Immediate care of newborn

Definition:

This care is introduced to baby after birth immediately and continued for at
least first week.

Objectives:

1. Establish and maintain respiratory function

2. Maintain warmth and prevent hypothermia
3. Stimulate circulation and maintain health
4. Ensure safety and prevent infection
5. Identify actual and potential problems that might need immediate action
6. Detect any congenital anomalies
7. Care of the umbilical cord
8. Care of the eyes
9. Identification of the infant
Equipment:

 Radiant warmer and warm receiving blankets

 Oxygen suction with sterile catheter
 Oxygen mask with three different size
 Laryngoscope with different sizes blades or airway
 Endotracheal tubes with different size and satellite
 Sterile gloves
 Cord care tray
 Sterile scissor
 Sterile clamp
 Dry cotton and gauze
 Cotton with alcohol
 Paper bag
  Vitamin k
 Insulin syringe
 Neonatal health card
 Baby scale ,measuring tape
 Stethoscope
 Rectal thermometer
 Eye drop
 Identification band
 Baby clothes

Steps/ Task Rational

1. Hand washing To prevent cross Infection
2. Prepare the equipment To safe effort and time
3. At birth, make an immediate assessment, of the
infant. If stable then immediately place the
neonate skin-to-skin on the mother’s chest. If
the infant is not stable or there is concern,
transfer the infant to the resuscitation cot and
reassess or initiate resuscitation as appropriate.
Immediate care of the new born steps
4. As the head is delivered wipe the mucus and To avoid the baby to grasp and aspirate
fluid from infant nose and mouth with use dry fluid with 1st breath
gauze
5. As soon as infant is born clamp the umbilical
cord with two kokar and cut in between

6. Receive the baby in a clean warm blanket To maintain warmth and prevent
hypothermia
7. Transfer the baby to the heater
8. Use the small rubber suction catheter which To remove aspiration fluids that may
is attached to a mechanical suction be obstructing the air way.
 Suction is performed through oropharynx.
 Suction the newborn’s nose if needed.
9. Maintain a modified trendelinburg position To facilitate drainage of secretions
10.provide warmth by keeping the baby dry (start To minimize loss of infant body heat
to dry from the head, face ,and the rest of the
baby by dry towel)
 be sure that the baby is dry from any
amniotic fluid
 avoid air draft in the room
11. Assess the new born condition immediately
after birth at 1minutes through Apgar score , 5
minutes after birth and 10 minutes if score 6
or less
12.Cord care as the following :
 The cord is clamped at 3-5 cm away
from abdomen and the cord is cut
after 1cm
 Assess that there are small two
arteries and one big vein to detect
any congenital malformation
 Clean umbilical cord from its base
with a cotton ball or cotton tipped
applicator, earplugs moistened with
70% alcohol then the stamp of cord
and finally the tip of the cord

Take the growth Measurement for the baby To detect if the baby appropriate for
gestational age or not using measuring
tapes
13.Head circumference :
 Use tap pass from frontal bone above eye
brow to occipital prominence
 Read and record
14.Chest circumference
 Use tap measure around chest at nipple line
 Take measurements during inspiration and
expiration
 Record the average of the two values

15.Length measurement :
 Put the newborn in dorsal position
 Hold head in midline
 Grasp knee and push gently toward table
to fully extended legs
 Put dot vertex of head to heals of feet then
measure
 Read and record
16. Weight measurement:
 Drape and balance the scale of zero line
 Put newborn on scale without clothes and
put hand over the baby (not touching him
,take and an accurate reading of weight and
record it
  Return the newborn
17.Eye care by Using antibacterial agent To protect the eyes from infection
18. A signal dose of vitamin k is administered As a preventive measures against
intramuscularly neonatal hemorrhagic disease
19.Identification :
 Apply ID band to the arm of the baby
which include( Mother name, Hospital number,
Newborn sex, Time and date of birth)
 Take the newborn foot prints according to
the hospital policy ,mother finger print
20.Examine the head for normal shape, size and For early detection of any birth trauma,
circumference or congenital anomalies( caput
succedaneum & cephalohaematoma)
21.Inspect anterior and posterior fontanels For detect the presence of bulging
or sunkenness
22.Examine face and neck for congenital
anomalies as cleft lips or cleft palate, neck
length, webbing mobility, nose symmetry,
septum patency and flaring of nostrils.
23.Assess the skin for scaling, undue wrinkling or To indicate the maturity of the baby
birthmarks, lanugo, vernix, texture or rash, and exclude any jaundice or
color abnormalities.
24. The abdomen is palpated for early
detection of any mass, enlargement, congenital
hernia, swollen organ (liver, spleen, kidney)
25. Examine the appropriateness of sex:
 The genitalia for male urethral opening,
scrotum and tests.
 Female labia and discharge.
 Insert the thin catheter into the anus to check
patency or thermometer when you take
infant’s body temperature
26.Provide suitable dress
27.Take the new born away from the heater
28.Clean and remove all equipment
29.Record your finding into the proper card
30.Wash hand
 APGAR SCORE
Definition:
It is an easy, quick assessment tool used to assess the status of a new born
after birth performed at 1 minutes and 5 minutes after birth and 10 minutes if
score 6 or less.
APGAR:

 Appearance(skin color)
 Pulse(heart rate)
 Grimace(reflex irritability)
 Activity(muscle tone)
 Respiratory(effort)
A PGAR scoring table

2 1 0
A Complete pink body Pink body ,blue limbs Pale or blue body
and face ,pale body and face and face
B >100 b/m <100 b/m No HR or response
G Crying ,coughing Grimace or puckering No response
Or sneezing Of face
A Active movement Some response to No movement of
,waving arms or legs stimulation legs ,arms,
Palm
R Strong cry Slow irregular No cry or
breathing or week cry breathing
Total scores =

10 : Normal, 7-10 : Moderate asphyxia, 4-6 : Sever asphyxia =0-3

Comments and required intervention

Apgar score Classification Intervention

7-10 Normal Routine post delivery
4-6 Moderate asphyxia Some resuscitation (oxygen
,suction, stimulate baby ,rub baby)
0-3 Sever asphyxia Full resuscitation.