P.point Newborn Care

8/14/2019 P.point Newborn Care

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NEWBORN CARE

As soon as the infant is born, she should

be dried and stimulated. Airway,

breathing and circulation are alsoassessed at the time of delivery. Keeping

the principles of preventing heat loss in

mind, youll remove wet linens and place

a cap on the newborns head.


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SUCTIONING THE NEWBORNTo prevent aspiration and to promote airway clearance

1. Lay baby to his side in the bassinet positioning him/her in slight trendelenberg(10-15 degrees angle).

2. Suctions the newborn observing the following considerations.

a. Starts with the mouth, then with the nose.

b. Uses a bulb syringe, deflates the ball of the bulb syringe before

inserting it to the mouth or nostril of the newborn as soon as the head is out of

the vaginal vault. Then release bulb compression to suction secretions.

c. When using mechanical suction machine, control the pressure bypinching the catheter (French #8 or #10) as it is withdrawn from the nose or

mouth.

d. Suctions secretions first on the mouth before the nose by rotating it

in a gentle manner.

e. Withdraws the catheter taking precautions not to traumatize the

membrane.f. Suction briefly and observes correct and safe suctioning periodPreterm less than 5-10 seconds per suctioning time.Full term 5-10 per suctioning time.

g. rinses the catheter with sterile water.

h. Take notes or secretions obtained as to color and consistency.


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KEEPING THE NEWBORN WARM

1. Dries the newborn right after birth to prevent heat loss by

evaporation.

2. Wraps the body and promotes flexion preventing heat loss byconvection and radiation.

3. Avoids pacing the newborn on cold and unlined surfaces

preventing heat loss by conduction.

APGAR SCORING

The Apgar score was devised in 1952 by Dr. Virginia Apgar as a

simple and repeatable method to quickly and summarily assess the

health of newborn children immediately after childbirth. Apgar was

an anesthesiologist who developed the score in order to ascertain

the effects of obstetric anesthesia on babies.

The Apgar score is determined by evaluating the newborn baby on

five simple criteria on a scale from zero to two, then summing up

the five values thus obtained. The resulting Apgar score ranges

from zero to 10. The five criteria (Appearance, Pulse, Grimace,

Activity, Respiration) are used as a mnemonic learning aid.


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Score of 0 Score of 1 Score of 2 Component of

acronym

Skin

color/Complexion

blue or pale all over Bluish discoloration

of hands and feet,

body pink

(Acrocyanosis)

no cyanosis,

body and extremities

are pink

Appearance

Pulse rate 0


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Interpretation of scoresThe test is generally done at one & five minutes after

birth, and may be repeated later if the score is and

remains low.

Scores 0 to 3 = Severely asphyxiated & requires

assisted ventilation.4 to 6 =Moderate respiratory depression & will usually

respond to stimulation & supplemental O2.

and 7 to 10 = Generally normal & no resuscitativemeasures needed


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PROVISION OF SKIN CARE

1. Render immediate soap and water bath to normal fullterms to

cleanse the skin of mucus, blood, at times meconium, in order to

prevent infection.

2. Give oil bath to preterm and high-risk infants. If oil bath wil be

given, follows the following procedures:

a.Scrub the hands with soap and water.

b.Cleanse babys face with lukewarm water using sterile cotton balls.

Applying single stroke from the inner to outer canthus of the eye.c. Cleanse babys skin using cotton balls wet with oil and water.

d. Continue to clean the following areas:

d.1. scalp

d.2. neck

d.3. chest

d.4. upper extremitiesd.5. back

d.6. lower extremities

d.7. genitalia and anus

e. Change cotton balls as often as necessary.


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OIL BATHING the normal fullterms using mineral oil is done prior to warm water bath.

1. Test the temperature of water with your elbow.

2. Wet washcloth with plain water first. Unwrapped the baby and start bathing the baby using

the following sequence:Football hold the newborn

EYES: start from the inner to outer canthi using the wash cloth, using the different portion of

the wash cloth.

NOSE AND CHEEKS: using the same wet wash cloth clean from the nose to the cheeks in

one direction, repeat on the other side. No attempt should be made to cleanse the nose

internally.

EARS: gently wipe external ear and behind the ear, never probe the ear canal.

HEAD: gently lather the hair using a mild soap or a baby shampoo, a soft brush maybe used.

NECK: hyperextend the neck, then wipe with a soapy washcloth.CHEST AND ABDOMEN (TRUNK): clean the trunk including the periumbilical area using the

soapy washcloth moved in long gentle motion, making sure that the cord is not soaked.

ARMS AND HANDS: washcloth in long gentle motions, wash the armpits and the interdigital

area.

BACK: in a side lying position wash the back including the buttocks using a long gentle

strokes.

LEGS AND FEET: wash in long gentle motions; include the webs between the toes.

GENETALIA

FEMALE: wash from the front to back unidirectional using a clean wet cotton ball

for each stroke.

MALE: gently retract the foreskin then clean the glands penis using clean wet

cotton balls. If the foreskin cannot be retracted, it must not be forced.

3. Using the same sequence, rinse quickly and thoroughly then dry the baby from head to toe.

Special attention to skin folds.


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CORD DRESSING

After birth, the umbilical cord falls off between 2-3 weeks.

Risk of improper (unsterile) cord care:

Omphalitis is the medical term for infection of the umbilical cord

stump in the neonatal newborn period. Most commonly caused by

bacteria such as Staphylococcus aureus and Streptococcus etc.Tetanus neonatorum- infection of umbilical area with Clostridium

tetani, often a result of unsterile & ritualistic practices. Tetanus Toxoid

(TT) vaccine is given during pregnancy to prevent tetanus to the

pregnant mother as well as the baby.


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Procedure:

1. Perform cord dressing under strict aseptic technique to prevent tetanus.

2. Examine the cord carefully for the presence of (3) blood vessels; (1) Umbilicalvein

(left) and (2) umbilical arteries (right and left).3. Prepares the following materials:

a. Forceps

b. Cord tie/clamps

c. Cotton balls with betadine

d. Sterile gauze with 70% alcohol

e. Straight scissors

f. Sterile gloves4. Restraint the baby exposing the umbilicus only.

5 Hold the forcep, clamp to the cord raised upward.

6. Paints the base of the cord with betadine.

7. Decolorizes with alcohol.

8. Place cord tie in the forceps and clamps the cord one (1) inch from the base.

9. Cut the cord with sterile scissors above the clamp providing allowances.

10. Wipes the area with dry cotton ball to remove the Whartons jelly.

11. Paints the top of the cord with betadine then decolorizes with alcohol.

12. Place the cord tie underneath the forceps, and then pulls the tie.

13. Apply gauze with alcohol 70%.


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CREDES PROPHYLAXIS

Prophylactic treatment of the newborns eyes against opthalmia neonatorum

(neonatal conjunctivitis) which the baby acquires as he passes through the birth

canal of his mother who has untreated gonorrheal infection. Prophylactic treatmentmust be administered within 1 hour of birth, but may be delayed until after the first

breastfeeding.

1. Wipe the face dry.

2 Shade the eyes from the light and open one eye at a time by exerting gentle

pressure on the upper and lower eyelids.

3. 2 drops of 1% silver nitrate are instilled - 1 drop into each lower conjunctival

sac. Gently massage the closed eyelid to help spread the solution to the wholearea of the conjunctiva. Advise the parents that transient chemical conjunctivitis

may occur.

4. 0.5% erythromycin a line of ointment 1-2 cm long is placed in each

conjunctival sac from inner to outer canthus. Avoid contact of the tip of tubing to the

eye to prevent eye injury. Gently massage the closed eyelid to help spread the

solution to the whole area of the conjunctiva.-drug of choice to prevent opthalmia neonatorum which is commonly caused by 2

pathogens: Neisseria gonorrhoeae and Chlamydia trachomatis

5. Others: Penicilin/ chloromycetin/ terramycin ophthalmic ointment may be

given instead since it does not irritate eyes. Apply from the inner to outer canthus of

the eye.

Note: Excess solution can be wiped away after at least one minute.


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NEWBORN IDENTIFICATION

1. Perform medical handwashing.2. Prepare the materials needed.

Newborn braceletsInk padNewborn information sheet

3. Accomplish newborn information sheet with pertinent data.4. Hold the baby foot then presses it on the ink pad, and then

transfer it to the information sheet. Foot printing is one of the most

reliable ways of newborn identificationWash off the excess ink with the use of alcoholized gauze

pads, let it dry and then put on the booties.

5. Accomplish the newborn bracelet then attach them to the arm of

the newborn as this will serve as his/her identifier.


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ADMINISTRATION OF VITAMIN KAdministering of Vitamin K intramuscularly in the vastus lateralis muscle within

the first hour after birth. It is given as a prophylaxis for newborn hemorrhagic

disease. The gut has not yet been colonized with Vitamin K producing bacteria,

and to prevent hemorrhagic disease, vitamin K shots are given to babies.

What is Vitamin K?

Vitamin K2(menaquinone) is normally produced by Escherichia colibacteria

in the large intestine but not Vitamin K1

(a.k.a. phytonadione) which is

commercially manufactured and is found in plants. Gut bacteria produce

significant amounts of usable vitamin K. And Vitamin K helps in the production of

coagulation factor II, VII, IX and X.In Hemorrhagic disease of the newborn(e.g Hemophilia B---->A clotting

disorder caused by a congenital deficiency of factor IX), the gut has not yet been

colonized with bacteria, and to prevent this disease, vitamin K shots are given to

babies.Escherichia coli (E. coli) a Gram negative rod-shaped bacterium that is

commonly found in the lower intestine of warm-blooded organisms. Most E. colistrains are harmless. The harmless strains are part of the normal flora of the gut,

and can benefit their hosts by producing vitamin K2

or by preventing the

establishment of pathogenic bacteria within the intestine.

E. coli was discovered by German pediatrician and bacteriologist Theodor

Escherich in 1885.


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Procedure:

1. Performs medical handwashing.

2. Prepares needed materialsCotton balls70% alcoholGauzeMicroporeTuberculin syringe (TB syringe)Vit K. (Aquamephyton,Phytonadione, etc.)

Blankets3. Prepares one (1) mg. of Vitamin K in the tuberculin syringe.

4. Restrain the newborn using the blankets exposing the mid-antero-aspect of

the thigh(vastus lateralis).

5. Using the non dominant hand, locates the injection site while the dominant

hand alcoholizes the mid antero aspect of thigh in circular motions.

6. Discard the cotton balls.

7. Inject 1 mg of Vit K intramuscularly (vastus lateralis) to the site.

8. Secure the injection site with either gauze or dry cotton balls placed with

micropore.

9. Remove the blankets.


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TAKING THE WEIGHT AND ANTHOPOMETRIC MEASUREMENTS

1. Weight (Wt: 2500 gm 4000 gm)Adjust the weighing scale and lines the scale.Places the baby on the scale-nude on the nursery scales at birth to

establish baseline weight.Protects the baby by sheltering hand during the weighing procedure,

never leaving the baby alone.Record the weight taken.

2. Length(L:50-52cm)

Uses a tape measure and measures from the upper end of the head tothe sole of the foot. Seeing to it that the knees are straightened.

3. Head circumference (HC:33-35cm)Using the tape measure, places the end of the tape measure on the

frontal part of the head. Encircling it to the back. Reads and records

measurement.

4. Chest circumference(CC:32-33cm)

Using the tape measure, places it over both breast at the level of thenipple line, extending it to the back, encircling the chest and back. Reads

and records measurement.

5. Abdominal circumference(AC: 31-33cm)Measure the abdominal circumference, tape measure should pass the

umbilicus AC: 31-33cm


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TAKING RECTAL TEMPERATURE

1. Positions the newborn on his back with ankles held in one hand then

raised or flexed toward the abdomen while the dominant hand inserts thethermometer and maintains it in place.

2. Checks the mercury level to 35C.

3. Lubricates the bulb of the rectal thermometer with cotton ball with small

amount of petroleum or oil.

4. Introduces slowly into the rectum of the newborn no more than the length

of the bulb or a maximum of 2.5 cm. (1 inch).5. Keeps the rectal thermometer in place for one whole minute.

6. Removes the thermometer, wipes it with cotton and reads it at eye level.

7. Records the obtained temperature on the chart.

Take note: Notify pediatrician if there is imperforate anus (congenital

defect in which the opening to the anus is missing or blocked. Watch out for

first stool within 48 hours.


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Newborn reflexes

Blink Reflex. A blink reflex in a newborn serves the same purpose as it does in

an adult to protect the eye from any object coming near it by rapid eyelid closure.

Rooting Reflex. If the cheek is brushed or stroked near the corner of the mouth,

a newborn infant will turn the head in that direction. Disappears at about the sixth

week of life.

Sucking Reflex. When a newborns lips are touched, the baby makes a sucking

motion. The sucking reflex begins to diminish at about 6 months of age. It

disappears immediately if it is never stimulated.

Swallowing Reflex. The swallowing reflex in a newborn is the same as in the

adult. Food that reaches the posterior portion of the tongue is automatically

swallowed.

Extrusion Reflex. A newborn extrudes any substance that is placed on the

anterior portion of the tongue. This protective reflex prevents the swallowing ofinedible substances. It disappears at about 4 months of age.

Palmar Grasp Reflex. Newborns grasp an object placed in their finger on it. This

reflex disappears at about 6 weeks to 3 months of age.


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Plantar Grasp Reflex. When an object touches the sole of a newborns

foot at the base of the toes, the toes grasp in the same manner as the

fingers do. This reflex disappears at about 8 to 9 months of age in thepreparation for walking.

Tonic Neck Reflex. When newborns lie on their backs, their heads

usually turn to one side or the other. The arm and the leg on the side

toward which the head turns extend, and the opposite arm and leg

contract. This is also called fencing reflex.

Moro Reflex. A Moro (startle) reflex can be initiated by startling a

newborn with a loud noise or by jarring the bassinet. It is strong for the

first 8 weeks of life and then fades by the end of the fourth or fifth month.

Babinski Reflex. When the side of the sole of the foot is stroked in aninverted J curve from the heel upward, a newborn fans the toes

(positive babinski sign). It remains positive (toes fan) until at least 3

months of age.

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P.point Newborn Care