1. CHAPTER 54
NEWBORN CARE
Part 2

2. IMMEDIATE NEEDS OF THE NEWBORN
Airway
Breathing
Circulation
Warmth

3. WARMTH Cold stress–excessive heat loss:
Conduction–loss by direct contact with cooler object
Convection–loss by air movement
Evaporation–water changed to vapor
Radiation–loss by transfer to cooler objects nearby

4. IMMEDIATE CARE OF THE NEWBORN
Apgar score
Resuscitation
Neutral thermal environment
Identification
Parent/infant bonding

5. PROPHYLACTIC CARE Vitamin K–to prevent hemorrhagic disorders
Hepatitis B vaccination–within the first 12 hours
Eye prophylaxis–to prevent ophthalmia neonatorum
Umbilical cord care–to prevent infection

6. PHYSICAL CHARACTERISTICS OF THE NEWBORN
Weight and length
Vital signs
General appearance: skin, head, eyes, ears, neck, chest, abdomen, genitalia, back, and extremities

7. COMMON VARIATIONS IN THE NEWBORN
Skin
Head
Eyes and ears
Mouth
Chest
Genitalia
Extremities

8. REFLEXES Rooting Sucking Extrusion Palmar grasp Plantar grasp
Tonic neck
Moro
Gallant
Stepping
Babinski’s
Crossed extension reflex
Placing

9. BEHAVIORAL CHARACTERISTICS
During first 6 to 10 hours after birth, infant has fairly predictable pattern of behavior called periods of reactivity.
Following that, infant will exhibit various behavioral states, divided into sleeping and waking phases.

10. ASSESSMENT OF EXTERNAL PHYSICAL CHARACTERISTICS
Resting posture
Skin
Plantar creases
Breast
Eye/ear
Male genitals
Female genitals

11. NEUROMUSCULAR MATURITY
Square window
Arm recoil
Popliteal angle
Scarf sign
Heel to ear

12. GESTATIONAL AGE RELATIONSHIP TO INTRAUTERINE GROWTH
Large for gestational age (LGA) –infant’s weight above 90th percentile.
Appropriate for gestational age (AGA) –weight falls between 90th and 10th percentile.
Small for gestational age (SGA) –weight falls below 10th percentile.

13. FIRST BATH AND CORD CARE
Newborns are not generally given a tub bath until the cord has fallen off.
Infant may remain in the warmer.
Check temperature in 30 minutes to 1 hour.
Treat the cord stump with alcohol.
Fold the diaper under the cord stump.

14. CIRCUMCISION
Surgical removal of the prepuce (foreskin) that covers the glans penis.
Considered an elective procedure for which parents must give written consent.
Only full-term, healthy newborns.
Check hourly for 12 hours for voiding, bleeding.

15. NUTRITION
Newborns need approximately 20 oz of breast milk or formula each day.
Newborns lose weight the first few days of life.
Infant regains birth weight by age 10 days.

16. BREASTFEEDING
Breast milk is biologically designed to meet the needs of human infants.
Colostrum (first few days) is rich in immunoglobulins, helps establish normal intestinal flora, and has a laxative effect.
Breastfeeding mother must take in extra 500 calories a day.

17. FORMULA FEEDING
Formula is fortified to be as much like breast milk as possible.
Special formulas are made to meet special needs of some infants.

18. BURPING All infants require burping.
Burping should be done about halfway through the bottle if bottle feeding.
Burping should be done when changing breasts if breastfeeding.

19. PROBLEMS OF THE NEWBORN
Hyperbilirubinemia
Respiratory distress
Cleft lip/palate
Hydrocephalus
Spina bifida
Down Syndrome
Talipes equinovarus

20. INFANT OF A DIABETIC MOTHER
Hypoglycemia
Respiratory distress
Hyperbilirubinemia
Birth trauma
Congenital birth defects

21. INFANT OF AN HIV POSITIVE MOTHER
Transmission may occur through placenta, maternal blood, secretions during birth, through breast milk.
At birth, infant typically has no symptoms.
All infants of HIV positive mothers should be presumed to be HIV positive.
Breastfeeding is not recommended.

22. INFANT OF A SUBSTANCE-ABUSING MOTHER
When umbilical cord is cut, the newborn experiences withdrawal.
Complications: withdrawal, respiratory distress, jaundice, behavior problems, congenital anomalies, growth retardation.
Infants of alcohol dependent mothers may have fetal alcohol syndrome (FAS).

23. PHENYLKETONURIA (PKU)
Inborn error of metabolism.
Infant cannot digest amino acid phenylalanine.
Test at least 24 hours after initial feeding.
Infant with PKU needs diet low in phenylalanine or severe mental retardation may occur.