Newborn Nursing Assessment

APGAR Scores

• APGAR scores are used to assess newborns

Normal Vital Signs for Babies

• Normal heart rate is 100-160 bpm.
• Normal respiratory rate is 40-60 breaths per minute.
• Abnormal temperature is >38.0 C/100.4 F or <36.6 C/97.8 F

Consequences of Cold Stress

• Possible consequences: hypoglycemia, metabolic acidosis, decreased surfactant production, neonatal death, and hypoxemia

Bulb Syringe Use

• A bulb syringe is used to establish uterine respirations outside the womb.
• Use the bulb syringe in the mouth first, then the nose, to prevent aspiration.
• Suction before giving oxygen

Delegation

• A UAP cannot evaluate, assess, or teach

Interventions for Cold

• Initiate skin-to-skin contact with the mother to warm the baby.
• Use a warm blanket over both the mother and baby.
• Delay eye ointment administration so the mother can hold the baby longer.

Hypothermia Prevention

• Dry the baby off to prevent evaporation.
• Keep the room warm and close windows/doors.
• Put a hat and blanket on the baby and initiate skin-to-skin contact.
• Assess for signs and symptoms of temperature instability like hypertonia.

Signs of Hunger in Newborns

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

Labor and Hypothermia/Hypoglycemia

• Monitor glucose if a baby shows signs of hypothermia or hypoglycemia during the 4 stages of labor.

High Risk for Hypoglycemia

• Babies at high risk include those whose mothers are diabetic, SGA babies, twins, those stressed during labor (late decelerations or low APGAR score), and premature infants.

Gestational Diabetes

• Check records, initiate skin-to-skin contact, delay bath, and monitor glucose (wait 12 hrs after birth) for mothers with GD.
• The baby should be put to breast within the first hour, but it doesn't mean they get a bottle.

Risk for Infection

• Babies are at higher risk if the mother is GBS positive, has ROM, or if there was trauma (forceps, fetal scalp electrodes, C-section), which break the skin barrier.

Circumcision Care

• Do not remove yellow exudate.
• Apply petroleum jelly to the tip using petroleum-pregnated gauze after hand hygiene and diaper change.
• Assess for bleeding larger than a quarter size.
• Administer Tylenol every 4-6 hours
• The baby should void within 24 hours.

Diaper Dermatitis Prevention

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

Definition of Colic

• Colic includes when a baby cries and cries and doesn't stop for 3 hrs a day for 3 days for 3 weeks.
• It's considered normal for healthy infants to steadily increases crying for 8 weeks.
• No known cause: curling legs, discomfort with BM, irritable with feeding and in crib, freq. cuddling.
• Parents should keep a diary of when the baby is awake, sleeping, or crying.

Premature Delivery

• Call NICU if a nurse and mom come in at 30-week delivery.

How to Help People Learn

• Use a calm voice and dim the lights in the room.

Mom in Pain or Anxious

• Diffuse the situation: turn down lights, turn off TV, give the baby 5 mL of formula, give the mother chocolate, and have her go to the bathroom to wash her face and brush her teeth.

Latch

• Proper latch prevents infection and pain in the mom as the baby gets nutrients and antibodies
• Assess if they won't breastfeed and don't force them.

Breastfeeding Preparation

• Recognize hunger cues, feeding readiness, and health benefits for both.
• Observe for app latch (less pain, stimulates milk production).

Breastfeeding Assessment

• LATCH is an assessment tool: Latch, Audible swallowing, Type of nipple, Comfort, Hold.

Bottle Feeding

• Wash nipples in hot soapy water or a dishwasher using rubber or silicone nipples.
• Powder and liquid formulas require that they are not watered down or too concentrated as it can cause water intoxication.
• Discard unused formula in bottle

Feeding

• Feed newborns on demand not on schedule.
• Keep head slightly higher than trunk to help with risk of otitis media.
• Do not prop bottles: higher risk for choking, ear infection, and tooth decay.

Lactogenesis

• Lactogenesis is a 3-phase process of milk production.
• Supply and demand should be between 9-10 days postpartum.
• The latch shouldn't be painful.
• Decrease suckling, 6-8 wet diapers a day and several stool per day once milk has come in.
• Refer to a lactation consultant if a nurse can't answer questions.

Comfort with Breast Feeding

• Comfort and relaxation is important.
• Provide easily understood breastfeeding info over several sessions and praise the mom for breastfeeding.

Introduction to Solid Foods

• Start solid foods at 6 months of age to reduce allergy risk after PCP determination.
• Rice and oats are first foods.
• Don't give cereal in bottles, which will cause choking and aspiration.

Safe Bathing

• Check baby temp to make sure they are not too cold, start with the cleanest parts first (inner eye to outer eye) and do not use soap on the face.
• Give bath quickly, provide neck support, and never leave them unattended.
• Do not use a Qtip inside the ear.

Swaddling

• Swaddling means to wrap infant snuggly in blanket, which can increase the risk of SIDS or hip dysplasia if done improperly.
• Stop at 2 months with 2-3 fingers between infant's chest and swaddle.

Newborn Follow-Up

• Newborn should be checked w/I 48-72 hrs after discharge where appointments must be made before leaving hospital.

Well Child Checkups

• Well child checkups assess growth, immunizations, and metabolic screens.

Mogen Clamp

• Mogen clamp used for Jewish people.

Circumcision Care with Mogen clamp

Report PCP for red, drainage, watch for urination and check for bleeding every 4 hours.

• Apply petroleum jelly.
• Notify if there is active bleeding more than a quarter size.
• Red with yellow film should not be washed off, and should heal w/I 2 weeks.

Cord Care

• Cord care: let it dry out and fold the diaper over it.
• Heals within 2 weeks.
• Keep it clean with plain water and dry it off.
• Tell parents to contact PCP if there is bleeding, drainage, redness, or fever.

Plastibell Circumcision

• The tip of penis can form red and form a crusted area.
• Do not apply lubricants on penis.
• 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.

Newborn Care

• Support the head when lifted, and use a cradle hold for eye contact with parents and good positioning for feeding.

Newborn Stools

• First stools are black, then green, then yellow with 6 wet diapers/day from day 5-month 1.
• Breastfeeding stools are yellow with a sour odor.
• Formula-fed stools are dry, formed, pale, and have an unpleasant odor.
• Newborns feed 8-12 times per day - growth spurts at 3-5 days, 1 week, 6 weeks, 3 months, and 6 months.
• Birth weight returns by 2 weeks of age.

Siblings and Newborns

• Never leave a newborn unattended with pets or small children.
• There may be sibling rivalry when a new baby is introduced.
• Prepare during pregnancy, attend classes, give a baby gift, and take special outings without the new baby.

Skin-to-Skin Care (Kangaroo Care)

• Holding a baby bare chest, is also known as kangaroo care, and you cover the pair with a blanket.

Key Points

• Breastfeeding is successful when there is stabilization of HR, breathing, decreased crying, increase milk supply.
• Teaching the mom benefits can make her more comfortable doing it.

Ballard Score

• Ballard score: premature vs mature: a score of 35 = 38 weeks gestation so mature baby, while a score of less than 35 indicates prematurity

Premature Infant

• Premature infants have immature lungs and decreased surfactant so it is important to make sure the airway is patent and support RR.
• They usually have more lanugo, increased risk for skin breakdown and cannot bend as much due to less flexion.

NAS

• Neonatal abstinence syndrome = score babies.
• Assess every 3-4 hours for withdrawal signs/symptoms, give within 2 hours of birth.
• Report to CPS, collect urine and stool.

LGA Babies

• LGA babies are greater than 90 percentiles which puts them at risk of hypoglycemia.
• Check for birth trauma like clavicle fracture.

Hyperbilirubinemia

• Hyperbilirubinemia is an increase in bilirubin in blood.
• Preterm infants are affected.
• Indicating jaundice >5, which causes various disorders.
• ABO incompatibility raises jaundice levels and breastfeeding causes it but blood incompatibility is a greater risk.

Breastfeeding Latch

• The baby is facing toward the breast and covers the nipple and some of the areola.
• Supports breast rooting reflex by touching chin to breast

Phototherapy

• Phototherapy treats jaundice.
• Except for feeding or visits, eye patches and lots of skin must be exposed continuously.
• Remove eye patches during feeds and have the mom hold the baby.
• Monitor I/O, change positions freq, and administer feedings every 2-3 hours to avoid fluid loss.
• Do not apply ointment or lotions as they can cause burns Early breastfeeding is important.

ECMO

• ECMO provides heart and lungs for the baby, which allows lungs to get better and pH balance to correct itself (respiratory acidosis)

IVH

• Intraventricular hemorrhage (brain bleed) occurs with premature neonates who have RDS and complications with ventilation.
• Look for worsening apnea, increased need for ventilation, drip in BP, seizures, increase in head size, and decreased LOC.
• Anterior fontanel should be soft and flat

Common Actions

• Outside of heel, capillary stick.
• In back in middle, rear facing is where babies sit in car.
• Vastus lateralis, upper outer 3rd, is where to administer baby shots.
• Axillary, is where to take a temperature.
• Across nipple line is how to measure a baby’s chest circumference.
• Above the ears and eyebrows is where to measure head circumference.
• Belly button, is where to measure an abdomen.
• Head to foot, is how to measure length.

Key Times

• Hepatitis HBIG is given if the mother has hep B within 12 hrs of birth.

Newborn Murmurs

• Murmurs usually stop 24-36 hours after birth when the PDA closes.

Newborn Considerations

• Two sleep and four awake is a normal sleep-wake cycle for newborns
• Safety: Nothin