Newborn Care

NEWBOR N CARE Nursing Skills Laboratory

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• Tremendous physiologic adaptation begins to take place in the newborn’s body after birth. Beware of these changes; newborns require close observation and special care to determine how smoothly they are making the transition to extrauterine life. ncm101skills/smbm

PURPOSES: 1. To promote the physical well being of the newborn 2. To assess and stabilize the newborn 3. To initiate appropriate care and intervention for any signs of distress 4. To support the establishment of a well ncm101skills/smbm functioning family unit

Immediate Care of the Newborn ncm101skills/smbm

Equipment: 1. Rubber bulb syringe or suction apparatus/machine 2. Two receiving blankets 3. Cord Clamp 4. Radiant warmer 5. Bassinet ncm101skills/smbm

Therape utic Interven tions

On Immediate Care of the Newborn

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AIRWAY 1. Hold baby with head lowered (10 to 15 degrees) 2. Suction oral pharynx with small bulb syringe as soon as the head is born 3. Suction nares next 4. Avoid deep suctioning with catheter if possible 5. Avoid suspending neonate by ncm101skills/smbm ankles

CORD CLAMPING 1.Immediately following birth, neonate is kept at about the same level as the uterus, until cord clamp is applied or until cord has stop pulsating 2.Without “milking” it, cord is clamp close to umbilicus approximately 30 secs after birth if neonate appear normal and mature ncm101skills/smbm

3. Cord is clamped 8 to 10 cm from umbilicus if there is possibility for exchange transfusion 4. Assess cord for 2 arteries and one vein 5. Cleanse the umbilical cord stump with betadine solution ncm101skills/smbm

ATTACHMENT & WARMTH

1. Unless immediate intervention is required, dry infant and place on mothers abdomen, covering both; or wrap infant in warm blanket first. 2. Caution parents to keep neonate’s head covered 3. Permit the mother to

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PERFORM ASSESSMENT TEST ncm101skills/smbm

APGAR Scoring Chart Sign

0

1

2

Heart Rate

Absent

Over 100

Respirator y Effort Muscle Tone

Absent

Slow (<100) Slow, irregular Some Flexion of Extremitie s Cry

Reflex Irritability Color

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Flaccid

No Response Blue, Pale Body is pink, Extremitie s are blue

Good Crying Active Motion Vigorous Cry Completely pink

• The Apgar is an excellent method for assessing the effectiveness of resuscitation, however it should not be used as the sole basis for making resuscitative decisions. • One limitation of the Apgar system is that it was designed to assess normal full term infants, not preemies, so it is less

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• For evaluating premature neonates, umbilical cord pH or the SilvermanAnderson scoring system may be more valuable than Apgar. ncm101skills/smbm

Silverman-Anderson Scoring System • In order to assess the degree of respiratory distress in neonates, practitioners often use the Silverman-Anderson scoring system. • Like the Apgar system it evaluates five parameters and assigns a numerical score for each parameter.

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• However, unlike the Apgar score, the lower the total score the better the baby in the Silverman-Anderson system. • The best score possible in each category is a "0" the worst is a "2". Parameters assessed are: retractions of the upper chest, lower chest, and xiphoid, nasal flaring, and expiratory grunt.

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• Neonates with no retractions, flaring or grunting with synchronized respiratory movements are scored with "0s". • Infants with visible retractions of the lower chest and xiphoid, with the upper chest lagging compared to the lower on inspiration, receives a "1". • Minimal nasal flaring and an expiratory grunt heard only ncm101skills/smbm

• Marked retractions with a "see-saw" movement of the upper and lower chests deserves a "2". • Marked nasal flaring and audible expiratory grunting also deserve a "2". • Normal babies have a cumulative score close to "0". • Severely depressed babies score close to "10". ncm101skills/smbm

Silverman-Anderson Scoring System Score 0 1 2 •

Upper Chest Retraction s Lower

synchronized

lag on see-saw inspiration movement

Chest Retraction s Xiphoid Retraction s

none

just visible

marked

none

just visible

marked

•

Nasal Flaring

none

minimal

marked

•

Expiratory Grunting

none

stethoscope only

naked eye and ear

•

•

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Dubowitz Maturity Scale -

Assessment of the Gestational Status

- Maturation level is rated Categories : 1. External Characteristics – ear cartilage , breast size, genitalia, sole, creases, skin edema, amount of lanugo 2. Neurological signs – posture , ankle dorsiflexion, leg and arm recoil , popliteal ankle, heel to ear, scarf sign, head lag and ventral ncm101skills/smbm suspension

Ballard’s Assessment of Gestational Criteria – done within 3-4 minutes ; determines SGA’s and prematurity Parts : 3. Physical maturity – skin texture, color, lanugo, foot creases, genitalia, ear, and breast maturity 4. Neuromuscular maturity – ncm101skills/smbm observe and position the baby

Crede’s Prophylaxis • Instillation of a prophylactic agent at the eyes of all neonate is mandatory as a precaution against opthalmia neonatorum. Medication: 3. Erythromycin 4. Opthalmic ointment 0.5% 5. Tetracycline ophthalmic ncm101skills/smbm ointment 1%

Prevention of Hemorrhage

• To prevent bleeding, Vitamin K ( Aquamephyton, phytonadione) is given intramuscularly in the vastus lateralis or rectus femoris muscle of the anterior thigh. • Dosage: Weight 2.5 – 3.5 kg (1mg) < 2.5 kg (0.5mg)

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Identification: Two Ways of Identification: 2. Use of pliable plastic tapes which are applied to the infants wrist and ankle ( it contains the mothers name, physician, date, time of birth and sex of the infant and hospital number) 3. Palm prints or foot prints ncm101skills/smbm

Anthropom etric Measureme nts ncm101skills/smbm

Equipment: 2.Tape Measure 3.Weighing Scale

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Implementation: 1. Weigh the newborn without any dress AGA= 2,500 – 4,000 gm SGA= lower 10% of 2,500 gm LGA= higher 10% of 4,000 gm 2. Put clean paper on the scale ncm101skills/smbm 3. Balance the scale at zero as

4. Wash hands and put on gloves if you haven’t bath the neonate yet 5. Place the neonate in the middle of the scale tray without any dress. Note the neonate’s weight. Keep one hand poise over him all times. Work quickly.

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6. Measure the Newborn Using a Tape Measure

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Head circumference 2. Measure head at the greater diameter or occipitofrontal circumference (33 – 35 cm) 3. Slide tape measure under the neonate’s head at the occiput and draw tape snugly around, just above the eyebrow.

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Chest Circumference • Measure the nipple line (30-33 cm which is lower in 1-2cm than HC • Place the tape under the back and wrap it snugly around the chest at the nipple line. • Take the measurement after the neonate inspires and before it begins to exhales. ncm101skills/smbm

Length • Measure from heel to head of the infant (normally 47-50 cm) • Fully extend the neonate’s legs with the toes pointing up. Measure the distance between the marks.

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7. Assess Vital Signs • • •

RR= 32-60 bpm CR= 110 – 160 bpm Temp: Oral= 36.4 – 37.4 C Rectal= 36.2 – 37.8 C Axillary= 35.9 – 36.7 C • BP- varies in height and weight

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Assess Vital Signs 1.Assemble the equipment beside the baby. If you are using a mercury thermometer, shake it until the mercury drops under 96F or 35.5C. If you have an electronic thermometer, apply the cover to the rectal probe. Use water soluble before taking rectal temp. ncm101skills/smbm

2. Observe respirations first, before the neonate becomes too active and agitated. Watch and count respiratory movements for one minute. Observe the chest as it rises and falls; normal movements should be symmetrical. ncm101skills/smbm

3. Place the stethoscope over the apical pulse on the fourth and filth intercostal space of the left mid clavicular line over the cardiac apex. 4. To take temp rectally, neonate lying supine, firmly grasp his ankle with finger between them insert the lubricated thermometer no more than 0.25 in to 0.5 in into

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5. Newborn’s legs stabilized by the nurse’s hand. Hold the thermometer in place for 3 minutes 6. Remove the thermometer and read the number on the scale where the mercury

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7. Although it is not routinely measured at birth, blood pressure is assessed by Doppler UTZ. 8. Record V/S and related measurements on your notes. Include any observation about the neonate’s condition. ncm101skills/smbm

Cord Care • The care of the umbilical cord is the same as that for any surgical wound. The goals of care are prevention and early identification of hemorrhage and infection. Hospital protocol directs the time and techniques for routing cord care.

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Purpose: •To prevent and early identify hemorrhage or infection.

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Equipments: •Dry cotton balls •Alcohol (70%) •Forcep •Betadine anticeptic ncm101skills/smbm

Implementation with Rationale Initial Cord Care (Day 1) : • Clamp 0.5 – 1 inch above umbilical base. Milking the cord towards the baby is not allowed. • Leave the umbilical stump uncovered. • With the use of forceps cleanse the Cord stump with betadine ncm101skills/smbm antiseptic or solution.

Suceeding cord care ( Day 2)

1. Assess for any odor, discharge, bleeding, or skin inflammation around the cord. 2. Cleanse the cord and the skin around the base of the cord with cotton swabs and prescribed preparation ( Alcoho 70%). 3. The clamp is removed when

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Guidelines for the mother:

1. Teach the mother to avoid covering the cord with the diaper for it may prevent drying. 2. Tech about the signs of tetanus (weak sucking, foul smelling discharge, fever and convulsion). 3. Drops of blood can be seen when the cord drops off. Assure ncm101skills/smbm that this is not dangerous and it

Baby Bath • Baby’s bath is postponed until the infant’s skin temperature stabilizes at 36.5 C (97.6 F) or core temperature stabilizes at 37 C ( 98.6 F) hours.

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Purposes: • It provides opportunities for complete cleansing of the infant. • To observe the infant’s condition. • To promote patient’s comfort and parent child family socialization. ncm101skills/smbm

Equipment: • Baby oil • Baby soap • Reveiving blanket • baby‘s clothing • Diaper • Cotton balls

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• Basin • Mittens • Warm water • Soft brush or baby’s comb • Gloves

Implementation and Rationale 1.Assemble all equipment. Do not leave the baby alone on the bath area. 2.Wear gloves until initial bath is completed. 3.A non medicated mild soap or oil may be used. Cotton balls not gauze are used to cleanse the nostrils and ears.

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4. Bath the newborn quickly exposing only a portion of the body at a time. 5. Checked the temperature 30 minutes after the completion of the bath. ncm101skills/smbm

Daily bath 1. Supplies and clothing are made ready. 2. Test temperature of the water. 3. Bring the infant to bathing area when all supplies are ready. 4. Hold the baby in football position, and head is washed before unwrapping and undressing. The scalp is washed ncm101skills/smbm daily with water and mild soap.

5. Cleanse the eyes from the inner canthus outward, using a clean washcloth. 6. Cleanse ears and nose with twists made of moistened cotton. 7. Creases under the chin and arms and groin may be exposed and cleansing the creases under the chin could be done by elevating the infant’s shoulders 5 m (2in)

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8. Undress the baby and wash body arms and legs. Baby may be tub bathed after the cord drops off.

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TUB BATHING 1.Add 3 inches of comfortably warm water into the basin at 98 F to 99 F pleasantly warm to the inner wrist 2.Baby can be carefully placed in to the warm water, the bather’s arm. 3.Use towel and pat the baby dry gently. Baby is dressed ncm101skills/smbm

Vernix Caseosa

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