Newborn Care Basics

APGAR Scores

• APGAR is performed on newborns to assess their condition

Newborn Vitals

• Normal heart rate for newborns is in the range of 100-160 beats per minute
• Normal respiratory rate is 40-60 breaths per minute
• Abnormal temperature is defined as greater than 38.0 C/100.4 F, or less than 36.6 C/97.8 F

Cold Stress Consequences

• Cold stress can cause hypoglycemia, metabolic acidosis, decreased surfactant production, neonatal death, and hypoxemia

Bulb Syringe Use

• Use a bulb syringe in the mouth first, then the nose to prevent aspiration
• Suction before administering oxygen

UAP Scope

• UAPs cannot evaluate, assess, or teach

Interventions for Cold

• Skin-to-skin contact with the mother can warm the baby
• Warm blankets help to warm the baby
• Delay eye ointment administration so the mother can hold the baby

Addressing Hypothermia

• Dry the baby off to prevent evaporation
• Close windows and doors to keep the room warm
• Put a hat and blanket and use skin-to-skin contact
• Address any damp material touching the baby
• Monitor for signs of temperature instability, such as hypertonia

Newborn Hunger Cues

• Newborns may show hunger through rooting, bringing hands to the face, and crying

Hypothermia/Hypoglycemia Nursing Actions

• Monitor glucose levels in babies showing hypothermia or hypoglycemia

High Risk for Hypoglycemia

• Babies at high risk include those whose mothers are diabetic, SGA babies, twins, babies from stressful labors, and premature infants

Gestational Diabetes Management

• For mothers with gestational diabetes, check records, encourage skin-to-skin contact, delay bathing
• Monitor glucose levels, have the baby breastfeed within the first hour, but do not immediately resort to bottle-feeding

Risk Factors for Infection

• GBS-positive mothers, ROM, trauma (forceps, fetal scalp electrodes, C-section) increase the risk

Circumcision Care

• Do not remove the yellow exudate
• Apply petroleum jelly
• Practice hand hygiene before diaper changes
• Look for bleeding larger than a quarter
• Administer Tylenol every 4-6 hours
• Baby should void within 24 hours of the procedure

Diaper Dermatitis Prevention

• Clean the baby's bottom with water or disposable wipes
• Use zinc oxide ointment at the first sign of rash
• Avoid powder
• Change diapers every 1-3 hours during the day and once at night
• Expose the baby's bottom to the air while sleeping

Colic Definition

• Colic is defined as crying for 3 hours a day, for 3 days a week, for at least 3 weeks
• In healthy infants, a steady increase in crying is normal for 8 weeks
• Has no known cause
• Parents should keep a diary of when the baby is awake, sleeping, and crying

30-Week Delivery

• Call NICU for 30-week delivery

How People Best Learn

• Calm, calm voice, decrease lights in room

Mom In Pain/Anxiety

• Diffuse the situation, turn down lights, turn off the television, offer the baby 5 mL of formula, give mom chocolate, and have her go to the bathroom to wash her face and brush her teeth
• Assess if she wants to breastfeed; do not force it

Appropriate Latch

• Important for skin integrity, preventing infection and pain in the mother
• Allows baby getting nutrients and antibodies

Recognition of Hunger Cues

• Observe for appropriate latch (less pain, stimulates milk production). PRIORTIY!!

Assessment For Breastfeeding Tool

• LATCH: latch, audible swallowing, type of nipple, comfort, hold

Bottle Feeding

• Wash in hot soapy water, wash in dishwasher, rubber, or silicone nipples (fewer odors and last longer)

Formula Feeding

• Do not water it down or have too concentrated can cause water intoxication
• Discard unused formula in bottle

Feeding Guidelines

• Feed newborns on demand, not on a set schedule
• Keep the baby's head slightly higher than the trunk when feeding to prevent otitis media
• Do not prop bottles, as it increases the risk of choking, ear infections, and tooth decay

Lactogenesis Phases

• Involves three phases and establishes milk production
• Operate via supply and demand
• Lasts 9-10 days postpartum
• A proper latch should not be painful
• Decrease suckling
• 6-8 wet diapers a day and several stools per day once milk is established
• Refer to a lactation consultant or nurse if needed

Anxiety and Breastfeeding

• Higher anxiety and discomfort interferes with breastfeeding
• Comfort and relaxation, easily understood breastfeeding info in several sessions, be calm and patient
• Explain it can take time
• The newborn should be alert and ready to feed before bringing him to the mother, praising women for breastfeeding

Introduction of Semi-Solid Foods

• Start solid foods at 6 months of age to reduce allergy risk, determined by PCP
• The baby is ready when they can sit independently, accept a spoon with their mouth, and open their mouth when food is in front of them
• Rice and oats are the first foods to introduce
• Cereal should not be given in bottles to avoid choking and aspiration

Safe Bath Tips

• Check the baby's temperature and start with the cleanest parts first (inner eye to outer eye)
• Do not use soap on the face
• Give baths quickly, swaddle baths
• Provide good neck support in the bathtub
• Never leave them unattended
• Do not use a Q-tip inside the ear

Swaddling

• Swaddling means wrapping an infant snugly in a blanket
• Improper swaddling can increase the risk of SIDS (Sudden Infant Death Syndrome) or hip dysplasia
• Stop swaddling at 2 months
• Ensure there are 2-3 fingers of space between the infant's chest and the swaddle

Routine Newborn Follow-Up

• There should be routine follow-up within 48-72 hours after discharge
• Make appointments before discharging home

Well Child Checkups

• Assess growth, immunizations, and metabolic screens

Mogen Clamp

• It is used for circumcision for Jewish people

Mogen Clamp

• Report PCP red, drainage
• Watch for urination
• Check for bleeding every 4 hours
• Apply petroleum jelly
• Notify if active bleeding more than quarter size
• Red with yellow film do not wash it off, should heal within 2 weeks

Cord Care

• Let it dry out and fold the diaper over it
• It should heal in 2 weeks
• Clean with plain water if dirty
• Parents should contact PCP if there is bleeding, drainage, redness, or fever

Plastibell

• Tip of the penis can form red and form a crusted area
• Do not apply lubricants
• The ring falls off in 7-10 days
• Do not pull it off
• Notify PCP if the area is red, warm, swollen, or has drainage

Basic Care for Newborns

• Support the head when lifting and cradle the baby
• Encourage eye-to-eye contact with parents and good positioning for feeding

Newborn Stools

• Initially black, then green, and then yellow, with frequent stools per day
• By day 5 to month 1, there should be 6 wet diapers per day and stools
• Breastfeeding stools are yellow
• Later stools have a more sour odor
• Formula-fed stools are dryer, formed, pallor, and have an unpleasant odor
• Newborns feed 8-12 times daily

Growth Spurts

• They typically occur at 3-5 days, 1 week, 6 weeks, 3 months, and 6 months

Siblings & Newborns

• Never leave a newborn unattended with pets or small children
• Sibling rivalry is common when a new baby is introduced
• Older children may react negatively
• Toddlers may start wetting the bed or diapers to get attention, or hit or pinch
• Prepare siblings during pregnancy, involve them in feeling the baby kick, include them around the newborn infant, attend classes together, give the baby a gift, and plan special outings without the new baby

Skin-to-Skin Care (Kangaroo Care)

• Involves holding the baby bare chest to bare chest, covered with a blanket

Stabilization of HR and Breathing

• Achieved by decreased crying, successful breastfeeding, increase milk supply, teaching mom benefits can help her feel more comfortable doing it

Ballard Score

• Premature vs mature: A Ballard score of 35 equals 38 weeks gestation and mature baby
• A score of less than 35 indicates prematurity

Premature Infants

• Characterized by immature lungs and decreased surfactant
• Make sure airway is patent and support of RR
• Skin translucent or sticky
• More lanugo
• Square window (less)
• Cannot bend as much. Less flexion.

NAS

• Neonatal abstinence syndrome: score babies
• Signs and symptoms of withdrawal
• Should be given within 2 hours of birth.
• Assessed every 3-4 hours.
• When neonate should be evaluated with treatment with medication
• The mother screen to using drugs

LGA Babies

• The babies are greater than 90 percentiles
• Babies are at risk for hypoglycemia
• Look for birth trauma

Premature Babies

• prevent skin breakdown (barrier against infection) translucent skin, sterile water when bathing and only bath soiled areas, adhesives sparingly, avoid friction, double wall incubator to prevent trans epidermal water loss and heat loss, water, air, and gel mattresses
• Skin assessment daily to minimize risk of skin breakdown

Hyperbilirubinemia

• Increase bilirubin in blood
• It often affects preterm infants

• 5 indicates jaundice

• Path: various disorders
• ABO incompatibility: makes jaundice level go up
• Breastfeeding can cause it, but blood incompatibility is a greater risk

Breastfeeding

• Ensure the baby's body is facing the breast, covering the nipple and some areola
• Mother identifies hunger cues, mother can support her breast, rooting reflex by touching chin to breast

Phototherapy to treat jaundice

• Discontinue during feeding time or visits, remove eye patches during these times for bonding
• During feeds eye patches should be removed and mom hold baby
• Change positions frequently. Monitor I and O.
• Can result in fluid loss.
• Feedings every 2-3 hours.
• Ointment should not be applied to skin or lotions can cause burns.
• Early breastfeeding.

ECMO

• It replaces the heart and lungs for the baby
• It helps lungs get better and correct pH imbalances

Pulmonary Hypertension

• Dopamine decreases shunting

Intaventricular Hemorrhage

• Occurs in premature neonates who have RDS, complications with ventilation
• Signs include worsening apnea, increased need for ventilation, drip in BP, seizures, increase in head size, decreased LOC
• Fontanel should be soft and flat

Capillary Heel Stick

• Outside of the heel

Where babies sit in the car

• In back in middle, rear facing

Baby Shots

• Vastus lateralis: upper outer 3rd

Murmurs

• Murmurs usually stop 24-36 hours of age when PDA closes up
• They can get louder before stopping
• Greater than that additional assessment or follow up

Baby Temp

• Take axillary

Hepatitis B Immunoglobulin

• Administered if mother has Hepatitis B within 12 hours of birth

Chest Circumference

• Across the nipple line

Head Circumference

• Above ears and eyebrows

Abdomen

• Belly button

Length

• Head to foot

Sleep Wake Cycle

• 2 hours sleep 4 hours awake
• Deep, light, drowsy, external stimuli can cause change in state, alert, crying,

Safe Sleep

• The crib should be empty, with the baby placed on their back, no bumpers, no toys
• No loose bedding

Metabolic Screen

• Test for PKU

Newborn Screen Test

• Test for hearing, CHD, and genetic and metabolic disorders; however, it is a screening, not diagnostic, test

Contraindications for Breastfeeding

• The mother has active TB, is taking cancer medications, radioactive isotopes, has herpes on the breast, is HIV positive, or is using street drugs or cocaine
• Galactosemia: women are encouraged to breastfeed (not contraindicated)

Phototherapy Steps

• Undress newborn
• Change position every 3 hours
• Measure radiance of fluorescent light, 20 inches away
• Cover baby's eyes
• Feed baby every 2-3 hours
• Assess signs of phototherapy (skin rash, loose stools, dehydration, hypothermia)
• Vital signs:
• Note that, you should listen to heart and lungs first so they don't become annoyed
• Listen for 1 min

Dehydrated

• Sunken fontanelle

Baby's Skin Cracking

• Greater than 40 weeks old, too long in womb, not lack of tears

Weight Loss

• Less than 10% is normal

Baby Breathing

• Babies use their diaphragms to breathe

Color change

• Changes in color or a different way of breathing mean that medical attention is needed

Group B Strep

• Leading cause of meningitis and sepsis
• Administering antibiotics during labor helps
• Screen all pregnant women bt 35-37 weeks
• Manage with prophylactic anx if status is unknown in birth
• Less than 37 weeks, maternal temp 100.4 or higher.
• Manage with Penicillin G 5 units or Ampicillin 2 g followed by 1 gram every 4 hours

Manage Pain

• Pacifier, sucrose, swaddling upper extremities

Bath and Gloves

• Yes, wear gloves

C-section

• Neonates are at higher risk during surgery with C-section

Respiratory Distress Signs

• Cyanosis, apnea/tachypnea, retractions, grunting, flaring of nostrils, hypotonia, central cyanosis

Brazelton Assessment Scale

• If a baby is in light sleep you should be able to know what this means

Immediate Newborn Needs

• Include warming and drying the baby, clearing the airway
• Bulb syringe should be used on the side of the mouth first, then on the nose, so as not to aspirate.

Warm Baby Tips

• Using skin-to-skin
• Small for gestational age babies are at risk for hypoglycemia and hypothermia
• Frequent feedings and drying them off

Gestational Diabetes Tips

• These moms can breastfeed
• Test blood sugar more often.

Swaddling Tips

• Circumcision care calls for light pressure
• Greater than a quarter size is bad
• Baby needs to pee before going home
• Clean Hands
• Avoid picking the scab

Premature NICU Staff

• Delivery is immenent and it is a prematures baby
• Need to call NICU team

Formula Type

• Start off babies on normal formula
• If failure to thrive baby use specialty formula

Dehydration

• Signs include mucus membranes and depressed fontanels

Foods to a Baby

• Introduce at six months of age
• Small portions

Bathing Tips

• Do NOT use q tips during a bath, do not put inside of the ear
• Bathe face first
• Quick instability
• You can give a real bath after the stump falls off, about 10-14 days

Swaddling Tips

• Hands up by face
• Up until they can roll
• 2 finger width

Cord Care Tips

• Fold the diaper over, leaving the cord open to the air
• If Can clean it

Breastfeeding Tips

• Loose stools
• Ok when water loss stool is present

Adaptive Strategies

• Behaviours include baby talk
• Baby may start wetting the bed or purposely hurt the baby

Clavicle Problems

• A creaky sound
• Don't move affected side

Preterm Babies

• Warm Prewarmed incubator, the turkey bag, gel mattress warmers

Thin Skin Protection

• High risk
• For jaundice and trauma

Eye Care

• Wear protections
• No lotions on baby

Lab Drawing Tips

• Outside heel

Car Tips

• Infant carrier in back of car seat

Immunization Tips

• Upper outer thigh
• Vitamin k with in 6 hours
• Special consent

What is not Normal

• Vomiting
• Poor feeding

Hear on Assessment

• Listen and where

Test Genetic

• Look at genetic

Brestfeed Precautions

• Hiv, Radiations, illegal substances

Galactosemia

• Can still breastfeed

Respiration Tips

• distress flaring

Cord Prolpse

• Prolonged membrane
• The 4 hrs is still needed

Baby Bassinnet

• Monitor thing on baby
• Only bassionet

tri 21

• Has low set
• Slant eyes