CARE OF INFANT AND FEEDING

STUDY GUIDE

Three types of newborn:

1. Preterm
2. Term
3. Post term
Immediate care of newborn
1. Establishment of respiration and maintain clear airway
2. Provision of warmth and maintenance of body temperature
3. Prevent infection
4. Prevent haemorrhage
5. Infant’s identification
6. Initial feeding
7. Bonding
8. Immunization
Normal Adjustment o Extrauterine Life
 First period of reactivity- first 15 to 30 mins
 Resting period- 30 to 120mins
 Second period of reactivity
Physiologic function
1. Respiratory System
The most critical and immediate change required of the newborn is the onset of breathing.
2. Cardiovascular System
Equally important as the initiation of respiration are the circulatory changes that allow blood flow through
the lungs.
3. Gastrointestinal System
The ability of the newborn to digest, absorb, and metabolize foodstuff is adequate but limited in certain
functions.
4. Renal System
The first voiding should occur within 24 hours. The urine is colorless and odourless.
Kidneys cannot sufficiently concentrate urine to conserve body water.
5. Integumentary System
Plugging of sebaceous glands causes milia. Retention of sweat may cause milliaria.
6. Musculoskeletal System
At birth the skeletal system contains larger amounts of cartilage that ossified bone.
7. Defences against infection
Infants are generally not capable of producing their own immunoglobulins until the beginning of 2 nd month of
life but they receive considerable passive immunity from maternal circulation and from human milk. They are
protected against major diseases provided the mother developed antibodies to these illness.
8. Endocrine System
Adequately developed but its function are immature. The effect of maternal sex hormone in newborn is
evident. The labia are hypertrophied and the breast are enlarged and secrete milk (witch’s milk) from the first
days until 2 months. Female newborns may have pseudomensration (milky secretion than actual blood) from
sudden drop of progesterone.
9. Neurologic System
At birth the nervous system is incompletely integrated but sufficiently developed to sustain extrauterine life.
Most neurologic functions are primitive reflexes.
10. Sensory Functions: Vision, Hearing, Smell, Taste, Touch
AGPAR Scoring –
Sign 0 1 2
Heart Rate absent slow, <100 >100
Respiratory absent irregular, slow, weak cry good strong cry
Muscle tone limp some flexion of extremities well reflex
Reflex irritability no response grimace cry, sneeze
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 Color blue, pale body pink, extremities blue completely pink

Score
o 0-3 severe distress
o 4-6 moderate difficulty
o 7-10 absence of difficulty in adjusting to extrauterine life.
Silverman and Anderson scoring system
Sign 0 1 2
Chest movement synchronized lag on inspiration see-saw respiration
Intercostals retraction none just visible marked
Xiphoid retraction none just visible marked
Nares dilatation none minimal marked
Respiratory grunt none audible by audible by ear stethoscope
Score
o No respiratory distress
o 4-6 moderately depressed
o 7-10 severely depressed

Physical assessment of the newborn

Assessment Area Usual findings
General Measurements:
Head circumference 33-35 cm
Chest circumference 31-33 cm
Crown to rump length 31-35 cm
Head to heel length 48-53 cm
Birth weight 2500-3000g (Fil) 6-9lbs
Abdominal cir. 29-30 cm
Vital Signs:
Temperature 36-37
Heart rate (Apical pulse) 120-160 beats/min
Respirations 30-60 breaths/min., quiet and shallow, diaphragmatic, occasional
periods of rapid breathing, alternating with short periods of apnea
Blood pressure 65/41mm Hg in arm and calf
General Appearance:
Posture Flexed
Skin At birth, bright re, puffy, smoot to third day pink, flaky, dry, vernix
caseosa, lanugo, Accrocyanosis, cutis marmorata, milia, milliaria,
erythema toxicum, monglian spot, stork bites, harlequin color
change
Hydration Good skin turgor
Cry lusty
Head Elongated
Anterior Fontanel Flat, soft, firm, diamonds shaped, 2-3 cm W, 3-4 cm L
Posterior Fontanel Triangular in shape, 1-2 cm, almost closed
Sutures Sagittal, Lambdoid, coronal, frontal
Face Small, round, symmetrical fat pads in cheeks, receding chin
Eyes Lids edematous, usually closed, colo (slate grey, dark blue brown),
absence of tears, presence of red reflex, pupils equal
Ears Positio (top of pinna on horizontal line with oute cantus of eye),
startle reflex, pinna flexible, patent
Nose Patent, sneezing, white nasal discharge
Mouth and throat Intact lips, gums, palate, sucking reflex, Epstein pearls, rooting reflex,
gag reflex, extrusion reflex, vigorous cry, absent of salivation
Neck Short, thick surrounded by skin folds, TNE, torticollis

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 Chest Equal, slight sternal retractions, breast engorgement
Lungs Respiration abdominal, equal breath sounds
Heart Apex (4th to 5th inercostal space)
Abdomen Cylindrical, slightly protuberant, no masses, femoral pulses equal
Umbilical cord No extensive protrusion or herniation, no discharges, 3 blood
vessels, whartons jelly
Genitalia Appropriate for gender
Female Labia and clitoris usually edemaous, urethral meatus behind clitoris,
vernix caseosa between labia, urination within 24 hours
Male Urethraloping at tip of glans penis
Scrotum usually large, edematous, pendulous, covered with rugae,
deply pigmented, smegma
Urination within 24 hours
Anus Patent, passage of meconium within 24 hours, anal reflex
Back Spine intact, no openings, masss or prominent curves
Ten fingers and toes
Full range of motion
Nails bedspink, with transient cyanosis, immediately after birth
Creases on anterior 2/3 of sole, sole usually fat
Symmetry of extremities, equal muscle tone

Reflexes Expected Behavioral Responses

Eyes
Blinking or corneal Infant blinks at sudden appearance of a bright light or at an approach of an object
toward conea: persists throughout lie
Pupillary Pupil constricts when a bright light shines toward I; it persists throughout life
Doll’s eyes As head is moved slowly to right or left, eyes lag behind and do not immediately
adjust to know position of head; disappears as fixiation develops; of indicates
neurologic damage
Nose
Sneeze Spontaneous response f nasal passages to irritation or obstruction; persists
throughout life
Mouth
Sucking Infant begins strong sucking movements of circumolar area is response o
stimulation; persists throughout infancy even without stimulation, such as during
sleep
Gag Stimulation of posterior pharynx by food, suction, or passage of a tube causes infant
to gag; persists throughout life
Rooting Touching or stroking the cheek alongside mouth causes infant to turn head toward
that side and begin to suck; should disappear at about 3-4 months; but may persist
for upto 12 months
Extrusion Wen tongue is touched or depressed, infant responds by forcing it outward;
disappears by age 4 months
Yawn Spontaneously response to decreased oxygen by increasing amount of inspired air;
persists throughout life
Cough irritation of mucus membrane of larynx or tracheabronchial tree causes coughing;
persists throughout life; ususlly present after first day of life
Extremities
Grasp Touching palms of hands of soles of feet near base of digits causes reflexion of hands
and toes; palmar grasp lessens after age 3 onths to be repaced by voluntary
movement; plantar grasp lessense by 8 months of age
Babinski Stroking outer sole of foot upward from heel and across ball causes toes to
hyperextend and hallux to dorsiflex; disappears after age 1 year
Mass

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Moro Sudden jarring or change in equilibrium causes sudden extension and abduction of
extremities and fanning of fingers, withindex finger and thumb orming a C shape,
followed by reflexion and abduction of extremities; legs may weakly flex; infant may
cry; disappears after 3-4 months, usually strongest during 2 months
Startle A sudden loud noise causes abduction of the arms with reflexion of elbows; hands
remain clenched; disappears by 4 months
Asymmetric When infant’s head is turned o one side, arm and leg extend on that side, and
opposite arm and leg Tonic neck flex; disappears by age -4 months, to e replaced by
symmetric positioning of both sides of body

Dance or step If infant is held so that sole of foot touches hard surface, there is a reciprocal flexion
and extension of leg, stimulating walking; disappears after age 3-4 weeks, to be
replaced by deliberate movement
Nutrition
1. Breast-milk is the most complete diet during the first 6 months
2. The addition of solid foods before 4-6 months is not recommended
3. During the second half of the first-year, BF or formula is the primary source of nutrition
4. Iron fortified cereal is generally introduced first because of its high protein content
5. The addition of other foods is arbitrary
6. Weaning should be gradually by replacing one bottle or BF at a time

Health Problems of Newborn

1. Birth Injuries
o Caput succedaneum – edema of scalp
o Cephallematoma- accumulation of blood between periosteum
o Fracture of clavicle – assymetric moro reflex, cry when arms are moved
o Facial paralysis – drooping corners of mouth
o Brachial palsy – arms hangs limp alongside of the body
2. Hemolytic disease of the newborn erythroblast

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