Lecture 5 - Well Newborn "Care of the Newborn"

Unit 2 Lecture 1 PPT 1

What is the first nursing priority right after birth?

Assess airway, breathing, and color to make sure the newborn is stable. 

Why is thermoregulation so important in a newborn?

Babies lose heat quickly, can cause hypoglycemia or respiratory distress.

***DRY AND KEEP WARM***

What’s the normal structure of the umbilical cord?

• 2 Arteries (carrying blood away)

• 1 Vein (carries oxygen to baby)

What causes the newborn to take its first breath?

Exposure to:

• Cold air

• Tactile stimulation (touch)

• Loss of placental oxygen supply

What happens to fetal shunts after birth?

• Foramen ovale closes

• Ductus arteriosus closes

• Ductus venosus closes

What’s the nurse’s role in bonding after birth?

Encourage skin-to-skin and early breastfeeding

• helps warmth

• attachment

• milk production

What’s a normal newborn heart rate?

110-160 bpm (count apically for 1 full minute)

What does meconium-stained skin indicate?

Fetal stress before or during labor

What does the APGAR test assess and when is it done?

It assesses the adjustment to life outside the womb

Done 1 & 5 minutes after birth

What are the 5 APGAR categories and what’s a “perfect” score?

• A – Appearance (pink)

• P – Pulse (>100 bpm)

• G – Grimace (strong cry/response)

• A – Activity (flexed/resists extension)

• R – Respiration (strong cry)
  Perfect score = 10

How is the APGAR score interpreted?

• 7–10: Good adaptation

• 4–6: Moderate distress → may need O₂/stimulation

• 0–3: Severe distress → needs resuscitation

• Reassess every 5 min until ≥7 or stable

What is the normal weight range for a term newborn?

2,700 g (6 lb) – 4,000 g (9 lb)

What are normal length and head circumference for a term newborn?

• Length: 45–55 cm (18–22 in)

• Head circumference: 32–36.8 cm (12.6–14.5 in)
  Head should be 2–3 cm larger than chest

What is the normal chest circumference for a newborn?

30–33 cm (12–13 in)

What is SGA?

SGA, Small for Gestational age

<10th percentile

What are the week-based classifications for newborns?

• Preterm: <37 weeks

• Term: 37+0 to 41+6 weeks

  • Early term: 37+0–38+6

  • Full term: 39+0–40+6

  • Late term: 41+0–41+6

• Postterm: ≥42 weeks

• Postmature: ≥42 weeks + placental aging

What is IUGR and what does it indicate?

Intrauterine Growth Restriction

• Baby grew slower than expected in utero

  • Indicate placental or maternal issues

What is AGA?

Appropriate for gestational age

10-90 percentile

What is LGA?

Large for gestational age

>90 percentile 

What is the purpose of the Ballard Score?

To estimate gestational age based on neuromuscular and physical maturity when uncertain.

What does a higher Ballard score indicate?

Greater maturity → term or postterm newborn.

In the Ballard exam, what does “posture” assess?

Muscle tone.
Term = flexed limbs; Preterm = floppy and extended.

What is the “square window” test?

Bending the wrist toward the forearm.
Term = 0° (tight); Preterm = >90° (loose).

What does the “arm recoil” test assess?

Flexor strength.
Term → arm snaps back quickly; Preterm → slow recoil.

What is a normal popliteal angle in a term newborn?

About 90°; preterm babies extend their legs more easily.

What does the “scarf sign” test show?

Shoulder flexibility.
Term → elbow doesn’t cross chest; Preterm → easily crosses.

What are normal findings for “heel-to-ear”?

Term → heel far from ear (tight hips)
Preterm → heel can reach ear (loose hips)

Describe skin and plantar surface changes with maturity.

Skin: Preterm = thin, visible veins; Term = smooth
Plantar: Creases develop with age; full creases = term.

What genital findings indicate a term newborn?

♀ Labia majora covers clitoris/minora
♂ Testes descended, scrotum with deep rugae

What are the 3 periods of newborn reactivity?

• First period (0–30 min): alert, active, rapid HR/RR

• Relative inactivity (30–100 min): sleepy, vitals stabilize

• Second period (2–8 hr): alert again, gag reflex active

How often are newborn vital signs and weight checked?

• VS: frequently right after birth

• Weight: daily, same time each day

In what order are newborn vital signs assessed?

Respirations
Heart rate
Blood pressure
Temperature

Normal newborn respiratory rate?

30–60/min, irregular and abdominal, apnea <15 sec is normal.

Normal newborn heart rate?

110–160 bpm (apical for 1 full minute).

Normal newborn blood pressure?

60–80 / 40–50 mmHg.
Check all extremities if heart issue suspected.

Normal newborn temperature range?

97.7–99.5°F
Maintain warmth to prevent cold stress and hypoglycemia.

What signs indicate newborn pain?

Behavioral: cry, grimace, fussiness, sleep change.
Physiologic: ↑ HR/BP, ↓ O₂, pallor, diaphoresis, hyperglycemia.

Which scales are used for newborn pain assessment?

CRIES scale and NIPS (Neonatal Infant Pain Scale).

Describe the heel stick procedure for newborn labs.

• Warm heel

• Clean/dry

• Use outer aspect

• Apply pressure & comfort baby

What are heel sticks used for?

Glucose, bilirubin, metabolic, PKU screening.

What are key steps for CCHD screening?

• Done at 24–48 hr

• Pulse ox on right hand + one foot

• Normal = >95% & <3% difference

• Abnormal → cardiac evaluation

When is newborn hearing screening done?

Before discharge (may repeat due to high false positives in first 48 hr).

What are complications of cold stress in newborns?

Hypoglycemia, metabolic acidosis, respiratory distress.

What physiologic change during reactivity period allows for first feeding?

Active suck reflex during the first period of reactivity

When are newborn ID bands applied, and how are they verified?

Placed at birth; must be checked every time the infant is returned to parents. Many units use electronic security tags.

How should the umbilical cord be cared for at home?

Normal: drying & darkening.

Infection: redness, swelling, purulent drainage → notify provider.

How can nurses prevent cross-contamination between newborns?

Hand hygiene before/after contact, separate bassinets, and follow unit scrub policy.

When is circumcision performed and why is it delayed immediately after birth?

Done in first few days after birth; delayed initially because Vit K levels are low at birth.

Health benefits of circumcision?

Easier hygiene, ↓ STIs, ↓ cancer risk for patient and partners.

Circumcision risks to monitor for?

Bleeding, infection, meatal stenosis, adhesions, concealed penis.

What is the nurse’s role before circumcision?

Verify consent, ensure NPO, perform time-out, prepare supplies, assist provider.

Parent teaching after circumcision?

• Don’t remove yellow crust.

• Mogen/Gomco: use petroleum jelly.

• Plastibell: no petroleum jelly.

• Clean with water only.

• Monitor for bleeding or infection.

What are the 3 routine newborn medications after birth?

Erythromycin eye ointment, Vitamin K injection, Hepatitis B vaccine.

Purpose of erythromycin eye ointment?

Prevents gonococcal or chlamydial eye infection (ophthalmia neonatorum).

Route and timing for vitamin K?

IM in vastus lateralis within 1 hour after birth (prevents bleeding disorder).

Hepatitis B vaccine schedule for infants?

At birth, 1 month, and 6 months; consent required.

Special consideration if birthing parent is Hep B positive?

Infant receives Hep B vaccine + HBIG within 12 hours of birth.

What injection precaution must the nurse remember for Vit K and Hep B?

Do not inject into the same leg to avoid irritation and interference of absorption.

What is the best way to initiate breastfeeding after birth?

Begin skin-to-skin contact immediately to encourage bonding and feeding reflex.

How often should a newborn breastfeed in 24 hours?

8–12 times per day (every 2–3 hours).

What are early hunger cues in a newborn?

Rooting, sucking motions, hand-to-mouth.

Crying is a late sign of hunger.

Why should each breastfeed last 15–20 minutes per side?

To allow baby to reach hindmilk, which is high in fat and promotes satiety.

When should feeding be stopped?

When baby slows sucking, softens breast, appears relaxed or asleep.

How should a poor latch be released?

Insert a finger into corner of baby’s mouth to break suction — never pull baby off.

What are signs of a good latch?

• Nose, cheeks, chin touch breast

• Lips flanged outward

• Rhythmic sucking/swallowing

• No pain or clicking sounds

What does a pinched or flattened nipple after feeding indicate?

Poor latch — baby may not be deep enough on breast.

Why is rooming-in encouraged?

Helps parents recognize hunger cues, feed on demand, and strengthens bonding.

What are the safe storage guidelines for expressed breast milk?

• Room temp: 4 hrs

• Refrigerator: 4 days

• Freezer: 6–12 months

• Thaw in fridge/warm water, never microwave

• Don’t refreeze or reuse leftovers.

What is nipple confusion?

Baby becomes confused switching between breast and artificial nipples; avoid early pacifier/bottle use until breastfeeding established.

What should be done with unused or thawed breast milk?

Discard—never refreeze or reuse leftover milk from a previous feeding.

How can a nurse support effective breastfeeding in the hospital?

Encourage skin-to-skin, teach proper latch and positions, promote hydration, and observe first few feedings.

What is the parent’s fluid recommendation while breastfeeding?

Increase fluids — mostly water — to stay hydrated and support milk production.

How often should a newborn receive formula feeds?

On demand, at least every 4 hours until gaining weight well.

What are the three main types of infant formula?

• Ready-to-use (no mixing, sterile)

• Concentrated liquid (mix equal parts water)

• Powdered (most economical)

What are key steps in formula preparation?

• Wash hands

• Check expiration date

• Mix per label instructions

• Use safe water

• Clean bottles thoroughly

• Refrigerate up to 48 hours.

Should you sterilize safe tap water for formula preparation?

Not necessary if local water supply is safe.

What is the proper position for bottle-feeding?

Semi-upright (≈45°) — prevents aspiration and improves digestion.

Why should the nipple be kept full of formula during feeding?

Reduces swallowed air → less gas and discomfort.

What are the dangers of propping a bottle?

Choking, ear infections, aspiration, and lack of bonding.

What should be done with leftover formula after a feed?

Discard immediately—don’t reheat or reuse.

How often should a baby be burped?

• Breastfeeding: between sides.

• Bottle-feeding: intermittently during feed.

Name two ways to burp a newborn.

• Over the shoulder

• Sitting upright with chin supported 

What can the nurse suggest to wake a sleepy baby for feeding?

• Unwrap/change diaper

• Talk or sing softly

• Massage back/hands/feet

• Apply cool cloth to face.

How can you calm a fussy newborn before feeding?

• Swaddle

• Hold close/rock gently

• Reduce noise & light

• Use skin-to-skin.

Why should babies always be placed “back to sleep”?

Reduces risk of SIDS and maintains open airway.

What are signs that a bottle nipple’s flow is too fast or too slow?

• Too fast → baby coughs/gulps, milk spills.

• Too slow → baby frustrated, sucks hard without progress.

How should bottles be cleaned?

In dishwasher, by boiling, or soap + brush; ensure no residue remains.

How long can prepared formula stay in the fridge?

Up to 48 hours.

When should parents contact provider about feeding?

• Baby not gaining weight

• Refuses feeds

• <6 wet diapers/day after day 5

• Persistent vomiting or diarrhea.

When can a newborn be discharged after a vaginal delivery?

After 48 hours, if stable and feeding well.

What is the discharge timeframe after a cesarean delivery?

After 96 hours, if the newborn and parent are stable.

What should the nurse assess before beginning newborn discharge teaching?

• Parental experience & education

• Attachment & bonding

• Social support

• Sibling involvement

What are effective ways to confirm understanding during teaching?

Teach-back or return demonstration.

Common reasons a newborn cries?

Hungry, gas, overstimulated, tired, bored, wet, hot, cold.

What are safe soothing techniques for crying infants?

• Swaddle

• Skin contact

• Rhythmic sounds

• Gentle motion

• Eye contact 

Why should you not feed every time a baby cries?

May cause overfeeding and gas.

Normal newborn sleep duration?

16–19 hours/day; may sleep through the night by 4–5 months.

What is the safest sleep position for a newborn?

Supine (on the back) — prevents SIDS.

What should the crib environment look like?

Firm mattress, no toys, pillows, bumpers, or loose blankets.

Why is tummy time important?

Strengthens neck and shoulder muscles, prevents flat head syndrome.