Immediate Care of the Newborn

IMMEDIATE CARE OF THE NEWBORN -After the birth of the infant every effort should be exerted to support him in his first minutes, hours and days of life. The quality of the immediate care given to the newborn will determine his later state of health or well being. Ten Essentials of Immediate Newborn Care I. Establish airway  This is the top priority in the immediate care of the newborn.  Right after the extension of the newborn’s head, before the chest is delivered, the mouth and nose should right away be cleared. This measure is the best prevention to meconium aspiration which results to lung infection: aspiration pneumonia.  Measures to promote patent air passages are continued: a. Position the baby in slight trendelenburg (10-15 degree angle) in order to drain secretions from oro-naso-pharynx. 1. Avoid acute trendelenburg position as this can cause abdominal contents to exert pressure onto the diaphragm causing more difficult breathing. 2. The head down position is contraindicated when there are signs of increased intracranial pressure. b. Suction the newborn observing the following conditions: 1. Start with the mouth then the nose  To prevent stimulation of nerve receptors present in the nose which can cause the newborn to gasp for breath and aspirate the oropharyngeal secretions (if nose is suctioned first.) 2. Deflate the rubber ball of the syringe before inserting its tip into the mouth and nostrils of the newborn. 3. Suction shallowly – by using the bulb syringe and not a long catheter.  Deep suctioning can cause vagal stimulation, bradycardia and laryngospasm in the the newborn. 4. Suction briefly  Suction does not clear the air passages of secretions, it also aspirates the much needed air oxygen if done continuously.  Observe correct and safe suctioning period:  Preterm: less than 5 seconds per suctioning time  Full term: 5-10 seconds per suctioning time c. Oxygenation is not a routine in the immediate care of the newborn.  Just ensure a patent airway and good supply of atmospheric air and a normal newborn is likely to breathe spontaneously.  Injudicious use of oxygen can result to damage of the retina causing neonatal blindness known as Retrolental Fibroplasia. II. Keep the Newborn Warm A. The newborn’s temperature at birth (37.3) drops quickly (35.5) owing to mechanism of heat loss: • Evaporation - loss of heat as liquid leaves the newborn’s body • Conduction – loss of heat from warm body to cool surface indirect contact (e.g. weighing scale, admitting table) • Convection – loss of heat to cool air.

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• Radiation – loss of heat to cool surface not in contact (walls, floor, ceiling) Most of newborn’s heat is loss by evaporation. B. Dry the newborn right away after birth to prevent heat loss by evaporation. C. Wrap the body and promote flexion to minimize the body surfaces exposed to cool air and cool surfaces not in contact thus preventing heat loss by convection and radiation. D. Never place newborn on cold and unlined surface to prevent heat loss by conduction Weighing scale or examination table should first be lined with dry and warn linen before placing the baby on it. The warm abdomen of the mother can be a good place to keep the newborn warm immediately after birth. E. The initial temperature of the newborn is taken per rectum in order to detect the most common congenital anomaly that is not compatible with life: Imperforate Anus Succeeding temperature taking should be per axilla this route can detect core temperature of the newborn faster as well as minimizes the potential risk of traumatizing the rectum of the newborn. F. During the entire procedure to provide immediate care to the newborn, he is under the floor lamp (droplight) primarily to keep him warm. G. Subjecting the newborn to cold stress can result to:  Increased brown fat metabolism causing an increase in fatty acids in circulation thus resulting to metabolic acidosis.  Increased metabolic rate causing increased utilization of glucose and oxygen thus resulting to low blood sugar (hypoglycemia) and respiratory distress. III. Do APGAR Scoring  APGAR Scoring is the initial evaluation of the newborn during the first and the five minutes of life after birth.  The first scores determines the general condition of the new and the need for immediate resuscitation  The second score measures how well the infant in adjusting to the extra uterine life. It is a useful index of the effectiveness of resuscitation efforts and thus determines prognosis. This is used to come up with the nursing care plan for the newborn.  The five adaptations scored in APGAR Scoring are: A – appearance; color P - pulse; apical beat for heart rate G - grimace; reflex irritability A - activity; muscle tone R - respiratory effort; cry • • • •

Each of these are given a score of 0, 1 or 2 Heart rate is the most important score. If is absent, all the rest of the adaptations are absent. So a total score of 0, means no heart rate. The least important APGAR score is color. It is not expected for the newborn to be pink all over it at first minutes of life because of sluggish peripheral perfusion. Because of this, the newborn’s skin is with mottling and underlying gray cyanosis. The newborn who is pink all over at 5 minutes is given a total score of 10 and for the Acrocyanosis, 9.

The APGAR Scoring

Adaptation

0

Heart rate Respiratory Effort

Absence/ Asystole Apnea

Muscle Tone

Limp

Reflex Irritability

No response/ Areflexia

Color

Blue/Pale

IV.

1 Below 100 No/ Weak Cry; Gasping Some Flexion/ Weak response Grimace Acrocyanosis

2 Over 100 Lusty cry Acute Flexion Cry/Sneeze Pink

Identify the Newborn Properly A.

B. C. V.

Identification is done as soon as possible after birth before the newborn is separated from the mother. • In cases of birth of a high risk newborn, proper identification must first be done before transporting him to the nearest hospital. The best way to identify newborn is by means of taking his footprints. Proper identification of the newborn is legal and moral responsibility of every nurse. Provide Skin Care

A. B. C.

The immediate soap and water bath is given to normal and full term newborns. This is primarily to cleanse the skin of the mucus, blood, at times meconium, in order to prevent infection. Oil bat is given to the pre terms and other high-risk newborns. Never give the newborn marine bath. This is the bath someone gives as he holds the newborn directly under the cold, running water of the faucet and briskly bathes him. This bath subjects the newborn to cold stress. VI.

VII.

Give Crede’s Prophylaxis • Crede’s Prophylaxis is given to all newborns as prevention against Opthalma neonatorum. It can be delayed for 1 to 2 hours in order not to interfere with bonding process. Perform Cord Dressing A. A Cord Dressing must be performed under strict aseptic techniques to prevent tetatnus Neonatorum. B. The Cord should be examined carefully for the presence of three vessels: Umbilical vein (left), and 2 smaller Umbilical arteries (right and

1. left)

• The presence of an incomplete number of vessels warrants reporting to the physician so the newborn can be thoroughly assessed for congenital defects. C. Leave about 1 inch of the cord from the base • The longer is left of the cord stump the longer is the crying and dropping off time. This implies more risk to local bacterial infection of the cord called Omphalitis. D. In the first 24 hours, the cord should be inspected for bleeding. (omphlangia)

VIII.

Inject Vitamin K intramuscularly A. Prohylactic Vitamin K is injected to prevent bleeding or hemorrhagic disease in the newborn by improving blood coagulation. B. The newborn’s gastrointestinal tract is initially sterile – no E. coli to synthesize vitamin K. (absence of clotting factor) C. The best site of intramuscular injections in the newborn, infants and young children is the thigh muscle, specifically the vastus lateralis.

IX.

TAKE WEIGHT AND OTHER ANTHROPOMETRIC MEASUREMENTS A. Weight – the normal weight of the newborns commonly ranges from 3000 grams to 3,400 grams with the lowest limit normal of 2, 500 grams. A pre-term newborn weighs less than 2,500 grams. • The birth in the first weight is expected to drop by 5% to 10 % (physiological weight loss) in the first 7-10 days of life owing to: 1. Urine and meconium passage 2. Drop in water-retaining maternal hormones from newborn’s body 3. Inadequate intake. • Reassure mother of the normality of weight loss and explain that gain weight is likely to be observed after day B. Height – the newborn height ranges from 19-21 inches or an average of 50 cm. The heel-to-crown measurement is to be taken. C. Head cirmcumference – the head, the biggest part is about ¼ of the body length. It measures 33 to 35 cm ( 13-14 in) D. Chest/Abdominal circumference – the chest is almost equal to the abdomen in measurement: 31-33 cm (12-13 in)

X.

PROVIDE GENTLE, MINIMAL HANDLING AND WATCHFUL EYES •

XI.

The newborn does not need maximum handling.

ROOMING-IN AND BREASTFEEDING • • • •

Rooming-in is a hospital policy whereby the mother has her new infant by her bedside, can take care of him or her as she desires and as her condition permits Check the baby’s chart if there’s an order for rooming-in Bring baby to mother. Be sure to check the baby’s identification with the mother. Give instructions to the mother regarding breastfeeding and care of the baby.  All roomed-in babies must be breastfed  Breastfeeding on demand will be instructed to mother during roomin.  Newborn shall not be given prelacteal feeds such as sterile water, glucose water or milk formula since breast milk can provide for their needs. R.A. 7600 – Rooming-in and breastfeeding Act

 of 1992 