THE NORMAL

NEWBORN
Prepared by: Kaycee F. Vicente
BSN-2

I. IMMEDIATE CARE IN THE

DELIVERY ROOM
A. Establish Respiration
1.

2.

Clear the neonates air passages with

extension of the fetal head, even before
the chest is born.
Wipe off mucus from mouth to nose;
suction the mouth gently and then the nose
using the bulb syringe.

3. Suction briefly. Suctioning time is 5-10 sec. in fullterm and low-risk newborns and less than 5 sec. in
preterm and other high risk newborns.
4. After expulsion, place the newborn in a slight
Trendelenburg position (10-15 degrees angle head
down).
5. Oxygenate the newborn between suctioning time;
suctioning the newborn may necessitate oxygenating
him.

B. KEEP THE NEWBORN WARM

1.
2.

Dry and wrap the newborn to prevent heat

loss.
Processes of heat Loss
a. evaporation
b. convection
c. conduction
d.radiation

3. There is no shivering in the newborn. When he is

exposed to cold stress, he produces heat by:
a. burning brown fat-Brown fat is located around the
scapula, sternum, kidneys and adrenals.

b. increasing activity/metabolism.
-this process utilizes more glucose and oxygen which
may result in respiratory distress and hypoglycemia.

C. PERFORM APGAR SCORING

-this is a scoring method that gives a numerical
expression of the newborns adaptation to
extra uterine life performed at 1 and 5 min.
after birth; a 10 min. Apgar is performed when
the 5-minute score is under 7.
a. 1-minute scoring
b. 5-minute scoring

Interpretation of Apgar Score

0-3: Poor
:need resuscitation
4-6: Fair
: May need suctioning and oxygenation
: condition guarded
8-10: Good
: no signs of immediate distress

: Needs only admission care, no special care

Heart rate- is the most important Apgar Score,

without the heart rate, all the others will not also
be observed.
Color- is the least important Apgar Score; a score of
9 means acrocyanosis due to the sluggish peripheral
circulation the newborn in the first 24 hours.

Reflex irritability evaluation should not be limited

to the ability to elicit cry or sneezing upon
stimulation.
Good cry means he is breathing well; score
respiration 2. There is no need to count his
respiratory rate.

D. PERFORM PROPER
IDENTIFICATION
The best way to identify is by means of foot
printing of the newborn and fingerprinting
of the mother, although identical ID bands,
bracelets or foot tags may be enough. The
identification bracelets should contain:
a. mothers name
b. mothers hospital number

1.

c. date of delivery
d. time of delivery
e. sex of the baby
2. Identify the newborn properly in the delivery room
and NOT in the Nursery.

E. PROMOTE EARLY BONDING/

ATTACHMENT
1.

2.
3.

Allow parents to hold the newborn to

promote bonding. Encourage breastfeeding
right on the DR table.
Delay eye prophylaxis or Cedes prophylaxis
for 1-2 hours after birth.
Implement early rooming in.

II. IMMEDIATE CARE IN THE

NURSERY
Maintain Respiration
Keep Warm
-maintain body heat and prevent heat loss.
Perform Credes Prophylaxis
Perform cord dressing
Inject Vitamin K
-is given to all newborns to prevent
bleeding due to a deficiency in the clotting
factor Vitamin K.

Best site: anterolateral aspect of the thigh ( vastus

lateralis ); alternate site: medical thigh (rectus
femoris)
Dose: usually 1 mg.
Provide skin care
Take the weight and other measurements
a. Weigh the newborn

-average weight: 3,400 g; normal range 2,500g to

4,000g.
b. Take the newborns length
- average of 50 cm from heel to crown.
c. Take the head circumference
-the normal head circumference is 33-38 cm.
Head- is the biggest part of the body; one fourth of
the bodys length.
e. head abnormalities

- Macrocephaly: greater than the 90th percentile.

- Microcephaly: under 37.7 cm.
- Hydrocephaly: over 36.8 cm. when the head is
excessively large due to an increased amount of
cerebrospinal fluid (CSF).
f. Take the chest Circumference: 31-33 cm.

g. Take the abdominal circumference: 31-33 cm.

h. Check vital signs: BT- axillary: 36.5-37C; rectal:
36.7C.

Caput Succedanum

Cephalhematoma

Scalp Edema

Collection of blood between a skull bone

and its periosteum

Present at birth

Appears 12-24 hours after delivery

From pressure of soft cervix

against presenting head

From pressure of hard pelvis/ forceps

against presenting head.

Bilateral; crosses suture line

Unilateral; does not cross the suture line

Disappears in few days, 3-4 days Regresses in few weeks: 2-3 weeks
(upper limit is 6 weeks)
(upper limit is 5 days)
No intervention needed

No intervention needed

III.NEWBORN SCREENING

Newborn Screening (NBS)-is a procedure to

determine if the newborn infant has a
irritable congenital metabolic disorder that
may lead to serious physical health
complications, mental retardation, and even
death if left undetected and untreated.
Under the NBS, the newborn is a child from
the time of complete delivery to 30 days
old.

HERITABLE CONDITIONS
Any condition that can result in mental
retardation, physical deformity or death if
left undetected and untreated and which is
usually inherited from the genes of either or
both biological parents. Disorders tested in
NBS:
a. Congenital hypothyroidism: endocrine
disorder also referred to as cretinism or
dwarfism; results from the absence or lack of
development of thyroid gland.

b. Congenital Adrenal Hyperplasia(CAH): an

endocrine disorder caused by an inborn defect in the
biosynthesis of adrenal CORTISOL that causes severe
salt or sodium losses.
c. Phenylketonuria (PKU): inborn error of metabolism
characterized by lack of enzymes
d. Galactosemia(GAL): inborn error of metabolism

e. Glucose-6-phosphate-dehydrogenase deficiency
(G6PD): Deficiency in G6PD
Red blood cells lack protection from the harmful
effects of oxidative substances found in drugs,
foods, beverages.

OBLIGATIONS OF HEALTH CARE

PROVIDER

To inform the parents or legal guardian of the

newborn, prior to delivery, of the nature and
benefits of NBS.

ROLES OF HEALTH CARE

PROFESSIONALS
1.
2.
3.
4.
5.
6.
7.
8.

Motivator
Educator
Collaborator
Implementor
Organizer
Change agent
Model
Advocate

IV. CHARACTERISTICS OF THE

NORMAL NEWBORN: CEPHALOCAUDAL ASSESSMENT
HEAD
-round and symmetrical; may have molding;
shaping of the fetal head to accommodate passage
through the birth canal.
B. FACE
1.with symmetrical movement (asymmetry may
indicate a birth injury: facial paralysis)
A.

2. Eyes: evenly placed on face with outer canthus in

line with the upper border of the ears.
3. Ears: Well-formed cartilage by term; may be flat
from pressure during birth
: same level on each side of the head.
3. Nose: Shape varies; may flattened because of
birthing process.

Milia: white or yellow papules commonly seen over

the nose due to obstructed sebaccous glands.
5. Mouth: Close; opens when crying
Lips: equal, complete, with symmetrical movement
Tongue: Midline; freely-moving
Taste: present at birth; prefers sweet over bitter
taste; Palates: intact

Milk Curds

Epsteins Pearls

Oral thrush /
oral moniliasis

white

White

White , cheesy

Patches; easy to remove

Round, pearl-like

Patches; difficult to
remove may cause
bleeding

Over the tongue

Along gum margins and

at the junction of hard
and soft palates

Mouth , over the

tongue and mucous
membranes
* May be as red rash on
the perineum ( brain ,
1999)

Cause; poor oral hygiene

Managed with oral care
and follow milk feeding
with small amount of
sterile water

Candida albicans /
fungi from birth canal
No special care; self
limiting

Oral paint of Mycostatin

( nystatin )
Prevention : treatment
of vaginal monilial
infection before birth

C. NECK
1. Short with skin folds, webbing
2. Moves freely
3. Non- palpable thyroid gland
D. CHEST
4. With
symmetrical chest movements
5. Breath sounds: clear and equal on both sides
6. Heart rate: 110 to 160 bpm, irregular rhythm, and
heard at 3rd or 4th interspace to the left of the
midclavicular line.

: Term neonates u sally maintain a heart rate of

between 110 and 160 bmp
4. May have fuctional, low-pitched, musical murmurs
heard just to the right of the apex of the heart;
common in the 1st month.
5. Cough reflex not present at birth; appears about 2
to 3 days.
6. Breasts enlarged with milky secretion called witch
milk.

E. AB DOMEN
1. Dome/ cylindrical shape. No gross distention or
bulging.
2. Moves with respirations(abnormal breathing)
3. Bowel sounds are positive by the 2nd hour.
4. The kidneys, liver and spleen are normally
palpable.
5. Umbilical cord stump: initially white and
gelatinous with apparent one vein and two
arteries dries within 1 to 2 hours after birth;
sloughs off by 7 to 10 days, although a granulating
area may remain for a few days.

6. Asses for Cord abnormalities

a. Omphalocele (umbilical hernia): the protrusion of
abnormal viscera through an abnormal defect.
b. Omphalanghia: bleeding of the a complication in
the first 24 hours, when the vessels are still
patent and there still is poor clotting in the
newborn.
c. Foul drainage: generally caused by local infection
and may lead to septicemia if not treated early.
d. Patent urachus: abnormal connection between the
umbilicus and bladder.

GENITALIA
a. Urinary meatus at the tip of the penis
b. Foreskin covers glans: pre prepuce can be
retracted but not easily retractable in a few
months
c. Tight foreskin, primroses, may be managed by
circumcision if it interferes with voiding.
d. Scrotum: dark and with extensive rugae (sign of
maturity).
F.

E. Testes: descended and palpable bilaterally

F. Variations

Epspadias: penile opening on the dorsal or upper

segment

Hypospadias: penile opening on the ventral or

under surface

Hydrocele: a collection of fluid surrounding the

testes in the scrotum is common in newborn and
should be identified

Cryptorchidism is undescended testes (common in

pre mature babies)

2.
a.
b.
c.

d.

Female Genitalia
Labia majora symmetrical, slightly edematous,
cover labia minora.
Hymen intact and evident (variation: imperforate
hymen)
Pseudo menstruation: normal, occasional bloodtinged vaginal discharge due to maternal
hormones
Clitoris: enlarged.

G. BACK
1. With the baby prone, check the spine.
2. Smooth with no sac nor dimple (variation:
spinabifida)
H. BUTTOCKS
3. Mongolian Spot: dark flat pigmentation of the
lower back and the buttocks common among
Oriental and black infants and other dark-skinned
newborn.
4. Symmetrical buttocks and gluteal folds
( variation: asymmetrical buttocks/ gluteal lines
in congenital hip dislocation).

ANUS
1. Patent and no fissures
2. Imperforate anus and rectal atresia may be ruled
out by a digital examination.
J. EXTREMITES
3. With good muscle tone, flexed, resist having
extremities extended.
4. Arm equal in length.
5. Legs equal in length; shorter than arms.
I.

K. SKIN
Skin color

Significances/ implications

Pinkish

Normal: may be darker if with pigmentation ;

depends on the race of the newborn

Bluish/cyanosis
Mucous membrane: most
reliable indicators of
central color in all babies

Central cyanosis: tongue and mucous

membranes are blue due to low oxygen
saturation blood levels demands urgent
attention; may be due to hypoxia or congenital
defects.

Yellowish/jaundice
may be physiologic or
pathologic
1st action if newborn is
found yellowish: identify
age

first 12 to 24 hours:
pathologic jaundice may be due to hemolytic
disease/ erythroblastogic fetalis
between 2 to 7 days: physiologic jaudice
if accompanied by undue lethargy, poor feeding,
unstable body temperature, and
vomiting, may be due to
infection/ neonatal sepsis.

Pallor
- It is unlikely for the newborn
to be pale because of fetal
polycythemia

May be due to amnesia; first

nursing action when identified:
blanch the forehead/ chest
region to detect the presence of
jaundice.
Anemia and hyper bilirubinemia
are characteristics signs of
erythroblastosis.

Reddish/plethoria/ruddy
Plethoria: defined as venous
hematocrit > 70%.

Polycythemia gives rise to

reddish/ruddy color
Red and wrinkled: premature
Red and smooth: full term

Greenish

Stained by meconium due to c

hronic fetal hypoxia
If green, dry, desquamating,
parchment-like: postmature.

V. NEUROBEHAVIOR TRANSITION OF
THE NEWBORN: FIRST 24 HOURS OF
LIFE
FIRST PERIOD OF REACTIVITY: from birth to 30
minutes.
. With intense period of activity and alertness.
B. SLEEP PERIOD OR PERIOD OR DECREASED ACTIVITY
. May represent the parasympathetic nervous
systems response as environmental stimuli
decreases and babys ability to cope increase.
A.

C. SECOND PERIOD OF REACTIVITY: 4-8 hours after

birth.

VI. NEWBORN SYSTEM

A.
B.
C.
1.
2.
3.
4.

REPIRATORY SYSTEM
CARDIOVASCULAR SYTEM
HEMATOLOGY IN THE NEWBORN: blood
values (venous samples)
Red blood cells: 5-7 million
Hemoglobin: 14-20 gm/100 mL
Hematocrit: 42%-52%
WBC: 20,000/mm

5. Platelets: platelet counts at birth are in the same

range as for adults.
6. Blood volume: 78-98 mL/kg depending on cord
clamping.
7. Newborn coagulation
D. NEUROMUSCULAR SYSTEM
1. Reflexes in the newborn
a. Feeding reflexes
. Rooting: turns head to the direction of the
stimulus.

Sucking: anything that touches his lips is sucked.

Swallowing: swallow anything that touches the
posterior tongue.
Extrusion(spitting up): anything that touches the
anterior tongue is extruted.

b. Protective reflexes
Blinking: protects the eyes from any objects coming
near it.
Sneezing: coughing: protects the airway
Yawning: protects cells from depleted oxygen
Gagging: lifelong reflex to protect airway
c. Moro (startle) reflex: most significant index of
the central nervous system.

d. Babinski: fanning of the toes when the sole is

stroked from the heel upwards.
e. Tonic head
f. Darwinian/step-in place/dancing/walk reflex
g. Grasp reflex: Palmar: the infant grasp an
examiners finger when palm is stimulated. Plantar:
tendency to curls toes inward when sole of the foot
is stimulated.
h. Landau: when held prone with a hand underneath
him supporting his trunk.

3 reflexes used as test of spinal cord integrity:

.
Magnet
.
Crossed extension
.
Trunk incurvation
E. NUTRITIVE/DIGETIVE SYSTEM
F. EXCRETORY SYSTEM
a. meconium: viscous/pasty, dark green
or black, passed within 24 to 48 hours.
i.

b. Transitional stool: loose/liquid, greenish

yellow/brown, passed within 2to 4 days.
c. Milk stool: passed within 4 to 6 days
Breastfeed newborns stool: golden yellow,
mushy/soft, sweet-smelling, often after feeding.
Bottle-newborns stool: more formed, light yellow,
foul-smelling.

G. URINATION
1. Initial: in the first 24 hours
2. Color: pale yellow
3. Cloudy: high in albumin content
4. Frequency: 6 to 10 times a day
H. IMMUNE SYSTEM
I.
THERMOREGULATION
.
Poikilothermia: the newborn readily takes on the
temperature of the environment.

VII.PHYSIOLOGIC CHANGES IN
THE NEWBORN
A.

B.
C.

JAUNDICE: because of immature liver;

occurs after 24 hours; first manifests in the
head, then progresses to chest, blanch the
skin on the forehead.
FEVER: primarily because of dehydration
and not necessarily a sign of sepsis.
HYPOPROTHROMBINEMIA: peaks by 3 to 5
days; prevent bleeding with vitamin K
injection and gentle handling.

D. DESQUAMATION: this occurs because of skin

dryness in the first 24 hours; evident on the palms
and soles; hand and body lotion may be applied if
mother wishes; may not really need treatment.
E. ANEMIA: usually by 4 to 6 months because stored
iron is often times; more common o0n the second
half of infancy than in the newborn period which is
characterized by poly cythemia.

F. PHYSIOLOGIC RESILIENCE : this id the newborns

indifference to several elements in the
environment.

VIII. DAILY CARE:HEALTH

FACILITY ROUTINE
A.
B.

C.

Airway maintenance: top priority.

Keeping newborn dry and warm: maintain
an axillary temperature between 97F and
99.5F.
Feeding: breastfeeding is the best infant
feeding. Demand feeding is the best
feeding schedule.

D. Daily cord care

E. Monitoring of VS, stool, and urine
F. Daily weighing
G. Daily bath(if ordered)
H. Diaper area care to prevent diaper dermatitis
(ammoniacal dermatitis).
I.
Continued assessment for problems/ anomalies
J. Gentle, minimal handling

K. Male newborns may need circumcision.

L. Parenteral teaching and demonstration, as
indicated.
1. Cradle hold
2. Shoulder gold
3. Football hold
4. Kangaroo hold
5. Transfer hold