1. Care of a Newborn
Dr. Kalpana Malla
MD Pediatrics
Manipal Teaching Hospital
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2. Care of Normal Newborn

3. Definition
• Neonatal period/neonate/
newborn – first 28 days of life
• Perinatal period – 22 weeks of gestation to 7
days after birth

4. Definition
• Early Neonate –birth to first 7 days of life
• Late Neonate –after 7 days – 28 days of lif

5. Definitions
Term – baby born after 37 completed weeks
upto 42 completed weeks of gestation
Preterm – baby born before 37 completed
weeks of gestation
Post-term – baby born after 42 completed
weeks of gestation

6. Definitions
• SFD / SGA : birth weight is <10TH CENTILE
FOR GESTATIONAL AGE
• AFD/ AGA :Birth weight is 10TH - 90TH
CENTILES FOR GESTATIONAL AGE
• LFD/ LGA :Birth weight is >90TH CENTILE
FOR GESTATIONAL AGE

7. Classification of Newborn
A) Depending upon gestational age:
Term
Preterm
Post-term

8. B) Depending upon Birth weight :
• Normal birth weight (NBW) :2500-3999 g
• Low birth weight (LBW) : <2500 g
• Very low birth weight (VLBW) : <1500 g
• Extremely low birth weight (ELBW) : <1000 g
• Preemie : <750 g
• Micropreemie : <500 g

9. Very Low Birth weight:
1000-1500g

10. Very Low Birth weight:
1000-1500g

11. Extremely low birth weight: 500-
1000g

12. C) Depending upon Gestational Age &
B.WT
Preterm - SFD / SGA
AFD/ AGA
LFD/ LGA
Term -SFD / SGA
AFD/ AGA
LFD/ LGA
Post –Term - SFD / SGA
AFD/ AGA
LFD/ LGA

13. Plotting Weight, Length, HC

14. Component of Newborn care
1. Clean delivery & clean cord care
2. Maintanance of body temperature –
room warm/cloths-cap, socks,oil
massage
3. Skin care- sponge, not to scrub vernix
4. Care of umbilical stump – keep dry (fall
after 5-10days)
5. Care of eyes

15. Component of Newborn care
6. Breast feeding
7. Weight record
8. Early detection of serious Ds
9. Immunization
10. Supplements and follow up

16. Follow up
• Well baby clinic – evaluation
• Exclusive breast feeding
• Growth and development
• Immunization
• Nutrition advice

17. Care at birth-DELIVERY ROOM CARE
• Ensure clean and safe delivery
• Delivery room - Clean, well
ventilated, adequately lighted, warm room
• Temperature stabilisation
• Suction - mouth and nostril
• Cut the umbilical cord -2.5 inch from skin
• Weigh and classify
• Assess under warmth

18. Basic care of the normal newborn
1.Rooming in
2. Receive the baby in sterile sheet
Cover adequately and dress
3. Check
color, respiration, temperature, and
umbilical cord
4. Record skin temperature

19. Basic care of the normal newborn
Mother’s role
- Has instinct, concern, interest, love and affection
- Can involve in nursing care
- Recognition of early evidence of disease

20. Basic care of the normal newborn
Mother’s role
Breast feeding
- First feed within 1-2 hours
- No prelacteal feeds
- Colostrum to feed
- No need of water
- Demand feeding 2-3 hours -15-20min, Burp
- Adequacy of breast feeding

21. Care of normal newborn
• Maintenance of body temperature
• - Avoid bath on first day
• - Cover adequately and dress
• Bath
• - At birth - clean blood, mucus and meconium
• - Bath can be given on next day, use unmedicated
• soap and lukewarm water
• - Sponging is sufficient
• - Avoid dip bath
• Skin care
• - No need to clean all vernix, but clean blood and
meconium
• - Skin abrasions - use topical antibiotics

22. Care of normal newborn
• Cord care
Clamp, inspect 2- 4 hourly for bleeding, no
dressing, spirit cleaning of tip and around
the base
• Eye care
Sterile cotton swab cleaning, each eye
separately, no kajal application
• Vitamin K - 1mg IM within 2 hours of life
• Dresses
Loose, soft, preferably cotton, woolen, nappies

23. Care of normal newborn
Routine care Supportive care
(Term, vigorous, crying, pink • Warmth
good tone , no meconium) • Position
– Put on mother’s chest
• Suction
– Dry
– Cover with dry linen
• Dry
– Skin to skin contact • Stimulate
– Clear airway • Give O2

24. Care during subsequent period
1.Weight recording - daily
- Weight loss during first 2-3 days, 5-8% of
body weight
- Stationary for next 1-2days
- Regain birth weight - at the end of first week
- Average weight gain thereafter- 30g / day
2. Immunisation - BCG
3. Discharge plan and future visits

25. Grades of care of newborn
Level I care:
• >89% require minimal care
• Wt >2000gm
• Gest maturity ≥ 37 weeks
• Care provided at – home/subcenter/primary
health care

26. Level II care :
• 10-15% require this care
• Wt- >1500gm
• Gest maturity 32-36 weeks
• Needs specialized neonatal care supervised by
trained nurses /pediatrician
• Equipments – Et tube/Laryngoscope
- IV infusion, NG tube,
- Phototherapy
- Facility for exchange transfusion ect

27. Level III care
• 3-5% require this care
• Intensive neonatal care
• < 1500 gm
• Gest < 32 weeks
• Skilled neonatologists/trained nurses
• Equipments – incubator, oxygen
- Suction apparatus
- Ventilator
- Infusion pump, trancutaneous
monitors

28. Early detection of serious disease
1. Bleeding from any site
2. Jaundice appearing <24 hours / Deep
jaundice / Physiological jaundice
3. Not passed meconium within 24
hours / urine within 48 hours
4. Regurgitation, vomiting / loose stools
5. Poor feeding / lethargy/ Excessive
sleepiness

29. Early detection of serious disease
6. Excessive frothiness / drooling of
saliva
7.Cold to touch / fever / Dehydration
fever
8.Abdominal distension
9.Difficult / rapid breathing
10.Convulsions

30. Common neonatal problems
11. Excessive cry- hunger, discomfort, full
bladder, colic, insect bite, soiling
12.Superficial infections - skin pustules,
umbilical, sepsis, conjunctivitis, oral
thrush
13.Blocked nasolacrimal duct

31. Minor developmental pecularities
1. Erythema toxicum /urticaria neonatorum-
erythematous rash with central pallor
,appears on 2-3rd day in term baby, starts on
face & spreads to trunk & extremities in 24
hrs, disappears in 2-3 days
2. Peeling skin
3. Milia- retention sebum
4. Mongolian blue spot

32. Minor developmental pecularities
5. Subconjunctival hge
6. Epstein pearl – epithelial inclusion cysts
7. sucking callosities
8. Tongue tie
9. Hymenal tags/ non retractable prepuce
10.Prominent xiphisternum
11umbilical hernia

33. Minor developmental pecularities
13. disorders due to transplacental passage of
hormones – Mastitis neonatorum
- vaginal bleeing
- mucoid vaginal secretions

34. Criteria of normal newborn
1. Gestation – 37-42 completed weeks
2. Birth wt – 2500 – 3999gm
3. Breathing – spontaneous,regular,RR – 30-
60/min
4. Color – pink but slight peripheral cyanosis
soon after birth
5. Heart rate – 100 -160/min
6. Temp ( axillary) – 97.5-990 F

35. Criteria of normal newborn
7. HC – 33-35cm
8. Length – 50 cm
9. Chest circumference – 3 cm< HC
10.Upper segment : lower segment – 1.7-1.9:1
11. Sucks soon after birth
12. Sleeps – 18 hr/day
13.Physiological photophobia, sclera bluish

36. Criteria of normal newborn
14. Ear cartilage – firm with good elastic recoil
15. Breast nodule > 5 mm
16.Liver palpable – 2 cm
17. Genitalia –
Male -Testes in scrotum,deeply pigmented
scrotum/adequate rugae
Female -Labia minora covered by labia majora
18. Sloes – >anterior 2/3rd show deep crease

37. Criteria of normal newborn
19. Muscle tone – increased by adult
standard/attitude of flexion
20. 95% term & preterm void within 24 hrs but
some pass in 48hrs
21. 99% term & 95% preterm pass meconium
within 24- 48 hrs of birth
22. No apparent cong anomalies

38. Examination of newborn
Examined region by region
• Soon after birth
• At 24 hrs of life
• Before discharge
Pre-requisites
• Wash and dry hands
• Good light
• Warm environment
• Concent

39. Examination of newborn
1.Overall impression – face,trunk,limbs,activity
2.Measurements – wt/length/HC
3. Color – pink,jaundice
4. Skin – pallor /jaundice/erythema toxicum
5. Head –fontanelles/ sutures/ cephalhematoma/
superficial injuries
6. Face – dysmorphic features

40. Examination of newborn
7.Ears – low set/demormity
8. Eyes – discharge/inflammation/cataract
9. Nose – choanal atresia
10. Mouth – cleft palate
/macroglossia/micrognathia/excessive
frothing
11. Neck – sternomastoid tumour /branchial &
thyroglossal cysts/webbing neck/short
neck/neonatal goiter/ cystic hygroma

41. Examination of newborn
12. Upper limbs – erb’s palsy/Klumky’s
palsy/extra digits
13. Chest – accessory nipples/wide apart
nipple/breast hypertrophy/lung field
14. CVS – mumurs
15. abdomen – organomegaly/distension
/bowel sound
16. umbilical cord – single U. artery/signs of
sepsis

42. Examination of newborn
17. Hip – congenital dislocation of hip
18. Genitalia
19.Anus – imperforated anus
20. Feet – club feet/sole creases
21. Spine – midline defect ( spina bifida)/
meningomyelocele
22. Primitive reflexes

43. Thank you
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Medical Post [ www.themedicalpost.net ]