The Normal Newborn:

Assessment, Care, Feeding

Presented by,

Joy Haskin, RN, MS
Joke for the day.
Should children witness
childbirth?
TERMS:
Neonatal Period:
Birth --> 28 days of life

Term Infant:
38 - 42 weeks of gestation

Transition Period: Phases of instability
during the first 6-8 hours after birth
Viability
Capacity to live outside of the uterus -
about 22 to 24 weeks since the last
menstrual period, or fetal weight greater
than 500 g.

In the past was 28 weeks - with
technology and advancements this is
becoming shorter and shorter...
Physiologic Changes of the NB to
adjust to extrauterine life:

What happens during birth to the neonate?


Circulatory:
Transitional Circulation = acrocyanosis
Peripheral circulation = sluggish
High: RBC 4.8-7.1; Hgb 14-24; Hct 44-64
WBC 18,000 @ birth; 23-24,000 @ 1 day
Coagulation: Vit K dependent clotting
factors are decreased.
Platelet counts ok (150,000-350,000)
Respiratory
Before birth O2 needs met by placenta
L/S ratio should be > 2:1
After delivery need mature lungs that are
vascularized, have surfactant and sacules
- usually adequate by 32-35 weeks-
at term the lungs hold approx. 20 ml of fluid/kg
What initiates respiration?

Periodic Breathing -vs-
Apnea
Apnea: no breathing for periods of
greater than 15 seconds should be
evaluated.
Periodic Breathing:


Notify MD if resp < 30 or > 60
Gastrointestinal System
Immature at birth, reaches maturity at 2-
3 years of age
place food at back of tongue
sucking becomes coordinated @32 wks
little saliva until 3 months of age
bowel sounds after 1 hour of birth

Gastrointestinal
(continued)
NB have difficulty digesting complex
starches and fat
Abdomen becomes easily distended after
eating
Initial fecal material = meconium
No normal flora at birth in GI system to
synthesize Vit. K


Immune System
Limited specific and Non-specific
immunity at birth
passive immunity(from mom- IgG) for the
first 3 months of life ~ this will be
reduced if baby is born premature
breastfeeding = ^ passive immunity (IgA)
Temperature Regulation
Non-Shivering thermogenesis:
brown fat is the primary source of heat
production. Brown fat is broken down into
glycerol & fatty acids producing heat.
Brown fat is found @ the nape of the
neck, axillae, around the kidneys and in
the mediastinum.
Slightly warmer to touch than nml skin.
Cold Stress
An increase in the metabolic rate
associated with non-shivering
thermogenesis --> increased O2 demands
and caloric consumption
Its important to provide a neutral
thermal environment to prevent
metabolic acidosis and prevent depleted
brown fat.
Kidneys and Urination
92% of all healthy infants void in the first
24 hrs of birth
initial urine:cloudy, scant amounts, uric
acid crystals-> reddish stain on diaper
Kidneys not fully functional until child is 2
years of age.

Hepatic Function
Liver produces substances essential for
clotting of blood.
Stores needed iron for the first few
months. Preterm & small infants have lower iron stores than
full term and heavier infants. (full term infants stores last 4-6 mo)
NB at risk for Physiologic Jaundice
after 24 hours of age, d/t increased
breakdown of RBCs and immature liver
functioning.


Increased Bilirubin Levels
Jaundice in the 1st day is NOT normal
Bilirubin level greater than 12 at any
time needs further attention
Maternal causes of increased bilirubin
levels in the NB: epidural use, oxytocin
induced labor, infection, hepatitis
Ethnic Influences: Asian infants levels
may be double other ethnic groups.
Kernicterus
Complication of neonatal
hyperbilirubinemia --> encephalopathy
basal ganglia and other areas of the brain
and spinal card are infiltrated w/ bilirubin
(produced by the breakdown of
hemoglobin -> levels of 20 - 25 or more).
Poor prognosis if untreated.
Neurologic
All neurons are present, but many are
immature:
uncoordinated movements
poor muscle control
startle easily
tremors in extremities
Weight Loss
It is normal for the newborn infant to
loose 5-10% of weight in the first 4 to 5
days of life.

Infants at Risk
RED FLAGS after birth include:
gagging --> turning blue (esp. after fdg)
generalized cyanosis
weak cry
grunting or respiratory distress
decreased or absent movements
excessive twitching or trembling
OTHERS>>>>>
Nursing Diagnosis:
Ineffective Airway Clearance R/T
excessive oropharyngeal mucus
Ineffective Thermoregulation R/T
newborn transition to extrauterine life
High Risk for infection R/T maturational
factors, immature immune system
PC: Hypoxemia PC: Hyperbilirubinemia
(W) Beginning Integration of NB into
Family Unit
Nursing Care to Meet NB
Needs
Prevent infection:
handwashing, stay away from large
groups or ill individuals, prophlactic
agents (EES, cord care, bathing)
Vernix
Breastfeeding
Warmth
Bath after temperature is stable
warmer/isolette/bundle
hat
keep out of drafts
skin to skin
Position of sleep/prevent
SIDS
Back to sleep
feet to foot of bed
no stuffed animals or excessive blankets
in bed
dont cover head in stroller
dont keep house too warm
No smoking around infant

Cleanliness
No tub baths until cord off and healed
clean around organs of elimination and
mouth after soiling to prevent skin break
down
daily head to toe bath not necessary
OK to clean and touch the soft spot
fold diapers away from umbilicus
NEVER leave child alone in tub!!

Research and Cord Care
1,811 NBs- 2 groups - one receiving cord
care with alcohol and one group not:
* equal # infections in infants who
received and did not receive cord care
*cord separation ~ alcohol use: 9.8 days
no alcohol used: 8.16 days
Carseats
AS a condition for licensure, public and
private hospitals, birth centers, and clinics
must have a written policy on the
dissemination of child passenger restraint
system information to parents or the
person to whom the child is released
(SB503 REQ)
Genital Care
Male Infant: if penis is uncircumcised
DO NOT RETRACT THE FORESKIN---
leave it alone
Female Infant: wipe front to back. If
smegma has accumulated in the labial
folds it can be carefully removed
Infant Feeding
Why may a mother decide to Breast
Feed?


Discussion
Formula feeding
Why may a mother decide to formula feed
her infant?

Discussion
Frequency of Feedings
Breastfeeding: successful latch-on and
feeding should occur every 1.5 to 3 hours
daily.
Formula Feeding: 3-4 oz every 3-4
hours for full-term babies.
Baby should have 6-10 wet diapers/day
calculate amnt of formula mult. babys
wt in lbs by 2 then 3, this is oz per day.
(EX: 8lb. Baby~ 8 X2 = 16; 8 x3 = 24 therefore 16-24oz of
formula per day is needed for adequate nutrition)
Nursing Diagnosis
Effective Breastfeeding
Risk for Altered Nutrition (more or less
than body requirements) R/T (insufficient
caloric intake or excessive caloric
intake)
Circumcision
Elective Procedure
Not pd for by medi-cal
Decision made based on tradition,
religion, culture, or personal factors
VALUE
OPPOSITION

Procedure
Usually delayed 12 to 24 hours until NB is
stabilized
Do not feed 1 hr prior to procedure
Consent required from one parent
Methods: Gomco or Plastibell
Restraint required
Anesthetic is physician dependent
After Care
Comfort measures
keep wound clean and dry (warm water)
ck urination w/in 12 hrs after procedure
monitor for bleeding
s/s of infection will not occur immediately
after procedure
Periods of Reactivity
REVIEW
1st period of reactivity:after birth of baby,
bursts of rapid movements. Quiet times during
this period are ideal for breastfdg & interacting
Deep Sleep - lasts 60-100 minutes
2nd period of reactivity: occurs 4-8 hrs after
birth lasts 10 min to several hours. Periods of
tachycardia & tachypnea. Increased muscle
tone, skin color, mucus production, pass
meconium

The end.