2. Objectives
Identify key physical differences between the preterm infant and full term infant
Identify normal vital signs for a newborn
What are key signs of resp distress?

3. Newborn facts Neonatal period- 1st 28 days of life
1st 24 hours after birth is the most hazardous time
2/3’s of infant deaths that occur during the 1st year of life happen during this time and ½ of those occurs in the 1st 24 hours

4. Physiologic Adjustment
Periods of reactivity
1st 6 hours of life, all newborns go thru periods of irregularity prior to their body systems stabilizing
1st period of reactivity (1st ½ hour)
Quiet resting period (sleeps for 1 ½ hours)

5. Physiologic Adjustment
Second period of reactivity (b/t 2 & 6 hours)
This typical reactivity pattern demonstrates that the newborn is adjusting well to extrauterine life

6. Dubowitz Maturity Scale
Gestational Assessment
Observation of sole creases
Breast nodule diameter
Scalp hair
Ear lobe
Testes and scrotum
Skin

7. Gestational Age Ballard’s assessment of gestational age
Score is determined and “matches” weeks gestation

8. Nursing Care Vital Statistics Weight Length Head circumference
Abd circumference
Temp, Pulse, Respirations
BP only if cardiac defect suspected

9. Weight Establish a baseline
Is infant small or large for gestational age?
IUGR?
Preterm? Post dates?
Average weight at term for infant = 7.5 lbs
Newborns of non-white women in USA weight 0.5 lbs less
Loses 5-10% of birth weight (6-10 oz) during first few days of life

10. Length Average 53 cm (20.9 in) female to 54 cm (21.3 in) male
46 cm to 57.3 cm (18-24 in)
All data points need to be plotted on graph

11. Head and Chest Circumference
The chest circumference of a newborn should be about two cm’s less than head circumference
Average cm.
Any >37 or < 33 needs
to be investigated

12. Vital Signs Temperature – range 36.5 to 37 axillary
Heat loss in newborns occurs by
Convection
Conduction
Radiation
Evaporation

13. Temperature
If chilling is prevented the neonates’ temperature will stabilize within 4 hours after delivery and be 98.6 F or 37 C
Infection may not cause an increase in temperature and subnormal temperatures need to be investigated

14. Etiology/Precipitating Factors for Temperature Changes
Hypothermia
Prematurity
Asphyxia
Sepsis
Neurologic conditions
Inadequate drying and warming
Exposure to cold environmental conditions

15. Etiology/Precipitating Factors for Temperature Changes
Hyperthermia
Excessive environmental temperature
Dehydration
Infection
Phototherapy
CNS damage from trauma or drugs

16. Pulse
Range bpm
May be as low as 100 bpm while sleeping to 180 bpm when crying
Color pink with acrocyanosis
May be irregular with crying

17. Signs of Distress
Heart murmurs - all murmurs should be followed up and referred for medical evaluation
Faint sound
Central cyanosis

18. Respirations Range 30 – 60 breaths per minute Nose breathers
Moist breath sounds may be present shortly after birth
Bronchial breath sounds bilateral

19. Respiratory Distress Asymmetrical chest movements Apnea >15 seconds
Diminished breath sounds
Grunting, Nasal flaring, Retractions
Persistent irregular breathing
Persistent fine crackles
Tachypnea- >60
Excessive mucus
Stridor

21. Blood Pressure Not done routinely
Average newborn 65/40 in both upper and lower extremities
Varies with change in activity level
Must use appropriate size cuff for accurate reading

22. Eyes and Ears
Acuity takes 6 months but able to track mom’s face, no peripheral vision, loves complex patterns
Ears-hearing acute

23. PREVENTING “SHAKEN Preventing “Shaken Baby Syndrome”
P=Peak of crying
U=Unexpected
R=Resists soothing
P=Pain like face
L=long lasting
E=Evening
Step back, take 5.

24. What’s New? (AAP 2012) Post
Transcutaneous Bilirubin meter done at 24 hours (a touch on the forehead)
Pulse Ox test done at 24 hours ( on hand right wrist and leg) CCHD screening
No rectal temps after birth
No use of bulb syringes in cribs (VVMC)

25. In delivery room Delay blow by O2
Observe infant closely by using O2 sat monitoring
New standard of practice in all hospitals