Goals of the Immediate Care of the

Newborn
• To establish, maintain and support
respiration
• To provide warmth and prevent hypothermia
• To ensure safety and prevent injury and
infection
• To identify actual or potential problems that
may require immediate attention
 Four separate mechanisms in which newborns
lose heat:

• Convection – is the flow of heat from the

newborn’s body surface to cooler surrounding
air. Eliminating drafts, such as from windows or
air conditioners, reduces convection heat loss.
• Conduction – is the transfer of body heat to a
cooler solid object in contact with the baby.
Covering surfaces with a warmed blanket or
towel helps to minimize conduction heat loss.
• Radiation – is the transfer of body heat to a
cooler solid object not in contact with the baby,
such as a cold window or air conditioner. Moving
an infant as far from the cold surface as possible
helps reduce this type of heat loss.
• Evaporation – is loss of heat through conversion
of a liquid to a vapor. Newborns are wet, and
they lose a great deal of heat as the amniotic
fluid on their skin evaporates.
- To prevent this heat loss, dry newborns as
soon as possible, especially their face and hair,
which will not be covered by clothing.
• Drying and wrapping newborns and
placing them under a radiant heat source,
are excellent mechanical measures to help
conserve heat.
• In addition, placing a newborn against the
mother’s skin and then covering the
newborn also helps to transfer heat from
the mother to the newborn; this is termed
kangaroo care.
• Insulation, an efficient means of conserving
heat in adults, is not effective in newborns
because they have little subcutaneous fat to
provide insulation.
• Shivering, a means of increasing metabolism
and thereby providing heat in adults, is also
rarely seen in newborns.
• Brown fat, a special tissue found in mature
newborn, apparently helps to conserve or
produce body heat by increasing metabolism.
 Initial Assessment and Apgar Scoring
SCORE
SIGN 0 1 2
◆Heart rate Absent Slow (<100) >100

◆Respiratory effort Absent Slow, irregular; weak Good; strong cry

cry
Well flexed
◆Muscle tone Flaccid Some flexion of
extremities

◆Reflex irritability Cough or sneeze

Response to catheter No response Grimace
Cry and
in nostril withdrawal of
Slap to sole of foot No response Grimace foot

Completely pink

◆Color
Body pink, extremities
Blue, pale blue
APGAR Scoring
 Score

• 7-10 Good adjustment, vigorous

• 4-6 Moderately depressed infant, needs
airway clearance
• 0-3 Severely depressed infant, in need of
resuscitation
The Silverman and Andersen
Scoring System
 Assess 0 1 2
Chest Synchronized Lag on See-saw
Movement respiration respiration

Intercoastal None Just visible Marked

retraction

Xiphoid None Just visible Marked

Retraction

Nares Dilatation None Minimal Marked

Respiratory None Audible by Audible by ear

Grunt stethoscope
 Score

• Score of 0 indicates no respiratory distress

• A score between 4-6 means moderately
depressed
• A score between 7-10 means severely
depressed
 Preventing Infection
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
baby
 Handwashing
Should be done:
• Before entering the nursery or caring for a
baby
• In between newborn handling or after the
care of each baby
• Before treating the cord
• After changing soiled diaper
• Before preparing milk formula
 Care for the Eyes:
Crede’s Prophylaxis
• Administering Erythromycin or
Tetracycline Ophthalmic Ointment
 Preventing Hemorrhage
and
Cord Care

• Vitamin K injection or Aquamephyton

- .5 mg (preterm) to 1 mg (full term) is injected IM
in the newborn’s vastus lateralis muscle
- Vitamin K prevents bleeding disorder called
Hemorrhagic Disease of the Newborn (HDN)
- Warning signs of HDN include spontaneous
bruising or excessive bruising after minor injury,
nose bleeds, oozing or bleeding from the
umbilicus, dark vomit, dark stools or excessive
bleeding from skin lesions.
 Instruction to the mother on cord care:
• No tub bathing until cord falls off.
• Do not apply anything on the cord except the
prescribed antiseptic solution.
• Avoid wetting the cord.
• Leave cord exposed to air.
• If you notice the cord to be bleeding, apply firm
pressure and check cord clamp if loose and
fasten.
• Report any unusual signs and symptoms that
indicate infection.
Vital Statistics for a newborn include
weight, length and head and chest
circumference.
Assessing the Average Newborn
 Newborn Identification
• Identification band
• Footprints
• Fingerprints
• Initial Feeding
• Immunization