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The Normal Newborn: Assessment, Care, Feeding Presented by, Joy Haskin, RN, MS

The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

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Page 1: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

The Normal Newborn:Assessment, Care, Feeding

Presented by,

Joy Haskin, RN, MS

Page 2: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Joke for the day….

Should children witness childbirth?

Page 3: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

TERMS:

Neonatal Period:Birth --> 28 days of life

Term Infant:38 - 42 weeks of gestation

Transition Period: Phases of instability during the first 6-8 hours after birth

Page 4: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Viability

Capacity to live outside of the uterus - about 22 to 24 weeks since the last menstrual period, or fetal weight greater than 500 g.

In the past was 28 weeks - with technology and advancements this is becoming shorter and shorter…...

Page 5: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Physiologic Changes of the NB to adjust to extrauterine life:

What happens during birth to the neonate?

Page 6: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Circulatory:

Transitional Circulation = acrocyanosisPeripheral circulation = sluggishHigh: RBC 4.8-7.1; Hgb 14-24; Hct 44-64WBC 18,000 @ birth; 23-24,000 @ 1 day Coagulation: Vit K dependent clotting

factors are decreased.Platelet counts ok (150,000-350,000)

Page 7: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Respiratory

Before birth O2 needs met by placentaL/S ratio should be > 2:1After delivery need mature lungs that

are vascularized, have surfactant and sacules - usually adequate by 32-35 weeks-

at term the lungs hold approx. 20 ml of fluid/kg

What initiates respiration?

Page 8: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Periodic Breathing -vs- Apnea

Apnea: no breathing for periods of greater than 15 seconds should be evaluated.

Periodic Breathing:

Notify MD if resp < 30 or > 60

Page 9: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Gastrointestinal System

Immature at birth, reaches maturity at 2-3 years of age

place food at back of tonguesucking becomes coordinated @32

wkslittle saliva until 3 months of agebowel sounds after 1 hour of birth

Page 10: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Gastrointestinal (continued)

NB have difficulty digesting complex starches and fat

Abdomen becomes easily distended after eating

Initial fecal material = meconiumNo normal flora at birth in GI system

to synthesize Vit. K

Page 11: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Immune System

Limited specific and Non-specific immunity at birth

passive immunity(from mom- IgG) for the first 3 months of life ~ this will be reduced if baby is born premature

breastfeeding = ^ passive immunity (IgA)

Page 12: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Temperature Regulation

Non-Shivering thermogenesis:brown fat is the primary source of heat

production. Brown fat is broken down into glycerol & fatty acids producing heat.

Brown fat is found @ the nape of the neck, axillae, around the kidneys and in the mediastinum.

Slightly warmer to touch than nml skin.

Page 13: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Cold Stress

An increase in the metabolic rate associated with non-shivering thermogenesis --> increased O2 demands and caloric consumption

It’s important to provide a neutral thermal environment to prevent metabolic acidosis and prevent depleted brown fat.

Page 14: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Kidneys and Urination

92% of all healthy infants void in the first 24 hrs of birth

initial urine:cloudy, scant amounts, uric acid crystals-> reddish stain on diaper

Kidneys not fully functional until child is 2 years of age.

Page 15: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Hepatic Function

Liver produces substances essential for clotting of blood.

Stores needed iron for the first few months. Preterm & small infants have lower iron stores than full term and heavier infants. (full term infants stores last 4-6 mo)

NB at risk for Physiologic Jaundice after 24 hours of age, d/t increased breakdown of RBC’s and immature liver functioning.

Page 16: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Increased Bilirubin Levels

Jaundice in the 1st day is NOT normalBilirubin level greater than 12 at any

time needs further attentionMaternal causes of increased bilirubin

levels in the NB: epidural use, oxytocin induced labor, infection, hepatitis

Ethnic Influences: Asian infants levels may be double other ethnic groups.

Page 17: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Kernicterus

Complication of neonatal hyperbilirubinemia --> encephalopathy

basal ganglia and other areas of the brain and spinal card are infiltrated w/ bilirubin (produced by the breakdown of hemoglobin -> levels of 20 - 25 or more).

Poor prognosis if untreated.

Page 18: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Neurologic

All neurons are present, but many are immature:

uncoordinated movementspoor muscle control

startle easilytremors in extremities

Page 19: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Weight Loss

It is normal for the newborn infant to loose 5-10% of weight in the first 4 to 5 days of life.

Page 20: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Infants at Risk

“RED FLAGS” after birth include:gagging --> turning blue (esp. after fdg)

generalized cyanosis weak cry

grunting or respiratory distress decreased or absent movements excessive twitching or trembling

OTHERS>>>>>

Page 21: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Nursing Diagnosis:

Ineffective Airway Clearance R/T excessive oropharyngeal mucus

Ineffective Thermoregulation R/T newborn transition to extrauterine life

High Risk for infection R/T maturational factors, immature immune system

PC: Hypoxemia PC: Hyperbilirubinemia(W) Beginning Integration of NB into Family

Unit

Page 22: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Nursing Care to Meet NB Needs

Prevent infection:handwashing, stay away from large

groups or ill individuals, prophlactic agents (EES, cord care, bathing)

VernixBreastfeeding

Page 23: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Warmth

Bath after temperature is stablewarmer/isolette/bundlehatkeep out of draftsskin to skin

Page 24: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Position of sleep/prevent SIDS

Back to sleepfeet to foot of bedno stuffed animals or excessive

blankets in beddon’t cover head in strollerdon’t keep house too warmNo smoking around infant

Page 25: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Cleanliness

No tub baths until cord off and healedclean around organs of elimination and

mouth after soiling to prevent skin break down

daily head to toe bath not necessaryOK to clean and touch the “soft spot”fold diapers away from umbilicusNEVER leave child alone in tub!!

Page 26: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Research and Cord Care

1,811 NB’s- 2 groups - one receiving cord care with alcohol and one group not:

* equal # infections in infants who received and did not receive cord care

*cord separation ~ alcohol use: 9.8 days

–no alcohol used: 8.16 days

Page 27: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Carseats

“AS a condition for licensure, public and private hospitals, birth centers, and clinics must have a written policy on the dissemination of child passenger restraint system information to parents or the person to whom the child is released” (SB503 REQ)

Page 28: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Genital Care

Male Infant: if penis is uncircumcised DO NOT RETRACT THE FORESKIN--- “leave it alone”

Female Infant: wipe front to back. If “smegma” has accumulated in the labial folds it can be carefully removed

Page 29: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Infant Feeding

Why may a mother decide to Breast Feed?

Discussion

Page 30: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Formula feeding

Why may a mother decide to formula feed her infant?

Discussion

Page 31: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Frequency of Feedings

Breastfeeding: successful latch-on and feeding should occur every 1.5 to 3 hours daily.

Formula Feeding: 3-4 oz every 3-4 hours for full-term babies.

Baby should have 6-10 wet diapers/daycalculate amnt of formula mult. baby’s wt

in lbs by 2 then 3, this is oz per day. (EX: 8lb. Baby~ 8 X2 = 16; 8 x3 = 24 therefore 16-24oz of formula

per day is needed for adequate nutrition)

Page 32: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Nursing Diagnosis

Effective BreastfeedingRisk for Altered Nutrition (more or

less than body requirements) R/T (insufficient caloric intake or excessive caloric intake)

Page 33: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Circumcision

Elective ProcedureNot pd for by medi-calDecision made based on tradition,

religion, culture, or personal factorsVALUE

OPPOSITION

Page 34: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Procedure

Usually delayed 12 to 24 hours until NB is stabilized

Do not feed 1 hr prior to procedureConsent required from one parentMethods: Gomco or PlastibellRestraint requiredAnesthetic is physician dependent

Page 35: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

After Care

Comfort measureskeep wound clean and dry (warm

water)ck urination w/in 12 hrs after

proceduremonitor for bleedings/s of infection will not occur

immediately after procedure

Page 36: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

Periods of Reactivity

REVIEW1st period of reactivity:after birth of baby,

bursts of rapid movements. Quiet times during this period are ideal for breastfdg & interacting

Deep Sleep - lasts 60-100 minutes2nd period of reactivity: occurs 4-8 hrs after

birth lasts 10 min to several hours. Periods of tachycardia & tachypnea. Increased muscle tone, skin color, mucus production, pass meconium

Page 37: The Normal Newborn: Assessment, Care, Feeding zPresented by, zJoy Haskin, RN, MS

The end….