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Prepared By /lamiaa Elsayed
Pediatric Nursing
Immediate care of newborn 1
The 1st 24 hours
of Life
The first 24 hours of life is a very significant time due to critical transition from intrauterine to extra uterine life .
Immediate care of newborn 3
Purposes of immediate care of newborn
• Establish and maintain respiratory function.
• Provide warmth and prevent hypothermia.
• Ensure safety from injury and infection.
• Identify actual and potential problems that might require immediate action.
Immediate care of newborn 4
Immediate Care of the Newborn
• Airway
• Breathing• Temperature• APGAR• IDENTIFICATION
Implementation:• Oro-pharengeal Suctioning:
• 1.Wipe the neonate’s mouth with a piece of gauze around your index finger once his head has been delivered.
• Wrap and dry the neonate in a warmed towel.
• Suction the neonate’s mouth with a disposable Suctioning.
Immediate care of newborn 6
Implementation:• Place the neonate in a radiant warmer.
• Replace the wet towel and wrap the neonate in another dry towel.
• Place newborn in trendlenburng position.
• Do suction of oropharyngeal canal.
• Oxygen may be given.
• Continue suction as fluid is aspirated.
Immediate care of newborn 7
Dry the Baby• Hypothermia is common• Wet newborns rapidly lose
heat• Use a warm, dry, soft towel• Any absorbent material:
Replace the Wet Towels• Then let the mother
hold the baby• Her body heat will
help keep the baby warm
• Cover the head to prevent heat loss
POSITIONING OF THE NEWBORN
• Positioning
Right side lying
1. promote drainage secretion
2. fasten gastric emptying time
• good airway.
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Airway & Breathing
• Suction gently & quickly using bulb syringe or suction catheter
• Starts in the mouth then, the nose to prevent aspiration
Suction first from Mouth and then from Nose Use a by use of bulb syringe
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Airway & Breathing
• Stimulate crying by rubbing
• Position properly- side lying / Provide oxygen when necessary
Assess the newborn’s condition
A- One minute APGAR Score& reassess at 5 minutes.
B-Neurological examination by checking common reflexes of the newborn.
C-Vital signs pulse, respiration & temperature.
D-Growth measurement include length, weight, head & chest circumferences.
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Assess the newborn’s condition
E-Assess for any gross abnormality, congenital defects in head,
F- eyes, ears, chest, spine,. face, nose, abdomen, anus, external genitalia &extremities.
G-Assess for any signs of eye infection.
Immediate care of newborn 15
Apgar score
• The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two and summing up the five values.The resulting Apgar score ranges from zero to 10.
Immediate care of newborn 16
Immediate care of newborn 17
APGAR Scoring System
A ctivity/ Muscle Tone
P ulse/ Heart Rate
G rimace/ Reflex Irritability/ Responsiveness
A ppearance/ Skin Color
R R espiration/ Breathing
1 2 3 4 5
APGAR
Apgar score
PinkPinkBody pink , Body pink , extremities blueextremities blue
Blue or Blue or palepale
ColorColor
CryCryGrimaceGrimaceNo No responseresponse
Reflex Reflex irritabilityirritability
Active motion , Active motion , extremities well flexed .extremities well flexed .
Some flexion of Some flexion of extremitiesextremities
nonenone Muscle toneMuscle tone
Good , strong cryGood , strong cryWeak cryWeak cryAbsentAbsentRespiratory Respiratory efforteffort
Above 100Above 100Below 100Below 100AbsentAbsentHeart rate(pulse Heart rate(pulse
221100Sign Sign
Immediate care of newborn 19
Significance of Apgar score
• Healthy newborn: 7-10 at both 1 and 5 minutes .• Moderately depressed newborn : 3-6 ( Need
resuscitation )• Severely depressed newborn : 1-2 ( Intensive
resuscitation )
Immediate care of newborn 20
Cord Care
Immediate care of newborn 21
Cord Care
• Use sterile plastic clamp or ligature, the first ligature is placed about 2.5-3 cm from the abdomen & second ligature is placed about 1cm from the first ligature.
• Press between the two ligatures.
• Cut the cord by blunt sterile scissor after the second clamp.
• Examine umbilical cord structure (two arteries and one vein)Immediate care of newborn 22
Cord Care Continue
• Paint the end of the stump with alcohol.
• Clean the cord at the base of cord firstly, then the stump from down to up with one direction and cleaning the cord clamp.
• Let the cord exposed not covered by the diaper.
• Assess the signs of cord healing and signs of infection (erythema edema tenderness).
Immediate care of newborn 23
Cord Care
Immediate care of newborn 24
Eye care:• Clean the eye lids é sterile warm sterile
water and cotton.
• Wipe from inner to outward.
• Install one drop of solution of isophenicol.
• Wipe the excess of solution by clean cotton.
Immediate care of newborn 25
Vitamin K Injection• Administer 1mg. Vitamin K by I.M
injection.
• Route: IM into the lateral anterior thigh (Vastus lateralis).
Immediate care of newborn 26
Immediate care of newborn 27
Vitamin K Administration
Identification of the newborn
• Identification of the newborn which place on wrist & ankle (mother name, hospital no, sex, weight of newborn).
• Before transferring to nursery, ID tag should be applied.
Immediate care of newborn 28
Immediate care of newborn 29
Dressing/ Wrapping
• “Mummy”• Wrap in warm
blanket• Cover head with
stockinette cap
Assessment of vital signs •temperature : the axillary method is the safest .Normal axillary temperature is 36 – 36.5 °C
•Heart Rate ( HR ) :HR is counted for 60 seconds at the apex of the heart (Range
from 100- 160 b/m immediately after birth ) .
•Respiratory Rate ( RR ) :RR varies from 30- 60 b/m when the infant is not crying .
•Blood Pressure ( BP ) :Not routinely assessed in healthy term infants .The range of normal blood pressure in term infants is 60- 90
mmhg for systolic pressure and 40 – 50 mmhg for diastolic pressure .
Immediate care of newborn 30
ANTHROPOMETRIC MEASUREMENT
• HEAD CIRCUMFERENCE : 33-35cm
• CHEST and ABDOMEN : 31-33cm
• LENGTH : 47-54cm
• WEIGHT : 2500-4000 gramsImmediate care of newborn 31
Assessment of Growth
Immediate care of newborn 32
Immediate care of newborn 33
Neurologic System
Neonatal Primitive Reflexes
Immediate care of newborn 35
Reflexes
Include the Moro , startle , palmer and planter grasps, sucking and rooting and swallowing reflexes, tonic neck reflex ,stepping , and babinski sign .
Immediate care of newborn 36
Moro Reflex or startle reflex• quick change in the infant's position will cause the infant to throw the
arms outward, open the hands, and throw back the head.
Immediate care of newborn 37
Palmer grasp
• Palmar and plantar grasp - the infant's fingers or toes will curl around a finger placed in the area
Immediate care of newborn 38
planter grasp
• Palmar and plantar grasp - the infant's fingers or toes will curl around a finger placed in the area
Immediate care of newborn 39
Babniski reflex
• the infant's foot is stroked, the toes will extend upward.
Immediate care of newborn 40
Rooting reflex
•This reflex begins when the corner of the baby's mouth is stroked or touched.
Immediate care of newborn 41
Sucking reflex
• When the roof of the baby's mouth is touched, the baby will begin to suck.
Immediate care of newborn 42
Asymmetric tonic neck reflex
Tonic neck reflex - When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow.
Immediate care of newborn 43
Dance or step reflex• This reflex is also called the walking or dance reflex because a baby appears to take steps
or dance when held upright with his/her feet touching a solid surface.
Immediate care of newborn 44
Immediate care of newborn 45
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