IMMEDIATE NEWBORN CARE

Goals: • To establish, maintain and support

respirations.

• To provide warmth and prevent hypothermia.

• To ensure safety, prevent injury and infection.

• To identify actual or potential problems that may require immediate attention.

• Establish respiration and maintain clear airway - The most important need for the newborn immediately after

birth is a clear airway to enable the newborn to breathe effectively

• To establish and maintain respirations

1. Wipe mouth and nose of secretions after delivery of the head2. Suction secretions from mouth and nose3. A crying infant is a breathing infant. Stimulate the baby to cry if

baby does not cry spontaneously, or if the cry is weak.

4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote drainage of secretions

5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction

Care of the Eyes

Neisseria gonorrhea- the causative agent for gonorrhea conjunctivitis or opthalmia neonatorum, may be passed on the fetus from the vaginal canal during delivery.

Drug of choice:

- Erythromycin or tetracycline Opthalmic Ointment

Care of the cord

•Report any unusual signs and symptoms which indicates infection.

- Foul odor in the cord- Presence of discharges- Redness around the cord- The cord remains wet and does not fall off within 7 to 10 days- Newborn fever

It may be treated with:1. Bactericidal substance

2. Antibiotic substance

3. Alcohol (70%)

4. Cleansed with mild soap solution

5. Air dry

ASSESS 0 1

2

HEART RATE Absent Below 100 Above 100

RESPIRATION Absent Slow Good crying

MUCLE TONE Flaccid Some flexion Active motion

REFLEX IRRITABILITY No response Grimace Vigorous cry

COLOR Blue all over Body pinkExtremities blue

Pink all over

ASSESSING THE AVERAGE NEWBORN

Head Circumference 34 – 35 cm

Temperature 97.6 – 98.6 F axillary

Chest Circumference 32 – 33 cm

Heart Rate 120 – 140 bpm

Respirations 30 – 60 bpm

Weight 2.5 to 3.4 kg

Length 46 to 54 cm

REMEMBER:

1. Crowning – ready for suction

2. Expulsion of head – wipe face and nose

3. Expulsion of newborn – provide warmth, take note of time and sex of baby

4 Mechanisms of Heat Lose

1. Convection

2. Conduction

3. Radiation

4. Evaporation

Other Means of Heat Loss:1. Insulation

2. Constriction of blood vessels and moving blood away from skin

3. Brown fat

4. Drying and wrapping newborns

WEIGHT

Varies depending on:

1.Race2.Nutritional status3.Intrauterine factor4.Genetic factor

REASONS for Wt.Loss1. 1st few days after birth

2. Diuresis

3. Voiding and passage of stool

4. Breastfed newborns

Bathing

- Remove blood, amniotic fluid, and excessive vernix caseosa as soon after birth as the temperature is stable

- It decreases exposure to maternal blood and possible bloodborne organism on th infants skin

e.g. Hep.B and HIV

Administer Vitamin KSite: Right Vastus LateralisClassification: - fat soluble vitamin - antihemorrhagic agentAction: -promotes the formation of factors II,VII,IX,X by the liver

for clottingfactor,thus prevent bleeding- Provides Vit.k which is not synthesized in the intestine

for the first 5 to 8 days after birth because the newborn lacks intestinal flora necessary for Vit.K production

DOCUMENT birth record1. Proper identification of the newborn and footprints must be

taken and kept in the chart.2. Attach ID bracelet with a number that corresponds to the

mother’s hospital number, mother’s full name, sex, date and time of birth.

3. Inspect for the presence of 2 arteries and 1 vein.

ASSESSMENT OF CARDIORESPIRATORY STATUS

AIRWAY

1.Respiratory rate – assess respirations at least once every 30 mins. until stable for 2 hours after birth.

Observe for:1.Periodic breathing2.Apnea

2. Breath sounds – auscultate anterior and posterior lung fields for equal sounds

- Sounds of moisture in the lungs during the 1st hour or two after birth is NOT UNUSUAL because fetal lung fluid has not been completely absorbed.

SIGNS OF RESPIRATORY DISTRESS1.Tachypnea – respiratory rate above 60

bpm2.Retractions – due to infant’s weak chest

wall muscles that are used to help draw air into the lungs

3. Flaring of Nares – a reflexive widening of nostrils

4.Central cyanosis – a purplish blue discoloration due to insufficient oxygen supply ( lips,tongue,mucous membrane and trunks )

• Peripheral cyanosis (acrocyanosis) – due to poor perfusion of blood to the periphery of the body

• Bruising of face – due to tight nuchal cord or pressure during birth and may look like central cyanosis

How to check for Cyanosis?

1. apply pressure to the area

2. use of pulse oximeter

3. Color of mucous membrane

5. Grunting – a noise made on expiration when air crosses partially closed vocal cords

6. Seesaw respirations – when the chest falls the abdomen rises and vice versa

7. Asymmetry – decreased on one side of the lung may indicate a collapse of the lung ( atelectasis )

Choanal atresia - Blockage of one or both nasal passages by

a narrowed bone or membrane that protrudes into the area

How to asses ?1.By closing the infant’s mouth and occluding

one nostrils at a time and observe for breathing while each nostril is occluded

2.Placing a cold metal object under the nostrils and observe for fogging

3.Passing a catheter (fr.5 or 8) thru each nostril tto check for patency

Color 1.Pallor – indicates slight hypoxia or

anemia2.Ruddy color ( plethora) – an excessive

number of RBC ( >65%)

Heart sounds- Auscultate for rate, rhythm and

presence of murmurs or abnormal sounds

Rhythm – should be regular , the 1st and 2nd sounds should be heard clearly, abnormalities should be noted.

Murmurs – abnormal sounds caused by abnormal blood flow through the heart and may indicate openings in the septum of the heart

- results from an incomplete transition from fetal to neonatal circulation

- is common until the ductus arteriosus functionally closed

Brachial and Femoral Pulses- Should be present equally and bilaterally

Blood pressure- Taken on all extremities if the infant has unequal

pulses or other signs of cardiac complications

Method:1.Doppler UTZ

Average BP:Systolic – 65 – 95 mmHgDiastolic – 30 – 60 mmHg

Capillary Refill

• Capillary Refill - assessed to help determine if

perfusion is adequate

B. Assessment of Thermoregulation

- Temperature should be assessed at least once every 30 minutes until the infant has been stable for 2 hours after birth

Method:1.Axillary 2.Rectal

Types of Thermometer

1.Mercurial 2.Digital 3.Disposable Plastic Strips4.Tympanic

C. PHYSICAL ASSESSMENT

A. HEAD & NECK

Head – makes up one fourth of the length of the body and is much larger in proportion to the rest of the body

- should be palpated to assess the shape and identify abnormalities

Note for:1.Molding – caused by overriding of the

cranial bones at the suture and is common especially a long second stage of labor

- parietal bones often override the occipital and frontal bones and a ridge can be felt at the areas

Craniosynostosis - a hard ridged area that is not a result

of molding due to premature closure of the cranial sutures before or shortly after birth which may impair brain growth and shape

Types:a. Single Suture Synostosis Sagittal (SAJ-

ut-ul)/ Scaphocephaly

- The sagittal suture is located on the midline, on top of the head and extends from the soft spot towards the back of the head. When the head is palpated, a ridge can be felt along the suture.

Preoperations at age 5 months

7 months Post operation

2. Coronal (co-RO-nul) Suture Synostosis / Plagiocephaly

- The coronal suture is located on the side of the head and extends from the soft spot to an area just in front of the ear. It allows the forehead and the frontal lobe to grow and expand forward.

3. Metopic (mih-TOP-ick) SutureSynostosis/ Trigonocephaly- This midline suture is located in the

middle of the forehead and extends from the soft spot to the root of the nose. It allows both frontal lobes to expand forward and sideways as well as the eye socket to move to either side.

4. Lambdoidal (lam-DOID-ul) Suture Synostosis

- Closure leads to posterior plagiocephalus (PLAY-gee-o-SEF-a-lee) with flattening of the back of the head on the affected side, protrusion of the mastoid bone and lowering of the affected ear. It may also cause the skull to tilt sideways.

2. Fontanels – are areas of the head where sutures between the bones meet

2.1 Anterior - is a diamond shape area where the frontal and parietal bones met - Measures 2 to 4 cm - Closes between 12 to 18 months of age

2.2 Posterior- Is a triangular area where the occipital

and parietal bones meet - Measures 0.5 to 1cm- Closes by the time the infant is 2 to 3

months

3. Caput succedaneum- Due to the pressure against the

mother’s cervix and it interferes the blood flow in the area causing localized edema which crosses suture lines

4. Cephalhematoma- Bleeding between the periosteum and

the skull

Face assessed for:-Symmetry -Positioning of facial features-Movement-Expression

• Mouth assessed for:

- cleft lip/palate- Precocious teeth- Epstein’s pearl

B. Neck and ClaviclesNeck – assess visually and note the ease with

which the head turns from side to sidee.g. Turner’s syndrome

Turner syndrome or Ullrich-Turner syndrome (also known as "Gonadal dysgenesis") encompasses several conditions, of which monosomy X (absence of an entire sex chromosome, the Barr body) is most common. It is a chromosomal abnormality in which all or part of one of the sex chromosomes is absent (unaffected humans have 46 chromosomes, of which two are sex chromosomes). Typical females have two X chromosomes, but in Turner syndrome, one of those sex chromosomes is missing or has other abnormalities. In some cases, the chromosome is missing in some cells but not others, a condition referred to as mosaicism[2] or 'Turner mosaicism'.

The syndrome manifests itself in a number of ways. Characteristic :1. physical abnormalities - short stature, swelling, - broad chest - low hairline - low set ears - webbed necks.[5] Girls with Turner syndrome typically

experience gonadal dysfunction (non-working ovaries), which results inamenorrhea (absence of menstrual cycle) and sterility.

2. Concurrent health concerns are also frequently present, - congenital heart - hypothyroidism (reduced hormone secretion by the thyroid) - diabetes - vision problems - hearing concerns

Turner's syndrome is named after Henry H. Turner.

Clavicle – fracture are more likely to occur in large infants

e.g. shoulder dystocia Shoulder dystocia is a specific case of dystocia

whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below the pubic symphysis, or requires significant manipulation to pass below the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. In shoulder dystocia, it is the chin that presses against the walls of the perineum. Shoulder dystocia is an obstetrical emergency, and fetal demise can occur if the infant is not delivered, due to compression of the umbilical cord within the birth canal.

Fracture – a lump or tenderness over the area

Method of Detecting:Moro Reflex – a difference in the movement of

the arm

Treatment :- Immobilization of the affected part for a short

time

C. Cord – should contain three (3) vessels arteries – (2) - are small and may stand up at the end cut vein - (1) - is larger than the arteries and resembles a slit

Thin cord – the infant may have been poorly nourished in uteroYellow Brown or Green tinge cord - indicates that meconium was released sometime before birthPatent urachus – abnormal connection between the umbilucus and bladderUmbilical cord hernia - "Paraumbilical Hernias" develop in and

around the area of the umbilicus (belly button or navel). - A congenital weakness (meaning present since birth)

exists in the naval area in the region where vessels of the fetal and infant umbilical cord exited through the muscle of the abdominal wall. After birth, although the umbilical cord disappears (leaving just the dimpled belly-button scar), the weakness or gap in the muscle may persist.

D. Extremities - normally a term infant should remain sharply

flexed & resist extension during examination

Poor muscle tone – results in a limp or “floppy” infant

Continued poor muscle tone – may result from prematurity or neurologic changes

All extremities are examines for signs of fracture:

1.Crepitus2.Redness3. Lumps or swelling4. Lack of use /immobility

Erb-Duchenne paralysis - paralysis of the arm resulting from injury to the brachial plexus (usually during childbirth)

- Instead of the usual flexed position, the affected arm is extended at the infant’s side with the forearm prone

Treatment: - exercise - splinting or both

A. Hands and Feet- Are examined for extra digits which are often

small and may not have bones

Nails : - in term infants it should extend to the end of

the fingers or slightly beyond

Creases :- normally, two long transverse creases extend

most of the way across the palm

Polydactyly - is a condition in which a person has more than five fingers per hand or five toes per foot.

Syndactyly - is a condition where two or more digits are fused together. It occurs normally in some mammals, such as the siamang and kangaroo, but is an unusual condition in humans.

Syndactyly can be complete or incomplete. In complete syndactyly, the skin is joined all the way

to the tip of the finger In incomplete syndactyly, the skin is only joined part

of the distance to the fingertip.Syndactyly can be simple or complex. In simple syndactyly, adjacent fingers or toes are

joined by soft tissue. In complex syndactyly, the bones of adjacent digits

are fused. The kangaroo exhibits complex syndactyly.

Feet – are assessed for club foot

Talipes equinovarus: The common ("classic") form of clubfoot. Talipes is made up of the Latin talus (ankle) + pes (foot). Equino- indicates the heel is elevated (like a horse's) and -varus indicates it is turned inward. With this type of clubfoot, the foot is turned in sharply and the person seems to be walking on their ankle.

A club foot, or congenital talipes equinovarus (CTEV) is a congenital deformity involving one foot or both.The affected foot appears rotated internally at the ankle.

TEV is classified into 2 groups: 1. Postural TEV 2. Structural TEV

2. Hips - Are examined for signs of developmental

dysplasia which occurs more often on breech presentation

- Normally both legs should abduct equally in normal infants with “click” sound while in dysplasia is a “ clunk” sound

Dysplasia – instability of the hip joint which occurs at the head of the femur which can be moved in and out of the acetabulum

Methods of Assessing:

1. The Barlow maneuver is a physical examination performed on infants to screen for developmental dysplasia of the hip.

- It is named for T.G. Barlow, 1962 at Hope Hospital Salford,

Manchester

- The maneuver is easily performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. If the hip is dislocatable - that is, if the hip can be popped out of socket with this maneuver - the test is considered positive. The Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated).

2. The Ortolani test or Ortolani maneuver is a physical examination for developmental dysplasia of the hip.

It is performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner's index fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting the infant's legs using the examiner's thumbs.

A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum:

This is part of the standard infant exam performed preferably in early infancy; it usually becomes negative after 2 months of age.

It is named for Marino Ortolani, who developed it in 1937.[3

3. Vertebral Column

- palpate the entire length of the newborn’s vertebral column to discover any defects in the vertebrae.

Check for:

Spina bifida - (Latin: "split spine") is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through the opening in the bones. There may or may not be a fluid-filled sac surrounding the spinal cord.

Other neural tube defects:

1. anencephaly, a condition in which the portion of the neural tube which will become the cerebrum does not close,

2. encephalocele, which results when other parts of the brain remain unfused.

Classification:

1. Spina bifida occulta

Occulta is Latin for "hidden". This is the mildest forms of spina bifida.

In occulta, the outer part of some of the vertebrae are not completely closed. The split in the vertebrae is so small that the spinal cord does not protrude. The skin at the site of the lesion may be normal, or it may have some hair growing from it; there may be a dimple in the skin, or a birthmark.

2. Spina bifida cystica In spina bifida cystica, a cyst protrudes through

the defect in the vertebral arch. These conditions can be diagnosed in utero on the basis of elevated levels of alpha-fetoprotein, after amniocentesis, and by ultrasound imaging. Spina bifida cystica may result in hydrocephalus and neurological deficits.

3. Meningocele- The least common form of spina bifida is a

posterior meningocele (or meningeal cyst).

- In a posterior meningocele, the vertebrae develop normally, however the meninges are forced into the gaps between the vertebrae. As the nervous system remains undamaged, individuals with meningocele are unlikely to suffer long-term health problems

- A meningocele may also form through dehiscences in the base of skull. These may be classified by their localisation to occipital, frontoethmoidal, or nasal. Endonasal meningoceles lie at the roof of the nasal cavity and may be mistaken for a nasal polyp. They are treated surgically.

- Encephalomeningoceles are classified in the same way and also contain brain tissue.

4. Myelomeningocele- In this, a serious and common form, the unfused

portion of the spinal column allows the spinal cord to protrude through an opening. The meningeal membranes that cover the spinal cord form a sac enclosing the spinal elements.

Nsg. Responsibility1.The protruding tissue should be covered with moist sterile saline

dressing immediately after birth

2. Intravenous antibiotics are started to prevent meningitis.

3. An adhesive plastic surgical field drape taped over the buttocks deflects feces away from the back--"mud flap.“

4. The most important words to say at the baby's birth are: "Congratulations on the birth of your child!" These words extend joy, optimism, reverence, respect, acceptance, and nonabandonment. This simple step facilitates parental interest, learning, and care provision.

D. Assessment of Body Systems

I. Neurologic system

a. Reflexes - assessment of the presence and strength of the

reflexes is important to determine the health of the newborns central nervous system

Moro reflex – is the most dramatic reflex - startle reflex or infantile reflex - It may be observed in incomplete form in premature birth after the 28th week of gestation, and is usually present in complete form by week 34 (3rd trimester) - It is normally present in all infants/newborns up to 4 or 5 months of age, and its absence indicates a profound disorder of the motor system

An absent or inadequate Moro response on one side is found in infants with :

- hemiplegia,- brachial plexus palsy- fractured clavicle.

Persistence of the Moro response beyond 4 or 5 months of age is noted only in infants with severe neurological defects.

* It was discovered and first described by Austrian pediatrician Ernst Moro (1874-1951).

• The primary significance of this reflex is evaluating integration of the central nervous system (CNS), and it involves 3 distinct components:

• spreading out the arms(abduction) - the reflex is initiated by pulling the infant up

from the floor and then releasing him; • unspreading the arms (adduction) - spreads arms and pulls arms in• crying (usually)

Palmar Grasp reflex - a flexion of the fingers caused by stimulation of the palm of the hand. The reflex is present at birth and usually disappears by 6 months of age.

Plantar Grasp reflex - a reflex characterized by the flexion of the toes when the sole of the foot is stroked gently. It is present in babies at birth but should disappear after 6 weeks.

Babinski reflex - is obtained by stimulating the external portion (the outside) of the sole. The examiner begins the stimulation back at the heel and goes forward to the base of the toes.

- Most newborn babies are not neurologically mature and therefore show a Babinski response - A Babinski response in an older child or adult is abnormal. It is a sign of a problem in the (CNS), most likely in a part called the pyramidal tract.

Rooting reflex - A reflex in infants in which rubbing or scratching about the mouth causes the infant to turn its head toward the stimulus.

Sucking reflex - sucking movements of the lips of an infant elicited by touching the lips or the skin near the mouth.

Stepping reflex - movements of progression elicited when the infant is held upright and inclined forward with the soles of the feet touching a

flat surface.

Tonic Neck reflex - extensions of the arm and sometimes of the leg on the side to which the head is forcibly turned, with flexion of the contralateral limbs;

seen normally in the newborn.

II. Sensory Assessment

A. Ears

assessed for :1. Placement 2. Appearance3. Maturity

Expected findings:* Loud noise elicits Startle Reflex

* Flexible pinna with cartilage present* Pinna top on horizontal line with outer

canthus of eye

Common variations:

* Skin tags on or around ears

Signs of potential distress or deviations from expected findings:

• Ear placement low• Clefts present• Malformations• Cartilage absent• Preauricular sinus

b. Eyes

Expected findings:• Slate gray or blue eye color• No tears• Fixation at times - with ability to follow objects to

midline• Red reflex• Blink reflex• Distinct eyebrows• Cornea bright and shiny• Pupils equal and reactive to light

Common variations:* Edematous Eyelids

* May focus for a few seconds* Uncoordinated movements

Signs of potential distress or deviations from expected findings:

• Discharges• Opaque lenses• Absence of Red Reflex• Epicanthal folds in newborns not of Oriental descent• Reflexes absent• "Doll's Eyes" Reflex (beyond 10 days of age):

When the head is moved slowly to the right or left, the eyes do not follow nor adjust immediately to the position of the head. This reflex should not be elicited once fixation is present. The persistence of the Doll's Eyes Reflex suggests neurologic damage.

Chemical conjunctivitis

* Subconjunctival hemorrhage

Causative Agent:

1.Staphylococcus2.Chlamydia gram (-) bacteria3.Neisseria gonorrhoea

Assessment on hepatic system

A.Newborns with hypoglycemia- a medical condition referred to as

neonatal hypoglycemia- have low levels of blood sugar in the

first days following birth. - Sugar levels in newborns may drop for a

number of reasons, including elevated insulin levels, decreased glycogen levels, low glucose production or overuse of glucose stores.

Signs:1. Irritability – high pitched cry2. Lethargy3. Seizure / jitteriness4. Sweating 5. Poor sucking6. Respiratory distress : - Tachypnea- Dyspnea- Apnea7. Discoloration / Cyanosis8. Poor appetite9. Excessive drowsiness

Causes of Hypoglycemia:1.Maternal diabetes2.Prematurity3.Infection / Illness4.Intrauterine growth retardation (IUGR)

Blood Sugar Level in Newborns- should remain above 40 milligrams per

deciliter, or mg/dL. • Levels below 35 mg/dL indicate severe

hypoglycemia• levels under 50 mg/dL warrant close

observation. • A level between 54 and 72 mg/dL indicates

a more normal newborn blood glucose• At-risk infants need blood glucose

monitoring within the first two hours after birth.

Treatment• If the baby can eat and the blood glucose

level is not too low, giving formula, sugar water or breast milk will raise blood glucose levels in most cases.

• Babies who can't eat or those with very low blood glucose levels need intravenous infusion of dextrose, a type of sugar, to raise their blood sugar.

• Infants receiving glucose infusions may develop temporary hyperglycemia, or blood glucose levels over 125 mg/dL, which usually requires no treatment,

Prevention

- At-risk infants require blood glucose screening via heel stick or from blood drawn from a central umbilical line.

- The baby may need frequent blood tests in the first 12 hours after birth to ensure that levels don't drop.

- Hypoglycemia most often develops within the first 24 hours after birth,

B. Newborn Jaundice• Jaundice is a yellow discoloration of the skin

and the white part (the sclera) of the eyes. It results from having too much of a substance called bilirubin in the blood.

• Bilirubin is formed when the body breaks down old red blood cells. The liver usually processes and removes the bilirubin from the blood.

• Jaundice in babies usually occurs because their immature livers are not efficient at removing bilirubin from the bloodstream.

Causes:

• Jaundice in newborns most commonly occurs because their livers are not mature enough to remove bilirubin from the blood. Jaundice may also be caused by a number of other medical conditions.

1. Physiologic jaundice is the most common form of newborn jaundice

2. Neonatal jaundice will be seen in cases of maternal-fetal blood type incompatibility

3. hemolysis

4. Polycythemia

5. Cephalohematoma

6. Sometimes a baby swallows blood during birth

7. A mother who has diabetes

8. Crigler-Najjar syndrome

9. Lucey-Driscoll syndrome

• Carotenemia - A condition that causes a yellowish discoloration of the skin and tends to be a darker orange than seen with jaundice.

• Eating a lot of yellow vegetables causes this condition.

• Children with carotenemia have normal bilirubin levels.

• Unlike jaundice, carotenemia does not cause a discoloration of the white part of the eyes.

• This condition causes no harm and requires no treatment.

Symptoms:• As a baby's bilirubin levels rise: jaundice moves from the head to include the arms, trunk,

and finally the legs. • bilirubin levels are very high : a baby will appear jaundiced below the knees and on the

palms of his or her hands.

How to Assess?- One easy way to check for jaundice is to press a finger

against your baby's skin, temporarily pushing the blood out of it. Normal skin will turn white when you do this, but jaundiced skin will stay yellow.

• Exams and Tests Before a baby can be treated, the exact

cause of an infant's jaundice must be determined. In some cases, a careful examination by a pediatrician is all that is needed. In other cases, blood tests may be required.

• Laboratory Tests:1. First, the total serum bilirubin level will be

checked. Based on this test, the doctor may request that more tests be done.

2. A Coombs test checks for antibodies that destroy an infant's red blood cells.

3. A complete blood count may be done. 4. A reticulocyte count checks to be sure your

baby is making enough new red blood cells.

5. Certain red blood cell diseases are found in people of Mediterranean descent. In such cases, it may be necessary to check blood samples for a condition known as G6PD deficiency.

Treatment• Self-Care at Home

* Sunlight helps to break down bilirubin so that a baby's liver can process it more easily.

– Placing a child in a well-lit window for 10 minutes twice a day is often all that is needed to help cure mild jaundice. Never place an infant in direct sunlight.

• If the bilirubin level is too high, the child may need to be placed under a special type of light.

This treatment is called phototherapy - These lights are able to penetrate a baby's skin

and affect the bilirubin within the child. The light changes bilirubin into lumirubin, which is easily handled by the baby's body.

• If an infant's bilirubin levels are very high or if the child appears ill, the baby will most likely be admitted to the hospital for treatment.

Assessment in gastrointestinal system

Assessment on endocrine system

• The endocrine glands are considered better organized than other systems. Disturbances are most often related to maternally provided hormones (estrogen, luteal, and prolactin) that may cause the following conditions:

a. Vaginal discharge and/or bleeding may occur in female infants.

b. Enlargement of the mammary glands may occur in both sexes

Physical Assessment—Genitourinary System

• Important to note that infant is voiding• Keep record of number of voiding

A. Male infants• Assess for descended testicles.• Care following circumcision• Care of the uncircumcised infant

B. Female infants• Labia may be swollen.• May have blood-tinged discharge.• Teach per-care.

Integumentary systemSKIN – is fragile and shows marked easily

especially for infants with fair color

Nsg. Responsibility:1.Must examine every inch of the skin

surface carefully during the initial assessment and at the beginning of the shift.

ASSESS for:1.Harlequin coloration- a clear color division over the body from the

head to the abdomen with one half deep pink or red and the other half pale or of normal color

- indicate shunting of blood with cardiac problems or sepsis. Redness may occur on the lower side when the infant lies on the side

2. Mottling (cutis marmorata)- Is a lacy pattern from dilated blood vessels

under the skin

May be a sign of:- Cold stress- Overstimulation- Sepsis

- - if persistent, may indicate chromosomal abnormality

3. Vernix caseosa- A thick ,white substance that resembles

cream cheese- Provides a protective covering for the fetal

skin in utero

4. Lanugo - Fine hair that covers the fetus during

intrauterine life

5. Milia- Are white cysts, 1-2 mm in size resulting

from distention of sebaceous glands that are not yet functioning properly

6. Erythema toxicum- A red, blotchy areas that may have white

or yellow papules or vesicles in the center- Commonly called as fleabite or newborn

rash

7. Birthmarks- Assess the size and location and should be

carefully documented

7.1 Mongolian spots – are bluish-black marks that resembles bruises

- Usually found in sacral area but may appear in arm andshoulder

7.2 Nevus simplex – also called salmon patch, stork bite or

telangiectatic nevus - a flat, pink or reddish discoloration from capillaries that

occur over the eyelids, just above the bridge of the nose or at the nape of the neck.

7.3 Nevus flammeus (port-wine stain) - is a permanent, flat dark, reddish-purple mark

and varies in size, location and blanches minimally or not at all with pressure.

- located over the forehead and eyelid and may be associated with Sturge-Weber syndrome

7.4 Nevus Vasculosus (strawberry hemangioma) - consists of enlarged capillaries in the outer layer

of the skin - is a dark red and raised with a rough surface

giving a strawberry like appearance

7.5 Café-au-lait spots - are permanent,light brown areas that may occur

anywhere on the body. Although harmless, the number and size are important.

8. Markings from Delivery

8.1 Petechiae – pinpoint bruises that resembles a rash, may appear over areas such as the back, face and groin

- due to increase intravascular pressure during the birth process such as in nuchal cord

8.2 Bruises – may occur on any part of the body where pressure occurred during delivery especially when second-stage labor was difficult

8.3 Small puncture mark – is present on the newborn’s head if a fetal monitor scalp electrode was attached

8.4 Forceps mark – occurs over the checks and ears where the instrument applied

- size and location are carefully documented, lack of movement or asymmetry of the face may indicate injury of the facial nerve

Breasts – note the placement of the nipple and look for extra nipples which may appear on the chest or axilla

Hair and Nails – hair should be silky and soft - nails come to the end of finger or beyond

ASSESSMENT OF GESTATIONAL AGE- Is an examination of the newborn’s physical and

neurological characteristics to determine the number of weeks from conception to birth

TOOLS:1.DUBOWITZ SCORING- is an in-depth, detailed

assessment tool that includes examination of physical, neurological and behavioral; characteristics

1.NEW BALLARD SCORE- focuses on physical and neuromuscular characteristics, eliminating the behavioral

I. Neuromuscular Characteristicsa. Posture – posture and degree of flexion of the

extremities are scoredb. Square Window- is elicited by bending the hand at the

wrist until the palm is as flat against the forearm as possible with gentle pressure

c. Arm recoil – nurse hold the neonates arms fully flexed at the elbows for 5 seconds, then extends the am by pulling the hands straight down to the sides and released quickly and the degree of flexion is measured

d. Popliteal Angle – newborns lower leg is folded against the thigh, with the thigh on the abdomen the lower leg is straightened just until resistance is met

e. Scarf Sign – the nurse grasps the infant’s head and brings the arm across the body to the opposite side, keeping the shoulder flat on the bed and the head in the middle of the body

f. Heel to Ear – the nurse gasps the infants foot and pulls it straight up alongside the body toward the ears while the hips remain flat on the bed surface

II. Physical Characteristicsa. SkinAssessed for:- Color- Visibility of veins- Peeling and cracking

b. Lanugo – appears at 20 wks of gestation and increases in amount until 28 wks and begins to disappear until little is left

c. Plantar Surface- begins to appear at 32 wks of gestation although the creases are only red lines near to toes at first, they gradually spread down toward the heal and become deeper

d. Breasts Assess:- Nipple- Areola- Size of breast bud

e. Eyes and EarsEyes- are fused until 26 to 28 weeks of gestationEars – the incurvation and thickness of pinna rated

f. GenitalsAssess:(Female)- Size of clitoris- -labia majora and minoraMale: location of testes and rugae of scrotum

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