NU 330 - Exam 1 - PP 3 (newborn assessment an care)

newborn respirations + Heart rate + Blood pressure

-30 - 60 resps/ min

-110 - 160 bpm (count one full minute/ listen for murmur)

-norm SBP 50 - 70/ DBP 30 - 45 (performed once during admission, place on upper arm/ thigh, newborn should be calm/ relaxed, mean can be similar to the weeks of gestational age

S/S respiratory distress in neonate

-tachypnea

-audible grunting

-retractions

-nasal flaring

-cyanosis

Newborn Axillary Temperature Measurement

Newborn’s arm should be tightly but gently pressed against the

thermometer and the newborn’s side, as shown

Normal range = 36.5ºC - 37.5ºC (97.7°F to

99.4°F)-– can be slightly elevated from being

held or swaddled/too many layer

Newborn Thermoregulation

 If temp is low (<36.5ºC axillary), notify instructor and primary RN and

quickly perform one of the following rewarming interventions:

• Place skin to skin (Kangaroo care)

• Place under a pre-heated warmer

• Apply a hat and swaddle with an extra blanket

 Reassess temp 30 minutes after initiation of rewarming intervention

Signs of newborn temperature instability or hypothermia:

• Skin cool to touch

• Poor feeding

• Difficulty arousing, very sleepy, lethargy

• Weak cry

• Decreased muscle tone

• Could be fussy or irritable for a short time

• Pallor and/or cyanosis

Temperature Instability

• If a newborn has a low temperature, their body will increase the

metabolic rate to try to warm itself (the newborn cannot shiver).

Increased blood flow through brown fat increases heat production.

Increasing the metabolic rate can use up the blood sugar reserves

and lead to hypoglycemia. If left untreated, oxygen consumption

increases which leads to respiratory distress (metabolic acidosis).

• Newborns with minimal brown fat (preterm or small for gestational

age) are at higher risk for temp instability

• Assessments per protocol or condition warranted:

• Monitor blood glucose

• Assess respiratory status

Using the Bulb Syringe

IF you need to clear secretions, breastmilk, or formula from the

newborn’s mouth or nose, remember M before N (Mouth before Nose)

and

• Compress bulb

• Place tip about 1 inch to the side of the newborn’s mouth and release

compression

• Excess secretions should be drawn up into bulb

• Repeat on other side of mouth

• Compress bulb prior to placing tip to nare and then release

compression, repeat process to other nare if needed

• Avoid roof of mouth, back of throat (will gag newborn)

• Wash in warm, soapy water daily and as neede

Newborn Weight

• Average full-term newborn is 7 pounds 8 ounces (3405 grams)

• Weigh every 24 hours; completely naked

• Expect 5-7% weight loss the first 2-4 days of life

• Should intervene and supplement feedings if at 8-10% loss

or more

Newborn Measurements

-length = 20 in/ 50 cm (top of heat to heel (must stretch leg out))

-head = 33 - 35 cm

-chest = 32 cm (measure nipple line)

-abdomen = 31 - 33cm (measure just above umbillicus)

Estimation of Gestational Age

• Performed ONCE on admission, needs to be within first 4 hours since birth

• Essential when no prenatal care was received or questioning size,

appearance, or accuracy of due date Gestational age assessment

– Entitled New Ballard Score (NBS) or Dubowitz

– Assesses external physical maturity characteristics and neuromuscular development

– Each finding given a point value

– Score should align with gestational age according to LMP/due dat

Assessment of Physical Maturity

• Skin

• Lanugo = fine downy hair found on upper back, sides of face, shoulders (more common in premature infants and Latino infants)

• Sole (plantar) creases = if sole creases cover ¾ of sole = neonate is closer to 36 weeks gestational age

• Areola and breast bud tissue (tissue underneath)

• Ear form and cartilage distribution

• Genitals

Assessment of Neuromuscular Maturity Characteristics

• Posture (31 weeks flat, all limbs out) / (35 weeks limbs kinda tucked in but still flat) / (40 weeks limbs all tucked inwards)

• Square window (wrist) = bend wrist back to arm

• Arm recoil

• Popliteal angle

• Scarf sign = pull arm across chest towards opposite shoulder

• Heel-to-ear extension

Gestational Age Determination + Birth Weight =

 Small for Gestational Age (SGA)

• Birth weight below 10th percentile

• Previous terms– Microsomia, Microsomic

• Appears thin with decreased muscle mass and subcutaneous fat tissue

• Increased risk for perinatal asphyxia, polycythemia (ruddy red appearance), temp instability, and hypoglycemia

 Appropriate for Gestational Age (AGA)

 Large for Gestational Age (LGA)

▪ Birth weight above 90th percentile

▪ Previous terms– Macrosomia, Macrosomic

▪ Example: Term infant weighing more than approx. 8 lb 13 oz

▪ Increased risk for perinatal asphyxia, birth injury, polycythemia (ruddy red appearance), and hypoglycemia

Nutritional Needs and Breast Milk/Formula Composition

• Healthy People 2030 (US Department of Health and Human Services)

• Goal for exclusive breastfeeding through 6 months of age

• American Academy of Pediatrics

• Recommends breastfeeding for first 12 months or longer

• Newborns lose weight within first 3–4 days of life

• Formula fed newborns expect up to 3-5% weight loss

• Breast fed newborns expect approximately 7% loss

• Feed only breast milk or iron-fortified 20-calorie/ounce formula for first 6 months

Nutrition as Energy Source

• Neonatal thermoregulation, cardiorespiratory function (transition from intrauterine to extrauterine life), cellular activity, and growth

• Adequate hydration and sufficient caloric intake

• Monitor intake/output, anterior fontanelle, and mucous membranes for signs of dehydration

• Fats make up approximately 15% of calories

• Carbohydrates (mainly lactose) make up approximately 40-50% of calories

• Casein and whey proteins

• Easily digested, requiring more frequent feeding

signs of dehydration in newborn

• Depressed fontanelles

• Rapid, weak pulse

• Elevated, low-grade temperature

• Dark, concentrated urine

• Dry, hard stools or not meeting output goals

• Increased weight loss or minimal weight gain

• Dry skin with little turgor

Timing of Newborn Feedings

• First hour of life

• Place newborn skin to skin and offer breast when within first hour

• Still place skin to skin even if plans to bottle-feed (thermoregulation)

• After first feeding, timing of feeds determined by:

• Physiologic and behavioral cues

• Often not a set schedule, feed on-demand

• Every 1.5-3 hours

• Assess for complications when feeding

• Choking, cyanosis

• Ongoing reflux (spitty)

• May be feeding too much or too frequently

• Could be gastroesophageal reflux (immature esophageal sphinct

common hunger cues

• Lip Smacking

• Rooting

• Sucking on hands, fists

• Intermittent cry

• Lusty cry is a late cue

Feeding baby

breast feeding

• Encourage as soon after birth as possible

• Positioning--football hold, cradle hold, cross cradle hold, side-lying

• On-demand feeding every 2-3 hour

bottle feeding

• Demand feeding every 2-5 hours

• En face position during feeding

• Typical intake ½ to 1 ounces per feeding

• Increase amount each day

*at birth stomach = marble, Day 10 = ping-pong ball

Newborn Assessment

• The Initial Newborn Assessment performed by RN includes:

• Maternal prenatal care history

• Maternal analgesia and anesthesia

• Labor and birth history, complications

• Newborn resuscitation measures and Apgar scores

• Initial weights, measurements, medications

• General observations:

• Posture, tone; flexed, with spontaneous movement and full ROM

• All aspects of body proportionally equal and symmetrical

• Absence of birth defects or birth trauma

• Color; pink, appropriate for ethnicity, acrocyanosis possible

• Cry; lusty, vigorous

skin color assessment = acrocyanosis

– Normal, expected within minutes after birth

– Bluish discoloration of hands and feet

– Poor peripheral circulation (shunting of oxygenated blood to vital organs)

– Result of increased systemic vascular resistance during transition phase

• All babies will have pink tinge/undertone to skin, regardless of genetics

– Choanal atresia may be present in newborns cyanotic at rest, pink when crying

• IF crying increases cyanosis

– Heart or lung problems suspected

Skin Characteristics = Erythema toxicum (normal newborn rash)

– Eruption of lesions in area surrounding hair follicles

– More common on trunk

– Looks like a small bug bite

– Very transient, disappears then other spots appear nearby or in another spot

– Can appear between 1 day and 6 weeks of age

– No treatment, will resolve on its ow

skin characteristics = mottling

– Lacy pattern of dilated blood vessels

– Reposition, rewarm, assess for sepsi

skin characteristics = Harlequin sign (rare occurrence

– Deep color on one side of newborn’s body, will resolve shortly

– Jumbled message from immature system

skin characteristics = Jaundice (common occurrence)

– Yellowish skin discoloration

– Related to immature liver function, hematomas, poor feeding

– Cephalocaudal (head to toeprogression and resolution

skin characteristics = milia

-exposed sebaceous glands

-will eventually fade

Skin Characteristics = Vernix caseosa

• Covers fetus in utero, lubricates the skin

• Normal, seen more in preterm newborns

• “Cheesy,” found in creases at term

• Can wipe away excess but leave if difficult to remove (will absorb or come off during first bath

skin characteristics continued

• Forceps and vacuum marks

• May be present on scalp/cheeks after a difficult forceps (vaginal) birth

• Red circle on scalp from vacuum extraction

• Sucking blisters

• Can be found on upper lip, fingers, hands, wrists

• No treatment required

• Ecchymosis, petechiae, or abrasions from delivery

• Skin tags

• Skin turgor (assess on abdomen) = Skin can appear dry and cracked as adjusts to environment, contact with linens, touch, etc.

Birthmarks = Telangiectatic nevi or “Stork Bite”

– Increased area of vascularization in middle of forehead and nape of neck

– Can become a deeper red during crying

– No clinical significance

– Usually fades by second birthday

Birthmarks = Congenital dermal melanocytosis or “Mongolian Spot”

– Dorsal area, buttocks

– Common in newborns of Asian, Hispanic, African descent

– Disappears over the first 4 years as pigmentation changes

– Document carefully since may be mistaken for bruises related to child abuse

Birthmarks = Nevus flammeus

– Port wine stain

– Severe involvement can include eyes or nervous system

– Sturge-Weber syndrome has involvement of fifth cranial nerve

-involve the overgrowth of vessels and/or capillarie

Birthmarks = Nevus vasculosus

– Strawberry mark

– Raised cluster of extra blood vessels

– Fades with time or can be treated

Assessment of Head

• General appearance

– One-quarter of body length, soft pliable skull bones

– Molding

▪ Asymmetry (cone) with pushing/vaginal birth

▪ Fundal (square) appearance if was breech

– Suture lines

 Overriding or approximated

– Extreme differences (abnormals)

▪ Microcephaly

▪ Hydrocephalus

Fontanelles

• Should be flat and soft, may change with position

• Fullness/bulging= increased intracranial pressure (ICP)

• Depression= dehydration

• Abnormal size= possible craniofacial abnormalities

• Anterior

• Junction of frontal, parietal bones

• Closes between 18 months to 2 years

• Posterior

• Junction of parietal, occipital bones

• Closes around 6-8 weeks of ag

Head

• If an amniotomy (bag of waters ruptured with amnihook) was performed or a fetal scalp electrode was used during labor, assess for a possible abrasion near top or back of head

• If vacuum extractor used during delivery, assess for bruising and caput where device was attached to fetal head

Cephalohematoma

• Collection of blood resulting from ruptured blood vessels between

surface of cranial bone and periosteal membrane

• Unilateral or bilateral and does not cross suture lines

• Increases risk for hyperbilirubinemia

• Neonate may be fussy, irritable

• Offer soft gel pillow?

• Resolves within 6 weeks

• Caput succedaneum

• Collection of fluid (serum) under the scalp

• Resolves within first 1-2 days of li

eyes

• Color– majority are slate blue at birth

• Transitions to genetic color by 6 months of age

• Edematous eyelids are normal for first 1-2 days of life (due to the pressure against the face during the birth)

• Cry is commonly tearless

• May appear cross-eyed at times due to neuromuscular immaturity– should resolve

• If a yellow discharge or crust is present in the inner corner of the eye either unilaterally or

bilaterally

• Infectious conjunctivitis vs. plugged tear duct?

• Tear duct massage

• Erythromycin or tetracycline ointment prescribed

• Subconjunctival hemorrhage

• Broken blood vessels in sclera; will reabsorb

• Changes in vascular tension & ocular pressure during birth

• Both mother and newborn can experience this

Nose and Mouth

• Nose breathers for first few months

• Must position so that nares are not covered by breast tissue while

breastfeeding

• Sneezing is a normal reflex to clear nose

• Nasal passages adjusting to normal air and particles

• Ability to smell

• Will turn toward mother’s breast

• Examine entire mouth (wear gloves!)

• Mucous membranes are pink and moist

• Intact vs. cleft palate

• Gag reflex present

• Sucking reflex is coordinated and vigorous

• Precocious teeth (rare)

• Rare; small, loose, discolored

• Epstein pearls (rare)

• On gum ridges

• Disappear within 1-2 week

Ears

• Well-formed yet soft, pliable, and should recoil

• Skin tags by ears may indicate possible hearing loss

• Top of ear should be parallel to outer, inner canthus of eye

• Low-set ears

– Characteristic of genetic abnormalities and syndrome

Neck

• Short, creased with skin folds

• Vernix might be present within folds

 Allow to absorb, rub in, or wipe excess away

• Cannot support full weight of head

• Some range of motion with minimal head control

• Palpate for masses, lymph nodes

 Thyroid is not palpable at this age

• Clavicles evaluated for evidence of fractures

 All newborns assessed but especially important for large for gestational age (LGA) newborns

Chest

• Thorax cylindric, symmetric at birth

• Xiphoid cartilage prominence

– Less apparent if newborn has adipose tissue

• Clavicles; assess for intactness

• Crepitus near and/or a bump on clavicle could indicate a fracture

• Engorged breast buds common in both boys and girls

• Due to exposure to maternal hormones in utero

Peripheral pulses can be assessed at the following locations:

• Brachial

• Femoral

• Pedal

Abdomen

• Cylindrical, protrudes slightly

– Few blood vessels apparent under skin

• Auscultate for bowel sounds by 1 hour after birth

• Small abdominal/umbilical hernia possible

• Will probably resolve when stump falls off

• Palpation in systematic manner

– Liver large in proportion

• Passage of first stool within first 24 hours of life

• Meconium: dark black, sticky, tar-like

• Transitional and regular stool pattern dependent upon amount of oral

intake and breast vs. bottle feeding

Diaper Changes

Genitourinary: Should void at least once within the first 24 hours of life

• May have slightly pink tinged urine x 1-2 diapers due to passage of uric acid crystals that formed within the kidneys during development (we call it brick dust)

STOOLS:

-day 1-2 = dark, watery → as days go on more form and lighter

• Urinary elimination pattern:

• At least 3-4 times per day in the first few days of life

• At least 5-6 times per day by 1 week of age

Umbilical Cord

• Initially light yellow to clear, gelatinous

 Check for two arteries, one vein (only necessary during the delivery room admission assessment) *Abnormal number of vessels indicates possible link to cardiac anomaly

– Dry, shriveled, and blackened by second or third day

 Cord clamp may be removed once cord is dry

 Cord stump falls off within 7 to 10 days

– Assess for bleeding, redness, edema, odor

– One or two old pink or red dots is acceptable, but more than that is abnormal

– Foul-smelling drainage is abnormal

– Clean skin folds with water-moistened Q-tip

– May place in bathtub, pat gently and air dr

Genitals; Neonatal Female

–Admission assessment of labia

– Labia could be enlarged, bruised, or edematous due to birth process and maternal hormones

– Labia majora should cover minora in the term neonate

– Refer back to gestational age assessment for physical maturity characteristics appropriate for the preterm neonate

–Presence of discharge (intermittent, first few days of life)

▪ Maternal hormone affect

▪ Vaseline-like creamy discharge

▪ Protects female reproductive tract from meconium stool

▪ Can remove excess by cleansing outer folds gently with baby wipe or wet cloth

Genitals; Neonatal Male

– Admission assessment of penis, testes, scrotum

– Scrotum could be enlarged, bruised, or edematous due to birth process (especially in the breech boy) and maternal hormones

– Is the urinary orifice (urethral meatus) correctly positioned?

– Hypospadias = opening is on the dorsal surface of penis shaft

– Epispadias = opening is on the ventral surface of penis shaft

– Phimosis

– Inability to retract the foreskin (tight at the top)

– Scrotum inspected for size, symmetry, rugae

– Pendulous

– Descended testicles?

– Cryptorchidism = undescended testes (more common in premature neonate)

– Hydrocele

– Fluid around the testicle

– 1 in 10 newborns born with, can resolve without treatme

Anus

-Verify patency: View during admission assessment

• Note when first passage of meconium occurred

• Was meconium fluid documented in the delivery record?

• Assess for birth anomalies that are not associated with fistulas

– Imperforate anus; could be a “pucker” there but no true opening

– Rectal atresia; stricture above the rectum not allowing passage of stool

• Rectal temperatures only performed if provider requests

• If newborn hasn’t stooled, lay on abdomen and gently wipe rectum

with baby wipe (rectal stimulation) to entice the urge to bear down

Extremities

• Full active range of motion (ROM)?

• Assess for gross deformities

• Arms and hands

– Polydactyly (extra digit)

– Syndactyly (webbing)

– Single (Simian) crease

– Clavicle fracture

– Brachial palsy

▪ Erb-Duchenne paralysis

▪ Arm lies limp at side

▪ Birth injury?

• Legs and feet

– Check for equal and

symmetric skin folds

– Hip dislocation/instability

▪ Ortolani maneuver

▪ Hip click felt and

heard if hip

dysplasia present

– Feet examined

▪ Talipes equinovarus

▪ Club foot

▪ Unilateral or bilateral

▪ Pediatric orthopedic consult

Back

• Lay neonate prone for exam

• Assess that spine is straight, flat

• Examine for dermal sinus

• Nevus pilosus

• Dark pigmentation with tuft of hair

• Pilonidal dimple (aka sacral dimple)

• A small pit in the sacral area just at the top of the buttock crease. The pilonidal dimple may also be a deep tract, rather than a shallow depression, leading to a sinus.

• If a tract or sinus is found (per CT scan), refer for follow-up for possible delays in gross motor movements of lower extremities

-May warrant further testing to assess for spinal defect, spina bifida, or tethered spinal cord

Assessment of Neurologic Status and Behavioral State

• Some reflexes are protective

– Blink

– Yawn

– Cough

– Sneeze

– Draw back from pain

• Assesses brain stem development and musculoskeletal intactness

• See Newborn Reflexes Video in Brightspac

Periods of Reactivity

FIRST

• First 30 minutes to 1 hour after birth

• Vigorous, lusty cry

• Awake and alert

• Hungry with a strong suck

• Resp rate may be up to 80/min due to transition

• Rapid heart rate up to 160 bpm

SECOND

• Usually 2-4 hours after birth (sometimes longer)

• Sleepy phase

• Resp and heart rate decrease but remain within normal values

• Difficult to awaken for feedings

• No interest in sucking, no hunger cues displayed

THIRD

• Usually 4-8 hours after birth

• Awake and alert between naps

• GI tract is more active; increased mucous– might gag or be spitty

(regurgitation)

• May have first stool (meconium)

• Sucking, smacking, and especially rooting reflexes noted

• Cluster feeding tends to occur

Newborn Reflexes = Sucking reflex

• Ability to latch and feed, such a pacifier

• May be diminished in the preterm infan

newborn reflexes = Rooting reflex

-The newborn automatically turns their face toward the

stimulus when their cheek is touched and make sucking

motions

newborn reflexes = Moro or startle reflex

• In response to sudden stimuli baby extends and abducts arms and opens hands then abducts and partially flexes arms and makes fists

• Initiated by bumping the crib, or sudden loud noise

newborn reflexes = Tonic neck reflex

-With baby supine turn head to one side,

baby will extend arm on side to which

head is turned and flex arm on opposite

side

newborn reflexes = Palmar grasp

-With placement of finger in palm of hand fingers will encircle finger

newborn reflexes = Babinski reflex

-Stroke sole of foot from heel upward

• Baby will spread toes

• Disappears by 12 months of ag

crying

• Cry should be strong, vigorous, lusty in the term newborn

• Associated with jerky motor movements

• Early stage vs. late-stage crying

• Missed feeding cues?

• Different cries for different needs

• Not crying when expected (example; during a heel stick) indicates lethargy and should be evaluated

• A high-pitched, shrill cry is abnormal in the term neonate and could be a sign of:

– Neurologic disorders

– Hypoglycemia

Neonatal Sleep

• Can sleep up to 20 hours each day

• Deep or quiet sleep

• 35–45% of total sleep time

• Active or light sleep

• 45–50% of total sleep time

• Rapid eye movement (REM)

• Eyelid fluttering motion

• Irregular respirations or sucking can occur

• Can be startled

Newborn Bathing

• Give first bath after newborn’s temperature has stabilized

• Tub bath or sponge bath

• Use hypoallergenic, baby-safe soap (no soap to face)

• Do not submerge circumcision for 24 hours post procedure

• Sponge bath: Wrap newborn in light blanket, unwrap and wash and dry one body part at a time

• Clean to dirty (save diaper area for last)

• Cover head as most heat loss occurs through the heat
*WEAR GLOVES for all diaper changes and document all wets and stool
*WEAR GLOVES for all cares if newborn has not had the first bat

Glucose Homeostasis

• Glucose is the main source of energy for 4–6 hours after birth

• Fuel source consumed quickly

• Assess glucose level of the at-risk newborn

• Newborn of diabetic mother

• Preterm, intrauterine growth restriction (IUGR), small or large for gestational age (SGA or LGA)

• Low Apgar score, prolonged resuscitation

• Vacuum extraction during delivery

• Point-of-care glucose monitoring per protocol

• Nadir occurs at about 1–2 hours of age

• Obtain first reading within first 2 hours of life, then based on hours or prior to feedings depending on protocol

• Normal neonatal blood glucose range between 40-80mg/dL

• A low blood sugar of < 40 needs IMMEDIATE INTERVENTION

• Repeat blood sugar 30 minutes after the feeding/intervention
*Note: The LOW blood glucose per Cedar Rapids/Iowa City providers = 45

Neonatal Hypoglycemia

Signs/symptoms of neonatal hypoglycemia:

• Tremors, jitteriness, irritability

• Exaggerated Moro reflex

• High pitched cry

• Lethargy, listlessness, hypotonia

• Cyanosis, apnea, tachypnea

• Hypothermia, temperature instability

• Poor suck, refusal to feed

Hypoglycemia Treatment:

• Follows order set/algorithm and depends upon how low the blood sugar is

• Feeding

• Oral glucose gel placed in the buccal space

• NICU admission

• IV infusion of 5% or 10% Dextrose

Circumcision Care

• Performed by provider under local anesthetic

• Neonate soothed by swaddling, sucrose pacifier, soft music, might be pre-medicated with Tylenol

• Scant amount of bleeding is normal initially, if more-- notify provider

• Apply petroleum jelly or antibiotic ointment to tip of penis with diaper changes (except if PlastiBell is used)

• Takes 7-10 days to heal

• Grayish white exudate (scab) part of healing process; do not remove

• Circ checks every 15 minutes x 4 (check for bleeding, edema, do NIPS score if applicable)

• Observe for urination within 12 hours post-procedure

*Uncircumcised penis care: DO NOT retract foreskin until instructed by provider; wash with warm soap and water

Physiologic Jaundice

• Occurs in 60% of term, 80% of preterm newborns

• Easier to assess in daylight near a window

• Occurs on days of life 2-4 up to 2 weeks of age

• Neonates at higher risk

• ABO incompatibility (maternal O+ blood type, neonate with different blood type and + Coombs)

• IUGR, SGA, LGA

• Neonates of diabetic mothers

• Male

• Exclusively breastfeeding

• Prevention, management, nursing care

• Encourage frequent feedings (bilirubin is excreted through the stools)

• Supplementation based on parental request or provider order

*AKA normal newborn jaundice or breastmilk jaundice
* Blanche skin over bony prominence to check for jaundice skin color/ton

Testing Bilirubin Levels

• Normal: 2-6 mg/dL

• Transcutaneous Bilimeter (less invasive)

• Press firmly to center of neonate’s forehead or sternum

• At 24 hours of age and more frequently as indicated

• Draw specimen from newborn’s heel

• Direct and Total Bilirubin

• Treatment initiated based on hours of age and protocol
*if unmonitored or untreated, severely elevated bilirubin levels

(<25mg/dL) can cause Kernicterus and possibly brain damage

Phototherapy

Precautions:

• Eye protection

• Undress except for diaper (gonad protection)

• Maintain warmth

• Reposition every 2 hours

• Only out of lights for feedings or assessments

• Isolette curtains; infant can room in with parent

Newborn Safety and Parent Education Topics

• BACK TO SLEEP, safe infant sleep (SIDS prevention)

• Parents receive PURPLE Crying info (shaken baby syndrome prevention)

• Never leave child unattended-- except in a safe, secure space

• Tummy time while awake

• Car seat law: rear-facing, middle of the back seat preferred; follow updated AAP guidelines

• Handwashing-- especially visitors

• Newborns have passive immunity

• Maternal antibodies received in utero last 2-3 months

• From antibodies in breastmilk

*know the PURPLE acronym

Screenings after 24 Hours of Life

3 parts:

-blood test or heel stick = small blood sample taken from heel and placed on newborn screening card.

-hearing screen = 1 or 2 tests used to determine hearing loss.

-pulse oximetry = tests measures amount of oxygen in blood, can detect some heart problems called critical congenital heart disease

*all babies in USA receive newborn screening

Post-Discharge Follow-Up

• Return for bilirubin and/or weight check at 3-4 days of age if ordered

• First provider appointment around 2 weeks of age

-Instruct parents on when to call the provider:

Lethargy, difficult to awaken

Refuses to feed twice in a row

Projectile vomiting or green watery stools

Less than 6 wet diapers per day after 4 days of age

Temperature less than 97.8ºF or greater than

100.4ºF degrees

Increased irritability/fussiness

Seizure activity

Respiratory difficulty (retractions, grunting, etc.)

Skin color is pale, cyanotic, or yello