Care of the Newborn

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Care of the Newborn
2014-10-28 23:13:47
Care Newborn

Care of the Newborn
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  1. Global newborn care goals
    —Infant will not demonstrate S/S of respiratory distress

    —Infant will not demonstrate signs of circulatory failure

    —By the end of the transition period, the infant will demonstrate two consecutive temperature readings of at least 36.5 C

    —The infant will be free of signs of infection at discharge

    —Parents will demonstrate ability to effectively care for infant’s needs
  2. First priority of care for newborns:
    Respirations (apgar score)
  3. Second priority of care for the newborn (after respirations)
  4. Initial Assessment and Care of newborn includes:
    • Apgar score
    • Thermoregulation
    • Gross PE
    • Newborn ID
    • Initiation of parent-infant attachment
  5. Upon nursery admission, significant data to record/obtain:
    • Condition of baby
    • L&D record
    • Antepartal Hx
    • Parent-infant attachment
  6. Initial nursing care once baby has been admitted to nursery
    • ID bands
    • Vital Signs/Measurements 
    • Labs
    • Meds- Vitamin K, Broad spectrum antibiotic OU
  7. 3 Types of assessments for the newborn:
    • Newborn physical assessment
    • Gestational age assessment
    • Behavioral assessment
  8. Provides warmth in response to infant skin temperature readings...ISC probe attached to trunk for continuous feedback
    Radiant Warmer
  9. Provides thermoneutral regulation for baby
  10. Temperature regulation methods for newborn:
    • Radiant warmer
    • Isolette
  11. The baby (with a good apgar score) should be held to mother's chest:
    immediately following birth
  12. Perferred method for temperature monitoring of newborns:
  13. Normal range of baby temp:
    36.5 -37 C

    (97.7- 98.6 F)
  14. Newborn temperature may be unstable at first because:
    newborns have immature temperature regulation abilities
  15. When the baby is being examined, place him on:
    Radiant heat panel to help keep the baby from losing body heat during the exam
  16. Environment created by any method or apparatus to maintain the normal body temperature to minimize oxygenation consumption and caloric expenditure
    neutral thermal environment
  17. Using NTE (neutral thermal environment)  for temperature control in newborns is like setting the temperature in a room
    • –Since we can not ask the newborn whether it
    • is too cold or too hot we use the NTE. We make the assumption the incubator or radiant warmer maintains the NTE (something you must check) and then monitor the infant temperature for hypothermia or fever.
  18. —Using Servo for temperature we set the temperature that we want the skin to be held at (usually 36.5 C).
    –We then monitor any changes to the environmental temperature required to keep this skin temperature. If the environmental temperature goes up, the infant is hypothermic. If it goes down, the infant has fever.
  19. Assessment of Airway consists of:
    Assessment of resp status: (30-60 RR), No nasal flaring, no grunting

    Assess secretions: note color, position for removal of secretions, use bulb syringe to clear airway
  20. When does suctioning usually occur first
    Once the fetal head emerges before being fully delivered (nose and mouth, sometimes throat)
  21. Important "First" Assessments of baby
    • First Stool
    • First Void
    • First Feeding
  22. Avg Weight of newborn
    2500-4000g (7 1/2 lbs)
  23. Avg head circumference of newborn:
    33- 35.5 cm
  24. Avg chest circumference for newborn
    30.5 to 33 cm
  25. Avg length of baby
    48-53 cm (20 inches)
  26. Average V/S
    • RR: 30-60
    • HR: 120-140
  27. As much as ___% weight loss during the first 3-5 days of life is expected in the is usually regained in 8-12 days
  28. Bilirubin level of 5-7 mg
    Physiologic Jaundice
  29. In full term infants, Physiologic jaundice develops in ____ days (if it occurs in the 1st 24 hours of life it is pathologic)
    2-4 days
  30. Factors that complication jaundince:
    Somewhat immature liver

    Lack of intestinal flora causes bilirubin to be reabsorbed (delayed stooling is associated with high bilirubin levels)

    Progesterone in breast milk inhibits liver enzymes needed for conjugation

    Plethoric infant has increased RBC

    Hematoma or other injury
  31. Unconjugated bilirubin deposits _____
    • Anywhere there are fat cells:
    • -skin
    • -sclera
    • -brain (myelin sheaths)
  32. High levels of bilirubin in the brain can cause
    Kernicterus (scarring of the brain)
  33. Ongoing newborn assessment consists of:
    • Vital Signs
    • Daily Weight
    • Skin color
    • Urine/Stools
    • Nutrition/Bowel sounds/Spitting
    • Umbilical Cord
    • Circumcision
    • Pain
    • Parent Education/Discharge Teaching
  34. The Ballard Score (Gestational Age Assessment) is based off what physical and neurological things:
    • Physical:
    • Skin
    • Lanugo
    • Plantar Surface
    • Breast Tissue
    • Eye/Ear
    • Genitals

    • Neurological
    • Posture
    • Square window
    • Arm recoil
    • Popliteal angle
    • Scarf sign
    • Heel to ear
  35. Assessment scale that evaluates 38 behaviors to build a behavioral profile of an infant up to 2 months old
    Brazelton Neonatal Assessment
  36. Brazelton Neonatal Assessment Scale
    Evaluates 38 behaviors to build a behavioral profile of an infant up to 2 months old

    Recognizes that a baby is a highly-developed organism even when just newly born

    Describes the baby's strengths, adaptive responses and possible vulnerabilities

    Helps parents develop appropriate caregiving strategies to enhance their earliest relationship with the child
  37. Newborn Behavioral Observations of the Brazelton Assessment
    Habituation- light/sound (sleep protection)

    Activity- quality of motor tone and activity level

    Consolability- capacity for self-regulation

    Threshold response to stress

    Interaction- alertness and response to stimuli
  38. Every state and US territory routinely screens newborns for
    certain genetic, metabolic, hormonal and functional disorders

    (Unless detected and treated early, these disorders can cause physical problems, mental retardation and, in some cases, death)
  39. Disorders included in the routine newborn screenings of every state and US territory
    • Phenylketonuria (PKU)
    • Congenital Hypothyroidism (CH)
    • Galactosemia
    • Sickle Cell Disease
    • Congenital Adrenal Hyperplasia (CAH)
    • Biotinidase deficiency
    • Hearing impairment
  40. Inborn error of metabolism of the essential amino acid phenylalanine...toxic build up results in mental retardation
  41. A child must have _____ 48 hours prior to PKU testing
    Milk Feedings
  42. Deficiency of the enzyme galactose-l-phosphate uridyltransferase leading to the inability to convert galactose to glucose

    *FATAL if not detected and treated within first few days
  43. First sign of galactosemia
    Feeding Problems
  44. Most common childhood endocrine problem (hypothyroidism)
  45. Metal retardation can occur within _____ if no replacement is given (breastfed infants do not show symptoms of hypothyroidism until weaned)
    3 months
  46. ____ screening is required by law for hypothyroidism
  47. S/S of Hypothyroidism
    Decreased fetal activity


    LGA (>4kg)

    Respiratory distress


    Poor feeding


    Late onset jaundice

    Large posterior fontanel due to a lag in bone maturation

    Peripheral cyanosis even when well oxygenated

    Lag in stooling (>20 hours)
  48. How soon is metabolic screen in newborn done?
    24-48 hours of life 

    (repeated at 2 weeks of life)
  49. Heel sticks can check for:
    • Jaundice
    • Hypothyroidism
    • PKU
    • Glucose
    • CBC

  50. Circumcision is an ____ procedure
    • Elective
    • (1999 policy statement: inform parents of risks/benefits)
  51. Risks to circumcisions


    Damage to penis
  52. Benefits to circumcision
    Decreased incidence of UTIs, STIs, Penile cancer, HPV
  53. Analgesia used for circumcisions:
    • Dorsal penile nerve block (Lidocaine)
    • EMLA cream
    • Non-pharm interventions
  54. Type of dorsal penile nerve block used for analgesia during circumcision
    Lidocaine SubQ at the 10 and 2 o'clock positions
  55. Topical anesthetic of prilocaine-lidocaine cream applied for 1 hour before circumcision
    EMLA cream
  56. Types of non-pharm interventions for analgesia during circumcision
    Non-nutritive sucking, swaddling, oral sucrose
  57. Prepuce is held between 2 clamps and appropriate size bell is placed over glans for protection
    Gomco Circumcision
  58. Parent education needs of newborn
    How to take temp

    Feeding/Feeding patterns

    Infant Hygiene (diapers, bathing, cord care, circumcision care)

    Normal elimination

    Holding/Supporting head

    Safe sleep positions

    Car Seat

    Immunizations - Hep B

    Infant Safety/Car seats

    "BACK to sleep"

    Follow up care- immunizations

    Infant development: (sensory enrichment, normal newborn activity, infant development milestones)