Chapter 22/23

Nursing Care of the Newborn and Family

Physiological Adaptations of the Newborn

Authors

  • Vicky White MSN, RNC-LRN

Birth Through the First 2 Hours

Interventions

  • Airway Maintenance:

    • Assess whether the infant is breathing.

    • Wipe the face, nose, and mouth clean.

    • Suction the nares with a bulb syringe if needed.

  • Maintaining Body Temperature:

    • It is crucial to dry the infant quickly; this is the second most important task after assessing breathing and the need for suction.

    • Drying the infant also stimulates respiratory activity.

  • Apgar Scoring:

    • 1-Minute Apgar: Perform as soon as possible; intervene if the score is 7 or below, indicating the need for immediate interventions.

    • 5-Minute Apgar: If the score remains low, consider performing a 10-minute Apgar.

  • Immediate Interventions:

    • Administer eye prophylaxis and Vitamin K prophylaxis.

    • Promote parent-infant interaction through skin-to-skin contact and breastfeeding.

Post-Birth Assessment

  • Evaluate gestation:

    • Determine if the infant is at term gestation.

    • Assess for breathing or crying.

    • Check for good tone.

  • If No Breathing:

    • Warm the infant, clear the airway if necessary, dry, and stimulate.

  • Routine Care:

    • Provide warmth and ongoing evaluation.

Resuscitation Steps

  1. Check for Labored Breathing:

    • If present, monitor heart rate and perform actions as necessary.

    • Assess heart rate; a heart rate below 100 beats per minute (bpm) needs further interventions.

    • If gasping or apnea present or persistent cyanosis, initiate appropriate responses.

  2. Targeted Preductal SpO₂ Monitoring:

    • After birth:

      • 1 min: 60%-65%

      • 2 min: 65%-70%

      • 3 min: 70%-75%

      • 4 min: 75%-80%

      • 5 min: 80%-85%

      • 10 min: 85%-95%

  3. Post-Resuscitation Care:

    • If HR is below 100 bpm, take corrective ventilation steps.

    • If HR is below 60 bpm, consider intubation if no chest rise is observed.

    • If HR is still below 60 bpm, initiate chest compressions in coordination with positive pressure ventilation (PPV).

    • Administer IV epinephrine if necessary, considering potential factors such as hypovolemia or pneumothorax.

Apgar Scoring

Sign

0

1

2

Heart Rate

Absent

Slow (<100/min)

>100/min

Respiratory Effort

Absent

Slow, weak cry

Good cry

Muscle Tone

Flaccid

Some flexion of extremities

Well flexed

Reflex Irritability

No response

Grimace

Cry

Color

Blue, pale

Body pink, extremities blue

Completely pink

Common Newborn Problems (From 2 Hours After Birth Until Discharge)

Birth Injuries

  • Soft-Tissue Injuries:

    • Caput injuries.

    • Cephalohematoma related to vacuum deliveries.

    • Forcep marks from forcep deliveries.

  • Skeletal Injuries:

    • Bruising related to face or breech presentation.

  • Lacerations:

    • Typically occur from cesarean section scalpel.

Jaundice

  • A common condition needing observation.

Hypoglycemia

  • Defined as blood glucose levels below 40-45 mg/dL.

  • Symptoms may vary; some infants will show symptoms at levels higher than others.

  • Asphyxia and other physiological stress during birth can increase hypoglycemic episodes.

  • Infants at risk include:

    • Large for gestational age (LGA)

    • Small for gestational age (SGA)

    • Preterm babies

    • Infants of diabetic mothers (IDDM)

  • Cold stress and feeding difficulties can elevate the risk of hypoglycemia.

Laboratory and Diagnostic Tests

  • Universal Newborn Screening:

    • Important for detecting genetic diseases and inborn errors of metabolism.

    • Phenylketonuria (PKU):

    • Mandated state law in West Virginia.

    • Testing done before discharge; the infant must be at least 24 hours old and have had feedings.

    • Inability to digest phenylalanine can lead to brain damage if not diagnosed and treated early.

    • Tested through a heel stick blood sample.

  • Newborn Hearing Screening:

    • Now mandatory before discharge.

Circumcision

Recommendations

  • The 2012 recommendations by the American Academy of Pediatrics (AAP) suggest that the benefits outweigh the risks.

Parental Decisions
Procedure
Care of the Newly Circumcised Infant

  • Watch for bleeding.

  • Apply petroleum or petroleum gauze as a precaution.

Umbilical Cord Care

Goals

  • Prevent hemorrhage and infection.

Care Guidelines

  • Keep the cord clamp on for 2-3 days before removal.

  • Rinse with water if contaminated by stool or urine.

  • No alcohol or other cleansing agents are recommended.

  • The cord should fall off in a dry gangrene condition between days 10-14.

Nursing Role in Promoting Parent-Infant Interaction

  • Promote early interactions between parents and newborns to enhance bonding.

  • Assess attachment behaviors using the "Taking in" and "Taking hold" model.

  • Provide support and education for new parents.

  • Avoid overstimulation of the infant during interactions to ensure a calm environment.

Question Regarding Vitamin K Administration

  • Reason for Vitamin K Administration:

    • Many mothers have diets deficient in vitamin K, which results in infants being deficient as well.

    • Vitamin K is essential for the synthesis of prothrombin in the liver; therefore, it must be administered by injection.

    • Newborn intestines do not contain bacteria capable of synthesizing vitamin K.

    • The infant's supply of vitamin K is insufficient for at least 3 to 4 months, necessitating supplementation.

References

  • Perry, S.E., Lowdermilk, D.L., Cashion, K., Rhodes, K., Olshansky, E.F., Hockenberry, M.J., Wilson, D., Rodgers, C.C. Maternal Child Nursing Care. (6th ed.) 2018. Elsevier: St. Louis, MO