nursing management of the newborn immediately after the birth of a newborn all parents are
faced with the task of learning and understanding as much as possible
about caring for this new family member even if the parents already have other children
in their new or expanded role as parents they will face many demands and challenges
for most this is a wonderful exciting time filled with many discoveries and much information the
period of transition from intrauterine to extra uterine life occurs during the first several
hours after birth during this time the newborn is undergoing numerous adaptations many of which
are occurring simultaneously the neonates temperature respiration and cardiovascular
dynamics stabilized during this period close observation of the newborn's status is essential
the initial newborn assessment is completed in the birthing area to determine whether the newborn is
stable enough to stay with the parents or whether resuscitation or other immediate interventions
might be necessary a second assessment is done within the first two to four hours
when the newborn is admitted to the nursery or the labor and delivery room where the parents are
the third assessment is completed before discharge the purpose of these assessments is to determine
the newborn's overall health status to provide information to the parents about their newborn and
to identify apparent physical abnormalities during the initial newborn assessment the caregiver will
look for signs that might indicate a problem these include nasal flaring chest retractions
grunting on exhalation labored breathing generalized cyanosis abnormal breathing sounds
abnormal respiratory rates a flaccid body posture abnormal heart rates or abnormal newborn size
apgar scoring was introduced in 1952 by dr virginia apgar the apcar score is used to evaluate
a newborn's physical condition at one minute and five minutes after birth five parameters are
assessed with apgar scoring a quickly to remember the parameters of apgar scoring is as follows a is
appearance p is pulse g is grimace this is reflex irritability a is activity or muscle tone and r
is respiratory each parameter is assigned a score ranging from zero to two points a score of zero
points indicates an absent or poor response a score of two points indicates a normal response
a normal newborn score should be between 8 to 10 points length and weight are two parameters that
new parents are excited to learn about length is measured from the head of the newborn to the heel
with the newborn unclothed the expected length range of a full term newborn
is usually 17 to 22 inches a newborn typically weighs between five pounds eight ounces
to eight pounds fourteen ounces newborns typically lose approximately ten percent of their
initial birth weight by three to four days of age secondary to loss of meconium extracellular fluid
and limited food intake this weight loss is usually regained by the tenth day of life
newborns can be classified by their birth weight regardless of their gestational age a low birth
weight is considered a newborn weighing less than 5.5 pounds very low birth weight is a newborn
below 3.5 pounds and extremely low birth weight would be a newborn weighing less than 2.5 pounds
heart rate and respiratory rate are assessed immediately after birth with apgar scoring
heart and respiratory rates are usually assessed every 30 minutes until stable
for two hours after birth heart rate is obtained by taking an apical pulse for one full minute
the newborn's heart rate is usually between 120 to 160 beats per minute the newborn's respiratory
rate is usually between 30 and 60 breaths per minute and is symmetric with chest movement
once the vital signs are stable the heart rate and respiratory rates are then checked every 8 hours
typically gestational age is determined by using a tool such as the dubits ballard or new ballard
scoring system this scoring system provides an objective estimate of gestational age by
scoring the specific parameters of physical and neuromuscular maturity points are given for each
assessment parameter with a low score of negative one or negative two points or extreme the maturity
up to four or five points for post maturity the scores from each section are then added
up and correspond to a specific gestational age in weeks the physical maturity section of
the examination is done during the first two hours after birth and includes the following
skin texture lenugo plantar creases ears and eyes the skin texture typically ranges from sticky
and transparent to smooth with varying degrees of peeling and cracking to parchment-like or leathery
with significant cracking and wrinkling lenugo is the soft downy hair on the newborn's body
which is absent in premature newborns lenugo appears with maturity and then disappears again
post-maturity plantar creases are the creases on the soles of the feet which range from being
absent to covering the entire foot depending on the maturity the greater the number of creases
the greater the newborn's maturity the eyelids can be fused or open and ear cartilage and stiffness
determines the degree of maturity the greater the amount of ear cartilage with stiffness
the greater the newborn's maturity six activities are evaluated to determine the newborn's degree
of maturity posture square window arm recoil popliteal angle scarf design and heel to ear
posture looks at how the newborn holds his or her extremities in relation to
the trunk the square window assesses how far the newborn's hands can be flexed towards the wrist
the arm recoil considers how far the newborn's arms are able to spring back to a flexed position
popliteal angle looks at how far the newborn's knees extend scarf design explores how far the
elbows can be moved across the newborn's chest an elbow that does not reach midline
indicates greater maturity heel to ear looks at how close the newborn's feet can be moved
towards the ears typically newborns are also classified according to gestational age as follows
a preterm or premature infant would be one born prior to 37 weeks of gestation regardless of
birth weight a term newborn would be considered those born between 38 and 42 weeks gestation
post-term or post-date infants are those born after the completion of 42 weeks of gestation
and postmature and post-mature infants are those born after 42 weeks that demonstrate
signs of placental aging newborns can also be classified as small appropriate or large
small for gestational age are those having a weight less than the 10th percentile on the
standard growth charts usually below five and a half pounds appropriate for gestational age
are infants weighing between the 10th and 90th percentiles large for gestational age
are those with a weight more than the 90th percentile on the standard growth charts
usually above nine pounds immediately after birth a newborn is suctioned to remove fluids and mucus
from the mouth and the nose the newborn will also commonly receive two id bracelets
one on the wrist and one on the ankle the mother receives a matching one usually on her wrist the
id bands usually state the name gender date and time of birth along with an identification number
the same identification number is on the bracelets of all family members the newborn's footprints
might also be taken using a form that includes the mother's fingerprint name date and time of birth
it is recommended that vitamin k be administered to all newborns soon after birth the newborn's
bowel is sterile so vitamin k is not produced in the intestine until after microorganisms have been
introduced such as with the first feeding usually it takes about a week for the newborn to produce
enough vitamin k to prevent vitamin k deficiency bleeding all newborns in the united states whether
delivered vaginally or by cesarean birth must receive an installation of a prophylactic agent
in their eyes within an hour or two after birth this is mandated in all 50
states to prevent a condition called ophthalmia neonatorum which can cause neonatal blindness
aptamia neonatorum is a hyper acute purulent conjunctivitis occurring during the first 10 days
of life it is usually contracted during birth when the baby comes in contact with infected vaginal
discharge of the mother most often both eyes become swollen and red with pearlescent discharge
several medical interventions take place to assist the newborn in maintaining its body temperature
the newborn is dried immediately after birth and wrapped in warm blankets stethoscopes and hands
are warmed before handling the baby or providing care are instructed to avoid placing newborns in
giraffes or near air vents to prevent heat loss through convection also there's often a delay in
the initial bath until the baby's temperature has stabilized this prevents heat loss through
evaporation it is also recommended to avoid placing cribs near cold outer walls to prevent
heat loss through radiation you might also notice that a cap is placed on the newborn's head after
it has thoroughly been dried after bird in some instances the newborn might be placed under a
temperature-controlled gradient warmer the vernix cassiosa is a vic white substance that protects
the skin of the fetus it is formed by secretions from the fetus's oil glands and is found during
the first two to three days after birth it does not need to be removed because it will
be absorbed into the skin molding is the elongated shaping of the fetal skull to accommodate passage
through the birth canal it occurs with vaginal birth from a vertex position in which elongation
of the fetal head occurs it typically resolves within one week after birth without intervention
the newborn's neck will appear almost non-existent because it is so short the neck should move freely
in all directions and should be capable of holding the head in midline position
the newborn should have enough head control to be able to hold it up briefly without support newborn
reflexes includes the following the sucking reflex the moral reflex also called the embrace reflex
that occurs when the neonate is startled there is also the stepping reflex the baby should make
a stepping motion or walking motion alternating flexion and extension with the soles of their feet
the tonic neck reflex resembles the stance of a fencer and is often called the fencing reflex
the rooting reflex is elicited by stroking the newborn's cheek the newborn should turn toward the
side that would stroke and should begin to make suckling motions the babinski reflex is elicited
by stroking the lateral sole of a newborn's foot when this is done the toes should fan out
the newborn also exhibits two grasp reflexes the palmer grass and the plantar grasp
the umbilical cord begins drying within hours after birth and is shriveled and becomes
blackened by the second or third day within seven to ten days it slops off and the umbilicus heals
during this transition frequent assessment of the area is necessary to detect any bleeding
or any signs of infection every state requires the use of car seats for infants and children
because motor vehicle accidents are still the leading cause of unintentional injury and death
in children under five years of age national highway traffic safety administration statistics
show that nearly one half of deaths and injuries in infants occurred because they were not properly
restrained child safety seats when installed and used properly can prevent injuries and save lives
select a car seat that is appropriate for the child size and weight caution caregivers against
the placement of car seats on elevated or soft surfaces outside the car to prevent falling use
the car seat correctly every time the child is in the car use rear-facing car seats for most infants
up to two years of age make sure the harness is in the slots at or below the level of shoulders
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