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Initial care of the newborn

  • Observe or assist with initiation of respirations
  • Assess APGAR score
  • Note characteristics of cry
  • Monitor abnormal respiration like nasal flaring, grunting, and retractions
  • Obtain vital signs
  • Observe for hypothermia or hyperthermia
  • Assess for any gross anomalies


  • Suction mouth, then nares with bulb syringe
  • Maintain temperature, warp newborn in Warm blankets, and a cap for the head
  • Dry the newborn and stimulate crying by rubbing
  • Keep the newborn with mother to promote bonding
  • Place the newborn at mother’s breast if breast feed is planned, or place on mother’s abdomen
  • Place newborn in warmer
  • Ensure newborn’s proper identification like foot print of the newborn and finger print of the mother should be made.
  • Place identification bracelets on mother and newborn hand.

APGAR score

  • Perform at one minute and after 5 minute
  • If the score is less than 7 at 5 minutes the apgar score should be performed at 10 minutes
  • A score of 7 to 10 indicate healthy new born
  • A score of 3 to 6 is considered moderately depressed
  • A score of 0 to 2 is severely depressed
Heart rate Absent Less than 100 More than 100
Respiratory rate Absent Slow irregular weak cry Good vigorous cry
Muscle tone Flaccid limp Some flexion of extremity Good flexion, active motion
Reflex irritability No response Weak cry and grimace Vigorous cry, cough, sneeze
Skin color Blue Body skin color normal, Extremities blue Body and extremity skin color normal



  • 7 to 10
    • Rarely needs resuscitation
  • 3 to 6
    • Requires resuscitation, suction, dry quickly, maintain warmth
    • Ventilate 30 to 50 times / minute until HR is above 100, color is pink, and spontaneous respiration begins.
    • Provide oxygen
  • 0 to 2
    • Require intensive resuscitation
    • Clean airway
    • Insert ET tube , and use AMBU bag if necessary
    • Ventilate with 100% oxygen at 40 to 60 birth / minute
    • Initiate full CPR as needed
    • Maintain body temperature
    • Support parents


General guidelines
  • Keep newborn warm during the examination
  • Begin with general observation then perform assessment
  • Initiate nursing intervention for abnormal findings
  • Document all abnormal finding
Vital signs
  • HR 100 to 160 b/m (apical) assess for full one minute
  • Respiration 30 to 80 Br/m check for full one minute
  • Axillary temperature 96.8 to 99F
  • Blood pressure 73/55 mm of hg
  • Length 45 to 55 cm (18 to 22 inch)
  • Weight 2500 to 4300gm (5.5 to 9.5 pound)
  • Head circumference 33 to 35 cm (13 to 14 inch)
  • Chest circumference 30 to 33cm (12 to 13 inches)
  • Bones of the skull are not fused
  • Anterior fontanel is soft, flat, diamond shaped 3 to 4 cm wide by 2 to 3 cm long, close between 12 to 18 months of age
  • Posterior fontanels is triangular in shape 0.5 to 1 cm wide closed between 2 to 3 months of age
Umbilical cord
  • Umbilical cord contains two arteries and one vein
  • If fewer than three vessels are noted to physician
  • Assess for intact cord and ensure that clamp is secured
  • Cord should be clamped for at least the first 24 hours. It can be removed when the cord is dried and occluded
  • Note any bleeding or drainage from cord
  • Triple dye is use to applied in the cord to prevent growth of microorganism and promote drying. It paint the cord at one time and 1 inch surrounding skin
  • Application of 70% isopropyl alcohol to the cord with each diaper change and at least 2 to 3 times a day to minimize microorganism and promote drying
  • Monitor for symptoms of infection such as moistness, oozing, discharge, and reddened base occur.
  • If so antibiotic treatment should be start
Management of cord

  • Umbilical clamp can be removed after 24 hours
  • Teach the mother how to perform cord care
  • Keep the cord wiping with alcohol swab with each diaper change
  • Keep the diaper below the cord
  • Assess cord for odor, swelling, or discharge.
  • Sponge bath the newborn until the cord fall off


Cardiovascular assessment
  • Take apical heart rate for 1 full minutes
  • Listen for murmurs
  • Assess for cyanosis
  • Observe for cardiac distress when newborn is feeding
Respiratory system
  • Suction if necessary, use a bulb syringe for suction
  • Position newborn on side
  • Observe for respiratory distress, hypoxemia, nasal flaring, severe retractions, grunting, cyanosis, and bradycardia
  • Administer oxygen via hood if necessary.
Hepatic system
  • Normal or physiological jaundice appear after the first 24 hours in full term neonates and after first 48 hours in premature neonates
  • Jaundice occurring before 24 hours known as pathological jaundice may indicate hemolysis of red blood cells and it must be reported
  • Monitor S. bilirubin levels
  • Feed early to stimulate intestinal activity and to keep the bilirubin level low
  • If bilirubin level exceed 15 to 20 mg/dl temporarily discontinue breastfeeding
  • Liver stores iron passed from the mother for 5 to 6 months
  • Neonate is at risk of hemorrhagic disorder so administer vitamin K
Renal system
  • The immature kidneys are unable to concentrate urine
  • A weight loss of 5% to 15%occur in the first week of life due to increase output and limited intake
  • Weigh newborn daily
  • Monitor I/O, weigh diaper if necessary
  • Assess for the signs of dehydration ex: dry mucous membrane, sunken eyeballs, poor skin turgor, Sunken fontanels.
Immune system
  • Passive immunity via the placenta (IgG)
  • Passive immunity via breast milk (IgA)
  • Use of aseptic technique when caring for the newborn
  • Ensure meticulous hand washing.
  • Wear gowns when caring for newborn.
  • Monitor newborn’s temperature.
  • Administer eye medication with in 1 hour after birth to prevent ophthalmia neonatorum.
Circumcision care
  • Apply petroleum gauze jelly to penis
  • Remove petroleum gauze jelly after first voiding following circumcision.
  • Observe for swelling, infection, or bleeding from the circumcision site.
  • Clean the penis after each voiding by warm water
  • A milky covering over the gland penis is normal and should not be disrupted.
  • Monitor for urinary retention.
Gastrointestinal system
  • Newborns are able to digest simple carbohydrates but are unable to digest fat because of lack of lipase
  • Newborns have a small stomach capacity about 90 ml.
  • Breast feed can start immediately after birth.
  • For bottle feed baby initially start with few milliliters of sterile water or 5% dextrose 1 to 4 hours after birth to feed with formula.
  • Monitor for reflexes such as rooting, sucking, and swallowing.
  • Burp newborn during and after feeding
  • Assess for regurgitation or vomiting.
  • Observe for the passage of meconium stool.
  • Soft, yellow stool are noted in breast feeding child.
  • Seedy, yellow stool are noted in formula feed child
Thermal regulatory system
  • Newborns do not shiver to produce heat.
  • Newborns have brown fat deposits, which produce heat.
  • Prevent heat loss through evaporation by keeping newborn dry and well wrapped with a Blanket.
  • Prevent heat loss through radiation by keeping newborn away from cold objects and outside walls.
  • Prevent heat loss resulting from conduction by performing all treatment on a warm padded surface.
  • Keep temperature in room warm.
  • Take temperature every hour for first 4 hours then every 4 hours remaining 24 hours by axillary.


Sucking and rooting
  • Touch the newborn’s lip, cheek, or corner of the mouth with a nipple.
  • Newborn turns head towards the nipple, open the mouth, takes hold of the nipple and suck.
  • Usually disappear after 3 to 4 months but may persist for up to 1 year.
Swallowing reflex
  • Occurs spontaneously after sucking and obtaining fluids.
  • Newborn swallows in coordination with sucking without gagging, coughing, or vomiting.
 Tonic neck or fencing
  • While the newborn is falling asleep or sleeping, gently and quickly turn the head to one side.
  • When the head turn to left side, the left arm and leg extend outward, while the right arm and leg flex.
  • When the head is turned to right side the right arm and leg extend outward while the left arm and leg flex.
  • Usually disappears with in 3 to 4 months.
Palmar- plantar grasp
  • Place a finger in the palm of the newborn’s hand, then place a finger at the base of the toes.
  • The newborn’s fingers curl around the examiner fingers, and newborns toes curl downward
  • Palmar response lessens within 3 to 4 months
Moro reflex
  • Hold the newborn in a semi sitting position; then allow the head and trunk to fall backward to at least a 30 degree angle.
  • The newborn symmetrically abducts and extends the arms.
  • It may present at birth complete response may occur up to 8 weeks.
  • No response may be noted by 6 months as neurological system matured.

Startle reflex

  • The examiner makes a loud noise or claps hand to elicit the response.
  • The newborn’s arms abduct while the elbows flex, the hand stay clenched.
Babinski sign – plantar
  • Gently stroke the heel of the foot upward along the lateral aspects of the sole, then the examiner moves the finger along the ball of the foot.
  • The newborn’s toes hyperextend while the big toe dorsiflexes.
  • Absence of this reflex indicates the need for a neurological examination.
  • Reflex disappears after one year old.
Stepping or walking
  • Hold the newborn in a vertical position allowing one foot to touch a table surface.
  • The newborn stimulate walking alternately flexing and extending the feet.
  • This reflex usually 3 to 4 months.
  • Place the newborn on the abdomen.
  • The newborn begins making crawling movements with the arms and legs.
  • The reflex disappears after about 6 weeks.


Formula feeding
  • Take purified water for making formula.
  • Do not heat the bottle of formula in microwave oven.
  • Inform the mother that formula is sufficient diet for the first 4 to 6 months.
  • Assess the mother’s ability to burp the newborn.
  • Bath the new born before feeding.
  • Keep the room warm.
  • Have all the equipment for bathing is available.
  • Use a mild soap.
  • Start the bathing from the cleanest area to the dirtiest.
  • Clean eyes from the inner canthus to outward.
  • Special care should be given under the folds of the neck, underarms, groin, and genitals.
  • Make bath time enjoyable for both the newborn and the mother.
Care of a uncircumcised new born
  • Inform the mother that the foreskin and glands are two similar layers of the cells that separate from each other, that will occur between 3 to 5 year.
  • So instruct the mother not to pull back the foreskin but allow for the natural separation to occur.


  • Jaundice during first 24 hr indicates a pathological process caused by haemolysis of blood.
  • Evaluation indicated when serum levels are over 12 mg/dl in the term newborn.
  • Jaundice
  • Elevated serum bilirubin levels
  • Enlarged liver
  • Poor muscle tone
  • Lethargy
  • Poor sucking reflex
  • Monitor the presence of jaundice.
  • Examine baby skin color in natural light.
  • Press the finger or nose to press out capillary blood from the tissues.
  • Note that jaundice start from the head first, spreads to the chest, then the abdomen then the arm and legs followed by the hands and feet.
  • Keep the newborn in well hydrated.
  • Facilitate early, frequent feeding, to eliminate meconium and encourage excretion of bilirubin.
  • Report to the physician if jaundice appear within 24 hours.
  • Prepare for phototherapy.
  • Use of intense fluorescent lights to reduce serum bilirubin levels in the new born.
Side effects
  • Eye damage.
  • Sensory deprivation can occur.
  • Expose as much as of the newborns’ skin as possible.
  • Cover the genital area and monitor genital area for skin breakdown.
  • Cover the eyes with eye shields or patches, make sure that eye lids are closed.
  • Remove it one per shift and inspect for infection or irritation.
  • Measure the quantity of light and every 8 hours.
  • Monitor skin temperature.
  • Increase fluid intake to compensate water loss
  • Expect loose green stools and green urine
  • Monitor the skin on normal light every 4 to 8 hour
  • Reposition newborn every 2 hours.


  • Destruction of R.B.Cs the result from an antigen antibody reaction.
  • It is characterised by hemolytic anemia or hyperbilirubinemia.
  • Jaundice develops rapidly after birth and before 24 hours.
  • Edema
  • Administer Rh D immuneglobuline to the mother during first 72 hours after delivery. if the Rh negative mother deliver Rh positive fetus.
  • Assist with exchange transfusion after birth.
  • The baby’s blood is replaced with Rh negative blood to stop the destruction of baby’s Red blood cells; the Rh negative blood is replaced with the baby’s on blood gradually.
  • High incidents of congenital anomalies, hypoglycemia, respiratory distress, hypocalcemia, and hyperbilirubinemia.

  • Excessive size and weight
  • Edema or puffiness in the face and cheeks.
  • Signs of hypoglycemia
  • Hyperbilirubinemia
  • Signs of respiratory distress.
  • Monitor for signs of respiratory distress
  • Monitor bilirubin and blood glucose level
  • Monitor weight
  • Feed early with 10% of glucose in water, breast milk, formula as prescribed
  • Administer I.V glucose to prevent hypoglycemia
  • Monitor tremors , seizure, apnea and acidosis


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