NURSING CARE OF

NEWBORN AND
FAMILY
High-quality universal newborn health care is the right of every newborn everywhere. Babies have the right to be
protected from injury and infection, to breathe normally, to be warm and to be fed. All newborns should have access to
essential newborn care, which is the critical care for all babies in the first days after birth. Essential newborn care involves
immediate care at the time of birth, and essential care during the entire newborn period. It is needed both in the health facility
and at home.
INTRODUCTION:
◦ Essential care of the normal healthy neonates can be the best provided by mothers under the supervision
of nursing personnel or basic/primary health care providers.
◦ About 80% of the newborn babies require minimal care.
◦ Mothers participates in the nursing care of the baby and develop self confidence in her. This will also
reduce the demand of nursing personnel. Nursing care of the healthy newborn baby after birth should be
provided as immediate care of the neonates and daily routine care.
IMMEDIATE BASIC CARE OF
NEONATES
Immediate Care After Birth
◦ The primary goal of care in the first moments after birth is to assist the newly born infant to
transition to extrauterine life by establishing effective respirations. If the infant is at term, is
crying or breathing, and has good muscle tone, routine care can begin (Kattwinkel, Perlman,
Aziz, et al., 2010). The infant is placed prone on the mother’s abdomen or chest, and the nurse
assesses the airway. Slight extension of the neck helps keep the airway patent. Drying the infant
with vigorous rubbing removes moisture to prevent evaporative heat loss and provides tactile
stimulation to stimulate respiratory effort. The mother and her newborn are covered with a
warm blanket (Niermeyer and Clarke, 2011).
◦ If the neonate is apneic or has gasping respirations, positive-pressure ventilation is needed. The
heart rate is quickly assessed by grasping the base of the cord or by auscultating the left chest
with a stethoscope. Count for 6 seconds and multiply by 10 to calculate the heart rate. It should
be greater than 100 beats/min. The newborn’s trunk and lips should be pink; acrocyanosis is a
normal finding (see Fig. 22-4) (Niermeyer and Clarke, 2011).
◦ If the newborn requires respiratory or circulatory support, the nurse and other members of the
health care team follows the American Heart Association guidelines for neonatal resuscitation
(Kattwinkel, Perlman, Aziz, et al., 2010). The neonatal resuscitation algorithm directs the care (
Fig. 23-1).
Apgar Scoring and Initial Assessment

SIGN SCORE
0 1 2
Heart rate Absent Slow (<100/min) >100/min
Respiratory effort Absent Slow, weak cry Good cry
Muscle tone Flaccid Some flexion of Well flexed
extremities
Reflex irritability No response Grimace Cry
Color Blue, pale Body pink, extremities Completely pink
blue
DAILY ROUTINE CARE OF
NEONATES
The major goal of nursing care of the newborn infant is to establish and maintain homeostasis, i.e. stability
in the normal routine care of the neonates are as follows:
RECEIVE THE BABY ON A WARM CLEAN AND DRY TOWEL

Warmth is provided by keeping the baby dry and wrapping the baby with adequate clothing in two layers.
Ensuring head and extremities are well covered.
Baby should be kept by the side of the mother, so that the mother’s body temperature can keep the baby
warmth.
Baby can be placed in the skin to skin contact with mother (kangarooing) to maintain temperature of
infant and facilitate breastfeeding.
Bathing is avoided to prevent hypothermia and infections.
Ambient atmosphere temperature to be kept warm adequately.
Temperature should be recorded (axillary,skin,and human touch method) frequently during initial
postnatal period.
Warmth to be maintained during transfer from hospital to home on discharge or whenever needed.
Prevent the baby from heat loss.
NEONATAL
THERMOREGULATION

Convection

Radiation

Conduction

Evaporation
BREASTFEEDING
The baby should be put to the mother’s breast within half an hour of birth or as soon as possible the
mother has recovered from the exertion of labor.
No prelacteal feeds to be given and the colostrum feeding must be offered.
Initially the feeding should be in short interval of 1 to 2 hours and then every 2 to 3 hours.
Nurse should assist the mother to feed her baby adequately for the maintenance of hydration and
optimum nutrition.
Exclusive breastfeeding procedure should be explained to the mother and family members.
All mothers should be informed about the importance and techniques of breastfeeding.
TECHNIQUES OF BREASTFEEDING
CRADLE HOLD
CROSS CRADLE HOLD
FOOTBALL OR CLUTCH HOLD
SIDE-LYING POSITION
LATCHING ON
SKIN CARE
The baby must be clean off blood, mucus, and meconium by gentle wiping before he/she is presented to
the mother.
No bath, especially dip baths, should be given till the umbilical cord has fallen off.
In summer months, the baby can be sponged using un-medicated soap and clean with lukewarm water.
Each baby should have own separate clothing and articles for care to prevent cross- infection.
BABY BATH
It can be given at the hospital or home following the instructions for bathing.
It should be given using warm water in the warm room gently and quickly.
The baby should be dried thoroughly from head to toe and wrapped in a dry warm towel or clothing.
Bathing should be avoided in the open place and unnecessary exposure should be avoided.
During winter months the baby should have sponge bath rather than dip bath to avoid cold stress or
hypothermia.
Use of olive oil or coconut oil can be allowed after 3 to 4 weeks of age.
Oil massage should be done before the bathing, in a warm place.
During bathing the baby should be observed for behavior and presence of any abnormalities or infection.
CARE OF THE UMBILICAL CORD
• The umbilical cord is cut about 2 to 3 cm from the naval with aseptic precautions during delivery and
tied with disposable plastic clip.
• The cord must be inspected afterwards for bleeding which commonly occurs due shrinkage of cord.
• Normally it falls off after 5 to 10 days but may take longer especially when infected.
• No dressing should be applied and the cord should be kept open and dry and clean the cord.
• Gently clean around the belly button stump, trying to keep it as dry as possible. Note: Never pull the
stump, as this may cause permanent damage. The stump will take about a week to dry out and fall off.
• Throw away each piece of cotton wool as you use it.
CARE OF EYES
◦ Eyes should cleaned at birth and once every day using sterile cotton swabs soaked in sterile water or
normal saline.
◦ Each eye should be cleaned using a separate swab.
◦ The eyes should be observed for redness, sticky discharge or excessive tearing for early detection of
problems and prompt management.
CLOTHING OF THE BABY
◦ The baby should be dressed with loose,soft and cotton cloths.
◦ The frock should be open on the front or back for easy wearing. Soft absorbent cloth should be used.
◦ The cloths should not be tight especially around the neck or abdomen.
◦ In winter, woolen cloths should be used. Woolen cloths should not be stored with moth balls.
◦ Baby clothing should always be cleaned with light detergent, that will be washed properly and sun- dried
to prevent skin irritation.
DIAPER ARE CARE
◦ Preventing diaper dermatitis is a practice that parents need to start from the very beginning with their
newborns.
◦ With each diaper change, the area should be washed with clear water and dried well.
◦ After cleaning, a mild ointment (e.g.., petroleum jelly) may be applied to the buttocks.
◦ The ointment keeps ammonia away from the skin and also facilitates the removal of meconium which is
sticky.
GENERAL CARE
◦ The newborn baby should be kept with the mother for continuous mothering in hospital or in home in a
well- ventilated room.
◦ Baby should be handle with gentle approach after proper hand washing.
◦ No infected person should take care or touch the baby.
◦ General cleanliness to be maintained and surroundings to be kept clean.
◦ Wet nappies/diapers should be changed immediately.
OBSERVATION
◦ The baby should be thoroughly observed for early detection of any abnormalities.
◦ Temperature, pulse/heart rate, respiration, feeding behaviors, stool, urine and sleeping patterns should be
assessed.
◦ Mouth, eyes, cord and skin should be looked for any infections.
NEWBORN MEDICATION AND
VACCINATION
◦ Hepatitis B vaccination
Is a serious disease that infects and damages the liver. It is spread by contact with infected blood or body
fluids. An infants who is infected is a high risk of becoming a carrier of hep.b virus. One quarter of babies
who become carriers die of liver disease or liver cancer. To prevent Hepatitis B infection, it is
recommended a series of vaccinations.
Sometimes the baby is given the first shot in the hospital after birth, or the baby’s healthcare provider may
give the first shot in the clinic during the baby’s early visit.
o Vitamin K Injection
It is needed to make blood clot. Because newborns only have small amounts of vitamin k they are given
vit.k injection soon after birth to prevent bleeding.
◦ Erythromycin Eye Ointment
To avoid the chance of serious eye infection, erythromycin ointment is placed in newborn’s eyes within the
first hour of birth.
RECOMMENDED IMMUNIZATIONS
HARMFUL TRADITIONAL PRACTICES
FOR THE CARE OF NEONATES
◦ Not adopting measures for clean delivery at home and conducting delivery in the dirty place and cutting
cord with dirty thing or blade.
◦ Use of unclean substance like cow dung, mud on umbilical cord.
◦ Immediate bathing of the baby after birth.
◦ Instillation of oil drops into the ears and nostrils during bathing the baby.
◦ Use of un- hygienically prepared herbal preparation.
◦ Use of prelacteal feeds or artificial feeding with diluted milk.
BIRTH RECORD DOCUMENTATION
◦ Time of birth
◦ Time the infant breathed
◦ Whether respiration were spontaneous or aided
◦ Apgar score at 1 minute and 5 minutes of life
◦ Whether eye prophylaxis was given
◦ General condition of the infant
◦ Number of vessels in the umbilical cord
◦ Whether culture were taken ( they are taken if at some point sterile birth techniques was broken or the
mother has a history of vaginal or uterine infection)
◦ Whether the infant voided and whether he or she passed stool (this information is helpful later on, the
diagnosis of bowel obstruction or absence of a kidney is considered)
CARE OF FAMILY
PARENTAL BONDING
◦ Bonding is the special emotional relationship that parents develop with their infant. Bonding starts during
early pregnancy, especially after the mother first feels her fetus move.
◦ Bonding is often poor with preterm infants when the parents are separated from their newborn infant.
Anxiety about sick infant or an infant with a birth defect can also interfere with the normal bonding
process.
ENCOURAGE THE BONDING
PROCESS
◦ During pregnancy you should encourage the parents to speak about the unborn fetus. They should think
possible names.
◦ When available, an antenatal ultrasound photograph of fetus strengthens bonding.
◦ Allow the mother to hold her infant and put the infant to the breast as soon as possible after birth. If
possible , the father should present during the labor and delivery.
◦ Practicing skin to skin contact care (kangaroo mother care) is a very powerful way promoting and
strengthening bonding with both parents.
◦ The infant should be given a name soon after delivery.
◦ Take photograph of the infant for the parents if the mother and the infant cannot be together.
◦ If the infants is small or ill and has to be cared in the nursery/nicu, the parents must be allowed to visit
their infant whenever they want.
PARENTS BE ENCOURAGE TO BOND WITH AN
INFANT WHO HAS A BIRTH DEFECT
◦ The sooner the parents are told of the abnormalities the better, if possible, tell the parents together.
◦ Encourage them to handle the infant. Point out the normal as well as the abno0rmal features.
◦ Handle the infant your5self as if you are not afraid to touch the infants. If possible, try to be optimistic.
◦ Explain the implications of the abnormalities.
◦ Tell the parents what the management will be. Where applicable, show photographs of corrected
abnormality, e.g. a repaired cleft lip and palate.
◦ Prepare the parents for having to break the news to any other children and other family and friends.
SUMMARIZATION
 Introduction the Care of newborn.
 Immediate basic care of the newborn at birth.
 Routine care of neonates.
 Harmful traditional practices for the care of neonates.
 Care of family
BIBLIOGRAPHY
◦ DUTTA PARUL TEXTBOOK OF PEDIATRICS JAYPEE PUBLISHERS. 6TH EDITION P.70-72
◦ PADAMJA. A. TEXTBOOK OF CHILD HEALTH NURSING. JAYPEE PUBLISHERS. 1ST EDITION
P.31-32
◦ MARLOW R. DOROTHY TEXTBOOK OF PEDIATRIC NURSING. ELSEVIER PUBLISHERS. 6TH
EDITION. P 374-379
◦ [Link]
essential-newborn-care
THANK YOU AND
GODBLESS!!!