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Care Of The Newborn
 

Care Of The Newborn

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    Care Of The Newborn Care Of The Newborn Presentation Transcript

    •  
    • The 1 st 24 hours of Life The first 24 hours of life is a very significant and a highly vulnerable time due to critical transition from intrauterine to extrauterine life
    • Immediate Care of the Newborn
      • A irway
      • B reathing
      • T emperature
    • Airway & Breathing
      • Suction gently & quickly using bulb syringe or suction catheter
      • Starts in the mouth then, the nose to prevent aspiration
      051104 Neonatal Care
    • 051104 Neonatal Care
    • Airway & Breathing
      • Stimulate crying by rubbing
      • Position properly- side lying / modified t-berg
      • Provide oxygen when necessary
      051104 Neonatal Care
    • Temperature
      • Dry immediately
      • Place in infant warmer or use droplight
      • Wrap warmly
      051104 Neonatal Care
    • APGAR Scoring
      • Standardized evaluation of the newborn
      • Perform 1 minute and 5 minutes after birth
      • Involves (5) indicators:
        • Activity
        • Pulse
        • Grimace
        • Appearance
        • Respirations
      051104 Neonatal Care
    • Care of the Newborn in the Nursery
    • Components
      • A nthropometric Measurements
      • B athing – Oil bath/ warm water bath
      • C ord Care
      • D ressing/ Wrapping - mummified
      • E ye prophylaxis – Crede’s
      • F oot printing / Identification
      • G et APGAR score – 1 & 5 mins
      • H R, RR, Temp, BP
      • I njection of Vitamin K
      051104 Neonatal Care
    • Components
      • Proper identification –tag/bracelet
      • Oil bath/ Warm water bath
      • Cord Care/ Dressing
      • Measurements
        • Weight
        • Anthropometric measurements
      051104 Neonatal Care
      • Crede’s Prophylaxis
      • Vitamin K Administration
      • Foot printing/ marking
      • Vital signs
      • Dressing/ wrapping
      051104 Neonatal Care
    • Proper Identification
      • After delivery, gender should be determined
      • Pertinent records should be completed including the ID bracelet
      • Before transferring to nursery, ID tag should be applied.
      051104 Neonatal Care
    • Bathing
      • Oil bath or complete warm water bath
      • From cleanest to dirties part
      • DO NOT remove vernix caseosa vigorously
      051104 Neonatal Care
    • Cord Care 051104 Neonatal Care
    • Weight/ Anthropometric Measurements 051104 Neonatal Care
    • 051104 Neonatal Care
    • Crede’s Prophylaxis 051104 Neonatal Care
    • Vitamin K Administration 051104 Neonatal Care
    • Foot Printing 051104 Neonatal Care
    • Vital Signs 051104 Neonatal Care
    • Dressing/ Wrapping
      • “ Mummy”
      • Wrap in warm blanket
      • Cover head with stockinette cap
      051104 Neonatal Care
    • Daily Care
      • Nutrition/ Feeding
      • Elimination
      • Weight
      • Bathing & Hygiene/ Grooming
      • Obtain vital signs
      • Rooming-in
      • Note for any abnormalities
      051104 Neonatal Care
    • NEWBORN ASSESSMENT Assessment of the newborn is essential to ensure a successful transition
    • Major Time Frames
      • Immediately after birth
      • Within the 1 st 4 hours after birth
      • Prior to discharge
      051104 Neonatal Care
    • APGAR Scoring System
      • A ctivity/ Muscle Tone
      • P ulse/ Heart Rate
      • G rimace/ Reflex Irritability/ Responsiveness
      • A ppearance/ Skin Color
      • R espiration/ Breathing
      051104 Neonatal Care 1 2 3 4 5
    • 051104 Neonatal Care APGAR Scoring System INDICATORS 2 1 0 Activity Active, spontaneous Some flexion of extremities No movement (flaccid, limp) Pulse >100 bpm < 100 bpm Absent Grimace Pulls away, sneezes, coughs Facial grimace only No response with stimulation Appearance Completely pink Acrocyanosis Bluish-gray or pale all over Respiration Good vigorous cry Slow, irregular Weak cry Absent
    • 051104 Neonatal Care Score Interpretation Score Interpretation Nursing Interventions 7 to 10 Well baby Rarely needs resuscitation 4 to 6 At risk INFANT NEEDS INTENSIVE CARE Requires resuscitation Suction Dry immediately Ventilate until stable Careful observation 0 to 3 Sick baby PROGNOSIS FOR NB IS GRAVE Intensive resuscitation ET/ Ambu bag Ventilate with 100% O 2 CPR Maintain body temperature Parental support
    • General Guidelines
      • Keep warm during examination
      • From general to specific
      • Least disturbing first
      • Document ALL abnormal findings & provide nursing care
      051104 Neonatal Care
    • GENERAL APPEARANCE
    • Posture
      • Full term:
        • Symmetric
        • Face turned to side
        • Flexed extremities
        • Hands tightly fisted with thumb covered by the fingers
      051104 Neonatal Care
    • Special Concerns
      • Asymmetric
        • Fractured clavicle or humerus
        • Nerve injuries (Erb-Duchenne’s Paralysis)
      • Breech Presentation
        • Knees and legs straightened or in FROG position
      051104 Neonatal Care
    • VITAL SIGNS
    • TEMPERATURE
      • Site: Axillary NOT Rectal
      • Duration: 3 mins
      • Normal Range: 36.5 – 37.6 C
      • Stabilizes within 8-12 hrs
      • Monitor q 30 mins until stable for 2 hrs then q 8 hrs
      051104 Neonatal Care
    • Heat Loss Mechanisms
      • Convection – the flow of heat from the body surface to cooler surrounding air
        • Eliminating drafts such as windows or air con, reduces convection
      • Conduction – the transfer of body heat to a cooler solid object in contact with the baby
        • Covering surfaces with a warmed blanket or towel helps minimize conduction heat loss
      051104 Neonatal Care
      • Radiation – the transfer of heat to a cooler object not in contact with the baby
        • Cold window surface or air con; moving as far from the cold surface, reduces heat loss
      • Evaporation – loss of heat through conversion of a liquid to a vapor
        • From amniotic fluid; NB should be dried immediately
      051104 Neonatal Care
    • Nursing Considerations
      • Keep dry and well-wrapped
      • Keep away from cold objects or outside walls
      • Perform procedures in warm, padded surface
      • Keep room temperature warm
      051104 Neonatal Care
    • Pulse
      • Awake: 120 – 160 bpm—120 – 140 bpm
      • Asleep: 90-110 bpm
      • Crying: 180 bpm
      • Rhythm: irregular, immaturity of cardiac regulatory center in the medulla
      • Duration: 1 full minute, not crying
      • Site: Apical
      051104 Neonatal Care
    • Nursing Considerations
      • Keep warm
      • Take HR for 1 full minute
      • Listen for murmurs
      • Palpate peripheral pulses
      • Assess for cyanosis
      • Observe for CP distress
      051104 Neonatal Care
    • Special Concerns
      • (+) Prominent radial pulse = CHD
      • (-) Femoral pulse = Coarctation of aorta
      051104 Neonatal Care
    • Respiration
      • Characteristics:
      • Nasal breathers, gentle, quiet, rapid BUT shallow; may have short periods of apnea (<15 secs) and irregular without cyanosis—periodic respirations
      • Rate: 30-60 cpm
      • Duration: 1 full minute
      051104 Neonatal Care
    • Nursing Considerations
      • Position on side
      • Suction PRN
      • Observe for respiratory distress
      • Administer oxygen via hood PRN and as prescribed
      051104 Neonatal Care
    • Silverman-Anderson Index
      • Perform to observe for signs of respiratory distress
        • Chest lag
        • Retractions
        • Nasal flaring
        • Expiratory grunting
      051104 Neonatal Care
    • Silverman Scoring System 051104 Neonatal Care 0 1 2
    • Example 051104 Neonatal Care 0 1 2 Score: 5
    • Score Interpretation 051104 Neonatal Care Score Interpretation 0-3 No RDS 4-6 Moderate RDS 7-10 Severe RDS
    • Blood Pressure
      • NOT routinely measured UNLESS
      • in distress or CHD is suspected
      • At birth: 80/46 mmHg*
      • After birth: 65/41 mmHg*
      • Using Doppler UTZ
      051104 Neonatal Care
    • ANTHROPOMETRIC MESUREMENTS
    • Body Measurements
      • Weight :
        • 5.5 to 9.5 lbs (2500-4300 gms)
          • Caucasian: 7 lbs
          • Filipinos: 6.5 lbs
        • 70-75% TBW is water
        • LBW = below 2500 gms; regardless of AOG
      051104 Neonatal Care
      • Length :
        • 45 to 55 cm (18-22 inches)
        • Average: 50 cm
        • Techniques: using tape measure
          • Supine with legs extended
            • Crown to rump
            • Head to heel
      051104 Neonatal Care
      • Head Circumference (HC) :
        • 33 to 35.5 cm (13-14 inches)
        • Technique: using tape measure
          • From the most prominent part of the OCCIPUT to just above the EYEBROWS
      051104 Neonatal Care
        • 1/3 the size of an adult’s head
        • Disproportionately LARGE for its body
        • HC should be = or 2cm > CC
      051104 Neonatal Care
      • Chest Circumference (CC) :
        • 30 to 33 cm (12-13 inches)
        • Technique: using tape measure
          • From the lower edge of the SCAPULAS to directly over the NIPPLE LINE anteriorly
        • CC should be = or < 2 cm than HC
      051104 Neonatal Care
    • SKIN
    • Nursing Considerations
      • Under natural light
      • Assess for:
        • Color
        • Hair distribution
        • Turgor/ Texture
        • Pigmentation/ Birthmarks
        • Other skin marks
      051104 Neonatal Care
    • Skin Color
      • Velvety smooth and puffy esp. at the legs, dorsal aspects of hands & feet and in the scrotum or labia
      • Pinkish red (light skinned) to pinkish brown to yellow (dark skinned)
      • “ Ruddy” or reddish due to increased RBC concentration and decreased subQ tissues
      051104 Neonatal Care
    • 051104 Neonatal Care
    • Skin Color
      • Cyanosis/ Acro cyanosis
      • Pallor
      • Jaundice
      • Meconium Staining
      051104 Neonatal Care
    • Acro cyanosis
      • Bluish discoloration of palms of hands & soles of feet
      • Due to immature peripheral circulation
      • Exacerbated by cold temperatures
      • Normal within 1 st 24 hrs
      051104 Neonatal Care
    • Pallor/ Cyanosis
      • May indicate hypothermia, infection, anemia, hypoglycemia, cardiac, respiratory or neurological problems
      051104 Neonatal Care
    • Jaundice
      • Under natural light
      • Blanch skin over the chest or tip of the nose
      051104 Neonatal Care
      • Physiologic
        • FT: after the 1 st 24 hrs (2-7 days)
        • PT:after the 1 st 48 hrs
        • Peaks at 5-7 days & disappears by the 2 nd week
        • Due to immaturity of liver
        • Usually found over the face, upper body and conjunctiva of eyes
      051104 Neonatal Care
      • Pathologic
        • Within 1 st 24 hrs
        • May indicate early hemolysis of RBC or underlying disease process
        • Duration:
          • FT: 1 wk
          • PT: 2 wks
      051104 Neonatal Care
    • Management of Jaundice
      • Monitoring serum bilirubin levels
        • Physiologic: not more than 5 mg/dl per day
        • Pathologic: more than 15-20 mg/dl (critical levels)
      • Maintain hydration
      • Place in bilirubin lights as needed
      • Provide emotional support to parents
      051104 Neonatal Care
    • Phototherapy units 051104 Neonatal Care
    • 051104 Neonatal Care Nursing Responsibilities: -cover eyes and sex organ
    • Meconium Staining
      • Over the skin, fingernails & umbilical cord
      • Due to passage of meconium in utero r/t fetal hypoxia
      051104 Neonatal Care
    • Lanugo
      • Found after 20 weeks of gestation on the entire body except the palms & soles
      • Fine downy hair that covers the shoulders, back & upper arms
      051104 Neonatal Care
    • Nursing Considerations:
      • More mature, less lanugo
      • May disappear within 2 weeks
      • Preterm: woolly patches of lanugo on skin and head
      • Post term: parchment-like skin w/o lanugo
      051104 Neonatal Care
    • Vernix Caseosa
      • Protective cheesy-like, gray-white fatty substance
      • FT: skin folds under the arms and in the groin under the scrotum or in the labia
      • Nursing Considerations:
        • Use baby oil
        • DO NOT attempt to remove vigorously
      051104 Neonatal Care Vernix Caseosa
    • Desquamation
      • Dryness/ peeling of the skin
      • Usually occurs after 24-36 hours
      • Marked scaliness & desquamation = signs of postmaturity
      051104 Neonatal Care
    • Milia
      • Multiple, yellow or pearly white papules approx. 1 mm wide
      • Due to enlarged or clogged sebaceous gland
      • Usually found on the nose, chin, cheeks, eyebrows and forehead
      051104 Neonatal Care
    • 051104 Neonatal Care
        •                                                               
    • Birthmarks
    • Mongolian Spots
      • Blue - green or gray pigmentation
      • Lower back, sacrum & buttocks
      • Disappears by 4 years of age
      051104 Neonatal Care
    • 051104 Neonatal Care
    • Salmon Patches
      • Seen commonly in NB
      • More on Caucasian
      • AKA: Naevus simplex, &quot;angel kisses&quot; (when on the forehead or eyelids), and &quot;stork bites&quot; (over the nape of the neck)
      • midline malformations consisting of ectatic capillaries in the upper dermis with normal overlying skin.
      051104 Neonatal Care
    • Stork bites
      • Telangiectatic Nevi
      • Flat red or purple lesions
      • Back of neck, lower occiput, upper eyelid and bridge of the nose
      • After 2 years of age
      051104 Neonatal Care
    • Strawberry marks
      • Nevus Vasculosus or Capillary Hemangioma
      • Dark red , raised lobulated tumor
      • Head, neck trunk & extremities
      • After 7 to 9 years of age
      051104 Neonatal Care                                          
    • 051104 Neonatal Care
    • 051104 Neonatal Care Large capillary hemangioma
    • 051104 Neonatal Care Cavernous Hemangioma
    • Port-wine stain
      • Nevus Flammeus or Capillary Angioma
      • capillary malformation
      • Flat Red to purple , sharply demarcated dense areas beneath the capillaries
      • Face
      • Does not fade with time
      • Associated with Sturge-Weber syndrome
      051104 Neonatal Care                                        
    • Sturge-Weber syndrome
      • PWS involving the forehead (V1 area of the trigeminal nerve), eye abnormalities (choroidal vascular abnormalities, glaucoma), and leptomeningeal and brain abnormalities (vascular malformations, calcification, or cerebral atrophy)
      051104 Neonatal Care
    • Other Skin Marks
    • Mottling
      • Cutis marmorata
      • reticulated pattern of constricted capillaries and venules due to vasomotor instability in immature infants
      • Bluish mottling or marbling of skin in response to chilling, stress or overstimulation
      051104 Neonatal Care
    • 051104 Neonatal Care
    • Erythema toxicum
      • Newborn rash
      • Small, white, yellow, or pink to red papular rash
      • Trunk, face & extremities
      • Within 48 hrs
      051104 Neonatal Care
    • 051104 Neonatal Care                                                             
    • Petechiae
      • Pinpoint hemorrhages on skin
      • Due to increased vascular pressure, infection or thrombocytopenia
      • Within 48 hrs
      051104 Neonatal Care
    • Ecchymosis
      • Bruises
      • As a result of rupture of blood vessels
      • May appear over the presenting part as a result of trauma during delivery
      • May also indicate infection or bleeding problems
      051104 Neonatal Care                                        
    • Harlequin Sign
      • When on side, dependent side turns red and upper side/ half turns pale
      • Due to gravity and vasomotor instability or immature circulation
      • Skin resembles a CLOWN’S SUIT
      051104 Neonatal Care CLOWN’S SUIT
    • Café-au-lait spots
      • Tan or light brown macules or patches
      • NO pathologic significance, if <3cm in length and <6 in number
      • If > 3 or 6 = Cutaneous neurofibromatosis
      051104 Neonatal Care
    • Neurofibromatosis 051104 Neonatal Care
    • HEAD
    • What to assess
      • For symmetry, shape, swelling, movement
        • Soft, pliable, moves easily
        • With some molding (if VSD); round & well-shaped (if CS)
      • Measure HC; HC = or > CC
      051104 Neonatal Care
      • Fontanelles “soft spot”
        • BAD (12-18 mos)
        • LPT (2-3 mos or 8-12 wks)
        • Bulging or sunken
      • Sutures
        • Overriding or separated
      051104 Neonatal Care
      • Head lag
        • Common when pulling newborn to a sitting position
        • When prone, NB should be able to lift the head slightly and turn head from side to side
      051104 Neonatal Care
    • Caput Succeedaneum
      • Swelling of soft tissues of the scalp
      • Due to pressure
      • Crosses the suture lines
      • Presenting part
      • 3 days after birth
      051104 Neonatal Care
    • Cephalhematoma
      • Subperiosteal hemorrhage with collection blood
      • Due to rupture of capillaries as a result of trauma
      • Does not crossed suture lines
      • Several weeks
      051104 Neonatal Care
    • Molding
      • Overlapping of skull bones
      • Due to compression during labor and delivery
      • Disappears in few days
      051104 Neonatal Care
    • 051104 Neonatal Care
    • Forcep Marks
      • U –shaped bruising usually on the cheeks after forcep delivery
      051104 Neonatal Care
    • Craniotabes
      • Localized softening of the cranial bones
      • Can be indented by pressure of fingers
      • MOST common among 1 st born babies, pathological in older child—metabolic disorder
      • Caused by pressure of the fetal skull against the mother’s pelvic bone in utero
      051104 Neonatal Care
    • Craniosynostosis
      • Premature closure of the fontanelles
      051104 Neonatal Care
    • Face/Eyes/Ears/ Nose /Mouth
    • What to Assess
      • Facial movement & symmetry
      • Symmetry, size, shape and spacing of eyes, nose and ears
      051104 Neonatal Care                    
    • Eyes
      • Color:
        • white sclera
        • Slate gray, brown or dark blue
        • Final eye color: after 6-12 months
      • Symmetrical
      • Pupils equal, round, reactive to light
      • (+) Blink reflex
      051104 Neonatal Care
      • (+) transient strabismus due to weak EOM
      • Able to move and fixate momentarily
      • (+) Red reflex – if (-), cataract
      • (+) Edema on eyelids r/t pressure during delivery or effects of medication
      • (-) Tear formation (begins @ 2-3 mos)
      051104 Neonatal Care
    • 051104 Neonatal Care                                                                                                                            
    • Nursing Considerations
      • Administer eye medication within 1 hr after birth to prevent Ophthalmia neonatorum
      • DOC: Erythromycin 0.5%
          • Tetracycline 1%
          • Silver Nitrate 1%
      • From inner to outer canthus of the eye (conjunctival sac)
      051104 Neonatal Care
    • Nose
      • Small & narrow
      • Flattened, midline
      • Nasal breathers
      • (+) Periodic sneezing
      • Reactive to strong odors
      • (+) Flaring = respiratory distress
      • (+) Low nasal bridge = Down’s syndrome
      051104 Neonatal Care
    • Ears
      • Soft and pliable; with firm cartilage Pinna should be at the level of outer canthus of the eye
      • (+) Low set ears = renal or chromosomal abnormalities
      • May be congested and hear well after few days
      051104 Neonatal Care
    • 051104 Neonatal Care Low set ears
    • 051104 Neonatal Care Accessory tragus: remnant of 1 st branchial arch Congenital preauricular sinus: ends blindly risk for infection
            •                                                  
    • Mouth
      • Pink, moist gums
      • Intact soft & hard palates
        • (+) Epstein’s pearls
      • Uvula midline
      • Tongue moves freely, symmetrical with short frenulum
      • (+) Extrusion & Gag reflexes
      051104 Neonatal Care
      • Small mouth or large tongue = chromosomal problems
      • (+) white patches on tongue or side of the cheek = Oral thrush
      051104 Neonatal Care
    • Neck
      • Short, thick, in midline
      • Able to flex and extend but cannot support the full weight of head
      • Creased with skin folds
      • Trachea midline
      • Thyroid gland not palpable
      • Intact clavicle
      051104 Neonatal Care
    • Chest
      • CC = or < 2cm than HC
      • Cylindrical; equal AP:T diameters
      • Symmetrical
      • Abdominal breathers
      051104 Neonatal Care
      • (+) Bronchial sounds
      • (+) Breast engorgement ; subsides after 2 wks
      • (+)Prominent/ edematous nipple
      • (+) Accessory nipples
      • (+) “Witch Milk”
      051104 Neonatal Care
    • Abdomen
      • Umbilical Cord
        • 2 arteries; 1 vein
        • White & gelatinous immediately after birth
        • Begins to DRY between 1-2 hrs following birth
        • Blackened or shriveled between 2-3 days
        • Dried & gradually falls off by 7 days
      051104 Neonatal Care
    • Daily Cord Care
      • Keep cord dry and clean & clamp secured
      • Apply 70% isopropyl alcohol to the cord with each diaper change and at least 2-3x a day.
      • DO NOT cover with diaper
      • Note for any signs of bleeding or drainage from the cord and other abnormalities
      • Sponge bath until cord falls off.
      051104 Neonatal Care
      • GIT:
        • Capacity: 90 ml, with rapid intestinal peristalsis ( 2 ½ to 3 hrs)
        • Bowels sounds; (+) within 1-2 hrs after birth
        • Presence of mass, distention depression or protrusion
        • (+) Scaphoid = diaphragmatic hernia
        • (+) Distended = LGIT obstruction/ mass
      051104 Neonatal Care
      • Anus
        • Check patency
        • First stool (Meconium) – within 1 st 24 hrs
          • Sticky, tarlike, blackish-green, odorless material
      051104 Neonatal Care
    • 051104 Neonatal Care
    • Transitional Stool
      • Within 2- 10 days after birth
      • Breastfed:
        • golden yellow, mushy, more frequent 3-4x and sweet smelling
      • Bottlefed:
        • Pale yello, firm, less frequent 2-3x, with more noticeable odor
      051104 Neonatal Care
    • Nursing Considerations
      • Breastfeeding can usually begin immediately after birth
      • Bottlefeeding may be started with sterile water to 4 hrs after birth prior to formula feeding
      • Burp during and after feeding
      • Position properly during and after feeding
      051104 Neonatal Care
    • Genitals
      • Female:
        • Labia: edematous
        • Clitoris: enlarged
        • (+) Smegma
        • Pseudomenstruation possible
        • Visible “hymen tag”
        • First voiding within 24 hrs
      051104 Neonatal Care
      • Male:
        • Prepuce covers glans penis
          • (+) adherent foreskin = Phimosis
        • Scrotum: edematous
          • (+) enlarged = Hernia
        • Meatus: central
          • (+) ventral/ dorsal = Hypo/epispadias
        • Testes: descended
          • (+) undescended = Cryptorchidism
      051104 Neonatal Care
    • 051104 Neonatal Care
      •                                
    • Back
      • Spine
        • Straight, posture flexed
        • Supports head momentarily
        • Arms & legs flexed
        • Chin flexed on upper chest
        • Check for protrusion, excessive or poor muscle contractions = CNS damage
      051104 Neonatal Care
    • Extremities
      • Flexed, full ROM, symmetrical
      • Clenched fists; flat soles
      • With 10 fingers and toes in each hand
      • Legs bowed
      • Even gluteal folds
      051104 Neonatal Care
      • (+) Creases on soles of feet
        • (-) Creases = prematurity
      • Check for hip fractures or dysplasia
        • (+) Ortolani’s click & uneven gluteal folds = Hip dysplasia
      051104 Neonatal Care click !
    • 051104 Neonatal Care                                                                                                     
    • 051104 Neonatal Care                                                              
      • (+) inward turning of the foot = club foot or talipes equinovarus
      051104 Neonatal Care
      • (+) extra digits = Polydactyly
      • (+) web fingers = Syndactyly
      051104 Neonatal Care
        •                                               
    • Neurologic System
    • Reflexes
    • Sucking/ Rooting
      • Touch the lip, cheek or corner of the mouth
      • Turns head toward the nipple, opens mouth, takes hold of the nipple and sucks
      • Disappears after 3-4 mos up to 1 year
      051104 Neonatal Care
    • Extrusion
      • Anything place on the anterior portion of the tongue will be “spit out’
      • To prevent swallowing of inedible substances
      • Disappears after 4 months
      • Disappearance indicates readiness for semi-solid to solid foods
      051104 Neonatal Care
    • Swallowing
      • Occurs spontaneously after sucking and obtaining fluids
      • NEVER disappear
      • Newborn swallows in coordination with sucking without gagging, coughing or vomiting
      051104 Neonatal Care
    • Tonic Neck/ Fencing
      • While the baby is falling asleep or sleeping, gently and quickly turn the head to one side
      • As the baby faces the left side, the left arm and leg extend outward while the right arm or leg flex and vice-versa
      • Disappears within 3-4 mos
      051104 Neonatal Care
    • Palmar(Grasping)/ Plantar
      • Place a finger in the palm of the baby’s hand, then place a finger at the base of the toes
      • Fingers will curl or grasp the examiner’s finger and the toes will curl downward
      • Palmar: fades within 3-4 mos
      • Plantar: fades within 8 mos
      051104 Neonatal Care
    • Moro
      • Hold baby in a semi sitting position then allow the head and trunk to fall backward to at least a 30-degree angle
      • Symmetrically abducts and extends the arms; fans the fingers out and forms a C with the thumb and the forefinger; and adducts the arms to an embracing position & returns to a relaxed state
      051104 Neonatal Care
      • Present at birth; complete response at 8 weeks
      • MOST significant singular reflex indicative of CNS problem (>6 mos)
      • Disappears after 4-5 mos.
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    • Startle
      • Best elicited if baby is 24 hrs old
      • Make a loud noise or claps hands
      • Baby ‘s arms adduct while elbows flex with fists clenched
      • Disappears within 4 mos
      051104 Neonatal Care
    • Babinski
      • Gently stroke upward along the lateral aspect of the sole, starting at the heel of the foot to the ball of the foot
      • Dorsiflexion of big toe and fanning of little toes
      • Disappears starts a 3 mos to 1 year
      • Disappearance indicates maturity of CNS
      051104 Neonatal Care
    • Stepping/ Walking/ Dancing
      • Hold baby in a standing position allowing one foot to touch a surface
      • Simulates walking by alternately flexing and extending feet
      • Disappears after 3-4 mos
      051104 Neonatal Care
    • Assessment of Gestational Age
      • Dubowitz Maturity Scale
        • Gestational rating scale
        • NB are observed and tested according to the criteria
        • Help determine whether the NB needs immediate high-risk nursery intervention
      051104 Neonatal Care
    • Usher’s Criteria 051104 Neonatal Care FINDINGS 0-36 WKS 37-38 WKS 39 WKS AND OVER Sole creases Anterior transverse crease only Occl creases in ant 2/3 Sole covered with creases Breast nodule diameter (mm) 2 4 7 Scalp hair Fine and fuzzy Fine and fuzzy Coarse and silky Ear lobe Pliable; no cartilage Some cartilage Stiffened by thick cartilage Testes and scrotum Testes in lower canal; scrotum small; few rugae Intermediate Testes pendulous, scrotum full; extensive rugae
    • Ballard’s Scoring
      • Completed in 3-4 min
      • 2 portions: physical maturity and neuromuscular maturity
      051104 Neonatal Care
    • 051104 Neonatal Care Physical maturity
    • 051104 Neonatal Care Neuromuscular Maturity
    • 051104 Neonatal Care Scoring
    • 051104 Neonatal Care Physical maturity 19
    • 051104 Neonatal Care Neuromuscular Maturity 17
    • 051104 Neonatal Care Scoring 19+17=36 36 39
    • Other Nursing Responsibilities
      • Identification band
      • Birth Registration
      • Birth record and
      • documentation
      051104 Neonatal Care
    • Newborn Screening
      • The Newborn Screening Reference Center (NSRC) is an office under the National Institutes of Health (NIH), University of the Philippines Manila created under RA 9288– The Newborn Screening Act of 2004
      • Performed after 24 hours of life up to 3 days except for patient in intensive care, must be tested by 7 days
      051104 Neonatal Care
      • Congenital Hypothyroidism (CH)
      • Congenital Adrenal Hyperplasia (CAH)
      • Galactosemia (GAL)
      • Phenylketonuria (PKU)
      • Glucose-6-Phosphate-Dehydrogenase Deficiency (G6PD Def)
      051104 Neonatal Care
    • 051104 Neonatal Care Disorder Screened If not screened If screened Congenital Hypothyroidism Severe mental retardation Normal Congenital Adrenal Hyperplasia Death Alive and Normal Galactosemia Death or Cataracts Alive and normal PKU Severe mental retardation Normal G6PD Deficiency Severe Anemia, Kernicterus Normal
    • Infant Care Skills
      • Holding the baby
        • Football Hold
        • Cradle Hold
        • Shoulder Hold
      051104 Neonatal Care
    • Football Hold
      • Purpose: to carry on one hand free
      • A holding technique in bathing a baby
      • Use for small babies
      • Procedure:
      • 1. slide forearm under his back
      • 2. support neck and head with your hand
      • 3. press his arm firmly against your side
      • 4. his head faces you
      • 5. infant’s feet tucked under your elbow
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    • Cradle Hold
      • Purpose: use for feeding and cuddling a baby
      •  
      • Procedure:
      • support head in the crook of your arm
      • encircle the body with your arm
      • press baby firmly against your side
      • use other hand to support bottom and thigh
      051104 Neonatal Care
    • Shoulder Hold
      • Purpose: use for burping
      •  
      • Procedure:
      • draw baby towards your chest with one forearm
      • bracing his back and your hand cradling his head
      • support your baby’s bottom and thighs with your other arm
      • gently press his head against shoulder
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    • The end 081007 Neonatal Care