Immediate Care of the Newborn

Goals:

To establish, maintain and support respirations. To provide warmth and prevent hypothermia. To ensure safety, prevent injury and infection. To identify actual or potential problems that may require immediate attention.

Establish respiration and maintain clear airway The most important need for the newborn immediately after birth is a clear airway to enable the newborn to breathe effectively since the placenta has ceased to function as an organ of gas exchange. It is in the maintenance of adequate oxygen supply through effective respiration that the survival of the newborn greatly depends. Newborns are obligatory nose breathers. The reflex response to nasal obstruction, opening the mouth to maintain airway, is not present in most newborns until 3 weeks after birth. To establish and maintain respirations: 1. Wipe mouth and nose of secretions after delivery of the head. 2. Suction secretions from mouth and nose.

Compress bulb syringe before inserting Suction mouth first, then, the nose Insert bulb syringe in one side of the mouth

3. A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously, or if the cry is weak. Do not slap the buttocks rather rub the soles of the feet. Stimulate to cry after secretions are removed. The normal infant cry is loud and husky. Observe for the following abnormal cry: High, pitched cry indicates hypoglycemia, increased intracranial pressure. Weak cry prematurity Hoarse cry laryngeal stridor 4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote drainage of secretions. Trendelenburg position head lower than the body Side lying position If trendelenburg position is contraindicated, place infant in side lying position to permit drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine position.

5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are obligatory nose breathers until they are about 3 weeks old. Care of the Eyes It is part of the routine care of the newborn to give prophylactic eye treatment against gonorrhea conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed on the fetus from the vaginal canal during delivery. This practice was introduced by Crede, a German gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose. Erythromycin or tetracycline Opthalmic Ointment:
1. These ointments are the ones commonly used now a days for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis. 2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes.

Vitamin K or Aquamephyton The newborn has a sterile intestine at birth, hence, the newborn does not possess the intestinal bacteria that manufactures vitamin K which is necessary for the formation of clotting factors. This makes the newborn prone to bleeding. As a preventive measure, .5 (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the newborns vastus lateralis (lateral anterior thigh) muscle. Care of the cord The cord is clamped and cut approximately within 30 seconds after birth. In the delivery room, the cord is clamped twice about 8 inches from the abdomen and cut in between. When the newborn is brought to the nursery, another clamp is applied to 1 inch from the abdomen and the cord is cut at second time. The cord and the area around it are cleansed with antiseptic solution. The manner of cord care depends on hospital protocol. What is important is that the principles are followed. Cord clamp maybe removed after 48 hours when the cord has dried. The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days. Instruction to the mother on cord care:
1. No tub bathing until cord falls off. Do not sponge bath to clean the baby. See to it that cord does not get wet by water or urine. 2. Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution which is 70% alcohol. 3. Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine. 4. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air. 5. If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten. 6. Report any unusual signs and symptoms which indicates infection. Foul odor in the cord Presence of discharge Redness around the cord The cord remains wet and does not fall off within 7 to 10 days Newborn fever

THE APGAR SCORING SYSTEM The APGAR Scoring System was developed by Dr. Virginia Apgar as a method of assessing the newborns adjustment to extrauterine life. It is taken at one minute and five minutes after birth. With depressed infants, repeat the scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation. The five minute score is more reliable in predicting mortality and neurologic deficits. The most important is the heart rate, then the respiratory rate, the muscle tone, reflex irritability and color follows in decreasing order. A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress. ASSESS 0 1 HEART RATE Absent Below 100 RESPIRATION Absent Slow MUCLE TONE Flaccid Some flexion REFLEX IRRITABILITY No response Grimace COLOR Blue all over Body pink, Extremities blue Score:

7 10 Good adjustment, vigorous Moderately depressed infant, needs airway clearance Severely depressed infant, in need of resuscitation.

2 Above 100 Good crying Active motion Vigorous cry Pink all over

ASSESSING THE AVERAGE NEWBORN

Head Circumference Temperature Chest Circumference Heart Rate Respirations Weight Length

34 35 cm 97.6 98.6 F axillary 32 33 cm 120 140 bpm 30 60 bpm 2.5 to 3.4 kg 46 to 54 cm

SUCTIONING
For most hospital births, it is routine procedure to suction the baby's mouth and nose as soon as the head emerges on the perineum, in advance of its full birth. Either a deep suction hose or a bulb syringe will be used to extract any mucus or meconium that may be present. According to the International Guidelines for Neonatal Resuscitation (2000), only approximately 5-10% of newborns will require some degree of active resuscitation (stimulation to breathe) at birth, which can vary from simple skin rubbing to suctioning or full resuscitation. This in turn means that 90-95% of all newborns need no assistance breathing at birth. While it may seem wise to suction as soon as possible, the reality is that the baby is not at great risk of breathing difficulties at this point since it will typically not take its first breath until it has been fully birthed. As long as the cord is pulsating and is not clamped, cut, nor compressed, the baby will continue to receive oxygen via the placenta until after it has been fully birthed. There is rarely a clear need to hurry the neonatal transition to breathing room air at this early stage when only the baby's head has emerged. Suctioning can be delayed until after the baby has been born. Alternately, suctioning can only be performed when indicated rather than a routine procedure for those infants who do not need it, as most infants will be able to clear their own airways with no outside assistance.

TO BATHE OR NOT TO BATHE

If there is one newborn baby care procedure that many families never consider, it'sbathing a

newborn. However, this may indeed be something a new family decides to decline. The vernix which coats the baby's extremely sensitive skin is the best natural moisturizer available and will protect it from infection when massaged into the skin. Additionally, a bath can cause a baby's body

temperature to drop, thus necessitating further interventions to regulate it.