A5. Newborn

NEWBORN JUSTINE MANANGAN
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Initial Assessments and Stabilization

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• Airway = #1 priority
• Respiratory effort
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- newborn sign: crying, screaming
• Warmth
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• APGAR scores
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- A = appearance (color)
- P = pulse (heart rate)
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- G = grimace (reflex irritability)
- A = activity (muscle tone)
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- R = respiratory effort (rate)
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- Max of 10 with 2 points for each assessment.
- Good APGAR, 8 or above
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- Low APGAR, resuscitate.
• Examination
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• Identification
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- Footprints
- Bracelets (4)—2 for baby, 1 for mom, 1 for dad/S.O./etc.
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NOTE:
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- Nurse’s responsibility changes from the laboring mother immediately to the newborn.
- Initial assessments include ensuring the infant has an open airway and respiratory effort is adequate.
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- Providing warmth either on the mother’s abdomen with blankets around the baby (skin-to-skin), or under a radiant warmer
- Good respiratory—crying, screaming
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Newborn Physiologic Adaptations

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CA R DI O VA SC UL A R
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• Switch from fetal to newborn circulation
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• Change from placental to pulmonary gas exchange
- Once the cord is clamped, oxygenation should occur in the baby’s alveoli
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• Physical forces leading to increased release of catecholamines critical for changes

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involved in transition to extrauterine life
• Changes in fetal structures: foramen ovale, ductus arteriosus, and ductus venosus
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close; umbilical arteries and vein
• Page 552—cardiovascular system adaptations.
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• Normal newborn heart rate: 120-160 bpm
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SUMMARY OF FETAL CIRCULATION TO NEONATAL CIRCULATION

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• Clamping umbilical cord at birth eliminates the placenta as a reservoir for blood.
• Onset of respirations causes a rise in PO2 in the lungs and a decrease in

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pulmonary vascular resistance, which…
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• Increases pulmonary blood flow and increases pressure in the left atrium,
which…
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• Decreases pressure in the right atrium of the heart, which causes closure of the foramen ovale (closes within minutes after birth secondary
to a decreased pulmonary vascular resistance and increased left heart pressure)
_________________________________________________________ • With an increase in oxygen levels after the first breath, an increase in systemic vascular resistance occurs, which…
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• Decreases vena cava return, which reduces blood flow in the umbilical vein (constricts, becomes a ligament with functional closing).
• Closure of the ductus venosus (becomes a ligament) causes an increase in pressure in the aorta, which forces closure of the ductus
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arteriosus within 10 to 15 hours after birth.
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R ES PI R ATO RY
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• Initiation of respirations
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• Role of surfactant
• Respirations: 30-60 breaths/min; irregular, shallow, unlabored;

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short periods of apnea (<15 sec); symmetrical chest movements.
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• Respiratory patterns:
- Nose breathers
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- Diaphragmatic (“belly breathers”)
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• Surfactant - protein made by the lung cells
- Lines the alveoli
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- Lowers lung surface tension
- Promotes lung expansion
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- Prevents alveolar collapse
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- Lecithin/Sphingomyelin (L/S ratio): 2:1 ratio = fetal lung maturity;
3:1 in diabetic moms
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• Before the newborn’s lungs can maintain respiratory function, the following events must occur:
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- Initiation if respiratory movement
- Exapnasion of the lungs
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- Establishment of functional residual capacity (ability to retain some air in the lungs on expiration)
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- Increased pulmonary blood flow.
- Redistribution of cardiac output.
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HE PATI C SYS T EM ( L I VER )
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• Iron storage, carbohydrate metabolism, blood coagulation, and conjugation of bilirubin.
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(1) IRON STORAGE
- As RBCs are destroyed after birth, the iron is released and is stored by the liver until new RBCs need to be produced.
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- Hgb and length of gestation = determinant
- The term newborn has iron stores sufficient to last approximately 4 to 6 months.
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(2) CARBOHYDRATE METABOLISM

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- Initially, the newborn’s serum glucose levels decline. A term newborn’s blood glucose level is 70% to 80% of the maternal blood
glucose.
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- With the newborn’s increased energy needs after birth, the liver releases glucose from glycogen stores for the first 24 hours.
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- Initiating feedings helps to stabilize the newborn’s blood glucose levels.
- Assessed using a heel stick sample of blood at approx. 4 hours of age.
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(3) BILIRUBIN CONJUGATION

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- Bilirubin—a yellow to orange bile pigment produced by the breakdown of red blood cells.
• Newborns produce bilirubin at a rate of approximately 6 to 8 mg/kg/day; typically declines to the adult level within 10 to 14 days afte
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birth.
• 2 Types of Bilirubin
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- (1) Direct (conjugated) bilirubin—by product of hemolysis of erythrocytes which is broken down by the liver and excreted from the
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body in urine and feces. NORMAL.
• Excreted from liver cells as a constituent of bile.
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- (2) Indirect (unconjugated) bilirubin—a fat-soluble breakdown product derived from hemoglobin that is released primarily from
destroyed RBCs.
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• Cannot be excreted because the liver can’t break it down. Builds up and spills over into the skin, mucous membranes and sclera
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—causing JAUNDICE.
- Total Bilirubin—combination of direct and indirect
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- Jaundice
• When unconjugated bilirubin pigment is deposited in the skin and mucous membranes, jaundice typically results.
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• Jaundice a.k.a. icterus, refers to the yellowing of the skin, sclera, and mucous membranes that results from increased blood bilirubin
levels.
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• Even in healthy term newborns, extremely elevated blood levels of bilirubin during the first week of life can cause kernicterus, a
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permanent and devastating form of brain damage.
• Common risk factors for the development of jaundice:
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- Fetal-maternal blood group incompatibility
- Prematurity
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- Breastfeeding
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- Drugs (such as diazepam [Valium], oxytocin [Pitocin], sulfisoxazole/erythromycin [Pediazole], and chloramphenicol [Chloromycetin])
- Maternal gestational diabetes.
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- Infrequent feedings
- Male gender
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- Trauma during birth resulting in cephalhematoma
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- Cutaneous bruising
- Polycythemia
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- Previous sibling with hyperbilirubinemia
- Infections such as TORCH
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- Ethnicity such as Asian or Native American.
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• The causes of newborn jaundice can be classified into three groups based on the mechanism of accumulation:
- (1) Overproduction: as a result of blood incompatibilities, drugs, trauma at birth, polycythemia, delayed cord clamping, or breast
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milk jaundice; too much; infection, diabetes, blood group incompatibility, positive Coomb’s.
- (2) Decreased bilirubin conjugation: as seen in physiologic jaundice (occurring > 24 hrs of life), hypothyroidism, and
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breastfeeding; not enough conjugation, can’t handle all the RBC excess.
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- (3) Impaired excretion: biliary obstruction, sepsis, drugs, chromosomal anomalies, and drugs; doesn’t break it down, can’t get rid
of it.
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ASSESSING FOR JAUNDICE

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• Assess skin color—from the head down; blanching forehead (yellow color)
• Bili-scan
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• Depends on the age of the newborn (check graph)
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PHOTOTHERAPY
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- Treatment with phototherapy is based upon the newborns age in hours post delivery and the level of serum bilirubin
level.
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- Infant placed under bank of lights
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- Need to be mostly undressed
- Closed eyes need to be covered
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- Monitor infant’s temperature
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- Frequent position changes
- Insensible water loss which may cause dehydration
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- Breakdown of bilirubin causes an increase in gastric motility, causing frequent, loose stools
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- Discontinue when bilirubin levels are within an acceptable range
- Also need to check bilirubin levels daily
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- Keep bili-lights or bili-bed in mom’s room to promote interaction with the newborn
- Also cover perineum
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- Bili-Blanket (Wallaby Blanket)
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• Monitoring and documentation the same for lights and Wallaby: infant’s temp, color, feedings, urine, and BMs
• Promotes bondings/feedings
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• Interventions:
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- Determine presence of jaundice
- Record and report findings to infant’s practitioner
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- Set up equipment for phototherapy or exchange transfusion
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- Follow unit protocols for phototherapy use
- Monitor and encourage frequent feedings to increase digestion and avoid dehydration
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- Assess number and color of BMs
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- Detect jaundice by blanching skin over a bony prominence.
- Jaundice begins in the head and progresses to the abdomen and extremities
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• Jaundice:
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- Physiologic—within the third and fourth day of life
• Occurs at least 24 hours after delivery/seen in up to 60% of infants. Due to increase in RBC mass/decreased lifespan
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of RBCs/liver immaturity
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- Pathologic—within the first 24 hours of life
• Most common cause is blood group incompatibilities or infections
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• Bilirubin levels are 17 mg/dL
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- Breast milk—early and late onset
• Early onset—within the first 2-4 days of life-associated with decreased fluid intake
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- Colostrum helps promote the passage of meconium and will decrease bilirubin levels
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• Late onset—usually occurs after approximately the 6-14th days of life (when mother’s milk is in).
- Should encourage mom to nurse infant 8-10x per day or may supplement with formula
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- May be related to change in breast milk composition
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• Possible Causes
- Delayed cord clamping
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- Forceps delivery
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- Vacuum extracted delivery
- Intrauterine infections
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- Neonatal hypoxia
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- Rh sensitization
- ABO incompatibility
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- Intestinal obstruction
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• Exchange Transfusion
- Done when the infant is at risk for kernicterus
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- Kernicterus—bilirubin encephalopathy
• Caused by excess jaundice
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- Bilirubin deposited in the brainstem
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- Disrupts motor function, vision and hearing
- If infants survives, may have CP, epilepsy, or mental retardation
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• Blood from infant is removed and replaced with whole blood through a UVC.
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• Watch for transfusion reactions and infection
- Allergic, febrile reactions, hemolytic
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- Baseline vitals then every 15 mins.
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G A ST R OI N TE ST I NA L
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• The full-term newborn has the capacity to swallow, digest, metabolize, and absorb food taken in soon after birth.
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• At birth, the pH of the stomach contents is mildly acidic, reflecting the pH of the stomach contents is mildly acidic,
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reflecting the pH of the amniotic fluid.
• The once-sterile gut changes rapidly, depending on what feeding is received.
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- Vitamin K administered because the GI can’t synthesize Vitamin K yet.
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• Bowel sounds are normally heard shortly after birth, but may be hypoactive on the first day.
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MUCOSAL BARRIER PROTECTION
• An important adaptation of the GI system is the development of a mucosal barrier to prevent the penetration of harmful
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substances (bacteria, toxins, and antigens) present within the intestinal lumen.
• The newborn must must be prepared to deal with bacterial colonization of the gut.
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- Colonization is dependent on oral intake.
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- It usually occurs within 24 hours of age and is required for the production of vitamin K.
• Take note! Human breast milk provides a passive mechanism to protect the newborn against the dangers of a deficient
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intestinal defense system. It contains antibodies, viable leukocytes, and many other substances that can interfere with
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STOMACH AND DIGESTION

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• Capacity: 30 to 90 mL (1 to 3 ounces), with a variable emptying time of 2 to 4 hours.
• Cardiac sphincter (LES absent) and the nervous control of the stomach is immature, which may lead to uncoordinated
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peristaltic activity and frequent regurgitation.
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- Avoiding overfeeding and stimulating frequent burping may minimize regurgitation.
• Most digestive enzymes are available at birth, allowing newborns to digest simple carbohydrates and protein.
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- However, they have limited ability to digest complex carbohydrates and fats, because amylase and lipase levels are low
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at birth.
- As a result, newborns excrete a fair amount of lipids, resulting in fatty stools.
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• Normally, term newborns lose 5% to 10% of their birthweight as a result of insufficient caloric intake within the first week
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after birth, shifting of intracellular water to extracellular space, and insensible water loss.
• To gain weight, the term newborn requires an intake of 108 kcal/kg/day from birth to 6 months of age.
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BOWEL ELIMINATION
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• Meconium—composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood. It is greenish black, has a
tarry consistency, and is usually passed within 12 to 24 hours of birth.
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• Transitional—thin, brown to green
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• Milk stools
- Breastfed infant: yellow gold, soft or mushy stools
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- Formula-fed infant: pale yellow, formed and pasty stools.
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• Take note! Newborns who are fed early pass stools sooner, which helps to reduce bilirubin buildup..
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R EN AL
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The majority of term newborns void immediately after birth, indicating adequate renal function.
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• Although the newborn’s kidneys can produce urine, they are limited in their ability to concentrate it until about 3 months of
age, when the kidneys mature.
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- Urine specific gravity: 1.001 to 1.020
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• Voiding patterns: about 6 to 8 voidings daily is average for most newborns; this indicates adequate fluid intake.
• Low GFR: The low GFR and the limited excretion and conservation capability of the kidney affect the newborn’s ability to
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excrete salt, water loads, and drugs.
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• Brick dust
• Pseudomenstruation
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• Take note! The possibility of fluid overload is increased in newborns; keep this in mind when administering intravenous
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therapy to a newborn.
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Substance Abuse
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• Alcohol. Fetal alcohol spectrum disorder (FASD), cranio-facial malformations, neurological problems: IQ deficient,
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spontaneous abortion, IUGR
• Nicotine. Vasoconstriction, low birth weight (LBW) infants, IUGR, miscarriage, abruption, decreased blood flow to placenta,
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increased risk to SIDS.
• Caffeine. Vasoconstriction, fetal stimulation, does not cause birth defects when used alone. May be related to IUGR when
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consumption is > 3-4 cups of coffee/day (300 mg/day)
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• Marijuana. Most common illicit drug used in America and by women 18-44 y/o. Crosses the placenta. May result in
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preterm birth, IUGR, LBW, hyperactive startle reflex, newborn tremors
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• Cocaine. VASOCONSTRICTION. “Crack” is most commonly used form. It is smoked and absorbed through the pulmonary
vasculature. Readily crosses the placenta. Causes maternal and fetal tachycardia, increase in BP, decreased uterine flow,
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and increased vascular resistance. Fetus suffers from decreased blood flow and oxygenation because of placental and fetal
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vasoconstriction. Abruption, abortion, IUGR, CNS defects, “Snow baby syndrome”: babies are born addicted to cocaine.
May cause fetal depression: lethargy, poor suck, hypotonia, weak cry, and difficult in arousal or excitability: high-pitched
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cry, hypotonicity, rigidity, irritability, inability to console.
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• Heroin/Opiates. Preterm labor, PROM, abruption, newborn sepsis and death, malnutrition, intellectual impairment.
Increased rate of stillbirths but not congenital anomalies. 50-75% of infants go through withdrawal within the first 48 hours
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after birth. Withdrawal symptoms similar for heroin and methadone: jittery/hyperactive, shrill and persistent cry, frequent
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yawning or sneezing, increased tendon reflexes but Moro reflex is decreased, poor feeding and sucking, tachypnea,
diarrhea, sweating and hypo/hyperthermia. 5-10x increase in SIDS for infants undergoing withdrawal. Need to treat
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withdrawal symptoms or infant may have vomiting and diarrhea, apnea, dehydration, and convulsions.
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• Methadone. A synthetic opiate. Given to heroin addicts. May not have signs of withdrawal until 1 week after birth. Also use
Suboxone for heroin addicts.
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• Methamphetamines. Effects are not well known but seem to be dose related. High doses during pregnancy seem to be
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related to low birth weight, premature births, and perinatal mortality. Cleft lip and palate and cardiac defects are also
common. R/t GERD infants.
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• Sedatives. Easily crosses the placenta. CNS depression, delayed lung maturity, infants may exhibit withdrawal symptoms
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due to their dependence on the substance.
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• Neonatal Abstinence Scoring Tool (Finnegan Score)
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- Higher score = higher the severity of withdrawal symptoms.
- Used by physicians to prescribe (usually Morphine) to newborns

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exhibiting symptoms
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7 OF 14
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G ES TAT I O NA L A G E A SS E SSM E NT
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• Preterm or Premature—born before 37 weeks’ gestation, regardless of birthweight.
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• Term—born between 38 and 42 weeks’ gestation.
• Postterm or postdates—born after completion of week 42 gestation.
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• Postmature—born after 42 weeks and demonstrating signs of placental aging
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• Small for gestational age (SGA)— weight less than the 10th percentile on standard growth charts (usually <5.5 lb)
• Appropriate for gestational age (AGA) —weight between 10th and 90th percentiles.
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• Large for gestational age (LGA)— weight more than the 90th percentile on standard growth charts (usually >9 lb)
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• Take note! Gestational age assessment is important because it allows the nurse to plot growth parameters and to
anticipate problems related to prematurity, postmaturity, and growth abnormalities.
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8 OF 14
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Diagnostic Data
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NE W BO R N SC R EE NI N G
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9 OF 14
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• GENETIC AND INBORN ERRORS OF METABOLISM SCREENING
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• GLUCOSE
- Rapid depletion of stored glycogen in the first 24 hours because of newborn’s increased energy needs after birth.
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- Normal values >40 mg/dL in the immediate newborn period.
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- Tested by heel-stick blood sample.
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• C-REACTIVE PROTEIN (CRP)
• BILIRUBIN
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- Phototherapy
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- See pages 3-4
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Circumcision
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• Anesthesia used for the procedure:
- Ring block
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- Dorsal penile nerve block
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- Topical anesthetics—EMLA cream
- Non-nutritive sucking with concentrated oral sucrose solution
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- Oral acetaminophen
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- Swaddling
- Combination—works the best.
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Discharge Teaching
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B UL B SU CT I ON I NG
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1. When suctioning a newborn with a bulb syringe, compress the bulb before placing it into the oral or nasal cavity.
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2. Release bulb compression slowly, making sure the tip is placed away from the mucous membranes to draw up the
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excess secretions.
3. Remove the bulb syringe from the mouth or nose, and then, while holding the bulb syringe tip over an emesis basin lined
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with paper towel or tissue, compress the bulb to expel the secretions.
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4. Repeat the procedure several times until all secretions are removed.
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Take note! Always keep a bulb syringe near the newborn in case he or she develops sudden choking or a blockage in the
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nose.
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P OS IT I O NI NG
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• Supine position when sleeping
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10 OF 14
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BATHI NG
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• Sponge bath without submerging
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• 2-3 times a week
Bathing the Baby

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• Start at the baby’s head while baby is still clothed.
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• Using a wet washcloth (no soap), wipe one eyelid from inner to outer corner.
• Change the spot on the washcloth to clean the other eye.
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• Wash external ears using index finger in washcloth.
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• Wash rest of face and, using soap now, progress to neck creases.
• Dry off each are after washing it to decrease heat loss.
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• Remove baby’s shirt and wash chest, arms, and hands (use soapy hands instead of washcloth if desired).
• Wash trunk and back (hold baby off table, supporting baby while doing the back).
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• Keep a circumcised baby off his abdomen if possible.
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• Keep baby’s upper body warm by wrapping in towel or blanket before washing legs and feet.
• Wash genitalia (wash girls front to back; do not retract foreskin of uncircumcised boys).
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• Wash hair: put a little water and shampoo on hair; use hairbrush to work it in; rinse, dry.
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UMBILI CAL C ORD CARE

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• Clean cord and skin around base with a cotton swab or cotton ball.
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• Clean 2—3 times a day or with each diaper change.
• Do not give tub baths until cord falls off in about 7—14 days.
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• Fold diaper below umbilical cord to let air circulate.
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• Check each day for any odor, oozing of yellow material, or reddened areas
• Expect tenderness around the cord and darkening and shriveling of cord.
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• A small drop of blood may be present when cord falls off.
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• Never pull on cord or attempt to loosen it.
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FEEDINGS
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BOTTLE-FEEDING
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Amount of Formula
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• Starts with 3 oz in each bottle (since a newborn usually takes 1—3 oz every 2.5 to 4 hours),
• Expect increase in baby’s appetite with demand feeding (as baby needs more he or she will start finishing each bottle).
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• Do not feed the baby a partially used bottle after 1 hour at room temperature.
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• Do not feed the baby a partially used bottle after 4 hours in refrigerator.
• Prepare a fresh bottle for each feeding: do not add new formula to old.
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• Refrigerate bottles made in advance.
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• Do not feed the baby an opened, refrigerated can of concentrated or ready-to-feed formula after 48 hours because milk is
superheated and plastic bottle bags may burst; use “defrost” setting on microwave oven and carefully check temperature
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of formula before feeding.
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Positioning the Baby for Feeding
• Hold baby close, establishing eye contact as in breastfeeding.
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Hold baby’s bottom or foot firmly, keeping his or her back straight to aid digestion and provide a sense of security.
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• Quiet baby before feeding.
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11 OF 14
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• Alternate the side baby is fed from to give baby two-sided stimulation.
• Avoid feeding while baby is on his or her back.
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• Do not prop the bottle.
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Procedure for Feeding
• Nipple hole should allow only drops of milk to flow.
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• Keep nipple full with milk to decrease air ingestion.
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How to Burp a Baby
• Position baby so his or her head rests on mother’s shoulder or face down on lap, or sit baby on lap with baby’s chin and
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chest supported.
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• Gently pat or stroke baby’s back.
• Burp baby halfway through feeding and at end of feeding.
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• Learn baby’s preferred burping position and whether baby is a slow or quick burper.
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• Regurgitation of small amounts of formula is common.
• Have burp cloth available.
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BREASTFEEDING
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Basics of Milk Production

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• Milk produced according to demand.
• Milk stored in sinuses under areola.
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• Adequate maternal fluid intake required.
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• Milk supply established by frequent breastfeeding (every 1 1/2 to 3 hours)
• Let-down reflex: flow of milk initiated by newborn’s sucking, presence, or cry; by mother’s thoughts; or during maternal
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orgasm.
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Positioning Baby at the Breast
• Turn baby’s entire body toward mother, with mouth adjacent to the nipple and the ear; should and hip are in direct
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alignment.
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• Mother should assume a comfortable position with arms supported.
• Direct nipple straight into baby’s mouth so that during sucking, jaw compresses ducts directly beneath areola.
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• Lightly brush infant’s mouth with breast to stimulate rooting reflex (but avoid touching both cheeks).
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Procedure for Feeding
• Avoid arbitrary time limits (since let-down reflex may take up to 3 minutes).
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• Allow baby to suckle at first breast until breast is emptied.
• Insert finger in baby’s mouth near nipple to break suction.
_________________________________________________________
• Burp baby before changing breast.
_________________________________________________________
• Burp baby again at completion of feeding.
• To prevent skin breakdown wash nipple with warm water and dry thoroughly.
_________________________________________________________
Helpful Hints
_________________________________________________________
• Be certain baby is well awake before attempting feeding.
• Alternate breast at which baby begins feeding (use safety pin as reminder).
_________________________________________________________
• Lift breast slightly or press lightly on breast above nares if mother’s large breast occludes infant’s nares.
_________________________________________________________
• Rotate baby’s position at breast to avoid undue trauma to nipples and improve emptying of ducts.
• Avoid supplementary formula feedings until lactation is established.
_________________________________________________________ • Check with caregiver before taking any medication while breastfeeding (because medications may cross into breast milk).
_________________________________________________________
_________________________________________________________
12 OF 14
_________________________________________________________
E LI MI N AT I O N
_________________________________________________________
• At least 6—10 wet diapers per day.
_________________________________________________________
• Urine straw to amber color without foul smell.
• Normal progression of stool changes:
_________________________________________________________
- Meconium (thick, tarry, dark green)
_________________________________________________________
- Transitional stools (thin, brown to green)
- Breastfed infant: yellow gold, soft or mushy stools; Formula-fed infant: pale yellow, formed and pasty stools.
_________________________________________________________
• Only 1—2 stools a day for formula-fed baby.
_________________________________________________________
• 6—10 small, loose yellow stools per day or only one stool every few days after breastfeeding is well established (after about
1 month)
_________________________________________________________
_________________________________________________________
CRY IN G
• Abnormal: high-pitched, inconsolable, non-stop.
_________________________________________________________
• Check temp for fever.
_________________________________________________________
_________________________________________________________
Use Quieting Techniques

• In first months after birth.
_________________________________________________________
• With a baby who is easily stimulated and excited.
• To calm an excited baby before feeding.
_________________________________________________________
• With an overly hungry or overeager baby
_________________________________________________________
Techniques for Quieting Baby

_________________________________________________________
•
Check for soiled diaper.
_________________________________________________________
• Swaddle or bundle baby (bring arms and legs into midline, which increases sense of security).
• Use slow, calming movements with baby.
_________________________________________________________
•
Softly talk, sing, or hum to baby.
_________________________________________________________
S IG NS O F I LL N ES S
_________________________________________________________
• Temp above 100.4 F
_________________________________________________________
• Continued rise in temperature
_________________________________________________________
• More than one episode of forceful vomiting or frequent vomiting (over 6 hours)
• Refusal of two feedings in a row.
_________________________________________________________
• Lethargy, difficulty in waking
_________________________________________________________
• Inconsolable infant (quieting techniques are not effective) or continuous high-pitched cry
• Cyanosis with or without a feeding
_________________________________________________________
• Absence of breathing longer than 15 seconds
_________________________________________________________
• Reddened umbilical cord
• Abdominal distention, crying when trying to pass stools, or absence of stools after stool pattern is established.
_________________________________________________________
• Two consecutive green or black, watery, loose stools or increased frequency of stooling.
• No wet diapers for 18-24 hours or less than 6 wet diapers per day after 4 days of age.
_________________________________________________________
• Increasing jaundice of the skin and jaundice over abdomen and extremities.
_________________________________________________________ • Pustules, rashes, or blisters other than normal newborn rashes.
_________________________________________________________
• Development of eye drainage.
_________________________________________________________
13 OF 14
_________________________________________________________
CI R CU MC I SI O N CA R E
_________________________________________________________
• Squeeze soapy water over circumcision site once a day.
_________________________________________________________
• Rinse area off with warm water and pat dry.
• Apply small amount of petroleum jelly (unless a Plastibell is in place) with each diaper change.
_________________________________________________________
• Fasten diaper loosely over penis.
_________________________________________________________
• Since the glans is sensitive, avoid placing baby on his stomach.
• Check for any foul-smelling drainage or bleeding at least once a day.
_________________________________________________________
• Let Plastibell fall off by itself (about 8 days after circumcision); Plastibell should not be pulled off.
_________________________________________________________
• Light, sticky, yellow drainage (part of healing process) may form over head of penis.
_________________________________________________________
CA R SE AT I NF O RM ATI O N
_________________________________________________________
• Certified car seat inspector.
• If you have knowledge, tell the patient and get someone certified.
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
14 OF 14

A5. Newborn

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A5. Newborn

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NEWBORN JUSTINE MANANGAN

Initial Assessments and Stabilization

- P = pulse (heart rate)

- A = activity (muscle tone)

- R = respiratory eﬀort (rate)

- Good APGAR, 8 or above

- Bracelets (4)—2 for baby, 1 for mom, 1 for dad/S.O./etc.

- Good respiratory—crying, screaming

Newborn Physiologic Adaptations

• Switch from fetal to newborn circulation

• Physical forces leading to increased release of catecholamines critical for changes

• Page 552—cardiovascular system adaptations.

• Normal newborn heart rate: 120-160 bpm

SUMMARY OF FETAL CIRCULATION TO NEONATAL CIRCULATION

• Onset of respirations causes a rise in PO2 in the lungs and a decrease in

pulmonary vascular resistance, which…

• Respirations: 30-60 breaths/min; irregular, shallow, unlabored;

- Lines the alveoli

- Promotes lung expansion

- Prevents alveolar collapse

- Exapnasion of the lungs

- Redistribution of cardiac output.

(2) CARBOHYDRATE METABOLISM

- Assessed using a heel stick sample of blood at approx. 4 hours of age.

(3) BILIRUBIN CONJUGATION

• Excreted from liver cells as a constituent of bile.

- Total Bilirubin—combination of direct and indirect

• Common risk factors for the development of jaundice:

- Maternal gestational diabetes.

- Infections such as TORCH

ASSESSING FOR JAUNDICE

• Depends on the age of the newborn (check graph)

- Closed eyes need to be covered

- Insensible water loss which may cause dehydration

- Discontinue when bilirubin levels are within an acceptable range

- Also need to check bilirubin levels daily

- Also cover perineum

- Bili-Blanket (Wallaby Blanket)

- Record and report findings to infant’s practitioner

- Set up equipment for phototherapy or exchange transfusion

• Most common cause is blood group incompatibilities or infections

_________________________________________________________ • Occurs during the first 24 hours

- May be related to change in breast milk composition

• Caused by excess jaundice

- Bilirubin deposited in the brainstem

- If infants survives, may have CP, epilepsy, or mental retardation

- Allergic, febrile reactions, hemolytic

- Baseline vitals then every 15 mins.

• The once-sterile gut changes rapidly, depending on what feeding is received.

- Colonization is dependent on oral intake.

STOMACH AND DIGESTION

peristaltic activity and frequent regurgitation.

- As a result, newborns excrete a fair amount of lipids, resulting in fatty stools.

• Transitional—thin, brown to green

- Breastfed infant: yellow gold, soft or mushy stools

cry, hypotonicity, rigidity, irritability, inability to console.

- Used by physicians to prescribe (usually Morphine) to newborns

• Postterm or postdates—born after completion of week 42 gestation.

- Dorsal penile nerve block

- Non-nutritive sucking with concentrated oral sucrose solution

- Combination—works the best.

Bathing the Baby

• Change the spot on the washcloth to clean the other eye.

• Dry oﬀ each are after washing it to decrease heat loss.