CARE OF THE NEWBORN

Newborn
 also called neonate
 a baby in the neonatal period (first 28 days of
life)
Activity
1. First period of reactivity (first 15-30
minutes) – baby has vigorous reaction
 Alert
 Watching
 Exploring
 Searching
 Makes sucking sounds
2. Resting period (next 30-120 minutes)
- Baby is difficult to arouse

 Quiet period
 Generally sleeps for about 90 minutes
3. Second period of reactivity (next 2-6
hours)
- Occurs when the baby is awake
 Gagging
 Choking on mucus
 Alert again
 Responsive and interested in
surroundings
Caring for Newborn during this period:

1. Stroke the baby gently.

2. Provide soft objects so the baby will be
in contact with soft objects.
Senses
Hearing
 Babies respond with generalized activity to a
sound (ex: stops crying when a bell rings)
 Calms in response to a soothing voice
 Startles at loud noises
 Recognizes their mother’s voice almost
immediately.

Caring:
1. Talk to the baby
2. Play nursery rhymes and simple songs.
Senses
Vision
 All newborns are born with blue or gray eyes (the
pigment called melanin is absent for the eyes)
 Newborns achieve permanent eye color by age of 6
months
Senses
 Newborns demonstrate sight at birth by blinking at a
strong light
 Lose track of objects easily
 Focus best on black and white objects at a distance of
9 to 12 inches.
 Squinting – lasts for 3 months (due to difficulty in
using pair of eyes to focus on things
Vision
 Newborns cry tearlessly until 3 months
when the lacrimal ducts are mature
Senses
Touch
 Well developed at birth
 Demonstrates by quieting or increased
sucking as a response to a soothing touch
 Reacts to a painful stimuli
Senses
Taste

 Has ability to discriminate taste

 Turns away from a bitter taste such as salt
 Readily accepts the sweet taste (milk or
glucose water)
Senses
Nose/Smell

 Turns towards their mother’s breast partly

out of recognition of the smell of breast milk

 Recognizes the smell of mother or caregiver

Senses
 Milia – pinpoint white papule found on the
cheek or across bridge of the nose due to
blocked sebaceous glands ; disappears by 2-4
weeks
Weight
United States
 Mature female – 3.4kg (7.5 lbs)
 Mature male – 3.5 kg (7.7 lbs)

Other races (0.5 lb less)

 2.5 kg (5.5 lbs) – arbitrary lower limit

 More than 4.7 kg (10 lb) – indicate diabetes

mellitus
Vital Statistics
Length
Normal: 46-54 cm

Average birth length for:

 Mature female neonate – 53 cm (20.9 in)
 Mature male neonate – 54 cm (21.3 in)
Head Circumference
 Normal: 34-35cm (13.5 to 14 inches)

 Greater than 37 cm or less than 33 cm may

indicate neurological involvement
(hydrocephalus or microcephaly)

 Measured across the center of the forehead

around
Chest Circumference
 Normal: 32 to 33 cm (2 cm less than the
head circumference)

 Measured at the level of the nipples.

Vital Signs
 Temperature – 36.5 – 37.5ºC
 Pulse – 120 -160 beats per minute
 Respiration – 30 – 60 breaths per minute (at
rest)
 Blood pressure – 80/40 mmHg at birth
Head
Fontanelles – are spaces or openings where skull
bones join.
 Anterior fontanelle – located at the junction of the
two parietal bones and two fused frontal bones.
- diamond shaped
- closes by 12 to 18 months
 Posterior fontanelle – located at the junction of the
parietal bones and occipital bone.
- triangular shaped
- closes by 6 weeks
 Caput succedaneum – edema of the scalp at
the presenting part of the head
 Cephalhematoma – a collection of
blood under the skull bone (bruising)
Reflexes
 Are instinctive movements usually
designed to protect babies.

 Swallowing, walking, sneezing, coughing

reflexes do not disappear.
 Palmar grasp reflex – pressing anything on
the palm of the hand, the baby will
automatically tighten her fingers around it.

 Sucking reflex – sucks immediately if

something enters her mouth and presses on
the upper palate just behind the gums.
 Moro or Startle reflex – hearing a loud
noise, the baby throws up her arms and legs,
stretch her fingers, then slowly draw her
limbs back into her body; fingers assume a
typical “C” position; fades by 4-5 mos.

 Swallowing reflex – food that reaches the

posterior portion of the tongue is
automatically swallowed.
 Rooting reflex – if the newborn’s cheek is
brushed or stroked near the corner of the mouth,
the child will turn the head in that direction.

 Blink reflex – rapid eye closure when a foreign

object comes near

 Extrusion reflex – a newborn extrudes any

substance that is placed on the anterior portion
of the tongue; disappears about 4 months of age
 Step-in-Place/Walking Reflex – newborns
held in vertical position with their feet
touching a hard surface will take a few quick,
alternating steps.

 Babinski reflex – when the side of the sole of

the foot is stroked in an inverted “J” curve
from the heel upward, the newborn fans the
toes’ disappears by 3 months
Urinary System
 Average newborn voids within 24 hours after
birth.
 Urine is usually light colored and odorless
 Single voiding is only about 15 ml
 Daily urine output for first 1-2 days is 30-60
ml.
Mechanisms of Heat Loss
 Convection – flow of heat from the body
surface to cooler surrounding air (ex: air
conditioned room, window)

 Conduction – loss of heat by direct contact to

a cooler solid object ( baby placed in a cold
crib loses heat)
Mechanisms of Heat Loss
 Radiation – transfer of body heat to a cooler
solid object not in contact with the baby (ex:
cold surface of the crib or wall)

 Evaporation – loss of heat through conversion

of a liquid to a vapor (baby loses heat as the
amniotic fluid on their skin evaporates)
Ways to Prevent Heat Loss
1. Eliminating drafts such as from windows or
air conditioners.
2. Covering surfaces with a warmed blanket or
towel.
3. Moving infant as far from the cold surface as
possible.
4. Dry the newborn’s skin immediately.
Ways to Prevent Heat Loss
5. Any wet items should be removed and
replaced with clean, pre-warmed linens.
6. Dry the newborn’s face and hair.
7. Covering the hair with cap after drying it.
8. Placing the newborn against the mother’s
skin and then covering the newborn helps
transfer heat from the mother to the baby
(KANGAROO CARE)
Skin
Birthmarks
 Nevus flammeus – a macular purple or dark red lesion
(sometimes called port wine stain because of its deep color)
- Generally appears on the face
- Others appear to ne lighter, pink patches at the nape of the
neck (stork’s beak marks)
 Strawberry mark – elevated areas formed by
immature capillaries and endothelial cells; may
disappear by 10 years of age
Skin
 Mongolian spots – collections of pigment cells
(melanocytes) that appear as slate gray patches
across the sacrum or buttocks; may disappear by
school age without treatment
 Vernix caseosa – a white, cream cheese-like
substance that serves as skin lubricant
 Lanugo – fine, downy hair that covers a newborn’s
shoulders, back, and upper arms; a newborn of 37-39
weeks has more lanugo than a 40 week old infant;
post mature infant has very few lanugo
Breathing
 First period – irregular; 30-90 breaths per
minute while crying; some nasal flaring with
strange snuffling noise

 Resting period – slowing to 30-50 breaths per

minute

 Second period – becomes irregular again with

activity
Breathing
 Hiccupping – a sign that the baby’s
breathing is getting stronger and muscles
for breathing (diaphragm and muscles
between ribs) are working in harmony.

 Labored breathing and rate of >60

breaths should be referred immediately.
Gastrointestinal System
Stools
 Meconium – first stool; usually passed within
24 hours after birth; a sticky, tarlike, blackish-
green, odorless material formed from mucus,
vernix, lanugo, hormones and carbohydrates
that accumulated during intrauterine life.
 Transitional stool – green and loose
stool; passed about 2-3 days after birth
Chest
 Witch’s milk – a thin, watery fluid passing
out of the baby’s breasts due to the influence
of maternal hormes.
Genitalia
Male genitalia
 Scrotum must be edematous and has rugae
 Both testes must be present

Female genitalia
 Vulva may be swollen
 Pseudomenstruation – mucus vaginal secretion that is
blood-tinged; influenced by maternal hormones
 Hermaphroditism: A very rare genetic
disorder where a baby is born having
both male and female internal sex organs.
 originally named after Hermes and
Aphrodite, the Greek god and goddess of
love and sex, but most 21st-century
physicians and patients refer to
hermaphroditism as intersex.
Causes
 chromosome defects
 abnormal amounts of the sex hormones
due to an underlying disease (e.g., ovarian
tumor that leads to male hormone
production during pregnancy).
 Some underlying diseases (e.g., congenital
adrenal hyperplasia) are caused by
inherited gene mutations.
Symptoms
 malformed outer sexual organs
 the presence of testes in females or the
presence of ovaries in males.
 True gonadal intersex, or true
hermaphroditism, occurs when the child
has both male and female sex organs on
the inside.
Hermaphrodite