Care of Newborn

1. Immediate Care of the Newborn

Baby
 The main goal for newborn care is the
promotion and maintenance of
homeostasis.

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Objectives of care for the newborn baby
• Establishment and maintenance of a patent
airway
• Maintenance of a stable body temperature

• Protection from infection and injury

• Provision of optimum nutrition

• Provision of infant-parent attachment

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 QUESTION ???

• What is the essential care for a newborn

immediately after birth?

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 Definition
• Essential Newborn Care is a package of

basic care provided to newborns to support

their survival and wellbeing

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 Activities that should be included under immediate
care of the newborn baby
• Dry the Baby
• Replace the Wet Towels
• Position the Baby
• Suction the Airway
• Evaluate the Baby
– Breathing
– Color
– Heart rate
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…Cont..
• Keep the Baby Warm
• Assign Apgar score
• Breast feeding
• Eye prophylaxis
• Vitamin k
• Umblical cord care
• Taking weight
• Identification tags
• Facilitating Baby-mother relationship
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 Steps in Immediate
Newborn Care After Birth

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 Immediate Newborn Care After
Birth; contd…
• Step 4: Skin to Skin Care
Place the infant in skin-to-skin
contact on the mother’s chest and
cover both with clean linen and
blanket as required.
• Step 5: Initiate breastfeeding
immediately within 1 hour
• Step 6: Eye care
Apply Tetracycline eye ointment
within 90 min of delivery
• Step 7: . Apply Chlorhexidine gel
(4%) on the cord
Within 30min of delivery
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 Immediate Newborn Care After
Birth; contd…
• Step 8: Give Vitamin K, 1mg IM on anterior
mid-lateral thigh (within 90min)
• Step 9: identification tag
Place the baby identification bands on the
wrist and ankle (within 90 min)
• Step 10: Weigh the Newborn
within 90 min & when baby is stable

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1. Dry the Baby
Immediately after delivery, the baby should be dried with a warm, soft
towel, but don't delay in drying the baby while searching for a warm, soft
towel.

In an emergency, any dry, absorbing material will work well for this purpose.

This would include:

• towels
• Shirts
• T-shirts
• Jackets
• Any other dry clothes

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2. Replace the Wet Towels
Babies can lose a tremendous amount of
heat very quickly, particularly if they are wet.
By removing the wet towels and replacing them
with dry towels, you will reduce this heat loss.
• Babies, during the first few hours of life, have
some difficulty maintaining their body heat
and may develop hypothermia if not attended
to carefully.
This is particularly true of premature infants.

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3. Position the Baby
Babies should be kept on their backs or tilted
to the side, but not on their stomachs.
• The orientation of the head relative to the
body is important for breathing. In adults, this
orientation is not usually crucial; adults
tolerate a relatively wide range of head
positioning without compromising their
airway.
• Not so with newborns who have a relatively
narrow range of head positioning that will
permit air to move unimpeded through the
trachea.
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…Cont..
• The optimal position for the baby is with the
head neither markedly flexed against the
chest, nor extended with the chin up in the air.
Instead, the head should be in a "military"
attitude, looking straight up.
• If there is any airway obstruction, make small
adjustments to the head position to try to
straighten the trachea and eliminate the
obstruction.

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4. Suction the Airway
When babies are born, they need to clear the mucous and

amniotic fluid from their lungs. Several natural mechanisms

help with this:

• As the fetal chest passes through the birth canal it is

compressed, squeezing excess fluid out of the lungs prior to

the baby taking its' first breath.

• After birth, babies cry loudly and repeatedly, clearing fluid and

opening air sacs in the process.

• Crying is a reassuring event and does not indicate distress.14

5. Evaluate the Baby
Evaluate the baby for breathing, color
and heart rate.
Breathing
• If the baby is not breathing well or is
depressed, additional drying with a towel
may provide enough tactile stimulation.
• Babies are not slapped on their buttocks
for this purpose, although flicking the
soles of the feet with a thumb and
forefinger can provide enough noxious
stimulation.
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 Evaluate the Baby…
Color
Asses the pinkness of the fetal skin.

• Acrocyanosis is normal for a newborn during

the first few hours, disappearing over the next
day.

• Central cyanosis is not normal and indicates the

need for treatment.
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… Cont..
Check the Heartbeat
• The normal newborn heart rate is over 100
BPM.
• Pediatric stethoscopes can be used to listen
to the heartbeat, but palpating the newborn
pulse is easy to do and requires no special
equipment.
• If the pulse is less than 100 BPM, you should
begin ventilating the baby artificially, using
whatever equipment and skills that are
available.
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6. Keep the Baby Warm
Newborn hypothermia can occur quickly and
depress breathing.
• Pay particular attention to keeping the head
covered (but the airway open) as heat loss
from the newborn head can be substantial.
• If the mother is available, dry the baby, place
the baby on the mother's chest, and cover
both of them with blankets or clothing.
• The mother's body heat will help keep the
baby warm.
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Ways of heat loss from the Neonate

 Evaporation: Normally evaporation is high in the

neonate as the neonate has large surface area and
come to the cooler environment from the uterus

 Conduction:
• Putting neonate on relatively cold surfaces

• By direct contact with the cooler solid body

• Contact with closes, bed

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 Radiation:
• Positioned the neonate near to window, metal
surfaces or cold walls
• Without direct contact with the cooler solid body

• As electromagnetic rays

 Convection:
• Heat loss to cooler surrounding
• When the body is exposed to wind heat
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Ways of heat loss from the neonate

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7. Assign Apgar score
The Apgar score is a commonly-used method to assess the
newborn status and need for continuing treatment.
A-appearance/color/
– Indicative of peripheral tissue oxygenation
P-Pulse/heart rate/
– < 100-indicative of severe asphyxia
G-Grimace /Response to stimuli/
– The neonate response
A-activity/Muscle tone/
Degree of flexion and resistance offered by the neonate when
to extend his extremity
R-respiratory effort
- Index of adequate ventilation
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… Cont..
Purpose
To measure the adjustment for extra uterine
environment
To identify the requirement of resuscitation for
hypoxia
Points are assigned according to each of five
categories.
• The Apgar score is usually assigned/evaluated/
at 1-minute and again at 5-minutes after birth.
N.B. A 1min Apgar score signals the need for
immediate resuscitation and the 5, 10, 15 and
20min scores indicate the probability of
successful resuscitating the infant.

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Apgar Score
Category 0 Points 1 Point 2 Points

Body pink,
Appearance/ Completely
Blue, pale extremities
Color pink
blue
Pulse/Heart
Absent <100 >100
Rate/
Grimace/
Response to No Response Grimace Vigorous cry
stimuli/
Some flexion
Activity/Muscle Active 24
Flaccid of
Key for scoring
≥ 7/10 –Absence of difficulty in adjusting to life
/doesn’t require resuscitation/
4-6/10-Modertely asphyxiated /difficulty/
/Needs clearing of the airway and supplementary
oxygen/
0-3- severely asphyxiated/in distress/
/needs immediate resuscitation/
Note:
• Most newborn infants with low Apgar scores will
be fine, once they are supported and
resuscitated.
• A 5min score of 0-3 correlates with a 50%
neonatal mortality rate.
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8. Breast-feeding
Babies can be breast-fed as soon as the airway is
cleared and they are breathing normally.

Some babies nurse vigorously while others are not

particularly interested in feeding until several hours
after birth.
• Breast-feeding babies generally make their needs
known by crying when they are hungry. They also cry
when they are uncomfortable from a wet or soiled
diaper. 26
11. Eye Prophylaxis

Within an hour of birth; treat the newborn's eyes to

prevent gonococcal infection.

Alternative medications include:

• 1% silver nitrate solution

• 1% tetracycline opthalmic ointment

• 0.5% erythromycin opthalmic ointment

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Essential Newborn care…

• Eye care
– Prevent and manage ophthalmia neonatorum
• Immunization
– At birth: bacille Calmette-Guerin (BCG) vaccine, oral
poliovirus vaccine (OPV) and hepatitis B virus (HBV)
vaccine (WHO)
• Identification and management of sick newborn
• Care of preterm and/or low birth weight newborn

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12. Vitamin K

A single injection of 1.0 mg of natural vitamin

K on anterior mid-lateral thigh (within 90min)

can help prevent hemorrhagic disease.

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13. Umbilical Cord Care

Keep the cord stump clean and dry.

Apply Chlorhexidine gel (4%) on the cord Within

30min of delivery

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 Cord Care…
• Cut cord under cover of a lightly wrapped gauze swab, to
prevent blood spurting.
• Chlorhexidine ointment is recently recommended
• Do not apply dressings or substances of any kind
• If cord bleeds, re-tie
• Usually falls off 4-7 days after birth
• Until the cord falls off, place the cord outside the nappy to
prevent contamination with urine/feces
• Wash with soap and clean water only (if soiled)

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14. Taking weight

Is a baseline for assessment of future growth

because weigh loss occurs rapidly.

Normally the neonate loses about 10% of the birth

weight by 3-4 days of age b/c of loss of excessive
extra cellular fluid, meconium and limited fluid intake.

 So the birth weight is regained by the tenth day of

life.

Normal weight: 2.5-4kgs 32

15.Identification tags

Place the baby identification bands on the

wrist and ankle (within 90 min)

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16. Immunization

– At birth: bacille Calmette-Guerin (BCG)

vaccine, oral poliovirus vaccine (OPV) and

hepatitis B virus (HBV) vaccine (WHO)

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2. Neonatal Resuscitation

Birth asphyxia is defined simply as the failure to

initiate and sustain breathing at birth.
The common worry of health professionals and
parents is the permanent brain damage that
birth asphyxia can cause.

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 Management of baby with birth
asphyxia
ABC’s of Resuscitation
A B C (A: Airway, B: Breathing, C: Circulation)
A - establish open airway
Position, suction
B - initiate breathing
Tactile stimulation
Oxygen
C - maintain circulation
Chest compressions 36
• Initial Steps:
–Thermal management
–Positioning
–Suctioning
–Tactile stimulation

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1.Anticipation
2.Adequate preparation
3.Timely recognition
4.Quick and correct action
are critical for the success of
resuscitation

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The important steps in
resuscitation are:
1. Prevention of heat loss
2. Opening the airway, and
3. Positive pressure ventilation
that starts within the first minute
of life.

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The surface on which the baby is
placed should always be warm as
well as flat, firm and clean.
Drying: provides sufficient
stimulation of breathing in mildly
depressed newborns and no further
stimulation is appropriate

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 The second step
(within 20-30 seconds of birth)
is assessment of neonatal respiration

If the newborn is crying and breathing

is normal,
no resuscitation is needed

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 The upper airway
(the mouth then the nose) should
be suctioned to remove fluid if
blood or meconium.
stained with
 If the newborn is not breathing or
gasping:
immediately start resuscitation.

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• Ventilation can almost always be
initiated using a bag and mask and
room air.
• When no equipment is available:
mouth to mouth-and-nose breathing
should be done.
• Adequacy of ventilation is assessed
by observing the
chest movements.

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47
  Taking an Apgar score is not a
prerequisite for resuscitation.
 The need for resuscitation must be
recognized before the end of the first
minute of life which is when the first
Apgar score is taken.

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3. Nursing Management of Low Wirth Wt
Definition
• Babies born weighing less than 2,500
grams considered low birth weight.
• Low-birth weight babies are at increased
risk for serious health problems as
newborns, lasting disabilities and even
death.

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Causes
• There are two main reasons why a baby may be
born with low birth weight:
Premature birth: Babies born before 37 completed
weeks of pregnancy are called premature.
• The earlier a baby is born, the less she is likely to
weigh.
• Very low-birth weight babies (those who weigh
less than 1,500 grams) have the highest risk for
health problems.
Fetal growth restriction: These babies are called
growth-restricted, small-for-gestational age or
small-for-date.
These babies may be full term, but they are
underweight. Some of these babies are healthy,
even though they are small.
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Clinical Manifestations of Low Birth Weight
• Overall wasted appearance
• Poor skin turgor
• Have a large head because the rest of the
body is small
• Hair is dull and lusterless
• Ineffective breathing patters
• Ineffective thermoregulation

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Nursing Responsibilities
• Initiating and maintaining respiration
• Fluid and electrolyte balance
• Temperature regulation
• Establishing adequate nutritional intake
• Preventing infection
• Establishing parent –infant bonding

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4. Nursing Management of Preterm Babies
Definition
• Pre-term babies are babies born too soon.
• Babies born before the end of the 37th
week of pregnancy are considered pre-
term.
• At one time, all low-weight babies were
thought to be pre-term.
– Now Medical persons know it is not
weight but time in the womb that
defines a pre-term.
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Causes
• We do not always know the cause of a
particular pre-term, and, in most cases,
there was probably little causes:
• The mother's past obstetrical history.
• Women with histories of difficult
pregnancies, spontaneous abortions, or
stillbirths
• Placental accidents that interrupt the
normal course of gestation prior to
completion of fetal development.
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Characteristic Features of Preterm Infants
• Gestational age ≤ 37 weeks.
• Thin extremities with very little muscle or
subcutaneous fat.
• Birth weight is usually less than 2500
grams
• Length ≤47cm.
• Skin is thin, translucent and wrinkled.
• More visible abdominal and scalp veins.
• Excessive lanugos over the extremities
back and shoulders.
• Undescended testes in males
• Prominent labia and clitoris in females
• Absent or weak typical newborn reflexes. 55
5. Nursing Management of Common
Neonatal Problems

A. Infant Respiratory Distress Syndrome

B. Asphyxia neonatrum
C. Hemorrhagic disease of the newborn
D. Birth injure

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1. Infant Respiratory Distress Syndrome

Defn: Infant respiratory distress syndrome

(IRDS), also called neonatal respiratory
distress syndrome or respiratory distress
syndrome of newborn, previously called
hyaline membrane disease, is a syndrome
or a common lung disorders caused in
premature infants.
• It is a breathing problem or decreasing of
blood perfusion to the lungs.

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Causes
• By developmental insufficiency of
surfactant production
• Structural immaturity in the lungs to make
surfactant.
• It can also result from a genetic problem
with the production of surfactant
associated proteins.
Extrapulmoary causes
• Obstruction of the air passage with thick
secretions or maternal blood.
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Clinical Manifestation
• Cyanosis
• Expiratory grunting
• Nasal flaring
• Tachypnea
• Tachycardia
• Retractions

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Treatment and Nursing Responsibilities
• O2ther
ap y
• Careful suctioning of the baby in the
delivery room to prevent to meconium
aspiration
• Appropriate antibiotic if infection is
suspected
• Frequent change of position

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2. Asphyxia neonatrum/Neonatal Hypoxia/
Definition:
– Asphyxia neonatrum is a respiratory
failure in neonate.
– It is a delay in the establishment of
normal respiratory function.
Degrees of asphyxia
• Mild asphyxia
• Sever asphyxia

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Causes
• Blockage of the air way passage by mucus,
liquor/blood/
• Immaturity of the respiratory centers
• Depression of the baby’s respiratory center
• Physical injury to the head during birth
• Prolonged intrauterine hypoxia
• RDS
• Cardiac insufficiency due to sever congenital
heart diseases/recurrent apnea/

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Predisposing Factors
 Maternal factors
Maternal diseases such as
• Anemia
• Hemorrhage
Uterine conditions including
• Tonic Uterine contraction
• Obstructed labor
 Baby/Fetal condition
• Airway obstruction
• Respiratory depression
• Congenital anomalies
E.g. congenital heart defects
 Placental conditions
• Acute accidental antepartum hemorrhage
• Placental previa

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Symptoms and signs of mild asphyxia
– Blueness of the extremities
– The baby moves its limbs
– Gasping /attempting to breath

Symptoms and Signs of Sever asphyxia

• The baby’s color becomes dusks gray (white)
• Limp (because of poor muscle tone)/Flaccid/
• Loss consciousness (stupor and coma)
• Loss of sucking reflexes
• No response to stimulation

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Assessment of Degree of asphyxia
• A method of assessing the degree of
asphyxia neonatorum is known as the
“Apgar score”.
• The assessment is based on the colour,
respiratory efforts, heart rate, muscle tone
and baby’s response to stimuli.

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Management of severe asphyxia
• Clear the air passages
• Make sure the air passages are open
• Warm the baby
• Prepare equipment for intubations
• Urgently call for medical aid
• If no O2co n ti
nu em outh to m out
h
b reathi
ng
• Check for the heart for beating

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3. Hemorrhagic Disease of the Newborn
(Vitamin K Deficiency)
Defn: Hemorrhagic disease of the newborn is a
bleeding problem that occurs in a newborn during
the first few days of life/1-5days/ due to low blood
prothrombin levels.
Causes
• Babies are normally born with low levels of vitamin
K, an essential factor in blood clotting.
• A deficiency in vitamin K is the main cause of
hemorrhagic disease of the newborn, because
Vitamin k stores are virtually low in the newborn.
• The newborn’s sterile intestinal tract is unable to
synthesize the vitamin until feedings have begun.

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Symptoms
Symptoms may include:
• blood in the baby's bowel movements /
bloody or black stool/
• blood in urine /Hematuria/
• oozing around the umbilical cord
• Epistaxis

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Treatment :
• If bleeding occurs, vitamin K is given as a
treatment.
• Bleeding usually ceases with in 2-4hours of vitamin
k administration.
• Blood transfusions may also be needed if bleeding
is severe.
Prevention
• Giving an injection of vitamin K for every newborn
baby after delivery.
Nursing Responsibilities
• Primarily directed toward prevention of
hemorrhagic disorders by careful administration of
vitamin k.
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4. Birth Injure
• Occasionally during the birth process, the baby
may suffer a physical injury that is simply the result
of being born. This is sometimes called birth
trauma or birth injury.
Causes
• large babies - birth weight over about 4,000 grams
• prematurity - babies born before 37 weeks
(premature babies have more fragile bodies and
may be more easily injured)
• cephalopelvic disproportion - the size and shape of
the mother's pelvis is not adequate for the baby to
be born vaginally
• dystocia - difficult labor or childbirth
• prolonged labor
• abnormal birthing presentation - such as breech
(buttocks first) delivery 70
Common Birth Injuries
 Caput succedaneum
Caput is a severe swelling of the soft tissues of the
baby's scalp that develops as the baby travels through
the birth canal.
The swelling usually disappears in a few days without
problems.
Babies delivered by vacuum extraction are more likely to
have this condition.
 Cephalo hematoma
Cephalohematoma is an area of bleeding underneath
one of the cranial bones.
The body resorbs the blood.
Depending on the size, most cephalohematomas take
two weeks to three months to disappear completely.

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 Bruising/forceps marks
Some babies may show signs of bruising on the
face or head simply as a result of the trauma of
passing though the birth canal and contact with
the mother's pelvic bones and tissues.
Forceps used with delivery can leave temporary
marks or bruises on the baby's face and head.
 Facial paralysis
During labor or birth, pressure on a baby's face
may cause the facial nerve to be injured.
This may also occur with the use of forceps for
delivery.

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Brachial palsy
Brachial palsy occurs when the brachial plexus
(the group of nerves that supplies the arms
and hands) is injured.
• It is most common when there is difficulty
delivering the baby's shoulder, called shoulder
dystocia.
Fractures
Fracture of the clavicle is the most common
fracture during labor and delivery.
The clavicle may break when there is difficulty
delivering the baby's shoulder or during a
breech delivery.

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