AUFMED

Dr. Rodolfo Ng | June 18, 2015 | Pediatrics

CARE OF THE NEWBORN

CARE OF THE NEWBORN

Transition from intrauterine to extrauterine what

is going to happen to the baby and how the baby
will adapt to the environment.
How we care for patients after delivery
To be able to know if baby is normal or abnormal

ST

THE 1

24 HOURS OF LIFE

The first 24 hours of life is a very significant and a

highly vulnerable time due to critical transition
from intrauterine to extrauterine life

PATTERN OF SUCCESSFUL TRANSITION FROM

INTRAUTERINE TO EXTRAUTERINE LIFE

Expansion of lungs following initiation of first

several breaths which clear the fetal lung field
and termination of R-L shunting
o Water content of lungs before delivery
(non-compliant)
Elevation of P02 in both the alveoli and the
arterial circulation (50-60 mm Hg)

PATTERN OF SUCCESSFUL TRANSITION FROM

INTRAUTERINE TO EXTRAUTERINE LIFE

Decrease in pulmonary vascular resistance

o Increased expansion and compliance of
the lungs
Conversion from fetal to neonatal circulation
o Failure of transition baby becomes
cyanotic

IMMEDIATE CARE OF THE NEWBORN

Airway check the patency

Breathing
Temperature

Position properly side lying

trendelenberg
Provide oxygen when necessary

modified

TRANSITIONAL PERIOD DURING THE FIRST 15-90

MIN

Immediate tachycardia up to 160-180/min,

gradual drop to 100-120/min
Irregular respirations, tachypnea up to 60-80/min,
brief apnea
o Abdominal breathers up to 6-7 years
Moist-sounding lung fields, transient grunting and
retraction
Awake, moving, alert, easily startled, transient
tremors
o Differentiate tremors from seizure and
hypoglycemia

ESSENTIAL NEWBORN CARE PROTOCOL: UNANG

YAKAP
- tremors: when you hold the neonate's
extremity, these will STOP
UNANG YAKAP - seizures: holding the shaking extremity
will NOT STOP the shaking
The campaign to spread the use of the Essential
Newborn Care protocol
Prevent at least half of newborn deaths without
additional cost to both families and hospitals
Timely to rapidly reduce neonatal mortality
ESSENTIAL NEWBORN CARE PROTOCOL

A simple, concise, and straightforward guideline

that is backed by solid research evidence
Emphasizes a core sequence of four actions that
are performed step by step
Time-bound interventions

AIRWAY AND BREATHING

Suction gently & quickly using bulb syringe or

suction catheter
Starts in the mouth then, the nose to prevent
aspiration - neonates are NASAL and ABDOMINAL breathers
Stimulate crying by rubbing

PI | ARELLANO GAGUI GALVAN PAMINTUAN TIMBANG

PROPERTY OF AUFSOM BATCH 2017
v3.1 s2015-2016

Page 1 of 7

Major Causes of Death in Newborns and Children,

WORLD, 2008

CHILDREN UNDER 5 YEARS

Injuries
(postneonatal)
3%

Noncommunica
ble diseases
(postneonatal)
4%

Other 13%

Newborn deaths
41%

Measles 1%

Essential Newborn Care Protocol

A simple, concise, and straightforward guideline
that is backed by solid research evidence
Emphasizes a core of sequence of four actions
that are performed step by step
Time-bound interventions 1. Drying
2. Skin to Skin Contact
3. Cord Clamping and
Cutting
Includes:
4. Breastfeeding
1. Immediate and thorough drying for 30 secs to
one minute warms the baby and stimulates
breathing.

HIV/AIDS 2%

Malaria 8%

Diarrhea
(postneonatal)
14%

Pneumonia
(postneonatal)1
4%

1. Neonatal Deaths
2. Postneonatal Pneumonia and Postneonatal Diarrhea

*35% of under-five deaths are due to the presence of

undernutrition*

NEWBORNS UNDER 1
MONTH
Prematurity &
low birth
weight 29%

2. Early skin-to-skin contact between mother &

newborn & delayed washing for at least 6 hours
prevents
hypothermia,
infection
and
hypoglycemia.

Other 11%
Congenital
anomalies 8%
Neonatal
tetanus 2%
Diarrheal
diseases 2%

Neonatal
infections 25%
Birth asphyxia
& birth trauma
23%

*Sources:
Cause of death: World Health Statistics 2010, WHO.
Undernutrition: Black et al. Lancet, 2008.

3. Properly-timed cord clamping & cutting prevents

anemia & protects against brain hemorrhage in
prematures. Wait for cord pulsation to stop (1-3
minutes).
*Milking the cord would push excessive RBC to
the babys circulation causing polycythemia and
later on, jaundice.

1. Prematuriy and Low Borth Weight

2. Neonatal Infections
3. Birth Asphyxia and Birth Trauma

PI | ARELLANO GAGUI GALVAN PAMINTUAN TIMBANG

PROPERTY OF AUFSOM BATCH 2017
v3.1 s2015-2016

Page 2 of 7

2.
3.
4.
5.
4. Continuous non-separation of newborn & mother
for early breastfeeding protects baby from dying
from infection. First feed provides colostrum
(babies' first immunization with protective
properties).
6.

If parents decline IM or (+) family history

of hemophilia in boy, offer oral vitamin K
(2 mg) within 6 hours after birth.
Hepatitis B & BCG vaccination at birth
Examine the baby
Check for birth injuries, malformations or defects
Cord care
Alcohol or betadine can be used.
o Do not apply too much betadine,
because it contains iodine. It
may cause thyroid problems
once it is excessively absorbed.
Provide additional care for a small baby (<2500
g) or twins.

COLOSTRUM
- first immunization
- passive natural immunization
- rich in IgA
Other Intervention: First 90 Min
1. Do eye care.
Erythromycin or tetracycline ointment or
2.5% povidone-iodine drops for both
eyes after baby has located breast.
o Erythromycin
is
a
more
advantageous prophylaxis to
prevent both chlamydia and
gonorrhea.

Crede's Prophylaxis:
Vitamin K Administration

Cord Care

Time Band Interventions: From 90 Min to 6 Hours

1. Vitamin K (1 mg) prophylaxis (Preterm: 0.5 mg)

PI | ARELLANO GAGUI GALVAN PAMINTUAN TIMBANG

PROPERTY OF AUFSOM BATCH 2017
v3.1 s2015-2016

The umbilicus is cut only after pulsations

have stopped, approximately 1-3
minutes after the delivery of the neonate.
The umbilicus is cut 2 cm above the
infants abdomen.
The umbilical stump is cleaned with 75%
alcohol. Use of excessive iodine is NOT
recommended as this could easily be
absorbed into systemic circulation,
leading to hyperthyroidism.

Page 3 of 7

UNANG YAKAP: Essential Newborn Care Protocol

*A video of the protocol is available
www.doh.gov.ph/files/ENC.mp4.

at:

Proper Identification
After delivery, gender should be determined.
Pertinent records should be completed including the ID
bracelet.
Before transferring to nursery, ID tag should be
applied.
Weight/Anthropometric Measurements
The following measurements are usually taken:
- Weight
- Length
- Head circumference (taken at the level of the eyebrows)
- Chest circumference (taken at the level of the nipples)
- Abdominal circumference (taken at the level of the
umbilicus)

Bathing
Oil bath or complete warm water bath
o Oil is used to enable removal of vernix caseosa
(Latin: vernix = varnish, caseosa = cheesy, cheesy
varnish). It is the waxy or cheese-like white
substance found coating the skin of newborn
human babies. Vernix starts developing on the
baby in the womb around 18 weeks into
pregnancy. The dry weight of the vernix is made
up primarily by lipids, and is therefore only
soluble in lipid (like-dissolves-like principle).
From cleanest to dirtiest part
DO NOT remove vernix caseosa vigorously
o Studies
(Singh
and
Archana,
2008:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC
2763724/)
have found
out
important
characteristics of the vernix, primarily as
INSULATOR, preventing hypoxia which may be
fatal to the newborn.
Done 6 hrs after birth
Foot Printing
It is performed as an adjunct to identification of
the newborn.

PI | ARELLANO GAGUI GALVAN PAMINTUAN TIMBANG

PROPERTY OF AUFSOM BATCH 2017
v3.1 s2015-2016

Page 4 of 7

GENERAL APPEARANCE
Normal Variants
1. Posture
Full term:
Symmetric
Face turned to side
Flexed extremities
Hands tightly fisted with thumb covered by the
fingers

Vital Signs
The first temperature is taken per rectum. This is
done to assess temperature while determining
whether the newborn has an imperforate anus.
Subsequent temperatures are assessed through
other sites, to prevent trauma to the rectum.
Special Concerns
Asymmetric
Fractured clavicle or humerus
Nerve injuries (Erb-Duchennes Paralysis)
o These usually happen as injuries to the upper
extremities following breech pregnancy or
improper delivery of the shoulders.
Breech Presentation
Knees and legs straightened or in FROG position
VITAL SIGNS

Dressing/Wrapping
Mummy
Wrap in warm blanket snuggly
Cover head with stockinette cap

TEMPERATURE

Normal skin temp of NB is 36-36.5 C

Rectal temp (aural): 36.5-37.5 C
Axillary temp may be 0.5-1.0 C lower
Stabilizes within 8-12 hrs
Monitor q 30 mins until stable for 2 hrs then q
8 hrs

Heat Loss Mechanisms

1. Convection
The flow of heat from the body surface
to cooler surrounding air
Eliminating drafts such as windows or air
con, reduces convection

PI | ARELLANO GAGUI GALVAN PAMINTUAN TIMBANG

PROPERTY OF AUFSOM BATCH 2017
v3.1 s2015-2016

Page 5 of 7

Nursery Care Considerations

2. Conduction
The transfer of body heat to a cooler
solid object in contact with the baby
Covering surfaces with a warmed blanket
or towel helps minimize conduction heat
loss

3. Radiation
The transfer of heat to a cooler object
not in contact with the baby
Cold window surface or air con; moving
as far from the cold surface, reduces
heat loss

PULSE
Awake: 120 160/min
Asleep: 90-110 bpm
o Heart rate normally decreases (with a
10% drop) at sleep. Cardiac problems
may be suspected in babies who still
have a high heart rate while asleep.
Crying: 180 bpm
Rhythm: irregular, immaturity of cardiac
regulatory center in the medulla
Duration: 1 full minute, not crying
Nursery Care Considerations

4. Evaporation
Loss of heat through conversion of a
liquid to a vapor
From amniotic fluid; NB should be dried
immediately

Keep dry and well-wrapped

Keep away from cold objects or outside walls
Perform procedures in warm, padded surface
Keep room temperature warm

Keep warm
Take HR for 1 full minute
Listen for murmurs
Palpate peripheral pulses
o To suspect any abnormalities like
coarctation of the aorta or Takayaso
arteritis
Assess for cyanosis
Observe for CP distress

Special Concerns
(-) Femoral pulse = Coarctation of aorta
(+) Bounding pulse = PDA
(-) Brachial pulse = Takayaso arteritis

PI | ARELLANO GAGUI GALVAN PAMINTUAN TIMBANG

PROPERTY OF AUFSOM BATCH 2017
v3.1 s2015-2016

Page 6 of 7

RESPIRATION
Characteristics:
Nasal breathers, gentle, quiet, rapid BUT shallow;
may have short periods of apnea (<15 secs) and
irregular without cyanosisperiodic respirations
Rate: 30-60 cpm
Duration: 1 full minute
Nursery Care Considerations
Position on side
Suction PRN
Observe for respiratory distress
Administer oxygen via hood PRN and as
prescribed
BLOOD PRESSURE

NOT routinely measured UNLESS in distress or

CHD is suspected
At term: > 90/60 mmHg
Preterm: > 80/50 mmHg
Values rise 1-2 mmHg per day during the first
week of life
Values rise 1-2 mmHg per week the next 6 weeks

The good physician treats the disease. The great

physician treats the patient who has the disease.

William Osler

PI | ARELLANO GAGUI GALVAN PAMINTUAN TIMBANG

PROPERTY OF AUFSOM BATCH 2017
v3.1 s2015-2016

Page 7 of 7