Nursing Care of a

Family with a Newborn

Ch-18
p425

Dr. Leonila M. Adarlo, MAN,RN

Objectives:
➢ Describe the normal
characteristics of a term
newborn
➢ assess newborn for normal
growth and development
➢ formulate nursing diagnoses
related to newborn
➢ implement nursing care for a
newborn
• Newborn undergo profound
physiologic changes at the
moment of birth
• immediately after birth the
newborn should initiate a
normal respiration and
circulation
• 24 hours after should initiate
neurologic, renal, endocrine,
GIT and metabolic functions
 Newborn Priorities in First Days of Life-
p673
1. Initiation and maintenance of
respiration
2. Establishment of extrauterine
circulation
3. Management of fluid and electrolyte
balance
4. Control of body temperature
5. Intake of adequate nourishment
6. Establishment of waste elimination
7. Prevention of infection
8. Establishment of infant parent,
caregiver relationship
9. Institution of developmental care, or
care that balances physiologic needs
and stimulation for best
development
 Basic Division of
Childhood
Stages Age Period
Neonate First 28 days
of life
Infant 1 mo-1 yr.
Toddler 1-3 yrs. Old
Pre-school 3-5 years
School-age 6-12 yrs
Adolescent 13-20 yrs
 8 Newborn Priorities in First Days of Life

Establishment of Control of
extrauterine Body
circulation temperature

Initiation and
maintenance of Intake of adequate
respiration nourishment

Developmental care, or
care that balances Establishment of
extrauterine
physiologic needs and
circulation
stimulation for
best development
Establishment of Prevention of
infant parent infection
relationship
 Vital Statistics
➢ Baby’s weight
➢ Length
➢ Head circumference
➢ Chest circumference

Note: safety issues must be

considered when taking
measurements
➢ Do not leave the baby
Profile of unattended
➢ Protect the baby against
the hypothermia
Newborn
 Vital Statistics
➢ Baby’s weight
➢ Length
➢ Head circumference
➢ Chest circumference

Note: safety issues must be

considered when taking
measurements
➢ Do not leave the baby
Profile of unattended
➢ Protect the baby against
the hypothermia
Newborn
 Head circumference
34 to 35 cm
Temperature
36.8 to 37.4
Chest circumference
Length 46 32 to 33 cm
to 54cm
Heart rate
120- 140

Respirations
30-60

Weight
2.5-
3.4kg
 Vital Statistics
Weight
➢ It helps to determine maturity
➢ Infant is weigh nude
➢ If baby is more than 4.7kg is
macrosomic associated with GDM
➢ Second born usually weighs more
than the first born
➢ Birth weight continue to increase
with each succeeding birth

Profile of
the
Newborn
 Weight loss of 5 to 10% during
the first 10 days of life
➢ Newborn is no longer
under the influence of salt
and fluid retaining
maternal hormone
➢ Diuresis begins to remove
infants high fluid load
➢ Passage of stool and urine
➢ Limited intake about the
Profile of 3rd day
the ➢ Ineffective sucking and
Newborn swallowing reflex
 Vital Statistics
Length
➢ Second important
determinant to confirm if the
baby is healthy
➢ 49 cm is the average length
for mature female newborn
➢ 50 cm is the average length
for mature male newborn
➢ 46 cm is the lower limit
➢ 57.5 cm length must be
Profile of reported
the
Newborn
 Vital Statistics
Head Circumference
➢ Use tape measure in doing it
➢ Draws at the center of the
forehead to the most
prominent portion of the
posterior head or the occiput
➢ 34-35cm for the mature
newborn
➢ Greater than 37 cm or less
than 33 cm should be
carefully assessed for
neurologic involvement
➢ Measured at birth and
routinely until 1-2 years
Profile of ➢ Head growth occurs because
the brain is growing
the ➢ Reflects brain growth and
potential neurologic function
Newborn
Chest Circumference
➢ Use tape measure in doing it
➢ Measured at the level of the nipple
➢ If large amount of breast tissue or edema of the
breast is present, this measurement becomes
inaccurate
➢ It is 2cm less than the head circumference
➢ Measures 32-33cm

Profile of
the
Newborn
Vital Statistics
Head Circumference
➢ Use tape measure in doing it
➢ Draws at the center of the forehead to the most prominent
portion of the posterior head or the occiput
➢ 34-35cm for the mature newborn
➢ Greater than 37 cm or less than 33 cm should be carefully
assessed for neurologic involvement

Profile f the
Newborn
 Vital Signs
➢ Begin to change from
intrauterine life and at the
moment of birth
Temperature
➢ Temperature of birthing room-
21-22⁰C (Pilliterri), 25-28⁰C
(Unang Yakap)
➢ 37.2 ⁰C at birth
➢ Fall immediately to below
normal due to heat loss
Profile of
the
Newborn
 Heat loss in the Newborn

Radiation transfer of body heat to a cooler

Evaporation loss of heat thru conversion of
solid object not in contact with the
liquid to a vapor
baby like open window or aircon

Conduction transfer of heat to a cooler solid Convection flow of heat from the baby to
object in direct contact with the baby cooler surrounding air
 Heat loss in the Newborn

Radiation transfer of body heat to a cooler

solid object not in contact with the
baby like open window or aircon

Management:
➢ Moving the infant as far from the
cold surface as possible helps
reduce this type of heat loss
 Heat loss in the Newborn
Evaporation loss of heat thru conversion of
liquid to a vapor
Newborn are wet when born , they loss
great deal of heat as amniotic fluid on
their skin evaporates
Management:
➢ Lay newborn on mother’s
abdomen immediately after birth
➢ Cover warm blanket
➢ Do Skin to skin contact
➢ Dry the baby s face and hair
effectively reduces evaporation
➢ Head is a large surface area and
can be responsible for great heat
loss
➢ Cover the head with a cap reduces
evaporation cooling
 Heat loss in the Newborn

Conduction transfer of heat to a cooler

solid object in direct contact with the
baby
Baby placed in a cold base quickly loses
heat to the colder metal surface
Management:
➢ Covering surface with a warmed
blanket or towels help minimize
conduction heat loss
 Heat loss in the Newborn

Convection flow of heat from the baby to

cooler surrounding air
Management:
➢ Eliminate drafts such as from air
conditioner
Brown fat- special tissue found among
mature newborn, helps to produce
or conserve heat by increasing
metabolism
Brown fat Location
P-erirenal area
A-xillary area
I-intrascapular area
N-eck
S-ternum
Note:
Baby doesn’t know how to shiver as
what the adults do
Baby can conserve heat by constricting
blood vessels and moving blood
away from the skin
Brown fat- special tissue
found among mature
newborn, helps to produce
or conserve heat by
increasing metabolism
Brown fat Location
P- erirenal area
A- xillary area
I- intrascapular area
N- eck
S- ternum
To produce heat kick and cry increases
metabolic rate forces to increase RR
glucose and oxygen utilized HYPOGLYCEMIA,
HYPOXIA further muscle become
overstressed releases lactic acid metabolic
acid life threatening death

Major Effects of cold stress

1. hypoxia which can lead to respiratory distress
2. hypoglycemia less than 30-50 mg/dl
3. metabolic acidocis
Hypoglycemia, full-term infant:
less than 40 mg/dL

Hypoglycemia, premature infant:

less than 30 mg/dL

Hyperglycemia:
greater than 150 mg/dL
 Vital Signs
Pulse
➢ 110-160 in the utero
➢ 180 at birth as baby
struggles to adjust
➢ 120-140 after rest period an
hour after birth
➢ 90-110 if the baby is asleep
➢ Apical pulse is best
determined
Profile of
the
Newborn
 Vital Signs
Respiration
➢ 90bpm on the first few mins.
➢ 30-60 average RR once
established
➢ Respiratory depth, rate ad
rhythm are likely irregular
➢ Periodic respiration is a short
period of apnea without cyanosis
are common and normal

Profile of
the
Newborn
 ➢ Respiratory rate can be observed
easily by watching the
movement of the newborns
abdomen
➢ Breathing primarily involves the
use of diaphragm and abdominal
muscle
Note:
➢ Coughing and sneezing reflex are
present to clear the airway
➢ Newborn are obligatory nose
breather
➢ Shows distress if their nose are
clogged
Profile of ➢ Short period of crying increases
depth of respiration and aid in
the aerating deep portion of the
lungs
Newborn
 Vital Signs
Blood Pressure
➢ Approximately 80/46 at birth
➢ 100/50 on the 10th day up to
infant year
➢ Bp cuff must be no more than
2/3 the length of the upper arm
or thigh

Note:
➢ Bp is not routinely measured
unless cardiac anomaly is
present
Profile of
the
Newborn
 Cardiovascular function
➢ As soon as umbilical cord is
clamped, which stimulates a
neonate to take in oxygen thru
the lungs, fetal cardiovascular
shunts begin to close
➢ First breath Bp decreases in the
pulmonary artery (leading from
the heart to the lungs)
➢ As pressure decreases , ductus
arteriosus (shunt between
pulmonary artery and aorta)
begins to close
➢ Increased blood flow to the left
side of the heart causes the
Physiologic foramen ovale (opening between
the right to left atria) to close
function
 Cardiovascular function
➢ With the remaining fetal
circulatory structures (AVA and
ductus venosus) no longer
receiving blood from the
placenta, the blood within them
clots and closed, the vessels
atrophied over the next few
weeks

Note:
➢ After birth lungs are responsible
for oxygenating blood that was
formerly done by the placenta
Physiologic
function
 Respiratory function
➢ First breath is a major
undertaking
➢ Fluid eases surface
tension on the alveolar
wall, allows alveoli to
inflate easily
➢ 1/3 of the fluid is forced
out of the lungs by the
pressure of vaginal birth
➢ The rest of body fluid is
Physiologic absorbed by lung blood
function vessels and lymphatic
after the first breath
 Respiratory function
➢ Preterm newborn alveoli may
collapsed each time they
exhale
➢ If alveoli do not open well ,
foramen ovale and ductus
arteriosus will not close

Note:
➢ A baby born by CS birth does
not have as much lung fluid
expelled at birth and has
more difficulty establishing
Physiologic respiration due to excessive
fluid blocks air exchange
function space
 Gastrointestinal System
➢ Sterile stomach at birth
➢ Bacteria are helpful and
necessary for digestion thru
probiotics and for the synthesis
of Vitamin K-
➢ Stomach can hold 60-90ml but
has limited ability to digest
everything

Physiologic
function
Gastrointestinal System
Stool
➢ Meconium is the first stool a
black tary, green , odorless,
formed from mucus, vernix,
lanugo, hormones, CHO
➢ Should pass within 24 to 48 hrs.
➢ Transitional stool appear loose
and green usually on the 2nd or
3rd days of life
➢ Breastfed babies pass 3 to 4 light
yellow sweet smelling stool
➢ Formula fed baby 2 or 3 bright
yellow stool with noticeable
odor
Gastrointestinal System
Stool
➢ Baby under photo light with
bright green stools due to
increased bilirubin excretion

➢ Baby with bile duct obstruction

clay-colored or gray stool
because the bile pigment cannot
enter the intestinal tract
➢ Blood-flecked stool usually
indicate an anal fissure
Gastrointestinal System
Stool
➢ Black tarry stool after 2 or more
days ; its either due to
swallowed maternal blood
during birth or bleeding
➢ Stool mixed with mucus, watery
and loose, a milk allergy , lactose
intolerance, or other condition
which interfere with digestion or
absorption
Urinary System
➢ Voids within 24 hours after birth
➢ Less intake of fluid for the first
24 hours may void later than this
➢ But the 24 – hour point is the
good general “ALERT RULE”

Note: do not void within 24 hours

should be assessed for the
possibility of urethral stenosis or
absent kidney or ureters
Urinary System
➢ Kidney of newborn do not
concentrate well, making urine
light colored and odorless
➢ 15 ml of urine / void
➢ 30 to 60 ml urinary output for 1
to 2 days
➢ Week 1 total daily volume rises
to 300ml

➢ 20g- new diaper

➢ 50g- used diaper
➢ = 30g or 30cc
Neuromuscular system
Reflexes
➢ Blink reflex
➢ Rooting reflex- disappear
at 6 weeks
➢ Sucking reflex- diminish
at about 6 months
➢ Swallowing reflex
Neuromuscular system
Reflexes
➢ Gag, cough and sneeze are
present to maintain clear
airway
➢ Extrusion reflex- fades at 4
months
➢ Palmar grasp reflex -6weeks
to 3 months
➢ Plantar grasp reflex-
disappear at about 8-9 mos.
 Neuromuscular system
Reflexes
➢ Gag, cough and sneeze are
present to maintain clear
airway
➢ Extrusion reflex- fades at 4
months
➢ Palmar grasp reflex -6weeks
to 3 months
➢ Plantar grasp reflex-
disappear at about 8-9 mos.
Palmar grasp reflex
 Neuromuscular system
Reflexes
➢ Babinski reflex- remains positive
until at least 3 months
➢ Magnet reflex- test the spinal
cord integrity
➢ Crossed extension reflex- test the
spinal cord integrity
➢ Trunk incurvation reflex- test the
spinal cord integrity
➢ Landau reflex
➢ Deep tendon reflex- biceps reflex
for spinal nerve C5 and 6,
patellar reflex for L2 through L4
 Neuromuscular system
Reflexes
➢ Babinski reflex- remains positive
until at least 3 months
➢ Magnet reflex- test the spinal
cord integrity
Trunk incurvation reflex
➢ Crossed extension reflex- test the
spinal cord integrity
➢ Trunk incurvation reflex- test the
spinal cord integrity
➢ Landau reflex
➢ Deep tendon reflex- biceps reflex
Babinski reflex for spinal nerve C5 and 6,
patellar reflex for L2 through L4
Neuromuscular system
Reflexes
➢ Step-walk-in-place reflex-
disappear by 3 months
➢ Placing reflex
➢ Plantar grasp reflex- disappear at
8 to 9 months
➢ Tonic neck reflex, boxer or
fencing reflex disappear
between 2nd and 3rd mo
➢ Moro reflex- strong for the first 8
weeks of life, fades by the end of
4th or 5th month
 Neuromuscular system
Reflexes
➢ Step-walk-in-place reflex-
disappear by 3 months
➢ Placing reflex
➢ Plantar grasp reflex- disappear at
8 to 9 months
➢ Tonic neck reflex, boxer or
fencing reflex disappear
between 2nd and 3rd mo
➢ Moro reflex- strong for the first 8
weeks of life, fades by the end of
4th or 5th month
Tonic neck reflex
Step-walk-in-place reflex
Neuromuscular system
Reflexes
➢ Step-walk-in-place reflex-
disappear by 3 months
➢ Placing reflex
➢ Plantar grasp reflex- disappear at
8 to 9 months
➢ Tonic neck reflex, boxer or
fencing reflex
➢ Moro reflex- strong for the first 8
weeks of life, fades by the end of
4th or 5th month
 Senses
Hearing
➢ acoustic stimulation reveals a
fetus can hear in the utero
➢ 25 to 27 weeks hearing is
functional and fetus can hear
mother’s heartbeat and voice
➢ hearing becomes acute as soon
as fluid is absorbed or drained
from the middle ear by way of
eustachian tube
 Senses
Vision
➢ Pupillary reflex or ability to
contract the pupil is present
from birth
➢ Blink or squint reflex at 26 weeks
➢ seeing light and dark in utero
focus best on black and white at
a distance of 9 to 12 inches
 Senses
Touch
➢ well developed at birth
➢ quiet down at a soothing touch
➢ Cry at painful stimuli
➢ Sucking and rooting as
stimulated by touch
Taste
➢ Ability to discriminate taste
because taste bud is developed
and functioning even before
birth
Smell
➢ present in newborn as soon as
the nose is clear
➢ Turns towards mothers breast
 APGAR SCORING
➢ Done at 1 minute and 5 minutes
after birth
➢ High correlation between low 5
minute Apgar score and
neurological illness
➢ Devised by dr. Virginia Apgar
year 1958
➢ Assessment scale o the following
heart rate, Respiratory effort,
Muscle tone, Reflex irritability,
Color

Assessment for
Well- Being
 Nursing Care of a
Family with a Newborn
Ch-18
Skills

Dr. Leonila M. Adarlo, MAN,RN

 Apgar Score
Sign 0 1 2
H-eart rate No heart rate <100 >100
R-espiratory No respiratory weak cry, slow Strong vigorous
effort effort or difficult cry
respiration
M-uscle Flaccid/limp minimal flexion Maintain a
tone of extremities position of
flexion w/brisk
Apgar Score movement
R-eflex No response to Grimace when Cries or sneezes
irritability stimulation stimulated when stimulated
C-olor Body extremities Body pink, Body and
blue(cyanosis) or extremities extremities pink
completely pale blue
(pallor ) (Acrocyanosis)
Interpretation of Results
0-3 – the baby is in serious danger and
needs immediate resuscitation
4-6 – condition is guarded and may need
more extensive clearing of the
airway
7-10 – the baby is in his best possible
health
 Ballard Score
NEUROMUSCULAR MATURITY
SIGN SIGN
SCORE SCORE

-1 0 1 2 3 4 5
Posture
Square
Window
Arm
Recoil
Popliteal
Angle
Scarf Sign
Heel To
Ear

TOTAL NEUROMUSCULAR SCORE

PHYSICAL MATURITY
SIGN SIGN
SCORE SCORE
-1 0 1 2 3 4 5
superfici
al cracking parchme
Sticky, gelatino smooth
peeling , pale nt, deep leathery,
friable, us, red, pink,
Skin &/or areas, cracking cracked,
transpare transluc visible
rash, rare , no wrinkled
nt ent veins
few veins vessels
veins

abundan bald mostly

none sparse thinning
Lanugo t areas bald

heel-toe anterior
creases
40- >50 mm transver
Plantar faint red creases over
50mm: -1 no se
Surface marks ant. 2/3 entire
<40mm: - crease crease
sole
2 only
SIGN SIGN
SCORE SCORE
-1 0 1 2 3 4 5

stippled raised
barely flat full areola
impercep areola areola
Breast perceptabl areola 5-10 mm
table 1-2 mm 3-4 mm
e no bud bud
bud bud

well-
lids fused lids open sl. curved formed &
curved thick
Eye / loosely: - pinna flat pinna; firm
pinna; soft cartilage
Ear 1 stays soft; slow instant
but ready ear stiff
tightly: -2 folded recoil recoil
recoil
testes in
scrotum testes testes
scrotum upper testes
Genital empty, descendin down,
flat, canal, pendulous,
s (Male) faint g, good
smooth rare deep rugae
rugae few rugae rugae
rugae

TOTAL PHYSICAL MATURITY SCORE

MATURITY RATING TABLE
TOTAL SCORE
(NEUROMUSCULAR + WEEKS
PHYSICAL)
-10 20
-5 22
0 24
5 26
10 28
15 30
20 32
25 34
30 36
35 38
40 40
45 42
50 44
 Nursing Care of a
Family with a Newborn
Ch-18
p440
Day-20

Dr. Leonila M. Adarlo, MAN,RN

 Skin
Color
✓ Acrocyanosis normal
✓ Ruddy complexion among
✓ Central Cyanosis newborn
✓ Gray Color

Acrocyanosis
➢ Bluish discoloration of the hands
and feet
➢ Normal within 24 to48 hrs.

Appearance of the
Newborn
 Skin
Color
✓ Acrocyanosis normal
✓ Ruddy complexion among
✓ Central Cyanosis newborn
✓ Gray Color

Acrocyanosis
➢ Bluish discoloration of the hands
and feet
➢ Normal within 24 to48 hrs.

Appearance of the
Newborn Acrocyanosis
 Central Cyanosis
➢ Cyanosis of the trunk
➢ Indicates decreased oxygenation
due to temporary respiratory
obstruction
➢ Can be due to respiratory or
cardiac problem

Appearance of the
Newborn
 Hyperbilirubenemia
➢ Due to accumulation of excess
bilirubin in blood serum
Physiologic Jaundice
➢ eyes and skin become
noticeably yellow on the 2nd or
3rd days of life as a result of
breakdown of fetal RBC
➢ Heme further broken down
into iron and protoporphyrin
➢ Protoporphyrin is broken
down into indirect bilirubin
which is fat soluble and cannot
Appearance of the
be excreted by the kidney
Newborn
 Hyperbilirubenemia

Note: in order to be removed from

the body it must be converted by
the liver enzyme Glucoronyl
Transferase into direct bilirubin
which is water soluble and then
incorporated to stool and
excreted as feces

Appearance of the
Newborn
 Hyperbilirubenemia
➢ Pathologic Jaundice- <24 hrs.
➢ Physiologic Jaundice-2nd & 3rd
days of life
➢ Blanch technique
Jaundice:
➢ Observe infant prone to
bruising , it can lead to
hemorrhage and blood can
be broken down and can add
to the amount of Indirect
bilirubin
Appearance of the
Newborn
 Hyperbilirubenemia
Jaundice:
Caphalhematoma
➢ Blood hemolyzed, additional
indirect bilirubin is released
and another cause of jaundice
Intestinal obstruction
➢ Stool cannot be evacuated
Early Feeding
➢ Promotes intestinal movement
, excretion of meconium helps
indirect bilirubin to build up
Appearance of the
Newborn
 Hyperbilirubenemia
Acute bilirubin encephalopathy
or kernicterus
- above normal bilirubin are
dangerous (20mg/100ml)
leaves in the bloodstream it
can interfere with chemical
synthesis of brain cells
resulting in permanent cell
damage
- Permanent neurologic
damage including cognitive,
vision, hearing
Appearance of the
Newborn
 Hyperbilirubenemia
Physiologic Jaundice
✓ 2nd & 3rd days of life
✓ Treatment is not necessary
✓ Early feeding to speed the
passage of meconium
➢ Pathologic Jaundice- <24 hrs.

➢ Blanch technique
Jaundice:
direct bilirubin- 1.7
indirect bilirubin- 13.2
kernicterus or ABE
Appearance of the
Newborn
 Hyperbilirubenemia
Jaundice
✓ 10-12ng/100ml- needs
treatment
✓ Phototherapy helps for
the maturation of the
liver enzyme

Appearance of the
Newborn
Management:
✓ Initiation of early feeding
✓ Phototherapy
• Cover the eyes
• Lights is 12-30 in above the newborn’s bassinet
• Monitor v/s particularly the temperature
• Hydration
• Cover the genital to prevent PRIAPISM
Management:
✓ Initiation of early feeding
✓ Phototherapy
• Monitor intake and output
• Assess the color of the stool (bright green and loose)
• Assess the skin turgor
 ;
Breast feeding jaundice (p471)
✓ Occurs in as many as 15% of
breastfed infant
✓ Pregnanediol in breast milk-
breakdown product of
progesterone depresses the
action of GT, remains in 24-
48 hrs
✓ Glucoronyl transferase –
responsible in the
conversion of indirect
bilirubin to direct bilirubin
 ; feeding jaundice (p471)
Breast
Management:
✓ Feed frequently
✓ Provide the colostrum
✓ Observe for jaundice at
home
Note: Colostrum is a natural
laxative and helps promote
passage of meconium and
bile. Pregnanidiol stays in
the breast milk for 24-48hrs
 ;
Note: Above normal indirect bilirubin levels are
potentially dangerous, about 20mg/100ml
leaves the bloodstream it can interfere with
the chemical synthesis of the brain cells
resulting to brain cell damage
 Pallor
➢ Occurs as a result of anemia
• Low iron stores caused by
poor maternal nutrition
• Blood incompatibility in
which large number of RBC
were hemolyzed in utero
• Fetal-maternal transfusion
• Inadequate blood flow from
the cord into the infant at
birth before the cord was cut

Appearance of the
Newborn
 Pallor
• excessive blood loss when the
cord was cut
• Internal hemorrhage
- to detect this monitor
closely for signs of blood in
the stool or vomitus
Management:
To restore blood volume;
✓ Give supplemental iron
✓ PRBC transfusion to restore
blood volume
Appearance of the
Newborn
✓ Harlequin sign
Birthmarks :
✓ hemangiomas
✓ Mongolian spot
- disappear by school age
✓ Harlequin sign
Birthmarks :
✓ hemangiomas
✓ Mongolian spot
- disappear by school age
✓ Vernix caseosa
✓ Lanugo
✓ 37-39 wks more lanugo as compare to post term
infant
✓ 42 weeks or more rarely have lanugo

Harlequin sign
✓ Vernix caseosa
✓ Lanugo
✓ 37-39 wks more lanugo as compare to post term
infant
✓ 42 weeks or more rarely have lanugo
✓ Desquamation
✓ Milia -disappear by 3 to 4 weeks
✓ Erythema toxicum (flea bite rash)
appear on the 1st to 4th day of life
✓ Forceps marks- marks disappear in 1 to 2 days
✓ Skin turgor
Milia
 HEAD
➢ Appears disproportionately
large
➢ It is about ¼ of the total body
length
➢ Forehead appears large and
prominent
➢ Chin appears receding and
quivers easily when startled
or cry
➢ Hair full bodied, poorly
nourished and preterm have
thin lifeless hair

Appearance of the
Newborn
 HEAD
Fontanelles
➢ Spaces or opening where the
skull bone join
Anterior fontanelle
➢ located at the junction of 2
parietal bone and 2 fused
bone
➢ felt a soft spot
➢ Not indented- (+) dehydration
➢ Not bulging- (+) IICP
➢ Diamond in shape
➢ A-D – 12-18 mos
Note: may bulge if strain to pass
Appearance of the stool, cries vigorously, lying
Newborn supine
 HEAD
Fontanelles
Posterior fontanelle
➢ located at the junction of
parietal bone and occipital
bone
➢ Triangular in shape
➢ PT – 2-3 mos
➢ So small that it cannot be
palpated readily

Appearance of the
Newborn
 HEAD
Fontanelles
➢ Spaces or opening where the
skull bone join
Posterior fontanelle
➢ located at the junction of
parietal bone and occipital
bone
➢ Triangular in shape
➢ PT – 2-3 mos
➢ So small that it cannot be
palpated readily
Appearance of the
Newborn
Indication Caput Succedaneum Cephalhematoma
Definition Edema of the scalp, size of Collection of bloody
an large egg, crosses the fluid, does not cross
Indi
suture line the suture line
Location Presenting part of the head Between periosteum
usually happened on the of the skull bone
2nd stage of labor
Cause Pressure (prolonged labor) Pressure (ruptured
capillaries)
absorption 3rd or 4th day Weeks-months
complication none Observe for jaundice
due to large amount of
indirect bilirubin
released
treatment none support
 HEAD
Fontanelles
➢ Spaces or opening where the
skull bone join
Posterior fontanelle
➢ located at the junction of
parietal bone and occipital
bone
➢ Triangular in shape
➢ PT – 2-3 mos
➢ Common among first-born infant
➢ Caused by pressure of the fetal skull against mother’s pelvic
bone
➢ Skull is so soft, pressure of examining finger can indent it
 Eyes
➢ To inspect the eye lay the
baby in supine position; lift
the head it causes the baby to
open the eyes
➢ Lacrimal duct not fully
mature until about 3 mos.
➢ Iris assume its permanent
color between 3-12 mos.
➢ Appears clear, no purulent
discharge or redness
➢ Erythromycin ophthalmic
ointment protect the eyes
Appearance of the from chlamydia infection
Newborn
 Eyes
✓ opthalmia neonatorum
✓ Chlamydia infection
✓ Subconjunctival hemorrhage-
due to pressure during birth
and completely absorbed 2-3
weeks
✓ Periorbital edema- 2-3 days
until the kidney are capable
of evacuating fluid efficiently
✓ Blinking reflex
✓ Black and white color
✓ 9-12 in distance
Appearance of the
Newborn
 Ears
✓ Low set ears- associated with
chromosomal abnormality
✓ Small tag- can be removed at
1 wk old, may be associated
with chromosomal or kidney
disease
✓ Startle reflex
✓ Bell- 6 in away
✓ Hearing test

Appearance of the
Newborn
Newborn Hearing Screening

➢ R.A. 9709: Universal Newborn

Hearing Screening and
Intervention Act of 2009
➢ Universal Newborn Hearing
Screening Program (UNHSP) for
the early detection of congenital
hearing loss and referral for early
intervention for infants
➢ hearing loss screening among
newborns or infants three (3)
months old and below
NOSE
➢ Normally has milia
➢ Appears large for the face
➢ Test for choanal atresia
➢ Close the infant’s mouth
while compressing one
naris at a time
➢ Note any distress with
breathing while one side
of the nose is blocked
MOUTH
➢ Should open evenly
➢ Tongue appear short or
“tongue tied”
➢ Intact palate
➢ Epstein pearl may be
present
➢ Natal teeth
➢ + sucking reflex and
swallowing
➢ Filled with mucus that
seems to be blowing
bubbles suspect for TEf
 MOUTH

Ankyloglossia

Epstein’s pearl Natal teeth

MOUTH
Abnormalities:
Cleft Palate
Cleft lip
NECK
✓ Short and chubby
✓ Head lag
✓ Thymus gland- enlarge due to rapid growth
of glandular tissue
• Triple in size by 3 yrs. of age and the
size remains until 10 yrs. old
CHEST
✓ Breast may be engorged
✓ Witch’s milk
✓ 2 inc. smaller than the HC
✓ 30-60 respirations
NOTE:
Retraction suggest respiratory
Grunting distress
ABDOMEN
✓ Slightly protuberant
✓ Scaphoid or sunken-
missing abdominal
contents or
diaphragmatic hernia
✓ Bowel sound and
bowel peristalsis is
present within 1 hour
after birth
ABDOMEN
✓ Liver- is palpable 1-2cm
below the right costal
margin
✓ Spleen- is palpable 1-
2cm below the left
costal margin
Umbilical cord
✓ Appears a white
gelatinous structure
marks with blue and red
streaks on the first hour
ABDOMEN
Umbilical cord
✓ AVA
✓ Inspect cord clamp is
secure
✓ After first hour the cord
will begin to dry and
shrink
✓ Turn brown as if a dead
end of a vine
✓ 2nd or 3rd day, turns
black
ABDOMEN
Umbilical cord
✓ 6-10 days it breaks free
leaving a granulating a
few cm that will heal
during the following
week
✓ No bleeding in the base
of the cord nor appears
wet
ABDOMEN
Umbilical cord
✓ Omphalangia
✓ Omphalitis- antibiotic
✓ Patent urachus a
narrow opening that
connects the bladder
and the umbilicus
✓ Inspect the base of the
cord for Abdominal
hernia
ABDOMEN
Umbilical cord
✓ a wall defect smaller than 2
cm will close by school age
✓ Larger defects requires
surgery
✓ Abdominal reflex – stroking
each quadrant of the
abdomen will cause the
umbilicus to wink
ABDOMEN
Umbilical cord
Abdominal reflex
✓ test for spinal nerves
T8-T10 but may not be
observable until it is
stronger at about 10th
day of life
ABDOMEN
Abnormalities
Omphalocele
Gastroschisis

Omphalitis Omphalangia
ANOGENITAL AREA
Anal patency
✓ Check the patency by inserting tip of a
gloved lubricated little finger
✓ Note the time of first meconium
✓ Should pass meconium within 24 hrs
✓ Suggest anatomical or physiologic problem
if no meconium passed and must be
investigated
ANOGENITAL AREA
MALE GENITALIA
✓ Scrotum- edematous, pendulous, rugae,
both testes are present
✓ Cryptorchidism- undescended testes
- vas deferens or artery is too short to allow
the testes to descend
✓ Agenesis – absence of testes
✓ Ectopic testes- testes is in the abdomen
and cannot enter the scrotum due to closed
scrotal sac opening
ANOGENITAL AREA
MALE GENITALIA
✓ Cremasteric reflex- T8-T10
- stroking the inner side of the thigh, as the
skin on the thigh is stroked the testis on
that side moves perceptibly in upward
motion
 MALE GENITALIA
✓ Penis- 2cm long
✓ EpispaDiaS-dorsal
surface
✓ Hypospadias-ventral
surface
✓ Left testicle is slightly
lower than the right

Hypospadias
MALE GENITALIA
✓ Penis- 2cm long
✓ EpispaDiaS-dorsal
surface
✓ Hypospadias-ventral
surface
FEMALE GENITALIA
✓ Pseudomenstration
 FEMALE GENITALIA
✓ Appears swollen due
to the effect of
maternal hormone
✓ Pseudomenstruation,
blood tinged mucus
cause by maternal
hormone
✓ Disappear 1 to 2 days

Hypospadias
BACK
✓ Appears flat in the lumbar and sacral area
Inspect for the ff:
➢ Pinpoint opening suggest
➢ Dimpling and spinal
➢ Sinus tract in the skin bifida
EXTREMITIES
✓ Arms and legs
appears short in
proportion to the
trunk
✓ Hands typically
clenched
✓ Fingernails, soft,
smooth and extends
to fingertips
EXTREMITIES
✓ Simian crease a single
palmar crease commonly
seen among Down
syndrome
✓ Arms and legs should
move symmetrically
✓ Asymmetry suggest birth
injury on the clavicle,
brachial or cervical
plexus or fracture of a
long bone
EXTREMITIES
✓ Polydactyl
✓ Syndactyl
EXTREMITIES
✓ Legs appears bowed or
short
✓ Term baby’s foot have
many crisscrossed lines on
the sole covering almost
2/3 of the sole
✓ Less creases or no creases
suggest prematurity
 Nursing Care of a
Family with a Newborn
Ch-18
p440
Day-21

Dr. Leonila M. Adarlo, MAN,RN

 Appearance of the Newborn
1.Establish and maintain airway
patency
Don'ts:
x Stimulate baby to cry unless
secretions have been
drained out
x Suction the nose will cause
reflex inhalation- aspiration
x Prolong suctioning process-
stimulate vagus nerve -
bradycardia
 Care of Newborn at Birth(p451)
1.Identification Band
- traditional form of
identification using a plastic
bracelet with a permanent
lock
2. Birth registration
- the primary care provider
who supervised a newborn
birth has the responsibility
to be certain of birth
registration
 Care of Newborn at Birth
3. Birth record documentation
- The infant chart is vital piece
of documentation. It should
contain the following:
1. time of birth
2. time the infant breastfed
3. whether respiration is
spontaneous or aided
4. Apgar score at 1 min and
5 min of life
5. whether eye prophylaxis
was given
 Care of Newborn at Birth
3. Birth record documentation
6. whether Vitamin K was
administered
7. general condition of the
infant
8. number of vessels in the
umbilical cord
9. whether cultures were
taken
10. whether the infant
voided or passed stool
 Immediate Care Essentials
The Neonate
1.Establish and maintain airway
patency
Don'ts:
x Stimulate baby to cry unless
secretions have been
drained out
x Suction the nose will cause
reflex inhalation- aspiration
x Prolong suctioning process-
stimulate vagus nerve -
bradycardia
Don'ts:
x Place the newborn in a
head down position if
there are sign of ICP
✓ B- ulging, tensed
fontanel
✓ A- bnormally large head
✓ D- ecreased PR and RR
✓ V- omiting
✓ I - ncreased BP
✓ W- idening pulse
pressure
✓ S- hrill, high-pitch cry
Don'ts:
x Place the newborn in a
head down position if
there are sign of ICP
✓ B- ulging, tensed
fontanel
✓ A- bnormally large head
✓ D- ecreased PR and RR
✓ V- omiting
✓ I - ncreased BP
✓ W- idening pulse
pressure
✓ S- hrill, high-pitch cry
Don'ts: During the 1st 30 secs:

• Do not ventilate unless the

baby is floppy/limp and not
breathing
• Do not suction unless the
mouth/nose are blocked with
secretions or other material
• Do not wipe off the vernix
• Do not bathe the newborn
• Do not do foot printing (in
12hrs. creases will change)
• No slapping
• No hanging upside-down
• No squeezing of chest
How not to hold the baby

1. holding the baby by

ankles upside down
Dangers of doing it:
• Increased ICP
• Compromised
breathing
• Ankle pain
2. Acute trendelenburg
10-15 degrees angle
Do’s:
✓ place the newborn in a
position that will facilitate
drainage of secretions
✓ head lower than the rest of
the body
✓ place on trendelenburg
position unless
contraindicated
✓ suction gently and quickly if
indicated- mouth first before
the nose
✓ test patency of the airway
NOTE: Newborn are obligatory
nose breather
Weight Variances
S-mall for gestational age
A-ppropriate for gestational
age
L-arge for gestational age
L-ow birth weight
V-ery low birth weight
E-xtremely low birth weight
Small for Gestational Age
✓ Below 10th percentile
✓ IUGR
✓ Nutrition
✓ Placental anomaly
✓ DM
✓ PIH
✓ Smoking heavily
✓ Narcotic
✓ Intrauterine infections
Small for Gestational Age
✓ Below 10th percentile
✓ IUGR
✓ Nutrition
✓ Placental anomaly
✓ DM
✓ PIH
✓ Smoking heavily
✓ Narcotic
✓ Intrauterine infections
Small for Gestational Age
Common problem:
✓ Hypoglycemia
✓ Hypothermia
Nursing Diagnosis:
Risk for ineffective
thermoregulation related
to lack of subcutaneous
fats
Large for Gestational Age
✓ Fall above 90th percentile of
weight
✓ born with diabetic mother
✓ Delivered by multiparous
woman
Common problem:
✓ Hypoglycemia
Other related problem
✓ Erb-duchenne paralysis
✓ Prominent caput and
cephalhematoma
Low birth weight
✓ weighs under 2,500 gms
Very Low birth weight
✓ Weighs under 1,000 to 1,500
Extremely low birth weight
✓ 500-1,000g
Appropriate for Gestational Age
✓ Fall between 10th and 90th
percentile of weight
Birth weight: 2,500 - 3,400 gm
• Doubles at 6 months
• Triples at 12 months
• Average weight gain – 2 lbs
( 1st 6 months)
- 1 lb ( 7 – 12 months)
• 4 X at 2 years
Abnormal Findings:
• SGA
• LGA
NUTRITION-(p468)
✓ Breast milk formed in the
acinar or alveolar cells of the
mammary glands
✓ After delivery of placenta,
progesterone falls
dramatically stimulating the
production of prolactin an
anterior pituitary hormone
NUTRITION-(p468)
Colostrum
✓ a thin watery, yellow fluid
composed of protein, sugar,
fat, water, minerals,
vitamins, and maternal
antibodies
✓ For the first 3-4 days
production of colostrum
continues
✓ Easily digested
✓ Can provide adequate
nutrition
NUTRITION-(p468)
✓ Transitional breast milk- on 2nd-
4th day
✓ True or mature milk on the 10th
day
✓ Fore milk continuously forming
milk
✓ Let-down reflex- forcing the milk
forward to the nipple
✓ Hind milk- new milk formed after
let down, higher in fat
that makes the infant
grow rapidly
NUTRITION
Contraindication of Breast feeding
✓ Infant with galactosemia- infant
cannot digest the lactose in milk
✓ Herpes lesion on mother’s nipple
✓ Maternal exposure to radioactive
compound such as thyroid testing
✓ Mothers receiving
antimetabolites or
chemotherapeutic agents
✓ Receiving prescribed medication
which is harmful to the baby such
as lithium or methotrexate
NUTRITION
Contraindication of Breast feeding
✓ Women with maternal active,
untreated TB
✓ Positive for HIV
- in developing countries women
with HIV is advised to BF the
baby due to unavailability of
commercial formula
✓ Women with substance abuse
 Nursing Care of a
Family with a Newborn
Ch-18
p-468
Day-22

Dr. Leonila M. Adarlo, MAN,RN

BREAST FEEDING
• Universally agreed that
breastmilk is the
preferred food for
newborn
• Provides numerous
health and benefits
• Remains the ideal
nutritional source for
infants through the first
year of life
 HEALTH EDUCATION
Implementing steps in health care
facilities:
1. Educating all pregnant women
about the benefits and
management of breast feeding
2. Helping women initiate bf within
half an hour after birth
3. Assisting mothers to breastfeed
and maintain lactation even if
they should separated from the
infant
4. Not giving newborn food or drink
other than breast milk unless
medically indicated. Advise
women not to introduce solid
food until at least 4 months
 HEALTH EDUCATION
Implementing steps in health care
facilities:
5. Not giving newborn pacifiers to
quiet them as this can reduce the
sucking initiative
6. Supporting rooming-in by allowing
mother and infant together 24
hours a day
7. Encourage bf on demand
8. Fostering the establishment of bf
support groups and referring
mother to them on discharge from
the birthing center or hospital
NUTRITION
Contraindication of Breast feeding
✓ An infant with galactosemia
where an infant cannot digest the
lactose
✓ Herpes lesion on mother's nipple
✓ Maternal exposure to radioactive
compounds like thyroid testing
✓ Mothers receiving
antimetabolites or
chemotherapeutic agents
NUTRITION
Contraindication of Breast feeding
✓ Mothers receiving prescribed
medication that is harmful to the
infant like lithium and
methotrexate
✓ Maternal active untreated TB
✓ Positive for HIV who are advised
not to breastfeed until further
studies confirm the risk of not bf
outweighs the risk of breast milk
transmission of the virus
✓ Toxicology screen for substance
abuse becomes positive
NUTRITION
Advantage of Breast feeding
✓ Release of oxytocin from the
posterior pituitary glands aids in
uterine involution
✓ BF serves as protective function I
preventing breast and ovarian
cancer
✓ May return to pre-pregnant
weight
✓ If menstruation is delayed, may
serve as temporary family
planning method
NUTRITION
Advantage of Breast feeding
✓ Successful bf have an
empowering effect , it is a skill
only a woman can master
✓ Reduces the cost of feeding and
preparation time of infant feeding
✓ Long term effect reduces hip
fracture and osteoporosis in
postmenopausal period
✓ Enhances symbiotic bonding
between mother and child
1.Interventions within the first 90
minutes
➢ Immediate and thorough drying
➢ Skin to skin contact between
mother and newborn
➢ Cord clamping 1 to 3 minutes after
birth
➢ Early initiation of breastfeeding
means breastfeeding within an
hour after birth
➢ Non-separation of baby from the
mother, also known as rooming-in
Essential newborn care after 90
minutes to 6 hours
➢Vitamin K prophylaxis;
➢Hepatitis B and BCG
vaccination;
➢Examination of the baby for
birth injuries, malformations, or
defects; and
➢Additional care for a small baby
(a baby with a birth weight
<2,500 Gms) or twin.
 THE EVIDENCE IS SOLID
The following Newborn care practices will save lives

Immediate and thorough drying

of the baby

Early Skin-to-Skin Contact

Properly-Timed cord clamping

Non-Separation of Newborn from

mother for early breast feeding
 Expanded Program on
Immunization (EPI)
➢ EPI was established in 1976 to ensure
that infants/children and mothers have
access to routinely recommended
infant/childhood vaccines
Supporting Legislation:
➢ R.A. 10152, also known as
Mandatory Infants and Children
Health Immunization Act of
2011
➢R.A. 7846 provided for
compulsory immunization
against hepatitis B for infants
and children below 8 years old
 Expanded Program on Immunization
Specific Goals of EPI
1. To immunize all infants/children against the
most common vaccine-preventable
diseases.
2. To sustain the polio-free status of the
Philippines.
3. To eliminate measles infection. Presidential
Proclamation No. 4, s. 1998 launched the
Philippine Measles Elimination Campaign
(Office of the President, 1998).
4. To eliminate maternal and neonatal tetanus.
Presidential Proclamation No. 1066, s. 1997
declared a national neonatal tetanus
elimination campaign starting 1997 (Office
of the President, 1997).
5. To control diphtheria, pertussis, hepatitis B
and German measles.
6. To prevent extra pulmonary tuberculosis
among children.
 Tetanus Toxoid (TT) Immunization Schedule
TT Dose Interval % Protected Duration of Protection

TT1 As early as possible

during first pregnancy

TT2 At least 4 weeks later 80% -Infants born to the mother are
protected against neonatal tetanus
- gives 3- year protection to the mother

TT3 At least 6 mos. later 95% -Infants born to the mother are
protected against neonatal tetanus
- gives 5- year protection to the mother

TT4 At least 1 year later 99% -Infants born to the mother are
protected against neonatal tetanus
- gives 10 years protection to the mother

TT5 At least 1 year later 99% - All infants born to the mother are
protected against neonatal tetanus
- gives lifetime protection to the mother
 Immunization Schedule
Antigen Age Dose Route Site
Right deltoid
BCG vaccine At birth 0.05 ml. region (arm)
Intradermal

Anterolateral
Hepatitis B vaccine At birth 0.5 ml. Intramuscular
thigh muscle
DPT-HepB-Hib
6 weeks, 10 weeks, Anterolateral
(Pentavalent vaccine) 0.74 ml. Intramuscular
14 weeks thigh muscle

6 weeks, 10 weeks,
Oral polio vaccine 2 drops Oral Mouth
14 weeks
Anti- measles vaccine
Outer part of
(AMV1) 9-11 months 0.5 ml. Subcutaneous
upper arm
Measles-mumps-
Outer part of
rubella vaccine 12-15 months 0.5 ml. Subcutaneous
upper arm
(AMV2)
Rotavirus vaccine 6 weeks, 10 weeks 1.5 ml. Oral Mouth
 Immunization Schedule
Vaccine
Antigen Age ContentsDose Route Form Site
BCG (Bacillus Calmette- Live, attenuated bacteria Freeze-dried, reconstituted
Right deltoid
Guerin) with a special diluent
BCG vaccine At birth 0.05 ml. region (arm)
Intradermal
RNA-recombinant, using Hepatitis B Cloudy, liquid, in an auto-
Hepatitis B vaccine surface antigen (HBs Ag) disable injection syringe if
available Anterolateral
Hepatitis B vaccine At birth 0.5 ml. Intramuscular
thigh muscle
DPT-HepB-Hib Diphtheria toxoid, inactivated pertussis
DPT-HepB-Hib 6bacteria,
weeks, tetanus toxoid, recombinant
10 weeks, Liquid, in anAnterolateral
auto-disable
(Pentavalent vaccine)
(Pentavalent vaccine) DNA surface antigen, 0.74
and ml.
synthetic Intramuscular
injection syringe
14 weeks of Haemophilus influenzae B
conjugate thigh muscle
bacilli
6 weeks, 10 weeks,
Oralpolio
Oral poliovaccine
vaccine 2 drops
Live, attenuated virus (trivalent) Oral Clear, pinkish
Mouth
liquid
14 weeks
Anti- measles vaccine Live, attenuated virus Freeze-dried, reconstituted
(AMV1)
Anti- measles vaccine with a special diluent
Outer part of
Measles-mumps-rubella 9-11 months
(AMV1)
Live, attenuated viruses
0.5 ml. Subcutaneous
Freeze-dried, reconstituted
upper arm
vaccine (AMV2) with a special diluent
Measles-mumps-
Outer
Clear, colorless partinofa
liquid,
rubella
Rotavirusvaccine
vaccine 12-15 months virus 0.5 ml.
Live, attenuated Subcutaneous
container with an oral
applicator upper arm
(AMV2)
Rotavirus vaccine
Tetanus toxoid 6Weakened
weeks, 10toxin
weeks 1.5 ml. Oral Clear, colorless
Mouthliquid
 Vaccines Side Effects Management
Koch’s phenomenon: an acute inflammatory reaction within 2
to 4 days after vaccination; usually indicates previous exposure No management is needed.
Vaccine
Antigen
to tuberculosis. Age Contents Dose Route Form Site
Deep abscess at vaccination site; almost invariably due to Refer to the physician for incision and
BCG
BCG
(Bacillus Calmette-
subcutaneous or Live,
deeper attenuated
injection. bacteria drainage.
Freeze-dried, reconstituted
Right deltoid
Guerin) with a special diluent
BCG vaccine Indolent ulceration:At
anbirth
ulcer which persists after 0.05 ml.from Treat with INH powder.region (arm)
12 weeks
vaccination date. Intradermal
RNA-recombinant,
Glandular enlargement: enlargement of lymph using Hepatitis
glands draining B
Cloudy, liquid, in an auto-
Hepatitis B vaccine disable
If suppuration injection
occurs, syringe
treat as deep if
abscess.
the injection site. surface antigen (HBs Ag) available Anterolateral
Hepatitis
Hepatitis B B vaccine At birth
Local soreness at the injection site. 0.5 ml. Intramuscular
No treatment is necessary.
vaccine thigh muscle
Fever that usually lasts for only 1 day.
Diphtheria Fever inactivated
toxoid, beyond 24 hours is
pertussis
DPT-HepB-Hib Advise mother to give antipyretic.
not due to the vaccine but to other
bacteria, causes.toxoid, recombinant
tetanus
DPT-HepB-Hib 6 weeks, 10 weeks, Liquid, in anAnterolateral
auto-disable
(Pentavalent
(Pentavalent vaccine)
vaccine)
Local soreness at the
DNA surface
injection
antigen, 0.74
and ml.
synthetic Intramuscular
Reassure mother that soreness will
injection syringe
DPT-HepB- 14 weekssite.
conjugate of Haemophilus influenzae B
disappear thigh muscle
after 3 to 4 days.
Hib
Abscess after a weekbacilli
or more usually indicates that the
(Pentavalent Incision and drainage may be necessary.
injection was not deep enough or the needle was not sterile.
vaccine) 6 weeks, 10 weeks,
Oralpolio
Oral poliovaccine
vaccine
Convulsions: althoughLive,
very attenuated
rare, may virus
occur
2 drops
(trivalent)
inchildren older
Oral ofMouth
Clear, pinkish
Proper management liquid
convulsions;
14 weeks pertussis vaccine should not be given
Anti- measles than 3 months; caused by pertussis vaccine.
vaccine Live, attenuated virus anymore.Freeze-dried, reconstituted
(AMV1)
Anti- measles
OPV Nonevaccine with a special diluent
Outer part of
(AMV1)
Anti- 9-11
measles Fever 5 to 7 days after
Measles-mumps-rubella monthsin some children.
vaccination 0.5 ml. Subcutaneous
ReassureFreeze-dried,
the mother and instruct her to
reconstituted
vaccine Sometimes, there isLive,
a mildattenuated
rash. viruses upper
give antipyretic to the child. arm
vaccine (AMV2) with a special diluent
Measles-mumps- Reassure the mother and instruct her to
MMR Local soreness, fever, irritability, and malaise in some children.
give antipyretic Outer
Clear,tocolorless
the child. partinofa
liquid,
rubella
Rotavirusvaccine
Rotavirus vaccine 12-15
Live,
Some children develop mild months
attenuated
vomiting andvirus 0.5fever
diarrhea, ml.and Subcutaneous
Reassurecontainer with
the mother and an oral
instruct her to
applicator upper arm
(AMV2) irritability.
vaccine give antipyretic and Oresol to the child.
Tetanus
Rotavirus vaccine Apply cold compress at the site. No other
Tetanus toxoid
toxoid 6Weakened
Local soreness at the weeks, 10toxin
injection site. weeks 1.5 ml. Oral
treatmentClear, Mouth
colorless
is needed. liquid
 Vaccines Side Effects Management
Koch’s phenomenon: an acute inflammatory reaction within 2
to 4 days after vaccination; usually indicates previous exposure No management is needed.
Vaccine
Antigen
to tuberculosis. Age Contents Dose Route Form Site
Deep abscess at vaccination site; almost invariably due to Refer to the physician for incision and
BCG
BCG
(Bacillus Calmette-
subcutaneous or Live,
deeper attenuated
injection. bacteria drainage.
Freeze-dried, reconstituted
Right deltoid
Guerin) with a special diluent
BCG vaccine Indolent ulceration:At
anbirth
ulcer which persists after 0.05 ml.from Treat with INH powder.region (arm)
12 weeks
vaccination date. Intradermal
RNA-recombinant,
Glandular enlargement: enlargement of lymph using Hepatitis
glands draining B
Cloudy, liquid, in an auto-
Hepatitis B vaccine disable
If suppuration injection
occurs, syringe
treat as deep if
abscess.
the injection site. surface antigen (HBs Ag) available Anterolateral
Hepatitis
Hepatitis B B vaccine At birth
Local soreness at the injection site. 0.5 ml. Intramuscular
No treatment is necessary.
vaccine thigh muscle
Fever that usually lasts for only 1 day.
Diphtheria Fever inactivated
toxoid, beyond 24 hours is
pertussis
DPT-HepB-Hib Advise mother to give antipyretic.
not due to the vaccine but to other
bacteria, causes.toxoid, recombinant
tetanus
DPT-HepB-Hib 6 weeks, 10 weeks, Liquid, in anAnterolateral
auto-disable
(Pentavalent
(Pentavalent vaccine)
vaccine)
Local soreness at the
DNA surface
injection
antigen, 0.74
and ml.
synthetic Intramuscular
Reassure mother that soreness will
injection syringe
DPT-HepB- 14 weekssite.
conjugate of Haemophilus influenzae B
disappear thigh muscle
after 3 to 4 days.
Hib
Abscess after a weekbacilli
or more usually indicates that the
(Pentavalent Incision and drainage may be necessary.
injection was not deep enough or the needle was not sterile.
vaccine) 6 weeks, 10 weeks,
Oralpolio
Oral poliovaccine
vaccine
Convulsions: althoughLive,
very attenuated
rare, may virus
occur
2 drops
(trivalent)
inchildren older
Oral ofMouth
Clear, pinkish
Proper management liquid
convulsions;
14 weeks pertussis vaccine should not be given
Anti- measles than 3 months; caused by pertussis vaccine.
vaccine Live, attenuated virus anymore.Freeze-dried, reconstituted
(AMV1)
Anti- measles
OPV Nonevaccine with a special diluent
Outer part of
(AMV1)
Anti- 9-11
measles Fever 5 to 7 days after
Measles-mumps-rubella monthsin some children.
vaccination 0.5 ml. Subcutaneous
ReassureFreeze-dried,
the mother and instruct her to
reconstituted
vaccine Sometimes, there isLive,
a mildattenuated
rash. viruses upper
give antipyretic to the child. arm
vaccine (AMV2) with a special diluent
Measles-mumps- Reassure the mother and instruct her to
MMR Local soreness, fever, irritability, and malaise in some children.
give antipyretic Outer
Clear,tocolorless
the child. partinofa
liquid,
rubella
Rotavirusvaccine
Rotavirus vaccine 12-15
Live,
Some children develop mild months
attenuated
vomiting andvirus 0.5fever
diarrhea, ml.and Subcutaneous
Reassurecontainer with
the mother and an oral
instruct her to
applicator upper arm
(AMV2) irritability.
vaccine give antipyretic and Oresol to the child.
Tetanus
Rotavirus vaccine Apply cold compress at the site. No other
Tetanus toxoid
toxoid 6Weakened
Local soreness at the weeks, 10toxin
injection site. weeks 1.5 ml. Oral
treatmentClear, Mouth
colorless
is needed. liquid
 Contraindications to Immunization
In general, there are no contraindications to
immunization of a sick child if the child is
well enough to go home
Absolute contraindications – DO NOT GIVE:
➢ Pentavalent vaccine/DPT to
➢ children over 5 years of age
➢ a child with recurrent convulsions or
another active neurological disease of
the central nervous system
➢ Pentavalent vaccine 2 or 3/DPT 2 or
DPT 3 to a child who has had
convulsions or shock within 3 days of
the most recent dose (WHO, 2005a);
 Contraindications to Immunization
In general, there are no contraindications
to immunization of a sick child if the child
is well enough to go home
Absolute contraindications – DO NOT
GIVE:
➢ Rotavirus vaccine when the child has a
history of hypersensitivity to a previous
dose of the vaccine, intussusceptions or
intestinal malformation, or acute
gastroenteritis
➢ BCG to a child who has signs and
symptoms of AIDS or other immune
deficiency conditions or who are
immunosuppressed (DOH, 2003a).
Administrative Order 2005-0014: National Policies
on Infant and Young Child Feeding
Supporting Legislation
Executive Order No. 51: Milk Code
Executive Order No. 382: National Food
Fortification Day
R.A. 7600: Rooming-In And Breast-Feeding Act
R.A. 8172: ASIN (Act for Salt Iodization
Nationwide) Law
R.A. 8976: Philippine Food Fortification Act
R.A. 10028: Expanded Breastfeeding Promotion
Act
A.O. 36, s2010 : Expanded Garantisadong
Pambata (GP)
Administrative Order 2005-0014: National Policies
on Infant and Young Child Feeding
Supporting Legislation
Executive Order No. 51: Milk Code
Executive Order No. 382: National Food
Fortification Day
R.A. 7600: Rooming-In And Breast-Feeding Act
R.A. 8172: ASIN (Act for Salt Iodization
Nationwide) Law
R.A. 8976: Philippine Food Fortification Act
R.A. 10028: Expanded Breastfeeding Promotion
Act
A.O. 36, s2010 : Expanded Garantisadong
Pambata (GP)
 Newborn Screening Test
➢ A simple procedure to find out if a
baby has a congenital metabolic
disorder even before clinical
signs and symptoms are present
➢Metabolic disorders may lead to
mental retardation or even death if
left untreated
➢ NBS is important because most
babies with metabolic disorders
look "normal" at birth
 Newborn Screening Test
➢ A simple procedure to find out if a
baby has a congenital metabolic
disorder even before clinical
signs and symptoms are present
➢Metabolic disorders may lead to
mental retardation or even death if
left untreated
➢ NBS is important because most
babies with metabolic disorders
look "normal" at birth
 Newborn Screening in the Philippines

➢ R.A. 9288: Newborn Screening Act of

2004 prior to delivery
➢ any health practitioner who delivers, or
assists in the delivery, of a newborn in the
Philippines has the obligation to inform
the parents or legal guardian of the
newborn of the availability, nature and
benefits of screening establishment of the
Newborn Screening Reference Center
(NSRC)
Newborn Screening in the Philippines

1. Congenital hypothyroidism inability to produce

enough thyroid hormone
2. Congenital adrenal hyperplasia inability of the
adrenal gland to secrete cortisol or aldosterone
3. Galactosemia unable to metabolize galactose and
the person is unable to tolerate any form of milk
– human or animal
4. Phenylketonuria inability to properly break down
an amino acid called phenylalanine
5. Glucose-6-phosphate-dehydrogenase (G6PD)
deficiency red blood cells break down when the
body is exposed to certain drugs, foods, severe
stress, or severe infection
6. Maple syrup urine disease Inability to break
down the amino acids leucine, isoleucine, and
valine; urine of affected persons smells like
maple syrup
 Newborn Screening in the Philippines

➢ Law provides that NBS be done after 24

hours of life, but not later than three (3)
days
➢ heel prick
➢ A few drops of blood are taken from the
baby's heel, blotted on a special
absorbent filter card and then sent to a
➢ Normal (negative) NBS Results are
available by 7 - 14 working days from the
time samples are received at the NSC
Thank You for
Listening-lma