IMMEDIATE CARE OF THE NEWBORN

GOALS

 To establish, maintain and support respirations.

 To provide warmth and prevent hypothermia
 To ensure safety, prevent injury and infection.
 To identify actual or potential problems that may require immediate attention.
 To promote maternal and child bonding

ESTABLISHING, MAINTAINING, and SUPPORTING RESPIRATIONS

 The most important need for the newborn 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.

 To establish and maintain respirations:

 Wipe mouth and nose of secretions after delivery of the head.

 Suction secretions from mouth and nose.
 Compress bulb syringe before inserting it.
 Suction mouth first, then, the nose.
 Insert bulb syringe in one side of the mouth.
 A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry
spontaneously, or if the cry is weak.
 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 lusty. Observe for the following abnormal cry:
 High-pitched cry – indicates hypoglycemia, increased intracranial pressure.
 Weak cry – prematurity
 Hoarse cry – laryngeal stridor

 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 that would promote drainage of secretions.

 Trendelenburg position – head lower than the body

 Side lying position – If trendelenburg position is contraindicated like in increased intracranial

pressure (shrill high pitched cry, projectile vomiting, bulging fontanels, abnormally large head,
decreased RR and PR with increased BP) 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 position. Right side lying is beneficial because it increases pressure in the left
side of the that will aid in the closure of the ductus arteriosus and foramen ovale.

 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.

 Give oxygen as necessary. Oxygen should be given when the infant remains cyanotic after initial
suctioning and stimulation.

 If the heart rate is below 60 BPM, cardiac massage may need to be carried out.
PROVIDE WARMTH AND PREVENT HYPOTHERMIA

Circumstances during delivery that contribute to HEAT LOSS:

1. Baby is born wet and naked
2. The delivery room is cold
3. The baby does not know how to shiver due to immature thermoregulation system
4. They do not have enough adiposities
5. They are POIKILOTHERMIC

HEAT LOSS could lead to COLD STRESS or hypothermia which could lead to complications like
hypoglycemia and metabolic acidosis. It occurs when BT drops to 37.2 C, initially BT will fluctuate but
stabilize in 10 hours from 36.5-37 C.

 Immediately after delivery, the baby should be dried. Newborn hypothermia can occur quickly and
depress breathing.

 It is very important to keep the newborn warm. This can be accomplished by covering the baby with
clothing as soon as it is dried.

 Pay particular attention to keeping the head covered (but the airway open) as heat loss from the
newborn head can be substantial.

 Typically, the baby is wrapped in warm, soft blankets and a head covering put in place. Ideally, the
newborn should be placed under a droplight if his temperature is below 36.5ºC.

 In sub-optimal circumstances, nearly any cloth material can be used keep the baby warm.

 Spread the vernix casseosa but do not remove them. This could help as insulation for the baby.

 If the mother is available, dry the baby, place the baby on the mother's chest, and cover both of
them with blankets or clothing. The mother's body heat will help keep the baby warm.

 Check the baby's temperature several times during the first few hours of life. The normal range of
newborn axillary temperature is about 36.5-37.4ºC (97.7-99.3F). Average newborn temperature is
around 37.2ºC. initial assessment is taken rectally to check for anal patency but succeeding
assessments are taken per axilla.

 Delay the initial bath of the baby until 6 hours after delivery to avoid hypothermia. Maintain ambient
temperature in the nursery at 24ºC.

 Hypothermia occurs when the body temperature falls below 36ºC. The newborn is most sensitive to
hypothermia during the first 6-12 hours of his life.

INITIAL ASSESSMENT

A. ANTHROPOMETRIC MEASUREMENTS
LENGTH: 48-54 cm
HEAD CIRCUMFERENCE: 33-35 cm
CHEST CIRCUMFERENCE: 31-33 cm
ABDOMINAL CIRCUMFERENCE: 31-33 cm
 WEIGHT: 3-3.5 kg (upper limit is 4 kg and lower limit is 2.5 kg)
MACROSOMIA – large for gestational age
MICROSOMIA – small for gestational age

B. APGAR SCORING

 The APGAR Scoring System was developed by Dr. Virginia Apgar as a method of assessing the
newborn’s adjustment to extrauterine life.

 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.

 The heart rate and respirations should be counted for one full minute because of the irregularities of
the rhythms.

 A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.

ASSESS SCORE
0 1 2
HEART RATE Absent Below 100 Above 100
(Pulse)
RESPIRATION Absent Slow Good crying
MUCLE TONE Flaccid Some flexion Active motion
(Activity)
REFLEX IRRITABILITY (Grimace) No response Grimace Vigorous cry

COLOR Blue all over Body pink, Extremities blue Pink all over
(Appearance) (acrocyanosis)

 Score:
 7 – 10 : Good adjustment, vigorous
 4 – 6 : Moderately depressed infant, needs airway clearance
 0 – 3 : Severely depressed infant, in need of resuscitation.

 Acrocyanosis is normal for a newborn during the first few hours, disappearing over the next day.
It is due to relatively sluggish circulation of blood through the peripheral structures, related to
immaturity or inexperience of the newborn blood flow regulatory systems.

 Central cyanosis is not normal and indicates the need for treatment. It is due to the
accumulation of desaturated (oxygen-depleted) hemoglobin.
C. PHYSICAL ASSESSMENT
a. Head and neck
 -HEAD: assess for hydrocephalus, capput succadeneum (molding of head that typically
disappears in 2-3 days and it crosses suture lines), cephalhematoma (blood collection
between the periosteum and the bone itself, disappears in 3-4 weeks), craniosynostosis,
premature closure of fontanels (posterior closes in 2-3 months and the anterior closes in 12-
18 months), craniotabes (softening of cranial bones, sunking or bulging fontanels.
-EYES: assess for color, infection, coloboma (key-holed shape pupil), occasional crossing of
eyes( strabismus/ lazy eye)
NOSE: presence of milia (small pinpoint white nodules in the face abundant in the nose),
normally large, presence of nasal deviations
-MOUTH: lips are pink and tongue symmetrical and smooth, the tongue should not extend or
protrude in between the lips, tongue should move freely, gums have tooth ridges, the roof of
mouth should be closed and uvula should be present. Epstein pearls (glistening spots/ firm
whitish depositions in the palate due to increased calcium level), precocious teeth/neonatal
teeth (must be removed to prevent aspiration), oral thrush (whitish plaques in the oral cavity
that is due to candida albicans)
-EARS: alignment to eyes, earlobes
-NECK: chubby with folds, head is able to extend backward, turn from side to side. No
palpable thyroid glands

b. Chest, abdomen and back

-CHEST: symmetrical and normal dome-shaped (abnormal-scaphoid)-diaphragmatic hernia,
breasts (engorgement. Witch’s milk due to increased maternal hormone in vitro),
-ABDOMEN: assess for the shape (protuberant), abdominal breathers, umbilical cord –
presence of omphalocele (abdominal contents is covered by a sac, no membrane to protect
them) and omphalangxa (bleeding cord)
-BACK: presence of meningocele, spina bifida (protrusion of meninges and spinal cord
covered only by a fluid sac)

c. Anogenital
-MALES: assess for cryptorchidism (undescended testes), phimosis (tight foreskin),
hypospadia and epispadia (abnormal location of meatus), priapism, swollen scrotum,
hydrocele (hernia in scrotum, inguinal hernia, imperforated anus
-FEMALES: pseudomenstruation and labial engorgement, inguinal hernia, imperforated anus

d. Skin
-mottling
-mongolian spots (discolorations in the buttocks and lower back)
-acrocyanosis (bluish discoloration in the extremities)
-color (ruddy or pinkish)
-jaundice (physiologic and pathologic yellowish discoloration of the skin)
-grayish skin (infection)
-general cyanosis(respiratory distress)
-Harlequin’s sign (dependent side becones ruddy while the other side becomes pale when
in sidelying position)
-lanugo (downy fine hair)
-vernix caseosa (cheese-like substance covering the skin)
-milia
-desquamation (due to shedding off of dead skin cells)

e. Extremities
-acrocyanosis
-short and plump extremities, hands are clenched into fists
-polydactyly
-pokomelia
-congenital hip dislocation
 -erb duchenne’s palsy (due to damage to brachial nerve plexus)

D. SYSTEMIC ASSESSMENT
a. RESPIRATORY
-first breath pressure is about 40-70 cm H20.
-all newborns have some fluids in their lungs from intrauterine life that eases the surface
tension in alveolar walls

b. CARDIOVASCULAR
-when the cord is clamped the lungs are forced to take in oxygen. This leads to decrease in
pressure in the right side of the heart closing the patent ductus arteriosus and as the left side
of the heart increases in pressure the foreamen ovale closes. The remaining fetal circulation
accessories like umbilical vein and arteries and ductus venosus no longer receive blood and
therefore eventually atrophy.
-a newborn’s blood volume is 80-110 ml per kg of body weight or 300 ml in total. RBC is
about 6 million cells per cubic mm, WBC is 15000-30000 cells per cubic mm.
-synthesis of blood coagulation is compromised due to vitamin K deficiency immediately
after birth.

c. IMMUNE
-mother has passive transfer of Immunoglobulin G (IgG) through the placental circulation and
colostrums to the infant
-the infant has difficulty forming antibodies upto 2 months of age
-vaccinations are necessary to initiate infant’s immunity

d. GIT
-STOMACH: capacity is 1 to 2 ounces or 30-60 mL at birth but increases rapidly. It is capable
of digesting simple carbohydrates and proteins but has a limited ability to digest fats

-INTESTINES: irregularity in peristaltic motility that slows down emptying but peristalsis
increases in the ileum that makes the baby pass stool upto 6 times a day.
-the first stool is called meconium upto 4 days, it is stringy, tenacious and greenish to black in
color and tarry.the stool then gradually becomes yellowish in color as breastfeeding
progresses. Formula stoiols are lemon yellow and curdy. Breast milk stools are yello orange,
soft and more frequent.

e. URINARY
-usually void within 24 hours after birth
-female-strong stream, male- small projected arc (if not suspect defect in meatus)
-they already have the ability to concentrate urine
Normal specific gravity is 1.001-1.020
-glomerular filtration rate (GFR) is greatly increased by months of age and reach adult values
by 2 years of age (30ml/hour)

f. NEUROMUSCULAR
-brain reaches 90% of total size by 2 years of age.
-all brain cells are present by the end of 1 year but the size and complexity will increase
-maturation of the brainstem and the spinal cord follows cephalocaudal and proximodistal.

Reflexes:
1. Blink – eyelid reflex, do not disappear
2. Rooting – head will turn to direction where check is stroked near the corner of the
mouth, disappears by 6 weeks
 3. Sucking – anything placed between the lips will be sucked, disappears by 6 months,
if baby is ordered NPO, provide pacifier to prevent delay of disappearance of this
reflex
4. Swallowing – anything placed in the posterior tongue will be swallowed
5. Extrusion- anything placed in the anterior tongue will be spitted out and disappears
by 4 months
6. Palmar grasp – anything placed on the palm will be grasped
7. Step/walk in place-if neonate is placed in vertical position with feet touching a hard
surface, they take few quick alternating steps
8. Placing – same with above but is stimulated when you touch the anterior portion of
the leg
9. Tonic neck – when they lie on their back, their head turn to the side and arm and leg
on that side extended and the extremities on the other side are flexed.
10. Moro/startle reflex – the baby’s arm assumes C-position when startled
11. Babinski – the toes fan as you touch the sole in an inverted J-fashion
12. Magnet-when there’s pressure applied on the foot, he pushes back against the
pressure
13. Crossed extension – when supine and the foot is stimulated by a sharp object the
leg will raise and the other will extend
14. Trunk in curvation- when placed in prone and the vertical area is stimulated the
trunk flexes and swings his pelvis towards the touch
15. Parachute – when infant is placed in vertical suspension and there’s a sudden change
in equilibrium, the extremities extend
16. Deep tendon – when the patella is tapped with patellar hammer, the leg will jerk

g. SENSES
-all are functional at birth
-hearing is the first to develop even in utero
-vision is last to develop completely. All newborns can see at birth but cannot see objects
past the midline. Visual field is about 20-22 cm or 9 inches. 20/20 vision is achieved at 7 years
old.
-touch is the most developed sense
-taste is present as soon as all secretions have been drained out
-smell is present as soon as secretions are cleared out

E. BALLARDS ASSESSMENT TOOL- a set of procedures developed by Dr. Jeanne L Ballard to

determine Gestational Age through neuromuscular and physical assessment of a newborn fetus.

1. Posture
- Total body muscle tone is reflected in the infant's preferred posture at rest and resistance to
stretch of individual muscle groups.
-As maturation progresses, the fetus gradually assumes increasing passive flexor tone that
proceeds in a centripetal direction, with lower extremities slightly ahead of upper extremities.

-To elicit the posture item, the infant is placed supine (if found prone) and the examiner waits
until the infant settles into a relaxed or preferred posture. If the infant is found supine, gentle
manipulation (flex if extended; extend if flexed) of the extremities will allow the infant to seek the
baseline position of comfort. Hip flexion without abduction results in the frog-leg position as
depicted in posture square #3. Hip abduction accompanying flexion is depicted by the acute
angle at the hips in posture square #4. The figure that most closely depicts the infant's preferred
posture is selected.

SIGN NEURO-MUSCULAR MATURITY SCORE SIGN SCORE

 -1 0 1 2 3 4 5

Posture                                 

2. Square Window - Wrist flexibility and/or resistance to extensor stretching are responsible for the
resulting angle of flexion at the wrist.

The examiner straightens the infant's fingers and applies gentle pressure on the dorsum of the
hand, close to the fingers. From extremely pre-term to post-term, the resulting angle between the
palm of the infant's hand and forearm is estimated at;

>90°, 90°, 60°, 45°, 30°, and 0°.

SIGN
NEURO-MUSCULAR MATURITY SCORE
SIGN SCORE
-1 0 1 2 3 4 5
Square
         
Window

3. Arm Recoil

-This maneuver focuses on passive flexor tone of the biceps muscle by measuring the angle of recoil
following very brief extension of the upper extremity.

With the infant lying supine, the examiner places one hand beneath the infant's elbow for support. Taking
the infant's hand, the examiner briefly sets the elbow in flexion, then momentarily extends the arm before
releasing the hand. The angle of recoil to which the forearm springs back into flexion is noted, and the
appropriate square is selected on the score sheet. The extremely pre-term infant will not exhibit any arm
recoil. Square #4 is selected only if there is contact between the infant's fist and face. This is seen in term
and post term infants.

Care must be taken not to hold the arm in the extended position for a prolonged period, as this causes
flexor fatigue and results in a falsely low score due to poor flexor recoil.

NEURO-MUSCULAR MATURITY SCORE SIGN SCORE

SIGN
-1 0 1 2 3 4 5

Arm Recoil                                     

4. Popliteal Angle

This maneuver assesses maturation of passive flexor tone about the knee joint by testing for resistance to
extension of the lower extremity. With the infant lying supine, and with diaper re-moved, the thigh is
placed gently on the infant's abdomen with the knee fully flexed. After the infant has relaxed into this
position, the examiner gently grasps the foot at the sides with one hand while supporting the side of the
thigh with the other. Care is taken not to exert pressure on the hamstrings, as this may interfere with their
function. The leg is extended until a definite resistance to extension is appreciated. In some infants,
hamstring contraction may be visualized during this maneuver. At this point the angle formed at the knee
by the upper and lower leg is measured.
Note:
a) It is important that the examiner wait until the infant stops kicking actively before extending the leg
b) The prenatal frank breech position will interfere with this maneuver for the first 24 to 48 hours of age
due to prolonged intrauterine flexor fatigue. The test should be repeated once recovery has occurred;
alternately, a score similar to those obtained for other items in the exam may be assigned.

SIGN
NEURO-MUSCULAR MATURITY SCORE
SIGN SCORE
-1 0 1 2 3 4 5
Popliteal
 
Angle
5. Scarf Sign

This maneuver tests the passive tone of the flexors about the shoulder girdle.

With the infant lying supine, the examiner adjusts the infant's head to the midline and supports the
infant's hand across the upper chest with one hand. the thumb of the examiner's other hand is placed on
the infant's elbow.

The examiner nudges the elbow across the chest, felling for passive flexion or resistance to extension of
posterior shoulder girdle flexor muscles.

The point on the chest to which the elbow moves easily prior to significant resistance is noted. Landmarks
noted in order of increasing maturity are: full scarf at the level of the neck (-1); contralateral axillary line
(0); contralateral nipple line (1); xyphoid process (2); ipsilateral nipple line (3); and ipsilateral axillary line
(4).

NEURO-MUSCULAR MATURITY SCORE SIGN SCORE

SIGN
-1 0 1 2 3 4 5

Scarf Sign                     

6. Heel to Ear

This maneuver measures passive flexor tone about the pelvic girdle by testing for passive flexion or
resistance to extension of posterior hip flexor muscles.

The infant is placed supine and the flexed lower extremity is brought to rest on the mattress alongside
the infant's trunk.
The examiner supports the infant's thigh laterally alongside the body with the palm of one hand. The
other hand is used to grasp the infant's foot at the sides and to pull it toward the ipsilateral ear.

The examiner fells for resistance to extension of the posterior pelvic girdle flexors and notes the location
of the heel where significant resistance is appreciated. Landmarks noted in order of increasing maturity
include resistance felt when the heel is at or near the: ear (-1); nose (0); chin level (1); nipple line (2);
umbilical area (3); and femoral crease (4).

NEURO-MUSCULAR MATURITY SCORE SIGN SCORE

SIGN
-1 0 1 2 3 4 5

Heel To Ear    
MATURITY RATING
TOTAL SCORE 
WEEKS
(NEUROMUSCULAR + PHYSICAL)
-10 20
-5 22
0 24
5 26
10 28
15 30
20 32
25 34
30 36
35 38
40 40
45 42
50 44

ASSESS FOR POTENTIAL PROBLEMS

 Instruct the mother to be aware of the following UNUSUAL/ABNORMAL MANIFESTATIONS and to
refer the baby immediately to the health care provider:
 Not gaining weight
 Excessive crying or not crying
 Convulsions, twitching
 Stiff neck, body, and limbs
 Pus discharge/swelling of the cord or the area around it
 Eye discharge/boils on body
 Feverish or cold baby
 Rapid respiration, groaning, and chest retraction
 Not accepting any feeding
 Irritable, lethargic
 Pale, jaundiced
 Blue nails, lips, or body
 Vomiting and abdominal distension
 Not passing urine and stool

PREVENTION OF INFECTION

 Care of the Eyes: Crede’s Prophylaxis

 It is part of the routine care of the newborn to give prophylactic eye treatment against
gonorrheal 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 Dr. Crede, a German gynecologist in1884.
 Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this
purpose.

 Erythromycin or Tetracycline Ophthalmic Ointment

 These ointments are the ones commonly used nowadays for eye prophylaxis because they do
not cause eye irritation and are more effective against Chlamydial conjunctivitis.

 Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes
starting from the inner and going into the outer canthus.

 Ophthalmia neonatorum is defined as any conjunctivitis with discharge occurring during the first two
weeks of life.

 It typically appears 2-5 days after birth, although it may appear as early as the first day or as late as
the thirteenth.

 Most often both eyelids become swollen and red with purulent discharge.

 Principles of cleanliness at birth are:

 Clean hands
 Clean perineum
 Nothing unclean to be introduced into the vagina
 Clean delivery surface
 Cleanliness in cutting the umbilical cord
 Cleanliness for cord care of the newborn

 Hand washing
 The single most effective way of preventing infection among newborns is proper hand washing
technique. Hand washing should be done:
 Before entering the nursery or before caring for the baby
  In between handling or after caring for each baby
 Before cleaning the umbilical cord
 After changing soiled diaper
 Before preparing milk formula

 Each newborn should have his/her own individual supplies to prevent cross infection

 Newborns should be handled with gloves until after the first initial bath.

 Persons with infectious diseases should not be allowed to care for newborns and excluded from
contact with newborns.

PREVENTION OF BLEEDING

 The newborn has a sterile intestine at birth; hence, the newborn does not possess the intestinal
bacteria that manufacture vitamin K which is necessary for the formation of clotting factors. This
makes the newborn prone to bleeding.

 As a preventive measure, 0.5 mg (preterm) and 1 mg (full term) Vitamin K or aquamephyton is

injected IM in the newborn’s vastus lateralis (lateral anterior thigh) muscle.

 Vitamin K prevents a now rare, but often fatal, bleeding disorder called hemorrhagic disease of the
newborn (HDN).

 This is a self-limiting hemorrhagic disorder of the first days of life, caused by a deficiency of the
vitamin K-dependent blood clotting factors II, VII, and X.

 HDN can cause bleeding into the brain, which may result in brain damage.

 The warning signs of HDN include the following:

 Spontaneous bruising or excessive bruising after minor injury
 Nose bleeds (epistaxis)
 Oozing or bleeding from the umbilicus
 Dark colored vomitus
 Dark stools (melena)
 Excessive bleeding from skin lesions

CARE OF THE CORD

 Traditionally, the cord is clamped and cut approximately within 30 seconds after birth. But new
standards advocated by DOH stated that the umbilical cord must be cut only once the pulsation
on it stopped.

 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.

Instruction to the mother on cord care:

 In the first few hours after birth, if you notice the cord to be bleeding, apply firm pressure and
check cord clamp if loose and fasten.

 No tub bathing until cord falls off. Do sponge bath to clean the baby. See to it that cord does not
get wet by water or urine.

 Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed
antiseptic solution which is 70% alcohol.

 Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet
when the diaper soaks with urine.

 Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and
separates more rapidly if it is exposed to air.

 Report any unusual signs and symptoms which indicate infection.

 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

 Based on the new guidelines set by the DOH regarding newborn care, the cord must be left as is
after it is cut. There is no more need to apply anything on the cord (even the 70% isopropyl alcohol).
If unusual signs and symptoms are noticed, the mother or the immediate caregiver is advised to
report it to a doctor.

NEWBORN IDENTIFICATION

 Proper identification is made in the delivery room before mother and baby are separated.

 Newborn identification is not performed in home delivery unless more than one infant is born.

 A final identification check of the mother and the infant must be performed before the infant
can be allowed to leave the hospital upon discharge.

 This is to ensure that the hospital is discharging the right infant.

 Several methods of identifying an infant are as follows:

 Identification band (ID tag): identification bands are placed around the infant’s wrist or ankle
and around the mother’s wrist. Information contained in the ID band includes name of the
mother, date, time and manner of delivery, hospital number, gender of the baby, and the
name of the doctor who facilitated the delivery.

 Footprints: footprints are obtained and kept with other records of the infant and mother.
Ridges of the foot are easier to obtain that the newborn’s fingerprints. The infant’s foot should
be clean and dry and must be pressed firmly on the ink pad and then gently on the
footprint form beginning from the heel to the toes.
BATHING
-Oil bath or water and soap
-Do not bathe within 30 minutes after feeding
-Do not remove but spread the vernix caseosa
-full bath is given only after cord has fallen off
-Bathing should proceed from cleanest to dirtiest - wash the eyes first then the face and then the trunks
-Wash the genital area from front to back
-Do not use soap in washing the face
-Be sure that the room is warm about 24 C and bath water is approximately 37-38 C pleasantly warm on
elbow or wrist
-Use hypoallergenic soap
-Give care to body creases, when washing the uncircumcised penis, the foreskin should not be forced
back.
-Do not soak the cord

INITIAL FEEDING

 If an infant is to be breastfed, feeding can be started as soon as after the umbilical cord is clamped.

 It is recommended that breastfeeding be started within the hour after the birth of the baby.

 There is no need to give water first because colostrum (first milk of the mother) is non-irritating
and is easily absorbed in the lungs if aspirated.

 Early breastfeeding not only provides early protection to the newborn. It also stimulates the release
of oxytocin from the mother’s body, which in turn stimulates uterine contractions that is necessary to
prevent bleeding.

 Early breastfeeding is also an ideal way of initiating bonding between mother and child.

 Breastmilk has unique anti-infective properties.

 By breastfeeding, the mother begins the immunization process at birth and protects her baby
against a variety of viral and bacterial pathogens before the acquisition of active immunity through
vaccination.

Other Advantages to baby:

 Protection against infection
o Haemophilus influenza
o Necrotizing Enteral Colitis
o Otitis Media
o Herpes Simplex
o Respiratory Syncyitical Virus
o Respiratory infections
 Protection against SIDS
 Reduced gastroesophageal reflux
 Reduced inguinal hernia
 Protection from eczema and allergies
 Enhances development and intelligence
Other Advantages to mother:
 Delays fertility
 Protection against cancer
 o Breast
o Uterine
o Ovarian
o Endometrial
 Enhances emotional health, reduces anxiety
 Decreased insulin requirements in diabetic postpartum woman
 Decreased osteoporosis
 Promotes POSTPARTUM WEIGHT LOSS

Proper positioning and latching:

Most common positions:

o Straight across the abdomen/chest --the baby should be on his side with body, ears, shoulders
making a straight line across the chest

o Football hold (good for mothers nursing twins)

Proper latching:
o When oddly loud suckling noises as the baby sucks, the baby is not properly latched
o Bottom lip will all be all the way out and cover most of the bottom of the areola
o The top lip should be completely visible not tucked into the mouth at all
o To break suction, slowly insert the pinky finger into the baby’s mouth until the suction breaks
o Do not pull nipple out before breaking the suction

IMMUNIZATION SCHEDULE

 Basic newborn immunization in the Philippines is composed of the following vaccines:

 BCG (bacillus calmette guerrin) vaccine
 OPV (oral polio vaccine)
 Hepatitis B vaccine (HBV)
 Diphtheria Pertussis Tetanus (DPT) vaccine
 Measles vaccine
 Tetanus toxoid (TT) vaccine
 BCG should be given as soon as possible after birth to protect the newborn from possible infection
from household members who may be carriers or have latent infections of tuberculosis.
 Generally, Hepatitis B vaccine is administered immediately after birth as well to protect the infant
from Hepatitis B infection from health care providers who are possibly carriers of the virus.

NAME OF MINIMUM AGE # OF DOSES MINIMUM INTERVAL ROUTE OF

VACCINE AT 1ST DOSE BETWEEN DOSES ADMINISTRATION

 BCG At birth or any 1 - Intradermal

time after birth

 DPT 6 weeks 3 4 weeks Intramuscular
 OPV 6 weeks 3 4 weeks Oral
 Hepatitis B 6 weeks 3 4 weeks Intramuscular

NURSING CARE ON IMMUNIZATIONS:

o Normal reactions are: low grade fever and sore arm and fussiness
o Do not give aspirin _ REYE”S SYNDROME (neurologic and deadly disorder in children)
o Give the child increased fluid intake
 o Keep child’s back dry
o Acetaminophen may be given

Serious Reactions:

o A large area of redness and swelling in the injection site

o High fever
o The child is pale and limp
o Crying incessantly for several minutes
o High pitched cry
o Shaking, twitching or jerking of body (convulsion)

NEWBORN SCREENING TEST- NBS is a simple procedure that tests for congenital metabolic disorders.

IMPORTANCE: Newborn Screening tests for a set of congenital, or inherited, disorders.

It is crucial that these disorders are detected as early as possible. Children diagnosed with one of the
tested congenital disorders can continue to live normal and healthy lives as long as they are given
treatment on time and consistently follow up with a specialist.

An affected baby looks healthy at birth because symptoms do not begin to show until a much later age.
Once the signs and symptoms set in, the ill effects are often already permanent. If these conditions are
left untreated, they may cause health complications, inhibit mental development, or become fatal.

Disorders screened by NBS:

• Congenital Hypothyroidism - A lack or absence of thyroid hormone, which is necessary for growth of
the brain and the body. Treatment is required within the first four weeks to prevent stunted physical
growth and mental retardation. One out of 3,369 babies are at risk.

• Congenital Adrenal Hyperplasia - An endocrine disorder that causes severe salt loss, dehydration, and
abnormally high levels of male sex hormones. Left undetected and untreated, it can be fatal within seven
to 14 days. One in 7,960 newborns are at risk.

• Galactosemia - A condition in which babies cannot process the sugar present in milk (galactose).
Increased galactose levels in the body lead to liver and brain damage, and to the development of
cataracts. One in 82,250 may be affected.

• Phenylketonuria - A condition where the body does not properly use the enzyme phenylalanine, which
may lead to brain damage. One in 109,666 may be at risk.

• Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency - A condition where the body lacks the
enzyme called G6PD. The deficiency may cause hemolytic anemia when the body is exposed to oxidative
substances that are found in certain drugs, foods and chemicals.

How the procedure is done:

The baby will be pricked at the heel and three drops of blood are taken. This process is ideally done
during the 48th to 72nd hour of life.

A negative screen means that results are normal. A positive screen will require the newborn to be brought
back to her pediatrician for further testing.

CIRCUMCISION
o Surgical removal of foreskin of penis
o Allows for easier hygiene
o Fewer UTI incidences

Contraindications:
-hypospadias and epispadias, the foreskin may be needed when he will repair the defect
-history of bleeding disorder

Complications:
-bleeding
-infection
-urethral fistula formation

Instructions:
- Keep area clean and covered for 3 days until healing is complete
- Refer the baby if redness and tenderness and constant crying due to pain manifest
- Circumcision site appears red but should never have a strong odor or discharge
- A film of yellowish mucus often covers the glans (this is a scab) by the second day of surgery
and should not be washed away for it is only an accumulated serum and is a normal assessment.