ASSESSMENT AND CARE The Normal Newborn

Three transition phases Phase One: the first hour Phase Two: from one to three hours Phase Three: from two to 12 hours

Care at birth (nurse’s job) 1. Call out time of birth 2. Receive the baby onto a warm clean towel and place on mother’s chest 3. Clamp and cut the umbilical cord 4. Dry the baby with a warm, clean towel or piece of cloth 5. Assess baby’s breathing while drying 3 Steps

Care at birth… 6. Wipe both eyes (separately) with sterile gauze pieces 7. Put the baby between mother’s breasts for skin-to- skin contact 8. Place an identity label on the baby 9. Cover mother and baby with warm cloth; put a cap on the baby’s head 10. Initiate breastfeeding NC- 4 Teaching Aids: ENC

Prevention of infections After delivery 1. Hand washing before handling the baby 2. Exclusive breastfeeding 3. Keep the cord clean and dry; do not apply anything 4. Use a clean cloth as a diaper/napkin 5. Hand wash after changing diaper/napkin NC- 5 Teaching Aids: ENC

Priorities in first hour Cardiovascular assessment and support Thermoregulation Assessment and support of blood glucose Identification Observing urinary/meconium passage Observing for major anomalies and for apparent gestational age concerns

APGAR ASSESSMENT One and five minutes Meant to identify the need for neonatal resucitation

APGAR SCORE

Criteria012 ColorBlue or paleAcro-cyanoticCompletelyPink Heart RateAbsentSlow (< 100/min) >100/min Reflex irritabilityNo responseGrimaceCough, sneeze, cry Muscle toneLimpSome flexionActive motion RespirationsAbsentSlow, irregularGood, crying

Vital Sign Normals F ( C)  A soundly sleeping baby can go to 80 bpm  A crying baby may be as high as 180

Voids and Stools Document from the moment of birth Urination sometimes missed in early minutes Generally expect both within the first 24 hours One really wet diaper per day of age until milk is fully in.

Quick Assessment of Gestational Age Skin Vernix Hair Ears Sole Creases Resting Posture

Cracked Skin

Abundant Lanugo

Ear of a preterm infant

Sole creases

Comparison of resting posture

Routine Medications Erythromycin Eye Ointment Aquamephyton (vitamin K) First Hepatitis B vaccine

DURING PHASES TWO AND THREE Physical Characteristics

Nervous System: Reflexes Head lag Moro reflex Rooting Tonic Neck reflex Dancing reflex Magnet reflex Rooting reflex Suck Hand and foot grasp Babinski Trunk incurvation Observe for symmetry

Head Lag

Moro Reflex

Tonic Neck Reflex

Dancing Reflex

Suck Reflex

Hand Grasp

Foot Grasp

Head Head circumference Molding Fontanelles  Anterior closes between months  Posterior closes by the end of the 2 nd month

Eyes Eye placement Blink reflex Discharge Pupil reaction

Hearing Check overall response to sudden sound  Moro reflex Check for placement of ears  Low set ears may indicate a congenital anomaly Most infants receive hearing screening within the first week of life

Respiratory and Cardiovascular Ongoing assessment of cardio respiratory status that has occurred since birth More thorough heart assessment Murmur may be present until fetal openings have completely closed however they must be carefully verified by pediatrician Femoral and brachial pulses Abdominal breathing; nose breathers

Femoral Pulses

Brachial Pulses

Assessment of Respiratory Status

Musculoskeletal Symmetry!! Five finger and five toes!!! Clavicles Movement of arms Hips for developmental hip dysplasia Lower legs/feet for “club foot” Back: curvatures, cysts or dimples

Hip Check

Hip Check Skin Folds

Gastrointestinal Passage of meconium Abdomen should be soft and non tender Round but not distended Bowel sounds are present after first hour of birth Umbilical cord inspection

CARE MEASURES FOR THE NORMAL NEWBORN PLUS A LITTLE MORE. The Normal Newborn

Jaundice Yellow coloring of an infants skin Common and is caused by the natural breakdown of RBCs in the infant after birth Is never considered normal in the first 24 hours.

Physiologic Jaundice Most jaundice in newborns is physiologic It peaks between hours Usually disappears within a week Usually benign Can become elevated to a point of concern for the baby

PHOTOTHERAPY