nursing care

1. ESSENTIAL NEWBORN CARE
ASHA SEBASTIAN
1ST YEAR M.Sc. NURSING

2. INTRODUCTION
• The satisfactory transition from fetus to newborn infant is the greatest task the baby has
to overcome.
• It necessitates a very rapid change from the warmth and shelter of the uterus to the cold
uncertain world outside. Survival depends on the baby to make this transition.
• Major physiological adjustments are therefore necessary at birth and continue within the
next few days and weeks. These include the establishment of respirations, changes in
cardiovascular system and the blood, the regulation of the body temperature, digestion
and absorption of food and the development of a resistance to infection.

3. DEFINITION
Essential Newborn Care (ENC) is care that every newborn baby
needs regardless of where it is born or its size. ENC should be applied
immediately after the baby is born and continued for at least the first 7
days after birth

4. HEALTHY NEWBORN
A healthy infant born at term between 38-42wks should have
average birth weight, cries immediately following birth, establishes
independent rhythmic respiration & quickly adapts to the changed
environment

5. IMPORTANCE OF NEWBORN CARE
• Most of the neonatal deaths occurring during delivery or on the day of
death.
• Even for the deaths occurring in the rest of neonatal period, care given
at the time of birth is an important influencer
• A lot of deaths of newborns due to hyperthermia, asphyxia and
infection can be prevented by providing essential newborn care to all
infants immediately after birth

6. ASSESSMENTS OF NEWBORNS
Each new-born baby is carefully checked at birth for signs of problems
or complications. The healthcare provider will do a systematic
examination (physical and neurological) of newborn.
Assessment helps to know infant’s state of development of wellbeing,
any deviation from normal and the progress of the child

7. Assessment includes
Head to foot assessment
APGAR scoring
Maturity assessment
Gestational age assessment
Transitional assessment

8. HEAD TO FOOT ASSESSMENT
• Head circumference: - Occipitofrontal circumference - place measuring tape around
front of head, below the brow and occipital area. - Normal range 32cm-37cm
• Length and Weight
• Vital signs
• a) Temperature: Rectal
• b) Respirations: Normal rate is 40-60
• c) Blood pressure: Correlates with gestational age, post natal age, birth weight.

9. HEAD TO FOOT ASSESSMENT
Head circumference: - Occipitofrontal circumference - place measuring tape
around front of head, below the brow and occipital area. - Normal range 32cm-
37cm
Length and Weight
Vital signs
a) Temperature: Rectal
b) Respirations: Normal rate is 40-60
c) Blood pressure: Correlates with gestational age, post natal age, birth weight.

10. • Pulse rate: Awake 120-160bpm, Asleep 70- 80bpm
• Colour: Plethora (deep rosy red), Jaundice, Pallor, Cyanosis (central,
peripheral, acrocyanosis) ,“Blue on pink: or “Pink on blue”, Harlequin
colouration, Mottling, Rashes , Milia, Erythema toxicum, Candida
albicans rash, Transient neonatal pustular me, Acne neonatorum
• Skin: This looks at skin colour, texture, nails, and any rashes.

11. • Head and neck: This looks at the shape of head, the soft spots (fontanels)
on the baby’s skull, and the bones across the upper chest (clavicles).
• Face: This looks at the eyes, ears, nose, and cheeks.
• Mouth: This looks at the roof of the mouth (palate), tongue, and throat.
• Lungs: This looks at the sounds the baby makes when he or she breathes.
This also looks at the breathing pattern.
• Heart sounds and pulses in the groin (femoral)

12. • Abdomen: This looks for any masses or hernias.
• Genitals and anus: This checks that the baby has open passages for
urine and stool.
• Arms and legs: This checks the baby’s movement and development

13. APGAR SCORING
• The Apgar score is a method to quickly summarize the health of new-
born children.
• The baby is checked at 1 minute and 5 minutes after birth for heart and
respiratory rates, muscle tone, reflexes, and color.
• Apgar scores of 6 or less usually mean a baby needed immediate
attention and care.

15. MATURITY ASSESSMENT
The physical maturity will be different
for babies with different gestational age
Skin textures: Is the skin sticky,
smooth, or peeling?
Soft, downy hair on the baby’s body
(lanugo): This hair is not found on
immature babies. It shows up on a
mature infant, but goes away for a post
mature infant.
Plantar creases: These are creases on
the soles of the feet. They can be absent
or range up to covering the entire foot.

16. • Breast: Look at the thickness and size of breast tissue and the darker ring
around each nipple (areola).
• Eyes and ears: The provider checks to see if the eyes are fused or open. He
or she also checks the amount of cartilage and stiffness of the ears.
• Genitals, male: check for the testes and how the scrotum looks. It may be
smooth or wrinkled.
• Genitals, female: check the size of the clitoris and the labia and how they
look. Search

17. GESTATIONAL ASSESSMNET
Gestational age can measure by weight for
gestational age chart.
Gestational Age:
SGA- small for gestational age-weight below
10th percentile
AGA-weight between 10 and 90th percentiles
LGA-weight above 90th percentile

18. TRANSITIONAL ASSESSMENT
• The new-born exhibits behavioral and physiologic characteristics that
can at first appear to be signs of stress.
• During the initial 24 hours changes in heart rate, respiration, motor
activity, color, mucous production, and bowel activity occur in an
orderly, predictable sequence, which is normal and indicative of lack
of stress. Distressed infants also progress through these stages but at a
slower rate

19. • For 6 to 8 hours after birth the new-born is in the first period of
reactivity.
• During the first 30 minutes the infant is very alert, cries vigorously,
may suck his fist greedily, and appears very interested in his
environment.
• At this time the eyes are usually open, suggesting that this is an
excellent opportunity for mother, father, and child to see each other.
• For the reason he has a vigorous suck reflex, an opportune time to
begin breast-feeding. The mother.
First
period

20. • After the initially highly active states, the infant may be quite
sleepy and uninterested in sucking.
• Physiologically the respiratory rate can be high as 80
breaths/minute, rales may be heard, heart rate may reach
180beats/minute, bowel sounds are active, mucous secretions are
increased and temperature may decrease.
• After this initial stage of alertness and activity the infant's
responsiveness diminishes.

21. • Heart and respiratory rates decrease, temperature continues to fall,
mucous production decreases, and urine or stool is usually not
passed.
• The infant is in a state of sleep and relative calm. Any attempt to
stimulate him usually elicits a minimal response.
• This second stage of the first reactive period generally lasts 2 to 4
hours. Due to the continued decrease in body temperature, it is best
to avoid undressing of bathing the infant during this time.
Fi
r
st

22. • The second period of reactivity begins when the infant awakes from the
deep sleep following the first period.
• The infant is again alert and responsive, heart and respiratory rates
increase, the gag reflex is active, gastric and respiratory secretions are
increased, and passage of meconium commonly occurs.
• This second period of reactivity lasts about 2 to 5 hours
• Following this stage is a period of stabilization of physiologic systems
and a vacillating pattern of sleep and activity
Second
Period

23. THE STEPS OF NEWBORN CARE AT THE TIME OF BIRTH
• Callout the time of birth.
• Deliver the baby on to a warm, clean and dry towel or cloth and keep on mother's
chest (between the breasts).
• Clamp and cut the umbilical cord.
• Immediately dry the baby with a warm clean towel or piece of cloth; wipe the
eyes.
• Assess the babies breathing while drying.

24. THE STEPS OF NEWBORN CARE AT THE TIME OF BIRTH…
• Wipe both the eyes separately with sterile gauze.
• Leave the baby between the mother's breasts to start skin-to-skin care.
• Place an identity label/band on the baby.
• Cover the baby's head with a cap. Cover the mother and baby with a warm
cloth.
• Encourage mother to initiate breastfeeding (within half an hour of birth).

25. ESSENTIALS OF NEWBORN CARE
The basic needs of all babies at the time of birth (and for the few weeks of
life)
• Establishing and maintaining normal breathing
• Ensuring warmth
• Initiating breast milk
• Protection from infection
• Cord care

26. ESSENTIALS OF NEWBORN CARE…
• Eye care
• Monitoring
• Care of skin
• Immunization
• Vitamin K administration

27. ESTABLISHING AND MAINTAINING NORMAL
BREATHING
• Wipe mouth and nose of secretions after delivery of the head.
• Suction secretions from mouth and nose.
• A crying infant is a breathing infant. Stimulate the baby to cry if
baby does not cry spontaneously or if the cry is weak
• Oral mucus may cause the newborn, to choke, cough or gag
during the first 12-18 hours of life.
• Keep the nares patent. Remove mucus and other particles that
may cause obstruction

28. ENSURING WARMTH
Baby must be dried immediately after birth
• Keep the baby between the mother's breasts
• The first skin-to-skin for at least 1 hour
without interruption
• The mother and baby should be covered with
a warm and dry cloth

29. INITIATING BREAST FEEDING
The baby should be breastfed within half an
hour after birth
This “early initiation of breastfeeding”
ensures that the infant receives the colostrum,
or “first milk”, which is rich in protective
factors.

30. PREVENTION OF INFECTIONS; CLEAN CHAIN
COMPONENTS OF CLEAN CHAIN
• Clean delivery (WHO’S six cleans)
• Clean attendants’ hands.
• Clean delivery surface.
• Clean cord-cutting instrument.
• Clean cloth to warp the baby.
• Clean cloth to wrap the mother.
• Clean string to tie cord.

31. After the delivery:
• All caregivers should wash hands before handling the baby
• Feed only breast milk
• Keep the cord clean and dry; do not apply anything
• Use a clean cloth as a diaper/napkin. Wash your hands after changing
diaper
• Keep the baby clothed and wrapped with the head covered

32. CORD CARE
The cord is clamped and cut approximately within
30 seconds after birth Keep the cord clean and dry.
The drier the cord, the sooner it will fall off.
Use a cotton swab dipped in alcohol to clean
around the base of the cord three times a day or
when soiled with urine or stool.
Continue to apply alcohol even after the stump
falls off until the area is dry.

33. Instructions to the mother on cord care:
• No tub bathing until cord falls off.
• Do not apply anything on the cord except the prescribed antiseptic solution.
• Avoid wetting the cord.
• Leave cord exposed to air.
• If any bleeding is noticed, apply firm pressure and check cord clamp if loose
and fasten.

34. EYE CARE
Eye care is given to protect the babies’ eyes from infection. In
areas where sexually transmitted diseases are common.
A baby’s eyes should be wiped as soon as possible after birth.
Eye drops or ointment should be given within 1 hour of delivery.
After instilling the eye drops, care should be taken, so that the
drug is not washed away.

35. MONITORING THE BABY
During the 1st hour after delivery, the
baby (and the mother should be
monitored every 15 minutes.
The three most important parameters that
need to be monitored are:
• Breathing.
• Temperature or warmth.
• Color.

36. CARE OF SKIN
The newborn should be gently wiped off blood,
mucosa and secretions quickly
No attempt should be made to wipe off vernix caseosa
Bathing the baby at the time of birth increases the risk
of hypothermia.
Do not bath the baby for 48-72 hours.

37. IMMUNIZATION
Immunizations (vaccines) are an important
way to protect the baby from life-
threatening diseases

38. VITAMIN K ADMINISTRATION
• Shortly after birth, vitamin K is administered as a single
intramuscular dose of 0.5-1 mg to prevent hemorrhagic disease of
the newborn, also called vitamin K deficiency bleeding..
• The major function of vitamin K is to catalyze the synthesis of
prothrombin in the liver, which is needed for blood clotting and
coagulation.
• The vastus lateralis muscle is the traditionally recommended
injection site, but the ventrogluteal (not dorsogluteal) muscle can
be used

39. BATHING
• Bathing is usually performed after the vital signs have stabilized, especially
the temperature.
• It is recommended that for the first 2 WEEKS the infant be bathed no more
than two or three times per week with a plain warm sponge bath.
• This practice will help maintain the integrity of the newborn skin and allow
time for the umbilical cord to completely dry.
• Routine daily soap bathing for newborns is no longer recommended.

40. CONCLUSION
There is good evidence that adherence to recommended essential
newborn care practices substantially reduces mortality risk especially
for very small newborns. Health service contacts are important
opportunities to influence these practices. In some settings community
health workers can serve as important channels to influence adoption of
these practices among pregnant women