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Prepared By /lamiaa Elsayed Pediatric Nursing Immediate care of newborn 1

Immediate care lamiaa slide share

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Prepared By /lamiaa Elsayed

Pediatric Nursing

Immediate care of newborn 1

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The 1st 24 hours

of Life

The first 24 hours of life is a very significant time due to critical transition from intrauterine to extra uterine life .

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Purposes of immediate care of newborn

• Establish and maintain respiratory function.

• Provide warmth and prevent hypothermia.

• Ensure safety from injury and infection.

• Identify actual and potential problems that might require immediate action.

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Immediate Care of the Newborn

• Airway

• Breathing• Temperature• APGAR• IDENTIFICATION

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Implementation:• Oro-pharengeal Suctioning:

• 1.Wipe the neonate’s mouth with a piece of gauze around your index finger once his head has been delivered.

• Wrap and dry the neonate in a warmed towel.

• Suction the neonate’s mouth with a disposable Suctioning.

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Implementation:• Place the neonate in a radiant warmer.

• Replace the wet towel and wrap the neonate in another dry towel.

• Place newborn in trendlenburng position.

• Do suction of oropharyngeal canal.

• Oxygen may be given.

• Continue suction as fluid is aspirated.

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Dry the Baby• Hypothermia is common• Wet newborns rapidly lose

heat• Use a warm, dry, soft towel• Any absorbent material:

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Replace the Wet Towels• Then let the mother

hold the baby• Her body heat will

help keep the baby warm

• Cover the head to prevent heat loss

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POSITIONING OF THE NEWBORN

• Positioning

Right side lying

1. promote drainage secretion

2. fasten gastric emptying time

• good airway.

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Airway & Breathing

• Suction gently & quickly using bulb syringe or suction catheter

• Starts in the mouth then, the nose to prevent aspiration

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Suction first from Mouth and then from Nose Use a by use of bulb syringe

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Airway & Breathing

• Stimulate crying by rubbing

• Position properly- side lying / Provide oxygen when necessary

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Assess the newborn’s condition

A- One minute APGAR Score& reassess at 5 minutes.

B-Neurological examination by checking common reflexes of the newborn.

C-Vital signs pulse, respiration & temperature.

D-Growth measurement include length, weight, head & chest circumferences.

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Assess the newborn’s condition

E-Assess for any gross abnormality, congenital defects in head,

F- eyes, ears, chest, spine,. face, nose, abdomen, anus, external genitalia &extremities.

G-Assess for any signs of eye infection.

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Apgar score

• The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two and summing up the five values.The resulting Apgar score ranges from zero to 10.

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APGAR Scoring System

A ctivity/ Muscle Tone

P ulse/ Heart Rate

G rimace/ Reflex Irritability/ Responsiveness

A ppearance/ Skin Color

R R espiration/ Breathing

1 2 3 4 5

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APGAR

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Apgar score

PinkPinkBody pink , Body pink , extremities blueextremities blue

Blue or Blue or palepale

ColorColor

CryCryGrimaceGrimaceNo No responseresponse

Reflex Reflex irritabilityirritability

Active motion , Active motion , extremities well flexed .extremities well flexed .

Some flexion of Some flexion of extremitiesextremities

nonenone Muscle toneMuscle tone

Good , strong cryGood , strong cryWeak cryWeak cryAbsentAbsentRespiratory Respiratory efforteffort

Above 100Above 100Below 100Below 100AbsentAbsentHeart rate(pulse Heart rate(pulse

221100Sign Sign

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Significance of Apgar score

• Healthy newborn: 7-10 at both 1 and 5 minutes .• Moderately depressed newborn : 3-6 ( Need

resuscitation )• Severely depressed newborn : 1-2 ( Intensive

resuscitation )

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Cord Care

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Cord Care

• Use sterile plastic clamp or ligature, the first ligature is placed about 2.5-3 cm from the abdomen & second ligature is placed about 1cm from the first ligature.

• Press between the two ligatures.

• Cut the cord by blunt sterile scissor after the second clamp.

• Examine umbilical cord structure (two arteries and one vein)Immediate care of newborn 22

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Cord Care Continue

• Paint the end of the stump with alcohol.

• Clean the cord at the base of cord firstly, then the stump from down to up with one direction and cleaning the cord clamp.

• Let the cord exposed not covered by the diaper.

• Assess the signs of cord healing and signs of infection (erythema edema tenderness).

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Cord Care

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Eye care:• Clean the eye lids é sterile warm sterile

water and cotton.

• Wipe from inner to outward.

• Install one drop of solution of isophenicol.

• Wipe the excess of solution by clean cotton.

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Vitamin K Injection• Administer 1mg. Vitamin K by I.M

injection.

• Route: IM into the lateral anterior thigh (Vastus lateralis).

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Vitamin K Administration

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Identification of the newborn

• Identification of the newborn which place on wrist & ankle (mother name, hospital no, sex, weight of newborn).

• Before transferring to nursery, ID tag should be applied.

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Dressing/ Wrapping

• “Mummy”• Wrap in warm

blanket• Cover head with

stockinette cap

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Assessment of vital signs •temperature : the axillary method is the safest .Normal axillary temperature is 36 – 36.5 °C

•Heart Rate ( HR ) :HR is counted for 60 seconds at the apex of the heart (Range

from 100- 160 b/m immediately after birth ) .

•Respiratory Rate ( RR ) :RR varies from 30- 60 b/m when the infant is not crying .

•Blood Pressure ( BP ) :Not routinely assessed in healthy term infants .The range of normal blood pressure in term infants is 60- 90

mmhg for systolic pressure and 40 – 50 mmhg for diastolic pressure .

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ANTHROPOMETRIC MEASUREMENT

• HEAD CIRCUMFERENCE : 33-35cm

• CHEST and ABDOMEN : 31-33cm

• LENGTH : 47-54cm

• WEIGHT : 2500-4000 gramsImmediate care of newborn 31

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Assessment of Growth

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Neurologic System

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Neonatal Primitive Reflexes

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Reflexes

Include the Moro , startle , palmer and planter grasps, sucking and rooting and swallowing reflexes, tonic neck reflex ,stepping , and babinski sign .

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Moro Reflex or startle reflex• quick change in the infant's position will cause the infant to throw the

arms outward, open the hands, and throw back the head.

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Palmer grasp

• Palmar and plantar grasp - the infant's fingers or toes will curl around a finger placed in the area

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planter grasp

• Palmar and plantar grasp - the infant's fingers or toes will curl around a finger placed in the area

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Babniski reflex

• the infant's foot is stroked, the toes will extend upward.

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Rooting reflex

•This reflex begins when the corner of the baby's mouth is stroked or touched.

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Sucking reflex

• When the roof of the baby's mouth is touched, the baby will begin to suck.

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Asymmetric tonic neck reflex

Tonic neck reflex - When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow.

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Dance or step reflex• This reflex is also called the walking or dance reflex because a baby appears to take steps

or dance when held upright with his/her feet touching a solid surface.

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