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ESSENTIAL NEWBORN
        CARE

PRESENTED BY:
A.PRIYADHARSHINI, M.Sc (N),
LECTURER,
DEPT. OF PAEDIATRICS,
JAI INSTITUTE OF NURSING AND RESEARCH,
GWALIOR.
INTRODUCTION:
     Essential care of the normal healthy
  neonates can be best provided by the
  mothers under supervision of nursing
  personnel or basic/ primary health care
  providers. About 80% of the newborn
  babies should be kept with their mothers
  rather than in a separate nursery.
HEALTHY NEWBORN
   A healthy infant born at term b/w 38-42
wks should have average birth wt, cries
immediately following birth, establishes
independent rhythmic respiration & quickly
adapts to the changed environment.
IMMEDIATE BASIC CARE
 Maintenance of temperature
 Establishment of open airway & circulation
 Identification of newborn
 Vitamin K injection
 Initiation of breastfeeding.
Maintenance of temperature:
 Immediately dry the infant under a
 radiant warmer
   Skin to skin contact with the mother.
   Keep neonates head covered.
 Rooming in (The baby should not be
 separated from the mother)
Establishment of open airway:
 (Majority of babies cry at birth & take
 spontaneous Respiration)
 When the head is delivered birth
 attendant immediately suction the
 secretions, wipe mucus from face and
 mouth and nose.
Suction the mouth and nose by using bulb
 syringe
Keep head slightly lower than the body
Position the Baby on their backs or tilted to
 the side, but not on their stomachs.
Importance of suctioning:
 Several natural mechanisms help with this:
 As the fetal chest passes through the birth
 canal it is compressed, squeezing excess
 fluid out of the lungs prior to the baby taking
 its' first breath.
After several seconds in this "partly
 delivered" position, fluid can be seen
 streaming out of the baby's nose and mouth.
Contd…
After birth, babies will be cough and
 sneeze, mobilizing additional fluid that
 may be in their lungs.
APGAR SCORING
     CRITERIA               0             1                2
Respiration       Absent        Slow, irregular    Good, crying

Heart rate        Absent        Slow (Below 100)   More than 100

Muscle tone       Flaccid       Some flexion of    Active body
                                extremities        movements
Reflex response   No response   Grimace            Cry

Skin color        Blue, pale    Body pink,         Completely pink
                                extremities blue
TOTAL SCORE = 10
 No depression: 7-10
Mild depression: 4-6
Severe depression: 0-3
Newborn Identification:
  Newborn Identification Before a baby
 leaves the delivery area, identification
 bracelets with identical numbers are placed
 on the baby and mother. Babies often have
 two, on the wrist and ankle.
Vitamin K:
         Vitamin K Prevent neonatal
 hemorrhage during first few days of life
 before infant is able to produce Vitamin K
 administration:
 Term infants (1mg) - IM
Preterm infants (0.5mg) – IM
• Alternative Route:
 Oral Dose: 2mg orally at birth;
 Repeat dose (2mg) at 3-5 days and at 4-
  6 weeks of age.
Initiation of breastfeeding:
 Babies can be breast-fed as soon as the
 airway is cleared and they are breathing
 normally.
DAILY ROUTINE CARE OF NEONATES
 The majority of complication of the normal
 newborn may occur during first 24 hours
 or within 7 days. So close observation &
 daily essential routine care is important for
 health & survival of the newborn baby.
The major goals:
 Establish & maintain homeostasis
 Stability of normal physiological status.
The daily routine care of the neonates are
 as follows:
   Warmth
   Breastfeeding
   Skin care & baby bath
   Care of umbilical cord
   Care of the eyes
   Clothing of the baby
General care
Observation
Taking anthropometric measurement
Immunization
Follow up & advice
WARMTH
  Warmth is provided by keeping the baby dry &
 wrapping the baby with adequate clothing in two
 layers, ensuring head & extremities are well
 covered. Baby should kept by the side of the
 Mother.
BREAST FEEDING
  Breastfeeding The baby should be put to the
 mother’s breast within half an hour of birth or as
 soon as possible the mother has recovered from
 the exertion of labour.
Skin care & baby bath:
  The skin should be cleaned off blood,
 mucus & meconium by gentle wiping
 before he/she is presented to the mother.
 Baby bath can be given at the hospital or
 home by using warm water in a warm
 room gently & quickly.
 First Bath: Once a baby's temperature
 has stabilized, the First bath can be given.
CORD BLOOD COLLECTION
  Make sure cord blood is collected for
 analysis and sent to laboratory for checking
 of: Rh Blood type, Hematocrit & possible
 cord blood gases.
CARE OF THE UMBILICAL CORD
 Keep the cord stump clean and dry.
 Topical application of antiseptics is usually
 not necessary unless the baby is living in a
 highly contaminated area.
Care of the eyes. :
  Eyes should be clean at birth & once in
 every day using sterile cotton swabs
 soaked in sterile water or normal saline.
 Separate swabs for each eye.
Clothing of the baby:
 The baby should be dressed with loose,
 soft & cotton cloths. The frock should be
 open on the front or back for easy
 wearing.
 Large button, synthetic frock and plastic
 or nylon napkin should be avoided.
General care:
 Rooming –in
 gentle approach
 Aseptic technique
sensory stimulation
 tender& loving care.
Observation:
   The baby should be kept in continuous
 observation twice daily for detection of any
 abnormalities.
• Anthropometric measurement:
Measure weight
length
Head circumference
Chest circumference
WEIGHT:
The average daily wt gain for healthy term
 babies is about 30gm/day in the first month
 of life
 It is about 20gm/day in second month
10gm per day afterwards during the first year
 of life.
LENGTH: (from top of head to the heel with
 the leg fully extended)
Average range: 18-22 inches (46-56 cm)
Head circumference:
Head circumference (repeat after molding
 and caput succedaneum are resolved).
 Average range: 33 to 35 cm (13-14
 inches) Normally, 2 cm larger than chest
 circumference Place tape measure above
 eyebrows and stretch around fullest part of
 occipital at posterior fontanel.
Chest circumference (at the nipple line):
  Average range: 30-33 cm (12-13 inches)
 Normally, 2 cm smaller than head
 circumference Stretch tape measure around
 scapulae and over nipple line.

Immunization:
   Newborn should be immunized with BCG
  vaccine & ‘0’ dose of ‘OPV’. Hepatitis ‘B’
  vaccine can be administered at birth as first
  dose & other two doses in one month & 6
  months of age.
Follow up & Advice:
  Each infant should be followed up, at
 least once every month for first 3 months
 & subsequently 3 month interval till one
 year of age.
HARMFUL TRADITIONAL PRACTICES
    FOR THE CARE OF NEONATES
   use of unclean substance such as cow
    dung, mud on umbilical card,
 immediate bathing,
use of prelacteal feeds,
application of kajal in the newborn eyes,
 instillation of oil drops into ears & nostrils,
during bathing the baby use of unhygienic
 herbal water,
 use of pacifiers,
 introduction of artificial feeding with
 diluted milk,
 giving opium & brandy to neonates
 use of readymade expensive formula
 foods.
Nursing Diagnoses:
• Ineffective airway clearance related to nasal
  and oral secretions from delivery.
• Ineffective thermoregulation related to
  environment and immature ability for
  adaptation.
• Risk for injury related to immature defenses of
  the newborn.
• Risk for infection related to immature immune
  system
Bibliography
• Adele Pillitteri (2010), Maternal and Child Health Nursing,
  6th edition, Lippincott Williams and Wilkins Publications.
• Lowdermilk Perry (2007), Maternity and Womens Health
  Care, 9th edition, Mosby Elsevier Publications.
• Wong Perry, Hockenberry and Lowdermilk Wilson (2006),
  Maternal Child Nursing Care, 3rd edition, Mosby Elsevier
  Publications.
• Emily Wone Mckinney, Sharon Smith Murray, Jean Weiler
  Ashwill (2009), Maternal Child Nursing, 3rd edition,
  Saunders Elsevier Publications.
• Susan A. Orshan (2008), Maternity, Newborn and
  Womens Health Nursing, 1st edition, Lippincott Williams
  and Wilkins.
• D.C. Dutta (2011), Text book of Obstetrics, 7th
  edition, New Central Book Agency (P) Limited.
• Meharban Singh (2004), Care of the Newborn,
  6th edition, Sagar Publications.
• B.T. Basavanthappa (2006), Textbook of
  Midwifery and Reproductive Health Nursing,
  1st edition, Jaypee Publications.
• Susan Scott Ricci, Terri Kyle (2009), Maternity
  and Pediatric Nursing, 1st edition, Lippincott
  Williams and Wilkins.
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Essential care of newborn

  • 1. ESSENTIAL NEWBORN CARE PRESENTED BY: A.PRIYADHARSHINI, M.Sc (N), LECTURER, DEPT. OF PAEDIATRICS, JAI INSTITUTE OF NURSING AND RESEARCH, GWALIOR.
  • 2. INTRODUCTION: Essential care of the normal healthy neonates can be best provided by the mothers under supervision of nursing personnel or basic/ primary health care providers. About 80% of the newborn babies should be kept with their mothers rather than in a separate nursery.
  • 3. HEALTHY NEWBORN A healthy infant born at term b/w 38-42 wks should have average birth wt, cries immediately following birth, establishes independent rhythmic respiration & quickly adapts to the changed environment.
  • 4. IMMEDIATE BASIC CARE  Maintenance of temperature  Establishment of open airway & circulation  Identification of newborn  Vitamin K injection  Initiation of breastfeeding.
  • 5. Maintenance of temperature:  Immediately dry the infant under a radiant warmer  Skin to skin contact with the mother.  Keep neonates head covered.  Rooming in (The baby should not be separated from the mother)
  • 6. Establishment of open airway: (Majority of babies cry at birth & take spontaneous Respiration)  When the head is delivered birth attendant immediately suction the secretions, wipe mucus from face and mouth and nose.
  • 7. Suction the mouth and nose by using bulb syringe Keep head slightly lower than the body Position the Baby on their backs or tilted to the side, but not on their stomachs.
  • 8. Importance of suctioning: Several natural mechanisms help with this:  As the fetal chest passes through the birth canal it is compressed, squeezing excess fluid out of the lungs prior to the baby taking its' first breath. After several seconds in this "partly delivered" position, fluid can be seen streaming out of the baby's nose and mouth.
  • 9. Contd… After birth, babies will be cough and sneeze, mobilizing additional fluid that may be in their lungs.
  • 10. APGAR SCORING CRITERIA 0 1 2 Respiration Absent Slow, irregular Good, crying Heart rate Absent Slow (Below 100) More than 100 Muscle tone Flaccid Some flexion of Active body extremities movements Reflex response No response Grimace Cry Skin color Blue, pale Body pink, Completely pink extremities blue
  • 11. TOTAL SCORE = 10  No depression: 7-10 Mild depression: 4-6 Severe depression: 0-3
  • 12. Newborn Identification: Newborn Identification Before a baby leaves the delivery area, identification bracelets with identical numbers are placed on the baby and mother. Babies often have two, on the wrist and ankle.
  • 13. Vitamin K: Vitamin K Prevent neonatal hemorrhage during first few days of life before infant is able to produce Vitamin K administration:  Term infants (1mg) - IM Preterm infants (0.5mg) – IM
  • 14. • Alternative Route:  Oral Dose: 2mg orally at birth;  Repeat dose (2mg) at 3-5 days and at 4- 6 weeks of age.
  • 15. Initiation of breastfeeding: Babies can be breast-fed as soon as the airway is cleared and they are breathing normally.
  • 16. DAILY ROUTINE CARE OF NEONATES The majority of complication of the normal newborn may occur during first 24 hours or within 7 days. So close observation & daily essential routine care is important for health & survival of the newborn baby.
  • 17. The major goals:  Establish & maintain homeostasis  Stability of normal physiological status.
  • 18. The daily routine care of the neonates are as follows:  Warmth  Breastfeeding  Skin care & baby bath  Care of umbilical cord  Care of the eyes  Clothing of the baby
  • 19. General care Observation Taking anthropometric measurement Immunization Follow up & advice
  • 20. WARMTH Warmth is provided by keeping the baby dry & wrapping the baby with adequate clothing in two layers, ensuring head & extremities are well covered. Baby should kept by the side of the Mother. BREAST FEEDING Breastfeeding The baby should be put to the mother’s breast within half an hour of birth or as soon as possible the mother has recovered from the exertion of labour.
  • 21. Skin care & baby bath: The skin should be cleaned off blood, mucus & meconium by gentle wiping before he/she is presented to the mother. Baby bath can be given at the hospital or home by using warm water in a warm room gently & quickly. First Bath: Once a baby's temperature has stabilized, the First bath can be given.
  • 22. CORD BLOOD COLLECTION Make sure cord blood is collected for analysis and sent to laboratory for checking of: Rh Blood type, Hematocrit & possible cord blood gases.
  • 23. CARE OF THE UMBILICAL CORD  Keep the cord stump clean and dry.  Topical application of antiseptics is usually not necessary unless the baby is living in a highly contaminated area.
  • 24. Care of the eyes. : Eyes should be clean at birth & once in every day using sterile cotton swabs soaked in sterile water or normal saline. Separate swabs for each eye.
  • 25. Clothing of the baby:  The baby should be dressed with loose, soft & cotton cloths. The frock should be open on the front or back for easy wearing.  Large button, synthetic frock and plastic or nylon napkin should be avoided.
  • 26. General care:  Rooming –in  gentle approach  Aseptic technique sensory stimulation  tender& loving care.
  • 27. Observation: The baby should be kept in continuous observation twice daily for detection of any abnormalities.
  • 28. • Anthropometric measurement: Measure weight length Head circumference Chest circumference
  • 29. WEIGHT: The average daily wt gain for healthy term babies is about 30gm/day in the first month of life  It is about 20gm/day in second month 10gm per day afterwards during the first year of life. LENGTH: (from top of head to the heel with the leg fully extended) Average range: 18-22 inches (46-56 cm)
  • 30. Head circumference: Head circumference (repeat after molding and caput succedaneum are resolved). Average range: 33 to 35 cm (13-14 inches) Normally, 2 cm larger than chest circumference Place tape measure above eyebrows and stretch around fullest part of occipital at posterior fontanel.
  • 31. Chest circumference (at the nipple line): Average range: 30-33 cm (12-13 inches) Normally, 2 cm smaller than head circumference Stretch tape measure around scapulae and over nipple line. Immunization: Newborn should be immunized with BCG vaccine & ‘0’ dose of ‘OPV’. Hepatitis ‘B’ vaccine can be administered at birth as first dose & other two doses in one month & 6 months of age.
  • 32. Follow up & Advice: Each infant should be followed up, at least once every month for first 3 months & subsequently 3 month interval till one year of age.
  • 33. HARMFUL TRADITIONAL PRACTICES FOR THE CARE OF NEONATES  use of unclean substance such as cow dung, mud on umbilical card,  immediate bathing, use of prelacteal feeds, application of kajal in the newborn eyes,  instillation of oil drops into ears & nostrils,
  • 34. during bathing the baby use of unhygienic herbal water,  use of pacifiers,  introduction of artificial feeding with diluted milk,  giving opium & brandy to neonates  use of readymade expensive formula foods.
  • 35. Nursing Diagnoses: • Ineffective airway clearance related to nasal and oral secretions from delivery. • Ineffective thermoregulation related to environment and immature ability for adaptation. • Risk for injury related to immature defenses of the newborn. • Risk for infection related to immature immune system
  • 36. Bibliography • Adele Pillitteri (2010), Maternal and Child Health Nursing, 6th edition, Lippincott Williams and Wilkins Publications. • Lowdermilk Perry (2007), Maternity and Womens Health Care, 9th edition, Mosby Elsevier Publications. • Wong Perry, Hockenberry and Lowdermilk Wilson (2006), Maternal Child Nursing Care, 3rd edition, Mosby Elsevier Publications. • Emily Wone Mckinney, Sharon Smith Murray, Jean Weiler Ashwill (2009), Maternal Child Nursing, 3rd edition, Saunders Elsevier Publications. • Susan A. Orshan (2008), Maternity, Newborn and Womens Health Nursing, 1st edition, Lippincott Williams and Wilkins.
  • 37. • D.C. Dutta (2011), Text book of Obstetrics, 7th edition, New Central Book Agency (P) Limited. • Meharban Singh (2004), Care of the Newborn, 6th edition, Sagar Publications. • B.T. Basavanthappa (2006), Textbook of Midwifery and Reproductive Health Nursing, 1st edition, Jaypee Publications. • Susan Scott Ricci, Terri Kyle (2009), Maternity and Pediatric Nursing, 1st edition, Lippincott Williams and Wilkins.