Newborns

Learning Objectives

  • Identify key anatomical and physiological changes that occur as the neonates adapt to life outside the womb, as well as corresponding care considerations.

  • Describe the components of neonatal assessment and intervention.

  • Describe and prioritize care interventions needed for the neonate.

  • Define the important components of infant feeding and supporting nursing care.

Anatomical and Physiological Changes of the Newborn

  • Respiratory System

    • Clamping of umbilical cord triggers respiratory changes.

    • Fluid in lungs decreases throughout pregnancy, aided by catecholamines that promote clearance of lung fluid.

    • Normal respiratory rate is fast and shallow: 40-60 breaths per minute with pauses that last up to 20 seconds.

    • Signs of respiratory distress must be monitored.

  • Cardiovascular System

    • Normal apical pulse rate: 102-162 beats per minute.

    • Respiratory changes significantly influence the circulatory system.

    • First breaths expand the lungs and cause dilation of pulmonary vascular resistance leading to:

    • Closure of foramen ovale (a shunt between atria).

    • Closure of ductus arteriosus, which occurs more gradually over days or weeks.

APGAR Score

  • The APGAR score is assessed at 1 and 5 minutes after birth to evaluate the newborn's transition to life after delivery.

  • Interpretation of scores:

    • 7-10: Considered normal; indicates that the newborn is in good health.

    • 4-6: May suggest that the newborn needs assistance with breathing or additional medical interventions.

    • 0-3: Indicates critical condition, requiring immediate medical intervention.

Ballard Score

  • The Ballard score is used to estimate a newborn's gestational age based on an evaluation of their physical and neuromuscular maturity.

Post-Birth Care

  • Vital Signs:

    • Recorded every 4 hours, including measurements in centimeters.

  • Medications Administered:

    • Hepatitis B vaccine.

    • Vitamin K shot to aid clotting (due to low Vitamin K levels, which are typically produced by gut bacteria).

    • Antibiotic eye ointment.

Assessment of the Head

  • Caput Succedaneum

    • Fluid collection that crosses suture lines.

    • Typically resolves within the first week of life (3-4 days).

  • Cephalohematoma

    • Blood collection between the skull and periosteum.

    • Does not cross suture lines and may take 2-8 weeks to resolve.

    • Can increase the risk of hyperbilirubinemia (elevated bilirubin in the blood).

  • Subgaleal Hemorrhage

    • A dangerous type of bleeding that does not cross suture lines and feels “boggy.”

    • Can continue expanding after delivery, posing serious risks.

Temperature Regulation

  • Newborns:

    • Do not have the ability to shiver or sweat.

    • Elevated temperatures can lead to tachypnea (rapid breathing).

    • Decreased temperatures can lead to hypoglycemia (low blood sugar).

Other Changes

  • Gastrointestinal System:

    • Meconium is the first stool passed; it appears black and tarry.

  • Integumentary System:

    • Presence of vernix (a protective coating).

    • Presence of lanugo (fine hair covering).

    • Development of slate gray nevi, also known as Mongolian spots.

  • Reproductive System:

    • Swelling can occur due to maternal hormones.

Feeding Considerations

  • Questions to guide infant feeding practices:

    • When do we initiate breastfeeding?

    • How often should feeding occur?

    • What feeding practices are beneficial?

    • Components to assess during breastfeeding, including techniques for pumping if necessary.

Discharge Planning

  • Initial Care Considerations:

    • Perform the first bath.

    • Conduct essential testing, including:

    • Newborn screening for metabolic and genetic disorders.

    • Hearing tests.

    • Circumcision procedures should be considered and discussed.

    • Monitoring subcutaneous bilirubin levels (a measure of jaundice).

    • Proper care for the umbilical cord.

    • Critical Congenital Heart Defects (CCHD) screening as per CDC guidelines.

  • CCHD Screening Protocol:

    • Screen measurements include:

    • Less than 90% in the right hand or foot.

    • Between 90%-<95% in the right hand and foot, or a difference of more than 3% between right hand and foot.

    • Greater than 95% in the right hand or foot with a less than 3% difference.

    • Repeat the screening in 1 hour if there are abnormal values:

    • Prioritizing follow-up for any results undershooting the thresholds necessary for normalcy.

Note: Newborn screening results guide follow-up actions, ensuring proper health care interventions.

This comprehensive guide serves as an extensive resource for understanding the critical aspects of neonatal care and physiology as newborns transition to life outside the womb.