PEDIATRIC 1CARE OF

NEWBORN
INITIAL CARE OF THE NEWBORN: ASSESSMENT

• 1- Observe and assist with initiation of respirations.

• 2- Asses Apgar score.
• 3- Monitor for nasal flaring, grunting, retractions, and
abnormal respirations such as seesaw respiratory
pattern( rise and fall of the chest and abdomen do not
occur together.).Asses for cyanosis.
• 4-Obtain vitals signs.
• 5-Observe the newborn for signs of hypothermia or
hyperthermia.
• 6-Asses for gross anomalies.
• 7-Footprintthe newborn and fingerprint the mother on
the identification sheet per agency policies and
procedure.
CARE OF NEWBORN: NURSING INTERVENTIONS

• 1- Suction the mouth first and then the nares with a

bulb syringe.
• 2-Dry the new born and stimulate crying by rubbing.
• 3- Maintain temperature stability, wrap the newborn
in warm blankets and place a stockinette cap on the
new born head.
• 4- Keep the new born with the mother to facilitate
bonding.
• 5-Place the new born at mother breast if
breastfeeding is planned.
• 6- Place the newborn in radiant warmer.
APGAR SCORE
APGAR SCORE EVALUATION.
0-3 CRITICAL RESUSCITATION
4-7 FAIRLY LOW
8-10 NORMAL DOCUMENTATION
NI: DRY WELL AND RUBBING BACK ,WRAP WITH WARM BLANKET AND PLACE
THE NEW BORN IN RADIANT WARMER. ( AVOID HYPOTHERMIA).
PLACE THE NEW BORN ON THE MOTHER BREAST.
KEEP THE NEW BORN WITH THE MOTHER TO MAINTAIN BONDING.
VITAMIN K( PHYTONADIONE)

• Is produce by bacterial in the gut but in

new born the GI is sterile and need to be
administered after the delivery Via IM
(side: vastus lateralis)
VASTUS LATERALIS INJECTION
OPHTHALMIA NEONATORUM

• Ocular application Erythromycin or

tetracycline ointment to avoid Gonorrhea
and Chlamydia bacterial infections.
HEPATITIS B VACCINATION

• Hepatitis B vaccination 0 ( first 12 • Mother with Hept BsAg positive

hours), 1 month, 6 months. • Hepatitis B vaccination/ plus
• Contraindications: Immunoglobulins Hept B
• 1-Newborn less than 2000 gr
• 2- Allergic Baker yeast and Neomycin
HYPOTHYROIDISM SCREENING NEWBORN

• TSH elevated: test performed blood

sample from umbilical cord.
• Tx Levotiroxin(Synthroid). Hormone
replacement therapy lifetime.
PHENYLKETONURIA SCREENING NEW BORN

• After feeding 24-48 hours detect high

blood level of phenylalanine.
• This patient had deficiency in
phenylalanine hydroxylase enzyme.
PHENYLKETONURIA TX

• Tx phenylketonuria
• Remove breast milk, regular formula to
avoid increase level of phenylalanine
• Dairy products and aspartame
A ONE MONTH OLD INFANT HAS A RECEIVED DIAGNOSIS OF PHENILKETONURIA
(PKU). WHAT STATEMENT OF THE PKU IS TRUE.SELECT ALL THAT APPLY ?

• 1-A low phenylalanine diet is required

• 2-Meat and a dairy products should not be introduced in the diet
• 3-Phenylketonuria is a self limiting disease that resolve by adulthood.
• 4- Special infant formula is required
• 5- Tyrosine should be removed from the diet.
PHENYLKETONURIA. CORRECT ANSWER: 1,2,4

• Explanation: PKU is a genetic inborn error metabolism. Patient with PKU LACK a
required enzyme Phenylalanine hydroxylase that converting amino acid phenylalanine
into the amino acid tyrosine.AS UNCONVERTED PHENILALANINA BUILD UP
IRREVERSIBLE NEUROLOGIC DAMAGE CAN OCCUR.
• A low phenylalanine diet is the only treatment for PKU. Phenylalanine can not totally
eliminated from the diet as it is an essential amino acid and necessary for a normal
development. The diet must need nutritional needs while maintaining a safety
phenylalanine level within the safe range( 2-6 mg).There is not know age at which the
diet can be discontinued safely, and lifetime dietary restrictions are recommended.
GALACTOSEMIA
GALACTOSEMIA
AUTOSOMAL RECESSIVE DISORDERS
HEP B2 MONTHS IS DR. HIP FOR DTAP, ROTAVIRUS, HIB, IPV, PCV13
4 IS 0, 1 TO 2, 6 MONTHS.
MONTHS ALSO DR. HIP.
6 MONTHS IS DR. HIP PLUS INFLUENZA STARTS AT 6 MONTHS AND THE LAST DOSE OF HEP B IS AT
SIX MONTHS.
12-15 MONTHS IS MAD HPV
4-6 YEARS IS VERY DIM
2 MONTHS, 4 MONTHS,6 MONTHS (2,4,6)

• Dtap ( Difteria, Tetanus, Pertussis) • Remember mnemonic: DR HIP

• Rotavirus
• Hemophilus Influenzae Type B
• IPV (Inactive Polio)
• PCV (Pneumococcus Vaccine)
1- BABINSKI REFLEX:

• The Babinski reflex occurs after the sole of the

foot has been firmly stroked. The big toe then
moves upward or toward the top surface of the
foot. The other toes fan out. This reflex is normal
in children up to 12 months old. What does an
abnormal Babinski reflex mean?
• When the Babinski reflex is present in a child
older than 12 months of life or in an adult, it
is often a sign of a central nervous system
disorder. The central nervous system includes the
brain and spinal cord. Disorders may include:
Amyotrophic lateral sclerosis (Lou Gehrig
disease) Brain tumor or injury.
2- MORO REFLEX:

• The Moro reflex is often called a startle

reflex. That’s because it usually occurs when
a baby is startled by a loud sound or
movement. In response to the sound, the
baby throws back his or her head, extends
out his or her arms and legs, cries, then pulls
the arms and legs back in. A baby's own cry
can startle him or her and trigger this reflex.
This reflex lasts until the baby is about 6
months old.
3- TONIC NECK REFLEX

• When a baby's head is turned to one

side, the arm on that side stretches out
and the opposite arm bends up at the
elbow. This is often called the fencing
position. This reflex lasts until the baby
is about 6 months old
4- ROOTING REFLEX

• Rooting helps the baby get ready to suck.

When the roof of the baby's mouth is touched,
the baby will start to suck. This reflex doesn't
start until about the 32nd week of pregnancy
and is not fully developed until about 36
weeks. Premature babies may have a weak or
immature sucking ability because of this.
Because babies also have a hand-to-mouth
reflex that goes with rooting and sucking,
they may suck on their fingers or hands.
5-GRASP REFLEX

• Stroking the palm of a baby's hand

causes the baby to close his or her
fingers in a grasp. The grasp reflex lasts
until the baby is about 5 to 6 months old.
A similar reflex in the toes lasts until 9 to
12 months.
NEW BORN

• Babies are born with some extra fluid,

so it's normal for them to drop a few
ounces when they lose that fluid in the
first few days of life. A healthy
newborn is expected to lose 7% to
10% of the birth weight, but should
regain that weight within the first 2
weeks or so after birth.
VITAL SIGNS
PEDIATRIC MILESTONES SPEECH LANGUAGE

• 3 months -----3 letter word = Coo

• Makes (Cooing) sounds examples (oo,ee,ah)
• Recognizes your voice
• Cries change for different needs.
PEDIATRIC MILESTONES SPEECH LANGUAGE

• 6 months -----6 letter word----Babble (By this age the infant starts to babble and repeat
sounds).
• Babble and repeat sounds( ma,da,ba,ga,pa)
• Makes gurgling sounds
• Uses own voice to express pleasure and displeasure.
• Notices and recognize sounds.
PEDIATRIC MILESTONES SPEECH LANGUAGE

• 9 months -----9 letter word----(Imitation)

• Imitates speech sounds
• Imitate non speech sounds
• Imitate actions and gestures
• Recognizes their own name
• Looks at objects when someone is talking about them
• Babbles longer string of sounds ( ma-ma-ma, da-da-da)
PEDIATRIC MILESTONES SPEECH LANGUAGE

• 12 months (1-2 words) Vocabulary of 1-2 words but could be more

• 12 Letter phrase= understand me
• Meaningful use of mama or dada.
• (Understand me) Begin to understand words, requests, instructions etc
• Understands simple phrases and instructions (ex come here, don’t touch)
• Answer simple questions nonverbally
• Recognizes words for common items ( shoe, cup ,dog)
PEDIATRIC MILESTONES SPEECH LANGUAGE

• 18 months---Vocabulary of18 words

• Repeat words overheads in conversation.
• Recognizes and point to familiar objects and people in pictures.
• Point the pictures in the book when you name them.
• Point to familiar body parts when you ask.
• Follow simple commands ( “put the toy down”, “roll the ball”)
• Understand simple questions ( where’s your cup?)
PEDIATRIC MILESTONES SPEECH LANGUAGE

• 2 years---2 word phrases----2 step directions

• Begin to use two word phrases to talk about and ask for things.
• Follow two step directions( pick up you toy and give it to mommy)
• Vocabulary of 50 wors or more, pronunciation often unclear)
• Speaks well enough to be understands at least half the time by the caregiver.
• User gestures and words during pretend plays
• Makes animal sounds( such as “moo”)
PEDIATRIC MILESTONES SPEECH LANGUAGE

• 3 years---3 word phrases to talk about and ask for things

• Vocabulary of 200 words or more
• Most speech is understood by the caregiver
• Understands spatial concept( in, on, under ,etc)
• Understands and uses more pronouns.( you, me, him)
• Uses plurals (cats, dogs)
PEDIATRIC MILESTONES SPEECH LANGUAGE

• 4 years-----4 or more word sentences

• Uses sentences with 4 or more words
• Uses about 4 sentences at a time to talk about day/tell stories
• Understands and ask “how” and “why “questions.
• Expresses ideas/feeling rather than just talking about world around them.
• Talks about activities at school/daycare and home.
• Identifiers colors, group objects such us food or clothes
GROWTH AND DEVELOPMENT
GROSS MOTOR FINE MOTOR
• 2 months: Raises head up when prone. • 2 months; Open/shuts hands when, brings
(Social: makes cooking sounds) hands together

• 4 months; Rolls from stomach to back. • 4 months :grasps objects

(Social: turns to voice)
• 6 months: Sits up. Rolls from back to
stomach.(Social:Stranger anxiety star
• 6 months: Passes a toy from one hand to
here)
another.
GROWTH AND DEVELOPMENT
GROSS MOTOR FINE MOTOR
• 9 months : pulls to standing • 9 moths: Pick up food and small objects
position.Crawls.( Social: Says with 3 fingers.
mama,dada) • 12 months: Pick up small objects with 2
• 12 months:Takes first step. Stands with fingers pincer grasp.
no support.( Social: Looks for hidden
objects)
• 18 months: Scribbles. Throw small ball.
• 18 moths: Walks up steps. Carries toys
while walking.( Social;Point two pictures
in a book,Name at least two body parts)
GROWTH AND DEVELOPMENT
GROSS MOTOR
• 2 years: Kicks a ball.
Runs. Climbs playground ladder. Jumps
with 2 feets. (Social: Follow two step
command. Names at least 5 body parts)
3 years: Ryde a tricycle. Jumps forward
( Social) :
FINE MOTOR
• 2 years: Draw lines. Stack objects. Uses
hands to turns objects.
• 3 years: Draw circles. Cuts with child
scissors.
THANK YOU