Newborn Care- Manulal.V.S

2. NEWBORN CARE
By;
Mr. Manulal .V.S
Senior Lecturer
SP Fort College of Nursing
Thiruvananthapuram.

3. NEWBORN BEHAVIORAL
ADAPTATIONS
• The cry of the Newborn baby is vigorous.
• A neonate spends about 80% of the time in
sleeping ( about 20 hours a day .) .

4. IMMEDIATE BASIC CARE OF
NEONATES
• Immediate basic care of newborn at birth
includes; maintenance of temperature,
establishment of open airway, initiation of
breathing, and maintenance of circulation.
• Healthy normal neonates need only warmth,
breastfeeding, close observation for early
detection of problems and protection from
infections and injuries. Baby should not be
separated from the MOTHER.
• As majority of babies cry at birth and spntaneous
respiration.

5. IMMEDIATE BASIC CARE OF
NEONATES
• Being prepared for resuscitation = Basic
readiness must be ensured to manage
asphyxia. The preparation includes;
1) A radiant heat source ready for use
2) All resuscitation equipments immediately
available and in working order
3) At least one person skilled in neonatal
resuscitation

6. IMMEDIATE BASIC CARE OF
NEONATES
• Signs to evaluate : Mainly 3 signs ;
respiration, H.R, and color. Low HR is an
important sign.
• Apgar Scoring – Described by Dr. Virginia Apgar

7. IMMEDIATE BASIC CARE OF
NEONATES

9. IMMEDIATE BASIC CARE OF
NEONATES
• Apgar Scoring – The fifth minutes’ score has
greater predictive value , since it correlate with
neonatal morbidity and mortality. It correlates
more closely with baby’s neurologic status at one
year of age.
• After cutting the cord aseptically, the baby should
be kept dry, wrapped with dry warm cloths,
examined thoroughly and quickly to assess
normal characteristics, to detect congenital
malformations or any signs of illness.

10. IMMEDIATE BASIC CARE OF
NEONATES
• Identification tag is given to the MOTHER and
BABY. The sex of the bay is shown to the
MOTHER.
• Recording to be done neatly and accurately about
the event of birth of the baby. ( DOB, Time,
Examination findings or presence of any
problems . ) .
• Prepare mother to start breastfeeding and
initiate breast feeding to the baby.
• Sick or at risk neonates need special care in
special seeting.

11. DAILY ROUTINE CARE OF
NEONATES.

12. DAILY ROUTINE CARE OF
NEONATES.
The major goal of NURSING CARE OF NEWBORN
is to establish and maintain homeostasis. This
care is performed involving Mother and
Family members. Majority of the
complications of the normal neonates may
occur during first 24 hours or within 7 days.
Close observation and daily essential routine
care are important for health and survival of
the newborn baby.

13. DAILY ROUTINE CARE OF
NEONATES.
1) PREVENTION OF INFECTION.
a) Clean environment. ( 5 CLEANS of Birthing
process) = clean hands, clean cord cut, clean
delivery surface, clean cord tie and clean cord
stump.
b) Hand washing for
care givers.
c) Strict asepsis.
d) No sharing.
e) Parental Education.

14. DAILY ROUTINE CARE OF
NEONATES.
2) DRYING AND TEMPERATURE
MAINTENANCE.
One of the first steps after birth is thorough drying
of the body, especially, head, which constitutes a
large part of the neonatal surface area.
The Vernix , the cheesy material stuck
on newborn skin made of dead skin, hair and
secretions, serves to conserve heat and protect the
delicate newborn skin from environmental stress;
no attempt is made to remove this.

15. Methods of heat loss
Evaporation – wet surface exposed to air
Conduction – direct contact with cool objects
Convection- surrounding cool air - drafts
Radiation – transfer of heat to cooler objects not
in direct contact with infant

16. Convection
Radiation
Evaporation
Conduction

17. 2) DRYING AND TEMPERATURE
MAINTENANCE.
• Baby can be carried to a pre-heated area or
under radiant warmer.
• Warmth is provided by keeping the baby dry and
wrapping the baby with adequate clothing in two
layers, ensuring extremities well covered. Baby
Should be kept inside
the mother, so that
The mother’s body –
Temperature can keep
The baby warm.

18. 2) DRYING AND TEMPERATURE
MAINTENANCE.
• Bathing is avoided to prevent hypothermia
and infections.
• Ambient atmospheric temperature to be kept
warm adequately ( 28 – 32 degree celcius.) .
• Temperature should be recorded ( by axillary,
skin or human touch method) freequently
during initial postnatal period.

19. DAILY ROUTINE CARE OF
NEONATES.
3) BREAST FEEDING
Start breast feeding within
½ hr of birth (if normal labour)
and within 1 hour if LSCS.
No prelacteal feeds to be
Given and colostrum feeding
Must be offered.

20. 3) BREAST FEEDING
• Initially feeding should be given in short
interval of 1 to 2 hours and then every 2 to 3
hrs.
• Most babies regularize their feeding pattern
by the end of first week and self demand
feeding is established in Q 3-4 H interval.
• Nurse should assist the Mother to feed her
baby adequately for the maintenance of
hydration and adequate nutrition.

21. DAILY ROUTINE CARE OF
NEONATES.
4) CORD CARE
The umbilical cord is cut about 2 to 3 inches
from the naval with aseptic techniques during
delivery and tied with sterile cotton thread or
disposable plastic clip. Inspected for any
bleeding which commonly occurs due to
shrinkage of cord and loosening of ligature.

22. 4) CORD CARE
No dressing should be applied and
kept it open and dry.
Normally it falls off
after 5 to 10 days but
may take longer
especially when infected.

23. 5) CARE OF THE EYES
5) CARE OF THE EYES
Should be cleaned at
birth and once every day
Using sterile cotton
swabs soaked in sterile water or normal saline.
Each eye should be cleaned using a separate swab,
moved over the lower edge of eyelid from medial
to lateral canthi. Application of kajal in the eyes
must be avoided to prevent lead poisoning.

24. 5) CARE OF THE EYES
• If there was evidence of gonococcal infection in
Mother, in which case 1% Silver nitrate is applied
in both eyes of the baby.
• The eyes should be observed for redness, sticky
discharge or excessive tearing for early detection
of problems and prompt management.
• The cultural practice of instillation of human
colostrum in the eyes has been found to be useful
to reduce the incidence of sticky eyes.

25. DAILY ROUTINE CARE OF
NEONATES.
6) VITAMIN K PROPHYLAXIS
Vitamin K is produced in the human body from bacteria
colonizing the gut. In babies the relative absence of
such micro-organisms and deficiency of viamin K in
breast milk predispose the baby to its deficiency.
This deficiency can manifest as vit.K deficiency with
bleeding with formation of subcutaneous haematomas ,
ecchymosis, mucosal bleeding and lifethreatening intra-
cranial bleed.
In order to prevent this , Inj. Vitamin K 1mg I/M to all
babies 1 kg or more and 0.5 mg to those less than 1 kg.

26. DAILY ROUTINE CARE OF
NEONATES.
7) NUTRITION
Breast milk is the best source of nutrition
for infants under 6 months of age. Information
regarding breast feeding and its importance need to
be discussed with the Mother.

27. DAILY ROUTINE CARE OF
NEONATES.
8) CLOTHING OF THE BABY
The baby should be
dressed with loose, soft, and
cotton cloths.
A triangle square piece of thick,
soft, absorbant cloth should be
used as napkin.
Cloths should not be tight especially
around the neck or abdomen.

28. 8) CLOTHING OF THE BABY
• Woollen cloths should not be stored with moth
balls (a small, white ball containing a chemical with
a strong smell that keepsmoths away from clothes),
because there is a chance of severe jaundice in
baby with G-6-PD deficiency.
• Wash the Baby’s cloth properly and sun dried
to prevent skin irritation.

29. DAILY ROUTINE CARE OF
NEONATES.
9) WEIGHT RECORDING
The average weight gain in healthy
term babies is about 30 gm/day in first month
of life. It is about 20 gm/ day in second month
and 10 gm / day afterwards during first year of
life.
Most babies double their birth weight
by 4 to 5 months.

30. 9) WEIGHT RECORDING
• But in the first week of life there is physiological
loss of body weight due to removal of vernix,
mucus, blood, passage of meconium and
reduction of extracellular blood volume.
• Delay and unsatisfactory feeding is also
contributing to weight loss. With adequate breast
feeding , majority of the babies regain the weight
within 7 to 10 days of Birth.

31. DAILY ROUTINE CARE OF
NEONATES.
10) IMMUNIZATIONS
In institutional delivery, all neonates should be
immunized with BCG Vaccine and Zero dose
of OPV. Hepatitis B Vaccine can be
administered at birth as first dose.
The OPV may preferably be given after 3 days
of age because colostrum may interfere with
its uptake.

32. DAILY ROUTINE CARE OF NEONATES.
11) OBSERVATION
The Baby should be thoroughly observed twice daily
for early detection of any abnormalities.
Temperature, PR/HR, RR, Feeding behaviors, stool ,
urine and sleeping pattern should be assessed.
Mouth , eyes , cord and skin should be looked for any
infections.
Daily observation is essential to detect the presence of
danger signs for early interventions.

33. DAILY ROUTINE CARE OF
NEONATES.
12) GENERAL CARE, FOLLOW UPAND
ADVICE TO MOTHERS
Keep baby in well ventilated clean
room.
Follow up at least 1 in every
month for first 3 months till
one year of age.
Assessment of Growth and
Development.