1. The Normal Newborn Assessment and Care

2. Three transition phases • Phase One: the first hour • Phase Two: from one to three hours • Phase Three: from two to 12 hours

3. Care at birth (nurse’s job) • Call out time of birth • Receive the baby onto a warm clean towel and place on mother’s chest • Clamp and cut the umbilical cord • Dry the baby with a warm, clean towel or piece of cloth • Assess baby’s breathing while drying Steps 3

4. Care at birth… • Wipe both eyes (separately) with sterile gauze pieces • Put the baby between mother’s breasts for skin-to-skin contact • Place an identity label on the baby • Cover mother and baby with warm cloth; put a cap on the baby’s head • Initiate breastfeeding 4 NC-

5. Prevention of infections After delivery • Hand washing before handling the baby • Exclusive breastfeeding • Keep the cord clean and dry; do not apply anything • Use a clean cloth as a diaper/napkin • Hand wash after changing diaper/napkin 5 NC-

6. Priorities in first hour • Cardiovascular assessment and support • Thermoregulation • Assessment and support of blood glucose • Identification • Observing urinary/meconium passage • Observing for major anomalies and for apparent gestational age concerns

7. APGAR ASSESSMENT • One and five minutes • Meant to identify the need for neonatal resucitation

8. APGAR SCORE

9. Criteria 0 1 2 Color Blue or pale Acro-cyanotic CompletelyPink Heart Rate Absent Slow    (< 100/min) >100/min Reflex irritability No response Grimace Cough, sneeze, cry Muscle tone Limp Some flexion Active motion Respirations Absent Slow, irregular Good, crying APGAR SCORE

10. Vital Sign Normals • 97.7-98.6 F (36.5-37 C) • 110-160 • A soundly sleeping baby can go to 80 bpm • A crying baby may be as high as 180

11. Voids and Stools • Document from the moment of birth • Urination sometimes missed in early minutes • Generally expect both within the first 24 hours • One really wet diaper per day of age until milk is fully in.

12. Quick Assessment of Gestational Age • Skin • Vernix • Hair • Ears • Sole Creases • Resting Posture

13. Cracked Skin

14. Abundant Lanugo

15. Ear of a preterm infant

16. Sole creases

17. Comparison of resting posture

18. Routine Medications • Erythromycin Eye Ointment • Aquamephyton (vitamin K) • First Hepatitis B vaccine

19. Physical Characteristics During Phases Two and Three

20. Nervous System: Reflexes • Head lag • Moro reflex • Rooting • Tonic Neck reflex • Dancing reflex • Magnet reflex • Rooting reflex • Suck • Hand and foot grasp • Babinski • Trunk incurvation • Observe for symmetry

21. Head Lag

22. Moro Reflex

23. Tonic Neck Reflex

24. Dancing Reflex

25. Suck Reflex

26. Hand Grasp

27. Foot Grasp

28. Head • Head circumference • Molding • Fontanelles • Anterior closes between 12-18 months • Posterior closes by the end of the 2nd month

29. Eyes • Eye placement • Blink reflex • Discharge • Pupil reaction

30. Hearing • Check overall response to sudden sound • Moro reflex • Check for placement of ears • Low set ears may indicate a congenital anomaly • Most infants receive hearing screening within the first week of life

31. Respiratory and Cardiovascular • Ongoing assessment of cardio respiratory status that has occurred since birth • More thorough heart assessment • Murmur may be present until fetal openings have completely closed however they must be carefully verified by pediatrician • Femoral and brachial pulses • Abdominal breathing; nose breathers

32. Femoral Pulses

33. Brachial Pulses

34. Assessment of Respiratory Status

35. Musculoskeletal • Symmetry!! • Five finger and five toes!!! • Clavicles • Movement of arms • Hips for developmental hip dysplasia • Lower legs/feet for “club foot” • Back: curvatures, cysts or dimples

36. Hip Check

37. Hip Check Skin Folds

38. Gastrointestinal • Passage of meconium • Abdomen should be soft and non tender • Round but not distended • Bowel sounds are present after first hour of birth • Umbilical cord inspection

39. The Normal Newborn Care measures for the normal newborn plus a little more.

40. Jaundice • Yellow coloring of an infants skin • Common and is caused by the natural breakdown of RBCs in the infant after birth • Is never considered normal in the first 24 hours.

41. Physiologic Jaundice • Most jaundice in newborns is physiologic • It peaks between 48-72 hours • Usually disappears within a week • Usually benign • Can become elevated to a point of concern for the baby

42. PHOTOTHERAPY