1F MCN RLE NEWBORN DELIVERY AND ASSESSMENT OF NEWBORN

Apnea

- refers to a temporary cessation or pause in breathing for at least ten (10) seconds, or may last for more than thirty (30) seconds. It can occur in various forms and for different reasons, and it can affect people of all ages.

- Obstructive Sleep Apnea (OSA) is the most common type of apnea. It occurs when the muscles in the throat relax excessively during sleep, causing a blockage of the airway. As a result, the person temporarily stops breathing, often accompanied by snoring or choking sounds.

Asphyxia

- is a medical term that refers to a condition in which the body is deprived of oxygen, leading to a range of symptoms and potentially life-threatening consequences. Oxygen is essential for the normal functioning of cells, tissues, and organs in the body. When oxygen supply is significantly reduced or completely cut off, asphyxia can occur.

Hypoxia

A type of Asphyxia, whereas it is a condition where there is a reduced supply of oxygen to the body's tissues and organs. It can result from various factors, such as lung diseases, heart problems, or exposure to high altitudes with reduced oxygen levels. Chronic hypoxia can lead to organ damage over time.

Anoxia

A type of Asphyxia, whereas it is the complete absence of oxygen supply to the body's tissues and organs. It can occur suddenly and result from events like drowning, choking, or suffocation. Anoxia can quickly lead to irreversible brain damage and other severe complications if not treated promptly

Newborn asphyxia or Asphyxia neonatorum

occurs when a baby experiences a lack of oxygen before, during, or immediately after birth. This can result from various complications during delivery and may require resuscitation and medical intervention.

Assist

- To help, support, or aid someone

- One of the roles of the nurse, which enables immediate care to the newborn. Ensures every step in the procedure or assessment is performed in accordance to appropriacy.

- In the context of newborn delivery, "assist" typically refers to the medical support and interventions provided by healthcare professionals, such as doctors, nurses, or midwives, to ensure a safe and successful childbirth.

Atelectasis

is a medical term used to describe the partial or complete collapse of a lung or a portion of a lung. This condition occurs when the tiny air sacs in the lungs, known as alveoli, deflate or become filled with mucus, preventing them from inflating properly. As a result, the affected lung or lung segment doesn't function as it should in terms of oxygen exchange.

Cord Care

in newborn delivery refers to the management and hygiene practices related to the umbilical cord stump after a baby is born. Proper cord care is essential to reduce the risk of infection and promote the healthy healing of the umbilical cord stump.

Cyanosis

is a medical term that describes a bluish or purplish discoloration of the skin or mucous membranes. It occurs when there is a reduced level of oxygen in the blood, leading to a change in the color of the skin, lips, or nails. Cyanosis is a clinical sign rather than a specific diagnosis and can be indicative of an underlying medical condition or problem with oxygen delivery to the body's tissues.

Dyspnea

is a medical term that refers to the sensation of difficult or labored breathing. It is often described as a feeling of breathlessness or shortness of breath. This can vary in intensity from mild to severe and may be acute (sudden onset) or chronic (long-lasting). It is a common symptom and can be caused by various underlying medical conditions, physical exertion, or emotional factors.

Handle

- To touch, hold, or manipulate something with one's hands

- Provides assistance to the obstetrician during the delivery by serving the needed instruments and by supporting the perineum to prevent laceration.

Hyperbilirubinemia

is a medical term that refers to a condition characterized by an elevated level of bilirubin in the blood. Bilirubin is a yellow pigment that is produced when red blood cells are broken down in the body. It is normally processed by the liver and then excreted in the bile, which is a fluid that aids in digestion.

Neonatal jaundice

is a common occurrence in newborns and is usually harmless. It often appears within the first few days of life, peaks in severity around the second or third day, and then gradually resolves as the baby's liver matures and becomes more efficient at processing bilirubin.

Hypoprothrombinemia

- is a medical condition characterized by a deficiency of prothrombin, which is a clotting protein (also known as a clotting factor) in the blood.

- Disease characterized by a deficiency of the blood-clotting substance prothrombin, resulting in a tendency to prolonged bleeding.

Prothrombin

Essential for the blood clotting process, also known as coagulation. When an injury occurs, prothrombin is converted into thrombin, which plays a key role in the formation of blood clots to stop bleeding.

Hypothermia

is a medical emergency that occurs when the body loses heat more rapidly than it can produce heat, causing a dangerously low body temperature.

Neonatal hypothermia is defined as an abnormal thermal state in which the newborn's body temperature drops below 36.5 °C (97.7°F).

Immediate newborn care

- also known as postnatal or neonatal care, refers to the essential medical and supportive measures provided to a newborn baby in the first moments and hours after birth. This care is critical for ensuring the well-being and health of the newborn.

- Immediate health assessment is done and care-related actions like early skin-to-skin contact, proper clamping and cutting of the umbilical cord and non-separation of the newborn from the mother.

Ophthalmia neonatorum

- Conjunctivitis of the newborn

- It is a term used to describe an eye infection or inflammation that occurs in newborn infants within the first month (30 days) of life. This condition typically involves redness, swelling, and discharge from one or both eyes and can be caused by various factors, including infectious agents.

Importance of Handle

● Provide proper guidance on when to push and how to push effectively can reduce the likelihood of severe perineal tearing.

● Healthcare providers can also provide support to the perineum during the baby's head crowning and delivery to minimize trauma to the area.

● Provide support to the baby’s head to avoid perineal laceration.

● Helps as the doctor performs episiorrhaphy to guarantee the baby’s safety during the procedure.

Importance of Assist

● Assisting ensures a safe and controlled delivery process, reducing the risk of complications or injuries to both the baby and the mother.

● Administering vitamin K and hepatitis B vaccines to the babies to prevent bleeding and hepatitis infection.

● Suctioning prevents Meconium staining and obstructions in the airway from occurring.

Importance of Cord care

● Cord care during labor and delivery is important as it safeguards the newborn's health.

● The umbilical cord is the baby's lifeline during pregnancy, responsible for delivering oxygen and nutrients.

● Proper cord care involves clamping and cutting the cord to prevent infection and hemorrhage. This essential step marks the baby's physical separation from the placenta.

Scientific principles involved in newborn delivery.

• Anatomy and physiologu

• Microbiology

• Safety and security

• Mathematics and Physics

• Pharmacology (Epidural anesthesia, Vitamin K, Antibiotic eye drops/ointment)

• Time and Energy

• Body Mechanics (used position for newborn delivery: Lithotomy position)

• Psychology

How much is the dose vitamin K given to preterm infants?

0.5 mL or 0.5 mg

How much is the dose vitamin K given to babies born at term?

0.1 mL or 1mg

Unang Yakap (First embrace)

This emphasizes the need to breastfeed within the first 60-90 minutes. It is during the early stage of breastfeeding when the protein and nutrient-rich colostrum is released. This gives the newborn baby protection against infections. Unang Yakap and exclusive breastfeeding are vital to Infection Prevention and Control (IPC) measures. With proper IPC, protection from infection becomes stronger, especially in challenging circumstances and in emergencies.

Steps essential in newborn care.

1. Immediate and thorough drying.

2. Early skin-to-skin contact.

3. Properly-timed clamping and cutting of the cord after 1 to 3 minutes.

4. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in.

Documenting outcome of newborn deliver and pertinent data

➢ Date and Time of Delivery

➢ Biological sex of the newborn

➢ Mechanism of Placental Expulsion

➢ Blood Pressure of Mother after placental expulsion

➢ Medications administered to the mother

➢ Document vital signs of the newborn

➢ Possible injuries and or/malformations of the newborn

➢ Vital statistics

➢ Physical Examination

➢ APGAR score

➢ Ballard Assessment

APGAR score

- A quick assessment tool used by healthcare professionals to evaluate the physical condition of a newborn baby immediately after birth. The newborn’s color, heart rate, reflex irritability, muscle tone, and respiratory rate are assessed at 1 minute and 5 minutes after birth. The score at one minute assesses how well your newborn tolerated the birth process while the fifth minute assesses how well the baby is transitioning to life outside the womb. A 10th apgar score is only performed when the newborn has a score of less than 7 during the 5th minute.

Ballard assessment

- The Ballard score is commonly used to determine gestational age. Assessment of gestational age is an important criterion because perinatal morbidity and mortality are related to gestational age and birth weight. Scores are given for 6 physical and 6 nerve and muscle development (neuromuscular) signs of maturity. The scores for each may range from -1 to 5. The scores are added together to determine the baby’s gestational age. The total score may range from -10 to 50, premature babies have low scores while infants born late have higher scores.

Povidone-iodine

is an antiseptic solution that is often used to disinfect the skin before medical procedures. Pouring it into a medicine cup serves the purpose of preparing the medication for use.

Twinning

Is a technique whereas putting the cord down to prevent bleeding and this is doe to prepare the cord for clamping.

How much is the dose for hepatitis B and where is the administration?

0.5 cc is the dose and it is administered in the right vastus laterallis.

Dose and Site of administration for BCG

- 0.05 intradermally on the deltoid area

Acrocyanosis

Generalized mottling of the skin is a common finding in newborns. The lips, and feet are likely to appear blue from immature peripheral circulation (termed acrocyanosis). This can be so prominent in some newborns that the infants hands appear as if a stricture at the wrist must be cutting off circulation, because there is usual or normal skin color on one side and blue on the other.

Caput succedaneum

is swelling of the scalp in a newborn. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery.

Cephalohematoma

A collection of blood between the periosteum of a skull bone and the bone itself. It is caused by a rupture of the periosteal capillary because of the pressure of the birth.

Cyanosis

refers to a bluish-purple hue to the skin. It is most easily seen where the skin is thin, such as the lips, mouth, earlobes and fingernails. Cyanosis indicates there may be decreased oxygen attached to red blood cells in the bloodstream. It may suggest a problem with the lungs or heart.

Erythema toxicum

- Commonly presents on the skin of most term newborns. The rash usually appears in the first to fourth day of life but may also appear as late as 2 weeks of age. It begins with small papule, increases in severity to become erythematous by the second day and then disappears by the third day.

Full-term

- When your baby is born between 39 weeks, 0 days and 40 weeks, 6 days.

Hemangioma

- A common vascular birthmark, made of extra blood vessels in the skin. A benign growth.

Superficial

A type of hemangioma where they are on the surface of the skin and These look flat at first, and then become bright red with a raised, uneven surface.

Deep

A type of hemangioma where it is under the skin and these appear as a bluish-purple swelling with a smooth surface.

Mixed

A type of hemangioma where it is both superficial and deep components.

Hemorrhage

Loss of blood greater than 1000 mL within a 24-hour period. Many things can cause hemorrhage inside and outside the body.

Kangaroo care

Also referred to as skin-to-skin care. This uses a parents skin in direct contact with the neonates skin to maintain body heat. This method of care not only provides and supplies heat but also encourages parent-infant bonding

Lanugo

Also referred to as skin-to-skin care. This uses a parent's skin in direct contact with the neonates skin to maintain body heat. This method of care not only provides and supplies heat but also encourages parent-infant bonding

Large for Gestational Age

Used to describe newborn babies who weigh more than usual for the number of weeks of pregnancy. Babies may be called large for gestational age if they weigh more than 9 of 10 babies (90th percentile) or more than 97 of 100 babies (97th percentile) of the same gestational age.

Low birth weight

- Used to describe babies who are born weighing less than 5 pounds, 8 ounces (2,500 grams).

Meconium

- Sticky, warlike, blackish-green, odorless material formed from mucus, vernix, lanugo hormones, and carbohydrates that accumulated in the bowel during intrauterine life.

Milia

- Sebaceous glands in a newborn are immature, so at least one pinpoint white papule measuring 1-2 mm in diameter (a plugged or unopened sebaceous gland) is usually found on the cheek or across the bridge of the nose of every newborn.

Mongolian Spot

- Also referred to as congenital dermal melanocytosis. They are collections of pigment cells (melanocytes) that appear as slate-gray patches across the sacrum or buttocks and possibly on the arms and legs of newborns.

Natal tooth

- Natal teeth are teeth that are already present at birth. They are different from neonatal teeth, which grow in during the first 30 days after birth.

Neonatal period

- The neonatal period is the first 4 weeks of a child's life. It is a time when changes are very rapid.

Neonate

A newborn infant, or neonate, is a child under 28 days of age

Nevus flammeus

Or post-wine stain is a capillary malformation presenting as a pink or red patch on a newborn's skin. It is a congenital skin condition that can affect any part of the body and persists throughout life.

Pathologic jaundice

- The most serious type of jaundice. It occurs within 14 days after birth, and is characterized by a rapid rise in a baby's bilirubin level. The most likely cause is blood incompatibility or liver disease.

Physiologic jaundice

- A newborn's immature liver often can't remove bilirubin quickly enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is called physiologic jaundice, and it typically appears on the second or third day of life.

Post-term

- A post-term pregnancy is one that extends beyond 42 weeks (294 days) from the first day of the last menstrual period; as many as 10 percent of pregnancies are post-term.

Pre-term

- Premature (also known as preterm) birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. The earlier a baby is born, the higher the risk of death or serious disability.

Prophylaxis

- A prophylactic is a medication or a treatment designed and used to prevent a disease from occurring

Pseudomenstruation

The vulva in female newborns may appear swollen because of the effect of maternal hormones during intrauterine life. Some female newborns also have a mucus vaginal secretion sometimes blood tinged (pseudomenstruation) which is also caused by maternal hormones.

Small for Gestational Age

is a term used to describe babies who are smaller than usual for the number of weeks of pregnancy.

Subconjunctival hemorrhage

- A subconjunctival hemorrhage occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva).

Transitional stool

- Your newborn will slowly begin to pass the meconium after birth as he or she begins to eat. The meconium will begin to change in consistency. These stools are called transitional stool.

Vernix caseosa

- a white, creamy, naturally occurring biofilm covering the skin of the fetus during the last trimester of pregnancy. Vernix coating on the neonatal skin protects the newborn skin and facilitates extra-uterine adaptation of skin in the first postnatal week if not washed away after birth.

Wharton’s jelly

- A gelatinous substance. Its main function is to insulate and protect the umbilical cord of the woman.

Physical assessment

is a comprehensive examination performed by healthcare professionals to evaluate the infant's overall health, physical condition, and developmental status shortly after birth. This assessment helps identify any potential health issues or concerns that may require further evaluation or intervention. The physical assessment of a newborn typically includes the following components:

Babinski Reflex

How to elicit it:

• Shining a strong light such as a penlight into an eye

• Sudden movement towards the eye

Normal Finding: Close eyes or blink in response to the light and gentle touch

Abnormal Finding: Absence of blink reflex might indicate a problem with the baby’s visual or neurological development.

Rooting Reflex

How to elicit it: Touch the newborn’s corner of the mouth or cheek with a gloved finger or sterile nipple. The newborn will move the head toward the stimulated area and open the mouth.

Normal finding: Baby will turn their head toward the side that was touched.

Abnormal finding: Absence of a rooting reflex indicates serious CNS disease.

Sucking Reflex

How to elicit it: Place a gloved finger or nipple in the newborn’s mouth, and note the strength of the sucking response on the newborn.

Normal finding: There is rhythmic and coordinated sucking motion when the lips are touched or stimulated.

Abnormal finding: A weak or absent sucking reflex may indicate a neurological disorder, prematurity, or CNS depression caused by maternal drug use or medication pregnancy.

Swallowing Reflex

How to elicit it: Allow newborn to suck or have bottle-feeding to see rhythmic and coordinated swallowing pattern after.

Normal finding: Rhythmic and coordinated swallowing pattern that follows after sucking.

Abnormal finding: If the baby frequently chokes or gags during feeds, it may suggest difficulty coordinating the swallowing reflex. This can be due to a variety of factors, such as a weak or underdeveloped swallowing reflex, a structural issue, or other medical conditions.

Extrusion Reflex

How to elicit it: Gently introduce a small spoon or a clean pacifier with a small amount of liquid or breast milk to the baby's lips, the baby’s tongue will thrust forward and rejects it.

Normal finding: The baby's tongue will automatically push the spoon or pacifier out of their mouth with a forward and outward motion.

Abnormal finding: The absence of the extrusion reflex in a newborn can be a cause for concern and may indicate a potential issue with oral motor development or neurological function.

The extrusion reflex is expected to diminish by around 4 to 6 months of age as a baby's oral motor control and coordination develop. If a baby continues to exhibit a strong extrusion reflex beyond this age, it could indicate potential issues with oral motor development or sensory processing.

Palmar Grasp Reflex

How to elicit it: Place an object or a finger against the infant's palm and then observe involuntary closing of fingers to the object

Normal finding: Instinctively and involuntarily close their fingers around the object or finger that touches their palm.

Abnormal finding: Diminished response usually prematurity; response neurologic asymmetric suggests fracture of the humerus or peripheral nerve damage. If this reflex persists past 4 months, cerebral dysfunction may be present

Step (Walk)-in-Place Reflex

How to elicit it: The newborn is held in a vertical position with their feet touching a hard surface to take a few quick, alternating steps.

Normal finding: Newborns are able to do quick and alternating steps

Abnormal finding: If the baby does not respond with stepping movements when their feet touch a solid surface, it could be a sign of an issue with the reflex arc or the nervous system's development.

Placing Reflex

How to elicit it: Touch the anterior lower leg against a surface such as the edge of a table

Normal finding: Newborn makes a few quick lifting motions and flexes their legs, as if to step onto the table.

Abnormal finding: If the baby's response to the placing reflex is notably weak or if there is an asymmetrical (uneven) response between the two legs, it may indicate differences in muscle tone or neurological function.

Plantar Grasp Reflex

How to elicit it: Touch the ball or the sole of the newborn’s foot.

Normal finding: The toes should curl downward tightly or grasp the same manner as the fingers.

Abnormal finding: Diminished response usually indicates prematurity; no response suggest neurologic deficit.

Tonic Neck Reflex

How to elicit it: Turn a newborn’s head to the opposite side they may change the extension and contraction of legs and arms accordingly.

Normal finding: When the arm and leg extend on the side toward which the head is turned, and the opposite arm and leg contract.

Abnormal finding: If there is a noticeable difference in the response between one side of the body and the other, such as one arm extending while the other remains flexed, it may suggest an imbalance or a neurological problem affecting one side of the body.

Babinski Reflex

How to elicit it: Stroke the sole of a newborn’s foot in an inverted “J” curve from the heel upward.

Normal finding: The big toe the moves upward or toward the top surface of the foot. The other toes fan out.

Abnormal finding: If the Babinski reflex is only observed on one foot and not the other, it may be indicative of an asymmetry or neurological problem affecting one side of the body.

Magnet Reflex

How to elicit it: Apply pressure on the soles of the foot of newborns lying in a supine position

Normal finding: The newborn would push back against the pressure.

Abnormal finding: If newborn is unable to push back against the pressure, it indicates problem with spinal cord integirty.

Crossed Extension Reflex

How to elicit it: Newborn is in a supine position by raising other leg and extending it when the other leg is extended and, the sole of that foot is irritated rubbed by a sharp object.

Normal finding: This maintain balance and prevent injury by extending and straightening the opposite leg while withdrawing the injured leg from the source of pain.

Abnormal finding: If the crossed extension reflex does not occur when a painful stimulus is applied to one side of the body, it may indicate a problem with the reflex arc or the central nervous system. The absence of the reflex can be a sign of neurological dysfunction.

Landau Reflex

How to elicit it: Support newborn in a prone position by a hand.

Normal finding: Newborn is not expected to raise their head or arch their back in this position.

Abnormal finding: Newborn who will sag into an inverted “U” position show extremely poor muscle tone.

Congenital Hypothyroidism

- The partial or complete loss of function of the thyroid gland, wherein the thyroid gland is not able to produce enough thyroid hormones which is essential for the infant’s growth and development. Screening for congenital hypothyroidism is important because it is hard to indicate whether the infant has the condition since newborns typically do not show any obvious signs of the condition. When left untreated, this may lead to irreversible mental retardation.

Galactosemia

- A hereditary disorder and condition in which the body is unable to metabolize galactose properly. With this, any form of milk cannot be tolerated by the body. Failure to screen and diagnose early may result in cataracts, developmental delays, liver failure or death.

Phenylketonuria

- A genetic condition characterized by the buildup of an amino acid called phenylalanine in the body. If left untreated, this can damage the brain and can cause challenges in cognitive development.

Cystic Fibrosis

- An inherited disorder in which fluids secreted by cells, such as mucus, are sticky and thick, instead of it being normally thin and slippery. With this, it will result in a plug up in the passageways of the body and affect different organs such as the lungs and pancreas. Failure in early diagnosis may result in recurring pneumonia, pancreatitis, and infertility.

Congenital Adrenal Hyperplasia

- A genetic disorder which affects the inability of the adrenal glands of the body to produce and secrete hormones such as cortisol, mineralocorticoids, and androgens which are all essential to the body, due to the lack of enzyme that is needed in order to produce the aforementioned hormones. If left untreated, adrenal crises such as fertility problems may occur.

Glucose-6 Phosphate Dehydrogenase Deficient (G6PDH)

- A genetic disorder which happens when the body is deficient of the enzyme Glucose-6-Phosphate Dehydrogenase (G6PD). The enzyme helps red blood cells by protecting them from harmful substances in the body. This disorder may be triggered by certain foods and medications. Severe jaundice and anemia may occur in newborns if not treated.

Maple Syrup Urine Disease

A rare genetic disorder in which the body is unable to process or break down 3 amino acids: (1) Leucine, (2) Isoleucine, and (3) Valine. Symptoms of the genetic disorder appear within the first few days or weeks after birth. A symptom, for example, is a sweet-smelling urine that smells like maple syrup. Without proper treatment, life-threatening symptoms can develop such as seizures, brain damage, developmental delay, or coma.

Homocystinuria

- An inherited genetic disorder wherein the body is unable to process proteins correctly. This results in high levels of amino acids called methionine or homocysteine. A deficiency or reduced activity of an enzyme called cystathionine beta-synthase (CBS) is usually the main cause of homocystinuria. A build-up of these amino acids may cause blood clotting or damage to the brain and eyes.

Medium chain acyl CoA dehydrogenase deficiency

- Belongs to a group of fatty acid oxidation disorders wherein the body is unable to metabolize fats due to a deficiency of enzymes that are needed to break down fats. With this, low energy and blood sugar may occur, and also a build-up of unused fats or fatty acids. If left untreated, a delayed mental and physical development may occur.

Sickle cell disease

- Sickle cell disease is an inherited red blood cell disorder which affects the shape of the RBCs making it hard for them to move easily through the blood vessels.

Scientific principles involved in assessment of the newborn

1. Anatomy and physiology

2. Microbiology

3. Safety and Security

4. Physics

5. Time and Energy

6. Body Mechanics

7. Mathematics

8. Psychology

Cardinal Movements of Delivery

1. Engagement

2. Flexion

3. Internal Rotaion

4. Extension

5. External Rotation

6. Expulsion

Engagement

- Referred to as baby dropping. This indicates that the head or buttocks of the newborn have settled into the pelvis before labor.

Descent

The baby’s head moves deep into the pelvic cavity. This occurs because of the pressure on the fetus by the uterine fundus. It occurs because of 4 forces: (1) Pressure of the amniotic fluid, (2) direct pressure of the uterine fundus on the breech, (3) contraction of abdominal muscles, and (4) extension and straightening of the fetal body.

Flexion

If descent is completed, the head then bends forward onto the chest which is brought by the resistance felt by the head of the baby against the soft tissues of the pelvis. With this, the smallest diameter of the fetal head presents into the pelvis and the fetal chin flexes downward onto the chest.

Internal Rotation

The fetal head rotates to accommodate for the changes in the diameter of the pelvis. The occiput of the fetal head meets resistance from the levator ani muscles and their fascia, the occiput rotates from left to right. The sagittal suture aligns in the anteroposterior pelvic diameter. The fetal head must rotate to be able to fit in the pelvic cavity.

Extension

When internal rotation has been completed, extension occurs wherein the head, face, and chin are born. The fetal head passes under the symphysis pubis. It is assisted by the resistance of the pelvic floor, and the mechanical movement of the vulva opening anteriorly and forward. The occiput, brow, and face of the fetus then emerges from the vagina.

External Rotation

The shoulders then rotate to the anteroposterior position in the pelvis which results in the turning of the head farther to one side.