THE NEWBORN CARE If score is less than 7 at 5 minutes, the score should be performed in 10 minutes.

The Nurses’ Role in MC Care APGAR Score Implementation:

 1. PA of the NB 7-10 - very good; rarely needs resuscitation
a. transitional – immediately after birth (initial) 3-6 - fair requires resuscitation, suctioning signify moderate difficulty
b. physiologic adaptation needs further assessment and medical intervention
 2. Physical/ Behavior 0-2 - poor, requires intensive resuscitation needs intensive medical intervention
 3. Promote parent-infants bonding – be alert in any problems in
Ensure Newborn’s Proper Identification
attachment
1. Check identification band
 4. Prepares the family for discharge
a. name of baby (e.g. Bb boy Fernando)
a. demonstrate physical care of the NB
b. name of mother
b. provide hx/discharge teaching/ info, anticipatory guidance
c. date and time of delivery
d. Doctors (OB and Pedia)
Immediate Care of the Newborn
2. Footprints (depends on agency)
1. Dry the newborn immediately after delivery
3. Baby tag and crib tag. Check always and should match at all times.
2. Clear airway PRN (as necessary)
4. Take fingerprint of mother
3. Assess baby’s response to birth
a. Check APGAR (1-5 mins after birth)
Identification of the Newborn
4. Promote skin to skin contact
• Safety concerns related to newborn identification procedures
5. Ensure newborn’s identification
• Specific facility procedures
6. Take vital signs, anthropometric and do PA
• NCMEC: National Center for Missing and Exploited Children
7. Dress the umbilical cord
• “Profile” of abductor
8. Administer medication
9. Swaddle the baby and place in side-lying position.
Take Vital Signs
10. Give a full bath
• Maintain stable body temperature
• 36.5 – 37.5◦C (99.7-99.5◦ F) axillary
1.Dry newborn immediately
• 36.5 – 37.6◦ C (97.7-99.7◦ F) rectal more accurate
- Wipe and dry using clean warmed blankets
• RR 30-60 breaths per minute
- Place baby in a radiant warmer (put thermometer with probe)
• CR 120-160 beat per minute
- Remove wet linens
• BP seldom taken
- Rub or flick soles of newborn if additional stimulation is required.
- Do not slap buttocks (no beneficial effect)
Maintain Temperature Stability
- Stimulate baby to breathe
• Wrap newborn in a warm blanket and put in a stockinet cap on newborn’s
- Stimulate crying by gentle friction
head.
- Assess characteristic of cry (should be strong and lusty)
• Usually unstable and takes 6-8 hours to stabilize (DOH recommends after
- Assess for nasal flaring, retractions and abnormal respiration
24 hrs)
• Observe for hypothermia/ hyperthermia
Factors Predisposing the Newborn to Excessive Heat Loss
• Sign of infection, dehydration, inadequate clothing, prematurity
• Large surface area results in heat loss to environment
• Newborn’s thin layer of adipose is poor insulator
Maintain Stable Body Temperature
• Newborn cannot shiver to increase heat production
• Mechanisms of NB heat loss
• Metabolizes brown fat stores to generate heat
- Evaporation
- Radiation
2. Clear airway
- Conduction
- Provide for patent airway
- Convection
- Suction PRN
- Newborns are obligatory nasal breather
The Anthropometric Measurements of Newborn
- APGAR SCORE Developed by Virginia Apgar (1950), American
• HC 33 – 35.5 cm (13-14 in) occipito-frontal
anesthesiologist
• CC 31- 33 cm measure at nipple line
• AC 31-33 cm
Purpose of APGAR score:
• Length 48-53 cm (19-21 inches)
1. She devised a scoring system that helped to evaluate a newborn’s physical
• Body weight 2500-4000 grams
condition after birth help to determine any urgent need for emergency or
extra medical care (e.g. acidosis, CPR)
The CORD
2. 2.To evaluate how well the newborn adjust to extra uterine life.
• Apply cord clamp 1in from the base; cut above the cord clamp
3. Assess newborn’s response to birth
• Cord is pearly white gelatinous
4. Performed and record at 1, 5 minutes and 10 minutes as needed
• Assess for the presence of the BV (2 Arteries, 1 vein AVA)
• Assess for intact cord and ensure that clamp is secured
• Cord should be clamped for at least the 1st 24 hours after birth
APGAR Score Interpretation:
• Clamp can be removed when cord is dried (usually on day 2)
7-10 - indicates healthy newborn
• Note for any bleeding or drainage from the cord
3-6 - moderately depressed
• Note for any foul odor from the cord
0-2 - severely depressed
• Monitor cord meconium staining (green = baby stool discharge)

Administer medications
1. Give Crede’s prophylaxis
2. Vitamin K
3. Hepatitis B vaccination
4. BCG vaccine (optional/it depends)
• 1. Crede’s Prophylaxis
1. Application of ophthalmic medication to prevent Ophthalmia
Neonatorum
2. Give eye medications
3. Ophthalmia neonatorum is an infectious conjunctivitis in newborn

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fcnlxa – St. Luke’s College of Nursing
4. An infection contracted in the birth canal of mother w/ gonorrhea or • Measure VS when the infant is still quiet
chlamydia • CR, RR, BP fluctuates with stress, crying,
5. Given within1st hour after birth • movements and sleep wake cycles
6. Rx: ophthalmic ointment or drops
- Erythromycin (0.5%) Heart
- Tetracycline (1%) / Gentamicin • Heart Rate: 120-160 beats per min
- Silver nitrate solution (used infrequently) • Low & high
7. Parental right to waive • Assess for 1 full minute (due to some irregularities)
8. How to apply Opthalmic medication? • Auscultation of heart sounds difficult
• the child is placed in a supine position: o Murmurs
a. Eye drops o S1, S2 should be clear
• to instill the medication, the lower lid is pulled to form a pocket • PMI: Point of maximum impulse
and the solution is dropped into the pocket o *Rhythm regular at 4th to 5th intercostal space
b. Eye Ointment - Slightly left of midclavicular line
• applied to inner to outer canthus • Rapid & irregular and with slight murmur
Take note: make sure that the tip of tube/dropper will not touch o Murmur normal
the eye - Foramen Ovale still open
• 2. Vitamin K injection (Aquamephyton, Phytonadione) - adjustment period
o Route: IM (single dose) o Tachycardia – RDS (Respiratory Distress Syndrome)
o Site: Vastus lateralis (or Rectus Femoris) o Bradycardia – CHD (Coronary Heart Disease)
o Dose: 0.5 to 1 mg (0.1 ml term / 0.05ml preterm) • Pulses sites: Apical, Brachial, femoral, pedal
o Given to prevent hemorrhagic bleeding o Check for equality and strength
o Catalyze the synthesis of prothrombin in the liver which is needed for o Femoral – check if absent, COA (Contraction of Aorta)
blood clotting and coagulation. • Dextrocardia – heart on right side
• 3. Hepatitis B Vaccine
o Hepatitis B (HBV) Vaccine Administration Blood Pressure
o Recommended by CDC (Center for Ds. Control) for all newborns • Normal: at birth systolic 60-80 mm Hg; diastolic 40- 50 mm Hg
before they leave the hospital • at 10th DOL (day of life) systolic 95 – 100 mm Hg diastolic slightly
o decrease the incidence HBV in children and its serious consequences increased
(e.g cirrhosis, liver Ca) • Not routinely checked in healthy newborn
o Given IM • Only if problem is suspected (e.g Cardiac Problem) e.g COA – all 4
o If infant is born to HBsAg + they should be immunized w/ HBV & extremities BP is taken
HBIG w/in 12 hours. BCG • Varies with changes in NB’s activity and blood volume
o BCG can be given.it depends on the institution. • More accurate if NB is resting
- Swaddle the Baby
- Place right side lying Respiratory Rate:
o Swaddling the baby will keep them from hypothermia • 30-60 breaths / minute. Assess for 1 full minute
o Putting them on right side to drain out secretions • Irregular, rapid, shallow, quiet, unlabored, symmetrical
• With short periods of apnea (5- 10 secs), with slight retractions
Bath • Breath sounds present, equal, clear
• Give Full bath • Diaphragmatic and abdominal
• To clean the baby and remove blood and mucus • Check and observe RR and effort
• Use lukewarm water and anti-microbial soap that is hypo allergenic • Bradypnea – Narcosis from analgesics, anesthetics, trauma
• Take note: full bath should be done under radiant warmer and when • Tachypnea – RDS, MAP (Meconium Aspiration), CDH
temperature is already stable (between 12-24 hrs, 24hrs suggested by DOH)
Lungs
II. Physical Assessment • Pauses >20 seconds suggestive of apnea
• Basic Principles: • Auscultate lungs when infant quiet
1. Review perinatal history • Check for: breath sounds
2. Keep newborn warm during the examination. - crackles, rhonchi, wheezes (fluid in lungs)
3. Begin with the general observations. Then perform assessment that are - expiratory grunting (narrowing of bronchi nasal flaring, retractions,
least disturbing. labored breathing (RDS)
a. Assess the infant’s color
b. Auscultate only in a quiet environment Temperature:
4. Take note of the life-threatening abnormalities that require immediate • Axillary is the preferred site
attention. • Rectal temperature more accurate.
5. Calm the infant before doing the examination • Temperature is taken per anal INITIALLY TO CHECK FOR PATENCY
6. Have the necessary tools at hand OF ANUS! (Insert 1 inch)
7. Handle the infant gently • Succeeding temperature is taken by axillary
8. Initiate nursing interventions for abnormal findings. Assess for gross • ROUTINE USE OF RECTAL TEMP IS AVOIDED because of POSSIBLE
anomalies INTESTINAL PERFORATION / ANAL MUCOSAL PERFORATION
9. Document all findings (normal and abnormal) for legal purposes, because of thermometer insertion and may also cause vagal nerve
document what has really been done stimulation.
o Other sites of temperature:
Take anthropometric measurements: a. Tympanic
• Birth weight - 2500 – 4000 g (6 – 9 lbs) b. Skin - 36.5 – 37 C
• Average weight 3400gms (7.5 lbs) - Using probe; slightly lower than the core
• Weight is taken soon after birth. WEIGHT LOSS occurs rapidly after birth. • Temperature stabilizes in 8 – 10 hours after birth
NEONATE LOSSES about 10 % of the BW by 3 -4 days of but usually • VS taken q 15 mins during the 1st hour and hourly during the next few
regained by the 10th day of life. hours then q 4 (depends on hospital policy) thereafter if it remains stable.
• BW & BL are very important because they provide a baseline for
assessment of future growth General Appearance:
• Assess for SGA (Small for Gestational age), AGA (Appropriate), LGA • yields valuable clues to the physical status of infant
(Large) A. Posture:
 Infant assume a well flexed position (normal position in utero)
Vital signs:
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fcnlxa – St. Luke’s College of Nursing
 Flexion decrease area of skin exposed to environment, thereby reducing heat • Located between occipital and parietal bone
loss • Triangular, 0.5 cm to 1 cm wide
 Fists are clenched, movement symmetrical • Small, not readily felt
 With slight tremors during crying • Closes between birth and 2-3 months
 Hypotonic, limp, flaccid, “floppy” or rigid extremities are seen in preterm,
hypoxia, medications, CNS trauma Caput Succedaneum
 Hypertonic – NAS (Neonatal Abstinence Syndrome), CNS damage • Edema of the scalp
 Jitteriness/tremors – low glucose / low calcium • This is due to the pressure of the presenting part during labor
• Disappears after 3 days
 Opisthotonos, seizure, stiff neck – CNS damage
Cephalhematoma
B. Behavior
• Rupture of periosteal capillary of the skull.
• Observe and monitor for alertness, drowsiness and irritability (common
• This is due to pressure in birth canal
signs of neurologic problems) some questions may be ask:
• Usually absorbed in 6 weeks without treatment
a. Is the infant awakened easily by loud noise?
b. is the infant comforted by rocking, sucking, cuddling?
Craniotabes
c. Do there seem to be periods of deep & light sleep?
• Localized softening of the cranial bones
d. Does infant seem to be satisfied after feeding?
• Can be indented by pressure of a finger
• Behavior
• Correct itself with treatment after some months
a. Level of responsiveness to noxious stimuli
• More common among 1st born because of early lightening
b. Transition of sleep states evident
Face
C. Skin Color
• Check for symmetry
• Check color. Inspect and palpate. Use natural light
• No bell’s palsy (facial nerve paralysis/drooping of mouth to one side
• Generally pinkish
• Due to use of forceps/ birth trauma
• Depends on the racial and familial background
o Permanent – CN7 is cut
• With acrocyanosis (normal / chilled)
• Check for cyanosis: o Temporary – pressure to CN7
a. circum-oral – cyanosis of mouth & central • Check for delivery history
b. areas (requires suctioning)
c. peripheral – due to cold environment Eyes
d. infection, hypoglycemia, cardiopulmo, cardiac ds. • Slate gray (light skin) or brown- gray (dark skin)
• Dark red (phletora) – premature • PERRLA – no keyhole (coloboma)
• Pallor – CV, CNS, blood dyscrasia, blood loss, twin to twin, nosocomial • Symmetrical and clear
infection • Cornea should be round and adult sized
• Petechiea (small rashes deep on the skin, possible bleeding) • may have subconjunctival hemorrhage (small broken tiny capillaries on
• Ecchymoses (manifestation of bleeding) sclera)
• Gray – hypotension, poor perfusion, infection • Eyelids edematous for first days of life
• Yellowish discoloration – jaundice • Drainage
• Able to track and fixate momentarily
General Assessment: • Eye cross because of weak extraocular muscles, normal strabismus, tearless
• Should be performed in cephalocaudal manner • Nystagmus
• Strabismus
Newborn Head: • Corneal Reflex
 25% of the body length. Largest part of infant’s body • Red reflex
• Blink Reflex present
 Bones are not fused
COLOBOMA
 Sutures – palpable; may override (only at birth)
EXOTROPIA STRABISMUS
 Assess for head circumference ESOTROPIA STRABISMUS
o Microcephaly (cranial synostosis)
o Macrocephaly (hydrocephalus) Ears
 Anencephaly • Pinna
 Head lag • Canals
• Assess contour of head (molding) • Tympanic membrane
• Assess fontanels—anterior, posterior • Otoacoustic Emission
• Degree of head control/head lag • Auditory ability (ABR testing)
• Result of birth trauma • Startle reflex
– Caput succedaneum • Well-formed notch of ears on straight line with outer canthus of the eye
– Cephalhematoma (pinna aligned w/ outer canthus)
– Physiologic craniotabes • Symmetrical
• Firm cartilage with recoil
Molding • Can hear once amniotic fluid has been absorbed (e.g. Startle Reflex)
• Assymmetry of the head as a result of pressure in the birth canal • Assess for low set ears (associated with chromosomal defects)
• Disappear in 72 hours o Note: if set lower-abnormal
- Chromosomal defects- Down syndrome/Kidney Ds.
Sutures - Patau syndrome
• Separating lines of the skull, may override at the birth because of extreme - Edward disease
pressure exerted by the passage through the birth canal, sort of overlap - Kidney defects
• Stop development at 7 yrs old - Craniofacial defects

Anterior Fontanel Nose

• At the junction of 2 parietal bones and the 2 fused frontal bones • Patency of nasal canals / No discharge
• felt as soft spot, flat diamond shape • Structure – flat, broad and at the center
• 3-4 cm wide and 2-3 cm long • Obligatory nasal breather
• It closes at 12 to 18 months • Occasional sneezing to remove obstructions
• If > 5cm maybe a sign of HYDROCEPHALUS and CRETINISM • No septal deviation
• Check for congenital anomaly (e.g Choanal Atresia)
Posterior Fontanel • Monitor for flaring, Observe for RDS
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Female Genitalia
Mouth and Throat  Labia majora edematous, clitoris enlarged
• Pink moist gums  Labia minora may have vernix caseosa and smegma.
• Tongue moves freely, symmetrical  Labia majora normally covers the minora and clitoris
• Sucking and crying movements symmetrical  hymenal tag maybe visible
• Able to swallow – do test feeding  Vaginal discharge/pseudomenstruation (blood- tinged mucus) maybe
• Should open mouth evenly when crying present.
• Check for oral thrush – not common  Smegma (thick white mucus discharge)
• Check for tongue tie - not common
 Take note: In preterm babies’ appearance is different: clitoris and minora
• Palate – soft and hard palates intactTEMP
larger than majora
• Epstein pearls – small white cyst may be present in hard palate
• Frenulum and lingual frenulum
Male Genitalia
• Reflexes present: sucking, rooting, gag swallowing
• Scrotum edematous, pendulous with rugae
• Uvula – at midline
• Testes should be present & descended into scrotum
• Natal teeth/neonatal teeth – not common
o Assess for Crytorchidism
• Urinary meatus at tip of penis.
Neck
o Assess for epispadia / hypospadia
• Short and thick neck
• Head held at the midline • Foreskin (prepuce) covers the glans penis and should be retracted
• Trachea on midline • Check for phimosis
• Good range of motion (ROM) and is able to extend. • Check for any abnormalities (hydrocele / hernia)
• Freely movable • Take note: Preterm male – appearance different
• Thyroid gland not palpable o Small penis, lack for rugae on scrotum
• Reflex present: Tonic – neck reflex (Fencer Position) • For both male and female 1st voiding should occur within 24 hours of life.
• Check for ambiguous genitalia:
Chest a. Hermaprodite
• Appears circular since anteroposterior and lateral b. Klinefelter’s syndrome
• Dm are equal – barrel shaped chest w/ bilateral chest expansion
• Respirations diaphragmatic CRYPTOORCHIDISM
• Bronchial sounds heard on auscultation (BS clear) HYPOSPADIAS
• Clavicles straight and intact HYDROCELE
• HR auscultated at border of left sternum extending mid of clavicle; regular
rate and rhythm.
• Observe for abnormalities (appearance, BS) Back (Spine)
• Chest AP and lateral diameters are equal • Spine
• Ribs flexible—observe for S/S of RDS o Sacral dimple
• Breasts – nipples are prominent and often edematous o Sacral tuft
o Supernumerary nipples o Pilonidal sinus/cyst
o “Witch’s milk” – small amt of milk present in newborn o Spina bifida (occulta)
• Straight and flexible
Abdomen • Posture well flexed.
• Contour • Movements well-coordinated
• Umbilical cord • No opening observed or felt on vertebral column
• Liver • Pilonidal cyst /sinus– a small dimple at the base
• Spleen - of the spine no connection w/ S. Cord
• Kidneys • Check for neural tube defect (Spina Bifida) e.g. meningocele
• Femoral pulses /myelomeningocele encephalocele
• Soft, dome shaped, round, some laxness of muscles, moves with respirations
• Bowel sounds present SPINA BIFIDA
• Liver, spleen and kidneys palpable at birth
• Umbilical cord present – white gelatinous with 2 arteries and 1 vein, no foul Extremities and trunk
odor. • Trunk – short, flexed and synchronized movements
• Femoral pulses palpable and equal, no bulges or nodes along bilateral • Trunk incurvature reflex (Galant Reflex)
inguinal areas.
• LIVER 2-3 cm BELOW RIGHT COSTAL MARGIN Extremities: (Upper)
• KIDNEYS 1-2 cm above umbilicus • Flexed with good muscle tone
• SPLEEN left quadrant • Full ROM; movements symmetrical
• Fists clenched
Gastrointestinal: • Equal in length
• Assess for abnormalities (hernia, gastroschisis, omphalocele, scaphoid – • Grasp reflex present
diaphragmatic hernia) • Five digits on each hand w/ palmar creases, nails present, separated and in
• Assess for abdominal distention associated with obstruction, mass or sepsis. correct formation
• Monitor bowel sounds – occur within 1-2 hours after birth. • Assess for polydactyly, syndactyly
• Reflex present: Grasp Reflex, Moro Reflex
OMPHALOCELE • Check for fracture / Erb’s Palsy
GASTROSCHISIS • Erb Duchenne Paralysis / Erb’s Palsy – newborn unable to move upper arm
or asymmetric more response maybe caused by damage in 5th & 6th
Anus cervical roots of the brachial plexus
• Check for anal opening
• Should be patent and well placed ERBS PALSY
• Check for Imperforate Anus
• Meconium should pass within 24 hours Legs (lower extremities)
• Take note: Strict monitoring of I & O important and should be well • Equal in length, bowed, well flexed
documented. • symmetric skin folds (major gluteal folds even)
• Creases on soles of feet
IMPERFORATE ANUS • pulses present (radial, brachial, femoral)
• Assess for fractures (e.g. Hip disclocation)
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o Ortolani’s sign / Barlow’s Test (clicking sound heard) o delineated dark red with rough surface
• Slight tremors are common but could be sign of a sign of hypoglycemia or o Common in head part
drug withdrawal o Disappears at 7-9 years old
• TELANGIECTASIS NEVI
HIP DISLOCATION/DYSPLASIA o Pale pink or red dilated capillaries on eyelids, nose, lower occipital
ORTOLANI TEST bone and nape of the neck
ALLIS/GALEAZZI o Disappear at 2 years of age Telangiectatic nevi

Feet Portwine Stains (Nevus Flammeus)

• Creases on soles • A macular purple or dark red lesion or patches
• May have “positional club foot” caused by intrauterine position but should • Non elevated, sharply demarcated, red to purple, dense areas of capillaries
be able to turn toward midline • Can be seen face, buttocks, thigh and genitals
• Reflexes present: plantar grasp, babinski • Does not fade in time
• EQUINOVARUS • May require surgery (cosmetic) in the future
o Club foot
o Characterized by: Mongolian spot
- Plantar flexion (toes pointing down) • Bluish, greenish black, gray patches
- Inversion (toes pointing inward) • Caused by accumulation of melanocytes
- Other types: • Seen at shoulder, upper arm, back and buttocks
- Eversion (toes pointing outward) • Disappears at in a year (white skinned)
- Calcaneus (toes pointing upward) • Pre-school (dark skinned)

PHOCOMELIA
Clinical Assessment of Gestational Age:
Skin • Important criterion because perinatal morbidity & mortality r/t gestational
• Color should be consistent with ethnic background age & BW
• Pinkish red (light skinned newborn to pinkish brown or pinkish yellow (dark • Ballard Scoring Tool / (Dubowitz scale)
skinned newborn) o An assessment that evaluates 6 neuromuscular and 6 physical
characteristics during the 1st few hours of birth.
• Different Colors: o A score of 1 to 5 is assigned to each characteristic
a. acrocyanosis
b. pallor Ballard Scoring
c. gray color • Neuromuscular maturity
d. jaundice o During the 1st 24 hrs the Nervous system is unstable
e. dark red color – common in preterm o Reflexes and assessments dependent on his or her brain centers.
f. cyanosis
o Maybe unreliable and need to be repeated in 24 hours
• Vernix Caseosa
o Components: Posture, Square window, Arm recoil, popliteal angle,
• Lanugo
• Milia scarf sign, heel to ear extension
• Desquamation
• Mottling Physical Maturity
• Cutis marmorata • Not influenced by labor and birth and do not change significantly within the
• Erythema toxicum 1st 24 hours after birth.
• Harlequin Sign • Components: Skin, Lanugo, Plantar surface, Breast, Eye/ear, male genitalia/
• VERNIX CASEOSA female genitalia
o White cheesy substance seen in areas like back, armpit,
• Preterm = below 37 weeks
inguinal, and buttocks
• Term = 37-42 weeks
o Serves as skin lubricant, protection from
• Post = above 42 weeks
o Infection and acts as insulator
o Seen 2-3 days of life
• LANUGO TERM (37- 40 weeks)
o Fine downy hair • SKIN: Smooth, pink, superficial, cracking, Less visible veins
o Seen upper arm, shoulder, back, forehead and ears • EARS: Formed and firm with instant recoil
o Disappear in 2 weeks • BREAST NODULE: 3-5 mm
o Common characteristic of premature babies • GENITALS:
• MILIA o MALE: Partially descended, more swollen and rugae
o White, pinpoint spots seen on the cheek and bridge of nose caused by o FEMALE: Partially covered by majora
immature sebaceous glands • SOLE CREASE: 2/3 of the sole w/ creases
o Disappears in 2-4 weeks as sebaceous glands mature and drain • LANUGO: Less
• ERYTHEMA TOXICUM
o Pink papules with superimposed vesicles Pre-term
o Common at the face, back and buttocks • PREMATURE (36 weeks & below)
o Self-limiting • SKIN: Gelatinous, transparent, with visible BV
• EAR CARTILAGE: Absent / Pliable
NEWBORN RASH/FLEABITE RASH (Erythema Toxicum) Desquamation • BREAST NODULE: 1-2 mm
• Assess skin turgor over the abdomen to determine hydration status • GENITALS:
• Observe for forcep marks o MALE: TESTES- undescended
• Observe also for birth marks: - SCROTUM- Less swollen, few rugae
a. Telangiectatic nevi o FEMALE: Clitoris and minor - PROMINENT
b. Nevus flammeus (port –wine stain) • SOLE CREASES: Anterior transverse
c. Nevus vasculosus (strawberry mark) • LANUGO: abundant
d. Mongolian spots • SCALP HAIR: Fine & Fussy
• STRAWBERRY MARKS (Nevus vasculosus)
o Elevated areas formed by immature capillaries POST TERM (42 weeks & above)
o and endothelial tissues • SKIN: Parchment, deep cracking, desquamates, no visible Blood vessels
o Capillary hemangioma, raised clearly • EARS: thick cartilage and stiff
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fcnlxa – St. Luke’s College of Nursing
• BREAST NODULE: 6 TO 10 mm – Low pH (acidosis)
• GENITALS:
o MALE: Fully descended, pendulous, marked swollen; Extensive Thermal stimuli
Rugae • Newborn leaves warm environment to relatively cooler atmosphere. Sensory
o FEMALE: Majora completely covers minora and clitoris impulses to the skin are transmitted to respiratory center in the medulla.
• SOLE CREASE: ENTIRE SOLE • Initiation of respiration thru tactile stimulation
• LANUGO: None
Newborn Respiration
Weight Related to Gestational Age • Fetal lung fluid removal
• Birth weight is poor indicator of gestational and fetal maturity – Compression of chest with passage through birth canal
• Gestational age reflects fetal maturity – Lymphatic vessels and pulmonary capillaries
• AGA—growth between 10th and 90th percentile
• SGA—<10th percentile • Expansion of alveoli
• LGA—>90th percentile – Occurs with initiation of breathing
– Role of surfactant in keeping alveoli expanded

Newborn Circulation
• Circulatory changes allow blood to flow through lungs
NOTES: • Pressure changes in heart, lungs, and vessels
• Functional closure of fetal shunts
Respiratory disorders – Foramen ovale
Convulsions – Ductus arteriosus
High glucose – Ductus venosus

The warm chain- prevents newborn hypothermia Sequential Circulatory Changes in the Newborn
Skipping one step breaks the chain, and increases the newborn’s • Inspired oxygen dilates pulmonary vessels
• Pulmonary vascular resistance decreases and pulmonary blood flow
36.5 – 37.5 normal increases
36.5 below – hypothermia • As the lung receives blood, the pressure in RA, RV, and pulmonary arteries
decreases
1. Warm delivery room • Gradual increase in systemic vascular and increase blood volume as a result
Room should be warm, no air from open window, air or fan of cord clamping.
Room should not be below 25 C
Further Circulatory Changes in the Newborn
2. Immediate drying • LA pressure > RA pressure leads to closure of foramen ovale
Warm, dry towel • Increase of pulmonary blood flow and dramatic reduction of pulmonary
Socks, bonnet, warm blanket vascular resistance begins to close the ductus arteriosus
23 C in infants = 0 C in adults
Typical Times for Newborn Circulatory Changes
3. Skin to skin contact • Foramen ovale: functional closure soon after birth
After 40 mins take newborns temp again • Ductus arteriosus: functional closure in about 4 days after birth in well
neonate.
3. Bathing postponed • Closure may delay in ill or preterm infants
Do not weight it must be performed 2 hrs after birth • Reversible blood flow through DA result in functional murmur occasionally
Bathe 24 hrs after birth heard
• Failed closure of the above shunts takes blood away from newborn’s
4. Breastfeeding pulmonary circulation
Start within first hour of birth • Ductus Venosus closes (FC, shunts Arterial Blood into IVC), shunts
Do not force baby to latch perfusion of the liver

5. Appropriate clothing Physiological Changes

Do not use tight and swaddling clothing Before Birth:
Inform the mother to bring baby’s clothes before birth • Only a small fraction of fetal blood passes through the fetal lungs.
They should be warmed • Fetal lungs do not function as a source for O2 or as a route to excrete CO2
• The fetal lungs are expanded in utero, but the potential air sacs are filled
6. Mother and baby together fluid, rather than air.
Move the newborn while the mother is carrying it, skin to skin contact • The BV that perfuse and drain the fetal lungs are markedly constricted.
• Most of the blood from the right side of the heart cannot enter the lungs
7. Warm resuscitation because of constricted blood vessels in the fetal lungs.
• Instead, most of this blood flows through the ductus arteriosus into the aorta.
8. Training of health care professionals
After birth:
• The newborn will no longer be connected to the placenta and will depend on
Cord clamping the lungs as the only source of O2.
AVA • Over a matter of seconds, the lungs must fill with O2, and the BV in the
KMC – Kangaroo Mother Care (used to prevent newborn from persistent lungs must relax to perfuse the alveoli and to absorb O2 and carry it to the
hypothermia rest of the body.

1 inch above abdomen, then cut above cord clamp 3 Major changes w/in 3 secs after birth
1. The fluid filled in the alveoli is absorbed into the lung tissue and
ADJUSTMENT TO EXTRAUTERINE LIFE: replaced by air. The O2 in the lungs is then able to diffuse into the
blood vessels that surround the alveoli.
Respiratory System 2. The umbilical arteries and veins are clamped. This removes the low
• Transition from fetal /placental circulation to independent respiration resistance placental circuit and increases systemic BP.
• Chemical factors stimulate breathing 3. As a result of gaseous distention and increased O2 in the alveoli, the
– Hypoxemia blood vessels in the lung tissue relax.
– Hypercarbia
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fcnlxa – St. Luke’s College of Nursing
• The relaxation together with increased in systemic BP, creates a dramatic 5. Evidence of Hemolysis
increase in pulmonary blood flow and decrease in flow through D. 6. feeding method
arteriosus. 7. Infant’s physiologic status
• The O2 from the alveoli is absorbed by the increased Pulmonary blood flow, 8.Progression of serial serum bilirubin
and the O2 – enriched blood returns to the left side of the heart where it is
pumped to the tissues of the newborn’s body. Renal System
• As blood levels of O2 increase and pulmonary blood vessels relax, the • Functional deficiency in kidney’s ability to concentrate urine
ductus arteriosus begins to constrict. • Total volume of UO per 24 hours is 200-300mL by the end of first week
• Blood previously diverted through the ductus arteriosus now flows through • Normal newborn urine production 1-2 mL/kg/hr
the lungs, where it picks up more O2 to transport to tissues throughout the • Bladder capacity approximately 15-30 mL
body. • First void should occur w/in 24 hrs after birth
• Initial cry and deep breaths help move fluid from airways. • Newborns may void 10-20 times/day
• Has immature kidneys – unable to concentrate urine
Cardiovascular System • GFR (reabsorption & filtration) low
1. Take note of the physiologic changes fetal – neonatal circulation. • NB may tend to reabsorb sodium and excrete large amount of water
2. Observe for cardiac distress in newborn (e.g. during feeding) • Decrease ability to excrete drugs and excessive fluid loss which can lead to
3. Blood values are high in NB as a response to the pulmonary circulation. acidosis and fluid imbalance
A high WBC during the newborn period is not a sign of infection. • Uric acid crystals may cause reddish stain the diaper
Implications
Hemopoietic System • Rate of fluid exchange in newborn much faster than in adult
• Blood volume depends on the amount of blood transferred via the placental • Rate of metabolism in newborn twice as great related to body weight
before clamping the cord • Acid forms quickly, leading to rapid development of acidosis
• FT newborn blood volume is approximately 80-85 mL/kg body weight • Immature kidney cannot concentrate urine to conserve body fluid
• Average total blood volume for newborn = 300 mL +/- 100 mL Newborn Resultant Problems
• Prone to dehydration
Fluid and Electrolytes • Prone to acidosis
• Newborn body weight is 73% fluid (Adult is 58% fluid) • Prone to overhydration/fluid overload
• Infant has higher ratio of extracellular fluid than adult • Nursing intervention;
• Infant has higher level of total body Na++ and Cl + 1. Weigh newborn daily.
• Infant has lower level of total body K+, Mg + + and phosphate + 2. Monitor I & O. Weigh diaper prn.
• GI System 3. Assess for signs of dehydration.
• Newborn has deficiency of pancreatic lipase which limits fat absorption.
• This makes cow’s milk indigestible. Newborn Skin
• Human milk despite its high fat content is easy to digest and absorb because • Immature integumentary function in newborn
it has lipase • Active sebaceous glands
• Eccrine (sweat) glands
GI System • Apocrine glands small and nonfunctional
• Stomach capacity varies from 5 ml to about 60ml on Day 3 • Hair follicles
• Colon has small volume leading to frequent stooling • Amount of melanin low at birth—lighter skin than in later life; UV
• Has rapid intestinal peristalsis (empty time 2.5-3 hrs) susceptibility
• Progressive changes in stool pattern in newborn
• Observe for feeding reflexes: rooting, sucking swallowing Skin
• Assist mother with breastfeeding or formula feeding • The more mature the NB, the more mature the skin and more likely will be
• Burp newborn during and after feeding protected from heat loss and infection.
• Assess for regurgitation and vomiting • Skin color depends on activity level, temperature, hematocrit levels and
• Position newborn on the right side after feeding race.
• Observe for passage of stool
Musculoskeletal System
Liver • Skeletal system contains more cartilage than ossified bone
• Liver is very immature in newborn • Rapid ossification in first year of life
• Immature liver affects conjugation of bilirubin and contributes to • Muscular system almost completely formed at birth
physiologic jaundice • Muscle growth by hypertrophy rather than hyperplasia
• Liver is deficient in forming plasma proteins in newborns (edema results)
• Prothrombin and other coagulation factors are low at birth Immune System
• Liver stores of glycogen are lower at birth than later in life. • Skin and mucous membranes are first line of defense from invading
• Newborn is at risk for hypoglycemia (importance of frequent feedings) organisms
• Liver controls the amount of circulating unconjugated bilirubin (a pigment • Second line of defense: cellular elements of the immunologic system:
derived from Hgb) neutrophils, eosinophils, lymphocytes
• Unconjugated bilirubin can leave the vascular system permeate other
extravascular tissues (skin, sclera, etc) resulting to icterus (jaundice)
• Third line of defense: formation of antibodies
• Types of jaundice: – Breastmilk provides passive immunity (IgG)
1. Physiologic • Passive immunity via placenta (IgG)
2. Pathologic • Passive immunity via colostrum (IgA)
3. Breast feeding associated with jaundice (early onset) • Increased IgM indicates infection in utero
4.Breastmilk jaundice (late onset) • Observe aseptic technique when caring for the NB
• Observe universal precautions when handling the NB

• Bilirubin Values: Endocrine System

a. Unconjugated bilirubin • Endocrine system well developed in newborns but function is immature
0.2 – 1.4 mg/dl (normal value) • ADH (vasopressin) production is limited, inhibits diuresis
5 mg/dl (jaundice observable) – Risk of dehydration
Other jaundice parameters: • Effects of maternal sex hormones in newborns
1. timing of the appearance of jaundice
2. Gestational age Neurologic System
3. Age in days since birth (DOL) • Reflexes
4. Family Hx (e.g maternal Rh factor) • Posture, tone, head control, body movement
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fcnlxa – St. Luke’s College of Nursing
• Behavioral response to care – Should occur within 24-48 hrs after birth
– Consolability – Description: green, black, sticky odorless, passed 4x/day
– Cry: frequency and pitch • Transitional stools
• At birth the nervous system is incompletely integrated – Usually appear by day 3rd day of life after the initiation of feeding
• Primitive reflexes – Transition from meconium to milk
• Autonomic nervous system crucial during transition because it stimulates – Description: yellowish-green, slimmy 6x or more
initial respiration. • Milk stools
• Myelination of nerves follows cephalocaudal and proximodistal progression – Usually appear by DOL 4
– Differ in breasted and formula fed baby
Sensory Functions
• Vision Breastfed Baby Stool
– Pupils react to light • Characteristic:
– Blink reflex responsive to minimum stimulus – Golden yellow (mustard)
– Corneal reflex activated by light touch – Mushy and soft
– Tear glands minimal function until 2-4 wks age – Sweet odor – due to lactic acid, high (sourmilk)
• Hearing – Passed every after breastfeeding (3-4 x a day)
• Smell
• Taste Bottlefed Baby Stool
• Touch • Characteristics:
– Pale yellow
Transitional Assessment: – Formed
• 6-8 hours after birth – Offensive (foul odor)
• Period of Reactivity: – Passed once/ day (depends)
1. First Period of Reactivity
– During 1st 30 mins after birth – awake, alert, cries vigorously Reflexes:
– Sucks his fingers or fist and appears interested in the envi • Blink/Corneal Reflex
– Eyes are usually open (opportunity to see one another) • Sucking
2. First Reactive period • Rooting
– Last 2-4 hours • Babinski
– HR, RR decrease, temperature continue to fall • Moro
-– In a state of sleep and relatively calm • Startle
– Any attempt to stimulate elicits minimal response • Grasp
3. Second Period of Reactivity • Galant
– Awakes from deep sleep, last about 2-5 hours
– Provides for NB and parents to interact Blinking Reflex (Corneal Reflex)
– NB alert and responsive • Infants blinks at sudden appearance of bright light or at approach of object
– HR, RR increase toward cornea.
– Gag reflex active • Persist throughout life
– Close observation required for changes in VS and color.
Babinski Reflex
Behavioral Assessment • Stroking outer sole of foot upward from heel and upward and across the ball
• Brazelton Neonatal Behavioral Assessment Scale (BNBAS) of foot causes toes to hyperextend and hallux to dorsiflex
• Interactive examination that assess infant’s response • Disappear at 1 year of age.
• Areas of behavior: sleep, wakefulness, activity
• Patterns of sleep and activity Galant Reflex (trunk incurvation)
– State modulation • Stroking infant’s back alongside spine causes hips to move toward
• Cry stimulated side.
– Communication of the newborn • Disappear by age 4 weeks
– Variations and meanings
Grasp Reflex
Assessment of Attachment Behaviors • Touching palms or soles near base of digits causes flexion of hands or toes
• Emotional bonding between parents and newborn • Palmar grasp lessens at 3 months to be replaced by voluntary movement
• En face position plantar grasp lessens by 8 months of age
• “Falling in love” with the newborn
• Absence of attachment behaviors Sucking Reflex
– Effect on newborn • Infant begins strong sucking in response to stimulation, persist throughout
– Effect on relationship with parents infancy

Family Involvement Rooting Reflex

• Family-centered maternity care • Touching or stroking the cheeks alongside of mouth causes infant to turn
• Fathers head toward that side, and begin to suck
– Cultural influences on fathering behaviors • Should disappear at 3-4 months but may persist up to 12 months
– “Paternal engrossment” concept
• Siblings Extrusion Reflex:
• Grandparents/extended family • When tongue infant reponds by forcing it outward
• Community • Disappear at 4 months

Preparation for Discharge and Newborn Care at Home Gag Reflex

• Mom/infant “dyad” concept • Stimulation of posterior pharynx by food, suction or passage of tube causes
• “Couplet care” infant to gag
• Discharge teaching • Persist throughout life.
• Teachable moments
• Follow-up care Moro Reflex
• Car seat safety • Sudden jarring or change in equilibrium causes sudden extension and
abduction of extremities and fanning of fingers, with index finger and thumb
Stool Patterns in Newborns forming C shape followed by adduction of extremities
• Meconium • Disappear at 3-4 months
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fcnlxa – St. Luke’s College of Nursing
Infant Stimulation
Startle Reflex • Newborn prefers human face for stimulation
• Sudden loud noise causes abduction of arms with flexion of elbows, hands • Visual benefit of black and white objects for newborn stimulation
remain clenched • Stimulation of human voice
• Disappear at 4 months • Importance of tactile stimulation

Newborn Screening Common Problems

• It is a screening / test for genetic congenital disorder. • Regurgitation
• Mandated by law. R.A 9288 (the NBS Law) o Common in newborn due to multiple factors
• This is a simple procedure to find out if baby has a rare metabolic disorder. – Intestine longer in relation to body size than adult
• Baby may look healthy at birth. – Rapid peristaltic waves and simultaneous nonperistaltic waves
• If left untreated may lead to MR along esophagus
• Done on the 3rd DOL – Decreased sphincter tone in lower esophagus
• Test for: Congenital Hypothyroidism, CAH, Galactosemia, PKU, G6PD
GI Problems
Newborn Nutrition • Constipation
• Comparison of human milk and cow’s milk o More common among bottle fed infants
• Recommendation: No cow milk before 1 year of age • Management: Offer fluids in between feedings
• Commercial formulas modified from cow milk
• Other commercial formulas Loose Stools
• Careful Hx taking. Management depends on the cause.

Breastfeeding Colic
• Discuss its disadvantages • It is the paroxysmal abdominal pain common in infants below 3 months of
• Cultural perspectives on infant feeding age.
• Need for support, encouragement, and assistance • Causes: overfeeding, gas distention, too much CHO in MF, tense and unsure
mother
Purposes of Breastfeeding • Management:
• Promotes bonding 1. Give feeding per demand.
• Facilitates release of colostrum and breast milk 2. Tell mother to burp the baby at least 2x during feeding.
• Stimulates production of prolactin and oxytocin. 3. Feed baby upright position. Burp. Place on right side
• Prevent jaundice lying position.
4. Change MF per doctor’s order
Breastfeeding 5. Reduce sugar content of formula.
• Human milk is the preferred form of nutrition for newborn
• WHO promotion of breastfeeding world wide Spitting Up
• Baby Friendly Hospital Initiative (BFHI) • Due to poorly developed cardiac sphincter, common among bottle fed
• Economical • Management:
• Always available 1. Feed the baby upright
• Breast cancer incidence significantly lower in women who have breastfed 2. Position in right side lying
• May also offer protection to child from obesity, allergy, diabetes,
atherosclerosis Skin Irritation
• May be due to either poor hygiene or irritation from urine, feces, and some
Physiologic Benefits of Human Milk laundry products.
• Species specific food for newborn humans • Management:
• Digestibility 1. Expose to air – most important
• Immunologic properties cannot be duplicated in commercial formulas 2. Careful hand washing and rinsing away of irritating soap from skin
• Availability/Infection control 3. Starch bath if it is due to miliaria
• Seborrheic dermatitis / cradle cap
Promotion of Successful Breastfeeding o Involves the sebaceous glands due to poor hygiene.
• Frequent and early breastfeeding (within first hr of life is important) • Clothing
• Promotion of skin-to-skin contact o Rule of thumb. If mother feels warm keep baby cool; if the mother
• Feeding on demand schedule feels cold keep the baby warm.
• Careful control of drugs (maternal and newborn) • Sleeping pattern
• Significance of nurses in breastfeeding success o Sleep varies it grows. Babies 16-20 hours day.
Keys to Breastfeeding Success Newborn Care and Hygiene
• Correct sucking technique • Bathing
• Correct positioning of infant at breast • Umbilical care
• Absence of a rigid feeding schedule • Circumcision
• Skin care and skin concerns
Commercial Formulas
• Lactose based Bathing:
• Lactose-free • It can be done any time of the day that is convenient for the mother. Bathe
• Soy based the baby in a warm room before feeding.
• Other specialty formulas • All equipment needed should be prepared prior to activity.
• Calorie content of formula • Make bathing enjoyable for both the infant and mother.
• Preparation of formula
Cord Care:
Bottle Feeding • Initial Cord Care
• Techniques • Routine Cord Care:
• Equipment 1. Teach mother how to perform cord care
• Positions 2. Keep cord care clean and dry after each diaper change. Use water only.
• Preparation of formula Expose to air
• Feeding schedules 3. Assess the cord for odor, swelling or discharge.
• Behaviors during feeding 4. Sponge bath the NB until cord falls off.

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fcnlxa – St. Luke’s College of Nursing
Circumcision
• Not routinely done. Done per request of the parents nipple line-apical pulse!
• Procedure: -if no femoral pulse- check baka may COA
Infant is restrained. Penis is cleansed with soap and water. Betadine
applied. Yellen clamp or Gomco clamp is used.Petrolatum gauze dressing BP LANG ANG BABY KAPAG DR SUSPECTS CARDIAC CLAMMING?
is applied to prevent adherence of the circumcised site to the diaper while
applying pressure to prevent bleeding. SLOW RESP RATE KAPAG MAY TRAUMA, ANALGESIC,

Nursing Care: -AXILLARY IS PREFERRED SITE

a. Check hourly for bleeding (common complication during the 1st day). SUPPOSITORY- 1INCH
b. If a small amount of bright red is present apply gentle pressure to the
area w/ a sterile gauze. ANAL TEMP CHECKING- IS TO KNOW IF THERE'S AN ANAL OPENING
c. Do not attempt to remove exudates which persist for 2-3 days. Just KAPAG NAG PASS NA MECONIUM WAG NA MAG ANAL TEMP
wash with warm water.
d. Diapers must be pinned loosely during the 1st 2- 3 days when the base CYANOSIS- INFECTION/HYPOGLYCEMIA/
of penis is tender.
phletora (kulay tocino)
NOTES:
ancephaly- absence of skull, dryness of brain
-"METHODS" MEDICATION, ENVIRONMENT, TREATMENT, HEALTH molding disappears 72 hrs- change the position
TEACHING, O=OUTPATIENT OR CHECK UP, DIET, SOCIAL, SPIRITUAL
AND SEXUAL-- FOR DISCHARGE cryptoorcidism (di pa nagpapakita yung genitals ni baby)

video 1- thermal protection of the newborn expected jaundice- after 24 hours

hypothermia pinch the skin- kapag naninilaw jaundice

-essential because babies can't produce their own heat VS INFANT

-newborn losses heat more easily -CHECK RESPIRATION- NORMAL 30-60 LOOK AT THE NOSE- LOOK AT
-smaller the premature the baby the higher the risk CHEST RETRACTIONS, SKIN (RISE AND FALL OF CHEST IN 1 FULL
-after birth a wet nb begins to lose heat easily MIN)
-36.5-37.5 C- normal temperature -HEART RATE (100-190BPM) 4TH INTERCOTAL SPACE (VAN HAVE
-newborn can lose heat: evaporation of amniotic fluid, conduction- if put on a SINUS ARHHYTHMIA;
cold surface, radiation- cold surfaces even no direct touch, convection; air -TEMPERATURE-
-HYPOTHERMIC BABIES NEEDS MORE OXYGEN
SWADDLE: MIMICS THE UTERUS AND FOR SUDDEN REFLEXES
promote nb thermal protection- wARM CHAIN
-preparing the delivery room- room should be warm, no warm, open window, and BATHING NB: 4 MINS
no fan. room temp should not fall below 25 MAXIMUM- 3MOS. 7 MINS
do not remove diaper immediately when bathing.. remove only when you are
-drying of newborn and skin to skin- after it is placed on top of mother's ready to clean the whole body
abdomen, dry again, DO NOT CUT THE CORD BEFORE DOING THIS, take
nb temp without interrupting skin to skin -remove the stool (if there is any) then clean body

-breastfeeding- helps maintain normal body temp ASSIGNMENT: DO 1ST CASE 2 NCP, PDAR AND HEALTH TEACHING

-perfect clothing- tight SWADDLING should be avoided, bby cap, socks, linen, T-TREATMENT (ALL TREATMENT POSSIBLE)
blanket should be pre warmed. ALL HEALTH TEACHING RELATED TO THE CASE

-make sure baby should not lose body heat.

PAG NAKA KUHA NG INFECTION- BLOOD CULTURE AND URINE
pag nag cut ng cord- abdomen -1inch, cord clamp then cut CULTURE

NEWBORN CARE NEWBORN CARE

CLEAR AIRWAY- AS NECESSARY chemical factors stimulate breathing:
APGAR SCORE< ASSESS BABY'S RESPONSE TO BIRTH stimuli
-flex position when they leave that environment, consider the temperature of the delivery
-nb are nasal breather room,, because the uterus is warm because of the amniotic fluid..

APGAR SCORE: when you wipe face

acrocyanosis-blue
-add all the score depending on the situation fetal fluid removal
-if the cord is dry you can remove the cord clamp (day 2 usually)
lung surfactant is very important - in order for alveoli to respond
fetal distress- prolonged labor
-bc of fetal distress = tachycardia pre-term- kulang lung surfactant
-amniotic fluid should be clear
-amniotic fluid-green =baby's poop below 35 weeks
lung surfactant- 28 weeeks- production starts
opthalma neonatorum- crede;'s prophylaxis is given
if mother is diagnosed with hepa b- they should be immunized murmur- closure of ductus arteriosus

on the 24th hour -nb bath before birth- small fraction of fetal blood passess thru fetal lungs

birth weight- 2500-4000 (6lbs-9lbs) most of the blood from the right side of the heart cant enter the lungs
-weight loss occurs rapidly after birth
aga- appropriate for gestational age during feeding- the baby
measure vs when the infant is still quiet
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fcnlxa – St. Luke’s College of Nursing
full time newborn blood volume is 80-85
-pwede pa naman mag breastfeed, we can do some remedies for the meantime, in
infant has higher level of total body Na++ and Cl + 2weeks to 1 month, the baby's liver will mature.. we can pump the milk and lagay
sa freezer then date & time of extraction.. the milk can be for 6mos to 1 year.. for
newborn mas mabilis dehydration and electorlytes are easily depleted the meantime pwede naman formula milk

colon has small volume that's why frequent stooling --

pag nursing diagnosis ,don't use medical terminology
position newborn on the right side after feeding -para maiwasan aspiration
HYPOGLYCEMIA---
assist burp, during and after feeding
CHECK VITAL SIGNS- PRONE TO DEVELOP RESPIRATORY DISTRESS
liver is very immature- contributes physiologic jaundice.. baby's have slight SYNDROME
edema pagkapanganak.. but nawawala naman as time goes by --THESE BABIES ARE PRONE TO (MIGHT BE RELATED TO
HYPOTHERMIA)
liver stores of glycogen are lower at birth-at risk for hypoglycemia
-- BABY GLUCOSE LEVEL HAS DROPPED GIVE formula milk or breastfeed
bilirubin- 0.2-1.4 mg/dl (normal)
--Human placental lactogen (hPL) is a hormone produced by the placenta, the
5mg- observable organ that develops during pregnancy to help feed the growing baby.

baby's are prone to dehydration, acidosis, overhydration placenta develops -20 to 24 weeks

weigh newborn daily

monitor i &o weigh per diaper
assess dehydration

mas maraming cartilage that's why it's soft

second line: cbc,

alamin din behavior ng mother baka "unwanted yung baby"

stool pattern
-meconium should occur within 24-48 hrs after birth
-should be greem, black, sticky odorless, passes 4 x a day

transitional stools
-usually appear by day 3 of life after initiation of feeding

milk stools
-usually appear by DOL 4

breastfeed baby stool

-golden yellow, mushy and sfot, sweet odor- due to lactic acid, high (sour milk)
-passed every after breastfeeding

bottle fed bby stool

-pale yellow
-formed
-offensive
-foul odor

newborn screening
-test for congenital disorder
-mandated by law ra 9288
-done on the 3rd DOL
-test for hypothyroidism, CAH, galactosemia, PKU, G6pd

regurgitation
colic- kabag
spitting up- lungad- poor cardiac sphincter

anytime of the day pwede paliguan baby

JAUNDICE
-- PUT DIAPER - FOR PROTECTION FOR EXPOSURE OF GENITALIA
AND LOOSE STOOLS MAY OCCUR AS BILUBIRIN LEVELS LEAVE THE
BODY

-EXPOSURE OF GENITALIA IN EXTREME LIGHT CAN RESULT TO

DRYNESS/MAGKAROON NG EFFECTS SA GONADS

-breastmilk is not enough /breastmilk associated jaundice- di enough nakuha ng

baby.. konti naeexcrete nya

glucocordinaze?? - jaundice in breastmilk

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fcnlxa – St. Luke’s College of Nursing