Care of newborn

Miss Shurouq Qadous

The period of transition from intrauterine to extrauterine
life occurs during the first several hours after birth.
During this time, the newborn is undergoing
numerous adaptations.
The neonate’s temperature, respiration, and
cardiovascular dynamics stabilize during this period.
Close observation of the newborn’s status is essential.
Careful examination of the newborn at birth can
detect anomalies, birth injuries, and disorders that can
compromise adaptation to extrauterine life. Problems
that occur during this critical time can have a lifelong
impact.
 Assessment
The initial newborn assessment is completed in the
birthing area to determine whether the newborn is
stable enough to stay with the parents or whether
resuscitation or immediate interventions are
necessary. A second assessment is done within the
first 2 to 4 hours, when the newborn is admitted to the
nursery. A third assessment is completed before
discharge.
During the initial newborn assessment, look for signs
that might indicate a problem, including:
• Nasal flaring • Chest retractions
• Grunting on exhalation • Labored breathing
• Generalized cyanosis
• Abnormal breath sounds: rhonchi, crackles (rales),
wheezing, stridor
• Abnormal respiratory rates (tachypnea, more than
60 breaths/minute; bradypnea, less than 25 breaths/
minute)
• Flaccid body posture • Abnormal heart rates (tachycardia,
more than 160 bpm; bradycardia, less than 100 bpm) •
Abnormal newborn size: small or large for gestational age
 Apgar Scoring

The Apgar score, introduced in 1952 by Dr. Virginia

Apgar, is used to evaluate newborns at 1 minute and 5
minutes after birth.
An additional Apgar assessment is done at 10 minutes if
the 5-minute score is less than 7 points.
Five parameters are assessed with Apgar scoring. A
quick way to remember the parameters of Apgar scoring
is as follows:
• A = appearance (color)
• P = pulse (heart rate)
• G = grimace (reflex irritability)
• A = activity (muscle tone)
• R = respiratory (respiratory effort)
- Evaluations are made at 1 and 5 minutes after birth.
- Scores of 0 to 3 indicate severe distress
- Scores of 4 to 6 indicate moderate difficulty
- Scores 7 to 10 indicate that the infant is having
minimal or no difficulty adjusting to extrauterine life

• The Apgar score is influenced by the presence of

infection, congenital anomalies, physiologic
immaturity, maternal sedation via medications, and
neuromuscular disorders.
 Length and Weight
Length is measured from the head of the newborn to the
heel with the newborn unclothed. Because of the
flexed position of the newborn after birth, place the
newborn in a supine position and extend the leg
completely when measuring the length. The expected
length of a full-term newborn is usually 48 to 53 cm
(19 to 21 inches).
Newborns are weighed using a digital scale
that reads the weight in grams. Typically, the term
newborn weighs 2,700 to 4,000 g (6 to 9 lb). Birth
weights less than 10% or more than 90% on a growth
chart are outside the normal range and need further
investigation. Newborns typically lose approximately
10% of their initial birth weight by 3 to 4 days of
age secondary to loss of meconium, extracellular fluid,
and limited food intake. This weight loss is usually
regained by the 10th day of life.
Newborns can be classified by their birth weight
regardless
of their gestational age (AAP, 2007a) as follows:
• Low birth weight: <2,500 g (<5.5 lb)
• Very low birth weight: <1,500 g (<3.5 lb)
• Extremely low birth weight: <1,000 g (<2.5 lb)
Typically newborns are also classified according to
gestational age as:
• Preterm or premature—born before 37 weeks’
gestation, regardless of birth weight
• Term—born between 38 and 42 weeks’ gestation
• Postterm or postdates—born after completion of
week 42 of gestation
• Postmature—born after 42 weeks and demonstrating
signs of placental aging
Ensuring Proper Identification
 Administering Prescribed Medications
Vitamin K, a fat-soluble vitamin, promotes blood
clotting by increasing the synthesis of prothrombin by
the liver. A deficiency of this vitamin would delay
clotting and might lead to hemorrhage. Generally, the
bacteria of the intestine produce vitamin K in
adequate quantities. However, the newborn’s bowel is
sterile, so vitamin K is not produced in the intestine
until after microorganisms are introduced, such as
with the first feeding. Usually it takes about a week
for the newborn to produce enough vitamin K to
prevent vitamin K deficiency bleeding
They recommend that vitamin K be administered
to all newborns soon after birth in a single intramuscular
dose of 0.5 to 1 mg (AAP, 2007).
Eye Prophylaxis
All newborns in the United States, whether delivered
vaginally or by cesarean birth, must receive an
instillation of a prophylactic agent in their eyes within
an hour or two of birth. To prevent ophthalmia
neonatorum, which can cause neonatal blindness
(CDC, 2007).
Prophylactic agents that are currently recommended
include erythromycin 0.5% ophthalmic ointment or
tetracycline 1% ophthalmic ointment in a single
application.
Thanks