Nursing Care of The

New Born Infant

Retnayu Pradanie
Introduction
• The neonatal period is the time from birth
through the thirty days of life.
• During this time the newborn must accomplish
a number of physiologic and behavioral
adjustments in order to establish and maintain
an extra uterine life
• Transition Period: Phases of instability during
the first 6-8 hours after birth
Nurses play a vital role during the transition period

• Help the newborn infant make a safe transition to extra uterine life
• Perform the initial assessment of the newborn infant
• Provide a physical environment conducive to adaptation
• Monitor the newborn infant’s condition during the early adaptation
phases
Newborn Health History
• General health, prenatal diseases or conditions,
prenatal care, number of pregnancies
• Maternal health problems (e.g., gestational diabetes, cardiac
or kidney disease) may cause potential risk factors in newborn.
• Use of prescribed or over-the-counter medications,
tobacco, alcohol, illegal drugs
• Medications and other agents may affect physiological systems
(e.g., smoking during pregnancy related to low birth weights,
alcohol use related to fetal alcohol syndrome [FAS])
• Duration of pregnancy and labor, type of anesthesia,
type of delivery, complications
• Details of labor and delivery alert nurse to observe for
potential newborn problems
 Immediate Care of the Newborn

• Start by congratulating the mother on the arrival of her new baby and ask if
she has any concerns. The mother is usually the first person to notice any
problems.
• Doing initial newborn assessment
• Stimulate and dry infant
• Asses ABCs
• Encourage skin-to-skin contact
• Assign APGAR score
• Give eye prophylaxis (sterile ophthalmic ointment containing 1% tetracycline or 0.5%
erythromycin)
• 1 mg of Vit K IM to prevent hemorhagic
Airway-Breathing-Circulation
• Is the newborn congested or gasping for
breath? Is the born cry loudly? Fetal fluid that
remains in the lungs can cause airway
obstruction
• Is there cyanosis? It may denote poor vascular
profusion. Is the newborn alert? A newborn in
difficulty will demonstrate irritability or be
unarousable.

Babies are obligatory nose breathers, so clear

secretions from nose to ease breathing.
Initial assessment: Apgar Scoring
SCORE
SIGN
0 1 2
• The Apgar score is affected by the
degree of :
Heart Rate Absent Slow (<100) Over 100
- Physiologic immaturity.
Raespiratory Slow, weak - Infection.
Absent Good cry
Rate cry - Congenital malformations.
Some flexion - Maternal sedation or
Muscle Tone Flaccide Well flexed analgesia.
of extremities
Reflex - Neuromuscular disorders.
No response Grimace Cry
irritability
Body pink,
Completely
Color Blue, pale extremities
pink
blue
Initial assessment: Apgar Scoring
• Evaluation of all five categories are made at 1 and 5
minutes after birth and repeated until the infant's
condition stabilized.
• Total Scores:
• Scores of 7-10: good condition (absence of difficulty in adjusting
to extra uterine life)
• Scores of 4-6: fair condition (the neonate may have moderate
central nervous system depression, muscle flaccidity, cyanosis,
and poor respirations)
• Total scores of 0-3 represent severe distress/ danger (the infant
needs immediate resuscitation as ordered).
Transitional assessment

• Periods for reactivity:

• First period of reactivity: For 6-8 hours after birth.
1.Initial stage of alertness and activity:
- During the first 30 minutes.
- The infant is very alert, cries vigorously, very interest in the environment.
- Neonate's eyes are usually open;
- The newborn has a vigorous suck; this is an opportune time to begin breast-
feeding
- Physiologically, the resp rate is high as 80 breath/min, crackles may be
heard, heart rate reach 180 beat/min, bowel sound are active , mucus
secretions are increased, and temp may decrease.
Transitional assessment
2. Second stage:
- Lasts to 2-4 hours,
- Heart and resp rate decrease, temp continues to fall, mucus production decreases ,and urine
is usually not passed.
- The infant is in state of sleep and relative calm.
- Undressing or bathing is avoided during this time

• The second period of reactivity: begins when the infant awakes from his deep
sleep.
- It lasts about 2-5 hours and
- The infant is again alert and responsive,
- Heart and resp rates increase.
- The gag reflex is active, gastric and respiratory secretions are increased,
- Passage of meconium frequently occurs.
- This period is usually over when the amount of respiratory mucus has decreased.
 Clinical assessment of gestational age

• A frequently used method of determining gestational age is the

simplifies Assessment of Gestational Age by Ballard(1979):
- It assess six external physical and six neuromuscular signs
- Each sign has a number score, and the cumulative score correlate
with a maturity rating from 20 to 44 weeks of gestation.
Weight Related to Gestational Age:
●Birth weight alone is a poor indicator of
gestational age and fetal maturity .
●Maturity: functional capacity: the degree to
which the neonate's organ systems are able to
adapt to the requirements of extrauterine life
●Classification of infants at birth by both
birthweight and gestational age provides amore
satisfactory method for predicting mortality
risks and providing guidelines for management
of the neonate than estimating gestational age
or birth weight alone.
Clinical assessment of gestational age
●Appropriate for gestational age (AGA) :the infant
whose weight is between 10th and 90th
percentiles. Can be presumed to have grown at a
normal rate regardless of the time of birth_
preterm, term, or post term.
●Large for gestational age (LGA): above 90th
percentile can be presumed to have grown at an
accelerated rate during fetal life
●Small-for-gestational-age (SGA) infant below 10th
percentile can be assumed to have intrauterine
growth retardation or delay.