Newborn Care Essentials

Newborn Care

• Newborn care focuses on stabilization, establishing a patent airway, maintaining oxygenation and thermoregulation
• Physical assessments every 8 hours or as needed, including vital signs, weight, and umbilical cord inspection
• Nursing interventions include family education, newborn screenings, feeding, bathing, and promoting baby-friendly practices
• First 6-8 hours post-birth are critical periods of reactivity, including alertness and sleep phases, crucial for observing adaptation to extrauterine life
• Pain assessments should be integrated into routine evaluations using facility-specific tools
• Vital signs monitored frequently, with heart rates ranging from 160-180/min during the first period of reactivity
• Weight measured daily at the same time for accurate growth tracking
• Umbilical cord inspected for bleeding, clamped securely to prevent hemorrhage
• First period of reactivity lasts around 30 minutes, followed by an inactive period (60-100 minutes)
• Second period of reactivity (2-8 hours after birth) where newborns might gag or choke on mucus

Laboratory Tests and Screenings

• Newborn genetic screening mandated for PKU, galactosemia, cystic fibrosis, and other conditions
• Blood glucose levels monitored for hypoglycemia per facility policy
• Serum bilirubin levels checked before discharge to assess for jaundice
• Heel stick blood samples collected using a spring-activated lancet for proper technique
• Newborn hearing screenings and critical congenital heart disease screenings performed (pulse oximetry)
• Accurate metabolic screening requires newborn to have received at least 24 hours of feeding

Therapeutic Procedures: Circumcision

• Circumcision is a surgical procedure discussed with the family, considering health, hygiene, and cultural factors
• Typically performed within the first few days of life
• Health benefits include easier hygiene and reduced risks of STIs and penile cancer
• Risks include hemorrhage, infection, and complications related to the urinary meatus
• Contraindications include hypospadias, family history of bleeding disorders, and lack of vitamin K administration

Nursing Actions and Post-Procedure Care

• Assess for family history of bleeding disorders and any congenital abnormalities like hypospadias or ambiguous genitalia
• Obtain informed consent from parents and prepare necessary supplies, including emergency equipment
• Administer prescribed medications and safely position newborn on a restraining board
• Use radiant heat; ensure readily available emergency equipment such as a bulb syringe
• Document information like time and type of circumcision performed

Post-Procedure Care for Newborns

• Liquid acetaminophen prescribed at 10-15 mg/kg orally after procedures (maximum daily limit 30-45 mg/kg)
• Parents educated on administering acetaminophen every 4-6 hrs as needed for pain relief
• Monitor for infection (redness, discharge, swelling, foul odor)
• Comfort measures include regular diaper changes, cleaning with warm water, and lubricant (like petroleum jelly)
• Avoid tub baths until circumcision site heals; avoid excessive crying, lack of urination, and frank bleeding
• Monitor for hemorrhage, cold stress, hypoxia, hypoglycemia, and respiratory complications
• Prompt intervention required for symptoms like jitteriness, poor feeding, and seizures.

Thermoregulation in Newborns

• Newborns susceptible to heat loss due to high surface-to-weight ratio
• Maintaining a neutral thermal environment minimizes oxygen consumption and caloric expenditure
• Cold stress increases oxygen demands and depletes brown fat reserves
• Normal core temperature 36.5–37° C (97.7–98.6° F)
• Monitoring for hypothermia is crucial, including cyanosis and increased respiratory rate