NEWBORN CARE (continuation) SILVERMAN-ANDERSEN INDEX

1. IMMEDIATE ASSESSMENT OF THE - An assessment of respiratory function is a

NEWBORN priority = ongoing assessment

APGAR
 Dr. Virginia Apgar
 Taken on 1st and 5th minutes at birth
 1st minute – neonate’s initial adaptation to
extrauterine life and necessity for
resuscitation
 5th minute – more reliable picture of
neonate’s overall status
MUSCLE TONE (ACTIVITY) – resistance to
extension
HEART RATE (PULSE RATE) – apical pulse or
pulsation from umbilical cord
REFLEX IRRITABILITY (GRIMACE)– suction
catheter; slapping of the soles of the Feet
COLOR (APPERANCE) – Pink; *acrocyanosis ASSESSMENT OF GESTATIONAL MATURITY
RESPIRATORY EFFORT – regular at 1 minute;  Not routinely done = UTZ
*analgesia / anesthetic  Ballad or Dubowits Assessment Scale
 Page 439 book
INTERPRETATION OF APGAR RESULT:
 Total score has corresponding age in weeks
0-3 = baby is in serious danger and needs
PROPER IDENTIFICATION OF NEWBORN
immediate resuscitation
FOOT PRINT
4-6 = the baby’s condition is guarded and may
need more extensive clearing of the airways and  The infant’s foot should be clean and dry
supplementary oxygen and must be pressed firmly on the ink pad
and then gently on the footprint from
7-10 = is considered good and in the best possible
beginning in the heel (upward motion)
health
ID BRACELETS

 Mother’s full name

 Date and time of delivery
 Hospital or admission number that
corresponds with the mother
 Gender of the baby
DOCUMENT IN THE BIRTH RECORD
 Time of birth
 Time the infant breastfed
 Whether respirations were spontaneous or
aided
 APGAR score at 1 and 5 minutes
 Whether eye prophylaxis and Vit. K were
given

CJBS KBBS BSN 2-C

  General condition of the infant
 Number of vessels in umbilical cord  CREDES PROPHYLAXIS
 Whether cultures were taken (lab) - Allow parents to interact with infant
 Whether the infant voided and passed a before giving
stool
- Given during 1st 24 hours
PROBLEMS FOR NEWBORN - Wipe the face dry
- One eye at a time
 Risk for Ineffective Thermoregulation - Apply ointment from inner to outer
r/t newborn’s Transition to canthus of the lower lid
extrauterine life - Massage eyelid gently to distribute the
- Mother abdomen for skin to skin ointment
contact - Wipe excess ointment after one minute
- Gently rubbing with sterile cotton balls moistened with
 Risk for Ineffective airway Clearance sterile water
- Record 1st cry
- Crying baby is breathing baby NURSING CARE OF THE NEWBORN IN THE
- More forcefully cry = breathing POST-PARTAL PERIOD
deeply and forcefully  Initial Feeding
- Mucus = suction mouth using - Written breastfeeding policy
bulb syringe, before laid to mother’s - Educate all staff with skills
abdomen (to avoid aspiration) - Inform about benefits of
 SUCTION QUICKLY AND GENTLY – breastfeeding
prolong and deep during 5-10 mins - Initiate BF within 1st hour
(stimulates vagus nerves) - X pacifiers, X food other than breast
 SUCTION THE MOUTH THEN THE milk
NOSE – if the nose is suctioned first, the  Bathing
stimulation of the nasal mucosa will - Sponge bath after 2-4 hrs post birth
cause reflex inhalation of pharyngeal (NO need to remove vernix)
material into the trachea and bronchi - Face, diaper area, and skin fold
causing aspiration - Use Gloves
- Bathe from feeding (Vomiting –
 CARE OF UMBILICAL CORD Aspiration)
- Inspect for the presence of AVA  Cleanest to dirtiest
- Continue to pulsate after infant is born - Warm room (24C) to prevent
- 2 clamps (8 inch above abdomen) chilling
- Clamp applies half inch from the - Wash clothes, towels, comb, clean
abdomen diaper, shirt,
- The corm stump usually dries and fall off - NO soap, powder, lotion
within 7 to 10 days  Position in Sleeping
- Avoid wetting the cord – fold the diaper - Sleep on their back (to prevent
below SIDS)
- Keep cord dry – DON’T apply anything - Room sharing without bed sharing
on the cord  DIAPER AREA CARE
- NO tub bathing until cord falls off - Changes diaper as frequent
- Alcohol 1x-2x daily (hasten drying) but
 Metabolic Screening Test
now we use Betadine
- Single drop of blood (newborn
- Leave cord exposed to air
screening)
CJBS KBBS BSN 2-C
 - Best result (feed for 24 hours)  Eosinophils reacting to rough sheets and
- If NOT performed on the 1st day, = clothing
can be 2 to 3 days’ time  Begins with a papule, ^ severity to become
 Hep. B Vaccination erythema by the second day; x 3rd day
 X clinical significance; lacks pattern,
- 1st vaccine within 12 hours after
sporadic
birth (1 month, 6 months)  X treatment
- In mother (+), infant receives HBIg
 Administration of Vit.K LANUGO
- Aquamephyton (Phytonadieone)  Fine downy hair may be noted over the
S1mg injected IM into the Lateral aspect face, shoulders and back, upper arms,
(vastus lateralis) to prevent forehead and ears
bleeding disorder Hemorrhagic Disease  Absent in postterm
of Newborn (HDN)  X 2 weeks of age

HARLEQUIN SIGN MONGOLIAN SPOTS

 red on the dependent side and pale on the  Gray patches across the sacrum or
upper side; due to immature circulation buttocks and consist of collection of pigment
cells (melanocytes)
DESQUAMATION  Arms and legs; x school age w/o treatment
 first 2-4 weeks of life  Asian, Southern European, African ethnicity
 skin becomes dry and it will peel BIRTHMARKS
 palms, soles of feet
 apply lotion HEMANGIOMAS

SKIN TURGOR  Vascular tumors of the skin

 good elasticity (well-hydrated) a. NEVUS FLEMMEUS

 skin is grasped between the thumb and
1. PORTWINE STAIN
finger -> released: skin should fall back to
form smooth surface  macular purple or dark red lesions;
 check on the sternum / abdomen doesn’t blanch
 poor S.T. indicates dehydration  face and thighs
 sunken fontanels – dehydration  fades spontaneously; may be removed by
 bulging fontanels – increased ICP laser
VERNIX CASEOSA 2. STORK BITES / TELANGIECTASIA
 white, cream-cheese like substance that  lighter pink patches; blanches
serves as a skin lubricant  nape of the neck
 skin folds  males; x fade; covered by hairline
 document color
 permanent
 DO NOT rub harshly (break in skin integrity)
 If meconium stained, wipe off b. STRAWBERRY HEMANGIOMAS
MILIA  elevated areas formed by immature
capillaries and endothelial cells
 Pinpoint white papule; distended
 rough texture
sebaceous glands; cheek; bridge of nose
 continue to enlarge up to 1 year of age
 Disappears 3-4 weeks of age
 absorbed and shrink in size; 7 y/o = 70%
 DO NOT scratch off or squeeze -> may
disappear; 10 yrs = x
become a portal of entry for microorganisms
 scalp, face, neck
ERYTHEMA TOXICUM / FLEA BITE RASH
CJBS KBBS BSN 2-C
  X surgery (complication); steroids; laser  Supine position and lift the head to open his
therapy / her eyes
 Rare tears (mature lacrimal @ 3 mos.)
c. CAVEROUS HEMANGIOMAS  Iris is gray or blue (permanent color @ 3-
 Dilated vascular spaces 12 mos.)
 Raised and irregular in shape; permanent - Check for symmetry in size and shape
marks (should be symmetric, x tears)
 Smooth texture - Check eyelids for size, movements, blink (

FORCEPS MARKS THE EARS

 Circular or linear contusion matching the rim  Not completely formed

of the blade of the forceps on the infant’s o Term = strong and recoils
cheeks; disappears in 1-2 days along with  External ear at level with outer canthus
the edema (abnormal: chromosomal abnormality)
 Assess the facial nerve while the newborn is  Small tag in front (chromosomal
at rest or during crying episodes abnormality; kidney dse)
o Observe pinpoint opening
THE HEAD  Hearing screening
 Forehead of newborn is large (1/4 of height)  Small bell 6 inches away –
and prominent, chin appears to be receding blink, startle
and quivers easily if infant is startled or cries NOSE
FONTANELLES  Covered with milia; larger for the face
 Spaces / openings where the skull bones  Assess for choanal atresia
join o Close mouth and compress one
 Anterior = diamond; indented (DHN); bulge naris at a time with finger, note
(^ ICP) discomfort or distress w/ breathing
 Posterior = triangle  Midline; apparent lack of bridge, flat, broad
 Some mucus but no drainage
CAPUT SUCCEDANEUM  Preferential nose breather; sneezing to
clear nose
 Edema of the scalp on the presenting part
 Gradually absorbed; x 3rd day of life MOUTH
 NO treatment needed
 Tissue trauma  Symmetry of lip movement; (Facial nerve
injury) – inspect and palpate; check
CEPHALHEMATOMA placement on face; assess lips for color,
configuration, movement)
 Collection of blood between the periosteum
 Pink gums; presence of natal teeth
of the skull bone and the bone itself; black
(evaluate for stability) unusual teeth one or
/ blue underneath
two erupted – check gums
 NO treatment needed; weeks absorbed
 Short; tongue tied (ineffective
 Observe for jaundice
breastfeeding)
CRANIOTABES  Tongue not protruding; freely movable;
symmetric in shape – assess tongue for
 Localized softening of the cranial bones attachment, mobility, movement, size
caused by pressure of the skull against the  Soft and hard palates intact; uvula in midline
mother’s pelvic bone  Presence of Epstein pearls disappears
 Skull is soft within 1 week
 It corrects after few months (Calcium on  Distinguish from candida (tongue sides of
milk). No treatment needed cheek) – assess palate (soft and hard) and
THE EYES uvula
CJBS KBBS BSN 2-C
  Distinct chin – assess chin  Vulva may be swollen
 Reflexes present – check reflexes (rooting,  Pseudomenstruation (blood-tinged mucus
sucking, extrusion) vaginal discharge); disappears 1-2 days
NECK MALE
 Short, thick, surrounded by skin folds, often  appears small, meatus at tip of penus
chubby (epispadias; hypospadias)
 Assess for nuchal rigidity  Prepuce (foreskin) covering glans penis and
o Congenital torticollis (SCM injury) it is not stenosed
o Meningitis (rupture membranes > 24  Edematous and rugaeted scrotum; deeply
hrs) pigmented
 Head lag (not strong enough to support total  Palpable testicles on each side
weight of head (cryptorchidism)
o press inguinal ring PRIOR to
CHEST
assessment (if not supported,
INSPECT AND PALPATE SHAPE testicles might ascend)
 positive cremasteric reflex
 Almost circular; appear small in proportion
to head (2cm smaller) DEFECTS: ANOGENITAL AREA
 No retractions (drawing in of the chest wall Imperforated anus – covered by membrane
w/ inspiration) strong force to pull air into
respi tract -> oxygen needed Cryptorchidism – absence of one or both testicle
CHECK RESPIRATORY MOVEMENT Ectopic testes – testes cannot enter the scrotum
the opening of scrotal sac is closed
 Symmetric chest movement, chest and
abdominal movements synchronized during Undescended testes – vas deferens is too short to
respirations; rhonchi allow the testes to descend
EVALUATE CLAVICLES Epispadias – malformation of the penis in which
the urethra ends in an opening on the upper aspect
 Clavicles intact; crepitus (Fracture)
(the dorsum) of the penis
ASSESS RIBS
Hypospadias – urethra opens anywhere along a
 Rib cage symmetric; intactl moves with line running from the tip along the underside
respiration (ventral aspect) of the shaft to the junction of the
 Rhonchi vs. grunting and stridor penis and scrotum or perineum

ASSESS NIPPLES FOR SIZE, PLACEMENT, AND BACK AND EXTREMITIES

NUMBER
 spine straight and easily flexed infant able
ABDOMEN to raise and support head momentarily
when prone
 Slightly protruded  shoulders, scapular, and iliac crests lining
o Slightly appearance – missing up in same place
abdominal contents or  arms and legs appear short in newborn
diaphragmatic hernia period
 Bowel sounds = within 1 hr after birth;  symmetric movement
meconium stool = 24-48 hours after birth  five fingers on each hand; fist often
 Inspect cord (color, odor, di ko natapos clenched with thumb under fingers
kasalanan to ni carl chika nya aq)  palm of hands have three creases
GENITALIA  soles of feet appear flat
 intact femur
FEMALE  major gluteal folds even
CJBS KBBS BSN 2-C
 PHYSIOLOGIC FXN / SYSTEMIC EVALUATION  Increased pressure in left atrium attempts to
reverse blood flow
CARDIOVASCULAR SYSTEM
 One way valve
- when cord is clamped, neonate is forced to BLOOD VALUES
take in O2 through the lungs
A. BLOOD VOLUME – 80-110 ml/kg of weight or
1. Closure of the foramen ovale (fossa ovalis) by
about 300 Ml
the 3rd month of life to 1 year
B. ERYTHROCYTES COUNTS – increased, 6
2. Change of the ductus arteriosus into a mere
million/mm3
ligament (ligamentum arteriosum) when the infant
is several weeks to 4 months C. HGB LEVEL – 17-18g/100 mL of blood
3. Ductus venosus becomes a mere ligament D. HCT LEVEL – 45%-50%
(ligamentum venosum) as well as due to decrease
E. WBC – 15,000 to 30,000 cells/mm3 (PRC)
pressure on the right side of the heart by 2 months
* assess for other signs of infection (pallor, DOB,
4. Arteries and umbilical veins atrophied and
cyanosis, increased temp = infection
degenerate by 2-3 months since no more blood
goes through these vessels F. BILIRUBIN LEVEL – 1-4 mg/100 mL
FETAL AND NEONATAL CIRCULATION RESPIRATORY SYSTEM
FETAL A. The first breath (about 50-70 cm H2O)
 constricted with very little blood flow (^ * combination of cold receptors a decreased PO2
pulmonary vascular resistance) (15 mmHg) and an increased PO2 (rises as high as
 lungs not expanded 70 mmHg)
 Fluid filled lungs
Systemic blood vessels B. Fluid in the lungs = decreased surface tension
 Dilated with decreased resistance on alveolar walls (easier breathing)l 1/3 drained
 Blood mostly in placenta through vaginal delivery; rest absorbed by lung BV
Ductus arteriosus and lymphatics after 1st breath
 large with no tone * CS = <fluid expel -> fluid blocks air; preterm =
 blood flow from PA to aorta lacks surfactant
 right to left shunting
foramen ovale
 patent
GASTROINTESTINAL SYSTEM
 increased blood flow from R-L atrium
a. Sterile at birth
NEONATAL
b. Most bacteria enter (NB’s mouth from airborne
 Vasodilation and increased blood flow (v
sources, vaginal secretions at birth, from hospital
pulmonary
bedding, and from contact at the breast)
Systemic blood vessels
 Increased arterial pressure (cord clamping) * necessary for Vit. K synthesus
with loss of placenta
 Increased systemic blood volume c. Newborn’s stomach holds about 60-90 ml at birth
Ductus arteriosus (size of a calamansi)
 Reversal of blood flow d. Decreased pancreatic enzymes (lipase and
 PA to lungs amylase) first few months
 Left to right shunting
 Increased atrial pressure and increased e. Immature cardiac sphincter -> regurgitation
systemic vascular pressure
Foramen ovale
CJBS KBBS BSN 2-C
f. Immature liver – decreased glucose and protein  Female = strong stream when voiding; Male
serum level = small projected arc when voiding, if NOT -
> urethral obstruction
STOOLS
 Weigh diapers to determine amount of
a. Meconium – 1st stool of the newborn voiding

 usually passed within 24 hours IMMUNE SYSTEM

 a sticky, tarlike, blackish-green, odorless
 Able to produce own by 2 months
material formed from mucus, vernix, lanugo,
 Born with passive natural immunity (IgA and
hormones, and CHO
IgG)
* meconium ileus, imperforate anus, volvulus  Newborns have antibodies from mother
against poliomyelitis, diphtheria, tetanus,
b. Transitional stool – occurs on the 2nd or 3rd day pertussis, rubella, measles, and chickenpox
of life
SENSES
 becomes green and loose
 resembles diarrhea to the untrained eye a. Hearing

By the fourth day of life, stool depends on the type  able to hear in utero (25-27 weeks AOG)
of feeding:  respond to sound through generalized
activity to a specific sounds
a. Breast-fed babies – light yellow, mushy, more  difficulty locating where sound is coming
frequent and sweet smelling (high in lactic acid – from
not foul smelling)  recognize mother’s voice = calms
b. Bottle-fed babies – bright yellow, firm, less b. Vision
frequent and foul-smelling
 positive pupillary reflex
c. Under phototherapy (jaundice) – bright green  focus best on black and white objects at 9-
stools 12 inches
d. Bile duct obstruction – clay colored (gray)  positive vision
stools c. Touch
e. Anal fissure – blood flecked  most developed sense
f. Bleeding (swallowed maternal blood during  quieting at a soothing touch
delivery / GI) – black, tarry stools  positive sucking and rooting reflexes
(elicited by touch)
+ Apt Downey Test -> remains black -> GI bleeding  reacts to pain stimuli
g. Milk allergy, lactose intolerance, digestion d. Taste
problems – mixed with mucus; watery and loose
 ability to discriminate taste (taste buds are
URINARY SYSTEM developed and functioning even before
birth)
 Voids within 24 hours after birth
 Urine is odorless and light in color e. Smell
 Daily urine output for the first 1-2 days of life
is 30-60 mL AND MAY INCREASE TO  present when nose is clear of mucus and
ABOUT 300 Ml AFTER 1 WEEK amniotic fluid
 Specific gravity is 1.008-1.010; may have  turn towards mother’s breast partly out of
small amount of protein recognition of the smell of breastmilk and as
 First voiding may be pink or dusky manifestation of rooting reflex
NEUROMUSCULAR SYSTEM
 Demonstrates neuromuscular function
CJBS KBBS BSN 2-C
 DISCHARGE INSTRUCTIONS  Done on the 48th hour or at least 24 hours
from birth
FEEDING
 * < 24 hours – some disorders are
Breastfeeding undetected
 Screening again after 2 weeks for more
 Preferred method of feeding a newborn accurate results
 Remains the ideal nutritional source for
infants through the first year of life BRIEF DECRIPTION OF THE DISORDERS

Bottle feeding CONGENITAL HYPOTHYROIDISM

 Infants routinely receives an initial feeding - Lack or absence of thyroid hormone, which
about 1 oz of sterile water at 4-6 hours of is essential to growth of the brain and the
age body
 To be certain the infant can swallow without CONGENITAL ADRENAL HYPERPLASIA
gagging and aspirating
 Fed every 4 hours - Endocrine disorder that causes severe salt
loss, DHN, and abnormally high levels of
BATHING
 May be given anytime convenient for
parents; not within 30 mins after feeding
 * increased handling can cause
regurgitation
 Sponge bath done until the cord falls off (7th
– 14th day)
 Wash infant’s hair daily with the bath. First
soap the hair with the baby lying on the
bassinet. Then hold the infant on one arm
over the basin of water (foot ball hold)
 Body 1st then head
SLEEPING PATTERNS
 Sleeps 16-20 hours / day
CORD CARE
 Use rubbing alcohol 70% 2 or 3x a day for
faster drying
 Fold down diapers so that cord does not get
wet during voiding
 Small pink granulating area may be seen on
the day the cord falls off
DIAPER CARE
 After each change, wash area with clear
water and dry well
 * to prevent ammonia
NEWBORN SCREENING
 Procedure to find out congenital metabolic
disorder that may lead to mental retardation
and even death if left untreated

CJBS KBBS BSN 2-C