CREDE’S AND

RITGEN’S
MANUEVER
RITGEN’S MANEUVER
press forward on the fetal chin while the other
hand is pressed downward on the occiput
helps a fetus achieve extension, so that the
head is born with the smallest diameter
presenting
also controls the rate at which the head is
born
CREDE’S MANUEVER
A technique for aiding the expulsion of
the placenta
The uterus is pushed toward the birth
canal by pressure exerted by the thumb
of one hand on the posterior surface of
the abdomen and the other hand on the
anterior surface
EPISIOTOMY &
EPISIORRHAPY
EPISIOTOMY
Perineotomy
Surgical incision of the perineum
made to prevent tearing of the
perineum with birth and to release
pressure on the fetal head with
birth
TYPES:
A. Medio-lateral
o Begun at the center of the fourchette and
directed posterio-laterally
o Not more than 3cm long
o Directed diagonally in a straight line
o 2-5cm distant from the anus
B. MEDIAN

o Begun at the center of the fourchette

o Directed posteriorly for 2-5cm in the midline of the
perineum
o Great risk for 3rd degree tear
o Less bleeding
o More easily and successfully repaired
C. J-shaped
o Begun at the center of the fourchette and directed
posterior to the midline for about 2cm and the directed
outward to avoid the anus

D. LATERAL
o Begun one or more cm distant from the center of
the fourchette and is not a favored incision
o Bartholin’s duct may be severed
o Bleeding is more profuse
o Suturing is more difficult
Advantages of episiotomy
Itsubstitutes a clean cut for a ragged
tear
Minimizes pressure on the fetal head
Shortens the last portion of the second
stage of labor
Problems with Episiotomies
Possible Complications
EPISIORRHAPY
 Is the repair of the lacerated vulva or episiotomy

CLASSIFICATIONS OF PERINEAL LACERATIONS:

1. First degree laceration – limited to the fourchette
and superficial perineal skin or vaginal mucosa
2. Second degree laceration – extends beyond
fourchette, perineal skin and vaginal mucosa to
perineal muscles and fascia but not to the anal
sphincter
3. Third degree laceration –
fourchette, perineal skin, vaginal
mucosa, muscles and anal sphincter
are torn
4. Fourth degree laceration – 3rd
degree plus rectal mucosa
CARING OF THE REPAIRED EPISIOTOMY
Proper
perineal care

High CHON,
vit. C diet;
adequate fluid
intake (2L)
Perineal
exercises

Medications
Ice packs

Sitz bath
Heat
lamps

Sex
 PERINEAL HEALING
 Vaginal distention decreases although muscle
tone is not completely restored to its pre-gravid
state
 Vaginal rugae begin to reappear around 3rd wk
 Laceration or episiotomy suture line gradually
heals
 Hemorrhoids generally subside
ASSESSING
BLOOD
LOSS
Normal blood loss
Normal spontaneous delivery –
500ml

Cesarean birth – 1,000-1,200ml

 POST-PARTUM HEMORRHAGE
 EARLY – more than 500ml that occurs during the first 24
hours post-partum
 Late
– excess of 500ml that occurs during the remaining
6-weeks post-partum period but after the first 24hours
 Causes:
 Uterine atony / relaxation
 Lacerations
 Retained placenta/placental fragment
 Disseminated intravascular coagulation
 LOCHIA
 Matter eliminated from the uterus through the vagina
after labor
 Vaginal discharges similar to menstrual flow
 May last until 6wks
 Contents: blood, mucus, particles of the decidua,
cellular debris, WBC, RBC
 Ambulation & strenuous activities may increase
lochia
CHANGES in LOCHIA
 RUBRA
 1-3 days
 Bright red in appearance
 Blood, fragments of decidua, mucus
 SEROSA
 4-10days
 Brownish or pinkish in color
 Blood, mucus, WBC
 ALBA
 11-14 days
 Whitish/yellowish
 Mostly mucus, WBC
 Abnormal Lochia
Odor: foul smell (infection)
Scanty during 1st stage (rubra)
Excessive amount in any stage
Return to rubra after serosa &/or
alba
POST PARTAL
EVALUATION
 Puerperium
oA Latin term for the period of involution
when the mother’s body return to its pre-
pregnant state
th
o4 trimester of pregnancy
oPostpartum period
oStarts immediately after delivery
oWoman adjusts to the new &
expanded responsibilities of
motherhood & non-pregnant life
st
o1 Hour: most common problem
THE UTERUS
 PHYSICAL CHANGES
 After pregnancy, estrogen and progesterone decrease,
which causes autolysis destruction of tissue, the layers of
the lining are shed in the form of lochia
 The placental site heals thru exfoliation rather than scar
tissue formation allowing future pregnancies
 By24 hours postpartum, the uterus is the same size it is at
20 weeks gestation
 By2 weeks postpartum, the uterus has descended into
the true pelvis
ASSESMENT
 FIRMNESS
 Palpation of the fundus
 The fundus should be firm and hard
 CENTEREDNESS
 Location of the fundus
 The fundus should be located midline to the umbilicus
 AFTERPAINS
 Cramping
 Increased with greater number of pregnancies
 Breastfeeding
 Involution
 Uterine Involution
o Vasoconstriction occurs @ placental site
o Reduction of uterus to pregestational size
 After birth 1000 g
 After 1wk500 g
 After 6wks 50 g (prepregnant weight)
o Usually takes 4-6 weeks to complete
Factors that Delay Uterine Involution
Multiparity
Conditions causing over distention of the
uterus
Infection
Retained placental fragments or membranes
Hormonal deficiency
Management
Proper nutrition
Early ambulation
HEALTH TEACHINGS
Encourage patient to empty
bladder every two hours
Encourage patient to breastfeed
Encourage patient to massage
own uterus
After 1 week, muscles begin to regenerate –
external os narrows to the size of pencil
opening
From soft to malleable, it becomes firm &
nongravid
Small lacerations – may need cauterization
External Os remains wider than in nulliparous
woman; may be stellate in shape ff delivery
Internal Os will close
 IMMEDIATE NEWBORN CARE

MODULE DESCRIPTION

The neonatal period (the first 28 days of life) is the crucial period for child survival; as this period carries the highest
risk of deaths per day than any other period during the childhood. The first month of life is also a foundational period for
lifelong health and development. Healthy babies grow into healthy adults who can thrive and contribute to their communities
and societies.
Labor, birth and the immediate postnatal period are the most critical for newborn and maternal survival. Many
newborn lives can be saved by the use of interventions that require simple technology. The majority of these interventions
can be effectively provided by a single skilled birth attendant caring for the mother and the newborn. Care of all newborns
includes immediate and thorough drying, skin to skin contact of the newborn with the mother, cord clamping and cutting
after the first minutes after birth, early initiation of breastfeeding, and exclusive breastfeeding.

Newborn care is defined as the management of the neonate during the transition to extrauterine life and
subsequent period of stabilization.

COURSE LEARNING OUTCOME

After completion of this module, the learner is expected to achieve and demonstrate the following learning
outcomes:

a. To be able to identify the purpose of newborn care

b. To be able to assess a newborn for normal growth and development
c. To be able to implement nursing care of the normal newborn
d. To be able to integrate knowledge of newborn growth and development and immediate care needs with the
nursing process to achieve quality maternal and child health nursing care.

TOPIC

Assessment of the newborn or neonate includes a review of the mother’s pregnancy history, physical
examination of the infant, analysis of the newborn’s laboratory reports such as hematocrit and blood type, if indicated,
and assessment of the parent-child interaction for the beginning of bonding. Assessment begins immediately after birth
and is continued at every contact during the newborn’s hospital or birthing center stay, early home visits, or well-baby
visits.
PROFILE OF THE NEWBORN
ANTHROPOMETRIC MEASUREMENTS:
Purposes:
 To assess the body’s size against known standards for the population.
 To compare the size with estimated period of gestation.
 To provide a baseline against which subsequent progress can be measured.

VITAL STATISTICS include weight, length, and head and chest circumference
A. WEIGHT - the average weight of a normal full-term newborn is about 2.9 kg with a variation of 2.5 kg – 3.9 kg or
more. The weight is variable from country to country.
- Plotting weight in conjunction with height and head circumference is helpful in pointing out
disproportionate measurements.
- The newborn is weight without clothes on and measured by pounds using the infant scale
B. LENGTH – at birth the average crown heel length of the term infant is 50 cm with the range of 48-53 cm (or 45.7
– 60 cm)
- It is measured from top of their head to the bottom to one of their heels.
C. HEAD CIRCUMFERENCE – it varies from 33 – 37 cm with an average of 35 cm.

IMMEDIATE NEWBORN CARE

- It is measured with a tape measure drawn across the center of the forehead (just above
the eyebrows) and around the most prominent portion of the posterior head (the
occiput).
D. CHEST CIRCUMFERENCE – chest circumference in a mature newborn is 2cm less than the head circumference.
- It is measured at the level of the nipples

VITAL SIGNS MONITORING – includes

temperature, pulse rate, respiration, blood
pressure

CORD CLAMPING AND CUTTING

 a. Clamp and cut the cord after cord pulsations have stopped (typically at 1-3 minutes)
b. Put ties tightly around the cord at 2 cm and 5 cm from the newborn’s abdomen.
c. Cut the ties with a sterile instrument.
d. Observe for oozing blood. Wipe excess blood with sterile gauze.
e. Do not milk the cord towards the newborn.
f. No dressing should be applied and the cord should be kept open and dry.
g. Normally it falls off after 5 to 10 days but may take longer especially when infected.

IMMEDIATE NEWBORN CARE

VITAMIN K ADMINISTRATION – newborns are at risk for bleeding disorders during the first week of life because
their GI tract is sterile at birth and unable to produce Vitamin K, necessary for blood coagulation. A single dose of 0.5 to
1.0 mg of Vitamin K is administered intramascularly within the first hour of life.

Vitamin K (Phytomenadione, Aquamephyton)

Action: Vitamin K is used for the prophylaxis and treatment of hemorrhagic disease in the newborn. It is a
necessary component for the production of certain coagulation factors (II, VII, IX, and X) produced by
microorganisms in the intestinal tract.

Dosage: prophylaxis – 0.5 to 1.0 mg IM one time immediately after birth; treatment of hemorrhagic disease – 1 to
2 mg IM or SC daily

Possible Adverse Reactions: local irritation, such as pain and swelling at the site of injection

Nursing Implications:
 Anticipate the need of injection immediately after birth.
 Administer IM injection into large muscle, such as the anterolateral muscle of the newborn’s thigh.
 If giving for treatment, obtain prothrombin time before administration (the single best indicator of Vitamin
K-dependent clotting factors.
 Assess for signs of bleeding, such as black tarry stools, hematuria, decreased hemoglobin and hematocrit
levels, and bleeding from any open wounds or base of the cord. (These would indicate that more Vitamin
K is necessary, because bleeding control has not been achieved.)
CREDES’S PROPHYLAXIS

ERYTHROMYCIN OPHTHALMIC OINTMENT

 An antibiotic, is effective against gonorrhea and chlamydia organisms, making it the drug
of choice for eye prophylaxis at birth
Dosage: 0.5-1 cm each eye
Possible Adverse Reactions: mild irritation to conjunctiva; slightly blurring of vision
Nursing Implications:
 Use a single-dose application tube.
 After gently pulling down on the newborn’s lower eyelid, extrude a line of ointment
the length of the lower eyelid from the inner canthus outward
 Discard any remaining ointment to prevent it from being used again
 Close the child’s eyes and count to about five
 Wipe away any excess ointment from the child’s eyes
 Know that application may be delayed for an hour after birth to allow the infant to
view his or her parents for the first time with the clearest vision possible

 Often called as CREDE’S PROPHYLAXIS – CREDE, a German gynecologist, first proposed

prophylaxis against gonorrheal conjunctivitis in 1884.
 IMMEDIATE NEWBORN CARE

BATHING

Baby Bath: Getting Ready

The first bath will be a sponge bath. Pick a warm room with a flat surface, like a bathroom or kitchen
counter, a changing table, or a bed. Cover the surface with a thick towel. Make sure the room
temperature is at least 75 degrees Fahrenheit, because babies chill easily.

Assemble all the baby bath products you will need:

 Baby bath sponge or clean wash cloth (double-rinsed)

 Clean blanket or bath towel (a hooded one is nice)
 Clean diaper
 Clean clothes
 Warm water (not hot)

Baby Bath: Time for a Sponge Bath

Gentle sponge baths are perfect for the first few weeks until the umbilical cord falls off, and the navel
heals completely.

The basics of bathing a baby:

a. First, undress baby -- cradling the head with one hand. Leave the diaper on (wash that area
last). Wrap baby in a towel, exposing only those areas that you are washing.
b. Using a baby bath sponge or wash cloth, cleanse one area at a time. Start behind the ears, then
move to the neck, elbows, knees, between fingers and toes. Pay attention to creases under the
arms, behind the ears, around the neck.
c. The hair comes toward the end of bath time so baby doesn't get cold. While newborns don't
have much hair, you can sponge the few wisps that are there. To avoid getting eyes wet, tip the
head back just a little. There's no need for shampoo; just use water.
d. Now it's time to remove the diaper and sponge baby's belly, bottom, and genitals.
e. Wash little girls from front to back. If there's a little vaginal discharge, don't worry -- and don't
try to wipe it all away. If a little boy is uncircumcised, leave the foreskin alone.
f. Gently pat baby dry. Rubbing the skin will irritate it.
g. Bath time is over, and your fresh little baby is ready for clean diaper and clothes!

REMINDER! DO NOT apply powder or lotion to newborns because some infants are allergic to these
products. If the newborn’s skin seems extremely dry, and portals of infection are becoming
apparent, a lubricant such as Nivea Oil added to the bath water or applied directly to the baby’s skin
should relieve the condition.
 In hospitals, newborns receive a complete bath wash away vernix caseosa within an hour after birth.

IMMEDIATE NEWBORN CARE

 They are bathed once a day. Although the procedure maybe limited to only washing the face, diaper area, and
skin folds.
 Wear gloves when handling newborns until a first bath to avoid exposing your hands to body
secretions; B
 Babies of HIV-positive mothers should be bathed immediately to decrease the possibility of HIV
transmission
 Bathing of the infant is best done by the parents under a nurse’s supervision.
 The room should be warm about 24°C to prevent chilling
 Bath water should be around 37°C to 38°C, a temperature that feels pleasantly warm to the elbow or
wrist.
 If soap is used, it should be mild and without hexachlorophene base.
 Bathing should take place before, not after, a feeding to prevent spitting up or vomiting and possible
aspiration.
 Equipment needed: basin of water, soap, washcloth, towel, comb, and clean diaper and shirt – these
items should be assembled beforehand, so the baby is not left exposed or unattended while the bather
goes for more equipment
 IMMEDIATE NEWBORN CARE

Essential lntrapartum and Newborn care (EINC) is the standard of care in all births by skilled attendants in
all government/private settings.

The EINC practices for newborn care constitute a series of time- bound, chronologically-ordered, standard
procedures that a baby receives at birth.

At the heart of the protocol are 4 time-bound interventions:

1) immediate drying;
2) skin-to-skin contact followed by clamping of the cord after 1-3 minutes;
3) non-separation of baby from mother
4) breastfeeding initiation

1. IMMEDIATE DYRING
• Using a clean, dry cloth, thoroughly dry the baby, wiping the face, eyes, head, front and back, arms &
legs.

2. SKIN-TO-SKIN CONTACT
• If a baby is crying & breathing normally, avoid any manipulation, such as routine suctioning, that may
cause trauma or introduce infection. Place the newborn prone on the mother’s abdomen or chest skin-to-
skin.
• Cover newborn’s back with a blanket & head with a bonnet. Place identification band on ankle.

3. PROPER CORD CLAMPING & CUTTING

• Clamp & cut the cord after cord pulsations have stopped (typically at 1-3 mins).
• Put ties tightly around the cord at 2 cm & 5 cm from the newborn’s abdomen.
• Cut between ties with sterile instrument.
• Observe for oozing blood.
• Do not milk the cord towards the newborn.
• After cord clamping, ensure oxytocin 10 IU IM is given to the mother

4. Non-separation of baby from mother and breastfeeding initiation

• Observe the newborn. Only when the newborn shows feeding cues (e.g., opening of mouth, tonguing,
licking, rooting), make verbal suggestions to the mother to encourage her newborn to move toward the
breast (e.g., nudging).
• Counsel on positioning and attachment.
When the baby is ready, advise the mother to:
a. Make sure the newborn’s neck is neither flexed nor twisted.
b. Make sure the newborn is facing the breast, with the newborn’s nose opposite her nipple and chin

IMMEDIATE NEWBORN CARE

touching the breast.

c. Hold the newborn’s body close to her body.
d. Support the newborn’s whole body, not just the neck & shoulders.
e. Wait until her newborn’s mouth is opened wide.
f. Move her newborn onto her breast, aiming the infant’s lower lip well below the nipple.
g. Look for signs of good attachment & suckling:
− Mouth wide open
− Lower lip turned outward
− Baby’s chin touching breast
− Suckling is slow, deep with some pauses
− If the attachment or suckling is not good, try again & reassess.

Notes
• Health workers should not touch the newborn unless there is a medical indication.
• Do not give sugar water, formula or other prelacteals.
• Do not give bottles or pacifiers.
• Do not throw away colostrum.

NEWBORN  If breathing with difficulty — grunting, chest in-

drawing or fast breathing, examine the baby as
 Wipe the eyes.
on.
 Apply an antimicrobial within 1 hour of birth.
 If feet are cold to touch or mother and baby are
→ separated:

either 1% silver nitrate drops or 2.5% povidone iodine  Ensure the room is warm. Cover mother and baby
drops or 1% tetracycline ointment. with a blanket

 DO NOT wash away the eye antimicrobial.
 If blood or meconium, wipe off with wet cloth and
dry.
 DO NOT remove vernix or bathe the baby.
 Continue keeping the baby warm and in skin-to-
skin contact with the mother.
→Reassess in 1 hour. If still cold, measure temperature. If
less than 36.5°C, manage as on.
 If unable to initiate breastfeeding (mother has
complications):
→Plan for alternative feeding method.
→If mother HIV-infected: give treatment to the newborn.

→Support the mother's choice of newborn feeding.

  Encourage the mother to initiate breastfeeding
when baby shows signs of readiness. Offer her
help.

 DO NOT give artificial teats or pre-lacteal feeds to

the newborn: no water, sugar water, or local
feeds.

IMMEDIATE NEWBORN CARE

REFERENCES

Pilliteri, A., MATERNAL AND CHILD HEALTH NURSING Volume 1 4 th Edition

https://www.verywellfamily.com/how-to-cut-an-umbilical-cord-2752960

https://www.google.com/url?sa=i&url=https%3A%2F%2Fnewbornsbaby.blogspot.com%2F2018%2F04%2Flength-of-
newbornbabies.html&psig=AOvVaw1wgA7rwxTMaSKtNV9lTmEJ&ust=1604375529645000&source=images&cd=vfe&ved
=0CAIQjRxqFwoTCLC4rMT64uwCFQAAAAAdAAAAABAg

https://www.slideshare.net/ulfatamin/newborn-nursing-care/9

file:///C:/Users/HP/Downloads/9789290616856_eng%20(1).pdf

https://www.ncbi.nlm.nih.gov/books/NBK326674/
APGAR
APGAR SCORE - is the quick test performed on a baby at 1 and 5
minutes after birth

Virginia Apgar ,MD introduced the Apgar score in 1952

= 1 minute evaluation after birth indicates initial adaptation to
extrauterine life and how well the baby tolerated the birthing
process.
= 5 minute score gives a more accurate picture of the overall
status, how well the baby adapts outside the mother's uterus.
= 0-3 danger sign, neonates needs immediate resuscitation ,
as ordered rescue saving measures and lifesaving techniques)
= 4-6 fair condition - neonate may have moderate central
nervous system depression, muscle flaccidity, cyanosis and
poor respiration (needs rescue saving measures such as
oxygen administration)
= 7-10 good condition
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= Assess the heart rate first- if the cord still pulsates, palpate the neonatal heart rate
by placing the fingertips at the junction of the umbilical cord and the skin ,or by the
use of stethoscope over the neonates fifth intercostal space to obtain the apical
pulse. Count for 1 full minute.
= Respiratory effort second most important APGAR sign. Assess for depth and
regularity
= Muscle Tone by evaluating the degree of flexion in the neonate's arms and leg and
their resistance to straightening ; by extending the limbs and observing their rapid
return to flexion (normal state)
= Assess reflex irritability by evaluating the neonate's cry for presence, vigor and
pitch
- can elicit a cry by flicking the soles
- usual response is loud , angry cry
- high - pitched or shrill cry is abnormal
= Assess the skin color
-Acrocyanosis - results from decreased peripheral oxygenation caused by the
transition from fetal to independent circulation to independent circulation
=when assessing non-white neonate, observe for color changes in the
mucus membranes of the mouth, conjunctiva, lips,palms, and soles
You’re assessing the one minute APGAR sore
of a newborn baby. On assessment, you note
the ff. about your newborn patient: heartrate
of 130bpm, pink body and hands with
cyanotic feet, week cry, flexion of the arms
and legs, active movement and crying when
stimulated. What is your APGAR score?
APGAR : 8

HEART RATE: 2
RR: 1
MUSCLE TONE: 2
REFLEX: 2
COLOR: 1
NEWBORN SCREENING
TEST
What is newborn screening?

Newborn Screening
 A simple procedure to find out if baby has a
congenital metabolic disorder that may lead to
mental retardation or even death if left
untreated.
Newborn screening is the process of testing
newborn babies for treatable genetic
endocrinologic, metabolic and hematologic
diseases
• Early diagnosis and proper treatment can make
the difference between lifelong impairment and
healthy development With a simple blood test,
these disorders can be diagnosed.
• These inherited disorders can hinder an infants
normal physical and mental development in a
variety of ways. These metabolic disorders
(Inborn errors of metabolism) interfere with the
body’s use of nutrients to maintain healthy
tissues and produce energy
Why in newborn screening done?

• Most babies with metabolic disorders look

“normal” at birth.
• By doing NBS, metabolic disorders may be
detected even before clinical signs and
symptoms are present.
• Treatment can be given to prevent
consequences of untreated conditions.
When is newborn screening done?

• NBS is usually done on the 48th – 72nd hour of

life.• It may also be done 24 hours from birth.•
Some disorders are not detected if the test is
done earlier than 24 hours.
How is newborn screening done?

Using the heel prick method, a few drops of

blood are taken from the baby’s heel and blotted
on a special absorbent filter card.•
 The blood is dried for 4 hours and sent to
Newborn Screening Center (NSC).
Who will collect the sample for newborn
screening?

 The blood sample for NBS may be collected by a

trained:
 Medical technologist
 Midwife
Nurse
 Physician
Where is newborn screening available?
NBS is available in participating Newborn
Screening Facilities:
Health Centers
If babies are delivered at home, they may be
brought to the nearest Newborn Screening
Facility.
Rural Health Unit
 Lying-ins
 Hospitals
When are newborn screening results
available?
 Normal NBS results are available 7-14 working
days from the time NBS samples are received at
the Newborn Screening Centers.
Positive NBS results are relayed from the NSC to
the NSF immediately.
 Parents should claim the NBS results from their
physician or health practitioner.
What is the meaning of the newborn
screening result?
A negative screen means that NBS result is
normal.
 A positive screen means that the newborn must
be brought back to his/her health practitioner
for further testing.
What should be done when a baby has a
positive NBS result?

 Babies with positive results should be referred

at once to a specialist for confirmatory testing
and further management
• Newborn screening program in the
Philippines currently includes screening
of six disorders:
1. congenital hypothyroidism (CH)
2. congenital adrenal hyperplasia (CAH)
3. phenylketonuria (PKU)
4. glucose-6- phosphate dehydrogenase
(G6PD) deficiency
5. galactosemia (GAL)
6. maple syrup urine disease (MSUD).
• The expanded NBS will be offered as optional to
parents in all participating facilities.
• First option is the screening of six disorders at
₱550, which is included in the newborn care
package for Philhealth members and the second
option is the full complement of disorder at
₱1500.
• At present, there is on-going discussion with
Philhealth to increase subsidy for expanded
newborn screening.
Metabolic problems:
• Metabolism is the process that converts food into
energy the body can use to move, think, and grow.
• Enzymes are special proteins that help
with metabolism by speeding up the chemical
reactions in cells. Most metabolic problems happen
when certain enzymes are missing or not working as
they should.
• Metabolic disorders in newborn screening include:
▫ phenylketonuria (PKU)
▫ methylmalonic acidemia
▫ maple syrup urine disease (MSUD)
▫ tyrosinemia
▫ citrullinema
▫ medium chain acyl CoA dehydrogenase (MCAD)
deficiency
Hormone problems
Hormones are chemical messengers made by
glands.
 Hormone problems happen when glands make
too much or not enough hormones.
Hormone problems in newborn screening
include:
▫ congenital hypothyroidism
▫ congenital adrenal hyperplasia
Hemoglobin problems

Hemoglobin is a protein in red blood cells that

carries oxygen throughout the body.
Some of the hemoglobin problems included in
newborn screening are:
▫ sickle cell disease
▫ hemoglobin SC disease
▫ beta thalassemia
Other problems
Other rare but serious medical problems
included in newborn screening are:
Galactosemia
biotidinase deficiency
cystic fibrosis
severe combined immunodeficiency (SCID)
Pompe disease (glycogen storage disease type II)
mucopolysaccharidosis type 1
X-linked adrenoleukodystropy
spinal muscle atrophy (SMA)
Cystic Fibrosis in Newborns

• One of the most common life threatening genetic

disorders in newborns; an infant with Cystic
Fibrosis has a faulty gene.
• This gene is responsible for the movement of salt
(sodium chloride) in and out of some cells.
• This condition can result in the clogging of the
lungs and subsequent rise in breathing disorders
among children.
• Children with cystic fibrosis may also have
problems with growth and digestion.
 Screening for Congenital
Hypothyroidism
It is important to note that babies born with this
condition tend to have a normal appearance and no
distinct physical signs.
This condition in neonates is almost always
overlooked. A delayed diagnosis often results in
mental retardation and increased severity of
congenital hypothyroidism.
The goal of early detection and initial therapies for
this condition is to minimize neonatal central
nervous system exposure to hypothyroidism.
This can be achieved by regulating the thyroid
function.
The congenital hemoglobin disorder
The congenital hemoglobin disorder is a genetic
disorder that cannot afford ignorance.
Hemoglobin E (Hb E) is one of the most
commonly detected versions of the disorder.
Even though the existence of the disease in its
original form, if co-present with beta-
thalassemia, can prove to be fatal for the child.
G6PD Deficiency
G6PD deficiency is quintessentially a genetically
inherited condition where the body does not have
sufficient amounts of enzyme glucose-6-phosphate
dehydrogenase (G6PD).
This enzyme essentially helps in the normal function of
red blood cells.
 If not diagnosed early enough, its deficiency can cause
hemolytic anemia once the infant is exposed to certain
foods, medications and infections.
Neonatal Jaundice
Jaundice in newborns is detectable by testing the serum
bilirubin levels.
This condition is known to occur in about 60% of term
infants and 80% of the pre-term infants.

Unconjugated hyperbilirubinaemia
can be potentially toxic. However, this may be
pathological or physiological. On the other hand,
conjugated hyperbilirubinaemia is never toxic but always
pathological. If not treated, the unconjugated bilirubin
may result in kernicterus.
Congenital Adrenal Hyperplasia (CAH)
• This condition is typically a genetically inherited
condition that impacts the adrenal glands of the
newborn.
• These glands are responsible to make a number
of hormones that are important for the regular
functioning of the body.
• Infants with CAH are unable to generate enough
cortisol and are born with a number of physical
changes.
• For instance, girls may be born with external
reproduction organs and may appear more
masculine than deemed conventional.
Breastfeeding
• is the normal way of providing young infants
with the nutrients they need for healthy growth
and development.
• Breastfeeding helps defend against infections,
prevent allergies, and protect against a number
of chronic conditions.
• -maternal active untreated TB, hep B or
C,cytomegalovirus or HIV.
• Maternal active untreated varicella- but once the
infant has been given varicella zoster IG. The
infant can receive expressed breastmilk if there
are no lesions in the breast.
BURPING
REASONS WES NEED TO BURP

• DIGESTION
• ALLERGIC REACTION OR FOOD
INTOLERANCE
• MOTHER’S DIET
• ALLOWING TOO MUCH AIR TO ENTER ON
BABY’S FORMULA
• NIPPLE FLOW
METHODS OF BURPING

• LEANING
SITTING
LAYING