!)7%&E and linoleic acid8 for brain development and increases %ntelience newborn baby nees $%&'cal 99day8 :50 cc most mils99day #irst nutrient receive by the baby is CARB()*DRATES Cereals+ ,egeta-les+ fruits an .uices+ meat an fish an egg a,oi honey !-otulism ris'" No egg /hite until $% months !ris' of allergy" 0uree meats+ fish+ 1oultry+ egg yol' introduce :new foods per wee easier to identify adverse reactions1 and allow a few da ys between •
by: Jonas Marvin M. Anaque RM, RN BREASTFEEDING
3 E’s Early – within 30 mins after birth Exclusive- up to 6 months Extended – 2 years and beyond Breastfeedin Breastfeedin should be initiated at once – about 30 minutes after normal delivery !nd about 3 - " hours after delivery by caesarian section #EE$%&' ()E* includes baby turns towards the breast and searches for the nipple+ nipple+ licking movements, flexing arms, clenching fists, s, tensing body and kicking leg s, Crying is the last sign of hunger • • •
C(LIC ❏ rule of 3’s8 unexplained paroxysms of irritability and cryin for ; 3 hours9day and ; 3 days9wee for ; 3 wees in an otherwise healthy+ well-fed baby timin8 onset :0 days to 3 months of ae< pea 6-5 wees ❏ child cries+ pulls up les and *ub-essaes passes as soon after after feedin manaement = parental relief+ rest and reassurance %dentify the sins and = hold baby+ soother+ car ride+ symptoms of diarrhea, music+ vacuum+ chec diaper A. /assae of watery stools at = AL2A AL2A*S B3R0 B3R 0 the -a-y - a-y least 3 times a day, = if breast feedin+ elimination B. Excessive thirst, of cow’s mil protein from C. *unen eyeballs or fontanel, mother>s diet effective in very small percentae of cases1 Anow the location of the nearest health facility9personnel facility9personnel Tu-ig 4u-eta (resol 5 where you can avail of medical Com-at of Cholera services, Brin the patient to the hospital if the sins and s ymptoms are present Dry mouth+ mouth+ sun'en or e1resse he four rules in the fontanels treatment of diarrhea, he eyes stop main A. Increase fluid intake. tears Hydration *weatin may stop ?eaness B. "ontinue #reastfeeding$ $ecreased urine C. %ake &inc supplement$ output D. Refer to health %ncreased thirst 1rofessional immeiately $ry mouth and if chil oes not im1ro,e# swollen tonue $i@@iness
health benefits of breastfeedin are Aey Behavioural lower ris of diarrhea+ essae pneumonia+ and chronic chronic illnesses, ?atch out for Oxytocin also calms and relax the sins and mothers emotion it controls the symptoms of emotional response of a mother diarrhea, “Milk ejection Reflex” Prolactin – Milk Milk Producing hormone Acinii al!eolar al!eolar cell- milk milk producing cells *ee medical .actiferous tubules – mil storae advice, /hysioloical benefits Breastfeedin promotes uterine involution+ decreases ris of postpartum hemorrhae hemorrhae and increases period of postpartum anovulation anovulation havin periods without #ollow the four ovulatin1, rules for the others can also practice treatment of natural child spacin diarrhea, since breastfeedin delays ovulation, his is is called Lactation Amenorrhea Metho !LAM"# ! lactatin woman has at least 45 protection from prenancy for six 61 months when she remains without her period ammenorrheic1 and fully or nearly fully breastfeeds, Breastfeedin also decreases the ris of breast cancer+ovarian cancer+ovarian cancer cancer and hip and bone fractures, Breastfeedin also maes it easier for niht feeds, •
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B7! $iet for severe dehydration1 B6 Banana R6 Rice A6 A11le T6 Toaste Toaste Brea
by: Jonas Marvin M. Anaque RM, RN
/lan !- home management /lan B – 7) C7* : lass of water+ " tsp of suar+ a pinch of salt1 0lan C 5 I7F De,elo1mental milestone (ne month--midline vision % mos6 6first social smile No hea control Closing of posterior fontanel Eyes bein to follow 7esponds to familiar voices by movin the whole body st (oo’s two sounds : vowel sounds1 8mos6 Can -ring o-.ects to mouth at /ill ead held erect and steady Laugh alou *mile in mothers presence 9 mos# STE0 refle:es isa11ears *teppin+ onic nec+ Extrusion+ /almar 'rasp1 ead rotation )ea control !hea lags isa11ears" 7each toys near to him ; mos# Rolls FA*B !Front to Bac'" aes obDect presented to him RO'' O()R Mirror image < mos 6 Dou-les -irth /eight 7olls from bac to abdomen Eru1tion of first tooth !lo/er central incisors" Sits /ith su11ort (an pull to sittin to standin Drin's from a cu1 *yllable Ch Ch beins = mos 6 Gras1 toys /ith hans and to hand coordination *ear of strangers #egin
> mos#6 Sits alone sits without support1 +tranger anxiety at peaks ? mos 5Says first /or @Daa hen mama CRA2L 7esponds to parent aner Elevate himself to sittin position Can hold bottle with good hand to mouth coordination Disappearance of fear of strangers
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$& mos 6 0incer gras1 0ea' a -oo /ull self to stand espond to own name !rings hand together ocali@es one or two sounds $$ mos 6 Stans /ith su11ort $% mos 6 Stans alone ?als with help Tri1les -oy /eight (an say two words Eats with finers :-3 years old weiht monthly Anterior fontanel starts to close $; mos 6 2al's /ell alone hrows toys Creep stairs Hand to eye coordination $> monhs6 3ses s1oon an for' "umps and plays Can climb upstairs !owel training starts
% years 6 (1en oor 'no-s !ladder training 2 words per tal F0 vocabulary words to/er of < cu-es 8years 6 Routine ,P taking Can draw Circle (an now ride tricycle iptoe can remove t- shirt alone #undress self$ 400 vocabulary word 9 years 6 Dra/s suare " word per tal :F00 vocabulary words uses scissors ; years ol 6 Dra/s Triangle Rides #icycle %ie the shoe laces (ount usin finers prints name
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Certain haars 1resent ifferent ages# Cho'ing from mechanical o#struction is the leading cause of death #y suffocation1 for infants youner than : year of ae for tolers+ there are more burns, poisoning, and drowning
by: Jonas Marvin M. Anaque RM, RN
%. ",
for 1reschoolers + more playround e&uipment accidents, choking, poisoning, and drowning'. adolescents+ more automobile accidents+ drownin+ fires+ and firearm accidents
PLAYS APPROPRIATE FOR AGE:
Infants: Solitary Play- self is the interest of activities. Toddlers: Parallel Play- plays alongside, but NOT with another. Preschool: ssociative Play- plays in rando! without group goal School ge: "ooperative Play- Organi#ed with rules and leadership dolescents: "o!petitive Play- with win-lose type of rules
CIRC3MCISI(N ❏elective procedure - prevention of phimosis - watch out for sins of Bleeing an hemorrhage
E# Ba-ins'is refle: (rigger) ! entle stroe on the sole of the foot from heel to toe1 esponse) #oot turns in and toes flare up Duration) *ix to 2" months eason) *erhaps an attempt to protect against falling
Dentition ❏ primary dentition 20 teeth1 first tooth at < months !;6?" !lo/er incisor"+ then : per month until 20 teeth = 6-5 central teeth by : year ❏ secondary
dentition 32 teeth1 = first adult tooth is :st molar at 6 years = 2nd molars at :2 years+ 3rd molars at :5 years he initial weiht loss for a healthy neonate is ; to $& of -irth /eight , Physiologic .eight loss REFLEES (F T)E NE2B(RN A# Root refle: (rigger) ! entle stroe on the newborn’s chee esponse) Baby turns toward the touch+ with mouth open Duration) )ntil baby is three to four months old sometimes+ babies continue doin this in their sleep past four months old1 eason) elps baby find food B# Suc' refle: (rigger) *omethin+ such as a nipple breast or bottle1 or parent’s finer+ touchin roof of baby’s mouth esponse) Baby sucs on nipple Duration) hree to four months eason) elps baby eat C# Galant refle: = infant is held in ventral suspension and one side of the bac is stroed alon paravertebral line = reflex consists of lateral curvature of the trun toward the stimulated side = disappears by 2-3 months
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D# Moro refle: !also calle startle refle:" (rigger 8 .oud noise even baby’s own cryG1+ sudden movement+ or sensation of fallin esponse) Baby cries and extends les+ arms+ and finers+ arches bac+ then retracts arms and les reflex consists of abduction and extension of the arms+ openin of the hands+ followed by flexion and adduction of arms Duration) )ntil baby is four to six months old eason) Baby’s first attempts to protect himself from harm If baby startles himself awake) ry swaddlin him to mae him feel more secure
F# 2al'ing !or ste11ing" refle: (rigger) oldin baby upriht with his feet on a flat surface esponse) Baby lifts one foot+ then the other+ as if walin Duration) !bout two months eason) ay prepare baby developmentally for walin several months from now G# Tonic nec' refle: (rigger) .yin on his bac with head turned to one side esponse) he arm on that side extends+ while the opposite arm bends at the elbow a HfencinI position1 Duration) !bout six months sometimes not present until two months of ae1 eason) ay prepare baby developmentally for voluntary reachin later )# Gras1 !or 1almar gras1" refle: (rigger) /ressin a finer or other obDect+ such as a rattle+ into baby’s palm esponse) Baby maes a fist and tries to rab finer Duration) hree to four months eason) ay prepare baby developmentally for voluntary raspin later +un fact) Baby’s rip can be stron enouh to support his entire body weiht 0yloric Stenosis ❏clinical features = non-bilious proDectile vomitin that occurs after feedin = usually starts at 2-6 wees of ae = infant hunry and alert+ will re-feed = astric peristalsis oes from left upper Juadrant .)K1 to epiastrium
by: Jonas Marvin M. Anaque RM, RN
= Holi!e sign”/ olive-shaped mass at marin of riht rectus abdominis muscle
= usual site8 ileocecal Dunction clinical features = Hclassic triadI :, abdominal pain 2, palpable sausae-shaped mass8 upper to mid abdomen 8# @re currant .elly stools !only in $&6$; of 1 atients"
Gastroeso1hageal Reflu: Disease ❏extremely common in infancy8 thrivin baby reJuires no investiation manaement = conservative8 thicened feeds+ elevate bed to "F derees = medical8 short-term enteral feedin to enhance weiht ain = drus8 ranitidine+ omepra@ole8 to decrease astric acidity+ AC3TE DIARR)EA Etioloy ❏viral infection = most common Rota,irus = sliht fever+ malaise+ vomitin+ vaue abdominal pain = resolves in 3-L days ❏ bacterial infection = *almonella+ (ampylobacter+ *hiella+ pathoenic E, coli+ = more severe abdominal pain+ hih fever+ bloody diarrhea alleric8 food
anaement prevention and treatment of dehydration is most important replacement of fluid deficit M maintenance M onoin losses antibiotic therapy when indicated oral rehydration therapy with freJuent small volumes of pediatric oral rehydration solutions e,, /edialyte1 % may be reJuired for severe dehydration early refeedin advisable antidiarrheal medications not indicated Celiac Disease ❏also nown as Hluten-sensitive enteropathyI ❏ defect at the mucosal level = toxic or immunoloic reaction to luten in @BR(2 !arley, ye, ats, heat$ !lternative foodsH RICE an C(RN )irschs1rungs Disease ❏also nown as Hconenital aanlionic meacolonI rectosimoid in LF of cases ❏ associated with $own *yndrome $*1
clinical features = severity depends on lenth of colon involved = no meconium within first 2" hours = palpable stool on abdominal exam with empty rectum on diital rectal exam $7E1 = intermittent diarrhea+ B only with rectal stimulation = constipation+ abdominal distention+ vomitin = failure to thrive #1 @RIBB(N LI4E ST((L Intussusce1tion telescopin of sement of bowel into distal sement ––; ischemia and necrosis
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D(2N S*NDR(ME !DS" most common abnormality of autosomal chromosomes trisomy 2: (linical #eatures ❏very wide rane of severity ❏ low %K+ developmental delay+ short stature+ obesity ❏shorter life expectancy ❏ EE&8 flat occiput+ 3rd fontanelle+ microcephaly+ small midface+ small mandible and maxillae+ upslantin palpebral fissures+ epicanthal folds+ specled iris Brushfield spots1+ refractive errors and strabismus+ furrowed prominent tonue+ hih arched palate+ ear anomalies+ freJuent !C+ hearin problems ❏ (*8 conenital cardiac defects F01+ particularly septal defects !*$1
E&%&'%%* sins of meninismus = Bruins'is signH reflex flexion of hips and nees upon flexion of the nec 4ernigs signH reflex contraction and pain in hamstrins upon extension of le that is flexed at the hip = o1isthotonosH spasm in which head and heels are bent bacward and body bowed forward = nuchal riidity
7E*/%7!C7N $%*7E** *N&$7CE 7$*1 ❏also nown as Hhyaline membrane diseaseI ❏most common cause of respiratory distress in the pre-term infant manifesttachypnea+ tachycardia+ chest wall retractions recession1+ expiratory runtin+ nasal flarin and cyanosis durin breathin efforts, •
/revention ❏steroid therapy e,, (elestone9bethamethasone1 for mothers prior to delivery of premature infants ❏ monitor lecithin8sphinomyelin .9*1 ratio !%H$"
!, A cleft li1 is a physical split or separation of the two sides of the upper lip and appears as a narrow openin or ap in the sin of the upper lip, his separation often extends beyond the base of the nose and includes the bones of the upper Daw and9or upper um, B, A cleft 1alate is a split or openin in the roof of the mouth, ! cleft palate can involve the hard palate the bony front portion of the roof of the mouth1+ and9or
by: Jonas Marvin M. Anaque RM, RN
the soft palate the soft bac portion of the roof of the mouth1, S1ina -ifia .atin8 Osplit spineO1 a developmental conenital disorder caused by the incomplete closin of the embryonic neural tube, most common location of the malformations is the lumbar and sacral areas, yelomeninocele is the most sinificant and common form+ and this leads to disability in most affected individuals, RA ?%>> 6 Ne/-orn Screening !NBS" is a simple procedure to find out if your baby has a conenital metabolic disorder that may lead to mental retardation or even death if left untreated,
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)eel 1ric' metho – used to obtain specimen &ewborn screenin is ideally done immediately after 2" hours from birth, he blood sample for &B* may be collected by any of the followin8 physician+ nurse9midwife+ medical technoloist or trained nurse9midwife 7esults can be claimed from the health facility where &B* was availed, &ormal &B* 7esults are available -y = 6 $9 /or'ing ays from the time samples are received at the &*(,
! &E'!%E *(7EE& E!&* ! E &B* 7E*). %* &C7!., ! positive screen means that the newborn must be brouht bac to his9her health practitioner for further testin,
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he disorders tested for newborn screenin are8 !$" Congenital )y1othyroiism !C)" !%" Congenital Arenal )y1er1lasia !CA)" !8" Galactosemia !GAL" !9" 0henyl'etonuria !043" !;" Glucose6<60hos1hate6Dehyrogenase Deficiency !G<0D Def#" !<" Ma1le Syru1 3rine Disease !MS3D"
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0seuomenstruation - vainal openin is visible and a mucoid dischare+ which miht be bloody secondary to estroen withdrawal
%n a neonate+ the s ymptoms of heroin .ithdra.al may #egin se!eral hours to 0 days after #irth$ %n a neonate+ the s ymptoms of methadone .ithdra.al may #egin 1 days to se!eral .eeks after #irth$ %n a neonate+ the cardinal sins of narcotic /ithra/al inclue coarse+ fla11ing tremors
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slee1iness restlessness 1rolonge+ 1ersistent+ high61itche cry an irrita-ility , %n a 1remature neonate+ sins of res1iratory istress include nostril flaring2 su#sternal retractions2 and inspiratory grunting$ Respiratory distress syndrome hyaline mem#rane disease3 de!elops in premature infants #ecause their pulmonary al!eoli lack surfactant$Normal ratio of surfactants LJS is %H$ ?henever an infant is bein put down to sleep+ the parent or careiver should position the infant on the bac,supine1 7emember bac to sleep,1 Clinical signs of a ehyrate infant inclue lethargy+ irrita-ility+ ry s'in ecrease tearing+ ecrease urinary out1ut+ an increase 1ulse# ! servin si@e of a food is usually : tablespoon for each year of ae, he characteristic of fifth disease erythema infectiosum1 is erythema on the face+ primarily the chees+ ivin a Hslapped faceI appearance, *ins that a child with cystic fibrosis is respondin to pancreatic en@ymes are the absence of steatorrhea+ improved appetite+ and absence of abdominal pain, 7oseola appears as discrete rose-pin macules that first appear on the trun and that fade when pressure is applied, Circumcision /oulnt -e 1erforme on a male chil /ith hy1os1aias because the foresin may be needed durin surical reconstruction, Bloo 1ressure in the arms an legs is essentially the same in infants, ?hen -ottle6feeing a ne/-orn /ith a cleft 1alate+ hol the infants hea in an u1right 1osition , Because of circulatin maternal antibodies that will decrease the immune response+ the measles+ mumps+ and rubella 71 vaccine shouldn’t be iven until the infant has reached : year of ae, Before feedin an infant any fluid that has been warmed+ test a ro1 of the liui on your own sin to prevent burnin the infant, ! newborn typically /ets < to $& ia1ers 1er ay , The most aeuate iet for an infant in the first < months of life is -reast mil' , !n infant can usually che/ foo -y = months+ hol s1oon -y ? month+ an rin' flui from a cu1 -y $ year of age# Aohlber’s staes of moral development< Erison’s eiht staes of development< and /iaet’s phases of conitive development, %n an infant+ a bulin fontanel is the most sinificant sin of increasin intracranial pressure, Co/s mil' shoulnt -e gi,en to infants younger than age $ -ecause it has a lo/ linoleic aci content an its 1rotein CASSEIN is ifficult for infants to igest# If .aunice is sus1ecte in a neonate + the nurseJmi/ife shoul e:amine the infant uner
by: Jonas Marvin M. Anaque RM, RN
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natural /ino/ light, %f natural liht is unavailable+ the nurse9midwife should examine the infant under a white liht, 7itamin 4 is administered to neonates to prevent hemorrhaic disorders because a neonate’s intestine can’t synthesi@e vitamin A, Fetal alcohol synrome 1resents in the first %9 hours after -irth an 1rouces lethargy+ seiures+ 1oor suc'ing refle:+ a-ominal istention+ an res1iratory ifficulty# %n a 1remature neonate+ sins of res1iratory istress include nostril flaring2 su#sternal retractions2 and inspiratory grunting$ Respiratory distress syndrome hyaline mem#rane disease3 de!elops in premature infants #ecause their pulmonary al!eoli lack surfactant$Normal ratio of surfactants LJS is %H$ ?henever an infant is bein put down to sleep+ the parent or careiver should position the infant on the bac,supine1 7emember bac to sleep,1 he 1ercentage of /ater in a neonates -oy is a-out => to >&# o 1erform nasotracheal suctioning in an infant+ the nurseJmi/ife 1ositions the infant /ith his nec' slightly hy1ere:tene in a @sniffing 1osition+ /ith his chin u1 an his hea tilte -ac' slightly# Suction for no more than $& secons !fter birth+ the neonates um-ilical cor is tie $K !%#; cm" from the a-ominal /all /ith a cotton cor+ 1lastic clam1+ A 1remature neonate is one -orn after %& /'s an -efore the en of the 8=th /ee' of gestation# Stress+ ehyration+ an fatigue may reuce a -reast6feeing mothers mil' su11ly# ?hen both breasts are used for breast-feedin+ the infant usually oesnt em1ty the secon -reast , (herefore, the second breast should be used first at the next feeding. A lo/6-irth6/eight neonate /eighs %+;&& g !; l- > o" or less at -irth# SGA6MICR(S(MIC INFANT A ,ery6lo/6-irth6/eight neonate /eighs $+;&& g !8 l- ; o" ?hen teachin parents to provide umbilical cord care+ the nurse9midwife should teach them to clean the umbilical area with a cotton -all saturate /ith alcohol ;& to =& after e,ery ia1er change to 1re,ent infection an 1romote rying# Teenage mothers are more li'ely to ha,e lo/6 -irth6/eight neonates because they see prenatal care late in prenancy as a result of denial1 and are more liely than older mothers to have nutritional deficiencies, Cutis marmorata is mottling or 1ur1le iscoloration of the s'in , %t’s a transient vasomotor response that occurs 1rimarily in the arms an legs of infants /ho are e:1ose to col#
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(rtolanis sign an aui-le clic' or 1al1a-le .er' that occurs /ith thigh a-uction 1 confirms congenital hi1 islocation in a neonate he first immuniation for a neonate is the BCG an he1atitis B ,accine+ /hich is aministere in the nursing shortly after -irth# %nfants with Do/n synrome ty1ically ha,e mar'e hy1otonia+ flo11iness+ slante eyes+ e:cess s'in on the -ac' of the nec'+ flattene -rige of the nose+ flat facial features+ s1aeli'e hans+ short an -roa feet+ small male genitalia+ a-sence of Moros refle:+ an a simian crease on the hans# BECA3SE IT IS A NE3R(M3SC3LAR DIS(RDER he circumference of a neonates hea is normally % to 8 cm greater than the circumference of the chest# )ea is 8868; cm+ chest an a-omen is 8$ to 88 an normal NB length is the same /ith the um-ilical cor /hich is 9; to ;; cm $urin the first hour after -irth !the 1erio of reacti,ity1+ the neonate is alert and a.ake, he specific ravity of a neonate’s urine is $#&&8 to $#&8&, ! lower specific ravity suests overhydration< a hiher one suests dehydration, he neonatal 1erio e:tens from -irth to ay %> , %t’s also called the first 9 /ee's or first month of life, ! /oman /ho is -reast6feeing shoul ru- a mil emollient cream or a fe/ ro1s of -reast mil' !or colostrum" on the ni11les after each feeing , *he shoul let the -reasts air6ry to 1re,ent them from crac'ing# Breast6feeing mothers shoul increase their flui inta'e to % to 8 t !%+;&& to 8+&&& ml" aily, !fter feedin an infant with a cleft lip or palate+ the nurse9midwife should rinse the infant’s mouth with sterile water, he nurseJmi/ife instills erythromycin in a neonates eyes primarily to 1re,ent -linnesscaused #y gonorrhea or chlamydia$ )uman immunoeficiency ,irus !)I71 has been cultured in breast milk and can be transmitted by an %-positive mother who breast-feeds her infant,&C B7E!*#EE$%&' /C.%(N /reterm neonates or neonates who can’t maintain a sin temperature of at least 4L,6P # 36,"P (1 should receive care in an incubator %solette1 or a radiant warmer, %n a radiant warmer+ a heat-sensitive probe taped to the neonate’s sin activates the heater unit automatically to maintain the desired temperature, Colostrum+ the 1recursor of mil' + is the first secretion from the #reasts after deli!ery$"ontains 45A Neonates /ho are eli,ere -y cesarean -irth ha,e a higher incience of res1iratory istress synrome,
by: Jonas Marvin M. Anaque RM, RN
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?hen 1ro,iing 1hotothera1y to a neonate + the nursemid.ife should co!er the neonate6s eyes and genital area$continue ,$* e!ery 7 hours and co!er the #reast also it is normal to pass a yello. greenish stool after photo therapy he narcotic antagonist nalo:one !Narcan" may be iven to a neonate to correct respiratory depression caused by narcotic administration to the mother durin labor, %n a neonate+ sym1toms of res1iratory istress synrome inclue e:1iratory grunting or /hining+ san1a1er -reath souns+ an seesa/ retractions# SIL7ERMAN ANDERS(N SC(RING S*STEM is use for e,aluation of 0REMAT3RIT* he nurse9midwife should assess a breech-birth neonate for hydrocephalus+ hematomas+ fractures+ and other anomalies caused by birth trauma, %n a neonate+ lon+ brittle finernails are a sin of postmaturity, Born after 9% /ee's gestation $esJuamation sin peelin1 is common in postmature neonates, ! mother should allow her infant to breast-feed until the infant is satisfied, he time may ,ary from ; to %& minutes# %n a neonate+ hypolycemia causes temperature instability+ hypotonia+ .itteriness+ an seiures, /remature+ postmature+ small-for-estational-ae+ and lare-for-estational-ae neonates are susceptible to this disorder, &eonates typically need to consume F0 to FF cal per pound of body weiht daily, ! neonate /hose mother has ia-etes shoul -e assesse for hy1erinsulinism# (r REB(3ND )*0(GL*CEMIA he -est techniue for assessing .aunice in a neonate is to -lanch the ti1 of the nose or the area .ust a-o,e the um-ilicus# 0rolactin stimulates an sustains mil' 1rouction# *trabismus or cross eye and nystaus is a normal findin in a neonate, Nystagmus is ue to IMMAT3RE E*E M3SCLES Fetal emise is death of the fetus after viability, o prevent her from developin 7h antibodies+ an 7h-neative primiravida should receive 7ho$1 immune lobulin !RhoGAM" after eli,ering an Rh61ositi,e neonate# Rh 5mother an an Rh -a-y he initial /eight loss for a healthy neonate is ; to $& of -irth /eight# 0hysiologic /eight loss he normal hemolobin value in neonates is :L to 20 9dl, he !par score is used to assess the neonate’s vital functions, %t’s obtained twice 2x1 at : minute and F minutes after delivery, he score is based on respiratory effort+ heart rate+ muscle tone+ reflex irritability+ and color,
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The 1reterm neonate may reuire ga,age feeings or NGT -ecause of a /ea' suc'ing refle:+ uncoorinate suc'ing+ or res1iratory istress+ &eonatal testin for 1henyl'etonuria is mandatory in the country this is the G3T)RIE TEST# he nurse9midwife should place the neonate in a 8&6 egree Trenelen-urg 1osition to facilitate mucus drainage$ he nurse9midwife may suction the neonates mouth firstan then nose as neee /ith a -ulsyringe or suction tra1# o 1re,ent heat loss+ the nurseJmi/ife shoul 1lace the neonate uner a raiant /armer @%; /atts durin suctionin and initial delivery-room care+ and then wrap the neonate in a warmed blanet for transport to the nursin, he um-ilical cor normally has t/o arteries an one ,ein# A7A S3A means single um-ilical artery ?hen providing care, the nursemidwife should expose only one part of an infant/s body at a time, In the neonate+ tem1erature normally ranges from 89: to 88: * ;<$1: to ;1$7: "32 a1ical 1ulse rate a,erages =7> to =<> #eatsminute+ an respirations are 0> to <> #reathsminute. he iamon6sha1e anterior fontanel usually closes -et/een ages $% an $> months , he triangular 1osterior fontanel usually closes #y age 7 months$ %n the neonate+ a straight s1ine is normal# A tuft of hair o,er the s1ine is an a-normal fining# Su1ernumerary ni11les are occasionally seen on neonates, hey usually appear alon a line that runs from each axilla+ throuh the normal nipple area+ and to the roin, Meconium is a material that collects in the fetus6s intestines and forms the neonate6s first feces2 .hich are #lack and tarry$ (he presence of meconium in the amniotic fluid during la#or indicates possi#le fetal distress and the need to evaluate the neonate for meconium aspiration. o assess a neonate’s rooting refle:+ the nursemidwife touches a finger to the cheek or the corner of the mouth, &ormally+ the neonate turns his head toward the stimulus+ opens his mouth+ and searches for the stimulus, )arleuin sign is present .hen a neonate .ho is lying on his side appears red on the dependent side and pale on the upper side$ he Guthrie test !a screening test for 1henyl'etonuria" is most relia-le if its one -et/een the secon an si:th ays after -irth an is 1erforme after the neonate has ingeste 1rotein, o esta-lish a mil' su11ly 1attern+ the mother shoul -reast6fee her infant at least e,ery 9
by: Jonas Marvin M. Anaque RM, RN
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hours, $urin the first month+ she should breast-feed 5 to :2 times daily demand feedin1, o a,oi contact /ith -loo an other -oy fluis + the nurse9midwife should wear gloves when handling the neonate until after the first bath is given.' !012CH is used to clean blood products %f a -reast6fe infant is content+ has goo s'in turgor+ an aeuate num-er of /et ia1ers+ an normal /eight gain+ the mothers mil' su11ly is assume to -e aeuate# ost authorities stronly encourage the continuation of -reast6feeing on -oth the affecte an the unaffecte -reast of 1atients /ith mastitis# %n a neonate+ lo/6set ears are associate /ith chromosomal a-normalities such as Do/n synrome# Meconium is usually 1asse in the first 70 hours ho/e,er+ it is still N(RMAL if 1assage may ta'e u1 to =% hours , Boys who are born with hy1os1aias urethral o1ening is in the ,entral surface or inferior sie 7 is to 7A7A" shouldn’t be circumcised at birth because the foresin may be needed for constructive surery, %n the neonate+ the normal blood lucose level is "F to 40 m9dl, )e1atitis B ,accine is usually gi,en /ithin 9> hours of -irth !RA =>9<"# Infants of ia-etic mothers are susce1ti-le to macrosomia as a result of increased insulin production in the fetus, o prevent heat loss in the neonate+ the nurse9midwife should bathe one part of his body at a time and eep the rest of the body covered, he occurrence of thrush in the neonate is 1ro-a-ly cause -y contact /ith the organism uring eli,ery through the -irth canal# Moniliasis is a /hite cheey 1atches in oral mucusa of a -a-y
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he nurseJmi/ife shoul 'ee1 the sac of meningomyelocele moist /ith normal saline solution# 0osition the chil into a 0R(NE 1osition 3nli'e formula+ -reast mil' offers the -enefit of maternal anti-oies IGA )eart e,elo1ment in the em-ryo -egins at % to 9 /ee's an is com1lete -y the en of the em-ryonic stage CBOH )eart starts to -eat as early as %8 ays #etusQ! human bein from about the eihth wee of life up until birth he administration of folic acid during the early stages of gestation may pre!ent neural tu#e defects$ ?ith a,ance maternal age+ a common genetic 1ro-lem is Do/n synrome, ,reast-feeding of a premature neonate #orn at ;7 .eeks6 gestation can #e accomplished if the mother expresses milk and feeds the neonate #y ga!age he nurseJmi/ife must 1lace ientification -ans on -oth the mother an the neonate -efore they lea,e the eli,ery room# Erythromycin is gi,en at -irth to 1re,ent o1hthalmia neonatorum# Accoring to the 3nang*a'a1 1rogram !Essential Ne/-orn Care"+ the cor shoul not -e clam1e until 1ulsations ha,e sto11e !thats a-out $68 minutes"# %nfants subsistin on cow’s mil only don’t receive a sufficient amount of iron !ferrous sulfate"+ which will eventually result in iron deficiency anemia, !n infant usually triples his birth weiht by the end of his first year
by: Jonas Marvin M. Anaque RM, RN
