The Normal Newborn: Needs and Care

Assessment Data: Condition of the Infant Apgar scores at 1 and 5 minutes Resuscitative measures Physical examination Vital signs Voidings Passing of meconium

Newborn Care

Assessment Data: Infant Complications Excessive mucus Delayed spontaneous respirations or responsiveness Abnormal number of cord vessels Obvious physical abnormalities

Assessment Data: Labor and Birth Duration and course Status of mother and fetus Analgesia or anesthesia

Assessment Data: Labor and Birth Complications Prolonged rupture of membranes Meconium-stained amniotic fluid Nuchal cord Precipitous birth Use of forceps or vacuum extraction assisted device Fetal distress

Assessment Data: Maternal Complications Preeclampsia Spotting Illness Recent infections Rubella status Serology results

Assessment Data: Maternal Complications (continued) Hepatitis B screen results Exposure to group B streptococci History of maternal substance Human immunodeficiency virus (HIV) test result

Assessment Data: Family Parents’ interactions with their newborn Their desires regarding infant care Information about other children in the home Available support systems Patterns of interaction within each family unit

Physiologic Alterations Respiratory distress Pallor Hypothermia Alterations in feeding and elimination

Nursing Care: Assessment Airway clearance Vital signs Body temperature Neurologic status Ability to feed Evidence of complications

Nursing Care: Assessment (continued) Review of prenatal and birth information Gestational age Newborn’s adaptation to extrauterine life Weight and measurement Vital signs every 30 minutes Assessment of Hct or blood glucose if warranted

Admission Procedures Newborn bath Vitamin K Eye prophylaxis Observation for distress Initiate feeding Facilitate parental-infant attachment

Daily Assessments Vital signs Weight Overall color Intake and output Umbilical cord Circumcision

Daily Assessments (continued) Newborn feeding Attachment

Daily Newborn Care Assist with feedings Thermoregulation Skin care Cord care Prevention of infection Security

Common Concerns How to pick up a newborn Holding and feeding the infant Changing the diaper Interpreting newborn cues Bathing the newborn

Common Concerns (continued) Cord and circumcision care Normal voiding and stooling pattern

Circumcision using the Yellen or Gomco clamp Circumcision using the Yellen or Gomco clamp. A, The prepuce is drawn over the cone

The clamp is applied. Pressure is maintained for 3 to 4 minutes, and then excess prepuce is cut away.

Circumcision using the Plastibel. The bell is fitted over the glans Circumcision using the Plastibel. The bell is fitted over the glans. A suture is tied around the bell’s rim, and the excess prepuce is cut away. The plastic rim remains in place for 3 to 4 days until healing occurs. The bell may be allowed to fall off; it is removed if still in place after 8 days.

Parent Education Periods of reactivity and expected newborn responses Normal physical characteristics of the newborn The bonding process The infant’s capabilities for interaction The role of touch in facilitating parent-infant interaction Comforting techniques

Parent Education (continued) Progression of infant behaviors Information about available educational materials and support

Family Education Newborn care videos Newborn care classes Individual instruction Observation of parent-infant interaction Role modeling

Discharge Education Safety measures Voiding and stool characteristics Circumcision care Cord care Waking and quieting the newborn Car safety

Discharge Education (continued) Immunizations Signs of illness

Signs of Illness Temperature above 38oC or below 36.6oC axillary Continual rise in temperature Forceful or frequent vomiting Refusal of two feedings in a row Difficulty in awakening baby Cyanosis with or without a feeding

Signs of Illness (continued) Absence of breathing longer than 20 seconds Inconsolable infant or continuous high-pitched cry Discharge or bleeding from umbilical cord, circumcision, or any opening Two consecutive green watery or black stools, or increased frequency of stools No wet diapers for 18 to 24 hours Fewer than 6 to 8 wet diapers per day after 4 days of age Development of eye drainage