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Newborns undergo profound physiologic changes at the moment of birth, as they are
released from a warm, snug, dark liquid-filed environment that has met all of their basic
needs, into a chilly, unbounded, brightly lit, gravity based outside world.

Within minutes after being plunged into this strange environment, a newbornƞs body
must initiate respirations and accommodate a circulatory system to extrauterine
oxygenation.

NursingCare of the Newborn

How well the newborn makes these major adjustments depends on his or her genetic
composition, the competency of the recent intrauterine environment, the care received
during the labor and birth period, and the care received during the newborn or neonatal
periodƜfrom birth through the first 28 days of life. (Adele Pillitteri, 2007)

Two thirds of all deaths that occur during the first year of life occur in the neonatal
period. More than half occur in the first 24 hours after birthƜan indication of how
hazardous this time is for an infant. Close observation of a newborn for this indication
of distress is essential during this period (National Center for Health Statistics, 2005).

Establish and Maintain a Patent Airway

1. Never stimulate a baby to cry unless secretions have been drained out.
2. Mucus should be sustained from a newbornƞs mouth by a bulb syringe as soon as the
head is delivered.
3. As soon as an infant is born, he/she should be held for a few seconds with the head
lightly lowered for further drainage of secretion.
4. Suction the newborn properly:
1. Turn the babyƞs head to one side
2. Suction gently and quickly.
3. Suction the mouth first before the nose.
4. Occlude one nostril at a time when testing for airway patency.
5. Record the first cry.
6. Maintain appropriate body temperature as chilling will increase the bodyƞs need for
oxygen.
7. Newborn suffers large losses of heat 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.

Keep Newborn Warm

Effects of Cold Stress

* · Metabolic acidosis
* · Hypoglycemia

1. Dry the newborn immediately

2. Wrap him with a warm blanket but not too tight as not to compromise respiratory
effort
3. Lay infant on his side in a warmed bassinet or place under a droplight
4. Place a head cap to conserve heat especially if they are in an open crib.
5. All nursing care should be accomplished quickly as possible to minimize exposure of
the infant.
6. Apgar scoreƜstandardized evaluation of the newbornƞs condition. Done at one
minute after birth to determine the general condition and then at 5 minutes to
determine how well the newborn is adjusting to extrauterine life.
1. ColorƜall infants appear cyanotic at birth and grow pink with or shortly after the first
breath
2. Heart RateƜauscultation of the newbornƞs heart
3. Reflex irritabilityƜresponse to a suction catheter or having the soles of their feet
slapped.
4. Muscle toneƜnewborn hold the extremity tightly flex. They should resist any effort to
extend their extremities
5. Respiratory effortƜa mature newborn usually cries spontaneously at about 30
seconds after birth. At one minute, the infant is maintaining regular although rapid
respirations.

Immediate Assessment of the Newborn

Sign 0 1 2
Appearance: Color Pale, Blue all over Pinky body, blue extremities Pink all over
Pulse: Pulse Rate Absent Less than 100 More than 100
Grimace: Reflex Irritability No response to stimulation Grimace/feeble cry when
stimulated Sneeze/Coughs/Pulls away when stimulated; good strong cry
Activity: Muscle Tone Limp, flaccid Some flexion of extremities Well-flexed extremities
Respiration: Breathing Absent Weak or irregular Good, strong cry

Scoring

* 0-3 pointsƜthe baby is serious danger and need immediate resuscitation.

* 4-6 pointsƜthe babyƞs condition is guarded and may need more extensive clearing of
the airway and supplementary oxygen.
* 7-10 pointsƜare considered good and in the best possible health.

Vital Statistics/Anthropometric Measurements

Vital Statistic Average Low or Arbitrary Low
Weight 6.5 to 7.5 lbs less than 5.5 lbs.
Length 50cms (20in) 46cms (18in)
Head Circumference 33 to 35 inches.
Chest Circumference 31-33cms or 2cms less than head circumference
Abdominal Circumference 31 to 33 cms

Vital Signs
Vital Sign Immediately At Birth After Birth
Temperature 36.5 to 37.2 Celsius
Pulse 180 beats/minute 120-140 beats/minute ave.
Respiration 80 breaths/minute 30-50 breaths/minute
Blood Pressure 80/46 mmHg 100/50 mmHg (by 10th day)

1. Proper Identification and Charting

1. Proper identification of the newborn and footprints must be taken and kept in the
chart.
2. Attach ID bracelet with a number that corresponds to the motherƞs hospital number,
motherƞs full name, sex, date and time of birth.
3. Inspect for the presence of 2 arteries and 1 vein. Suspect a congenital anomaly if
blood vessels are not complete.
4. Apply triple dye or Betadine for faster healing effect.
5. This is to cleanse the baby of blood mucus and vernix, and then followed with
sponge bath. Dry infant, wrap and keep him warm.
6. Credeƞs ProphylaxisƜprophylactic treatment of the newborns eyes against gonorrheal
conjunctivitis aka opthalmia neonatarum, which the baby acquires as he passes through
the birth canal of the mother who has untreated gonorrhea.

Care of the Umbilical Cord

Give Initial Oil Bath
Administer Eye Care

Procedure

* Wipe the face dry.

* Shade the eyes from light and open one eye at a time by exerting gentle pressure on
the upper and lower lids.
* Apply Erythromycin/Terramycin Opthalmic ointment from the inner to outer canthus
of the eye. The antibiotic will eliminate gonorrhea and Chlamydia as well.

Administration of Vitamin K

1. Vitamin K facilitates production of the clotting factor, thus preventing bleeding.

Method: Aquamephyton 1mg (Phytonadione), a synthetic Vitamin K is injected IM into

the lateral aspect of the anterior thigh (vastus lateralis).
Document Birth Record

1. Accomplish the form properly.

Continue Physical Assessment

Characteristics of a Newborn

1. General AppearanceƜposition and activity

2. Skin

1. a. ColorƜruddy complexion due to increased RBC concentration and decreased

subcutaneous fat which makes blood vessels more visible.
1. Acrocyanosis
2. Physiologic Jaundice
3. TextureƜslight desquamation for the first 2 to 4 weeks of life
4. Skin TurgorƜgood elasticity
5. Vernix CaseosaƜwhite cream-cheese like that serves as a skin lubricant
6. MiliaƜpinpoint size white spots seen on the nose and chin due to obstruction of the
sebaceous glands.
7. Erythema ToxicumƜnewborn rash. It begins with a papule and eventually to an
erythematic appearance.
8. LanugoƜis the fine downy hair that covers a newbornƞs shoulders, back and upper
arms. Immature newborns have more lanugo than mature infant.
9. Birthmarks
1. HemangiomasƜare vascular tumors of the skin.
1. Nevus flammeusƜmuscular purple or dark red lesion. Generally appear on the face
and thighs.
2. Strawberry hemangiomasƜelevated areas formed by immature capillaries and
endothelial cells.
3. Cavernous hemangiomasƜthese are dilated vascular spaces.
4. Mongolian spotsƜslate gray patches across the sacrum or buttocks and consist of a
collection of pigment cells.
5. Forceps marksƜthese are circular or linease contusion matching the rim of the blade
forceps on the infantƞs cheeks.

3. HeadƜnewbornƞs head is disproportionately large

1. FontanellesƜspaces or opening where the skull bones join

2. MoldingƜthe part of the infantƞs head that engages the cervix. It is molded to fit the
cervix contours.
3. Caput SuccedaneumƜis edema of the scalp at the presenting part of the head.
4. CephalhematomaƜis a collection of blood between the periosteum of the skull bone
and the bone itself caused by rupture of the periosteum capillary due to the pressure of
birth.
5. CraniotabesƜis a localized softening of the cranial bones.

4. EyesƜvision is present as evidence of blinking reflex

5. EarsƜhearing is present as soon as amniotic fluid is drained or is absorbed from the

middle ear.

6. NoseƜmay appear large for the face.

7. MouthƜshould open evenly when the baby cries.

8. NeckƜis short and chubby, creased with skin folds and head rotate freely.

9. ChestƜappear small in proportion to infantƞs head.

1. AbdomenƜcontour is slightly protuberant (sticking out from the surroundings)

2. Anogenital AreaƜanus should not be covered by a membrane. Take note of the time
meconium is first passed.
1. BackƜthe spine appears flat in the lumbar and sacral areas
2. Extremities
1. Arms and legs appear short
2. Hands are plump and clinch into fists
3. Should move symmetrically
4. Fingernails are soft, smooth
5. Good muscle tone, arms always in flexed position
6. Palm of hands should have three creases.
7. Legs are bowed as well short
8. Soles of the feet appears to be flat
9. Presence of crisscrossed lines on the soles of the foot.
3. Feeding

Provide Discharge Instructions

1. Breast-fed babies are fed immediately after birth and can be fed on demand or at
least every 2 hours for the first few days of life. Advice to alternate both breast at 10-15
minutes each.
2. Bottle-fed babies routinely received an initial feeding of about 1oz of sterile water at
4-6 hours of age to be certain the infant can swallow without gagging and aspirating.
The newborn is then fed every four hours.
1. Sleep patternsƜnewborns sleep 16-20 hours a day
2. BathingƜmay be given anytime convenient as long as it is not within 30 minutes
after feeding as handling might cause regurgitation. Sponge baths are done until cord
falls off.
3. Cord Care
1. Dab rubbing alcohol (70% solƞn) two or three times a day for faster drying.
2. Fold down diapers so that cord does not get wet during voiding.
3. Small, pink granulating area may be seen on the day the cord falls off. If it remains
moist or with foul discharge, advise mother to bring baby to the doctorƞs clinic.
4. Car Safety. Until a child reaches a weight of 20lbs, the best type of car seat is an
Ơinfant onlyơ seat that faces the back of the car.

Bibliography

Pillitteri, A. (2007). Maternal and Child Health Nursing:Care of the Childbearing and
Childrearing Family. Winsconsin: Lippincott Williams & Wilkins.