Assessment of the

Newborn

Melanie Iskandar
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
RESPIRATORY CHANGES

Intrauterine Extrauterine
Lungs serve no Within a few
respiratory function minutes after birth
the vital capacity is
Oxygen supply established
secured through the
placenta Surfactant reduces
surface tension in
Lungs are filled alveoli and keeps
with lung fluid lungs from
which keeps them collapsing
partially expanded
CARDIOVASCULAR CHANGES
3. Ductus Arteriosus
begins to constrict
1. Blood flows
to the lungs

4. Pressure in the
2. Pressure LA increases
in RA decreases

5. Increase pressure
in the LA forces
the foramen ovale
to close
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.
IMMEDIATE CARE OF THE NEWBORN
Pink ~ ensure a patent airway and good
circulation
Warm ~ maintain body temperature
Sweet ~ give food as soon as possible
MAINTAIN BODY TEMPERATURE
Dry off
Place in warmer
Skin to skin contact
APGAR SCORE
Scoring system to appraise the newborn

Done at 1, 5, and 10 minutes after birth

 0 1 2
Heart rate Absent < 100 > 100
Respiratory Absent Slow, weak Good cry
effort irregular cry
Reflex No response Weak cry or Vigorous cry
irritability grimace
Muscle tone Flaccid Some flexion Active
of extremities motion, resist
effort to
extend
Color Blue/pale Body pink, Completely
extremities pink
blue

Interpretation:
Score of 7 - 10 = Good Condition
Score of 4 - 6 = Fair Condition
Score of 0 - 3 = Poor Condition
EYE CARE
Legal requirement that all newborns have
treatment to prevent Ophthalmia neonatorium
which can lead to newborn blindness.

Treated with antibiotic eye medication either

ointment or drops
(Tetracycline or Erythromycin )
HEMORRHAGE PROPHYLAXIS
Administration of Vitamin K (AquaMEPHYTON)
This promotes liver formation of clotting factors
The newborn does not have bacteria in the GI
tract to synthesize vit. K
By 5 - 8 days after birth, it is formed
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
NURSING CARE TO MEET NB NEEDS
Prevent infection:

Hand washing, stay away from large groups

or ill individuals, 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
FREQUENCY OF FEEDINGS
Breastfeeding: successful latch-on and feeding
should occur every 1.5 to 3 hours daily.

Formula Feeding: 110-120 kkal/kg/day, every 2-3

hours

Baby should have 6-10 wet diapers/day

SUMMARY
The essential components of normal newborn care include:

Need for warmth and dry

Need for protection from infection
Need for food
Need for attachment and loving
Need for bathing and cord care