NEWBORN CARE As soon as the infant is born, the prior management is to establish, establish, maintain and support respirations, to provide warmth and prevent hypothermia, to ensure safety, prevent injury and infection and to identify actual actua l or potential problems that may require immediate attention. Establish respiration and maintain clear airway
The most important need for the newborn newbo rn immediately after birth is a clear airway to enable the newborn to breathe effectively since the placenta has ceased to function as an organ of gas exchange. It is in the maintenance of adequate oxygen supply through effective respiration that the survival of the newborn greatly depends. Newborns are obligatory nose breathers. The r eflex response to nasal obstruction, opening the mouth to maintain airway, is not present in most newborns until 3 weeks a fter birth. To establish and maintain respirations:
1. Wipe mouth and nose of secretions after delivery of the head. 2. Suction secretions from mouth and nose. y y y
Compress
bulb syringe before inserting Suction mouth first, then, the nose Insert bulb syringe in one side of the mouth
3. A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously, or if the cry cr y is weak. y y y
Do
not slap the buttocks rather rub the soles of the feet. Stimulate to cry after secretions are removed. The normal infant cry is loud and husky. Observe for the following abnormal cry: hypog lycemia, increased intracranial pressure. o High, pitched cry ± indicates hypoglycemia, Weak cry ± prematurity o o Hoarse cry ± laryngeal stridor
4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position p osition that would promote drainage of secretions. y y
Trendelenburg position ± head lower than the body Side lying position ± If trendelenburg position is contraindicated, place infant in side lying position to permit drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine pos ition. ition.
5.
Keep the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are obligatory nose breathers until they are about 3 weeks old.
Care of the Eyes
It is part of the routine care of the newborn to give pro phylactic eye treatment against gonorrhea conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed on the fetus from the vaginal canal during delivery. This practice was introduced by Crede, a German gynecologist in1884. Silver nitrate, erythromycin and tetrac ycline ophthalmic ointments are the drugs used for this purpo se. Erythromycin or tetracycline Opthalmic Ointment :
1. These ointments are the ones commonly used now a day for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis. 2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes. Vitamin
K or Aquamephyton
The newborn has a ster ile intestine at birth, hence, the newborn do es not possess the intestinal bacteria that manufactures vitamin K which is necessary for t he formation of clotting factors. This makes the newborn prone to bleeding. As a preventive measure, .5 (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the newborn¶s vastus lateralis (lateral anterior thigh) muscle.
Care of the cord
The cord is clamped and cut approximately within 30 seconds after birth. In the delivery room, the cord is clamped twice about 8 inches from the abdomen and cut in between. When the newborn is brought to the nursery, another clamp is applied ½ to 1 inch from the abdomen and the cord is cut at second time. The cord and the area around it are cleansed with antiseptic solution. The manner of cord care depends on hospital protocol. What is important is that the principles are followed. Cord clamp maybe removed after 48 hours when the cord has dried. The cord stump usually dries and falls within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days. The nurse must instruct the mother no tub bathing until cord falls off. Do not apply anything on the cord such as baby powder or antibiotic, except t he prescribed antiseptic solution
which is 70% alcohol. Avoid wetting the cord. Leave cord exposed to air and not apply dressing or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air. If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten. Report any unusual signs and symptoms which indicates infection. y y y y y
Foul
odor in the cord Presence of discharge Redness around the cord The cord remains wet and does not fall off within 7 to 10 days Newborn fever
THE APGAR SCORING SYSTEM
The APGAR Scoring System provides a valuable index for evaluating the newborn infant¶s condition at birth. Every nurse who is responsible for the care of the newborn infants should be familiar with the pr inciples set forth by APGAR for infant evaluation because they provide a simple, accurate and safe means of quickly appraising the child condition. It is taken at one minute and five minutes after birth. With depressed infants, repeat the scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation. The five minute score is more reliable in predicting mortality and neurologic deficits. The most important is the heart rate, and then the respiratory rate, the muscle tone, reflex irritability and color follows in decreasing order. A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.
ASSESS HEART RATE RESPIRATION MUCLE TONE REFLEX IRRITABILITY COLOR
0 Absent Absent Flaccid No response Blue all over
1 Below 100 Slow Some flexion Grimace Body pink,
2 Above 100 Good crying Active motion Vigorous cry Pink all over
Extremities blue
Score: y y y
7 ± 10 Good adjustment, vigorous Moderately depressed infant, needs airway clearance Severely depressed infant, in need of resuscitation.
ASSESSING THE A VERAGE NEWBORN Head Circumference Temperature Chest Circumference Heart Rate Respirations Weight Length
34 ± 35 cm 97.6 ± 98.6 F axillary 32 ± 33 cm 120 ± 140 bpm 30 ± 60 bpm 2.5 to 3.4 kg 46 to 54 cm
The Newborn Screening Newborn Screening (NBS) is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation and even death if left untreated. The goal of newborn screening is to give all newborns a chance to live a normal life. It provides the opportunity for early treatment of diseases that are diagnosed before symptoms appear. Included in the panel of disorders under the Philippine Newborn Screening Program are: Congenital Hypothyroidism (CH), Congenital Adrenal Hyperplasia (CAH), Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency, Galactosemia (Gal) and Phenylketonuria (PKU). Most babies with metabolic disorders look normal at birth. One will never know that the baby has the disorder until the onset of signs and symptoms and more often ill effects are already irreversible. Newborn screening is ideally done on the 48th hour or at least 24 hours from birth. Some disorders are not detected if the test is done earlier than 24 hours. The baby must be screened again after 2 weeks for more accurate results.
Expanded Program on Immunization (EPI) The standard routine immunization schedule for infants Provides
maximum immunity against the seven vaccine preventable diseases in the country
before the child's first birthday. The fully imm unized child must have completed BCG 1, D PT 1, DPT 2, DPT 3, OPV 1, OPV 2, OPV 3, HB 1, HB 2, HB 3 and measles vaccines before the child is 12 months of age Vaccine
Minimum Number st Age at 1 of Doses Dose
Dose
Minimum Route Interval Between Doses
Site
Reason
Bacillus CalmetteGuérin
Birth or anytime after birth
1
0.05 mL
--
Intradermal
Right deltoid region of the arm
Diphtheria-
6 weeks
3
0.5 mL
4 weeks
Intramuscular
Upper outer portion of the thigh
BCG given at earliest possible age protects the possibility of TB meningitis and other TB infections in which infants are prone An early start with DPT reduces the chance of severe pertussis
6 weeks
3
4 weeks 2-3 drops
Oral
Mouth
The extent of protection against polio is increased the earlier the OPV is given. Keeps the Philippines polio-free
At birth
3
0.5 mL
Intramuscular
Upper outer portion of the thigh
An early start of Hepatitis B vaccine reduces the chance of being infected and becoming a
PertussisTetanus Vaccine
Oral Polio
Vaccine
Hepatitis B
Vaccine
6 weeks interval from 1st dose to 2nd dose, 8 weeks interval from
[6]
2nd dose to third dose.
Measles Vaccine (not MMR)
9 months
1
0.5 mL
--
Subcutaneous
Upper outer portion of the arms
carrier . Prevents liver cirrhosis and liver cancer which are more likely to develop if infected with Hepatitis B early in [7][8] life . About 9,000 die of complications of Hepatits B. 10% of Filipinos have Hepatitis B [9 infection At least 85% of measles can be prevented by immunization at this age
Tetanus Toxoid Immunization Schedule for Women When
given to women of childbearing age, vaccines that contain tetanus toxoid (TT or Td) not only protect women against tetanus, but al so prevent neonatal tetanus in their newborn infants. Vaccine
TT1 TT2
Minimum Age/Interval As early as possible during pregnancy At least 4 weeks later
Percent Protected
Duration of Protection
--
--
80%
y
y
TT3
At least 6 months later 95%
y
y
TT4
At least 1 year later
99%
y
y
TT5
At least 1 year later
99%
y
y
infants born to the mother will be protected from neonatal tetanus gives 3 years protection for the mother infants born to the mother will be protected from neonatal tetanus gives 5 years protection for the mother infants born to the mother will be protected from neonatal tetanus gives 10 years protection for the mother gives lifetime protection for the mother all infants born to that mother will be protected
References: 1.) Adele Pillitteri, MATERNAL & CHILD HEALTH NURSING edition #6 ³Care of the Childbearing & Childrearing Family´(2009) Newborn Period, Newborn Care, Apgar Scoring, Newborn Screening (pages, 448-483) th
2.) Public Health Nursing in the Philippines 10 edition (2007) Immunization (pages 177,239)
Perpetual Help College of Manila 1240 V. Conception St. Sampaloc, Manila
Submitted by: Bacual, Shaykh Norman E. Submitted to: Mrs. Marqueses
