorrhage R/T 3. Avoid wetting the cord. Fold diaper below so
physiologic hypoprothrombinemia that it does not cover the cord and does not get
 Aquamephyton, wet when the diaper soaks with urine.
phytomenadione or konakion 4. Leave cord exposed to air. Do not apply dressing
 .1 ml term IM, vastus lateral or or abdominal binder over it. The cord dries and
lateral ant thigh separates more rapidly if it is exposed to air.
 .05 ml preterm baby 5. If you notice the cord to be bleeding, apply firm
 Vit K – synthesized by normal flora of pressure and check cord clamp if loose and
intestine fasten.
 Vit K – meds is synthetic due intestine is 6. Report any unusual signs and symptoms which
sterile indicates infection.
Foul odor in the cord
Procedure for Vitamin K injection. Presence of discharge
 Cleanse area thoroughly with alcohol swab and Redness around the cord
allow skin to dry. The cord remains wet and does not fall
 Bunch the tissue of the upper outer thigh (vastus off within 7 to 10 days
lateralis muscle) and quickly insert a 25-gauge Newborn fever
5/8-inch needle at a 90-degree angle to the thigh.
Care of the Newborn Abejo

5. Maternal and Child Health Nursing
Care of the Newborn
NOTE: If 2 vessel cord- suspect kidney malformation
- leave about 1” of cord
- if BT or IV infusion – leave 8” of cord best
access - no nerve
- check cord every 15 min for 1st 6 hrs –
bleeding .> 30 cc of blood
bleeding of cord – Omphalagia – suspect
hemophilia
NOTE: Cord turns black on 3rd day & fall 7 – 10 days
Faiture to fall after 2 weeks- Umbilical
granulation
Mgt: silver nitrate or catheterization
- clean with normal saline solution not
alcohol
- don’t use bigkis – air
- persistent moisture-urine, suspect patent
uracus – fistula bet bladder and normal
umbilicus
dx: nitrazine paper test – yellow – urine
mgt: surgery
VIII. Initial feeding
IX. Immunization
• May breastfeed immediately after birth
• Formula feeding- 2 to 4 hours of age
 BCG should be given as soon as possible after
• Demand schedule
birth in all population at high risk of
tuberculosis infection
Mother's milk is the best food a baby can have in the
 OPV a single dose of OPV at birth or in the two
first 6 months of life…
weeks after birth is recommended to increase
early protection.
ADVANTAGES OF BREAST FEEDING
 Hepatitis B vaccine it is important to administer
 Enhances the infant’s immune system (IgA
the first dose as soon as possible or within 24
Lactoferrin, lysozyme, interferon, bifidus Factor)
hours after birth
 It reduces the cost of feeding and preparation
time
 An excellent opportunity to enhance symbiotic
NOTE: Instruct the mother to be aware of the
bond
following EARLY SIGNS OF SERIOUS DISEASE
 It is easy to digest.
and refer the baby immediately to a doctor
 It is clean and has the right temperature.
 Not gaining weight
 It contains the ideal electrolyte and mineral
 Excessive cry or not crying
composition for infant growth
 Convulsion, Twitching, Eye blinking
 Stiff neck, body and limbs
 Breastfeeding should start within 30 minutes after
 Pus discharge or swelling of cord
birth
 Eye drainage
 COLOSTRUM (first 2-3 days): good for babies and
 Feverish or cold baby
helps protect them against infection
 Fast respiration, groaning and chest
 When the baby is 6 months old, start giving other
retraction
food in addition to breastmilk
 Not accepting feed
 Continue to breastfeed sick babies
 Irritable or lethargic
 Breastfeeding mothers should eat nutritious food to
 Pale or Jaundice
become stronger
 Cyanotic
 Vomiting and Abdominal distension
 Not passed urine within 2 days and stool
within 1 day
Care of the Newborn Abejo