Transcript Newborn Care


Nursing Assessment
 Maternal
history/labor data
indicating
potential problems
with newborn
 Apgar Scores
 Findings of brief
physical
examination
performed in the
delivery room



Ineffective airway clearance related to nasal and
oral secretions from delivery
Ineffective thermoregulation related to
environment and immature ability for
adaptation
Risk for injury related to immature defenses of
the newborn

1. When the head is
delivered birth attendant
immediately suction
secretions
Wipe mucus from face and
mouth and nose
 Aspirate/suction mouth and
nose bulb syringe
 Keep head slightly lower
than the body


2. Assess airway status
 A.
Assess for 5 Symptoms of
respiratory distress
 Retractions
 Tachypnea (rate: >60 cpm)
 Dusky color/circumoral cyanosis
 Expiratory grunt
 Flaring nares

B. Do not hyperextend
neck at anytime (may close
glottis)

Place infant in “sniff”
position
 Neck slightly extended
as if sniffing air
 Opens airway

3. Immediately dry infant
under a radiant warmer
or skin to skin contact
with the mother

Keep neonates head
covered


Infant temperature
should be above
36.4°C.
Infants lose heat
through evaporation,
radiation, conduction
and convection.

4. Obtain APGAR Scoring at 1 min
and 5 min
Apgar test is a scoring system
 designed by Dr. Virginia Apgar,
an anesthesiologist,


a systematic and measurable method
to access the newborn in the crucial
minutes after birth.

Purposes:
evaluate the conditions of the baby at
birth,
 determine the need for resuscitation,
 evaluate the effectiveness of
resuscitative efforts,
 identify neonates at risk for morbidity
and mortality.

Test
0 Points
1 Point
2 Points
Activity (Muscle Tone) Absent
Arms & legs Active movement
extended
with flexed arms &
legs
Pulse (Heart Rate)
Absent
Below 100
bpm
Above 100 bpm
Grimace (Response
Stimulation or Reflex
Irritability)
No
Response
Facial
grimace
Sneeze, cough,
pulls away
Appearance (Skin
Color)
Blue-gray,
pale all
over
Pink body
and blue
extremities
Normal over entire
body – Completely
pink
Respiration
(Breathing)
Absent
Slow,
irregular
Good, crying
 If
there are problems with
the infant:
 an additional score may be
repeated at a 10-minute
interval.
 For
a Cesarean section:
 the baby is additionally
assessed at 15 minutes after
delivery.

Scoring




7-9 = free from immediate distress; normal
4-6 = moderately depressed; may require additional
resuscitative measures
0-3 = severely depressed; necessitates immediate
medical attention
Note: APGAR score
 is strictly used to determine the newborn’s immediate
condition at birth and
 does not necessarily reflect the future health of your
baby.

Scores done at 1 minute to identify who
needs immediate intervention.

Scores taken again at 5 minutes to
assess recovery from depression or a
subsequent turn for the worse.

Resuscitation takes precedence over
determining score.

5. Do quick Gestational Age
Assessment
 A.
Sole Creases
 B. Breast tissue bud
 C. Skin, vessels, and peeling
 D. Genitalia
 E. Resting Posture
 6.


Cord Care
A. Clamp
umbilical cord
approximately 2.5
cm (1 inch) from
abdominal wall w/
cord clamp
Examine clamp for
closure, no oozing
of blood from cord

B. Examine
Cord for
presence of 3
vessels and
document
2
arteries and 1
vein

7. Make sure cord
blood is collected for
analysis and sent to
laboratory for
checking of:
RH
 Blood type
 Hematocrit
 Possible cord blood
gases

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
8. Document passage of
meconium or urine after
delivery
For presence of
meconium before
delvery, mechanical
suctioning of
naspharynx upon
delivery of infant w/ an
8-10 French catheter is
done

11.Administer a prophylactic vitamin K
 Prevent neonatal hemorrhage during first few days of
life before infant is able to produce vit. K
 Recommended route of administration: intramuscular
 Dose:
 1mg (of Konakion MM®, 2mg/0.2ml) being given at birth.
 Preterm infants may receive 0.5mg.


Alternative Route: Oral
Dose:
 2mg orally at birth;
 Repeat dose (2mg) at 3-5 days and at 4-6 weeks of age.
 Repeat dose if the infant vomits or regurgitates within 1
hour

12. Bath
 once a baby's
temperature
has stabilized,
the first bath
can be given.

Measure weight, length, and head
circumference

helps determine if a baby's weight and
measurements are normal for the number of weeks
of pregnancy.

Small or underweight babies, as well as very large
babies, may need special attention and care.

Average range:


18-22 inches (46-56 cm)
Measured from crown to rump and
rump to heel or from crown to heel at
birth

Average range:
33 to 35 cm (13-14 inches)
 Normally, 2 cm larger than chest
circumference


Place tape measure above eyebrows
and stretch around fullest part of
occiput at posterior fontanele

Average range:



30-33 cm (12-13 inches)
Normally, 2 cm smaller than head circumference
Stretch tape measure around scapulae and over
nipple line


Before a baby leaves
the delivery area,
identification
bracelets with
identical numbers
are placed on the
baby and mother.
Babies often have
two, on the wrist
and ankle.