STUDY ON
OBSERVATION
AND
NEWBORCASE N
CARE
Submitted By
Ankita Manna
M.Sc Nursing 1st Year
EBMCON
Introduction
• Newborns are one of the most curious and interesting
humans you could ever encountered. They continue to
become everyone’s joy wherever they go. As their
healthcare provider, we are one of them who handled them
primarily at the moment they were delivered, so it is up to
us to give the best primary care to these little angels before
we handover them to their parents.
Care provided during the prenatal and neonatal period
is critical to ensure the health of mother and baby and
new born care is a comprehensive strategy designed to
improve the health of new born through intervention
before conception, during pregnancy and soon after
birth. Components of essential new born care are
ensuring warmth, immediate skin to skin care,
initiation of early breast feeding, umbilical cord care,
eye care, vitamin K administration and immunization.
DEFINITION
“The period from birth to 28 days of life is called
neonatal period and infant in this is termed as neonate
or new born baby.” The first week of life is known as
early neonatal period and the late neonatal period
extends from 7th day to 28 days of age. Care given to
new born during neonatal period is known as new born
care.
TYPES OF NEWBORN CARE
Immediate care of newborn
• Care of the baby that needs to be given at birth in the
labor room. Later care of newborn
• Care of the baby that needs to be given in the postnatal
ward and after discharge at home.
ELEMENTS OF NEW BORN CARE
A) Basic preventive care including clean delivery
practices and exclusive breast feeding.
B) Early detection of danger signs.
C) Treatment of problems such as sepsis and birth
asphyxia.
APGAR SCORE
Apgar scoring is described by Dr.Virginia Apgar.
It is useful to quantitative assessment of newborn’s
condition at birth especially for the respiratory,
circulatory and neurological status.
Five objective criteria are evaluated at 1 minute and 5
minute, after the newborn body is completely born.
APGAR SCORE
Respiration
Heart rate /minute
Muscle tone
Reflex irritability
Skin colour
Each parameter can have the highest score of two and
the lowest is 0.
The scores of the five parameters are added to
determine the status of the infant.
0-3 points: the baby is serious & in danger and need
immediate resuscitation.
•4-6 points: the baby’s condition is guarded and may
need more extensive clearing of the airway and
supplementary oxygen.
•7-10 points: are considered good and in the best
possible health.
IMMEDIATE CARE OF NEWBORN
Objectives-
• To establish and maintain respiration.
• To ensure warmth.
• To prevent infection.
• To provide care to the eyes.
• To provide care to the umbilical cord.
• To provide care to the skin.
• To make observation and documentation.
• To make identification and transfer.
CARE AT BIRTH
1. Wipe mouth and nose of secretion after delivery of the head
with clean sterile gauze pad.
2. Position- Trendelenburg- Head lower than the body. 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.
3. Gently suctioning with bulb syringe and short catheter from
mouth first then nose to prevent aspiration of fluid into the
lungs.
4. Deliver the baby onto a warm, clean and dry towel or cloth and
keep on mother's abdomen or chest (between the breasts).
5. Wipe both the eyes separately with sterile swab.
6.Clamp and cut the umbilical cord after 1 minute, if baby
breathing well.
7. Immediately dry the baby with a warm clean towel or piece of
cloth.
8. Assess the baby's breathing while drying.
9. Leave the baby between the mother's breasts to start skin-to-
skin care for at least an hour.
10. Cover the baby's head with a cap. Cover the mother and baby
with a warm cloth.
11. Place an identity label/band on the baby.
12. Encourage mother to initiate breastfeeding (within half an
hour of birth in normal delivery) & (after 2 hrs. in LSCS)
LATER CARE OF NEWBORN
Objectives –
• To receive the baby in the postnatal ward.
• To initiate feeding.
• To preventing infection.
• To maintain personal hygiene.
•To observe for early signs of disease or congenital
anomalies.
• To provide parental teaching.
WARMTH
Warmth is provided by keeping the baby dry with
adequate clothing.
Baby should be kept to the side of the mother, so that
the mother’s body temperature can keep the baby
warm.
Baby can be placed in skin to skin contact with mother
(kangarooing) to maintain temperature of infant and
facilitate breast feeding.
Bathing at first day is avoided to prevent hypothermia
ESTABLISH NORMAL BREATHING
BREAST FEEDING
The baby should be put to mother’s breast within half an
hour of birth as soon as possible .The mother has
recovered from exertion of labour .
Colostrums feeding must be offered.
Mother should be informing about the importance and
techniques of breast feeding.
Demand feeding should be encouraged.
Exclusive breast feeding procedure should be explained to
the mother and family members
SKIN CARE AND BABY BATH
The baby must be cleaned off blood, mucus and
meconium.
No vigorous attempts should be met to remove the
vernix caseosa, as it provides protection to the delicate
skin.
Baby bath can be given in the hospital by using warm
water in a warm room gently and quickly.
Bathing should be avoided in open place.
During winter months the baby should have sponge
bath rather than deep bath to avoid hypothermia.
Use of olive oil or coconut oil can be allowed after 3-4
weeks of age. Oil massage improves circulation and
muscle tone.
Oil massage should be given before the bathing.
Exposure to morning sunrays is an important source of
vitamin D and warmth.
The talcum powder should be applied over the axillae ,
groins and buttocks.
CARE OF UMBILICAL CORD
The umbilical cord is cut about 2-3 inches from the navel
with aseptic precaution during delivery and tied with
cotton thread or disposable plastic clip.
The cord must be inspected for bleeding afterwards which
commonly occurs due to shrinkage of cord and loosening
of ligature.
No dressing should apply and the cord should be kept open
and dry.
Normally it falls of after 5-10 days.
Application of triple dye or junction violet is not advocated
as a routine any more.
CARE OF EYES
Eye should be cleaned at the birth and once every day
using sterile cotton swabs soaked in sterile water .
Each eye should be cleaned using a separate swab.
Application of kajal in the eyes must be avoided to
prevent infection or lead poisoning.
The eye should be observed for redness , discharge or
the excessive tearing for early detection of problems
and prompt management.
CLOTHING OF BABY
The baby should be dressed with loose, soft and cotton
cloths.
Large buttons synthetic frock and plastic or nylon
napkin should be avoided.
A triangular shaped soft, absorbent cloth should be
used as napkin.
The cloths should not be tight especially around the
neck or abdomen.
In winter woolen clothing should be used.
GENERAL CARE
The new born should be kept with the mother for
continues rooming in a well ventilated room.
Baby be should handled with gentle approach after hand
washing.
No infected person should take care or touch the baby.
Baby should allow to sleep in a supine position which can
prevent sudden infant death syndrome.
General cleanliness is to be maintained and surrounding to
be kept clean.
Wet nappies should be change immediately.
OBSERVATION
The baby should be thoroughly observed twice daily for early
detection of any abnormalities.
Temperature, pulse, respiration, feeding behavior, stool, urine
and sleep pattern should be assessed .
Mouth, eyes, cord, and skin should be looked for any infections.
WEIGHT RECORDING
Assess daily weight gain in healthy term babies which
is about 30gm/day.
Most infants double their weight by 4-5 months but in
first week of life there is physiological loss of body
weight because of removal of vernix, mucus, blood,
passage of meconium and reduction of extracellular
blood volume & also due to adaptation to new
environment.
With adequate breast feeding majority of babies regain
the weight within 7-10 days of birth.
IMMUNISATION
within first week of life.
The mother should be informed about national
immunization schedule and explanation should given
about important of complete immunization and all
possible reaction following vaccines.
In institutional deliveries all neonates should be
immunized with BCG vaccine and zero polio.
In outside or home deliveries the BCG and OPV
should be given
FOLLOW UP AND ADVISES
Each infant should be followed up, at least once every months
for first 3 months and subsequently 3 months interval till one
year of age.
Follow up is necessary for assessment of growth and
development, early detection and management of health
problems.
Health education should be given regarding exclusive breast
feeding, warmth, hygiene, rooming in, clothing, immunization
and follow up.
Harm full cultural practices should be discouraged.
Care at home should be discussed and demonstrate to the
mother and family.
CONCLUTION
The newborn care is very essential to reduce infant
morbidity and mortality rate.
