Nursing Care of A Neonate Part 1
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Rani G SNursing Care of A Neonate Part 1
Uploaded by
Rani G SUNIT V
Rani.G.S.,
MSc(N)
SYLLABUS
SL.NO CONTENT
1 NURSING CARE OF A NORMAL NEWBORN
2 ESSENTIAL NEWBORN CARE
3 KANGAROO MOTHER CARE
4 NURSING MANAGEMENT OF HIGH RISK NEONATE:
• LBW BABIES
• PRETERM BABIES
5 MANAGEMENT OF COMMON NEONATAL PROBLEMS:
• RESPIRATORY DISTRESS SYNDROME
• HYPERBILIRUBINEMIA
• MECONIUM ASPRIRATION SYNDROME
• INFANT OF DIABETIC MOTHER
• NEONATAL SEPSIS
DEFINITIONS
• Neonate:- From birth to 4 weeks (28 days) of age, the baby is called neonate or
new born.
• Early neonatal period: From birth to 7 days of life or 168 hours, is early
neonatal period.
• Late neonatal period: From 7th day to 28th days of life is late neonatal period.
• Live birth:- Live birth is defined as complete expulsion or extraction from mother
of product of conception, which after separation shows signs of life for at least 1 hour.
• Term baby:- Any neonate born between 37-42 weeks of gestation is known
as term baby.
• Pre term: Any neonate born before 37th week of gestation is called pre term.
• Post term:- Any neonate born at or after 42 weeks of gestation is known as
post term.
• Perinatal period:-The period extending from 22nd week of gestation to 7
days after birth known as perinatal period.
Classification According to Size
• Low birth weight (LBW) Infant - An Infant whose birth weight is less
than 2500g, regardless of gestational age.
• Moderately-low-birth-weight (MLBW) infant -An infant whose birth weight is 1500
to 2500g.
• Very-low-birth weight (VLBW) Infant -An infant whose birth weight is less than
1500g.
• Extremely low-birth-weight (ELBW) Infant - An infant whose birth weight is less
than 1000g.
• Appropriate-for-gestational-age (AGA) infant - An infant whose birth weight falls
between the 10th and 90th percentiles on intrauterine growth curves.
• Large-for-gestation-age (LGA) infant - An infant whose birth weight falls above
90th percentile on intrauterine growth charts.
• Small-for-dates (SFD) or small-for-gestational-age (SGA) infant - An infant whose
rate of intrauterine growth was slowed and whose birth weight falls below the 10th
percentile on intrauterine growth curves.
• Intrauterine growth retardation (IUGR) -Found in infants whose intrauterine
growth is retarded.
Classification According To Gestational
Age
• Premature (Preterm) infant - An infant born before completion of
37 weeks of gestation regardless of birth weight.
• Full-term infant - An infant born between the beginning of 38 weeks
and completion of 42 weeks of gestation, regardless of birth weight.
• Postmature (Post term) infant - An infant born after 42 weeks of
gestational age, regardless of birth weight.
NURSING CARE OF NEW BORN
• Aim is to help the newborn to adapt physiologically to extrauterine
environment.
• Physiological adaptation includes:
Initiation of respiration and oxygenation of arterial blood
Temperature regulation.
Initiation of feeding.
FIVE CLEANS
• To prvent sepsis at birth.,
CLEAN HANDS: Hand hygiene & wear sterile gloves
CLEAN SURFACE: Use clean & sterile towel to dry and cover the baby.
CLEAN BLADE: The umbilical cord to be cut with a clean and sterile blade /
scissor
CLEAN TIE: Clamp cord with a clean sterile clamp or tie
CLEAN CORD: Nothing to be applied on the cord. Keep it dry.
IMMEDIATE / ESSENTIAL NEWBORN CARE AT BIRTH
1. Deliver the baby on a warm and clean towel.
2. Establish and maintain a patent airway.
3. Ensure warmth.
4. Assessment and documentation of baby's condition.
5. Care of eyes.
6. Clamp and cut the cord.
7. Care of skin.
8. Administration of vitamin K.
9. Identification of baby.
10.Transfer of the baby according to level of care required.
Establish and maintain a patent airway
• Suction secretions ( mucus & amnioticfluid) of mouth and nose to
clear the airway during crying.
• Suction should be done gently using a bulb syring or mucus trap to
prevent bradycardia, laryngospasm, & cardiac arrhythmias from vagal
stimulation.
• Mouth is first suctioned,then the nose .
• If the baby not crying, provide gentle tactile
stimulation.
• Start CPR, if not cried even after stimulation.
Ensure warmth
• Loss heat due to evaporation,
radiation, conduction, convection.
• To prevent heat loss
Delivery room temperature -25-28 deg
cel
Dry the infant thoroughly soon after
birth using a warm towel.
Place the bay under radiant
warmer or
Over the mother’s chest in skin
to skin contact with her
Assessment and documentation of baby's
condition.
• APGAR Scoring at 1 & 5 minute
Care of eyes
• Using sterile cotton swabs
dipped in sterile water
• Clean from inner canthus to
outer canthus with separate
swabs for each eye.
Cord clamping
• Clamp at 2-3 cm away from the abdomen using a commercially
available clamp, a clean and autoclaved thread or a sterile rubberband.
• The stump should be away from the genitals to avoid contamination.
• Cord should be inspected every 15-30 minutes during initial few hours
after birth for aerly detection of any oozing.
Skin Care
• Gently wipe off blood, mucus
and secretions.
• Not recommended to rub off the
protective vernix caseosa.
• Prevent hypothermia
Vitamin K
• Vit K is required for synthesis of prothrombin by liver.
• Generally bacteria of intestine produce Vit K.
• As newborn intestinal flora don’t produce Vit K for
fewdays, there is risk for abnormal bleeding.
• Vit K 1 mg IM
Identification of the baby
• Identification band on baby’s wrist include
name of mother
registration number
date & time of birth
sex
• Foot impression of baby is also taken for identification.
Transfer
• Normal babies are transferred to mother and nursed in postnatal area
(Rooming-in).
• Breast feeding should be started with in half an hour of birth
• Sick or at risk neonates should be transferred to a NICU
LATER / ROUTINE CARE OF THE
NEWBORN
• Rooming in
• Initiating feeding
• Observation for early signs of diseases
• Prevention of infections
• Care of bowel & bladder
• Maintenance of personal hygiene
• Parental teaching & followup
Observation for early signs of diseases
• Observe for danger signs
Failure to pass meconium within 24 hours of birth.
Failure to pass urine within 48 hours of birth.
Bleeding from any site.
Failure to take feed.
Excessive crying or undue lethargy.
• Jaundice within 24 hours of birth (Pathological Jaundice)
• Hypothermia or Hyperthermia
• Seizures
• Persistent vomiting or diarrhea
• Breathing difficulty
• Evidence of superficial infection like oral thrush,
conjunctivitis, umbilical cord infection, pustules on skin etc.
Care of bladder & bowel
• Notify the physician if the neonate fails to pass urine and stool within 24 hours of
birth.
• The urine output is about 200-300ml by the end of first week of life so neonate
voids about 15-20 times a day.
• Diaper should be changed as soon as wet. The neonate also passes stool
frequently so diaper area should be cleaned with mild soap and water.
• The baby should be kept clean and dry.
Personal hygiene
• The personal hygiene of both baby and mother should be maintained
to prevent infections.
• The baby should be given sponge bath daily in summers and every
alternate day in winters.
• Care should be taken to prevent chilling and draughts while giving dip
bath to the baby.
• Lukewarm water and mild baby scap should be used for giving baby bath.
• Special attention should be paid to skin creases at axilla, neck, groin and thighs.
• After giving bath, dry the baby thoroughly and put on soft clothes.
• The umbilical stump should be kept dry and clean.
• The cord dries and falls off within 10-14 days.
• Eye care should also be done daily using sterile swabs dipped in sterile water.
• Eyes should be cleaned from inner canthus to outer canthus using separate swab
for each eye.
NEWBORN ASSESSMENT
1. The initial assessment
2. Transitional assessment
3. Assessment of gestational age
4. Systematic physical examination
Initial Assessment
• Apgar scoring system
• Developed by Virginia Apgar in 1952
• Evaluation of newborn made at 1 & 5 minute after birth.
• Total score : 10
• No depression: 7-10
• Mild depression: 4-6
• Severe depression: 0-3
1. GLABELLAR REFLEX
2. BLINKING REFLEX
3. DOLL’S EYE
4. SNEEZING & COUGHING REFLEX
5. ROOTING REFLEX
Appears at birth
Disappears at 4-6 months
6. SUCKING REFLEX
Appears at birth Disappears at 6 -12 months
7. SWALLOWING REFLEX 8. GAG REFLEX
9. PALMAR GRASP
Disappears at 6 wks - 3 months
10. ASYMMETRIC TONIC NECK
REFLEX
• Fexion of hand on opposite side and
extension of hands on same side where head
• Disappears at 6-7 months of age
turns when lying in supine
11. MORO REFLEX/STARTLE REFLEX
• Symmetric abduction and extension of arms and legs • Disappears at 3-4 months
with fanning of fingers, followed by adduction of arms
and flexion at elbows with curling of fingers.
12. BABINSKI REFLEX
• Dorsiflexion of great toe with
extension of other toes • Disappears at 12 months
13. STEPPING/ DANCING REFLEX
Transitional Assessment
• Behavioural changes can be assessed during the period of reactivity.
• Two periods of reactivity followed by a sleep phase.
The first period of reactivity
• Begins at birth and lasts for the first 30 minutes after birth.
• The newborn is alert and moving and may appear hungry.
• Spontaneous moro reflex, sucking, chewing and rooting are present.
• Respiration and heart rates are elevated .
• This period of alertness allows patients to interact with their newborns
and to enjoy close contact with their new babies.
• The appearance of sucking and rooting behavior provides a good
opportunity for initiating breastfeeding in many newborns, latch on the
nipple and suck well at the first experience.
Transition state of sleep
• At 30-120 minutes of age, the newborn enters the second stage of transition state of sleep/decrease
in activity.
• This phase is referred to as period of decreased responsiveness.
• Movements are less jerky and less frequent.
• Heart and respiratory rate decline as the newborn enters the sleep phase.
• The muscles become relaxed and responsiveness to outside stimuli diminishes.
• During this phase, it is difficult to arouse/interact with the newborn.
• No interest in sucking is shown.
Second period of reactivity
• Begins as the newborn shows an interest in environmental stimuli.
• This period lasts 2-8 hours in the normal newborn.
• Heart and respiratory rates increase; peristalsis also increases.
• Thus, it is not uncommon for the newborn to pass meconium during this period.
• In addition, motor activity and muscle tone increase in conjunction with an
increase in muscular co-ordination.
Gestational Age assessment
• Frequently used method of determining gestational age is
The New Ballard Scale (NBS) by Ballard, Khoury, Wedig, and others
(1991) .
• This scale, an abbreviated version of the Dubowitz scale, assesses six
external physical and six neuromuscular signs.
• https://www.youtube.com/watch?v=GNqzV7LuFGE
SYSTEMATIC PHYSICAL EXAMINATION
VITAL STATISTICS:
• Weight
• Length
• Head circumference
• Chest circumference
Weight
• Birth Weight: The first weight of a live or dead product of conception, taken after complete
expulsion or extraction from its mother.
• Measured with in first 24 hrs of birth preferably first 24 hrs of birth.
• During the first few days after birth, a new born loses 5% to 10% of birthweight.
• This weight loss occurs because a newborn is no longer under the influence of salt and fluid
retaining maternal hormones.
• Diuresis and limited intake during first days of life also contribute to this weight loss.
• The breastfed newborn recaptures birth weight within 10 days of life.
Length
• The average birth length – 49 to 53 cm
Head circumference
• 33-35cm
Chest circumference
• About 2 cm less than HC.
VITAL SIGNS
