Newborn Warming &

Immunization
Presented by
Jennifer Foster. MSc. Nsg.Ed,
BSc.PHN,RM,RN
Essential Newborn care
1. Deliver the baby onto the mother’s abdomen or a dry
warm surface close to the mother.

2. Dry the baby’s body with a dry warm towel as you try to
stimulate breathing. Wrap the baby with another dry
warm cloth and cover the head

3. Assess APGAR 1 & 5 minutes

4. Clamp and cut cord

Essential newborn care
5. Place the baby in skin-to-skin contact with the mother,
cover with a warm cloth and initiate breastfeeding.

6. Give eye care (while the baby is held by its mother)

7. Give vitamin K, 1 mg by intramuscular injection (IM) on

the outside of the upper thigh (while the baby is held by
its mother).

8. Weigh the baby

Thermoregulation
 This is the ability to balance heat production and heat loss

in order to sustain body temperature inside the normal

limits.

 Thermal care is vital to reducing morbidity and mortality in

newborns.

 Normal axillary temperatures ranges between 36.5°C and

37.5°c.
Hypothermia
 A potentially fatal condition, which occurs when the

body temperature falls below 95°F (35°C).

 Occurs when the newborn’s axillary temperature drops

below 36.5°C.
Risk factors
 A large surface area-to-body mass ratio

 Decreased subcutaneous fat

 Greater body water content

 Immature skin leading to increased evaporative water and

heat losses

 Poorly developed metabolic mechanism for responding to

thermal stress e.g. No shivering

Risk factors
 Delivery in an area with environmental temperatures below

recommended levels

 Maternal Hypertension

 Cesarean delivery

 Low APGAR scores

 Underlying conditions e.g. sepsis, intracranial hemorrhage.

 METHODS OF HEAT LOSS

http://fayllar.org/n106-nursing-care-of-the-newborn-immediate-baby-care/img5.jpg
Heat Loss
 Evaporation:

 Heat loss when amniotic fluid evaporates from the infants

skin to the surrounding air. This can also occur after a bath.

 Conduction:

 Heat loss when the infant is placed naked on a cooler

surface, such as the cold table / weighing scales or

wrapped in a cold blanket or towel.
Heat Loss
 Convection:

 Heat loss from the infant’s skin to the a surrounding air

when the baby is exposed to cold air e.g. near a window

 Radiation:

 Loss of heat from an infant’s skin to distant cold objects

such as walls /window panes. The closer the infant is the

greater the heat loss
Mechanism of heat production
 Metabolic process –production of metabolic energy by

oxidative metabolism of glucose, fat and protein by the

brain, heart, and liver .

 Voluntary muscle activity – heat is generated by increased

muscle activity during crying.

 Heat is preserved by assuming a flexed position which

decreases exposed surface area.

Mechanism of heat production
 Peripheral vasoconstriction – this reduces blood flow to

the skin and consequently decreasing loss of heat in

response to cooling.

 Non shivering thermogenesis – production of heat by the

metabolism of brown fat.

 Brown fat is found around the scapulae, kidneys, adrenal

glands, head, neck, heart and axillary regions.

Non shivering Thermogenesis
 Thermal receptors transmit impulses to the hypothalamus,

which stimulates the sympathetic nervous system to release

nor-epinephrine in brown fat

 Nor-epinephrine activates lipase, which causes lypolysis

and fatty acid oxidation.

 Heat is generated from the energy produced from this

chemical process.
Complications of hypothermia
 Hypoxia, cardio-respiratory complications and acidosis.

 Hypoglycemia - increased glucose consumption is needed

for heat production.

 Neurological complications

 Hyperbilirubinemia

 Clotting disorders
Signs and symptoms of hypothermia
 Acrocyanosis

 Seen in healthy newborns

 Refers to the peripheral cyanosis around the mouth and

the extremities including hands and feet.

 Cool, mottled, or pale skin

 Hypoglycemia

 Bradycardia
Signs and symptoms of hypothermia
 Tachypnea, shallow and irregular respirations

 Respiratory distress, apnea, hypoxemia, metabolic acidosis

 Decreased activity, lethargy

 Hypotonia (decreased muscle tone)

 Feeble cry

 Poor feeding
 NEWBORN WARMING BLANKET

https://www.dhresource.com/260x260s/f2-albu-g9-M00-BB-D9-rBVaVVxK34OADmjvAAA4ZAm7nw4020.jpg/baby-knit-button-
sleeping-bag-swaddle-wrap.jpg
Maintaining Warmth
 Warm Chain adapted from WHO, (1997)

 Warm the delivery room.

 The temperature of the delivery room should be at least

25°C - 28°C, free from the drafts from open windows,

doors, or fans.

 Items to keep the newborn warm are prepared ahead of

time.
Maintaining Warmth

 Personnel should never decide the temperature of the

delivery room for their own comfort.

Maintaining Warmth
 Immediate drying.

 Immediately dry the newborn after birth with a warm

towel or cloth to prevent heat loss from evaporation.

 Skin-to-skin contact at birth.

 While the newborn is being dried, place on the mother’s

chest or abdomen (skin to-skin contact) to prevent heat

loss
 SKIN TO SKIN WITH MOTHER

https://i1.ytimg.com/vi/BAX4gB48Ewk/hqdefault.jpg
Maintaining Warmth
 Newborns can be maintained in skin-to-skin contact with

their mothers:
 -while she is being attended to (placenta delivery,

suturing)
 -during transfer to the postnatal unit / recovery room

 -during assessments and initial interventions.

Maintaining Warmth
 Breastfeeding.

 Initiate as soon as possible, preferably within one hour of

birth.

 Newborns should be fed on demand.

Maintaining Warmth
 Delay bathing and weighing

 Bathing the newborn soon after birth causes a drop in the

body temperature and may cause hypothermia and

hypoglycemia.

 After the transition period (6-8 hours), assess newborns

for bathing readiness.

 Bathing may be considered when vital signs are stable.

Maintaining Warmth
 Delay bathing and weighing

 Weighing can be done after a period of continuous skin-to-

skin contact and the first feed, with a warm blanket on the
scale.

 Bathing is done quickly in a warm room using warm water.

 Immediately after bathing dry thoroughly, diaper and place

skin-to skin.
 SKIN TO SKIN WITH MOTHER

http://www.parenting-with-love.com/wp-content/uploads/2012/05/skin-to-skin-baby-momma.jpg?w=640
Maintaining Warmth
 Appropriate clothing/blanket . Dress newborn in loose

clothing and blanket.

 Mother and baby together. Keep mother and newborn

together 24 hours a day (rooming-in), in a warm room (at

least 25°C).

 Skin-to-skin can be used to rewarm a newborn

experiencing mild to moderate hypothermia

 NEWBORN SWADDLING IMAGE

https://ae01.alicdn.com/kf/HTB1D4lHBeuSBuNjSsplq6ze8pXas/Baby-swaddle-and-Hat-set-Newborn-Bow-Beanie-Infant-Cotton-
Flower-Print-Warmer-Blanket-Personalized-Baby.jpg
Maintaining Warmth
 Warm transportation for a baby that needs referral

 Keep newborn warm while waiting for transportation

 Dress the newborn and wrap in blankets if a transport

device is used.
Maintaining Warmth
 Warm assessments (if newborn is not skin-to-skin with

mother)

 Lay on a warm surface in a warm room.

 Put under an additional heat source as necessary (i.e.

radiant warmer).

 Utilize servo control if on radiant warmer for >10 minutes.

Maintaining Warmth
 Training and raising awareness

 Alert health care providers and families to the risks of

hypothermia and hyperthermia.

 Provide on the job training and supervised practice to

ensure that warmth maintenance becomes part of the

routine care of the newborn.

 Demonstrate and provide supervised practice as necessary

Maintaining Warmth
 Re-warm neonates in an incubator or under a radiant

warmer if hypothermic

 Administer treatment for any underlying conditions

identified.
Immunization
 This is the process whereby a person is made immune

or resistant to an infectious disease, typically by the

administration of a vaccine.

 Immunization is a proven tool for controlling and

eliminating life-threatening infectious diseases

 Immunization confers active artificial immunity

Immunization
 The first immunization given in Jamaica is BCG.

 Done from birth to 6 weeks

 Hepatitis B is the first vaccine given in the US

 Given from infancy to childhood

Immunization
 Schedule for Jamaica

 Birth to 6/52 – BCG

 6/52 – 1st pentavalent (DPT, Hib, HepB) & IPV

 3/12 – 2nd pentavalent (DPT, Hib, HepB) & OPV

 6/12 – 3rd pentavalent (DPT, Hib ,HepB) & OPV

Immunization
 Schedule for Jamaica cont’d

 1yr – 1st MMR (Measles, Mumps Rubella)

 1yr & 6/12 – 2nd MMR 1st DPT/OPV booster

 4-6yrs – 2nd DPT/OPV booster

 Other vaccines are available in the private sector.

Immunization card
 Vaccinations are recorded on a document which is

known as a immunization card

 This card is issued by the immunizing officer.

 Immunization records are also kept within the child

health & development passport (CHDP)

Immunization Record
 Proof of immunization is frequently a necessity for

enrollment in school or day care.

 This proof is maintained on an immunization record or

card or passport.

 It's important to advise parents and care givers to

keep children up to date on their vaccines and store the

record in a safe place .
 IMAGE OF AN IMMUNIZATION
RECORD

http://www.schsa.org/shopping/images/imm-75.jpg
Immunization Law
 The immunization regulations of 1986, which were

drafted under the public health act of 1974 states;

 All children in Jamaica are required to be

adequately vaccinated by their first birthday.

 It is the duty of every parent to have his or her child

immunized .
Immunization Law
 All children under seven years must be adequately
vaccinated before they are permitted entry to school.

 Children must be vaccinated against the vaccine

preventable diseases
Immunization Benefits
 Saves lives – protection against life threatening

diseases e.g. polio

 Protects the vulnerable – persons who can receive

vaccinations are vaccinated to protect who cannot

(persons with leukemia & severe allergies)

 Safe & effective – Vaccines are carefully tested and

monitored. They have an excellent safety record.

Immunization Benefits
 Cost effective – saves time and money as vaccine

preventable diseases are costly to treat and can result

in disabilities.

 Protects future generations – vaccines have reduced

& eliminated disease that previously killed / severely

disabled persons years ago e.g. smallpox (eliminated)
and rubella.
Immunization Benefits
 Prevents disease outbreaks – it has stopped

epidemics of once common infectious diseases in the

past.

 Prevents illness – protection given improves the

quality of life and reduces absenteeism from work and

school.
Immunization Risks
 Risk of death / serious injury

 Risk of severe reaction to a vaccine

 Delaying / refusing vaccination leads to outbreaks of

vaccine-preventable diseases that endanger public

health.

 The risks of natural infection is greater than the risks

of immunization.
Common Side Effects
 Redness at injection site

 Pain and swelling at injection site

 Loss of appetite

 Crying , Fussiness

 Fever

 Drowsiness
 Vaccine side effects
image

https://imageserve.babycenter.com/26/000/281/PAa7vO5IQk9bvIiM5AJtzLp7t7dJh2Wr_lg.jpg
Other Side Effects
 Fatigue

 Headache (temporary)

 Sometimes, a small, hard lump (nodule) at the

injection site may continue for some weeks or months.

 This should not be of concern and requires no treatment.
Rare side Effects
 Its advised to remain at the health facility for at least

15 minutes after receiving a vaccine should further

action be required.
 Severe allergic reaction

 Anaphylaxis – dramatic immediate allergic reaction

after a vaccination which is totally reversible if

treated swiftly.
Rare Side Effects
 Febrile seizure – caused when the child’s fever rises

quickly. seizure usually lasts one or two minutes and

does not cause permanent harm or lasting effects
 Neurological reaction (seizure )

 Contact a physician or return to the care facility if this

or any other reaction occurs.

Management of Side Effects
 Advise parents / guardians

 To use panadol / acetaminophen as ordered

 Anti fever

 Anti pain

 To use a wet cool cloth to the sore area

 Offer more fluids for drinking if child has fever

Vaccines
 Are biological preparations that improves immunity to
a particular disease.

 Contains an agent that resembles a disease-causing

microorganism, and is often made from weakened or

killed forms of the microbe, its toxins or one of its
surface proteins.
Vaccines
 Vaccination is a simple, safe, and effective way of
protection against harmful diseases, before contact with
them
 The agent stimulates the body's immune system to
recognize the agent as foreign, destroy it, and "remember"
it, so that the immune system can easily recognize and
destroy any of these microorganisms in the future.
 Vaccines are used in the immunization process.
Vaccines
 Vaccines normally prevent disease onset or else lessen

disease severity.

 Vaccines contain either killed or weakened forms of

microorganisms such as viruses or bacteria.

 Vaccines do not cause the disease.

 Vaccines are frequently given via an injection, however a

few are given orally (by mouth) or sprayed into the nostrils.
 Injectable Vaccine Preparation

http://www.jamaicaobserver.com/apps/pbcsi.dll/storyimage/JO/20170919/ARTICLE/309199958/AR/0/AR-309199958.jpg
 Oral Polio Vaccines & Dropper

https://www.who.int/immunization_standards/vaccine_q https://www.who.int/immunization_standar
uality/pq_247_bopv13_20dose_sanofi_510.jpg ds/vaccine_quality/pq_245_bivalent_OPV_
1-3_Bharat_container_image_thumb.jpg
 Nasal Spray Vaccine Administration

https://cdn-prod.medicalnewstoday.com/content/images/articles/312/312767/a-child-being-given-a-nasal-spray-
vaccine.jpg
Vaccines
 BCG, or bacille Calmette-Guerin, is a vaccine for

tuberculosis (TB) disease.

 Bacterial infection

 BCG is used in many countries with a high prevalence

of TB to prevent childhood tuberculous meningitis and

miliary disease.
Vaccines
 Diphtheria – bacteria infection that can block the

airway and cause breathing problems.

 Pertusis / whooping cough – bacteria infection that

causes lung infection / collapse. Most severe in

children

 Tetanus / lockjaw – bacteria found in the soil. Causes

muscle spasms that affects breathing & swallowing

Vaccines
 Polio – virus which causes paralysis of the diaphragm

& chest muscles, muscle weakness and severe muscle

pain

 IPV – inactivated polio vaccine – given via an

injection and protects children against polioviruses

types 1, 2 and 3.
Vaccines
 OPV – oral polio vaccine – given orally , bOPV

targets polioviruses types 1 & 3

 Wild type 2 polio virus has been eradicated since 1999

 Haemophilus influenza type b (Hib) – bacteria that

causes brain inflammation and long term damage.

 Hepatitis B – virus that attacks the liver which can

result in death.
Vaccines, MOH
 Measles (Red measles / Rubeola). Very contagious

viral infection that can cause brain inflammation &

seizures.

 Mumps – viral infection that affects the salivary glands

which causes deafness and brain damage

 Rubella (German measles) – viral infection that is

very serious during pregnancy.

Vaccines, Others
 Varicella (chicken pox) – viral infection

 Pneumococcal – bacterial infection. Prevnar 13 is the

vaccine .

 Meningococcal – bacterial infection

 Influenza – viral infection

 Rotavirus – viral infection causing severe diarrhoea in

children
https://www.medlife.com/blog/wp-content/uploads/2019/08/importance-of-vaccination.png
Discharge Planning
 Discuss under the following;

 Bathing the newborn

 Cord care

 Eye care

 Care of the genitalia

 Immunization

 Breastfeeding
References
 Integrated Management of newborn and Childhood Illness (2018).Maternal,
Newborn and Child Health. Retrieved from
http://www.open.edu/openlearncreate/mod/oucontent/view.php?id=246&printa
ble=1
 WHO health topics (2018) Immunization. Retrieved from
http://www.who.int/topics/immunization/en/
 WHO health topics (2018) Vaccines. Retrieved from
http://www.who.int/topics/vaccines/en/
 Chamberlain maternal newborn regional program. (2013). Newborn
Thermoregulation : A Self-Learning Package. Retrieved from
http://www.cmnrp.ca/uploads/documents/Newborn_Thermoregulation_SLM_2
013_06.pdf
 Mayo Foundation for Medical Education and Research. (2021). Childhood
vaccines: Tough questions, straight answers. Retrieved from
https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-
depth/vaccines/art-20048334
References
 Henderson, C.,Macdonald, S. (Eds) (2004). The fetal skull. In Mayes
Midwifery. A text book for midwives. (pp. 220-221). Bailliere Tindall.
 Gale Encyclopedia of Medicine. (2008). Hypothermia. Retrieved
from https://medical-dictionary.thefreedictionary.com/hypothermia
 Aprahamian, N. & Hogencamp, T.C. (2018). Common newborn
complaints. Retrieved from
https://www.sciencedirect.com/topics/neuroscience/cyanosis
 Bettercare Learning programmes. (n.d). Temperature control and
hypothermia. Retrieved from https://bettercare.co.za/learn/newborn-
care/text/07.html#heat-production-and-loss
 Jamaica Information Service. (2012). Immunization Programme Protects
All. Retrieved from https://jis.gov.jm/immunization-programme-protects-
all/#targetText=According%20to%20the%20Immunization%20Regulations
,vaccinated%20by%20their%20first%20birthday.
References
 CDC. (2015). Five Important Reasons to Vaccinate Your Child. Retrieved from
https://www.cdc.gov/measles/downloads/matte-reasons-vaccinate.pdf
 WHO. (2014). Polio and the Introduction of IPV for health workers. Retrieved
from
https://www.who.int/immunization/diseases/poliomyelitis/inactivated_polio_va
ccine/Key_mess_FAQs.pdf#targetText=There%20are%20two%20vaccines%20
for,and%20can%20be%20easily%20administered.&targetText=In%20countries
%20still%20using%20OPV,and%20protect%20them%20from%20polio.
 CDC. (2019). Mumps. Retrieved from
https://www.cdc.gov/mumps/index.html#targetText=Mumps%20is%20a%20co
ntagious%20disease,and%20a%20tender%2C%20swollen%20jaw.
 Balest. A., L. (2021). Hypothermia in Neonates. Retrieved from
https://www.merckmanuals.com/professional/pediatrics/perinatal-
problems/hypothermia-in-neonates
References
 CDC. (2016). BCG vaccine. Retrieved from
https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm
 WebMD LLC. (2005 – 2019). Immunizations and Vaccines. retrieved from
https://www.webmd.com/children/vaccines/immunizations-vaccines-power-of-
preparation#1
 Colorado Children's Immunization Coalition. (2010 – 2019). Fact or Fiction
Benefits vs. Risks. Retrieved from http://www.immunizeforgood.com/fact-or-
fiction/benefits-vs.-risks
 Vancouver Coastal Health . (2008). Immunization.
http://www.vch.ca/Documents/parent-handbook-immunization-choice.pdf
 State of Victoria . (2018). Immunization – side effects. Retrieved from
https://www.betterhealth.vic.gov.au/health/healthyliving/immunisation-side-
effects
 World Health Organization. (2021). Vaccines and immunization: What
is vaccination? Retrieved from https://www.who.int/news-room/q-a-
detail/vaccines-and-immunization-what-is-vaccination