NURSING CARE OF THE

NEWBORN
Newborn
• Also called neonate
• Baby in the neonatal period, the first 28
days of life
PROFILE OF THE NEWBORN
Vital Statistics
• Weight
1. Average (female, white) – 3.4 kg (7.5 lbs)

2. Average (male, white) – 3.5 kg (7.7lbs)

3. All races – 2.5 kg (5.5 lbs) to 8lbs

• Weight >4.7 kg (10 lb)

1. Macrosomia
2. Diabetes mellitus
 Weight loss
• 5-10% loss (6-10 oz) – first 3-4 days

Causes:

1. Small intake
• Breastfed – due to low caloric content of
colostrum
• Bottle-fed – ineffective sucking
 Weight loss
2. Meconium

3. Diuresis – 75 – 90% of weight is fluid

4. Not under the influence of salt and fluid

retaining maternal hormones
• NB recaptures weight within:

• Breastfed – 10 days

• Bottle-fed – 7 days
• Length

1. Female – 53 cm (20.9 in)

2. Male – 54 cm (21.3 in)

3. Lower limit – 46 cm (18 in)

• Head circumference (HC)
• Mature NB – 34-35 cm or 13.5-14 in)

• Less than 33 cm or >37 cm – neurological

involvement
 Measuring HC
• Use a tapemeasure

• Across the center of forehead and around

the occiput
• Chest circumference (CC) – 2-3 cm less
than the HC
• Normal – 30.5-33cm (12-13 in)

• Measured at the level of the nipples

Vital Signs
• Temperature – 36.5 – 37.2°C (97.6°F-
98.9°F)

- usually falls below normal due to:

1. heat loss
2. immature temperature-regulating
mechanisms
 Methods of Heat Loss
• Conduction

• Convection

• Radiation

• Evaporation
 Conduction
• Transfer of body heat to a cooler object in
contact with the baby

• Example:
• Touched with cold hands or cold
stethoscope
• Placed in a cold surface such as scale
 Convection
• Flow of heat from the body surface to cooler
surrounding air (air currents)

Example:
• Air currents from open window
• Air conditioner (cooling ducts)
• People moving around
 Radiation
• Transfer of body heat to a cooler solid
object not in contact with the baby (cooler
objects nearby)

Example
• Placed near a cold window surface
• Exposed to cold sides of the crib
 Evaporation
• Loss of heat through conversion of liquid
to a vapor

Example
• NB wet with amniotic fluid looses heat
when fluid dries and evaporates
 Heat Retention/Conservation
• Peripheral blood vessel constriction

• Increased brown fat metabolism

1. Brown fat- special tissue that helps to

conserve or produce heat (intrascapular
region, thorax, perirenal area)
 Exposure to Cold
• Cold stress
Increased O2 demand → increased RR
→unable to supply sufficient oxygen to
system → anaerobic catabolism →
acidosis
 Ways to Prevent Heat Loss
1. Drying and wrapping newborns

2. Place NB in warm crib

3. Drying and placing under a radiant heat

source
 Ways to Prevent Heat Loss
4. Placing NB against mother’s skin and
covering the NB (Kangaroo care)

5. Do early care at a speed to avoid

exposing the NB unnecessarily

6. Do procedures in which NB must be

uncovered under a radiant heat source.
• Pulse rate
Normal – 120=160 bpm (increased up to
180bpm immediately after birth as NB
struggles to initiate respirations)

Sleep – 90-110bpm
• Immaturity of cardiac regulatory center
(medulla) – irregular heart rate

• Transient murmurs – results from

incomplete closure of fetal circulation
shunts
Respiration
• Average – 30-60 breaths/minute
• First few minutes after birth (80bpm)

• Periodic respirations

• OBLIGATE NOSE BREATHERS

Short period of crying is beneficial

• increases depth of respiration and aid in

aerating deep portions of the lungs
Blood pressure

• At birth - approx. 80/46 mmHg

• At 10th day – 100/50 mmHg

• Place cuff width no more than 2/3 of

length of upper arm
Physiologic Function
Cardiovascular
 Cardiovascular system
Drying/clamping of cord and stimulation of cold receptors
↓
↑ PCO2, ↓PO2, ↑acidosis (transitory asphyxia)
↓
first breath →lungs inflate
↓
decreased pulmonary artery pressure
↓ ↓ ↓
↑PO2 closure of ductus closure of foramen
↓ venosus, umbilical ateries ovale
Closure of ductus & vein
arteriosus
Ductus arteriosus

– closure due to increased pressure in

aorta and oxygen
- Closure complete by 24 hours; permanent
by 3-4 weeks
Foramen ovale
• Closes due to increased pressure in the
LA and decreased pressure in RA

• Closes within minutes; permanent in

approx. 3 mos.
Ductus venosus
• Blood ceases flowing through umbilical
vein to ductus venosus
• Blood now flows through the liver and is
filtered
Acrocyanosis

• Cyanosis of the hands and feet (feet feel

cold to touch)
 Blood values
• Volume – 80-110 ml/kg/body weight (300
ml)
• Erythrocyte – 6,000,000/mm3
• Hgb – 17-18/100 ml of blood
• Hct – 45-50%
BLOOD COAGULATION
• Prolonged coagulation time or prothrombin
time

• Vitamin K – administered after birth

 Vitamin K
• Necessary for formation of:
1. Factor II (prothrombin)
2. Factor VII (proconvertin)
3. Fcator IX (plasma thromboplastin
component)
4. Factor X (Stuart-Prower factor)
 Respiratory system
• First breath

– initiated by a combination of cold

receptors, a lowered PO2 (as low as 80
mmHg) and increased PCO2 (as high as
70 mmHg)
• Fluid in the lungs
- Helps inflate alveoli easier
- 1/3 of fluid is forced out by pressure of
vaginal birth
- Additional fluid is absorbed by lung blood
vessels and lymphatics after first breath
 Gastrointestinal system
• Stomach – holds 60-90 ml
- limited ability to digest fat and
starch due to deficient pancreatic
enzymes
• Stools

1. Meconium – first stool

- sticky, tarlike, blackish green, odorless material
- formed from mucus, vernix, lanugo, hormones,
carbohydrates

2. Transitional stool – green and loose, usually by 2-3

days of life
3. Breastfed- light yellow stools; sweet-
smelling
4. Bottle-fed – bright yellow (foul smelling)
5. Under phototherapy – bright green
6. Bile obstruction – clay-colored (gray)
7. Anal fissure – blood-flecked
 Urinary system
• Voids within 24 hours

• Males – void with enough force to produce

a small projected arc

• Females – produce a steady stream

• Projecting urine – urethral obstruction

• Light-colored and odorless – kidneys do not

concentrate urine well

• Normal – pale straw

• Color – pink/dusky (first voiding)

• Single voiding – 15 ml

• Specific gravity – 1.008-1.010

• Urinary output – 30-60 ml/day (first 2

days)
- 300 ml (one week)
 Immune System
• Difficulty forming antibodies until 2 months

• Passive immunization
1. Poliomyelitis
2. Measles
3. Diptheria
4. Pertussis
5. Chickenpox
6. Rubella
7. tetanus
 Neuromuscular System
• Reflexes – instinctive movements
designed to protect babies

• Limpness – absence of muscular

response (narcosis, shock, cerebral injury)
 Reflexes
• Blink

• Rooting

• Sucking

• Swallowing
• Gag, cough, sneeze

• Extrusion

• Palmar grasp

• Step (Walk) In Place

• Placing

• Plantar grasp

• Tonic neck

• Moro
• Babinski

• Magnet

• Crossed extension

• Trunk Incurvation
• Landau

• Patellar
Common variations
• Jaundice

Types
1. Physiologic
2. Pathologic
• Milia
• Erythema toxicum neonatorum
• Telangiectactic nevi
Nevus flammeus
Nevus vascularis (Strawberry mark)
Mongolian spot
Caput succedaneum and cephalhematoma
• Mouth – epstein pearls
Genitalia
Female
• Pseudomenstruation

Male
• Hypospadias
• Cryptorchidism
• Hydrocele
• Epispadias
• Phimosis
Hypospadias
Hydrocele
• Extremities

1. Syndactyly

2. Polydactyly

3. Hallux varus
Syndactyly
Polydactyly
Circumcision
Immediate Care of the Newborn
 Apgar scoring
• Assesses the infant’s cardiopulmonary
adaptations to extrauterine life.

• Assessed at 1 and 5 minutes after birth

from most important (heart rate) to the
least (color).
• Given score of 0 to 2 for each item.
• Perfect score=10
Interpretation

• Score(8 and higher) – no special

interventions
• Score (4-7) – stimulation (back rubbing)
and oxygen
• Score (0-4) – resuscitation (head flat or
slightly elevated)
 Resuscitation
LPN’s duty

• Suctioning the infant’s mouth

• Gentle rubbing for stimulation
• Oxygen administration.
Identification band
• Wrist and ankle (or both wrists or both
ankles)

• Write the infant’s name, mother’s name,

time and date of delivery, doctor’s name,
room number
Parent/Infant Bonding

• Assist the mother to hold infant

• Do breast care with cotton wet with water.
• “Latch on” the infant to the mother.
Prophylactic care

1. Eye care
• Apply terramycin opthalmic ung to both
eyes
• Apply from inner to outer canthus.
2. Vitamin K

• Given IM injection – lateral anterior thigh

muscle
• Phytonadione (1mg) = 0.1 cc (mature)
= 0.05 ml (premature)
3. Hepatitis B vaccine

• Given IM injection – lateral anterior thigh

• Given within 12 hours after birth.

• Infant whose mother is Hepa B positive = Hepa B

vaccine + Hepa B immune globulin (separate
sites)
Umbilical Cord Care
Newborn Screening
• RA 9288 –” Newborn Screening Act of
2004”

• The process of collecting a few drops of

blood from the newborn onto an
appropriate collection card
• Performing biochemical testing for
determining if NB has a heritable condition
or congenital metabolic disorder (mental
retardation)
 Metabolic disorders
• Congenital Hypothyroidism (CH)

• Congenital adrenal hyperplasia (CAH)

• Galactosemia (Gal)

• Phenylketonuria (PKU)

• Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD)