1. IMMEDIATE CARE OF NEWBORN

3. DEFINE A HEALTHY NEWBORN
The healthy newborn infant is born at term, cries almost immediately after delivery and establishes satisfactory rhythmic pulmonary respiration

4. IMPORTANCE OF IMMEDIATE CARE
Period of transition from intrauterine to extrauterine condition
Changes in the CVS and respiratory system
Immaturity of the body in thermoregulation
Loss of heat through conduction, convection, radiation and evaporation
Check for bleeding

5. CLEARING THE AIR PASSAGES
It is an urgent duty that must be performed without delay
Mucus should be suctioned from the mouth as soon as the head is born.
As soon as the body is born the body should be held for a few seconds with the head slightly dependent for the drainage.
Some hold the baby upside down.
Mucus must be removed before the first breath to prevent aspiration.
If the body cries immediately there should be no need to use suctioning.
If the infant continues to have an accumulation of mucus in the mouth or nose do suction again.

12. SUCTIONING Use a bulb syringe or a soft, small catheter for suctioning
Do suction first in the mouth followed by nose.
Avoid vigourous suctioning
If the bulb syringe is used for suctioning it should be decompressed before being inserted the infant’s mouth or nose.
In case of asphyxiated baby endotracheal suctioning has to be done.
Keep ready resuscitation equipments and medications

13. Baby laryngoscope
Endotracheal tube
Suction tubes
Mucus extractors
Paediatric I.V administration set

14. MEDICATIONS Inj. Sodium bicarbonate Inj. Calcium gluconate
Sodium chloride
Glucose 10%
Neonatal nalaxon (Narcan)

15. Slow, irregular weak cry Response to flicking foot
APGAR SCORING
Signs
Score 1 2
Colour
Blue pale
Body pink limbs blue
Completely pink
Respiratory effort
Absent
Slow, irregular weak cry
Strong cry
Heart beat
Slow, less than 100
Over 100
Muscle tone
Limp
Some flexion of limbs
Active movement
Response to flicking foot
Fascial grimace
Crying
Severe Moderate 3-4 Mild 5-7
No asphyxia 8-10

17. THERMOREGULATION Maintain the room temperature 21C (70 F)
Loss of heat through conduction, convection, radiation and evaporation.
Dry the body and wrap the baby with a warm sterile blanket.
Cover the head
Keep the baby under radiant warmer
Immediate bath is not permitted
Re-assess the temperature after one hour.
If the temperature is 98.6 F and stable, bath can be given
Keep the baby warm
Hot water bottles are potentially dangerous in providing warmth.

19. ATTENTION TO THE UMBILICAL CORD
Time of clamping and cutting the cord.
Where do you clamp the cord?
Type of scissors used for cutting the cord
How did you cut the cord?
Examination of the cord for arteries and veins
Types of clamps
Plastic cord clamps (disposible)
Rubber bands
Pieces of compression tubing
Assess cord haemorrhage

21. OTHER NURSING MEASURES
Case of the eyes
Rest after the trauma of birth
Bonding of mother and baby
- Initiation of breast feeding within half an hour
- By administering sedatives during labor
- By encouraging fathers to be present
By ascertaining and complying with the mother’s wishes regarding the bonding process.
By allowing the mother to cuddle here whapped baby
By practising rooming in

22. NURSING DIAGNOSIS
Risk for ineffective airway clearance related to presence of mucus in mouth and nose at birth.
Risk for ineffective thermo regulation related to newborn’s transition to extra uterine environment.
Risk for infection related to newly clamped umbilical cord and exposure of eyes to vaginal secrtens.