NEW BORN CARE  Staring when the newborn awakes, is

marked by hyperresponsiveness to
GOAL OF NEWBORN CARE stimuli, skin color changes from pink to
Initial postpartum care slightly cyanotic and rapid HR.
 Occurs between 2-6 hours.
 To establish and maintain an airway and  Oral mucus may cause choking, gagging
support respiration. and coughing problems.
 To maintain warmth and prevent
hypothermia. APGAR SCORE
 To ensure safety and prevent injury or  Dr. Virginia Apgar developed the APGAR
infection. scoring system.
 To identify actual or potential problems  Taken at one minute and five minutes
that might require immediate attention. after birth.
 With depressed infants, repeat scoring
Continuing care every five minutes as needed.
 To continue protecting from injury or  The one-minute score indicates the
infection and identifying actual or necessity for resuscitation.
potential problems that could require  The five-minute score is more reliable in
attention. predicting mortality and neurologic
 To facilitate development of a close defects.
parent-newborn relationship.  The most important is the heart rate
 To provide parents with information then the respiratory rate, the muscle
about newborn care. tone, reflex ability and color follows in
 To assist parents in developing healthy decreasing order.
attitudes about childbearing practices.  Heart rate below 100 signifies an
asphyxiated baby and heart rate above
TRANSITION TO EXTRAUTERINE LIFE 160 signifies distress.
 Phase of instability during the first 6  7-10 good adjustment, vigorous.
hours of life through which all  Moderately depressed infant needs
newborns pass. airway clearance.
 These period of adjustment was first  Severely depressed infant, in need of
described by Desmond in 1963 and resuscitation
were termed as periods of reactivity.
I. ESTABLISHING RESPIRATION AND
First period of reactivity MAINTENANCE OF AIRWAY
 Lasts about half an hour. CLEARANCE
 Newborn exhibits: rapid respiration,  The most important need of the
transient nostril flaring, retraction and newborn immediately after birth is a
grunting. HR may reach up to 180 bpm clear airway to enable it to breathe
during the first few minutes. effectively.
 Respiratory rate of the newborn in the
Resting period first few minutes of life may be as high
 Newborn becomes quiet, relaxes, and as 80 cpm.
falls asleep.  As respiration activity is established,
 Sleep lasts up to 90 min. rate settles to an average of 30-60 cpm.
 Periods of apnea are considered
Second period of reactivity normal.
  Newborns are obligatory nose  Initial temperature of newborn is taken
breathers. rectally to assess patency of the anus at
To establish and maintain respiration: the same time.
 Wipe the mouth and nose of secretions  Rapid heat loss in a cool environment
after delivery of the head. occurs by conduction, convection,
 Suction secretions from mouth and radiation and evaporation.
nose.  Cold stress in the newborn, with its
 Compress bulb syringe before inserting associated metabolic acidosis, can be
to prevent air from forcing mucus back lethal even for a vigorous, full –term
into the bronchi and alveoli. newborn.
 Suction mouth first, next is nose to
prevent the baby from having a sudden Stabilize and Maintain Normal Temperature:
inspiratory gasp which could result in  Dry head and body, then wrap with
aspiration of secretions an amniotic warm blanket immediately after birth
fluid into the lungs. before giving to the mother to hold.
 Insert bulb syringe on one side of the  Place newborn under droplight without
mouth. Inserting the bulb syringe at the clothes for two hours after birth or until
center will stimulate the gag reflex. temperature has stabilized.
 A crying infant is a breathing infant.  Delay initial bath until temperature has
Stimulate baby to cry if baby does not stabilized for at least 2 hours.
cry spontaneously or if baby’s cry is  Perform any extensive examination or
weak. procedure under radiant heat to
 Rub the soles of the feet to stimulate prevent heat loss.
crying.
 Stimulate to cry only after secretions
are removed to prevent aspiration. III. CARE OF THE CORD
 Normal infant cry is loud and lusty.
 Oral mucus may cause newborn, to  Cord is clamped and cut approximately
choke, cough or gag during the first 12 within 30 seconds after birth.
to 18 hours of life.
 Keep the nares patent. Cord Ligation:
 Clamp the cord twice with two Kelly
forceps an inch apart, 8-10cm. From the
II. HEAT REGULATION umbilicus and cut in between. (BMC
 Heat regulation is the second most Institutional policy is to use sterile
important task a newborn must achieve plastic cord clamp in the cord near the
after birth. baby and one Kelly forceps)
 Achieved by maintaining the balance  Hold the Kelly Forceps and position the
between heat loss and heat production. cord so that it is perpendicular to the
 Newborn temperature is about 37.2 ⁰C infant’s abdomen.
at birth the and fluctuates because of  Clean the cord with sterile cotton balls
immature temperature regulating soaked in Povidone Iodine starting from
mechanism. the base in a circular motion from
 Normal newborn axillary temperature inside going outside, from the base
average 37 ⁰C. towards the Kelly forceps/plastic cord
 Rectal temperature is 0.2 ⁰C to 0.8 ⁰C or clamp making sure all the sides are
higher. cleaned. . (BMC Institutional policy is
 to use 70% alcohol rather than  Measure head circumference at the
povidone iodine) level of the eyebrows to the most
 Milking the cord might cause hemolysis prominent portion of the infant’s head
of RBC’s. with the use of the tape measure.
 Apply plastic cord clamp 2cm from the  At birth, head circumference may be
umbilicus. Make sure it is securely equal or greater than chest
locked. Cut between the cord clamp circumference.
and the Kelly forceps to form a cord
stamp. Chest Circumference:
 Inspect the cord for presence of two  Normal chest circumference ranges
arteries and 1 vein; report any from 30-32 cm.
abnormalities noted  Measured at the level of the nipple
 Clean the stamp with sterile cotton ball using a tape measure.
moistened with Povidone-Iodine  A chest circumference less than 30 cm
starting from the top of the stamp to indicates prematurity. An enlarged
the base of the cord then continue heart may make the left side of the
cleansing the base in a circular manner chest larger.
from inside going outside. (BMC
Institutional policy is to use 70% Abdominal Circumference:
alcohol rather than povidone iodine)  Is approximately the same as chest
 Wrap the cord stamp with sterile gauze circumference.
or expose it to air depending on  Measured just below the umbilicus.
hospital policy.  The neonate’s abdomen usually
enlarges after feeding due to lax
Care of the Cord: abdominal muscles.
 Tub bathing is prohibited until cord falls
off by itself. Weight:
 Do not apply anything on the cord  Birth weight of a full-term newborn
except the prescribed antiseptic infant ranges from 2500 g. to 4000 g.
solution which is 70% alcohol. average is 3500 g.
 Avoid wetting the cord. Fold diaper  Average female infant birth weight is 7
below so it does not cover the cord. lbs.
 Leave cord exposed to air.  Male infant is around 7.5 lbs.
 Do not apply dressing or abdominal  Boys are usually heavier than girls by
binder over it. 100 g. or ounces.
 Average birth weight of Filipino infants
are 3000 g.
IV. ANTHROPOMETRIC
MEASUREMENTS Length:
 Newborn length average 45cm to 55
Head Measurement: cm.
 Range: 33-35 cm./ Average 35 cm.  Average is 50 cm.
 It increases at approximately one  Female infants generally are ½ inch
centimeter a month. shorter than male infants.
 The head circumference is usually  The average length of boys is 50 cm.
greater than chest circumference by 2  Average length of girls 49 cm.
cm.  Measure newborn length from top of
 The head is ¼ of total body length. the head to heel using a tape measure.
  A length of less than 47 cm. is a sign of  Clean the eyelids carefully with a sterile
prematurity. cotton ball moistened with sterile NSS
from the inner to outer canthus of the
eye.
 Retract the lower eyelid using your
V. INFANT BATH thumb.
 Cleaning of the baby’s body provides an  Drop generous amount of the
excellent opportunity for making prescribed antibiotic ointment on the
observations. lower conjunctural sac from inner to
 Wear gloves when handling newborns outer canthus of the eye
until the first bath, to avoid exposing  Wipe off excess medication with sterile
hands to body secretions. OS.
 Be sure room is warm. Water should be  Do the same procedure with the outer
approximately 98⁰ C to 100⁰ C. eye.
 Soap used should be mild without
hexachlorophene base.
 Bathing should take place before not VIII. VITAMIN K ADMINISTRATION
after feeding to prevent spitting up or
vomiting and possible aspiration.  Vitamin K is use d to prevent and treat
 Give particular care to creases of the hemorrhagic disease in newborns. It is a
skin where milk tends to build up. necessary component for the
 The use of colognes, scented powders, production of certain coagulation
lotions, and strong soaps is factors (II,VII, IX and X) and is produced
discouraged. by microorganisms in the intestinal
tract.
VI. EYE CARE  Dosage: prophylaxis- 0.5 to 1.0 mg IM
 Used against the treatment gonorrheal one time immediately after birth.
conjunctivitis.  Possible adverse reaction: local
 Erythromycin is the drug of choice. irritation, such as pain and swelling at
 Always use a single-use tube or package the site of injection.
erythromycin to avoid transmission of  Administer vitamin K into large muscle,
infection from one newborn to another. such as the anterolateral muscle of the
newborn’s thigh.
Opthalmia neonatorum  If given as treatment acquire
prothrombin time before
 Defined as any conjunctivitis with administration.
discharge occurring during the first two  Assess for signs of bleeding, such as
weeks of life. black tarry stools, hematuria, decreased
 Typically appears 2-5 days during the hemoglobin and hematocrit levels, and
first two weeks of life. bleeding from any open wounds or base
 Both eyes become swollen and red with of the cord.
purulent discharge.
 Corneal damage with ulceration,
perforation, synechiae, and -END-
panopthalmitis develop if there is delay
in treatment.

VII. CREDE’S PROPHYLAXIS