Initial Newborn Assessment/ Immediate Interventions

Initial Newborn Assessment

• Infant examined quickly for cardiorespiratory problems

• Assess for possible resuscitation

• Stable newborn can be placed skin to skin with mother

• Thermoregulation

• Perform Apgar score

• Golden hour

APGAR Score Newborn Assessment

• Assessment of newborn’s transition to extrauterine life

• Done 1 min & 5 min after birth

• 10 min score is done if 5 min score is < 7

• Score of 4-7 =

  • Neonate is experiencing moderate difficulty

• Score of 0-3 =

  • Neonate is experiencing severe distress

• Highest score is 10

APGAR

• APGAR

• A - Appearance

• P - Pulse

• G - Grimace

• A - Activity

• R - Respiration

Score 0 APGAR

• Appearance:

  • Pale or blue

• Pulse:

  • No pulse

• Grimace:

  • No response to stimulation

• Activity:

  • No movement

• Respiration:

  • No breathing

Score 1 APGAR

• Appearance:

  • Extremities blue

• Pulse:

  • < 100 bpm

• Grimace:

  • Grimaces or weak cry

• Activity:

  • Arms, legs flexed

• Respiration:

  • Slow, irregular

Score 2 APGAR

• Appearance:

  • Pink

• Pulse:

  • > 100 bpm

• Grimace:

  • Cries & pulls away

• Activity:

  • Active movement

• Respiration:

  • Strong cry

Immediate Interventions

• Maintain airway patency

• VS

• Maintain thermoregulation

• Ensure proper identification

• Anthropometric (birth) measurements

• Newborn weight loss

• Footprints

• Admin. medications

Maintain Airway Patency (Immediate Interventions)

• Suction w/ bulb syringe

  • Mouth FIRST, then nose

  • Push air out BEFORE inserting into mouth or nose

  • If needed

• Evidence supports just using a towel to wipe secretion from the mouth for term infants

Newborn VS (Immediate Interventions)

• VS q 30 mins until stable for 2 hrs

  • Then q 4 hrs or 8 hrs per hospital protocol & newborn condition

• Temperature:

  • 97.7 - 99.5 F (36.5-37.5 C)

• HR:

  • 110-160 bpm

• Respirations:

  • 30-60 rpm

Maintain Thermoregulation (Immediate Interventions)

• Stabilize newborn temp: 97.7-99.5 F

  • Dry infant immediately

  • Skin to skin w/ mom

  • Can use radiant warmer

  • Wrap in warmed blankets

  • Newborn hate

• Neutral thermal environment (NTE)

• Regulate environmental temperature

  • Warm room temperature

  • Eliminate drafts or ceilings

Ensure Proper Identification (Immediate Interventions)

• Mother/ newborn/ significant other ID bracelets

  • 2 on newborn

• Same identification number on all bands

• Security band

• Preventing infant abduction

Anthropometric (Birth) Measurements (Immediate Interventions)

• Weight

• Length

• Head circumference

• Chest circumference

• Abdominal circumference

Newborn Weight Loss (Immediate Interventions)

• Newborns can lose up to 10% of their weight after birth

  • Most will gain it back by 1-2 weeks

  • We don’t want them to lose too much weight

• Newborns are weighed daily

• Determine amount of weight loss (Grams)

  • Subtract current weight from birth weight

• Calculate percentage of loss (Grams)

  • Divide amount of weight loss by birth weight

  • Then multiply by 100

Footprints (Immediate Interventions)

• Could be done w/ ink & paper

• Could be done w/ a digital scanner

Admin. Medications (Immediate Interventions)

• Vit. K (Phytonadione)

  • To synthesize clotting factors

  • They do NOT have clotting factors

• Erythromycin Ophthalmic Ointment

  • To prevent ophthalmia neonatorum conjunctivitis

    • Can cause blindness if left untreated

• Ophthalmia neonatorum conjunctivitis

  • Contracted during birth

  • Baby comes in contact w/ vaginal discharge of a mother who has gonorrhea or chlamydia