newborn assessment and care

1. NEW BORN BABY PROFILE AND
CHARACTERISTICS OF THE NEW BORN,
ASSESSMENT OF THE NEW BORN, NURSING
CARE OF THE NEW BORN AT BIRTH, CARE OF
THE NEW BORN AND FAMILY
PRESENTED BY ULFAT AMIN
M.SC NURSING 1ST YEAR
CHILD HEALTH NURSING

2. Profile of the Newborn and Characteristics of
the Newborn
• Newborns may look alike, but each has their own
physical attributes and personalities. Some
newborns are fat and short while some are long and
thin.
• The weight of newborns varies according to their
race, genetics, and nutritional factors.

3. CONT…
• Weight:-The average weight of a normal full term
newborn is about 2.9 kg with a variation of 2.5-3.9
kg or more. The weight is very variable from country
to country .
• The newborn loses 5% to 10% of its birth weight
during the first week of life, then regains the birth
weight by 10th day and gains weight rapidly
afterward.

4. • The baby continues to gain weight about 20-30
g/day for next 3 months of age.
• Length:- At birth the average crown heel length of
the term infant is 50 cm with the range of 48-53 cm.
• Head circumference:-The head circumference
usually varies from 33-37 cm, with the average of
35cm.
• The chest circumference in a mature newborn is 2
cm less than the head circumference.

5. • Chest circumference is measured at the level of the nipple
using a tape measure. The chest is rounded rather than
flattened anteroposteriorly.
• Skin is pinkish but bluish hand and feet (Acrocynosis)
• It may covered with vernix Caseosa, milia and laugo hair,
especially at back.
• Ear:-Ear cartilage is firm and fully curved, showing good
elastic recoil.

6. • Externa auditory canal is relatively short and straight
• Eardrum is thick and Eustachian tube is short and broard
• Eyes:-Eyes are largely covered with eye lids
• Breast:-Breast nodules is palpable measuring over 5mm
in diameter.
• Abdomen:- Prominent with short neck and large head

7. • The trunk is relatively larger and the extremities are
short.
• Kidney, liver, and spleen may be palpable
• Scrotum (in male) :-It shows palpable testes and shows
adequate rugae with deep pigmentation
• Genetilia (in females) The labia majora covers the labia
minora and the clitoris.
• Foot:- prominent deep creases .

8. VITAL STATISTICS
Parameter Average
• Weight 6.5 to 7.5 lbs (2.9 kg -3kg)
• Length 50 cm (20 inches)
• Head circumference 33 to 35 cm (13 to 13.7 in)
• Chest circumference 31 to 33 cm or2cm less
than head circumference
• Abdominal circumference 31 to 33 cm

9. VITAL SIGNS
• Vital Sign Immediately At Birth AfteBirth
• Temperature 36.5 to 37.2 Celsius
• Pulse 180 beats/minute 120-140 B/M
• Respiration 80 brths/m 30-50b/m
• Blood Pressure 80/46 mmHg 100/50 mmHg
(by 10th day)

10. Adjustment to Extrauterine Life
• The newborn’s color on the first 15 to 30 minutes of life is
still acrocyanotic, and after 2 to 6 hours, there are quick
color changes that may occur with movement or crying.
• The temperature within the first 15 to 30 minutes after
birth falls from the intrauterine temperature of 100.6⁰F or
38.1⁰C then stabilizes at 37.6⁰C after 2 to 6 hours.
• The rapid heart rate of a newborn is as much as 180 BPM
on the first 15 to 30 minutes of life will have wide swings
in rate with activity as it slows to 120-140 BPM.

11. • The newborn’s respirations are irregular in the first few
minutes of life, then slows to 30-60 breaths per
minute after 30 minutes and will become irregular
again only during activity.
• The newborn would be alert in the first 15 to 30
minutes of life, and later on, will alternate between
the sleeping and awakening phases. A neonate spends
about 20 hours a day in sleeping.

12. • The energy requirement initially is 55 cal/kg/day
which increases to about 120 cal/kg/day at the end
of the first week of age.
• The bowel sounds can be heard after the first 15
minutes of life and becomes present afterwards.
• The normal blood volume of neonate is about 80
ml/kg of body weight with RBC 6-8 million/cmm,
Hb% 18 g%, WBC 10000 to 17000/cmm, platelets
350000/cmm.

13. ASSESSMENT OF THE NEW BORN
• The period from birth to 28 days of life is called neonatal
period and the infant in this period is termed as neonate
or newborn baby. The first week of life is known as early
neonatal period and the late neonatal period extends
from 7th to 28th days of age.
• The healthy newborn infant born at term, between 38
to 42 weeks, cries immediately after birth, establishes
independent rhythmic respiration, quickly adapts with
the extra uterine environment ,having an average birth
weight and no congenital anomalies .

14. • Assessment of the newborn, as soon as possible
after birth are vital responsibility of the nurses
working in the hospital or in the community. The
assessment should include details history of
prenatal and intranatal period and genetic history of
family along with head to foot examination and
review of maternal investigation.

15. • The purpose of initial assessment are mainly to assess
the need for resuscitation,
• To ascertain the gestational age,
• To detect presence of any congenital anomalies or any
disorders which may affect the well being of the baby.
• It should be done at the place of birth by the trained
personnel immediately after delivery of the neonate.

16. • The assessment in the postnatal period should be
done at least for three times, first postnatal
assessment should be done within 24 hours, second
assessment within 2 weeks of age and third
assessment within 4-6 weeks of age of baby.
• In home delivery, the first postnatal assessment
should be done within 3 days and others are same
as institutional delivery.

17. • The initial assessment of neonate is very important
activity immediately after birth. The most essential
assessment is the “first cry”. Good cry helps in
establishment of satisfactory breathing .The
respiration, heart rate and skin color are the basic
criterias which should be evaluated immediately to
determine the need for life saving support. Another
significant assessment of the neonate is “Apgar
scoring” as described Dr Virginia Apgar

18. ABGAR SCORE
• CRITERIA 0 1 2
• Respiration. Absent Slow Irregular GoodCrying
• Heart Rate. Absent Slow(Below 100) Morethan 100
• Muscle tone. Flaccid Some flexion of extremities Active body
movements.
• Reflex response. No response Grimace Cry.
• Skin colour. Blue, pale Body pink extremities blue Completely pink
• Total score=10
• .No depression:7-10
• .Mild depression:4-6
• .Severe depression:0-3

19. • Assessment should be done in a comfortable warm
room with good light. Safety measures should be
followed especially, about prevention of infection.
All information should be recorded immediately, if
possible mother should be allowed to be along with
baby to promote bonding process

20. VITAL STATISTICS
Parameter Average
• Weight 6.5 to 7.5 lbs (2.9 kg -3kg)
• Length 50 cm (20 inches)
• Head circumference 33 to 35 cm (13 to 13.7 in)
• Chest circumference 31 to 33 cm or2cm less
than head circumference
• Abdominal circumference 31 to 33 cm

21. VITAL SIGNS
• Vital Sign Immediately At Birth AfteBirth
• Temperature 36.5 to 37.2 Celsius
• Pulse 180 beats/minute 120-140 B/M
• Respiration 80 brths/m 30-50b/m
• Blood Pressure 80/46 mmHg 100/50 mmHg
(by 10th day)

22. ASSESSMENT OF GESTATIONAL
ASSESSMENT AT BIRTH
PHYSICAL CHARACTERISTICS TERM BABY
• Hair texture and distribution on scalp Silky, black coarse and individual strants
• Skin texture and opacity Pink, scanty lanugo and only large veins
are seen. Good elasticity and turgor
• Breast nodule and nipple formation More than 10mm diameter breast
tissue and nipple raised above skin level
• Ear cartilage Pinna is firm with definite cartilage and
Instant recoil
• Planter creases Entire sole covered with deep creases
• Genitalia-Male At least one testes descends in the scrotum
Prominent rugae and deep pigmentation
• Genitalia-Female Labia majora completely cover the
labia minora and clitoris.

23. PHYSICAL EXAM
• A complete physical exam is an important part of newborn
care. The healthcare provider checks each body system is
carefully for health and normal function. The provider also
looks for any signs of illness or birth defects. Physical exam
of a newborn often includes:
• General appearance. This looks at physical activity, muscle
tone, posture, and level of consciousness.
• Skin. This looks at skin color, texture, nails, and any rashes.
• Head and neck. This looks at the shape of head, the soft
spots (fontanelles) on the baby’s skull, and the bones across
the upper chest (clavicles).

24. • 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)
• 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

25. CARE OF NEWBORN BABY
• Newborns undergo profound physiologic changes at
the moment of birth, as they are released from a
warm, snug dark liquid-filed environment that has
met all of their basic needs, into a chilly ,unbounded
brightly lit gravity based outside world. The
immediate care that a child need is :
• 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.

26. • About 80 percent of the newborn babies require
minimal care.
• The normal term babies should be kept with their
mothers rather than in separate nursery. Rooming in
promotes better emotional bondage, and
establishes breastfeeding easily.
• Nursing care of healthy newborn baby after birth
should be provided as immediate care of neonate
and daily routine care.

27. 1.ESTABLISH RESPIRATION AND MAINTAIN
CLEAR AIRWAY
• The most important need for the new born
immediately after birth is a clear airway to enable
the newborn to breath effectively ,since the
placenta has ceased to function as an organ of gas
exchange. It is in the maintenance of adequate
oxygen supply through effective respiration that the
survival of the newborn greatly depends.
• Wipe mouth and nose of secretions after delivery
of the head

28. • 2.Suction secretions from the mouth and nose,
compress bulb syringe before inserting suction mouth
first ,then the nose insert bulb syringe in one side of the
mouth.
• 3,A crying infant is a breathing infant, stimulate the
baby to cry if baby does not cry spontaneously or if the
cry is week . Do not slap the buttocks rather rub the
soles of the feet. Stimulate to cry after secretions are
removed ,The normal infant cry is loud and husky and
observe the following abnormal cry:

29. • High pitched cry- indicates hypoglycemia.
• Week cry- prematurity.
• Hoarse cry-laryngeal stridor.
• 4.Keep the nares patent remove mucus and other
particles that may cause obstruction because
newborns are obligatory nose breathers until they
are about 3 weeks old.

30. 2.WARMTH:
• Warmth is provided by keeping the baby dry and wrapping
the baby with adequate clothing in two layers, ensuring head
and extremities are well covered because baby looses heat
through evaporation, radiation, conduction and through
convection. Baby should be kept by the side of the mother,
so that the mother’s body temperature can keep the baby
warm. Baby can be placed in skin to skin contact with mother
to maintain temperature of infant and facilitate breathing .
Ambient atmospheric temperature to be kept warm
adequately(28 -32 c) and if the temperature falls below 25c
then the baby should be kept under incubator to maintain the
normal temperature of the baby.

31. 3.SKIN CARE
•
• The baby must be cleaned off blood, mucus and
meconium by gentle wiping before he/she is
presented to the mother. During hospital stay no bath
should be given to the infants and dose not reduce
the incidence of neonatal infections, No vigorous
attempts should be made to remove the vernix
caseosa as it provides protection to the delicate skin.
Each baby should have own separate clothing and
articles for care to prevent cross infection.

32. 4.CARE OF THE UMBILICAL CORD
• The umbilical cord is cut about 2 to 34 cm from the
navel with aseptic precautions during delivery and
tied with sterile cotton thread or disposable plastic
clip. The cord must be inspected afterwards for
bleeding which commonly occurs due to shrinkage
of cord and loosing of ligature. No dressing should
be applied and the cord should be kept open and
dry. Normally it falls off after 5 to 10 days but may
take longer especially when infected

33. 5. CARE OF THE EYES
• 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. The eyes should be observed for
redness ,sticky discharge or excessive tearing for
early detection of problems and prompt
management

34. 6.VITAMIN K ADMINSTRACTION
• Shortly after birth vitamin K is administered as a single
intramuscular dose of 0.5 TO 1 mg to prevent
hemorrhagic disease of the newborn also called vitamin
K deficiency bleeding. Normally vitamin K is synthesized
by the intestinal flora ,however because the infants
intestine is sterile at birth and because breast milk
contains low level of vit.K the supply is inadequate for at
least first 3 to 4 days. The major function of vit,K is to
catalyze the synthesis of prothrombin in the liver which
is needed for blood clotting.

35. 7.HEPATITIS B VACCINE ADMINSTRATION
• To decrease the incidence of hepatitis B virus in
children and its serious consequences, cirrhosis
and liver cancer in adulthood the first of three doses
of hepatitis B vaccine is recommended soon after
birth and before hospital discharge for all newborns.

36. 8.BREAST FEEDING
• The baby should be put to the mothers breast
within half an hour of birth or as soon as possible
the mother has recovered from the exertion of
labor. All babies should invariably receive the
colostrums during first three days of life. Mothers
should be informed about the importance and
technique of breastfeeding .Initially the feeding
should be given in short intervals of 1 to 2 hrs and
then every 2 hrs. Nurses should assist the mother to
feed her baby adequately for the maintenance of
hydration and optimum nutrition. Exclusive
breastfeeding procedures should be explained to
the mother and family members.

37. 9.PROTECTION FROM INFECTION AND
INJURY
• The most important practice for preventing cross -
infection is thorough hand washing of all the
individuals involved in the infants care . other safety
measures are practiced ,particularly in terms of
proper identification and screening tests are used to
detect various disorders.

38. ROUITINE CARE OF THE NEW BORN
• The newborn baby should be kept with the mother for
continuous mothering in hospital or in home in a well-
ventilated room .Baby should be handle with gentle
approach after proper hand washing. No infected
person should take care or touch the baby. Baby should
be allow to sleep in supine position which can prevent
sudden infant death syndrome. General cleanliness to
be maintained and surrounding to be kept clean.
Mother should be taught about art of mothering and to
provide stimulation of touch and sound the baby.

39. OBSERVATION
• The baby should be thoroughly observed twice daily
for early detection of any abnormality. Temperature,
pulse/heart rate respiration, feeding behaviors
,stool, urine and sleeping pattern should be
assessed .Mouth, eyes cord and skin should be
looked for any infection. Daily routine observation is
essential to detect the presence of danger signs for
early interventions.

40. WEIGHT RECORDING
• The average daily weight in healthy term babies is
about 30-g/day in the first month of life. It is about
20g/day in the second month and 10g/day
afterwards during the first year of life. Most infants
double their birth weight by 4 to 5 months. But in
the first week of life there is physiological loss of
body weight due to removal of vernix ,mucus, blood
passing of meconium and reduction of extracellular
blood volume, With breast feeding majority of the
babies regain the weight within the 7 to 10 days.

41. IMMUNIZATION
• In institutional delivery all neonates should be
immunized with BCG vaccine and O dose of OPV.
Hepatitis B vaccine can be administered at birth as
first dose and other two doses in one month and six
month of age.
• Mother should be informed about the
recommended National immunization schedule and
explanation to be given about importance of
complete immunization and all possible reactions
following vaccinations epically about BCG vaccine .

42. FOLLOW UP AND ADVICE
• Each infant should be followed up at least once every
month for first three months and subsequently 3 months
intervals till one year of age. Follow up is necessary for
assessment of growth and development early detection
and management of health problems .Health advice should
be given during hospital stay and at the time of discharge
regarding exclusive breast feeding, warmth, hygienic
measures and immunization. Danger sings related to child
hood illnesses should be explained to the mother and
family members. Preventive measures against various child
health problems like ARI, and Diarrhea should be informed.

43. CARE TO THE FAMILY
• Illness and hospitalization are often critical events that a
child is faced and the stress of it can effect all the family
members, maternal stress and anxiety can also affect
the child in two ways, transferring stress to the child
and interfering with the mothers ability of childcare,
Many aspects of the parents life will change during
hospital stay, including their natural needs, social and
economic issues which can cause stress and anxiety for
the parents.

44. • Feeling of stress and anxiety are often associated
with the lack of information on disease and
medical procedures, unfamiliarity with the hospital
rules and regulations , unfriendly staff and being
afraid of asking questions .It is the nurses
responsibility to provide care to the family during
their hospital stay by:
• 1.Aware the family about the hospital policies, staff
pattern.

45. • 2.Allow the parents in taking care of their child, this
promotes the bonding process.
• 3.Give positive feedback to the parents when they need
the assistance of the nurses.
• 4.Assess the family situation regularly.
• 5.Nurses should provide supportive environment.
• 6.Provide support in decision making.

46. • 7. Be available to the family when they need assistance .
• 8. Nurses should strengthen the coping abilities of the
family members.
• 9. what ever the information they need the nurse
should be available to provide about the Childs health.
• 10. Help the family to be involved in various
organizations which provide financial assistance to the
child during their course of treatment, so that financial
support will be provided.

47. REFERENCES
1. Dutta. D.C, Textbook of obstetrics, seventh edition.
2. Dorothy R. Marlow, RN., Ed.D, Textbook of pediatric
nursing, W.B.Saunders, sixth edition.
3. Ghai.O.P, Essential pediatrics, CBS publishers, seventh
edition.
4. Dutta Parul, Pediatric nursing, jaypee publications,
third edition.
5. Nancy T Halfield, Broadribb’s; Introductory pediatric
nursing, seventh edition.
6. IAP, Textbook of pediatrics, jaypee brothers’ medical
publishers, fifth edition.
7. www.google.com.
8. Terri Kyle and Susan Carman, “Essentials of Pediatric
Nursing” 2nd Edition Lippincott Williams and Wilkins.
9. Ripple Sharma, ‘a text book Pediatric nursing’ 2nd. ed.