Care of the Normal Newborn

M. Rogers-Walker, MSN/Ed, RN
 Apgar Scoring
Activity (muscle tone)
0 — Limp; no movement; flaccid
1 — Some flexion of arms and legs
2 — Active motion

Pulse (heart rate)

0 — No heart rate
1 — Fewer than 100 beats per minute
2 — At least 100 beats per minute
Grimace (reflex response)
0 — No response to airways being suctioned
1 — Grimace
2 — Vigorous Cry; cough, or sneeze

Appearance (color)
0 — The baby's whole body is completely bluish-gray or pale
1 — Good color (pink) in body with bluish hands or feet
2 — Good color all over (completely pink)

Respiration (breathing)
0 — Not breathing
1 — Weak cry; may sound like whimpering, slow or irregular breathing
2 — Good, strong cry; normal rate and effort of breathing
Pulmonary System Transition
 First baby must take that first breathe
 Function of respiration switches
 Management
Cardiac System Transition
 Closure of the foramen ovale- after cord is
clamped

 Closure of the ductus arteriosus

 Closure of the ductus venosus

 Common variations
 Murmurs
 Acrocyanosis
 Nursing Responsibilities
 Dry and Stimulate- to make
baby cry
 Suction (if needed)
 Assess heart rate
 Weight and identify
Newborn Thermoregulation
Heat production
 Brown adipose tissue

Heat loss
 Convection

 Radiation

 Evaporation- most common

 Conduction

Response to heat
Nursing Interventions to
Prevent Hypothermia
 Dry infant, remove wet
blankets
 Apply a hat and warm
blankets
 Avoid placing infant on
cold surfaces
 Avoid placing infants in
drafts
 Place under radiant
warmer if temperature
is unstable- naked
 Normal Newborn Vital Signs
 Temperature:
Axillary: 36.5-37c (97.7-98.6F)
Rectal: 36.6-37.2c (97.8-99F)
 Heart rate:

Apical: 120-160bpm. Varies with

sleeping or crying
 Respiration: 30-60 breaths/min

 Blood Pressure: 80/40.varies.

Arm/Thigh- not part of normal
v/s for baby
 Newborn Sleep Cycle
Sleep states:
 Deep or quiet sleep

 Active (REM)

Alert states:
 Drowsy

 Wide awake

 Active awake

 Crying
Nursing Assessment of the newborn
Newborn Appearance
Head circumference
 32–37 cm (12.5-14.5)

 Approx. 2-3 cm larger than chest

circumference
 Fontanels- Anterior and posterior

 Molding

 Caput succedaneum

 Cephalhematoma
Newborn Measurements
 Weight
2,500 – 4,000 g
5 lb 8 oz – 8 lb 13 oz
Average: 3405g
7 lb 8 oz
 Length
48–52 cm (18-22 in)
Average: 50cm(20in)
 Newborn Appearance

Caput succedaneum Cephalhematoma

Newborn Appearance

Chest circumference
 Average: 32cm (12.5 in)

 Range: 30-35cm (12-14 in)

 Evident xiphoid

 Breast enlargement (normal

because of hormones)
 Sternal retractions- indication of
resp. distress
 Eyes, Ears, Nose, and Mouth
Assessment
Eyes
 Symmetry in appearance, aligned with the ears. if below
indicates down syndrome.
 normal placement

Ears
 Without lesions, cysts, nodules

 Sinus tract

Nose
 Patent nares bilaterally

 Sneezing (common)- this is like a reflex to clear airway. Is

normal. Doesn't mean infection or cold.
Mouth
 Palpate soft and hard palate

 Teeth

 Tongue
 Abdominal and Back Assessment
Abdomen
 Round, full, symmetrical, normal bowel sounds
 Two arteries, one vein in cord
 Brachial and femoral pulses- make sure is
present & strong
 Hernia- common in African Americans

Back
 Spine intact- nice straight curve
 Patent anus
 No sacral dimples- can be sign of spinal bifida.
Report to doctor.
 Lanugo
 Genital and Anal Assessment
Normal finding
 Patent anus

 Stool and urine by 24 hours after birth

Male Findings:
 Testes palpable in scrotum

 Undescended testes

 Epispadius -pee hole is on the top part of the

shaft
 Hypospadius- pee hole is on the bottom part of
the shaft
 Scrotum pendulous- when is swollen. You see it
on breech babies.
 Imperforate anus
Genital and Anal Assessment

Female Finding:
 Labia & clitoris edematous

 Hymenal tag

 Vaginal discharge- normal

 Pseudomenstruation- spot of
bleeding from the maternal hormone
passing through the babies system
causes this or breast to swell
 Skin Assessment
 Acrocyanosis
 Vernix caseosa- whitish coat when
born. Lubricate and protect their
skin in utero.
 Milia- white spots on the nose and
face. It will disapear.
Mongolian spot
 Erythema toxicum (newborn rash).
Disappear by itself.
 Mongolian spots
 Birthmarks
 Telangiectacic nevi (stork bites)
 Nevus flammeus (pork wine stain)
 Nevus vasculosus (strawberry mark)
Birthmark
 Neurologic System

Normal reflexes
 Blink- reaction to light within 2 hours after birth. Open
and close the eyes.
 Sucking
 Rooting- stroke the side of face. They should turn to
that side. To see if able to find breast.
 Grasp (plantar and palmer)- finger in hand. Clamp.
 Moro – when you lift them of the crib a little or through
startle. Their hand come to a “C”. Up to 6 months.
 Babinski- finger through feet. Flare till 2 yr. opposite
after that.
 Stepping- when u stand them up and move legs like if
they are stepping
 Tonic neck- head one side and hand goes other way
General Nursing Care
 Erythromycin ointment

 Vitamin K prophylaxis (0.5–1.0 mg)

 First bath
Gestational Age Assessment-
not important
Dubowitz Tool
 Neuromuscular  Physical maturity
maturity  Skin
 Posture  Lanugo
 Square window  Plantar surface
 Arm recoil  Breasts
 Popliteal angle  Eye and ear
 Scarf sign  Genitalia
 Heel-to-ear
 Newborn Nutrition
Calorie requirements:
 50 to 55kcal/lb/day or 105-108kcal/kg/day

Breast Milk
 Colostrum- provides baby with passive immunity

 Transitional

 Mature milk

 Fore milk

 Hind milk

Frequency
 1 and a half to 3 hours

 Determined by baby cues

 Newborn Stools
 Meconium- 1rst poop. Passes first 8-24
hours. Thick and tarry.

 Transitional- switches to greenish loose

stool.

 Breast fed stools- liquid. Seed. Yellow

color stool.

 Formula fed stools- more formed and

pasty brown color
Newborn Stools
Questions
 If newborn temp is 96.5F, what would you do?
You warm up the baby with radiant warmer,
naked. You want it to be at least 97.5F. Do
double wrapping if is slightly lower or put on
mother stomach and out blankets over it. Sign of
infection is low temp., babies cant maintain body
temp and have to be put on the radiant several
times.
 The caput crosses the suture line. Caput is full of
fluids. Heals hours to days.
 Vitamin k given in vastus lateralis and is given to
prevent bleeding. Promotes clotting factor.
 Baby looses heat to cold window, how
is it loosing heat? Radiation.
 Rectal temp done initially to newborn
to check for patency.
 What is the bluish discoloration in the
hand and feet? Acrocyanosis.
 Baby should be placed to sleep on the
back to prevent SID. And have them
turn the head to the side.