THE NEONATE

DEFINITION: The first 28 days of life.

PRINCIPLES OF NEWBORN CARE

I. Establish and maintain a patent airway.

A. Never stimulate a baby to cry unless secretions have been drained out.
B. The position should be one that promotes drainage of secretions (head lower than the rest
of the body) EXCEPT when there are signs of increased intracranial pressure (vomiting;
bulging, tense fontanelles; abnormally large head; increased BP, decreased PR and RR
and widening pulse pressure; shrill, high-pitched cry), in which case, the head should be
higher than the rest of the body.
C. Suction the newborn properly:
1. Turn the baby’s head to one side.
2. Suction gently and quickly – prolonged and deep suctioning of the nasopharynx
during the first 5-10 minutes of life will stimulate the vagus nerve (located in the
esophagus) and cause bradycardia.
3. Suction the mouth first before the nose when suctioning the nose, the stimulation of the
nasal mucosa will cause reflex inhalation of pharyngeal material into the trachea and
bronchi, causing aspiration.
4. To test for patency of the airway, occlude one nostril at a time (REMEMBER:
Newborns are nasal breathers). If the newborn struggles when a nostril has been
occluded, additional suctioning is indicated.

II. Maintain appropriate body temperature.

Chilling will increase the body’s need for oxygen. The newborn suffers large losses of heat
(cold stress) 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. Effects of cold stress:
A. Metabolic acidosis – one of the ways by which heat is produced in the newborn is by
increasing metabolism. When this occurs, fatty acids accumulate because of the
breakdown of brown fat (seen only in newborns).
B. Hypoglycemia – due to the use of glucose stored as glycogen.
1. Dry the newborn immediately
2. Wrap the baby warmly
3. Put the baby under a droplight

III. Immediate assessment of the newborn

A. Apgar/APGAR score = standardized evaluation of the newborn’s 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.
Table 11. Apgar Score
SIGN 0 1 2
1. Heart rate* Absent <100 >100 = 2
2.Respiratory effort Absent Weak Cry = 1 Good, strong cry
Some flexion of Well-flexed
3. Muscle tone** Limp, flaccid
extremities extremities = 2
Grimace; Sneeze; good,
4. Reflex irritability No response
Weak cry = 1 strong cry
Pale, Extremities blue,
5. Color Pink all over
blue body pink = 1
* Most critical observation
** The general attitude of the baby at birth is that of flexion
1. Interpretation of results:
a. 0 – 3 = the baby is in serious danger and need immediate resuscitation.
b. 4 – 6 = condition is guarded and may need more extensive clearing of the airway.
c. 7 – 10 = baby is in the best possible health
 B. Assessment of gestational age
1. Methods of estimating gestational age:
a. Mother’s LMP (Nagele’s Rule)
b. Fundic height (McDonald’s method)
c. Bartholomew’s rule
d. Time quickening is first felt
e. Time fetal heart tones are firs heard
f. Ultrasound
g. Assessment of newborn at birth

Table 12. Clinical Criteria for Gestational Age Assessment

SIGN Till 36 weeks 37 – 38 weeks 39 weeks

Occasional
Anterior transverse Sole covered with
1. Sole creases creases, anterior
crease only creases
two-thirds
2. Breast nodule
2 mm. 4 mm. 7 mm.
diameter
3. Scalp hair Fine & fuzzy Fine & fuzzy Coarse & silky
Pliable, no Stiffened by thick
4. Earlobe Some cartilage
cartilage cartilage
Testes pendulous;
5. Testes and Testes lower
intermediate scrotum full with
scrotum scrotal sac
extensive rugae

C. Cephalometry = measurement of diameters of the skull; suboccipitobregmatic, biparietal,

occipitofrontal, occipitomental, bitemporal.

IV. Proper identification – of the newborn must be done is the delivery room before bringing to
the Nursery. Although before Footprints are said to be done to identify the baby in the past but
the ink chemical may harm the baby. The DNA test is the best way by which we identify
newborns.

V. Nursery care
A. Check identification band
B. Take anthropometric measurements:
1. Length = average: 50 cm. (20 in.) = 19-21½ inches (47.5 – 53.75 cm.)
2. Head circumference = 33-35 cm.
3. Chest circumference = 31-33 cm.
4. Abdominal circumference = 31-33 cm.
C. Take the temperature – at birth is 37.2°C or 99°F, but because of evaporation from the
moist skin and the cold delivery room, will stabilize in 8 hours’ time and must be
maintained at 35.5°-36.5°C (97°-99°F) so as to prevent hypoglycemia and acidosis due to
hypothermia. Axillary and rectal temperatures are approximately the same immediately
following birth but the rectal route is preferred in order to check patency of the anus.
D. Specific nursing actions:
1. Give initial oil bath to cleanse the baby of blood, mucus, and vernix.
2. Dress the umbilical cord. Inspect for the presence of 2 arteries and 1 vein. Suspect a
congenital anomaly if blood vessels are not complete; a mere thorough physical
assessment is indicated and closer observation in an ICU is done.
3. Crede’s prophylaxis = prophylactic treatment of the newborn’s eyes against gonorrheal
conjunctivitis (opthalmia neonatorum) which the baby acquires as he passes through
the birth canal of his mother who has untreated gonorrhea:
a. Wipe the face dry
b. Shade the eyes form light and open one eye at a time by exerting gently pressure
on the upper and lower lids.
 c. 2 drops of 1% silver nitrate are instilled one at a time into the lower conjunctival sac
(Be careful not to drop on the cheeks because parents at worry about the stain.
d. Wash silver nitrate away with sterile NSS after 1 minutes to prevent chemical
conjunctivitis (inflammation, edema, purulent discharge)
e. Penicillin/chloromycetin/teramycin ophthalmic ointment may be used since it does
not irritate the eyes (although the baby may develop sensitivity at an early age).
Apply from the inner to the outer canthus of the eye.
4. Vitamin K administration
a. Rationale: Vitamin K facilitate production of the clotting factor, thus preventing
bleeding. But Vitamin K is synthesized in the presence of normal bacterial flora in
the intestines. Since the newborn’s intestines are still relatively sterile, therefore,
they will not be able to synthesize Vitamin K; that is why synthetic Vitamin K is
given to prevent hemorrhage.
b. Methods: 1 mg. Aquamephyton (generic name is phytonadione) is injected IM into
the lateral anterior thigh (vastus lateralis). In children below 12 months of age who
have not yet learned how to walk, this is the preferred site of injection because
gluteal muscles are not yet fully developed.
5. Weight-taking
a. Average birth weight = 6½ - 7.5 lbs = 3 – 3.4 kgs. = 3000-3400 gms.
b. Arbitrary lower limit – below which the newborn is said to be of low birth weight: 5.5
lbs. = 2.5 kgs. = 2500 gms.
c. Ideal procedure
 Weigh the clothes first
 Put on baby’s clothes
 Weight the baby with his clothes on
 Subtract the weight of the clothes form the total weight of the baby and his
clothes
d. Physiologic weight loss of 5-10% of birth weight (6-10 oz) during the first 10 days of
life because the newborn:
 Is no longer under the influence of maternal hormones
 Voids and passes out stools
 Has limited intake
 Has beginning difficulty establishing sucking
6. Feeding
a. Initial feeding – is a test feeding consisting of an ounce of sterile water (glucose
water has been found to be irritating to the lungs if aspirated) is given to find out if
the newborn can swallow without aspirating.
b. Subsequent feedings – preferably given by demand.
E. Physical Assessment
1. Pulse – normally irregular and 120-140 beats per minute. Apical pulse (stethoscope
below the left nipple) is recommended since radial pulses are not ordinarily palpable (if
prominent, in fact, may be a sign of congenital heart anomaly).
2. Respirations – are gentle, quiet, rapid but shallow; normally 30-60 breathes per
minutes. Largely diaphragmatic and abdominal (watch for the rise and fall of the chest
and abdomen).
3. Blood pressure - not routinely measured in newborns unless coarctation of the aorta is
suspected.
a. Normal values:
 At birth = 80/46 mm. Hg.
 After 10 days = 100/50 mm. Hg.
b. Size of cuff in children: must not be more than 2/3 the size of the extremity (will
result in false low BP) nor less than ½ the length of the extremity (will result in false
high BP).
c. Procedure = flush-method:
 Cuff is applied to an extremity
  Extremity is elevated and an elastic bandage is wrapped around the distal portion
of the extremity
 Slowly inflate the cuff up to 100 mm. Hg, then remove the bandage (extremity is
expectedly pale)
 Slowly deflate the cuff, while watching the pale extremity
 As soon as the extremity turns pink (flushes), read the manometer.
 Only one reading can be obtained, the average between the diastolic and the
systolic pressures, called flush pressure (therefore, is normally 60).
4. Skin
a. Color – normally ruddy because of the increased concentration of RBCs and the
decreased amount of subcutaneous fat
 Acrocyanosis = body pink, extremities blue. Normal during the first 24-48 hours
of life.
 Generalized mottling is common due to an immature circulatory system
 Pallor – due to anemia which results from excessive blood loss when cord is cut,
inadequate blood flow from cord to infant at birth, inadequate iron stores
because of poor maternal nutrition. May also be due to blood incompatibility.
 Gray color – indicates infection
 Jaundice – yellowish discoloration of the skin and sclerae;
i. Cause: inability of the newborn to conjugate bilirubin (Figure 18).
ii. Normal values:
o Total serum bilirubin = 15 mg%
 Direct bilirubin = 1.7
 Indirect bilirubin = 13.2
o Most accurate method is assessing presence of jaundice: use natural
light and blanch skin on the chest or top of the nose
o Physiologic jaundice – from the 2nd to the 7th day of life.
 Breastfeed babies, however have longer physiologic jaundice
because human milk has pregnanediol which depresses the action of
glucoronyl transferase (the enzyme responsible for converting
indirect bilirubin to direct bilirubin)

DESTROYED RBCS
release

HEME GLOBIN
broken down

IRON PROTOPORPHYRIN
(reused by the body; not further broken down
involved in jaundice)
INDIRECT BILIRUBIN
(fat-soluble; cannot be excreted by the kidneys)

converted by liver enzyme

glucoronyl transferase

DIRECT BILIRUBIN
(water-soluble; can be excreted by the kidneys)
Figure 18. Normal Process of RBC Breakdown

 Harlequin Sign – because of immaturity of circulation, an infant who has been

lying on his side will appear red on the dependent side and pale on the upper
side.
 Mongolian spots = slate-gray patches seem across the sacrum/buttocks and
consist of collection of pigment cells (melanocytes). Disappear by school-age.
Seen only among Southern European, Asian and African children.
 Lanugo = fine, downy hair that covers the shoulders, back, and upper arms.
 Desquamation = drying of newborn’s skin
 Petechiae on face and neck – due to increased intravascular pressure during
delivery
 Milia = unopened sebaceous glands found on the nose, chin, and cheeks;
disappear spontaneously by 2-4 weeks.

5. Head – largest part of the infant’s body (¼ of his total length).

a. Forehead is large and prominent
b. Chin is receding and quivers when startled or crying
c. Fontanelles are neither sunken (a sign of dehydration) nor bulging a sign of
increased intracranial pressure)
d. Suture lines should neither be separated nor fontanelles prematurely close (=
craniosynostosis; leads to mental retardation)
e. Craniotabes = localized softening of the cranial bones; can be indented by pressure
of a finer, corrects itself without treatment after some months. More common
among first-borns because of early lightening.

Table 13. Comparison Between Caput and Cephalohematoma

INDICATORS CAPUT SUCCEDANEUM CEPHALOHEMATOMA
Definition Edema of the scalp Collection of blood
Between periosteum of
Presenting part of the
Location skull bone and the bone
head
itself
Confined to an individual
Extent of involvement Both hemispheres bone; does not cross
suture lines
Pressure (as in prolonged Rupture of capillaries due
Cause
labor) to pressure
Period of absorption
(most significant On or about the third day Takes several weeks
differences)
None; support the
Treatment None
anxious parents
6. Eyes
a. Method of assessment: Put infant on upright position
b. Characteristics:
 Cry tearlessly during first 2 months because of immature lacrimal ducts
 Cornea should be round and adult-sized
 Pupils should be round, not key-holed (= coloboma)
7. Ears – level of top part of external ear should be in line with outer canthus of the eye.
If set lower, maybe a sign of kidney malfunction or Down’s syndrome
8. Nose – may appear large for the face; there should be no septal deviation
9. Mouth
 a. Should open evenly when crying; if not, suspect cranial nerve injury
b. Tongue appears large
c. Palate should be intact; no breaks on the lips
d. Epstein’s pearls – 1 or 2 small, round, glistening cysts seen on the palate; due to
extra load of calcium while in utero
e. A tooth may be seen; if loose, should be extracted to prevent aspiration when
feeding
f. Oral thrush = white or gray patches on the tongue and sides of the cheeks due to
Candida albicans acquired during passage of the baby through the birth canal of
the mother with untreated Moniliasis; also known as oral moniliasis.
10. Neck
a. Thyroid gland is not palpable
b. Appears soft and chubby and creased with skin folds
c. Head should rotate freely on the neck and flex forward and back
11. Chest – as large as, or smaller than, the head:
a. Should be symmetrical
b. Breasts may be engorged, a result of the influence of maternal hormones
c. Witch’s milk – thin, watery fluid also due to maternal hormones
12. Abdomen
a. Liver, spleen, and kidneys are palpable at birth. Liver is about 1-2 cm, below the
right costal margin.
b. Normally dome-shaped; if scaphoid, suspect Diaphragmatic Hernia
13. Anogenital area
a. Take note of the time meconium is first passed (it should be within the first 2
hours of life)
b. Female genitalia: may have female swollen labia and drops of blood due to
maternal hormones
c. Male genitalia:
 Scrotum may be edematous – also due to maternal hormones
 Foreskin should be retracted to test for phimosis (= tight foreskin)
 Testes should be present: if not descended, the condition is called
cryptorchidism (repair of undescended testes is called orchidopexy)
 Circumcision – maybe done prior to discharge from the nursey, preferably by
the end of the first week
i. Procedure:
o Vitamin K injected IM
o Infant is restrained; penis is cleansed with soap and water
o Yellen clamp is used
o Petrolatum gauze dressing is applied to prevent adherence of
circumcised site to the diaper while applying pressure to prevent
bleeding
ii. Nursing care:
o Check hourly for bleeding (most common complication) during the first
day. If small amount of bright red is observed, apply gently pressure to
the area with a sterile gauze pad
o Do not attempt to remove exudate which persists for 2-9 days. Just
wash with warm water.
o Diaper must be pinned loosely during first 2-3 days when the base of
the penis is tender
14. Back – on prone, appears flat (curves start to form only when sitting or walking has
been achieved).
15. Extremities
a. Arms and legs are short; hands are plump and clenched into fists.
b. Should move symmetrically
c. Abnormalities:
 Erb-Duchenne paralysis/Brachial plexus injury
 i. Causes:
o Lateral traction exerted on head and neck during delivery of the
shoulders in vertex presentation
o Excessive traction on the shoulders during breech extraction, especially
when the arms are extended over the head
ii. Signs and symptoms:
o Inability to abduct arm from the shoulder, rotate arm externally or
supinate forearm
o Absent Moro reflex on affected arm
iii. Management: abduct the affected arm in external rotation position with the
elbow flexed
 Congenital hip dislocation/dysplasia
i. Signs and symptoms:
o Assist in replacing head of the femur into the acetabulum of the hip bone
by using 3 diapers instead of one, or by putting a pillow between the
thighs to maintain abduction of the thighs and flexion of the hip and knee
joints
o Infant preferably carried astride mother’s hip
o Hip spica cast is applied at a later age, before the infant starts to walk.
Cast extends from the waistline to below the knee of the affected leg and
above the knee of the unaffected leg. If treatment is delayed (after the
baby has already learned how to walk), the child will become lordotic
and walk with a protective limp at a later age.

F. Systemic Evaluation /ROS

1. Cardiovascular System
a. Major differences in fetal circulation:
 Exchange of oxygen and carbon dioxide takes place in the placenta, not in the
fetal lungs
 Because little blood goes to the fetal lungs, pressure in the left side of the fetal
heart is less than the pressure in the right side of the fetal heart.
Figure 19. Fetal Circulation

Brai
SVC n,
heart
&
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Asce r half
ndin of
g the
aorta body
RA FO LA

IV Ductu
C s
LI De
VE LUN sc
R GS en
Du Pulm Aort di
ct onary a ng
us arter ao
ve R y LV rta
no V
su
s
U
m
 Ex
tre
mi
U
PL tie
m
AC s
 Presence of fetal accessory bilistructure:
&
cal
i. Foramen ovale – bypasses the pulmonary circulatory system since it islothe
art
opening between the right and the left atria we
eri
ii. Ductus arteriosus – communication between the pulmonary artery and rthe
aorta es
hal
iii. Ductus venosus - communication between the pulmonary artery and fthe
aorta of
iv. Ductus venosus – communication which bypasses the liver th
v. Umbilical vein – carries the most highly oxygenated blood e
vi. Umbilical arteries carry deoxygenated blood bo
b. Neonatal/adult circulation – as soon as breathing has been initiated, oxygenation dy
now takes place in the newborn’s lungs. The change from fetal to neonatal
circulation is, therefore, associated with lung expansion, causing pressure in the
left side of the newborn’s heart to become higher compared to pressure in the right
side of the newborn’s heart.
 Increased pressure on the left side of the newborns heart results in:
i. Closure of the foramen ovale
ii. Change of the ductus arteriosus into a mere ligament (ligamentum
arteriosum)
 The decreased pressure on the right side of the newborn’s heart causes the
ductus venosus to become a ligament (ligamentum venosum)
 Since no more blood goes through the umbilical vein and arteries, these blood
vessels atrophy and degenerate.
c. Blood values – are all high in the newborn period as a response to the pulmonary
circulation:
 Red blood cells = 6 million/ml3
 Hemoglobin = 17-18 gms. %
 Hematocrit = 52%
 White blood cells = 15,000-45,00 per ml 3. A high WBC count during the
newborn period, therefore, is not a sign of infection; with or without infection,
all newborns have high WBC count.

2. Gastrointestinal tract – differences in stools.

a. Meconium = sticky, tarlike, blackish-green, odorless material formed from mucus,
vernix, lanugo, hormones, and carbohydrates that accumulated while in the utero.
b. Transitional – on the 2nd to the 10th day of life in response to the feeding pattern;
are slimy, green, and loose, resembling diarrhea to the untrained eye
c. Breastfed – golden-yellow, mushy, more frequent (3-4 times/day) and sweet-
smelling because breast milk is high in lactic acid which reduces the amount of
putrefactive organisms.
d. Bottle-fed – pale, yellow, firm, less frequent (2-3 times/day) and with a more
noticeable odor.

3. Urinary system – newborn should void within the first 24 hours of life
a. Female newborns – form a strong stream when voiding
b. Male newborns – for a small projected arc when voiding. If not, suspect a defect on
urethral meatus:
 Hypospadias – urethral opening located in the ventral (under) surface of the
penis
 Epispadias – urethral opening located in the dorsal (above) surface of the penis
 i. Management:
o Inspect for cryptorchidism – often found associated with
hypo-/epispadias
o Meatotomy is done to establish better urinary function
o When the child is older (12-18 months), adherent chordae (= fibrous
bands that curve that cause the penis to curve downward) may be
released surgically. If repair will be extensive, surgery might be delayed
until 3-4 years old. Child should not be circumcised because at the time
of repair, the surgeon may wish to use a portion of the foreskin
o Surgical correction is done before school-age so that the child appears
normal to his schoolmates.

4. Autoimmune system
a. Type of immunity transferred from mother to newborn: passive natural immunity
b. Newborns have antibodies from the mother against poliomyelitis, diphtheria,
tetanus, pertussis, rubella, measles (present in the infant for one year). But little or
no immunity against chickenpox (that is why chickenpox is often fatal in the
newborn).
c. Newborns have difficulty forming antibodies until 2 months of age (that is why
immunizations are started at 2 months)
d. Immunoglobulins (Ig): GAMED

5. Neuromuscular system
a. Blink reflex– rapid eyelid closure when strong light is shone; always present
b. Feeding reflexes:
 Rooting reflex- head will turn to the direction where cheek s stroked near the
corner of the mouth; will help infant to find food; disappears by 6 weeks of age
when infant is already capable of seeing things past the visual midline
 Sucking reflex – anything places between the lips will be sucked; disappears by
6 months. IMPORTANT: Sucking reflex disappears immediately if not
stimulated regularly. IMPLICATION: Any infant who will be put on NPO should
be given a pacifier not only for psychological reasons, but also to prevent
premature disappearance of the sucking reflex
 Extrusion reflex – anything placed on the anterior portion of the tongue will be
spit out; disappears by 4 months of age when infant is about ready for semi-
solid or solid foods,
 Swallowing reflex – anything places at the back of the tongue will be
swallowed; will never disappear.
c. Tonic neck reflex (TNR)/Fencing reflex/boxer reflex – when on his back, the
infant’s arm and leg are extended on the side where the head is turned, while the
arms and leg on the opposite side are flexed; disappears by 2-3 months.
d. Babinski reflex – when side of the sole is stroked with a “j” from heel upward, the
infant will ran out his toes; starts to disappear by 3 months of age. (If the adult’s
sole is stroked, the adult will curve in his toes).
e. Landau reflex – when on prone, the newborn should demonstrate some muscle
tone; a test of spinal cord integrity
f. Palmar or plantar grasp/step-in-place reflexes – accessory reflexes
g. Moro reflex – singular most important reflex indicative of neurological status. If the
bassinet is jarred or the infant’s head is allowed to drop backward in supine
position (change infant’s equilibrium), the infant will abduct and then adduct his
arms. Disappears by 4-5 months

6. Senses – all are functional at birth:

a. Sight – all newborns can see at birth, although they cannot see objects past the
visual midline (not until 6-8 weeks). The visual field is 20-22 cm. or 9 inches.
 b. Hearing – as soon as amniotic fluid has been absorbed, the newborn can already
hear.
c. Taste – as soon as secretions have been suctioned, newborns can already taste
d. Smell – as soon as the nose has been cleared of mucous and fluid, newborns can
smell
e. Touch – the most developed of all the senses.

G. Discharge Instructions
1. Bathing – may be given anytime convenient for the parents as long as it is not within
30 minutes after feeding because the increased handling during the bathing can
cause regurgitation. Sponge baths are done until the cord falls of (7 th-14th day).
2. Cord care
a. Fold down diapers so that the cord does not get wet during voiding
b. Dab rubbing alcohol (70%)once or twice a day
c. Small, pink granulating area may be seen on the fay the cord falls off. If it remains
moist for a week, advise mother to bring baby to the doctor’s clinic where cautery
with silver nitrate stick will be done to speed healing.
3. Nutrition
a. Recommended Daily Allowances
 Calories – 120 cal/kg. Body weight (KBW) = 50-55 cal/lb. body weight = more
or less 380 cal/day
 Proteins = 2.3 gms./KBW/day
 Fluids = 16-20 cc/KBW = 2.5-3 oz. per lb. body weight = more or less 20 oz/day
b. Vitamins – vitamins A, C, and D are recommended for both bottle-fed and
breastfed babies during the entire first year of life.
NUTRIENTS HUMAN MILK COW’S MILK
Protein 8% 20%
Fats 50% 50%
Carbohydrates 42% 30%
Sodium 7 mEq/liter 25 mEq/liter
Potassium 14 mEq/liter 36 mEq/liter
Calcium 12 mEq/liter 61 mEq/liter
Phosphorus 9 mEq/liter 53 mEq/liter
Chloride 12 mEq/liter 34 mEq/liter
Table 14. Comparison Between Human Milk & Cow’s Milk

c. Differences between human milk and cow’s milk

 Human milk contains less proteins. Cow’s milk has more proteins but the
newborn’s kidneys become overwhelmed with the higher protein content of
cow’s milk that is why cow’s milk need to be diluted. The main protein in human
milk is lactalbumin. The main protein in cow’s milk is casein. Since the curd
tension in milk is related to the amount of casein, the curd in cow’s milk is
therefore larger, tougher, and more difficult to digest (that is why bottle-fed
babies have frequent constipation). Heating reduces the curd, that is why cow’s
milk must be sterilized or pasteurized so newborns can digest it.
 Human milk and cow’s milk have similar fat content; but, linoleic acid, which is
necessary for growth and skin integrity, is three times higher in human milk
than in cow’s milk. Besides, human milk has larger fat globules.
 Human milk contains more carbohydrates. Moreover, lactose in human milk
appears to be the most easily digestible of all the sugars; it also improves
calcium absorption and aids in nitrogen retention.
 Cow’s milk has more minerals but, again, newborn’s kidneys become
overwhelmed with the high mineral content of cow’s milk that is why it has to be
diluted first.
 d. Similarities between human milk and cow’s milk
 Both of them should be given by demand feeding
 Both bottle-fed and breastfed babies should be burped at least twice during a
feeding – midway and after the feeding
 Both have the same energy value = 20 cal/oz.
 Both are deficient in iron

4. Common health problems

a. Constipation – more common among bottle-fed infants. Management:
 Add more fluids or carbohydrates/sugar
 If due to an unusually tight anal sphincter, dilate twice or thrice a day by means
of gloved little finger
b. Loose stools – careful history should be taken; management depends on the
cause
c. Colic = paroxysmal abdominal pain common in infants below 3 months of age
 Causes:
i. Overfeeding
ii. Gas distention
iii. Too much carbohydrates
iv. Tense and unsure mother
 Management:
i. Feed by self-demand. It Is the best schedule because it meets the individual
needs of the newborn
ii. Tell mother to burp the infant at least twice during a feeding
iii. Feed baby in upright position
iv. May need to change formula, as per doctor’s order
v. Reduce sugar content of formula
d. Spitting up – due to poorly developed cardiac sphincter; more common among
bottle-fed infants. Will disappear when coordination with swallowing is achieved
and digestion improves. Management:
 Feed in upright position because gravity will aid in gastric emptying
 Position on right side after feeding
 Bubble/burp more frequently
e. Skin irritation – maybe due to poor hygiene or irritation from urine, feces, and some
laundry products.
Management:
 Expose to air – more important
 Careful washing and rinsing away of irritating soap from the skin
 Starch bath, if a case of miliaria (= prickly heat).
f. Occasional “crossed eyes” – normal in many babies because the eye muscles of
coordination have not yet fully developed; will disappear spontaneously
g. Seborrheic dermatitis/cradle cap – involves the sebaceous glands; due to poor
hygiene. Management: apply mineral oil or Vaseline on the scalp at night before
giving shampoo in the morning.
5. Clothing the newborn – rule of thumb: if the mother feels warm, keep the baby cool;
if the mother feels cold, keep the baby warm.
6. Sleep patterns – babies sleep 16-20 hours a day