The document provides information on the immediate and essential care of newborn babies. It discusses the characteristics, reflexes, and measurements of newborns. It also outlines the steps for immediate basic care including maintaining temperature, establishing breathing, vitamin K injection, and initiating breastfeeding. The document summarizes assessment methods for gestational age and provides details on the Ballard scoring system.

1. MITTAL COLLEGE OF NURSING
PRESENTATION ON
IMMEDIATE AND ESSENTIAL CARE OF
NEW BORN BABY
SUBJECT :- OBSTETRIC $ GYNECOLOGY
SUBMITTED TO, SUBMITTED BY
MRS SNEHLATA PARASHAR Miss KHUSHBU RAWAT
M.SC LECTURER B.Sc Nursing
(OBG $ GYN) IVth Year
SUBMITTETED
DATE :- 27/03/2019

3. SPECIFIC OBJECTIVE:-
At end at the class presentation, students will able
to :-
1 To explain the introduction and definition of new born.
2 To discuss the characteristic and reflexes of new born.
3 To discuss the immediate care of new born.
4 To discussion the immunization.
5 Assessment of gestational age.
6 To discuss the essential and daily routine care.
7 Explain about the follow up care and general observation
of new born.
8 To explain the grade of neonatal care.

4. NEW BORN BABY
Introduction ;-
The healthy new born infant born at
term , between 38-42 weeks ,cries
immediately after birth , establishes
independent rhythmic respiration ,
quickly adapts with extra uterine
environment.

6. Definition;-
New born refers to an infant
in the birth 28 days after
birth , a new born is an infant
with in hours , days or up to a
few weeks from birth.

7. Characteristics of new born -
1.General measurement –
weight=
length=
apgar score=

8. 2. Head measurement-
Shape – round symmetrical , may
have moulding and over riding suture.
Head circumferance-33-35cm
Fontanel in size ,shape-
1. Anterior-
2. Posterior-

9. 3.Eyes-
Colour - blue white sclera
Movement - random
Reaction to light - pupils equal in
size ,round and reaction to light.
Tears - absent or occasionally
Eyelids - Oedema present

10. 4.Ears-
Reaction to noise – startle reflex
to loud noise
Position – symmetrical
Patency – evidence of hearing

11. 5.NOSE=
1.Mucus-clear
2.patency-Infant are obligatory nose
breathers.
6.MOUTH=
Sucking and swallowing reflex
present

12. 7.CHEST=
1.breast tissue – Nipple
prominent
2.shape – almost circular and
barrel shaped.
3. size – 30-35cm[12-13inches].

13. 8.Respiration -
1. Rate – 30-60 min
2. Rhythm – shallow ,irregular
3. muscular activity - diaphragmatic
and abdominal
9.PULSE -
1. Rate - 120-160 min
2.Rhythm – irregular after crying

14. 10.ABDOMEN -
Rounded ,protruded , bowel sound
audible after 1-2 hours after birth.
11.UMBLICUS –
1.Apperance – clear ,gelatin,odorless
2.Number vessels at birth-

15. 12.ARMS -
1.movement –spontaneous.
2.Muscle tone –Flexed
3.fist – often clenched

16. 13.GENITO –URINARY -
Female genitals – usually oedematous
Male genitals – testes palpable each side
Voiding – start by 24 hrs. after delivery ,3-
4 times/day.
14.RECTUM –
Number of stool – meconium by 24
hrs.

17. 15.HIPS -
Symmetrical , glateal folds even .
16 . SKIN –
 Colour – generally pink
 Birth mark – may be present
 Lenguo – present over shoulder , pinnas
,forehead
 Vernix caseosa – white , cheesy odorless ,
present in creases and folds .

18. CONT.....
Hair – amount varies
17. TEMPRATURE –
Normal –
Heat loss – by conduction ,radiation
and evaporation

19. 18.REFLEXES -
 DOLL ‘S EYE – present
 Rooting - present
 Sucking /swallowing – present
 Gag reflex – present
 Grasp - present
 Babinski – present
 Moro – present
 Tonic neck reflex – present

20. 19.CRY -
1.Frequancy – variable
2.pitch – moderate , pitch may be
strong .
20. BEHAVIOUR –
Responding to handling

21. .Reacts to environment .
Eating ,sleeping pattern varies in
interest
21.EXTERMITIES –
1.polydactyly
2.syndactyly
3.talipes equinovarus

22. 22.BACK -
 Check abnormal spinal curvature
 Spina bifida occulta ,meningocele
,meningomyelocele.
23.BUTTUCKS -
Observed for any mass .
Perianal area examined – anal opening
,anal fissures or any other
abnormalities.

23. 24.PATTERN OF
ELIMINATION -
The neonate passes urine and
meconium within 24 hrs.
Afterwards for first few days baby
voids 10-15 times and average six
stool per day .

24. ASSESSMENT OF
REFLEXES =
1. Reflexes' of EYE –
1.blinking – infant blink at
sudden appearance of bright
light or any object towards eye .
At birth .

26. 2.Pupillary reaction -
Pupil constrict when bright light falls
on it

27. 3.DOLL’S EYE -
At head is
moved to right
or left ,slowly .
Disappearance
– 3-4 month.

28. REFLEXES OF NOSE -
1.Sneeze –
spontaneous
response of
nasal passage to
any irritant .

29. 2.Globellar -
Repetitive
tapping on the
forehead , cause
eye to close
tightly .
At birth

30. REFLEXE’S OF MOUTH -
1. Rooting –
Disappearance -
3-4 month

31. 2.SUCKING 3.GAG

32. 4.EXTRUSION 5.COUGH

33. REFLEX OF EXTERMITIES -
 1.GRASP –
 Disappearance – 3
month
2. BABINSKI –
Disappearance
- 1 yr.

34. BABINSKI -

35. MASS REFLEX’S -
 1. MORO’S -
 Disappearance – 3-4
month
 2. TONIC NECK
–
 Disappearance - 3-4
month

36. MORO TONIC
NECK

37. CONT...
 3.CRAWL REFLEX
 Disappearance – 4
weeks
 4.DANCE /
STEPPING –
 Disappearance – 3-4
weeks .

38. CONT...

39. 5.GALANT [ TRUNK
INCURVATION]

40. IMMEDIATE CARE OF
NEW BORN
INTRODUCTION –
 Essential care of the normal healthy
neonates can be provided by the mothers
under supervision of nursing personnel or
basic /primary health care providers . About
80percent of the newborn babies should be
kept with their mothers rather than in
separate nursery .

41. IMMEDIATE BASIC CARE
 Maintenance of temperature .
 Establishment of open airway and
circulation .
 Identification of new born .
 Vitamin k injection .
 Initiation of breast feeding .

42. MAINTENANCE OF
TEMPERATURE -
 Immediately dry the infant under a radiant warmer .
 Skin to skin contact with mother .
 Keep neonate head and extremities covered .
 Rooming in [the baby should not be separated from
mother ].
 Bathing is avoided to prevent hypothermia and infection .
 Temperature should be recorded and observation .
 Avoided to unnecessary exposure and undressing baby.

44. ESTABLISHMENT OF
OPEN AIRWAY-
 [majority of babies cry at birth and take
spontaneous respiration ]
 When the head is delivered birth attendant
immediately suction the secretions ,wipe
mucus from face and mouth and nose .

45. CONT....
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 .

46. Importance of suctioning ;
 As the foetal chest passes through the birth
canal it is compressed ,squeezing excess
fluid out of 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
.

47. NEONATAL
RESUSCITATION -
Series of action ,used to assist newborn
babies who have difficulty with making
the physiological ‘transition ‘ from the
intrauterine to extra uterine life .
Neonatal resuscitation is a set of
intervention used to assist the airway,
breathing ,and circulation of a
following birth.

49. CONT...
It means a to support a maintain
breathing ,circulation ,for an neonate
.who has stop breathing or whose heart
stop .

50. Initial steps of resuscitation -
 Receiving the newborn baby in a prewarmed
towel and placing the baby on the preheated
radiant warmer .
 AIRWAY-
 Positioning the baby on the back with the
neck slightly extended .[sniffing position]

51. SNIFFING POSITION

52. CONT...
 Providing tactile stimulation – [rubbing the infant
back , slapping the sole of the foot , flicking the
heel ].
BREATHING –
1.Bag mask ventilation
2.Mouth to mouth
3.Mouth to mask

54. CHEST COMPRESSION -
 Techniques –
 1.two finger method.
 2. two thumb encircling hand .
 RATIO –
 15;2 =2 RESCUE
 30;2 = 1 RESCUE

56. APGAR SCORING -
A –Activity /muscle tone
P-Pulse / heart rate
G-Grimace /reflex response
A-Appearance /skin colour
R-Respiration

58. A- ACTIVITY
 0 points – flaccid /floppy limp
 1 points – some flexion of extremities
 2 point – active body movement
P - Pulse rate
0 points –absent
1 points – below [100 beats /min.]
2 points –more than [100 beats /min.]

59. G-GRIMACE
 0 points –no response
 1 points –facial movement /grimace with
stimulation
 2 points – cry
A-APPEARANCE
0 points –blue ,pale ,bluish -gray
1 points –body pink ,but extremities blue
2 points – complete pink

60. R-RESPIRATION
 0 points –absent
 1 points –irregular ,slow cry
 2 points –good , strong cry
TOTAL SCORE = 10
no depression – 7-10
Mild depression – 4-6
Severe depression – 0-3

62. CONT.....
 Apgar score quick test performed on a baby at 1 -5
min. After birth .
 The 1 min. Score determine how well the baby
tolerate the birthing process .
 The 5 min. Score tells the health care provider
how well the baby is doing outside’s the mother
womb .
 In rare case ,the test will be done 10 min. After
birth

63. NEW BORN
IDENTIFICATION -
New born 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.

64. VITAMIN – K
Vit.k prevent neonatal haemorrhage
during first few days of life before
infant is able to produce vit.k
administration .
Term infant [ 1mg ] –IM
Preterm infant [ 0.5 mg ] – IM

65. ALTERNATIVE ROUTE -
ORAL DOSE - 2 mg orally at birth
REPEAT DOSE – [ 2 mg ] at 3-5 days
and at 4-6 weeks of age .

66. INITIATION OF BREAST
FEEDING -
 Babies can be breast – feed as soon as the
airway is cleared and they are breathing
normally .
 Breast feeding is the most effective way to
provide baby with a caring environment and
complete nutrition .
 The first breast feeding should be with in 30
min. Of normal delivery and 4 hrs.in lscs .

67. CONT...
 Breast milk and colostrums prevent neonate
from anaemia and many nutritional
deficiency disease .
 Breast milk contains high lactose , low
protein , enhance growth of lactobacillus
which inhibit growth of E.Coli .
 Breast milk reducing the risk of breast and
uterine cancer in mother .

68. ASSESSMENT OF GESTATIONAL AGE AT
BIRTH
 INTRODUCTION –
 Assessment of gestational age is mandatory
for all neonates for further management . Last
menstrual period is important clue for
calculation of gestational age .
 Using a new Ballard scale ,can be use with
neonate born between 20-44 week
gestational.

69. NEW BALLARD
SCORE -
 The Ballard scale is a commonly used
technique of gestational age assessment .
 These criteria are divided into two type
physical and neuromuscular maturity .
 The new Ballard score is a set of procedures
developed by Dr. JEANNE L
BALLARD .

70. COMPARISON -
OLD NEW
 Score ranged from
5 – 50 26 -44
wks.
 Score starts with
0
 Inaccurate in
extremely preterm
 -10 to 50 20 -
44 wks.
 Starts with - 1
 More accurate

71. cont...
 Optimal age for
maturational
assessment ;
between 30 and
42 hrs. Of age .
 Eyes ; not included
Birth to 96 hrs.
Included

72. NEURO MUSCULAR
MATURITY -
1.POSTURE ;
As maturation progresses –
increasing passive flexor tone.
Increasing passive flexor tone –
centripetal direction .
Lower extremities slightly ahead of
upper extremities .

73. POSTURE -