NURSING CARE OF THE NEWBORN •Uses brown fat to conserve heat by

increasing metabolism
PROFILE OF A NEWBORN •If chilling is prevented, temp
stabilizes at 37oC within 4 hours after birth
VITAL STATISTICS: •Subnormal temp. indicates infection
WEIGHT
• Varies depending on racial, nutritional, PULSE
intrauterine and genetic factors •120 to 160 bpm at birth
• Female: 3.4 kg (7.5 lbs) •Within 1 hour, will stabilize at 120 – 140
• Male: 3.5 kg (7.7 lbs) bpm
• Lowest limit: 2.5 kg •When crying, can be as high as 180 bpm
• Initial weight loss of 5% to 10% during the •When asleep, can be as low as 90 to 110
first few days after birth, then 1 bpm
day of stable weight and begins to gain •Absence of femoral pulse may suggests
weight coarctation of the aorta
• Breast-fed: recaptures birth weight within
10 days RESPIRATION
• Formula-fed: regain weight after 7 days •At birth, may be as high as 80 breaths per
• Then, will gain 2lbs/month for the first 6 minute
months of life •Average: 30 to 60 breaths per minute
•Periodic respirations
LENGTH (short periods of apnea) can be normal
46 – 57.5 cm •Obligatory nose-breathers
(range) •Uses abdominal muscles for breathing
Female: 53 cm
Male: 54 cm BLOOD PRESSURE
•Approximately 80/46 mmHg at birth
HEAD CIRCUMFERENCE •100/50 mmHg by the 10th day
•34 to 35 cm
(average) PHYSIOLOGIC
•33 to 37 cm FUNCTIONS
(range)
CARDIOVASCULAR SYSTEM
CHEST CIRCUMFERENCE • Functional closure of the fetal structures:
32 to 33 cm or • Ductus arteriosus
about 2 cm less • Foramen ovale
than head • Ductus venosus
Circumference • Umbilical arteries
• Umbilical vein
VITAL SIGNS • Peripheral circulation is sluggish for the
TEMPERATURE first 24 hours
•At birth: 37.2oC • Prolonged coagulation due to low levels of
•Insulation and shivering are not Vit. K
effective means of conserving heat
• BLOOD VALUES
• BLOOD VOLUME:
• Total 300 ml
• 80 to 110 ml per kg body weight
• RBC: 6 million cells/ kg body weight
• Hemoglobin: 17 to 18 g/ 100ml
• Hematocrit: 45% to 50%
• Indirect bilirubin: 1 to 4 mg/ 100 ml
• WBC: 15,000 to 30,000 cells/mm3
RESPIRATORY SYSTEM
• Low pO2: 15mmHg and high pCO2
70mmHg before the first breath
• With some fluid in the lungs from
intrauterine life that eases the surface
tension which facilitates alveolar expansion
GASTROINTESTINAL SYSTEM
• GI is sterile at birth
• Cultured bacteria within 5 hours after birth
• Passed out meconium (sticky, tarlike,
blackish-green, odorless stool) during the
first 24 hours
• Transitional stool on the 2nd to 3rd day
URINARY SYSTEM
• Voids within 24 hours
• First voided urine is pink and dusky due to
presence of uric acid crystals and small
amount of protein
• Daily urinary output
• 1 to 2 days: 30 to 60ml
• By week 1: 300ml
IMMUNE SYSTEM
• Unable to produce antibody for the first 2
months
• With some immunologic protection
because they receive IgG
from the mother
NEUROMUSCULAR SYSTEM
(REFLEXES)
BLINK REFLEX - Rapid eyelid closure after
shining a strong light
ROOTING REFLEX - Disappears at about
the 6th week
SUCKING REFLEX - Diminished at about
the 6th month
SWALLOWING REFLEX
EXTRUSION REFLEX - Disappears at
about the 4th month
STEP (WALK) –IN-PLACE REFLEX -
Disappears by 3 months of age
TONIC NECK REFLEX - Disappears
between the 2 nd and 3rd month of life
PALMAR GRASP REFLEX - Disappears
about the 6th week to 3rd month
PLANTAR GRASP REFLEX - Disappears at
about the 8th-9th month
BABINSKI REFLEX - Remains positive up
to the 3rd month
Test of spinal cord integrity
- MAGNET REFLEX
- CROSSED EXTENSION REFLEX
- TRUNK INCURVATION REFLEX
MORO REFLEX
- Startle reflex
- Strong for the first 8th weeks
- Fades by the end of the 4th or 5th
month
LANDAU REFLEX - To check for muscle
tone
DEEP TENDON REFLEX
- Biceps reflex (C5 to C6)
- Patellar reflex (L2 to L4)
PHYSIOLOGIC ADJUSTMENT TO
EXTRAUTERINE LIFE
Periods of Reactivity
First period of Reactivity - First 15-30
minutes
Resting Period - 30 to 120 minutes
Second Period of Reactivity - 2 to 6 hours of
life
 Milia
•Pinpoint white papule
•Disappear by 2 to 4 weeks of age
Erythema toxicum
•Flea-bite rash
•Newborn rash that appears in the first to
fourth day of life but may appear up to 2
weeks
Forceps Marks •

HEAD
Fontanels
APPEARANCE OF NEWBORN SKIN
Anterior fontanel
COLOR
•Diamond shape
● Ruddy
•Junction of 2 parietal and 2 frontal bones
● Acrocyanosis
•Closes at 12 to 18 months
● Central cyanosis
Posterior
● Jaundice
fontanel
● Pallor
•Triangular in shape
● Harlequin Sign
•Junction of parietal bones and occipital
bone
SKIN BIRTHMARKS
•Closes at 2 months
HEMANGIOMAS - vascular tumors of the
Sutures
skin
•The separating lines of the skull
Nevus flammeus / port-wine stain - Macular
•May override at birth
purple or dark-red lesion; Stork’s beak
•Overriding subsides within 24 to 48 hours
marks: Lighter pink patches at the nape of
•Wide separation suggests increase ICP
the neck
Strawberry hemangioma
MOLDING
•Elevated areas formed by immature
• Head is molded to fit the cervix contours
capillaries and endothelial cells
CAPUT SUCCEDANEUM
•May appear up to 2 weeks of age
• Edema of the scalp at the presenting part
•Disappears at about 7 years old
of the head
Cavernous hemangioma
• Disappears about the 3rd day
•Dilated vascular spaces
CEPHALHEMATOMA
•Remains throughout life
• Collection of blood between the
periosteum of a skull bone and the bone
SKIN
itself
Mongolian Spots • Collections of pigment
• Caused by rupture of a periosteal capillary
cells that appear slate-gray
• Takes weeks to disappear
patches across the sacrum or buttocks
CRANIOTABES
Lanugo • Fine, downy hair that disappear at
• Softening of the cranial bones caused by
2 weeks of age
pressure of the fetal skull against the
Desquamation • Due to dry skin
mother’s pelvic bone
Vernix Caseosa •
• The skull is so soft that that the pressure GENITALIA
of an examining finger can indent it MALE
• Scrotum appears edematous and has
EYES rugae
• Cry tearlessly at birth • Cremasteric reflex may be absent up to 10
• Iris is gray or blue color at birth years old
• Assumes its permanent color between 3
and 12 months of age FEMALE
• Subconjunctival hemorrhage • Vulva is swollen
• Appears as a red spot on the sclera • Pseudomenstruation
• Edema remains for 2 to 3 days
ASSESSMENT FOR WELL-BEING
EARS
• Pinna should recoil after bending • APGAR Scoring
• The top of the auricle should be in level • Respiratory Evaluation
with the outer canthus of the eye • Laboratory Studies
• Assessment of Gestational Age
NOSE
• Appear large for the face APGAR Scoring
• Can distinguish the smell of • A standardized assessment scale used to
the mother evaluate newborn after birth and serves as
baseline for future evaluations.
MOUTH • Performed at 1 minute and 5 minutes after
• Should open evenly birth.
• Epstein’s pearls
• Small round glistening well- circumscribed
cysts at the palate
• Disappear spontaneously about 1 week
• Natal teeth

CHEST
• Only at 2 years of age that the chest
measurement exceed that of the head
• Breast are engorged
• Witch’s Milk • A total score less than 4 indicates the
• Thin, watery fluid secreted by the nipple need for resuscitation
• A score of 4 to 6 means that the infant’s
ABDOMEN condition is guarded requiring for clearing of
• Slightly protuberant the airway and supplementary oxygen
Cord stump • A score of 7 to 10 is considered good or
• First hour of life, the cord begins to dry normal
and shrink
• Falls off at the 6th to 10th day Respiratory Evaluation
• Respiratory function is the highest priority
in newborncare
• Use of Silverman and Andersen index to
evaluate respiratory function
Silverman and Andersen Index
• A total score of 0 indicates no respiratory
distress
• Scores of 4 to 6 indicate moderate distress
• Scores of 7 to 10 indicate severe distress
Laboratory Studies
• Heel-stick tests for hematocrit, hemoglobin
and hypoglycemia
• Newborn Screening / Metabolic Screening
Newborn / Metabolic Screening
• Phenylketonuria (PKU)
• Hypothyroidism
• Cystic fibrosis
• Maple syrup urine disease
Assessment of Gestational Age
• Usher Clinical Criteria for Gestational
Assessment
• Dubowitz Maturity Scale
• Ballard’s Newborn Assessment
Dubowitz Maturity Scale
• Indications: all newborns appearing to be
immature by Usher’s criteria or who are light
in weight at birth
• Uses more definitive criteria
•Helps determine whether a newborn needs
immediate
high-risk nursery intervention
Ballard’s Assessment of Gestational Age
Criteria
Consists of two portions
• Physical Maturity
• Skin texture
• Color
• Lanugo
• Foot creases
• Genitalia
• Ear
• Breast maturity
• Neuromuscular Maturity
• Illustrations of mature and immature body
features
Ballard’s Assessment of Gestational Age
Criteria
• Each component is given a score of 0 to 5
• Should be done as soon as possible after
birth
2020 National Health Goals
Related to the Newborn Period #1
• Increase the proportion of mothers who
breastfeed
their babies in the early postpartal period
from a baseline of 74% to 81.9%.
• Increase the proportion of mothers who
continue exclusive breastfeeding until their
babies are 3 months old from a baseline of
33.6% to 46.2%.
• Increase the percentage of healthy full-
term infants who are put to sleep on their
backs from a baseline of
69% to 75.9%.
2020 National Health Goals Related
to the Newborn Period #2
• Reduce the proportion of young children
aged 3 to 5 years with
dental caries in their primary teeth (which
could originate from
nighttime bottle feeding) from a baseline of
33.3% to 30%.
• Reduce the perinatal mortality rate to no
more than 5.9 per 1,000
live births from a baseline of 6.6 per 1,000
live births.