THE NEWBORN

NORDIANNA SEMAN
RN, MSC NURSING

nordianna@uitm.edu.my
 • Define newborn and the
classification of newborn
• Explain immediate care for
LEARNING newborn
OUTCOMES • Discuss the physical
examination for newborn
• Discuss the medical
management of the newborn

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 Introduction
• Care given immediate after birth
• immediate and thorough drying
• skin to skin contact of the newborn with the
mother
• cord clamping and cutting after the first
minutes after birth
• early initiation of breastfeeding
• exclusive breastfeeding

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 Definition of Newborn
• From birth to 28 days (4 weeks of life)
• Neonate
CLASSIFICATION
OF NEWBORN

Gestation Birth Weight

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 Classification: Gestation
PRETERM

• Less than 37 weeks

TERM

• 37 – 40 weeks

POST-TERM

• Beyond 42 weeks

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 Classification: Birth weight
MACROSOMIC
• More than 4.0 kg

NORMAL WEIGHT
• 2.5 – 4.0 kg

LOW BIRTH WEIGHT (LBW)

• 1.5 – 2.5 kg

VERY LOW BIRTH WEIGHT

• 1.0 – 1.5 kg

EXTREME LOW BIRTH WEIGHT

• Less than 1.0 kg

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 IMMEDIATE CARE FOR THE NEWBORN
INITIAL ASSESSMENT
• need for resuscitation
• ascertain gestational age
• presence of any congenital anomalies or
• neonatal disorders
Done by trained personnel immediate after
born

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 IMMEDIATE CARE FOR THE NEWBORN
Cord
assessment &
First cry Apgar score Suction of airway
clamping of
cord

Head to toe;
Gender
Eyes care congenital Feeding
identification
anomalies

Medical
management

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 First Cry
• Most crucial
• Spontaneous cry
• Indicate spontaneous breathing
• Not crying
• Truncal stimulation
• Vigorous wiping on the skin
• Chest rub
• Back rub

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 APGAR Score
• Virginia Apgar (1952)
• Rapid method; need for prompt intervention
• clinical signs of neonatal depression
• cyanosis or pallor, bradycardia, depressed reflex response to stimulation,
hypotonia, and apnea or gasping respirations.
• Elements can be subjective
• physiologic maturity
• variations in normal transition
• 1 min, 5 mins,
• 10 mins (if necessary; low score & after resuscitation)

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 APGAR Scoring
• Total score 10/10
• Common score: 9/10; body pink, extremities blue
• 0-3: severe asphyxia; resuscitation needed
• 4-6: require airway clearance & supplemental oxygen
• 7-10: good & possible health

Relative risk of cerebral palsy & neonatal encephalopathy

for low score during 5 mins & 10 mins report

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 Umbilical Cord Assessment & Immediate Care
• Normal new born; delayed cord clamping by 1
to 2 minutes; provides extra 50-100 ml blood to
improves Hbgm%
• Preterm neonate; immediate clamping of cord
• resuscitation & prevent overload
• Cord scissor & sterile cord clamp
• 5 cm away from umbilicus
• Emergency; umbilical cord cut > 15 cm
• Assessment: 2 arteries & 1 vein

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 Suction of Airway
• Most newly born infants clear their own
airway very effectively and do not require
suctioning at birth
• Bulb suctioning, gentle suctioning if
• An increase in CO2
• Increased oxygen needs
• Bradycardia and apnea
• Audible breathing, gasping, or wheezing
• Visible secretions, or obvious difficulty clearing
the airway
• Aspiration

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 Care for eyes
• Immediately clean after birth; following with top
& tail
• Soaked sterile cotton with sterile water or
distilled water
• Observe for redness, sticky discharge or
excessive tearing; problem identification &
prompt management

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 Gender identification & tag
• Immediately after birth, infant body is
wiped clean to clear of the vernix, mucus
& blood
• Gender assignment & shown to mother
• Identification tag is applied @ feet;
• Blue (boy); Pink (girl)
• Mother’s detail: B/O (baby of)
• well covered in warm blanket/wrap to
prevent hypothermia

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 Immediate Feeding & Rooming in
• Skin to skin immediate after birth; at least 30 mins
• Bonding & initiate feeding
• Lactation is established within 2-3 days

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 Physical Examination of the Newborn
• must be performed within 24 hours of birth; common
practice is immediate after skin to skin
• To detect observable congenital malformations
• Assess initial adaptation to extrauterine life
• Anthropometry
• Weight
• Length
• Head circumference

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 Physical Examination of the Newborn
HEAD

• caput / molding /
cephalhematoma & feel for
anterior and posterior fontanelles

MOUTH

• cleft lip / palate or any loose

tooth

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 Physical Examination of the Newborn
NECK

• enlargement of thyroid glands / any

swelling

FACE

• any features of chromosomal

abnormalities / eyeballs / cataract /
subconjunctival hemorrhage

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 Physical Examination of the Newborn

CHEST
• intercostal recession /
pigeon chest

UPPER LIMBS
• fractures / paralysis / extra
digits / missing digits /
webbed fingers

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 Physical Examination of the Newborn

ABDOMEN
• soft / tense

UMBILICAL CORD
• stump / clamp insitu , any
bleeding / abnormalities
(Wharton jelly)

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 Physical Examination of the Newborn
• GENITALIA
• boy : testes (well descend), scrotum &
penis (epispadias/hypospadias)
• girl : labia majora & labia minora,
discharge
• ambiguous

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 Physical Examination of the Newborn
• LOWER LIMBS
• fractures / paralysis / extra digits /
missing digits / webbed toes / talipes /
congenital
• dislocation of hip ( developmental
dysplasia of hip)

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 Physical Examination of the Newborn
• SPINAL COLUMN
• spina bifida / spina bifida
occulta / open neural tube
defects
• ANUS
• perforated / imperforated

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 Physical Examination of the Newborn: REFLEXES

• Neurological exam
• Simultaneous with head to toe exam

Grasp Babinski

Rooting Moro
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 REFLEXES: Moro Reflex
• Startle reflex
• Begin @ 28/52 POG
• At birth until 3/12

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 REFLEXES: Rooting Reflex

• Onset 28/52
• Integration up to 3/12

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 REFLEXES: Babinski @ Plantar Reflex

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 REFLEXES: Grasp Reflex

• Begin 32/52 POG

• Disappear 9-12 months

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 MEDICAL MANAGEMENT

IM VITAMIN K
• All newborn incl. preterm neonate,
instrumental deliveries & C-sect

• vastus lateralis

• Prevent HDN (Hemorrhagic disease of

newborn); vitamin K deficiency; ‘Vitamin
K Deficiency Bleeding’ (VKDB)

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 MEDICAL MANAGEMENT
BLOOD INVESTIGATION PROPHYLAXIS ANTIBIOTICS
• Cord blood • Confirmed maternal infections
• GBS
• G6PD screening • Chorioamnionitis

• Bilirubin level • Newborn with s/s of infection

• Resuscitation
• T4, TSH; congenital hypothyroidism
• Admission to NICU
• Coomb's test; Rh incompatibility

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 MEDICAL MANAGEMENT
IMMUNIZATION

• National Immunization Program

• After birth

• BCG

• Hepatitis B

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 • Hashim, A., Hassan, H., Sood, M., & Padubidri, V. G. (2016). Obstetric Nursing (2nd ed.). New York:
Oxford University Press
• Davidson, M. R., Ladewig, P. W., & London, M. L., (2016). Olds maternal-newborn nursing & womens
health across the lifespan. (10th ed.). Boston. ISBN: n/a
• Ladewig, P. W., London, M. L., & Davidson, M. R., (2017). Contemporary maternal-newborn nursing
References care. (9th ed.), Boston. ISBN: n/a
• Murray, S. S., & McKinney, E. S., (2014). Foundations of maternal-newborn and womens health
nursing. (6th ed.) Elsevier. ISBN: n/a
• Tarbell, M. M., & Low, M., (2013). Maternal-newborn nursing, (3rd ed.). Pearson Education. ISBN:
n/a
• Marshall, M., & Raynor, M. (2014). Myles Textbook for Midwives (16th ed.). Edinburg: Churchill
Livingstone.

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