THE NEWBORN CARE 7-10 - indicates healthy newborn

3-6 - moderately depressed

The Nurses’ Role in MC Care 0-2 - severely depressed
• 1. PA of the NB If score is less than 7 at 5 minutes, the score should be performed in
a. transitional – immediately after birth (initial) 10 minutes.
b. physiologic adaptation
• 2. Physical/ Behavior APGAR Score Implementation:
• 3. Promote parent-infants bonding – be alert in any problems in 7-10 - very good; rarely needs resuscitation
attachment 3-6 - fair requires resuscitation, suctioning signify moderate difficulty
• 4. Prepares the family for discharge needs further assessment and medical intervention
a. demonstrate physical care of the NB 0-2 - poor, requires intensive resuscitation needs intensive medical
b. provide hx/discharge teaching/ info, anticipatory intervention
guidance
Ensure Newborn’s Proper Identification
Immediate Care of the Newborn 1. Check identification band
1. Dry the newborn immediately after delivery a. name of baby (e.g. Bb boy Fernando)
2. Clear airway PRN (as necessary) b. name of mother
3. Assess baby’s response to birth c. date and time of delivery
a. Check APGAR (1-5 mins after birth) d. Doctors (OB and Pedia)
4. Promote skin to skin contact 2. Footprints (depends on agency)
5. Ensure newborn’s identification 3. Baby tag and crib tag. Check always and should match at all
6. Take vital signs, anthropometric and do PA times.
7. Dress the umbilical cord 4. Take fingerprint of mother
8. Administer medication
9. Swaddle the baby and place in side-lying position. Identification of the Newborn
10. Give a full bath • Safety concerns related to newborn identification procedures
• Specific facility procedures
1.Dry newborn immediately • NCMEC: National Center for Missing and Exploited Children
- Wipe and dry using clean warmed blankets • “Profile” of abductor
- Place baby in a radiant warmer (put thermometer with probe)
- Remove wet linens Take Vital Signs
- Rub or flick soles of newborn if additional stimulation is required. • Maintain stable body temperature
- Do not slap buttocks (no beneficial effect) • 36.5 – 37.5◦C (99.7-99.5◦ F) axillary
- Stimulate baby to breathe • 36.5 – 37.6◦ C (97.7-99.7◦ F) rectal more accurate
- Stimulate crying by gentle friction • RR 30-60 breaths per minute
- Assess characteristic of cry (should be strong and lusty) • CR 120-160 beat per minute
- Assess for nasal flaring, retractions and abnormal respiration • BP seldom taken

Factors Predisposing the Newborn to Excessive Heat Loss Maintain Temperature Stability
• Large surface area results in heat loss to environment • Wrap newborn in a warm blanket and put in a stockinet cap on
• Newborn’s thin layer of adipose is poor insulator newborn’s head.
• Newborn cannot shiver to increase heat production • Usually unstable and takes 6-8 hours to stabilize (DOH
• Metabolizes brown fat stores to generate heat recommends after 24 hrs)
• Observe for hypothermia/ hyperthermia
2. Clear airway • Sign of infection, dehydration, inadequate clothing, prematurity
- Provide for patent airway
- Suction PRN Maintain Stable Body Temperature
- Newborns are obligatory nasal breather • Mechanisms of NB heat loss
- APGAR SCORE Developed by Virginia Apgar (1950), American - Evaporation
anesthesiologist - Radiation
- Conduction
Purpose of APGAR score: - Convection
1. She devised a scoring system that helped to evaluate a
newborn’s physical condition after birth help to determine any The Anthropometric Measurements of Newborn
urgent need for emergency or extra medical care (e.g. acidosis, • HC 33 – 35.5 cm (13-14 in) occipito-frontal
CPR) • CC 31- 33 cm measure at nipple line
2. 2.To evaluate how well the newborn adjust to extra uterine life. • AC 31-33 cm
3. Assess newborn’s response to birth • Length 48-53 cm (19-21 inches)
4. Performed and record at 1, 5 minutes and 10 minutes as needed • Body weight 2500-4000 grams

The CORD
• Apply cord clamp 1in from the base; cut above the cord clamp
• Cord is pearly white gelatinous
• Assess for the presence of the BV (2 Arteries, 1 vein AVA)
• Assess for intact cord and ensure that clamp is secured
• Cord should be clamped for at least the 1st 24 hours after birth
• Clamp can be removed when cord is dried (usually on day 2)
• Note for any bleeding or drainage from the cord
• Note for any foul odor from the cord
• Monitor cord meconium staining (green = baby stool discharge)

Administer medications
1. Give Crede’s prophylaxis
APGAR Score Interpretation: 2. Vitamin K

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 3. Hepatitis B vaccination
4. BCG vaccine (optional/it depends)
• 1. Crede’s Prophylaxis
1. Application of ophthalmic medication to prevent
Ophthalmia Neonatorum
2. Give eye medications
3. Ophthalmia neonatorum is an infectious conjunctivitis in
newborn
4. An infection contracted in the birth canal of mother w/
gonorrhea or chlamydia
5. Given within1st hour after birth
6. Rx: ophthalmic ointment or drops
- Erythromycin (0.5%)
- Tetracycline (1%) / Gentamicin
- Silver nitrate solution (used infrequently)
7. Parental right to waive
8. How to apply Opthalmic medication?
• the child is placed in a supine position:
a. Eye drops
• to instill the medication, the lower lid is pulled to form a
pocket and the solution is dropped into the pocket
b. Eye Ointment
• applied to inner to outer canthus
Take note: make sure that the tip of tube/dropper will
not touch the eye
• 2. Vitamin K injection (Aquamephyton, Phytonadione)
o Route: IM (single dose)
o Site: Vastus lateralis (or Rectus Femoris)
o Dose: 0.5 to 1 mg (0.1 ml term / 0.05ml preterm)
o Given to prevent hemorrhagic bleeding
o Catalyze the synthesis of prothrombin in the liver which is
needed for blood clotting and coagulation.
• 3. Hepatitis B Vaccine
o Hepatitis B (HBV) Vaccine Administration
o Recommended by CDC (Center for Ds. Control) for all
newborns before they leave the hospital
o decrease the incidence HBV in children and its serious
consequences (e.g cirrhosis, liver Ca)
o Given IM
o If infant is born to HBsAg + they should be immunized w/ HBV
& HBIG w/in 12 hours. BCG
o BCG can be given.it depends on the institution.
- Swaddle the Baby
- Place right side lying
o Swaddling the baby will keep them from hypothermia
o Putting them on right side to drain out secretions
Bath
• Give Full bath
• To clean the baby and remove blood and mucus
• Use lukewarm water and anti-microbial soap that is hypo
allergenic
• Take note: full bath should be done under radiant warmer and
when temperature is already stable (between 12-24 hrs, 24hrs
suggested by DOH)
II. Physical Assessment
• Basic Principles:
1. Review perinatal history
2. Keep newborn warm during the examination.
3. Begin with the general observations. Then perform
assessment that are least disturbing.
a. Assess the infant’s color
b. Auscultate only in a quiet environment
4. Take note of the life-threatening abnormalities that require
immediate attention.
5. Calm the infant before doing the examination
6. Have the necessary tools at hand
7. Handle the infant gently
8. Initiate nursing interventions for abnormal findings. Assess for
gross anomalies
9. Document all findings (normal and abnormal) for legal
purposes, document what has really been done
Take anthropometric measurements:
fcnlxa – St. Luke’s College of Nursing
• Birth weight - 2500 – 4000 g (6 – 9 lbs)
• Average weight 3400gms (7.5 lbs)
• Weight is taken soon after birth. WEIGHT LOSS occurs rapidly after
birth. NEONATE LOSSES about 10 % of the BW by 3 -4 days of but
usually regained by the 10th day of life.
• BW & BL are very important because they provide a baseline for
assessment of future growth
• Assess for SGA (Small for Gestational age), AGA (Appropriate),
LGA (Large)
Vital signs:
• Measure VS when the infant is still quiet
• CR, RR, BP fluctuates with stress, crying,
• movements and sleep wake cycles
Heart
• Heart Rate: 120-160 beats per min
• Low & high
• Assess for 1 full minute (due to some irregularities)
• Auscultation of heart sounds difficult
o Murmurs
o S1, S2 should be clear
• PMI: Point of maximum impulse
o *Rhythm regular at 4th to 5th intercostal space
- Slightly left of midclavicular line
• Rapid & irregular and with slight murmur
o Murmur normal
- Foramen Ovale still open
- adjustment period
o Tachycardia – RDS (Respiratory Distress Syndrome)
o Bradycardia – CHD (Coronary Heart Disease)
• Pulses sites: Apical, Brachial, femoral, pedal
o Check for equality and strength
o Femoral – check if absent, COA (Contraction of Aorta)
• Dextrocardia – heart on right side
Blood Pressure
• Normal: at birth systolic 60-80 mm Hg; diastolic 40- 50 mm Hg
• at 10th DOL (day of life) systolic 95 – 100 mm Hg diastolic slightly
increased
• Not routinely checked in healthy newborn
• Only if problem is suspected (e.g Cardiac Problem) e.g COA –
all 4 extremities BP is taken
• Varies with changes in NB’s activity and blood volume
• More accurate if NB is resting
Respiratory Rate:
• 30-60 breaths / minute. Assess for 1 full minute
• Irregular, rapid, shallow, quiet, unlabored, symmetrical
• With short periods of apnea (5- 10 secs), with slight retractions
• Breath sounds present, equal, clear
• Diaphragmatic and abdominal
• Check and observe RR and effort
• Bradypnea – Narcosis from analgesics, anesthetics, trauma
• Tachypnea – RDS, MAP (Meconium Aspiration), CDH
Lungs
• Pauses >20 seconds suggestive of apnea
• Auscultate lungs when infant quiet
• Check for: breath sounds
- crackles, rhonchi, wheezes (fluid in lungs)
- expiratory grunting (narrowing of bronchi nasal flaring,
retractions, labored breathing (RDS)
Temperature:
• Axillary is the preferred site
• Rectal temperature more accurate.
• Temperature is taken per anal INITIALLY TO CHECK FOR PATENCY
OF ANUS! (Insert 1 inch)
• Succeeding temperature is taken by axillary
• ROUTINE USE OF RECTAL TEMP IS AVOIDED because of POSSIBLE
INTESTINAL PERFORATION / ANAL MUCOSAL PERFORATION
because of thermometer insertion and may also cause vagal
nerve stimulation.
o Other sites of temperature:
2
 a. Tympanic • Assymmetry of the head as a result of pressure in the birth canal
b. Skin - 36.5 – 37 C • Disappear in 72 hours
- Using probe; slightly lower than the core
• Temperature stabilizes in 8 – 10 hours after birth Sutures
• VS taken q 15 mins during the 1st hour and hourly during the next • Separating lines of the skull, may override at the birth because
few hours then q 4 (depends on hospital policy) thereafter if it of extreme pressure exerted by the passage through the birth
remains stable. canal, sort of overlap
• Stop development at 7 yrs old
General Appearance:
• yields valuable clues to the physical status of infant Anterior Fontanel
A. Posture: • At the junction of 2 parietal bones and the 2 fused frontal bones
• Infant assume a well flexed position (normal position in utero) • felt as soft spot, flat diamond shape
• Flexion decrease area of skin exposed to environment, thereby • 3-4 cm wide and 2-3 cm long
reducing heat loss • It closes at 12 to 18 months
• Fists are clenched, movement symmetrical • If > 5cm maybe a sign of HYDROCEPHALUS and CRETINISM
• With slight tremors during crying
• Hypotonic, limp, flaccid, “floppy” or rigid extremities are seen in Posterior Fontanel
preterm, hypoxia, medications, CNS trauma • Located between occipital and parietal bone
• Hypertonic – NAS (Neonatal Abstinence Syndrome), CNS • Triangular, 0.5 cm to 1 cm wide
damage • Small, not readily felt
• Jitteriness/tremors – low glucose / low calcium • Closes between birth and 2-3 months
• Opisthotonos, seizure, stiff neck – CNS damage
Caput Succedaneum
B. Behavior • Edema of the scalp
• Observe and monitor for alertness, drowsiness and irritability • This is due to the pressure of the presenting part during labor
(common signs of neurologic problems) some questions may be • Disappears after 3 days
ask:
a. Is the infant awakened easily by loud noise? Cephalhematoma
b. is the infant comforted by rocking, sucking, cuddling? • Rupture of periosteal capillary of the skull.
c. Do there seem to be periods of deep & light sleep? • This is due to pressure in birth canal
d. Does infant seem to be satisfied after feeding? • Usually absorbed in 6 weeks without treatment
• Behavior
a. Level of responsiveness to noxious stimuli Craniotabes
b. Transition of sleep states evident • Localized softening of the cranial bones
• Can be indented by pressure of a finger
C. Skin Color • Correct itself with treatment after some months
• Check color. Inspect and palpate. Use natural light • More common among 1st born because of early lightening
• Generally pinkish
• Depends on the racial and familial background Face
• With acrocyanosis (normal / chilled) • Check for symmetry
• Check for cyanosis: • No bell’s palsy (facial nerve paralysis/drooping of mouth to one
a. circum-oral – cyanosis of mouth & central side
b. areas (requires suctioning) • Due to use of forceps/ birth trauma
c. peripheral – due to cold environment o Permanent – CN7 is cut
d. infection, hypoglycemia, cardiopulmo, cardiac ds. o Temporary – pressure to CN7
• Dark red (phletora) – premature • Check for delivery history
• Pallor – CV, CNS, blood dyscrasia, blood loss, twin to twin,
nosocomial infection Eyes
• Petechiea (small rashes deep on the skin, possible bleeding) • Slate gray (light skin) or brown- gray (dark skin)
• Ecchymoses (manifestation of bleeding) • PERRLA – no keyhole (coloboma)
• Gray – hypotension, poor perfusion, infection • Symmetrical and clear
• Yellowish discoloration – jaundice • Cornea should be round and adult sized
• may have subconjunctival hemorrhage (small broken tiny
General Assessment: capillaries on sclera)
• Should be performed in cephalocaudal manner • Eyelids edematous for first days of life
• Drainage
Newborn Head: • Able to track and fixate momentarily
• 25% of the body length. Largest part of infant’s body • Eye cross because of weak extraocular muscles, normal
• Bones are not fused strabismus, tearless
• Sutures – palpable; may override (only at birth) • Nystagmus
• Assess for head circumference • Strabismus
o Microcephaly (cranial synostosis) • Corneal Reflex
o Macrocephaly (hydrocephalus) • Red reflex
• Anencephaly • Blink Reflex present
• Head lag COLOBOMA
• Assess contour of head (molding) EXOTROPIA STRABISMUS
• Assess fontanels—anterior, posterior ESOTROPIA STRABISMUS
• Degree of head control/head lag
• Result of birth trauma Ears
– Caput succedaneum • Pinna
– Cephalhematoma • Canals
– Physiologic craniotabes • Tympanic membrane
• Otoacoustic Emission
Molding • Auditory ability (ABR testing)
• Startle reflex
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 • Well-formed notch of ears on straight line with outer canthus of • Femoral pulses palpable and equal, no bulges or nodes along
the eye (pinna aligned w/ outer canthus) bilateral inguinal areas.
• Symmetrical • LIVER 2-3 cm BELOW RIGHT COSTAL MARGIN
• Firm cartilage with recoil • KIDNEYS 1-2 cm above umbilicus
• Can hear once amniotic fluid has been absorbed (e.g. Startle • SPLEEN left quadrant
Reflex)
• Assess for low set ears (associated with chromosomal defects) Gastrointestinal:
o Note: if set lower-abnormal • Assess for abnormalities (hernia, gastroschisis, omphalocele,
- Chromosomal defects- Down syndrome/Kidney Ds. scaphoid – diaphragmatic hernia)
- Patau syndrome • Assess for abdominal distention associated with obstruction,
- Edward disease mass or sepsis.
- Kidney defects • Monitor bowel sounds – occur within 1-2 hours after birth.
- Craniofacial defects
OMPHALOCELE
Nose GASTROSCHISIS
• Patency of nasal canals / No discharge
• Structure – flat, broad and at the center Anus
• Obligatory nasal breather • Check for anal opening
• Occasional sneezing to remove obstructions • Should be patent and well placed
• No septal deviation • Check for Imperforate Anus
• Check for congenital anomaly (e.g Choanal Atresia) • Meconium should pass within 24 hours
• Monitor for flaring, Observe for RDS • Take note: Strict monitoring of I & O important and should be
well documented.
Mouth and Throat
• Pink moist gums IMPERFORATE ANUS
• Tongue moves freely, symmetrical
• Sucking and crying movements symmetrical Female Genitalia
• Able to swallow – do test feeding • Labia majora edematous, clitoris enlarged
• Should open mouth evenly when crying • Labia minora may have vernix caseosa and smegma.
• Check for oral thrush – not common • Labia majora normally covers the minora and clitoris
• Check for tongue tie - not common • hymenal tag maybe visible
• Palate – soft and hard palates intactTEMP • Vaginal discharge/pseudomenstruation (blood- tinged mucus)
• Epstein pearls – small white cyst may be present in hard palate maybe present.
• Frenulum and lingual frenulum • Smegma (thick white mucus discharge)
• Reflexes present: sucking, rooting, gag swallowing • Take note: In preterm babies’ appearance is different: clitoris
• Uvula – at midline and minora larger than majora
• Natal teeth/neonatal teeth – not common
Male Genitalia
Neck • Scrotum edematous, pendulous with rugae
• Short and thick neck • Testes should be present & descended into scrotum
• Head held at the midline o Assess for Crytorchidism
• Trachea on midline • Urinary meatus at tip of penis.
• Good range of motion (ROM) and is able to extend. o Assess for epispadia / hypospadia
• Freely movable • Foreskin (prepuce) covers the glans penis and should be
• Thyroid gland not palpable retracted
• Reflex present: Tonic – neck reflex (Fencer Position) • Check for phimosis
• Check for any abnormalities (hydrocele / hernia)
Chest • Take note: Preterm male – appearance different
• Appears circular since anteroposterior and lateral o Small penis, lack for rugae on scrotum
• Dm are equal – barrel shaped chest w/ bilateral chest expansion • For both male and female 1st voiding should occur within 24
• Respirations diaphragmatic hours of life.
• Bronchial sounds heard on auscultation (BS clear) • Check for ambiguous genitalia:
• Clavicles straight and intact a. Hermaprodite
• HR auscultated at border of left sternum extending mid of b. Klinefelter’s syndrome
clavicle; regular rate and rhythm.
• Observe for abnormalities (appearance, BS) CRYPTOORCHIDISM
• Chest AP and lateral diameters are equal HYPOSPADIAS
• Ribs flexible—observe for S/S of RDS HYDROCELE
• Breasts – nipples are prominent and often edematous
o Supernumerary nipples
o “Witch’s milk” – small amt of milk present in newborn Back (Spine)
• Spine
Abdomen o Sacral dimple
• Contour o Sacral tuft
• Umbilical cord o Pilonidal sinus/cyst
• Liver o Spina bifida (occulta)
• Spleen • Straight and flexible
• Kidneys • Posture well flexed.
• Femoral pulses • Movements well-coordinated
• Soft, dome shaped, round, some laxness of muscles, moves with • No opening observed or felt on vertebral column
respirations • Pilonidal cyst /sinus– a small dimple at the base
• Bowel sounds present - of the spine no connection w/ S. Cord
• Liver, spleen and kidneys palpable at birth • Check for neural tube defect (Spina Bifida) e.g. meningocele
• Umbilical cord present – white gelatinous with 2 arteries and 1 /myelomeningocele encephalocele
vein, no foul odor.

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SPINA BIFIDA inguinal, and buttocks
o Serves as skin lubricant, protection from
Extremities and trunk o Infection and acts as insulator
• Trunk – short, flexed and synchronized movements o Seen 2-3 days of life
• Trunk incurvature reflex (Galant Reflex) • LANUGO
o Fine downy hair
Extremities: (Upper) o Seen upper arm, shoulder, back, forehead and ears
• Flexed with good muscle tone o Disappear in 2 weeks
• Full ROM; movements symmetrical o Common characteristic of premature babies
• Fists clenched • MILIA
• Equal in length o White, pinpoint spots seen on the cheek and bridge of nose
• Grasp reflex present caused by immature sebaceous glands
• Five digits on each hand w/ palmar creases, nails present, o Disappears in 2-4 weeks as sebaceous glands mature and
separated and in correct formation drain
• Assess for polydactyly, syndactyly • ERYTHEMA TOXICUM
• Reflex present: Grasp Reflex, Moro Reflex o Pink papules with superimposed vesicles
• Check for fracture / Erb’s Palsy o Common at the face, back and buttocks
• Erb Duchenne Paralysis / Erb’s Palsy – newborn unable to move o Self-limiting
upper arm or asymmetric more response maybe caused by
damage in 5th & 6th cervical roots of the brachial plexus NEWBORN RASH/FLEABITE RASH (Erythema Toxicum) Desquamation
• Assess skin turgor over the abdomen to determine hydration
ERBS PALSY status
• Observe for forcep marks
Legs (lower extremities) • Observe also for birth marks:
• Equal in length, bowed, well flexed a. Telangiectatic nevi
• symmetric skin folds (major gluteal folds even) b. Nevus flammeus (port –wine stain)
• Creases on soles of feet c. Nevus vasculosus (strawberry mark)
• pulses present (radial, brachial, femoral) d. Mongolian spots
• Assess for fractures (e.g. Hip disclocation) • STRAWBERRY MARKS (Nevus vasculosus)
o Ortolani’s sign / Barlow’s Test (clicking sound heard) o Elevated areas formed by immature capillaries
• Slight tremors are common but could be sign of a sign of o and endothelial tissues
hypoglycemia or drug withdrawal o Capillary hemangioma, raised clearly
o delineated dark red with rough surface
HIP DISLOCATION/DYSPLASIA o Common in head part
ORTOLANI TEST o Disappears at 7-9 years old
ALLIS/GALEAZZI • TELANGIECTASIS NEVI
o Pale pink or red dilated capillaries on eyelids, nose, lower
Feet occipital bone and nape of the neck
• Creases on soles o Disappear at 2 years of age Telangiectatic nevi
• May have “positional club foot” caused by intrauterine position
but should be able to turn toward midline Portwine Stains (Nevus Flammeus)
• Reflexes present: plantar grasp, babinski • A macular purple or dark red lesion or patches
• EQUINOVARUS • Non elevated, sharply demarcated, red to purple, dense areas
o Club foot of capillaries
o Characterized by: • Can be seen face, buttocks, thigh and genitals
- Plantar flexion (toes pointing down) • Does not fade in time
- Inversion (toes pointing inward) • May require surgery (cosmetic) in the future
- Other types:
- Eversion (toes pointing outward) Mongolian spot
- Calcaneus (toes pointing upward) • Bluish, greenish black, gray patches
• Caused by accumulation of melanocytes
PHOCOMELIA • Seen at shoulder, upper arm, back and buttocks
• Disappears at in a year (white skinned)
Skin • Pre-school (dark skinned)
• Color should be consistent with ethnic background
• Pinkish red (light skinned newborn to pinkish brown or pinkish
yellow (dark skinned newborn) Clinical Assessment of Gestational Age:
• Important criterion because perinatal morbidity & mortality r/t
• Different Colors: gestational age & BW
a. acrocyanosis • Ballard Scoring Tool / (Dubowitz scale)
b. pallor o An assessment that evaluates 6 neuromuscular and 6
c. gray color physical characteristics during the 1st few hours of birth.
d. jaundice o A score of 1 to 5 is assigned to each characteristic
e. dark red color – common in preterm
f. cyanosis Ballard Scoring
• Vernix Caseosa • Neuromuscular maturity
• Lanugo o During the 1st 24 hrs the Nervous system is unstable
• Milia o Reflexes and assessments dependent on his or her brain
• Desquamation centers.
• Mottling o Maybe unreliable and need to be repeated in 24 hours
• Cutis marmorata o Components: Posture, Square window, Arm recoil, popliteal
• Erythema toxicum angle, scarf sign, heel to ear extension
• Harlequin Sign
• VERNIX CASEOSA Physical Maturity
o White cheesy substance seen in areas like back, armpit,

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 • Not influenced by labor and birth and do not change
significantly within the 1st 24 hours after birth. 3. Skin to skin contact
• Components: Skin, Lanugo, Plantar surface, Breast, Eye/ear, After 40 mins take newborns temp again
male genitalia/ female genitalia
3. Bathing postponed
• Preterm = below 37 weeks Do not weight it must be performed 2 hrs after birth
• Term = 37-42 weeks Bathe 24 hrs after birth
• Post = above 42 weeks
4. Breastfeeding
Start within first hour of birth
TERM (37- 40 weeks) Do not force baby to latch
• SKIN: Smooth, pink, superficial, cracking, Less visible veins
• EARS: Formed and firm with instant recoil 5. Appropriate clothing
• BREAST NODULE: 3-5 mm Do not use tight and swaddling clothing
• GENITALS: Inform the mother to bring baby’s clothes before birth
o MALE: Partially descended, more swollen and rugae They should be warmed
o FEMALE: Partially covered by majora
• SOLE CREASE: 2/3 of the sole w/ creases 6. Mother and baby together
• LANUGO: Less Move the newborn while the mother is carrying it, skin to skin contact

Pre-term 7. Warm resuscitation

• PREMATURE (36 weeks & below)
• SKIN: Gelatinous, transparent, with visible BV 8. Training of health care professionals
• EAR CARTILAGE: Absent / Pliable
• BREAST NODULE: 1-2 mm
• GENITALS: Cord clamping
o MALE: TESTES- undescended AVA
- SCROTUM- Less swollen, few rugae KMC – Kangaroo Mother Care (used to prevent newborn from
o FEMALE: Clitoris and minor - PROMINENT persistent hypothermia
• SOLE CREASES: Anterior transverse
• LANUGO: abundant 1 inch above abdomen, then cut above cord clamp
• SCALP HAIR: Fine & Fussy

POST TERM (42 weeks & above)

• SKIN: Parchment, deep cracking, desquamates, no visible Blood
vessels
• EARS: thick cartilage and stiff
• BREAST NODULE: 6 TO 10 mm
• GENITALS:
o MALE: Fully descended, pendulous, marked swollen;
Extensive Rugae
o FEMALE: Majora completely covers minora and clitoris
• SOLE CREASE: ENTIRE SOLE
• LANUGO: None

Weight Related to Gestational Age

• Birth weight is poor indicator of gestational and fetal maturity
• Gestational age reflects fetal maturity
• AGA—growth between 10th and 90th percentile
• SGA—<10th percentile
• LGA—>90th percentile

NOTES:

Respiratory disorders
Convulsions
High glucose

The warm chain- prevents newborn hypothermia

Skipping one step breaks the chain, and increases the newborn’s

36.5 – 37.5 normal

36.5 below – hypothermia

1. Warm delivery room

Room should be warm, no air from open window, air or fan
Room should not be below 25 C

2. Immediate drying
Warm, dry towel
Socks, bonnet, warm blanket
23 C in infants = 0 C in adults

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