Newborn care

The neonatal transition period

When cord is clamped. (Placental has exchange ceases)

Abnormal

Expand the collapsed lungs or alveoli

Occur for several days

• Newborn should always have bulb syringe in crib.
• Always suction mouth before the nose.
• Suction along the cheeks and not the back of the mouth.
• Deflate bulb before inserting.

Cyanosis can occurs from oxygenated and deoxygenated blood is mixing.

Right

Left.

• Leakage of BL through openings.
• Two types: functional and organic.

• Aka “innocent”
• BL passed through NL openings or valves

Occurs when BL passes through normal openings r/t structure.

Normal

• Newborns have an unstable heat regulatory system
• No functional sweat glands.
• May use skin to skin contact with mom or little incubators to keep infant warm

• Took used to evaluate the newborn.
• Taken at 1 minute after birth and 5 minutes after birth.

Includes: heart rate, rr, muscle tone, reflex irritability, and color.

• 0-3 needs resuscitation
• 4-7 needs gentle stimulation
• 8-10 no action needed

• Clean environment
• Hand washing**** (up to two months, wash hands prior to handling baby. )
• Heated Isolette

• Vitamin K- prevents hemorrhage. Baby can’t produce it on its own due to lack of normal flora
• HEP B- done at birth or at the first well baby check. Can be administered at hospital. Is recommend that they do the 3 step.
• Erthromycin Eye Ointment- protects against STIs

• Clamp is removed after 24-48 hrs
• Beta done applied after initial assessment by MD
• Watch for bleeding for 24 hr
• Observe for moistness, odor, drainage, or redness.
• Keep area clean and dry.

6-10 days after umbilical cord falls off.

5-10%

Temperature.

First temp at birth is rectal then all are axillary

97.6-99

120-160

30-60

• Abnormal vitals
• Nasal flaring or retractions
• Noisy respiration’s or breath sounds.

• Cheesy like substance
• Normal

• Fine downy hair.
• Normal finding when scarce.
• Abundance may indicate premature baby

33-35 cm

Should be equal to chest circumference and no more than 2 cm more for the first 2 years of life.

Soft spots

• If sunken in= dehydration
• If bulging= sign of increased ICP

2 fontenelles: anterior and posterior

Between 12-18 mo

After 2 months.

• Not well focuses
• Blue or brown coloration until 6-12 mo
• Crossed Bc lack of muscle coordination
• Tears absent

Should be able to hear. Hearing checked twice at hospital before needing to see specialist

• ABR- auditory brain stem device
• Low set ears = abnormality

• 12-13inches
• Should be similar to head (33-35cm)

Cream in color

Edematous

• Tufts of hair
• Sacral dimples

ROM

• Jaundice
• Ecchymosis
• Milia
• Erythema toxicum neonatorum
• Stork bites
• Port wine stains
• Strawberry nevus
• Mongolian spots

Bruising

White pimples on nose or chin

Pink rash with firm papules often found on trunk

Dilated capillaries that Blanche at back of neck and eyelids

Reddish purple birth mark that doesn’t fade

Cluster of superficial blood vessels

Blueish spots on butt or sacrum, will fade.

• Large and misshapen
• Molding
• Caput succedaneum (cap)
• Cephalohematoma

Process of confirming to the birth canal. Will return to normal after a few days

• “CAP”
• Edema of the soft tissue of the scalp.
• Crosses fissure lines. No tx, fixes self.
• Feels mushy.

• Collection of blood between periosteum and skull. Does not cross suture lines.
• Is contained.
• Caused by trauma at birth.
• Reabsorbs in 3-6 weeks

• Kidneys may not be fully developed at birth.
• Monitor I& o
• Very important to note first void (usually within 24hr)
• Genitals are sometimes underdeveloped.

• Urination occurs in utero
• Any change in color or urine should be reported and noted. As well as odor

Possible “imperforated meatus” -no opening to urethra

• Swollen
• Blood tinged vaginal discharge (pseudomenstruation)
• ALWAYS wipe front to back.

• Tested normally descend before birth
• (Cryptorchidism is failirento descend )

• Location of urethral opening on tip of penis
• Hypospadias- it’s located underside
• Epispadias- located topside
• Phimosis- too small of opening in foreskin

Hydrocele-fluid around rested in the scrotum

• Syndactyly- fusion of 2 or more fingers or toes
• Hallux varus- big toe has a gap between the other toes
• Polydactyly- extra digits

• Rooting
• Sucking
• Extrusion
• Plantar snd Palmer grasp
• Tonic-neck reflex (fencing)
• Moro
• Dancing or stepping
• Babinskis

Head turns toward direction of cheek stimulation.

Sucks when lips are touched

Tongue forced out when tip of tongue is touched

Baby grips your finger when you touch the base of their fingers or toes.

Baby turns head to side and the extremities on that side extend and the opposite side flexed

• Steele reflex.
• When surprised, legs pull up and arms extend outward rapidly the come back in.
• Makes C shape with fingers

Baby appears to take steps or dance when held upright with his or her feet touching a solid surface

Fanning of toes when some of foot is stroked

• Bones are soft and flexible
• Movement is uncoordinated
• Coordination occurs from head to toe from center out.
• Head and neck muscles first ones under control.

• Eyes- inner to outer
• Shampoo head last unless in isolette
• Clean females front to back
• Keep environment very warm
• Makes sure all skin folds are clean and dried to prevent skin irritation

• Two types: gomco and plastibell
• Vaseline with each diaper change to prevent diaper from sticking
• Watch for : bleeding, swelling, and decreased urine output

• Immature at birth
• Meconium stools (black tarry, stinky. May take several bowel movements to clear)
• Breastfed stools (yellowy, 3-6 times daily is normal)
• Constipation ( straining isn’t always an indicator of constipation. Always check stool first )
• Drooling- shouldn’t drool- abnormal
• Imperforated anus- no opening. May need colostomy

• Hypoglycemia - loss of maternal glucose with high infant insulin production
• Resp distress- increases insulin production hinders surfactant ( fatty protein that matures the lungs)
• Birth trauma - LGA
• Congenital birth defects are more common

Babies typically weigh more.

genetic disease where there is a deficiency in the enzyme needed to digest the amino acid phenylalanine.

• Most states obtain labs after birth to test (48-72 hrs)
• Undetected can lead to severe MR

Failure to thrive, eczema, MUSTY ODOR, developmental delays

Tx: diet low in phenylalanine

• Dx: when levels are greater than 20
• Normal
• Levels are 2-10.