NCM 109 Prelims: Newborn Assessment & Care PDF

**NEWBORN ASSESSMENT AND REFLEXES** **Essential Normal New-born Care** **Significance of the First 24 Hours** - The first 24 hours of life are critical for new-borns. - This period involves a significant transition from life in the womb to life outside. **CHARACTERISTICS OF A NORMAL INF...

**NEWBORN ASSESSMENT AND REFLEXES** **Essential Normal New-born Care** **Significance of the First 24 Hours** - The first 24 hours of life are critical for new-borns. - This period involves a significant transition from life in the womb to life outside. **CHARACTERISTICS OF A NORMAL INFANT** - **Normal Pregnancy and Delivery**: - Born at term. - 1-minute Apgar score of 7 or more. - No resuscitation needed. - **Birth Weight**: - Between 2500 g and 4000 g. - No signs of soft tissue wasting. - **Physical Examination**: - Appears healthy with no congenital abnormalities. - Feeds well and has had no problems since delivery. **NEWBORN CARE OVERVIEW** - A comprehensive strategy to improve newborn health through interventions: - Immediately after birth. - In the postnatal ward. - Up to 28 days of life. **PURPOSES OF NEWBORN CARE** 1. Early detection of problems and danger signs. 2. Support mothers in meeting basic needs: - Breastfeeding. - Warmth. - Infection prevention. 3. Initiate breastfeeding within 1 hour of birth. 4. Educate mothers on exclusive breastfeeding and baby care. 5. Detect and treat issues like asphyxia and sepsis. 6. Advise on continuous care, immunizations, and growth monitoring. **CHARACTERISTICS OF A HEALTHY NEW-BORN** - Born at term with average birth weight. - Cries immediately after birth. - Establishes independent breathing. - Adapts quickly to the new environment. **IMMEDIATE CARE OF THE NEW-BORN** - **Airway and Breathing**: - Suction gently using a bulb syringe or suction catheter (mouth first, then nose). - Stimulate crying by rubbing the back. - Position the infant properly (side-lying or modified Trendelenburg). - Provide oxygen if necessary. - **Temperature**: - Dry the infant immediately. - Place in a warmer or use a droplight. - Wrap warmly. **APGAR Scoring** - A standardized evaluation performed at 1 and 5 minutes after birth. - Indicators: 1. Activity 2. Pulse 3. Grimace 4. Appearance 5. Respirations **CARE OF THE NEWBORN IN THE NURSERY** - **Components**: - Anthropometric measurements. - Bathing (oil bath or warm water bath). - Cord care. - Dressing/wrapping. - Eye prophylaxis (Crede's prophylaxis). - Footprinting/identification. - Vital signs monitoring. - Vitamin K injection. **ANTHROPOMETRIC MEASUREMENTS** - **Weight**: - Normal range: 2500 to 3900 grams (average 2900 grams). - **Length**: - Normal range: 48 to 53 cm (average 50 cm). - **Head Circumference**: - Normal range: 33 to 37 cm (average 35 cm). - **Chest Circumference**: - Approximately 3 cm less than head circumference. - **Abdominal Circumference**: - Similar to chest circumference; measured above the umbilicus. **BATHING** - First bath can be delayed for 6 hours after birth. - Use oil bath or warm water bath, starting from cleanest to dirtiest areas. - Do not remove vernix caseosa vigorously. **CORD CARE** - Keep the umbilical cord stump clean and dry. - Topical antiseptics are usually unnecessary unless in a contaminated area. **WRAPPING THE NEWBORN** - Use a warm blanket and cover the head with a stockinette cap. - Ensure the baby is dry and wrapped adequately to maintain warmth. **EYE PROPHYLAXIS** - **Crede's Prophylaxis**: - Use of ophthalmic ointment to prevent ophthalmia neonatorum. - Apply ointment from inner to outer canthus of the eye. **Footprinting and Identification** - Determine gender and take the baby's footprint. - Complete pertinent records and apply an ID bracelet before nursery transfer. **VITAMIN K ADMINISTRATION** - Prevents neonatal hemorrhage. - **Dosage**: - Term infants: 1 mg IM. - Preterm infants: 0.5 mg IM. - Injection site: Vastus lateralis (lateral thigh). **VITAL SIGNS MONITORING** - **Temperature**: - Site: Axillary. - Normal range: 36.5 - 37.6°C - **Pulse**: - Awake: 120 - 160 bpm - Asleep: 100 bpm - Crying: 180 bpm - **Respiration**: - Rate: 30 - 60 cpm - Characteristics: Nasal breathers, gentle, quiet, rapid but shallow. **Nursing Considerations** - Keep the newborn warm and dry. - Monitor vital signs regularly. - Observe for any signs of distress or abnormalities **NEWBORN CARE AND ASSESSMENT** **SCORE INTERPRETATION** - **RDS Score Interpretation:** - 0 - 3: No RDS - 4 - 6: Moderate RDS - 7 - 10: Severe RDS **BLOOD PRESSURE** - **At Birth:** 80/40 mmHg - **After Birth:** 65/41 mmHg - **Measurement:** Not routinely measured unless in distress or congenital heart disease (CHD) is suspected. **Major Time Frames** 1. Immediately after birth 2. Within the first 4 hours after birth 3. Prior to discharge **DAILY CARE** - **Focus Areas:** - Nutrition/Feeding - Elimination - Weight - Bathing & Hygiene/Grooming - Obtain vital signs - Rooming-in - Note for any abnormalities **Immediate Newborn Care** - **Policies and Protocols:** - A: Airway - B: Body Temperature - C: Certify the Birth - D: Determine adaptation to extrauterine life (APGAR Score) **AIRWAY MANAGEMENT** - **Causes of Death Without Medical Professional:** 1. **Asphyxiation:** - Umbilical cord clamped → no oxygen from placenta → hypoxia → hypercapnia → acidosis → CNS depression → potential death. 2. **Aspiration:** - Avoid wall suction; deep suctioning may cause hypoxia and arrhythmias. - **Prevention:** 1. Babies must breathe after birth; stimulate crying to ensure breathing. 2. Use bulb syringe for suction if nasal obstruction or meconium-stained amniotic fluid is present. - **Meconium Aspiration Syndrome:** 3. Meconium is sticky and can cause alveoli collapse, leading to sepsis. - **Oxygen Use:** 4. Can cause blindness (Retrolental Fibroplasia); use pulse oximeter on the sole of the foot. **BODY TEMPERATURE MANAGEMENT** - **Physiologic Heat Loss:** - Normal: 37.2 °C down to 35.5 - 36.5°C - Extreme hypothermia (below 35.5°C) can cause cold stress and acidosis. - **Management Strategies:** - Dry baby immediately after birth. - Skin-to-skin contact with mother. - Avoid cold drafts. - Use heating devices (e.g., radiant warmer). **CERTIFYING THE BABY\'S BIRTH** - **Identification Methods:** - Plastic bracelet and crib card (not reliable). - Footprints (more reliable but technique-sensitive). - DNA/HLA compatibility (most ideal). - **Registration:** - Must register with Local Civil Registrar and NSO/PSA for birth certificate to claim Newborn Package from Philhealth. **APGAR Score** - **Scoring Timing:** - Done at 1 minute and 5 minutes after birth. - **Activity Assessment:** - Limp, floppy tone indicates potential issues. - Flexion indicates better condition. **INITIAL ASSESSMENT** - **Measurements:** - **Birth Weight:** Normal: 3000 grams; Abnormal: 2500 - 3500 grams. - **Birth Length:** Normal: 50 cm. - **Head Circumference:** Normal: 33 - 35 cm. - **Chest and Abdominal Circumference:** Normal: 31 - 33 cm. - **Color Assessment:** - Normal: Pinkish or reddish. - Gray: Septicemia. - Green: Meconium-stained. - Blue: Congenital cyanotic heart disease. - Yellow: Pathologic jaundice. **JAUNDICE TYPES** - **Physiologic Jaundice:** - Term babies: 3rd to 7th day. - Preterm babies: 2nd to 10th day. - **Pathologic Jaundice:** - Noticed at birth or in babies less than 24 hours old. - Caused by blood incompatibility. **HEMOLYSIS IN NEONATES** - Neonates excrete excess blood due to polycythemia, leading to increased RBC production in response to low oxygen levels in utero. **ESSENTIAL NEWBORN CARE PRACTICES** **JAUNDICE OBSERVATION** - Important to note the timing of jaundice appearance. - Consider the child\'s age during observation. **EYE CARE (CREDE'S PROPHYLAXIS)** - **Purpose**: Prevents Ophthalmia Neonatorum caused by maternal gonorrhea or chlamydia. - **Procedure**: - Administer broad-spectrum antibiotics or povidone iodine eye drops in the lower conjunctival sac. - Silver nitrate can cause irritation; rinse with isotonic solution to prevent conjunctivitis. - Replace silver nitrate with betadine eyedrops (no rinsing required). **INITIAL CORD CARE** - **Clamping**: Clamp the cord when it is no longer pulsating (1-3 minutes). - **Do Not Milk**: Milking can cause hemolysis and hyperbilirubinemia. - **Cord Structure**: - Normal: 2 arteries, 1 vein. - Abnormal: 1 artery, 1 vein may indicate organ defects (e.g., kidney, heart). - **Infection Prevention**: - Clean with soap and water if soiled. - Promote drying; do not use abdominal binders. - Cord should fall off between 7-10 days. - Use Betadine if meconium stained. **Vitamin K Administration** - **Purpose**: Promotes synthesis of prothrombin. - **Administration**: - Given IM (1 mg) in the thigh muscle (Vastus Lateralis). - Half dose for SGA (Small for Gestational Age) at discharge. - Oral Vitamin K can be offered if parents refuse IM. **VACCINATIONS** - **Hepatitis B and BCG**: - BCG vaccine protects against tuberculosis. - Administered intradermally at the right deltoid muscle. **INITIAL BATH** - **Timing**: Best done when vital signs are stable (6 hours after birth). - **Vernix Caseosa**: Do not remove; it provides insulation and moisture. - **Bathing Guidelines**: - Oil bath for meconium-stained babies. - Avoid bathing if the baby is sick or immediately after feeding. - No tub bath until the cord is off. **ROOMING IN (RA 7600)** - **Breastfeeding**: - Exclusive breastfeeding on demand (at least 8 times a day). - Passive natural immunity provided through breastmilk. - **Breast Pumping**: - Store milk in labeled bags; use first in, first out method. - Frozen milk is good for 1 year if kept continuously frozen. **NEWBORN SCREENING ACT OF 2004 (RA 9288)** - **Purpose**: Diagnose inborn errors in metabolism. - **Conditions Screened**: 1. **Congenital Adrenal Hyperplasia**: - Symptoms: Decreased cortisol, severe salt loss. - Management: NaCl supplement. 2. **Galactosemia**: - Symptoms: Vomiting, diarrhea, liver damage. - Management: No animal source/milk; use soy formula. 3. **Phenylketonuria**: - Symptoms: Inability to utilize phenylalanine. - Management: Special formula (Lofenalac). 4. **G6PD Deficiency**: - Symptoms: Breakdown of RBC causing anemia. - Management: Avoid triggers (e.g., beans, naphthalene). 5. **Congenital Hypothyroidism**: - Symptoms: Physical and developmental delays. - Management: Lifelong thyroid supplement (Synthroid). **GENERAL APPEARANCE** - **Posture**: - Full term: Symmetric face, flexed extremities, hands tightly fisted. - Asymmetric: May indicate fractures or nerve injuries. - Breech presentation: Legs in frog position. **SKIN ASSESSMENT** - **Considerations**: - Assess color, hair distribution, turgor, texture, pigmentation, and birthmarks. - **Normal Skin Color**: - Velvety smooth and puffy, especially in legs, hands, and scrotum. **SKIN AND HEAD ASSESSMENT IN NEWBORNS** **Skin Color** - **Normal Skin Color**: - Light-skinned: Pinkish red to pinkish brown - Dark-skinned: Pinkish brown to yellow - **Ruddy Appearance**: Increased RBC concentration and decreased subcutaneous tissues. **Skin Conditions** 1. **Cyanosis / Acrocyanosis** - **Cyanosis**: Bluish discoloration, may indicate issues like hypothermia or respiratory problems. - **Acrocyanosis**: Bluish discoloration of palms and soles, normal within the first 24 hours. 2. **Pallor** - Pale appearance may indicate anaemia or other health issues. 3. **Jaundice** - Yellowing of the skin, assessed under natural light. - **Physiologic Jaundice**: - Appears after 1st 24 hours (full term) or 48 hours (preterm). - Peaks at 5-7 days, resolves by 2 weeks. - **Pathologic Jaundice**: - Appears within the first 24 hours, may indicate early hemolysis. - Duration: 1 week (full term), 2 weeks (preterm). 4. **Management of Jaundice** - Monitor serum bilirubin levels: - Physiologic: Not more than 5 mg/dl per day. - Pathologic: More than 15-20 mg/dl (critical). - Maintain hydration and use bilirubin lights as needed. 5. **Meconium Staining** - Presence of meconium on skin, nails, or umbilical cord due to fetal hypoxia. **SKIN FEATURES** - **Lanugo**: Fine downy hair, disappears within 2 weeks. - **Vernix Caseosa**: Protective substance found in skin folds, use baby oil for removal. - **Desquamation**: Dryness/peeling of skin, occurs after 24-36 hours. **COMMON SKIN MARKS** 1. **Milia**: Small, white or yellow papules due to clogged sebaceous glands. 2. **Birthmarks**: - **Mongolian Spots**: Blue-green pigmentation, disappears by age 4. - **Stork Bites**: Flat red lesions, disappears after 2 years. - **Strawberry Marks**: Dark red, raised tumors, disappears by age 7-9. - **Port-Wine Stain**: Flat red to purple areas, does not fade. 3. **Other Skin Marks**: - **Mottling**: Bluish marbling due to chilling or stress. - **Erythema Toxicum**: Rash appears within 48 hours. - **Petechiae**: Pinpoint hemorrhages, may indicate infection. - **Ecchymosis**: Bruises from delivery trauma. **HEAD ASSESSMENT** 1. **Symmetry and Shape**: Check for swelling and movement. 2. **Head Circumference (HC)**: Should be equal to or greater than chest circumference (CC). 3. **Fontanelles**: - Anterior: 12-18 months. - Posterior: 2-3 months. 4. **Sutures**: Check for overriding or separation. **COMMON HEAD CONDITIONS** 1. **Caput Succedaneum**: Swelling of scalp, resolves in 3 days. 2. **Cephalhematoma**: Blood collection due to trauma, does not cross suture lines. 3. **Molding**: Overlapping skull bones, resolves in a few days. 4. **Craniotabes**: Softening of cranial bones, common in first-borns. 5. **Craniosynostosis**: Premature closure of sutures, may increase intracranial pressure. **FACE, EYES, AND EARS ASSESSMENT** 1. **Facial Symmetry**: Check for movement and symmetry. 2. **Eyes**: - Color: White sclera, final color develops by 6-12 months. - Reflexes: Red reflex should be present. - Transient strabismus is common. 3. **Nose**: Small, narrow, and midline; nasal breathers. **NURSING CONSIDERATIONS** - Administer eye medication (***Erythromycin 0.5%***) within 1 hour after birth to prevent infections.