1. ASSESSMENT AND CARE The Normal Newborn

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

3. 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

4. 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

5. 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

6. 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

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

8. APGAR SCORE

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

10. Vital Sign Normals 97.7-98.6 F (36.5-37 C) 110-160  A soundly sleeping baby can go to 80 bpm  A crying baby may be as high as 180

11. 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.

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

13. Cracked Skin

14. Abundant Lanugo

15. Ear of a preterm infant

16. Sole creases

17. Comparison of resting posture

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

19. DURING PHASES TWO AND THREE Physical Characteristics

20. 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

21. Head Lag

22. Moro Reflex

23. Tonic Neck Reflex

24. Dancing Reflex

25. Suck Reflex

26. Hand Grasp

27. Foot Grasp

28. Head Head circumference Molding Fontanelles  Anterior closes between 12-18 months  Posterior closes by the end of the 2 nd month

29. Eyes Eye placement Blink reflex Discharge Pupil reaction

30. 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

31. 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

32. Femoral Pulses

33. Brachial Pulses

34. Assessment of Respiratory Status

35. 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

36. Hip Check

37. Hip Check Skin Folds

38. 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

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

40. 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.

41. Physiologic Jaundice Most jaundice in newborns is physiologic It peaks between 48-72 hours Usually disappears within a week Usually benign Can become elevated to a point of concern for the baby

42. PHOTOTHERAPY