Study Notes on Normal Newborn (Chapters 17+18)
OB MODULE 1: NORMAL NEWBORN (CHAPTERS 17 + 18)
TOPICS
Newborn System Adaptations
Immediate Newborn Management
Newborn Medications
Nursing Management of the Newborn
Newborn Skin Variations
Newborn Head Variations
General Newborn Care
Feeding the Newborn
NEWBORN SYSTEM ADAPTATIONS: NEWBORN TRANSITIONING
Respiratory System
Surfactant: A substance that reduces surface tension within the alveoli, aiding in lung expansion.
Respirations: Newborns typically exhibit respiratory rates of 30-60 breaths per minute, characterized by irregular shallow breathing.
Cardiovascular System (Pages 528-529)
Fetal to Neonatal Circulation Changes: Transition changes involves closure of fetal shunts (e.g., ductus arteriosus, foramen ovale).
Heart Rate: Normal heart rate ranges between 110-160 beats per minute.
Hepatic System
Iron Storage: Newborns have iron reserves from maternal stores, sufficient for the first 4-6 months.
Carbohydrate Metabolism: Glucose is crucial; hypoglycemia may occur if not adequately nourished post-birth.
Bilirubin Conjugation: Newborns are at risk for hyperbilirubinemia due to immature liver function.
Gastrointestinal System
Bowel Elimination: The first stool (meconium) should be passed within the first 24-48 hours post-delivery.
Renal System
Concentration of Urine: Newborns' kidneys are immature and typically can concentrate urine moderately.
Voiding: Newborns should void within the first 24 hours, with normal frequency thereafter.
Immune System
Immune responses are naive; newborns rely on maternal antibodies transferred during pregnancy.
Integumentary System
Adaptations include changes in skin texture and color.
Neurological System
Senses: Newborns can hear and respond to noises and have limited sight.
Reflexes: Important reflexes include the Moro reflex, rooting reflex, and grasp reflex.
BODY TEMPERATURE REGULATION
Thermoregulation: The balance between heat loss and production impacting core body temperature.
Overheating: Can lead to hyperthermia; monitoring environmental conditions is crucial.
Neutral Thermal Environment: The ambient temperature (between 24-26°C or 75-78°F) where the newborn can maintain a normal body temperature without metabolic changes.
Cold Stress: Occurs when excessive heat loss leads to compensatory mechanisms to maintain body temperature.
MECHANISMS OF HEAT LOSS
Conduction: Heat transfer via direct contact; e.g., placing a newborn on a cold surface.
Convection: Heat loss via air movement; warm air moving away from the body. (Pushing through halls uncovered)
Radiation: Heat loss to nearby solid surfaces (e.g., walls) without direct contact.
Evaporation: Heat loss when moisture on the skin evaporates, contributing to cooling. (don’t let them sit wet)
IMMEDIATE NEWBORN MANAGEMENT
ABC’s Newborn Resuscitation
APGAR Scoring: Assessed at 1 and 5 minutes after birth to evaluate the newborn's condition.
Parameters:
Appearance/Skin Color (0-2 Points):
0: Cyanotic or pale
1: Appropriate body color; blue extremities (acrocyanosis)
2: Completely appropriate color (pink on trunk & extremities)
Pulse/Heart Rate (0-2 Points):
0: Absent
1: Slow (< 100 bpm)
2: > 100 bpm
Grimace/ Reflex Irritability (0-2 Points):
0: No response
1: Grimace or frown
2: Sneeze, cough, or vigorous cry
Activity/Muscle Tone (0-2 Points):
0: Limp, flaccid
1: Some flexion
2: Tight flexion with good resistance to extension
Respiratory Effort (0-2 Points):
0: Apneic
1: Slow, irregular, shallow
2: Regular respirations (30-60 breaths/min), strong cry
Initial Assessment/Interventions
Identify if the newborn is term, assess tone, and observe for breathing/crying.
If respiratory distress is present: Dry, stimulate, and suction if necessary.
Perform assessments for large for gestational age (LGA) or small for gestational age (SGA).
Check fontanelles for signs of dehydration or increased intracranial pressure.
Ensure proper identification (ID bands, footprints, picture).
NEWBORN MEDICATIONS
Erythromycin: Used as a prophylactic eye ointment to prevent gonococcal ophthalmia.
Vitamin K (phytonadione): Administered to prevent hemorrhagic disease in newborns.
NDC: 0676-4024-35
Hepatitis B Vaccine: Prevents Hepatitis B virus infection; NDC: specific to product.
RSV Vaccine: Administered to mitigate the risk of Respiratory Syncytial Virus infection.
NURSING MANAGEMENT OF THE NEWBORN
Prenatal & Perinatal History
Important factors influencing newborn health include maternal health, pregnancy complications, and delivery conditions.
Newborn Vital Sign Range of Values
Temperature: 36.5-37.5°C (97.7-99.5°F)
Heart Rate: 110-160 bpm (as low as 70 during sleep, as high as 170+ with activity or crying)
Respiratory Rate: 30-60 breaths/min at rest; increases with crying
Labor + Birth: Documentation of labor progression and delivery details is essential.
NEWBORN SKIN VARIATIONS
Vernix Caseosa: A protective coating on the skin formed during gestation.
Stork Bite: Nevi are flat, pink marks usually seen on the nape of the neck or eyelids.
Milia: Small cysts that appear on the face, often mistaken for acne.
Epstein Pearls: Small, white cysts found on the gums or roof of the mouth.
NEWBORN SKIN (CONTINUED)
Dermatoses
Congenital Dermal Malanocytosis: Variations in skin pigmentation and anatomy. (Looks like bruises on the butt)
Erythema Toxicum: Common rash seen in newborns, usually self-resolving.
Harlequin Sign: A condition where half the body is red while the other half is pale.
Nevus Flammeus: A capillary malformation (port-wine stain). (Becomes thicker and darker with age and can indicate cancer)
Nevus Vasculosus: A raised, centrally pink lesion (strawberry mark). (Decreases, lightens, and flattens with age)
Melanocytosis: Birthmarks that appear darker due to increased melanin.
NEWBORN HEAD VARIATIONS
Caput Succedaneum: Localized swelling on the scalp, which crosses suture lines and is due to pressure during delivery.
Cephalhematoma: A collection of blood beneath the cranial bone that does NOT cross suture lines.
Molding: The elongation of the fetal head shape to accommodate passage through the birth canal; resolves naturally over time.
GENERAL NEWBORN CARE
Bathing + Hygiene: Bath is typically delayed for 6+ hours post-delivery to promote bonding and thermal stability.
Cord Care: Clean and dry application of antiseptic; monitor for signs of infection.
Circumcision Care: Pre-operative care includes ensuring the infant is at least 12 hours old, has voided, has received Vitamin K, and informed consent has been documented. Post-operative care should include application of Vaseline to the area, monitoring for bleeding, edema, and voiding.
FEEDING THE NEWBORN
Breastfeeding
Frequency: Every 2-3 hours with sessions lasting approximately 10-20 minutes on each breast.
Emphasize proper positioning during feeding and education for successful breastfeeding, including recognizing hunger cues and maintaining latch.
Formula Feeding
Frequency: Every 3-4 hours; ensure feeding is completed within 30 minutes to prevent risk of aspiration.
Emphasize education on formula preparation and management, along with promoting nutritional needs considering limited stomach capacity and immature systems.
Address the immaturity of the immune system and limitations in the supply of pancreatic enzymes and bile, and manage fluid load considering immature kidneys.