Newborn Care: Immediate Care and Thermoregulation

• The term newborn refers to the infant during the first 28 days of life

Immediate Newborn Period

• The priority after birth is to establish effective respirations
• Normal newborn respirations range from 30 to 60 breaths per minute and are shallow and irregular
• The Apgar score is a rapid assessment of the newborn's transition to extrauterine life
• Apgar score is performed at 1 minute and 5 minutes after birth
• Five signs are evaluated: heart rate, respiratory effort, muscle tone, reflex irritability, and color
• Each sign is given a score of 0, 1, or 2
• A total score of 8 to 10 indicates a newborn in good condition
• A score of 4 to 7 indicates a newborn who needs some resuscitative measures
• A score of 0 to 3 indicates a newborn requiring full resuscitation

Thermoregulation

• Newborns have difficulty regulating their body temperature
• Newborns have a large surface area in relation to their mass
• Newborns have limited subcutaneous fat
• Newborns lose heat more easily than adults
• Four mechanisms of heat loss: conduction, convection, evaporation, and radiation
• Conduction: Heat loss by direct contact with a cooler surface
• Convection: Heat loss by the flow of heat from the body surface to cooler ambient air
• Evaporation: Heat loss when liquid is converted to vapor
• Radiation: Heat loss from the body surface to a cooler solid surface not in direct contact but in relative proximity
• Nonshivering thermogenesis is the primary method of heat production in newborns
• Brown adipose tissue (BAT) is oxidized in response to cold exposure
• Cold stress can lead to depletion of glucose stores and respiratory distress

Cardiovascular System

• The foramen ovale, ductus arteriosus, and ductus venosus close after birth
• The heart rate ranges from 110 to 160 beats per minute
• Blood pressure averages 60 to 80 mm Hg systolic and 40 to 50 mm Hg diastolic

Respiratory System

• The newborn's respiratory system undergoes significant changes at birth
• The alveoli must remain open for gas exchange
• Surfactant reduces surface tension and prevents alveolar collapse

Hepatic System

• The liver plays a role in glucose regulation and bilirubin conjugation
• Physiologic jaundice occurs in most newborns
• Physiologic jaundice is caused by the normal breakdown of red blood cells and the immature liver's inability to conjugate bilirubin
• Pathologic jaundice occurs within the first 24 hours of life and requires intervention

Gastrointestinal System

• The newborn's stomach capacity is limited
• Meconium is the first stool passed by the newborn
• Meconium is a black, tarry substance
• The newborn's digestive system is immature, making it difficult to digest complex carbohydrates and fats

Urinary System

• The newborn's kidneys are immature
• Newborns have a limited ability to concentrate urine
• The first void should occur within 24 hours

Immune System

• Newborns have passive immunity from their mothers
• The passive immunity lasts for a few months
• Breastfeeding provides additional immune protection

Neurological System

• Newborn reflexes include: Moro, rooting, sucking, tonic neck, Babinski, stepping, and grasping
• These reflexes disappear over the first few months of life

Sensory Capacities

• Newborns can see, hear, smell, and taste
• Newborns prefer sweet tastes
• Newborns are sensitive to touch

Periods of Reactivity

• The first period of reactivity lasts up to 30 minutes after birth
• The newborn is alert and active
• The heart rate and respiratory rate are elevated
• The period of decreased responsiveness lasts from 30 minutes to 2 hours
• The newborn is sleepy and less responsive
• The second period of reactivity lasts from 2 to 8 hours
• The newborn is again alert and active

Assessment

• A complete physical assessment should be performed within 24 hours of birth
• Measurements include: weight, length, and head circumference
• Vital signs should be assessed regularly
• Skin color, tone, and lesions should be noted
• The head, face, eyes, ears, nose, mouth, and neck should be examined
• The chest, heart, lungs, abdomen, and genitalia should be assessed
• The extremities and back should be examined for abnormalities
• The reflexes should be elicited

Common Newborn Problems

• Jaundice is a common problem
• Hypoglycemia is low blood glucose
• Respiratory distress can occur
• Infections can be serious
• Birth injuries can occur

Interventions

• Maintaining a clear airway is essential
• Thermoregulation is important
• Providing adequate nutrition is necessary
• Protecting from infection is a priority
• Promoting bonding is beneficial
• Parent education is important

Discharge Teaching

• Newborn feeding should be discussed
• Bathing and skin care should be reviewed
• Cord care should be explained
• Circumcision care should be taught
• Safe sleep practices should be reinforced
• Signs and symptoms of illness should be reviewed
• Follow-up appointments should be scheduled

Skin Care

• Bathing two or three times a week is sufficient
• Avoid soaping everyday as this can dry out the skin
• Mild soaps or cleansers should be used
• Emollients can be used to moisturize dry skin
• Diaper changes should be frequent
• The perineal area should be cleaned with each diaper change
• Air drying the perineal area can help prevent diaper rash

Cord Care

• The umbilical cord should be kept clean and dry
• Fold the diaper below the cord
• Sponge bath until the cord falls off
• Watch for signs of infection
• The cord usually falls off within 10 to 14 days

Circumcision Care

• Clean the penis with warm water
• Apply petroleum jelly to the glans with each diaper change
• Fasten the diaper loosely

Safety

• Newborns should always be held securely
• Never leave a newborn unattended
• Crib slats should be no more than 2 3/8 inches apart
• Car seats should be rear-facing
• Car seats should be installed properly
• Avoid smoking around the newborn
• Keep small objects out of reach
• Check the temperature of bath water
• Use sunscreen when exposed to the sun

Newborn Nutrition

• Breast milk or formula
• Feed on demand
• Burp frequently
• Avoid propping bottles
• Educate families that newborns do not need additional water
• Newborns typically eat every 2-3 hours

Sleep

• Newborns sleep approximately 16-19 hours per day
• Place the baby on their back to sleep to prevent SIDS
• Room-sharing is recommended, not bed-sharing
• Avoid soft bedding
• Maintain a comfortable temperature
• Swaddling can help to soothe