Physiologic & Behavioral Transition to

Extrauterine Life
The Normal Newborn

Assessments @ 1 min. and 5

min.

A = appearance
P = pulse
G = grimace
A = activity
R = respirations
APGAR Scores

Physiologic Transitions of
Major Systems

Pulmonary system transition

Cardiac system transition
Thermoregulation
Metabolic transition
Gastrointestinal system transition

Assessing for Congenital

Anomalies:
Observe general appearance.

Gross external anomalies.

Observe breathing pattern & auscultate

chest.

Cardiorespiratory problems, diaphragmatic

hernia.

Observe breathing with infants mouth

closed.

Choanal atresia.

Congenital Anomalies (cont.)

Pass gastric tube or aspirate stomach
contents.

Esophageal atresia.

Observe appearance of abdomen.

Intestinal atresia (distended), diaphragmatic

hernia (scaphoid), omphalocele, gastroschisis.

Confirm passage of meconium & observe

appearance of anus including wink reflex;
perform rectal temperature.

Imperforate anus.

 Count umbilical vessels.

<3 associated with genitourinary or cardiac

anomalies.

Measure head circumference & palpate

fontanelles.

Microcephaly, hydrocephalus.

Inspect and palpate palate.

Cleft palate.

Evaluate hips.

Congenital hip dysplasia.

IMPORTANT NORMAL
VALUES:
Axillary temp: 97.1-97.8 F (36-36.5 C).
Heart rate: 120-160 bpm apical (assess for 1
full minute).
Respirations: 30-60 per min. not crying
(assess for 1 full minute).
Infants are considered AGA if weight, length,
& head circumference are btw.10th & 90th
percentiles, on standardized growth chart.

Average weight: 7.5 lbs. (3.5 kg).

Average length: 20 in. (51 cm).
Head circumference: 13-14 in. (3335.5 cm).
Chest circumference: 12-13 in. (30.533 cm).
Head circumference: 0.8 in. larger
than chest circumference (2 cm).

Assessment of the Normal Newborn

NEONATAL PHYSICAL
ASSESSMENT:
GENERAL APPEARANCE:
Color.
Observe general tone, activity, & posture
(initially & throughout exam).
Observe & palpate skin.
Measure & record weight & length, and plot
on growth curve.
Measure & record temperature.

Head, Face and Neck:

Measure & record head circumference,

& plot on growth curve.
Inspect & palpate head.
Palpate sutures.
Palpate & measure fontanelles.
Observe face, nose, & lips.
Observe eyes & measure position.

Observe and palpate ears, measure

position.
Inspect & palpate mouth.
Inspect & palpate neck, clavicle, &
shoulders; assess mobility.

Chest, Abdomen, and Back:

Observe thorax.
Measure chest circumference at nipple line.
Observe breathing movements.
Count respiratory rate.
Auscultate lungs.
Auscultate heart sounds.
Count heart rate.
Auscultate bowel sounds (all 4 quadrants,
before palpation).

 Observe & palpate abdomen.

Inspect umbilical cord & umbilicus.
Palpate femoral lymph nodes & pulses.
Record passage & character of stools.
Determine patency of anus (rectal
temperature).
Palpate & inspect spinal column.
Observe back & buttocks.

Genitals & Urinary System:

Confirm urination; observe stream of
urine in male infant.
Note appearance of external genitalia.
Observe genitalia & palpate testes of
male infant.
Observe genitalia of female infant.

Extremities:
Observe arms & legs for symmetric
appearance, size, length, & movement.
Observe hands & feet.
Evaluate rotation of hips: Ortolani &
Barlow maneuvers.
Palpate peripheral pulses.

Reflexes:
Rooting (assess bilaterally).
Swallow.
Sucking.
Moro (startle reflex).
Palmar and planter grasp (assess
bilaterally).
Tonic neck reflex or fencing (assess
bilaterally).

Stepping or walking.
Pull to sit (traction).
Blink (glabellar).

Nutritional Needs of the Newborn

THE
NORMAL
NEWBORN

NUTRITIONAL ALLOWANCES
FOR THE NEWBORN

Calories
Growth in the neonatal period
Needs of the newborn and infants up to 2
months and after 2 months
Actual caloric requirement...depends on the
infant activity level and growth rate

Protein
Necessary for the formation of the new
cells
The newborn and infant need amino acids
Unaltered cows milk not recommended
Casein Vs. Lactalbumin

Fat
Linoleic acid
......Necessary for growth and skin integrity
in infants

Carbohydrate
Lactose found in human milk and commercial
formulas
........Improves calcium absorption and assist
in nitrogen retention.
........Allows protein to be used for building
new cells rather than calories
........Decrease the possibility of
gastrointestinal illness

Calcium
Aid in bone growth
Decrease level lead to tetany

Iron
Term infant will not need iron supplement
for the first 3 months
Until they begin to produce adult
hemoglobin

Fluoride
Aid in building teeth and preventing tooth
decay
Given to child at 6 months of age
......If the child not receiving adequate
amount from breast feeding

Fluid
Fluid requirements for a newborn is 150200 ml/kg (2.5-3.0 oz) over 24 hrs
Fruit juice is not recommended.

Physical examination of the newborn

Vital signs
Growth measurements
Skin
Head and neck
Respiratory System
Cardiovascular system
Abdomen
Genitalia
Musculoskeletal system
Central nervous system

Positions for Breastfeeding

Advantages of Breastfeeding
For Mother:
Helps the uterus to shrink back to pre-pregnancy
size more quickly
Serves as a protective function in preventing
breast cancer
Convenience breast milk is always ready to use,
clean & is always at the right temperature for the
baby and can be refrigerated for later use
Strengthens mother-baby bonding
Cost

Advantages of Breastfeeding
For Baby:
Breast milk is individualized for the baby
Better digestion
Lessens susceptibility to allergies
Better mouth development
A DISADVANTAGE of breastfeeding is that the
breast milk may carry microorganisms (i.e.:
Hep B, Cytomegalovirus, HIV)

Burping

Burping is important during and after

feedings to bring up any excess air that was
taken in during feeding
Baby should be burped every couple of
ounces or between breast change
Three common ways of burping baby:
1. Over the shoulder
2. Face baby down on your lap while sitting
3. Sitting Up

Myths about Breastfeeding

Myth: You cant breast feed if you have small breasts.
Reality: Breasts of all shapes and sizes can satisfy the hungry baby.
Myth: Breast feeding is a lot of trouble.
Reality: Breasts, as opposed to bottles, are ready when the baby is ready.
Myth: Breast feeding ties you down.
Reality: Breast milk can be stored if mother decides she wants to go out. When the mother goes
out she always has the food supply for the baby no matter how long she plans to stay out.
Myth: Breast feeding ruins your breasts.
Reality: Breast-feeding does not change the shape or size of the breasts. There are other factors
(i.e. age, not wearing a bra, or excess weight) that can change the shape & size of breasts.
Myth: The father is excluded during breast feeding.
Reality: An involved father will take advantage of opportunity such as bathing, diapering,
holding, & playing with the baby.

Nursing Outcomes Mom is able to

demonstrate following:
Comfortable position to breastfeed
Determines whether or not the breast is
full prior to feeding
No nipple tenderness
Recognizes hunger signs
Is satisfied with breastfeeding

Teaching

Milk Production
First stage of milk
Colostrum
milk ejection or let down reflex
Milk production can be influenced by
1. Emotional stress
2. Ambivalence to breastfeeding
3. Physical well being of infant and mother

Nutrition
extra calories (250 - 500)
6-8 glasses of water or liquid
Selection from each of the four main food
group
Maternal use of iron or iron supplements
Advance of alcohol, tobacco and drugs

Nutritional Management at home

Nurse baby every 1-3 hours
both breast at each feeding
expect 6-8 wet diapers every 24 hours (after
first week
bowel movement (consistency + appearance)
most babies have periods of irritable crying
growth spurts
community resources - LaLeche League, WIC,
community Lactation Consultants, hospital
programs + support groups

Common Problems Encountered

in Breast Feeding

Cracked or Sore Nipples

check for correct latch
frequent feedings
rotation during breastfeeding
air drying
warm soaks

Flat or Retracted Nipples

use of milk cups
electric pumps
ice wrapped

Infants Position
Encourage rooting reflex
areola into mouth
avoid having infant press nose
removal of infant from the breast
last first, first last
burp

Care of the Breast and Nipples

air dry
pads
support bra
cramp

Advantages of Bottle Feeding

Baby is satisfied longer
Monitoring intake
More freedom for mother (i.e.: if she wishes to
go out for the evening)
Father is able to participate in feeding the baby
Increased opportunity for sibling as to
participate in feeding
Birth control methods are less restrictive
Less stress for feeding the baby in public

Infant Formula

What is formula? All formula is designed to similate nutritional content of breast milk
What does formula contain? Protein,fat,iron,carbs &vit A,D,E,K linoleic acid
Caloric: 20 cal. per oz.
Allergies
Soy for sensitivity to milk protein,lactose free for possible lactose , and alimentum for
severe
for severe food allergies/colic r/t protein sensitivity

Types Of Formula
Powdered, Prepared,Concentrate
Cost $$$- Which is best?
Preparation-boil H2O approx 1 min.

Feeding
Initial feedings are only -1 oz.
Most newborns approx. 2-3 oz per feeding q 2-3
hrs. Add 2 or 3 to infants age. Ex. A 3 month
old would require 5-6 oz.
Ample feedings will produce 6-8 wet diapers
per day
Discard unused bottle formula after, discard
formula after baby is done, bacteria from
babys mouth has passed into milk. Bacteria.
Can be stored in fridge up to 24 h

Nursing Process

Assessment
Nutritional status prior to and during mothers
pregnancy
Assess the newborn for adequate nutrition
Identify mothers skills and knowledge about
breastfeeding vs. formula usage.
Mothers ability to recognize signs of hunger in a
newborn (e.g., restlessness, tense body posture,
smacking lips, or tongue thrusting)
Check moms knowledge whether newborn is receiving
enough feeding by voiding, growing, and alert

Nursing Dx:
Imbalanced nutrition, less than body requirements r/t poor
newborn sucking response.
Health seeking behavior r/t lack of knowledge about lactation
and breast feeding technique
Effective breast feeding r/t well prepared mother and healthy
newborn
Ineffective breast feeding r/t anxiety and inexperience
Pain r/t breast engorgement or sore nipples
Deficit knowledge r/t potential harm to baby of drugs taken
by breast feeding mother
Health seeking behaviors r/t techniques of bottle feeding

Planning/Interventions
Begins while the newborn is pregnant
Focus on providing information on breast feeding or
bottle feeding
Provide information to woman who expects to formula
feed to purchase supplies in advance
Advise client to drink at least 4 to 6 8oz. Glasses of fluid
per day
Give information on how / where to allocate community
resources base on financial needs

Outcomes For Breastfeeding

The client will be able to verbalize
knowledge in the following:
Hunger signs of the baby & signs of proper
nourishment
Proper positioning & techniques of
breastfeeding

The client will be able to verbalize

knowledge in the following:
Latch on properly, proper sucking & tongue
placement
Swallowing should be audible at a minimum of
5-10 minutes per breast at 8 feedings per day
2 or more loose, yellow, seedy stools per day (at
least 6 voidings per day)

Nursing Outcomes Mom is able to

demonstrate following:
Comfortable position to breastfeed
Determines whether or not the breast is full
prior to feeding
No nipple tenderness
Recognizes hunger signs
Is satisfied with breastfeeding