THE HEALTHY NEWBORN (cont.

)
How To Use A Bulb Syringe
Clear the Mouth first, then the Nose

(M before N)
v Compress the bulb prior to suctioning
v Gently insert the tip of the syringe into the dependent side of the
newborns mouth to collect drainage
v Release the compression of the bulb to allow for re-expansion and
collection of the secretions
v Remove the blub syringe from the mouth and squeeze the bulb to
release the collected drainage into the appropriate receptacle or
tissue

THE HEALTHY NEWBORN (cont.)

THE NEWBORN BATH
Wash the head first (keep the infant wrapped to prevent heat loss)

Wash the body in 1-2 minutes and dry completely. Remove wet
linen

IMPORTANT TO WORK EFFICENTLY TO PREVENT

HEAT LOSS!!

THE HEALTHY NEWBORN (cont.)

MEDICATIONS YOU WILL BE ADMINISTERING
VITAMIN K Administer within 1 hour of birth. Vitamin K is not

required to make clotting factor but is required to convert precursor

proteins made in the liver into activated proteins with coagulant
properties.
Without Vitamin K at birth, bleeding can occur from the GI tract,
umbilicus, circumcision site, and any other puncture site.
Vitamin K is given intramuscularly
into the thigh.

THE HEALTHY NEWBORN (cont.)

MEDICATIONS YOU WILL BE ADMINISTERING (cont.)
EYE PROPHYLAXIS To prevent from unknown Gonorrhea or

Chlamydia infection in the mother which can cause blindness in the

infant
Can use: Tetracycline Ointment 1%
Erythromycin Ointment 0.5%
Ophthalmic sol. of Povidine-Iodine 2.5%

Needs to be given within 1 hour of birth

Deposit a 1-2 cm ribbon of sterile ointment into the conjuctival sac

THE HEALTHY NEWBORN (cont.)

MEDICATIONS YOU WILL BE ADMINISTERING (cont.)
ENGERIX, Hepatitis B vaccine
Mother must sign consent before
this can be given
Given intramuscularly in opposite
thigh of the Vitamin K injection

THE HEALTHY NEWBORN (cont.)

6 Rights of Medication Administration
vRight
vRight
vRight
vRight
vRight
vRight

Person
YOU MUST
Drug
ALWAYS CHECK
THE DRUG WITH
Dose
THE PHYSICIANS
Time
ORDER.
Route
documentation

THE HEALTHY NEWBORN (cont.)

REFLEXES
MORO (Startle) Hold infant in semi-sitting position, allow head and
trunk to fall backward with support, or place the infant on a flat
surface, make a loud abrupt noise.
The infant will have symmetric abduction and extension
of arms, and legs will follow in a similar pattern; slight shaking or
tremor may be included, infant may cry.

THE HEALTHY NEWBORN (cont.)

REFLEXES (Cont.)
STEPPING or WALKING Hold infant vertically under arms or on trunk,
allowing one foot to touch table surface. The infant will simulate
walking alternating flexion and extension of feet.
Term infants will walk on the soles of their feet while
preterm will walk on their toes. This reflex will
disappear at 3-4 months.

PALMAR GRASP Press the palmar surface of the infant's hand with a
finger. The infant will grasp the finger and hold tight when you
attempt to withdraw. This reflex will disappear at 2 months

THE HEALTHY NEWBORN (cont.)

REFLEXES (Cont.)
BABINSKI (Plantar) On the sole of the foot, beginning at the heel,
stroke upward along lateral aspect of sole, then move finger across
ball of foot. All toes hyperextend, with dorsiflexion of big toe
recorded as Positive sign. Absence of the Babinski requires
neurologic evaluation. This reflex will disappear after 1 year of age.

THE HEALTHY NEWBORN (cont.)

REFLEXES (Cont.)
ROOTING Stroke the infants cheek and corner of the mouth and the
infants head turns toward the stimulus and the mouth opens. This
will disappear at 3-4 months.

SUCKING Touch or stroke the babys lips the mouth opens and
sucking movement begin. This reflex will disappear at 12 months.

THE HEALTHY NEWBORN (cont.)

REFLEXES (Cont.)
TONIC NECK Place the infant supine and turn his or her head to
one side the infant extends the arm on the side in which the
head is turned and flexes the upper extremity on the opposite
side (fencing position)

THE HEALTHY NEWBORN (cont.)

REFLEXES

THE HEALTHY NEWBORN (cont.)

GENERAL APPEARANCE
COLOR Consistent with genetic background; pink ucous membranes;
mottled with cooling, bruises over presenting part.
Acrocyanosis blue palms and soles

Circumoral cyanosis blue around mouth requires IMMEDIATE

attention
Jaundice yellow skin color; mild jaundice normal after day 1 of life

THE HEALTHY NEWBORN (cont.)

GENERAL APPEARANCE (Cont.)
HARLEQUIN COLOR CHANGE In side-lying position, red color
demarcated on dependent side, pale color on upper half; persists
1-13 minutes; color reverses if infant is rotated to other side.

THE HEALTHY NEWBORN (cont.)

RESPIRATORY

Diaphragmatic and abdominal breathing

Rate 40-60 breaths/minute (may decrease in sleep and

increase after crying)

Periodic Breathing pauses in breathing up to 20 seconds

without bradycardia or color change (this is normal)

Respiratory Distress - expiratory grunting, nasal flaring,

cyanosis

Allow the newborn to cry helps to clear retained fetal lung fluid

THE HEALTHY NEWBORN (cont.)

TONE/NEUROMUSCULAR

Term infant is flexed, fists clenched

Term infant with healthy tone can be pulled up to sitting position

using the palmar grasp reflex

Head moves side to side, moves all extremities, moves smoothly

between behavioral states

Frank breech presentation may

have extended legs for a brief time

THE HEALTHY NEWBORN (cont.)

Skin
Vernix caseosa greasy yellow-white substance covering infant
Lanugo fine hair on cheeks, shoulders, forehead, pinna of
ears
Milia tiny white papules on brow, cheek, and nose
Erythema toxicum (newborn rash) small white or yellow
papules on a red base which can last several hours to several
days
Sucking blisters vesicles on lips, hands from in utero
Stork bite (nevus simplex) pink macule on nape of neck, upper
eyelids, bridge of nose or upper lip that usually fades
Mongolian spots bluish or gray-blue areas of pigmentation on
dorsum and buttocks, commonly found on dark skinned races

THE HEALTHY NEWBORN (cont.)

HEAD
Fontanels
Anterior palpated as 5cm diamond
Posterior palpated as smaller triangle

Palpate sutures should be enjoined (sutures are

membranous attachments that make the bones join in
such a way that the head can squeeze through the birth
canal)

THE HEALTHY NEWBORN (cont.)

GI/GU
ABDOMEN
Soft and rounded not distended
Bowel sounds present 1-2 hours after birth
Abdominal distention caused by mucus, blood and amniotic fluid
swallowed during birth
Infant should void by 24 hours of age
Meconium stools
(black tarry sticky substance)
may last for 3 days then become
the seedy yellowish transitional stool
Failure to pass meconium stool is sign of intestinal obstruction
and places the newborn at high risk for hyperbilirubinemia

THE HEALTHY NEWBORN (cont.)

HEPATIC
HYPOGLYCEMIA
Glucose checks Untreated hypoglycemia may result in
long term neurologic complications. Immediate
identification and intervention are essential
Newborns at risk Small for gestational age, large for
gestational age, born to mothers with diabetes,
premature, or stressed by sepsis, shock, asphyxia, or
hypothermia
Prevention Minimize stress, maintain normal body
temperature and initiate feeding as soon as the newborn
is stable

THE HEALTHY NEWBORN (cont.)

Glucose Monitoring
Normal Blood Glucose for the term infant during the first day of life:

40 60 mg/dL
And after the first day of life will range between 50 90 mg/dL

Heel puncture for blood glucose testing

must be done on the lateral aspect of the
foot to avoid damage to the nerves and
calcaneus bone
Murray & McKinney 2010

THE HEALTHY NEWBORN (cont.)

Conjugation of Bilirubin
Contributing factors in increased bilirubin

Excess production
Red blood cells break down more quickly
Decreased albumin
Immature liver
Preterm and late term infants
Lack of intestinal flora
Decreased intestinal motility
Trauma such as bruising
Fatty acid release
Family background

THE HEALTHY NEWBORN (cont.)

HYPERBIRUBINEMIA
Physiologic Jaundice also called nonpathologic or
developmental jaundice. Jaundice is visible when
the bilirubin level reaches 5-7 mg/dL
Bilirubinometer non invasive devise to measure bilirubin
level in the infants skin
Transcutaneous bilirubinometer
(TcB)

THE HEALTHY NEWBORN (cont.)

NEWBORN ASSESSMENT

To A Beautiful Mom

MEDICATIONS

MEDICATIONS TO KNOW
ANTEPARTUM
Prenatal vitamins

Terbutalin

Iron

Indocin

Folic acid

Magnesium Sulfate
Colace

Rhogam
Procardia

MEDICATIONS TO KNOW (cont.)

INTRPARTUM
Pitocin

Ampicillin

Terbutaline

Gentamycin

Magnesium sulfate

Clindamycin

Fentanyl

Cefotan

Marcaine

Prostin F2 alpha (hemabate

Nubain

Methergine

Stadol

Penicillin-G

Numorphan

Narcan

Misprostil

Barbituates (Seconal)

Phenergan

Benzodiazepines (Valium,
Versed)

MEDICATIONS TO KNOW (cont.)

POSTPARTUM
Mylicon/Mylanta

Rubella Vaccination

Colace

Vicodin

Motrin

Duramorph
Benadryl

Tylenol

Nubain

Tylenol #3

Gentamycin

Percocet/Percodan

Clindamycin

Charcoal

Methergine, Hemabate

MEDICATIONS TO KNOW (cont.)

NURSERY
Erythromycin Ophthalmic
Vitamin K
Hepatitis vaccination
Narcan

REFERENCES
Murray, S. S., & McKinney, E. S. (2010). Foundations of
maternal-newborn and womens health nursing (5th ed.).
Maryland Heights, MN: Saunders Elsevier.
Harnikka (October 4, 2007). Fundus. Retrieved May 1, 2011,
from http://www.youtube.com/watch?v=13bR8kRCQxA
Wibenson888 (March 14, 2007). Primitive Reflexes. Retrieved
May 1, 2011, from http://www.youtube.com/watch?v=8dI1UOziOgg
CypressCC (June 3, 2010). Newborn Assessment. Retrieved
May 1, 2011, from http://www.youtube.com/watch?v=vtypUA1Nzpw