Growth & Development - THE NEWBORN

First 28 days of life

PRINCIPLES

OF NEWBORN CARE

1. Stimulation2. Position should promote drainage

3. Suctioning4. Airway patency

B. Maintain appropriate body

temperature.

Chilling will increase the body’s need for

oxygen.

COLD STRESS

Metabolic acidosis

Hypoglycemia

Dry the newborn immediately.

Wrap warmly

Put under a droplight

C. Immediate assessment of

the newborn

APGAR SCORING – standardized evaluation of

the newborn’s condition and serves as a baseline

for future evaluations

• Performed at 1 minute and 5 minutes after birth

APGAR SCORING

SIGN 0 1 2

Heart rate Absent <100 >100

Respiratory effort Absent Weak cry Good, strong cry

Muscle tone Limp, flaccid Some flexion of

extremities

Well-flexed

extremities

Reflex irritability No response Grimace; weak cry Sneeze; good,

strong cry

Skin color Pallor or cyanosis Extremities blue,

body pink

Pink all over

APGAR SCORING

• Interpretation:

• 0 – 3

• Serious danger and needs resuscitation

• 4 – 6

• Condition is guarded and needs clearing

of airway and supplementary oxygen.

• 7 – 10

• Good

BALLARD SCORING

• A revised assessment of Dubowitz scale

(Maturity scale).

• Assessment for gestational age

• The total score of both portions is compared

with the standard scale.

• cit different parameters

• Numeric scores from 0-5 is given

BALLARD SCORING

• Two portions:

1. PHYSICAL MATURITY

• Series of observation about skin texture, color,

lanugo, foot, creases, genitalia, ear and breast

maturity.

• The body part is inspected, and given a score 0-5.

• Should be done as soon as possible after birth

2. NEUROMUSCULAR MATURITY

• Observe and position the body to elicit different

parameters

PHYSICAL

MATURITY

SIGN

SCORE

-1 0 1 2 3 4 5

SKIN sticky, friable,

transparent

gelatinous,

red,

translucent

smooth pink,

visible veins

superficial

peeling &/or

rash, few

veins

cracking, pale

areas, rare

veins

parchment,

deep

cracking, no

vessels

leathery,

cracked,

wrinkled

LANUGO none sparse abundant thinning bald areas mostly bald

PLANTAR

SURFACE

heel-toe

40-50 mm: -1

<40 mm: -2

>50 mm

no crease

faint red

marks

anterior

transverse

crease only

creases ant.

2/3

creases over

entire sole

BREAST imperceptable barely

perceptable

flat areola

no bud

stippled

areola

1-2 mm bud

raised areola

3-4 mm bud

full areola

5-10 mm bud

EYE / EAR lids fused

loosely: -1

tightly: -2

lids open

pinna flat

stays folded

sl. curved

pinna; soft;

slow recoil

well-curved

pinna; soft but

ready recoil

formed & firm

instant recoil

thick cartilage

ear stiff

GENITALS

(Male)

scrotum flat,

smooth

scrotum

empty,

faint rugae

testes in

upper canal,

rare rugae

testes

descending,

few rugae

testes down,

good rugae

testes

pendulous,

deep rugae

GENITALS

(Female)

clitoris

prominent &

labia flat

prominent

clitoris &

small labia

minora

prominent

clitoris &

enlarging

minora

majora &

minora

equally

prominent

majora large,

minora small

majora cover

clitoris &

minora

BALLARD SCORING

BALLARD SCORING

BALLARD SCORING

SCORE -10 -5 0 5 10 15 20 25 30 35 40 45 50

WEEKS 20 22 24 26 28 30 32 34 36 38 40 42 44

MATURITY RATING

D. Proper identification

Must be done the DR.

Use of identification band with permanent locks

case/hospital number

the mother’s full name

sex, date , and time of birth of the newborn.

Footprints are said to be the best way to identify

newborns.

E. Nursery Care

Check identification of the newborn.

Take the temperature

At birth is 37.2 °C

Must be maintained at 35.5-36.5 °C

Rectal route is preferred in order to check the

patency of the anus

• Take anthropometric

measurements

• Length

• Head circumference

• Chest circumference

• Abdominal circumference

• Weigh-taking

• Average birth weight

• 3000 – 3400 g

• Lower limit - 2500 g (5.5 lbs)

• Physiologic weight loss

E. Nursery Care

• Vitamin K administration

• Facilitates production of clotting

factors

• 0.5 – 1.0 mg IM into the vastus

lateralis

• Dress the umbilical cord.

• Check for the presence of 2

arteries and 1 vein

• If not complete, suspect a

congenital anomaly

• Fall-off at 7-10 days

E. Nursery Care

• Crede’s prophylaxis

• Prophylactic treatment against ophthalmia neonatorum

• Drugs used:

• Silver Nitrate 1%

• Erythromycin ophthalmic ointment

• Feeding

• Initial feeding – test feeding consisting of an ounce of sterile water

• Subsequent feedings – per demand

E. Nursery Care

F. Physical Assessment

Pulse120-140 bpm

Irregular

Respiration30-60 cpm

Irregular and with periodic respirations

Gentle, quiet, rapid but shallow, diaphragmatic and abdominal

Blood pressureNot routinely measured in newborns unless cardiac anomaly is

suspected.

Normal valuesAt birth – 80/46 mmHg

By tenth day – 110/50 mmHg

• Head

• Largest part of the

infant’s body

• Forehead is large and

prominent

• Chin is receding and

quivers when startled

or crying



• Fontanelles

• Spaces or openings where

the skull bones join

• Anterior fontanelle

• Diamond shaped

• Measures 2-3 cm in width

and 3-4 cm in length

• Closes at 12-18 mos

• Abnormal findings:

• Indented or sunken

• Bulging

• Posterior fontanelle

• Triangular in shape

• Measures 1cm in length

• Closes 2-3 months

• Sutures

• Separating lines of the skull

• Overriding is normal at birth

• Should never appear separated or fused.

• Molding

• Craniotabes

• Localized softening of the cranial bones.

• The condition corrects itself without treatment after a

few months.


INDICATORS CAPUT SUCCEDANEUM CEPHALHEMATOMA

Definition Edema of scalp Collection of blood

Location Presenting part Between periosteum of the

skull bone and the bone

itself

Involvement Both hemispheres Does not cross suture lines

Cause Pressure Pressure

Period of absorption 1 – 3 days Several weeks

Treatment None Support parents



• Eyes

• Tearless

• Should appear clear

• Small Subconjuctival Hemorrhage

• Appears as a red spot on the sclera

• Bleeding is slight and needs no treatment

• Completely reabsorbed in 2-3 weeks.

• Edema around the orbit or on the eyelids

• Remain for the first 2-3 days

• Cornea should be round and proportionate to that of an

adult.

• The pupil should be dark.

• Ears

• The level of the top part of the external ear should be on a line

drawn

• Small tags of skin

• Test hearing by ringing a bell 6 inches from each ear.

• Nose

• Appear large for the face.

• Test for choanal atresia.

• Presence of milia – small pinpoint white or yellow dots usually

found in the nose, forehead & cheeks.


• Mouth

• Epstein’s pearls

• Thrush

• Blowing bubbles of mucus

• Natal teeth

• Neck

• Short and often chubby with creased skin folds.

• Head should rotate firmly on the neck and should be

able to flex forward and back.


• Chest

• Should be symmetrical.

• Breast may be engorged.

• Witch’s milk

• Retraction should not be present

• Abnormal sounds:

• Grunting – suggestive of respiratory distress syndrome

• High, crowing sound –suggestive of stridor or immature

tracheal development


• Skin

• Color

• Normally with ruddy complexion

• Generalized mottling

• Cyanosis:

• Acrocyanosis

• Central cyanosis

• Gray color indicates infection


• Jaundice

• Due to inability of the newborn to conjugate bilirubin

• Pathologic jaundice

• Physiologic jaundice

• Breastfed babies have longer periods of physiologic

jaundice

• Kernicterus.

• Pallor - due to anemia

• Harlequin Sign


• Birth marks

• Hemangiomas - Vascular tumors of the skin

• Nevus flammeus

• A macular purple or dark red lesion - “port-wine stain”

• May appear lighter, pink patches at the nape of the neck – “stork’s beak

marks”

• Strawberry hemangiomas

• Elevated areas formed by immature capillaries and endothelial cells

• Formation is due to high estrogen levels of pregnancy.

• Tend to be absorbed and shrink in size after 1 year.

• Cavernous hemangiomas

• Dilated vascular spaces

• Raised and resemble strawberry hemangiomas

• Mongolian spots


• Vernix caseosa• A white, cream cheese-like substance that serves as a skin

lubricant.

• Takes color of the amniotic fluid

• Lanugo

• Desquamation

• Milia

• Erythema toxicum• Newborn rash

• “flea bite rash”

• Skin turgor• Resilient, feel elastic, fall back to form smooth surface after

being grasped.



• Abdomen• Slightly protuberant

• Bowel sounds should be present within an hour after birth

• Anogenital Area• Passage of meconium

• Male Genitalia• Scrotum may be edematous and has rugae

• Testes should be present; if not descended, the condition is called cyrptorchidism

• Elicit cremasteric reflex

• Urethral opening should be open at the tip of the glans

• Female Genitalia• Vulva may be swollen

• Psudomenstruation

• Back

• Spine of newborn appears flat in the lumbar and sacral areas

• Extremities

• Arms and legs are short

• Hands are clenched to fists

• Unusually short arms may signify achondroplastic dwarfism

• Note for simian crease

• Arms and legs should be symmetrical

• Erb-Duchenne paralysis

• Congenital hip dislocation

• Assess for finger abnormalities

• Syndactyly

• Polydactyly

• Assess for talipes deformity (clubfoot)


G. Physiologic Function

• Gastrointestinal System

• Regurgitates if stomach is overfull

• Meconium

• Sticky, tarlike, blackish-green, odorless material formed from mucus, vernix, lanugo, hormones, and carbohydrates that accumulated during intrauterine life.

• Transitional stool

• Second or third day of life

• Green and loose, and may resemble diarrhea to the untrained eye

• Breastfed babies’ stool

• Golden yellow, mushy, sweet smelling, more frequent

• Bottle-fed babies’ stool

• Pale yellow, firm, slight more noticeable odor, less frequent

• Urinary System

• Must void within the first 24 hours

• First voiding may be pink or dusky because of uric

acid crystals that were formed in the bladder in utero.

• Immune System

• Prone to infection

• Passive natural immunity

• May have antibodies from the mother


• Neuromuscular System

• Should demonstrate general neuromuscular function

by

• moving their extremities, attempting to control head

movement, and exhibits a strong cry.

• Limpness – total absence of a muscular response to

manipulation.

• Senses:

• All are functional at birth

• Touch is the most developed of all senses


• Reflexes

• Blink

• Rooting

• Sucking

• Extrusion

• Swallowing

• Palmar Grasp

• Step-in

• Plantar Grasp

• Tonic Neck

• Neck Righting

• Moro

• Babinski

• Magnet

• Trunk Incurvation

• Landau

• Parachute


NURSING CARE

OF NEWBORN

A. FEEDING

Term newborn

Breastfed - may be fed immediately.

Formula fed – first feeding at 2-4 hours

of age

Feed by demand

Feed by schedule

Should be burped at least twice during

feeding.

B. BATHING

Initial complete bath

Bathed once a day.

Best done by parents under nurse’s supervision.

The room should be warm and water temperature should be 37 – 38 °C.

Should be done before feeding.

Should proceed from the cleanest to the most soiled areas.

Talcum powder is not advisable.

C. SLEEPING

Should be positioned on the back for

sleeping.

Newborn sleeps an average of 16 hours of

every 24 hours in the first week.

By 4 months of age, the child sleeps an

average of 15 hours of every 24 hours and

through the night.

D. CORD CARE

Fold down diaper so that cord does

not get wet during voiding.

Dab rubbing alcohol (70%) once or

twice a day

E. DIAPER AREA CARE

With each diaper change, the area should

be washed with clean water and dried

well.

Wear gloves for diaper care as part of

standard precautions.

F. CLOTHING

Cover newborn’s head to prevent heat loss

As a rule, to be comfortable, the infant

should be dressed in one more layer of

clothing than what the parents are

wearing.

Documents

Growth & Development - THE NEWBORN