CHAPTER 54 NEWBORN CARE Part 2

IMMEDIATE NEEDS OF THE NEWBORN Airway Breathing Circulation Warmth

WARMTH Cold stress–excessive heat loss: Conduction–loss by direct contact with cooler object Convection–loss by air movement Evaporation–water changed to vapor Radiation–loss by transfer to cooler objects nearby

IMMEDIATE CARE OF THE NEWBORN Apgar score Resuscitation Neutral thermal environment Identification Parent/infant bonding

PROPHYLACTIC CARE Vitamin K–to prevent hemorrhagic disorders Hepatitis B vaccination–within the first 12 hours Eye prophylaxis–to prevent ophthalmia neonatorum Umbilical cord care–to prevent infection

PHYSICAL CHARACTERISTICS OF THE NEWBORN Weight and length Vital signs General appearance: skin, head, eyes, ears, neck, chest, abdomen, genitalia, back, and extremities

COMMON VARIATIONS IN THE NEWBORN Skin Head Eyes and ears Mouth Chest Genitalia Extremities

REFLEXES Rooting Sucking Extrusion Palmar grasp Plantar grasp Tonic neck Moro Gallant Stepping Babinski’s Crossed extension reflex Placing

BEHAVIORAL CHARACTERISTICS During first 6 to 10 hours after birth, infant has fairly predictable pattern of behavior called periods of reactivity. Following that, infant will exhibit various behavioral states, divided into sleeping and waking phases.

ASSESSMENT OF EXTERNAL PHYSICAL CHARACTERISTICS Resting posture Skin Plantar creases Breast Eye/ear Male genitals Female genitals

NEUROMUSCULAR MATURITY Square window Arm recoil Popliteal angle Scarf sign Heel to ear

GESTATIONAL AGE RELATIONSHIP TO INTRAUTERINE GROWTH Large for gestational age (LGA) –infant’s weight above 90th percentile. Appropriate for gestational age (AGA) –weight falls between 90th and 10th percentile. Small for gestational age (SGA) –weight falls below 10th percentile.

FIRST BATH AND CORD CARE Newborns are not generally given a tub bath until the cord has fallen off. Infant may remain in the warmer. Check temperature in 30 minutes to 1 hour. Treat the cord stump with alcohol. Fold the diaper under the cord stump.

CIRCUMCISION Surgical removal of the prepuce (foreskin) that covers the glans penis. Considered an elective procedure for which parents must give written consent. Only full-term, healthy newborns. Check hourly for 12 hours for voiding, bleeding.

NUTRITION Newborns need approximately 20 oz of breast milk or formula each day. Newborns lose weight the first few days of life. Infant regains birth weight by age 10 days.

BREASTFEEDING Breast milk is biologically designed to meet the needs of human infants. Colostrum (first few days) is rich in immunoglobulins, helps establish normal intestinal flora, and has a laxative effect. Breastfeeding mother must take in extra 500 calories a day.

FORMULA FEEDING Formula is fortified to be as much like breast milk as possible. Special formulas are made to meet special needs of some infants.

BURPING All infants require burping. Burping should be done about halfway through the bottle if bottle feeding. Burping should be done when changing breasts if breastfeeding.

PROBLEMS OF THE NEWBORN Hyperbilirubinemia Respiratory distress Cleft lip/palate Hydrocephalus Spina bifida Down Syndrome Talipes equinovarus

INFANT OF A DIABETIC MOTHER Hypoglycemia Respiratory distress Hyperbilirubinemia Birth trauma Congenital birth defects

INFANT OF AN HIV POSITIVE MOTHER Transmission may occur through placenta, maternal blood, secretions during birth, through breast milk. At birth, infant typically has no symptoms. All infants of HIV positive mothers should be presumed to be HIV positive. Breastfeeding is not recommended.

INFANT OF A SUBSTANCE-ABUSING MOTHER When umbilical cord is cut, the newborn experiences withdrawal. Complications: withdrawal, respiratory distress, jaundice, behavior problems, congenital anomalies, growth retardation. Infants of alcohol dependent mothers may have fetal alcohol syndrome (FAS).

PHENYLKETONURIA (PKU) Inborn error of metabolism. Infant cannot digest amino acid phenylalanine. Test at least 24 hours after initial feeding. Infant with PKU needs diet low in phenylalanine or severe mental retardation may occur.