NEWBORN CARE

NEWBORN CARE

 Vitamin K administration
 Hepatitis B vaccine administration
 Crede’s Prophylaxis
 Cord dressing/cord care
 Thermoregulation of the Newborn
 Suctioning
 APGAR Scoring
 Ballards scoring
 Anthropometric assessment
 Newborn reflexes
 Newborn identification and registration
 Infant bath
 VITAMIN K
ADMINISTRATION
 VITAMIN K ADMINISTRATION

 Vitamin K, synthesized through the action of intestinal flora, is responsible for the
formation of factor II (prothrombin), factor VII (proconvertin), factor IX (plasma
thromboplastin component), and factor X (Stuart–Prower factor) in the clotting sequence.
 Because a newborn’s intestine is sterile at birth unless membranes were ruptured more
than 24 hours, it will take about 24 hours for flora to accumulate and for ongoing vitamin
K to be synthesized.
 This causes most newborns to be born with a lower than usual level of vitamin K,
approximately 40% to 60% of normal adult values, which are usually reached at around 6
months of age.
 This decrease in vitamin K leads to a prolonged coagulation or prothrombin time.
 VITAMIN K ADMINISTRATION

 Because almost all newborns can be predicted to have this diminished blood coagulation
ability, vitamin K (phytonadione, AquaMEPHYTON) is usually administered
intramuscularly (IM) into the lateral anterior thigh, the preferred site for all injections in
newborns, immediately after birth.
 Dosage: Prophylaxis: 1 mg IM one time in the first hour after birth
 If parents object to an injection, vitamin K can be administered orally, although it is not
as effective.
 Whether giving this orally or by injection, be certain that the administration doesn’t
interfere with parent bonding or beginning breastfeeding as these are also vitally
important in the first hours after birth.
 VITAMIN K ADMINISTRATION
 Nursing Implications:
 Practice the Rights of Medication Administration: right patient, right medication, right route, right time,
right dose, right reason, right documentation.
 Anticipate the need for injection within an hour of birth.
 Administer IM injection into a large muscle, such as the anterolateral muscle of a newborn’s thigh.
 Be certain to administer the injection at a time it doesn’t interrupt parent–child bonding or beginning
breastfeeding.
 If giving vitamin K for treatment, obtain prothrombin time before administration (the single best indicator
of vitamin K–dependent clotting factors).
 Assess for signs of bleeding in the infant, such as black, tarry stools (different from meconium stools,
which have a greenish shade), hematuria (blood in urine), decreased hemoglobin and hematocrit levels,
and bleeding from any open wound or at the base of the cord. (These signs would indicate more vitamin K
is necessary because bleeding control has not been achieved.)
HEPATITIS B VACCINE
ADMINISTRATION
 HEPATITIS B VACCINE ADMINISTRATION

 Hepatitis B is a viral infection of the liver.

 Acute infection either resolves or progresses to chronic infection, which may lead to
cirrhosis or liver cancer several decades later.
 In developing countries like the Philippines, hepatitis B infection usually occurs in
childhood, at the time of birth, during infancy, or in early childhood.
 Symptoms are not usually apparent in infected young people, but the likelihood that an
infected child will develop lifelong chronic infection is higher than if the infection occurs
in older children or adults.
 HEPATITIS B VACCINE ADMINISTRATION

 Newborns born in a hospital or a birthing center usually receive a first

vaccination against hepatitis B within 12 hours of birth;
 a second dose will then be administered at 1 month
 a third dose at 6 months.
 Infantswhose parents are positive for the hepatitis B surface antigen
(HBsAg) also receive hepatitis B immune globulin (HBIG) at birth.
 HEPATITIS B VACCINE ADMINISTRATION

 It should be injected intramuscularly into the anterolateral aspect of the

thigh.
 1 dose is 0.5 ml
 A sterile syringe and needle should be used for each injection.
 Vaccines should be kept in a storage between +2 and +8 degrees Celsius.
CREDE’S PROPHYLAXIS
 CREDE’S PROPHYLAXIS
 An installation of a prophylactic agent in the eyes of all neonates that serves as a precautionary measure
against ophthalmia neonatorum, which is the inflammation of the eyes resulting from gonorrheal or
chlamydial infection contracted by the newborn during passage through the mother’s birth canal.
 The agent used for prophylaxis varies according to the hospital protocols but usually includes forms of
erythromycin or tetracycline.
 Occasionally, the administration of an antibiotic ointment such as erythromycin at birth, to protect against
gonorrhea, has caused the eyes to appear reddened with a slight discharge; if this has occurred, it lasts for
about 24 hours of life and then clears.
 The eye should not be erythematous with eyelid edema and purulent discharge, as seen in conjunctivitis.
 CREDE’S PROPHYLAXIS

 PURPOSE:

● To prevent blindness caused by gonococcal organisms that may be present in

the vagina.
● To prevent ophthalmic neonatorum
 CREDE’S PROPHYLAXIS

 OPHTHALMIA NEONATORUM
 Ophthalmia neonatorum is an eye infection that occurs at birth or during
the first month of life.
 The most common causative organisms are Neisseria gonorrhoeae and
Chlamydia trachomatis, which are contracted from vaginal secretions.
A N. gonorrhoeae infection is an extremely serious form of infection and, if
left untreated, progresses to corneal ulceration and destruction, resulting in
opacity of the cornea and severe vision impairment.
CORD DRESSING/
CORD CARE
 CORD DRESSING/ CORD CARE

 Cord Dressing is a process done after delivery of the baby in which the baby’s cord
detaches from the placenta and cuts it into the length to form a cord stump.

 Two Kelly hemostats placed 8 to 10 inches from the infant’s umbilicus are cut between
them and umbilical clamp is then applied.

 Clamping the cord is part of the stimulus that initiates the first breath.
 CORD DRESSING/ CORD CARE

 Purposes

1. To separate the umbilicus between the mother’s placenta and the newborn’s cord.
2. To examine fully for the presence of the three vessels- 1 umbilical vein and 2 umbilical
arteries. AVA
3. To prevent tetanus neonatorum.
4. To prevent infections and prevent bleeding.
THERMOREGULATION OF
THE NEWBORN
 THERMOREGULATION OF THE
NEWBORN
 Temperature

 The temperature of newborns is about 99°F (37.2°C) at birth because they have been confined in their birthing parent’s warm and
supportive uterus.

 Temperature will fall almost immediately to below normal because of heat loss, the temperature of birthing rooms (approximately 68°F
to 72°F [21°C to 22°C]), and the infant’s immature temperature-regulating mechanisms if the baby is not protected from heat loss at
birth and in the moments afterward.

 The majority of heat loss occurs because of four separate mechanisms:

 Convection

 Radiation

 Conduction

 Evaporation
THERMOREGULATION OF THE
NEWBORN

Heat loss in the newborn

A. Convection.
B. Radiation.
C. Conduction.
D. Evaporation.
 THERMOREGULATION OF THE
NEWBORN

 Convection is the flow of heat from the newborn’s body surface to cooler surrounding air.
 Eliminating drafts, such as from air conditioners, is an important way to reduce convection heat loss.
 Radiation is the transfer of body heat to a cooler solid object not in contact with the baby, such as a
cold window or air conditioner.

 Moving an infant as far from the cold surface as possible helps reduce this type of heat loss.

 Conduction is the transfer of body heat to a cooler solid object in contact with a baby. For example,
a baby placed on the cold base of a warming unit quickly loses heat to the colder metal surface.

 Covering surfaces with a warmed blanket or towel is necessary to help minimize conduction heat
loss.
 THERMOREGULATION OF THE
NEWBORN
 Evaporation is loss of heat through conversion of a liquid to a vapor.
 Newborns are wet when born, so they can lose a great deal of heat as the amniotic fluid on their
skin evaporates.
 To prevent this type of heat loss, lay a newborn on the parent’s abdomen immediately after birth
and cover with a warm blanket for skin-to-skin contact.
 In addition, drying the infant—especially the face and hair—also effectively reduces evaporation
because the head, which is a large surface area in a newborn, can be responsible for a great amount
of heat loss.
 Covering the hair with a cap after drying further reduces the possibility of evaporation cooling.
 THERMOREGULATION OF THE
NEWBORN
 Excellent mechanical measure to help conserve heat or prevent heat loss:
 Drying and placing newborns on their parent’s abdomen (covered by a warm blanket)
 Drying and wrapping them and placing them in warmed cribs
 Drying and placing them under a radiant heat source
 Perform all early newborn care speedily and expose the newborn to cool air as little as possible.
 Be certain that any procedure during which a newborn must be uncovered, such as resuscitation or
circumcision, is done under a radiant heat source.
SUCTIONING
 SUCTIONING

 Promote Adequate Breathing Pattern and Prevent Aspiration

 Although not done routinely, if a newborn appears to have a great deal of mucus in the mouth following birth, the
primary care provider can suction mucus from the infant’s mouth with a bulb syringe.
 If needed, this is done before the infant is laid on the parent’s abdomen in order to prevent aspiration of the
secretions.
 If the infant continues to have an accumulation of mucus in the mouth or nose after these first steps, you may need
to suction further after the baby is placed under a warmer.
 Use a bulb syringe or a soft, small (#10 or 12) catheter.
 Always suction gently to prevent mucous membrane irritation that could leave a portal of entry for infection.
 SUCTIONING

 Brisk suctioning also has been associated with bradycardia in newborns because of vagal nerve
stimulation.
 With a bulb syringe, decompress the bulb before inserting it into the infant’s mouth first and then the
nose; otherwise, the force of decompression of the bulb could push secretions back into the pharynx or
bronchi.
 Although the use of the procedure is not standardized, when an infant is born with meconium-stained
amniotic fluid, intubation may be performed so that deep tracheal suction can be accomplished before
the first breath to help prevent meconium aspiration into the lungs.
APGAR SCORING
 APGAR SCORING

 APGAR SCORING
 At 1 minute and 5 minutes after birth, newborns are observed and rated
according to an Apgar score, an assessment scale used as a standard for
newborn evaluation immediately after birth since 1958 (Apgar et al., 1958).
 As shown in table, heart rate, respiratory effort, muscle tone, reflex irritability,
and color of the infant are each rated 0, 1, or 2. There is a high correlation
between low 5-minute Apgar scores and neurologic illness (American Academy
of Pediatrics [AAP], 2015).
APGAR SCORING
 APGAR SCORING

2 1 0

Appearance Color Body and extremities pink Body pink, Body and extremities blue
extremities blue (cyanosis) or completely
pale (pallor)

Pulse Heart rate Heart rate >100 beats/minute Heart rate present, No heart rate
(bpm) but <100 bpm

Grimace Reflex irritability Cries or sneezes when stimulated Grimaces when No response to stimulation
stimulated

Activity Muscle tone Maintains a position of flexion Minimal flexion of Limp and flaccid
with brisk movements extremities

Respiration Respiratory effort Strong, vigorous cry Weak cry, slow or No respiratory effort
difficult respirations
 APGAR SCORING

 Heart Rate
 Auscultating a newborn heart with a stethoscope is the best way to determine heart rate; however, heart rate also
may be obtained by observing and counting the pulsations of the umbilical cord at the abdomen if the cord is still
uncut.
 Respiratory Effort
 Respirations are counted by observing chest movements. A mature newborn usually cries and aerates the lungs
spontaneously at about 30 seconds after birth. By 1 minute, they are maintaining regular, although rapid,
respirations. Difficulty with breathing might be anticipated in a newborn whose parent received large amounts of
analgesia or general anesthetic during labor or birth.
 Muscle Tone
 Term newborns hold their extremities tightly flexed, simulating their intrauterine position. Muscle tone is tested
by observing their resistance to any effort to extend their extremities.
 APGAR SCORING

 Reflex Irritability
 One of two possible cues is used to evaluate reflex irritability: response to a suction
catheter in the nostrils or response to having the soles of the feet flicked. A baby whose
parent was heavily sedated for birth will probably demonstrate a low score in this category.
 Color
 All infants appear cyanotic at the moment of birth. They grow pink with or shortly after the
first breath, which makes the color of newborns correspond to how well they are
breathing. Acrocyanosis (cyanosis of the hands and feet) is so common in newborns that a
score of 1 in this category can be thought of as normal
BALLARDS SCORING
 BALLARDS SCORING
 Maturity Rating
 Many healthcare facilities do not routinely do maturity testing.
 They rely on the ultrasound, done at 20 weeks gestation, to assess maturity in most cases.
 The Ballard or Dubowitz test may be performed if the parent did not have prenatal care or if there is
another question regarding maturity of the newborn.
 Gestational rating scales such as the Ballard or Dubowitz use extensive criteria to assess gestational
age.
 The process of rating the infant, completed shortly after birth, includes physical maturity and
neuromuscular maturity.
 Scoring for the Ballard assessment scale. The point total from assessment is compared to the left
column. The matching number in the right column reveals the infant’s age in gestation weeks.
BALLARDS SCORING
 BALLARDS SCORING

 Physical maturity assessment criteria:

 Skin
 Lanugo
 Plantar surfaces/ foot creases
 Breast maturity
 Eyes and ears
 Genitalia
 BALLARDS SCORING

 Neuromuscular maturity assessment criteria:

 Posture
 Square window
 Arm recoil
 Popliteal angle
 Scarf sign
 Heel to ear
 BALLARDS SCORING
NEUROMUSCULAR SCORING
MATURITY ASSESSMENT
CRITERIA
Posture With infant supine and quiet, score as follows: arms and legs extended 5 0;
slight or moderate flexion of hips and knees 5 2;
legs flexed and abducted, arms slightly flexed 5 3;
full flexion of arms and legs 5 4.
Square window Flex hand at the wrist. Exert pressure sufficient to get as much flexion as possible. The angle
between hypothenar eminence and anterior aspect of forearm is measured and scored. Do not
rotate wrist.
Arm recoil With infant supine, fully flex forearm for 5 seconds and then fully extend by pulling the hands
and release. Score as follows: remain extended or random movements 5 0; incomplete or partial
flexion 5 2; brisk return to full flexion 5 4.
Popliteal angle With infant supine and pelvis flat on examining surface, flex leg on thigh and fully flex thigh with
one hand. With the other hand, extend leg and score the angle attained according to the chart
Heel to ear With infant supine, hold infant’s foot with one hand and move it as near to the head as possible
without forcing it. Keep pelvis flat on examining surface.
 BALLARDS SCORING
NEUROMUSCULAR MATURITY SCORING
ASSESSMENT CRITERIA
Scarf sign With infant supine, draw infant’s hand across the neck and as far
across the opposite shoulder as possible. Assistance to elbow is
permissible by lifting it across the body. Score according to location
of the elbow: elbow reaches opposite anterior axillary line 5 0;
elbow between opposite anterior axillary line and midline of the
thorax 5 1; elbow at midline of thorax 5 2; elbow does not reach
midline of thorax 5 3; elbow at proximal axillary line 5 4.

Heel to ear With infant supine, hold infant’s foot with one hand and move it as
near to the head as possible without forcing it. Keep pelvis flat on
examining surface.
ANTHROPOMETRIC
ASSESSMENT
ANTHROPOMETRIC
ASSESSMENT
 ANTHROPOMETRIC
ASSESSMENT
 VITAL STATISTICS
 Vital statistics measured for a newborn usually consist of the baby’s weight,
length, head circumference, and chest circumference.
 Be certain that all healthcare providers who care for newborns are aware of safety
issues specific to newborn care when taking these measurements, such as not
leaving a newborn unattended on a bed or scale and protecting against
hypothermia.
 ANTHROPOMETRIC
ASSESSMENT
 WEIGHT
 As long as newborns are breathing well,
they are weighed nude and without a
blanket soon after birth in the birthing
room.
 Measurements such as body length and
head, chest, and abdominal
circumferences are also done, but these
can be obtained later because performing
the measurements while an infant is still
damp exposes the newborn unnecessarily
to chilling.
 ANTHROPOMETRIC
ASSESSMENT
 A newborn’s weight is important because it helps to determine maturity as well as establish a
baseline against which all other weights can be compared.
 According to the CDC (2010) Growth Chart data, the average birth weight (50th percentile) for a
mature female newborn is 3.2 kg (7.0 lb) and for a mature male newborn is 3.4 kg (7.5 lb). The
arbitrary lower limit of expected birth weight for all newborns is 2.5 kg (5.5 lb). Birth weight
exceeding 4.5 kg (10 lb) is unusual, but weights as high as 10 kg (22 lb) have been documented
(CDC, 2010).
 If a term newborn weighs more than 4.5 kg, the baby is said to be macrosomic, a condition that
usually occurs in conjunction with a maternal illness, such as gestational diabetes (Feldman et
al., 2016). Second-born children usually weigh more than first-born ones. Birth weight tends to
increase with each succeeding child in a family.
 ANTHROPOMETRIC
ASSESSMENT
 LENGTH
 A newborn’s length at birth in relation to weight is a second important
determinant used to confirm that a newborn is healthy.
 The average birth length (50th percentile) of a mature female newborn is 49 cm
(19.2 in.).
 For mature males, the average birth length is 50 cm (19.6 in.).
 The lower limit of expected birth length is arbitrarily set at 46 cm (18 in.).
 Although rare, babies with lengths as great as 57.5 cm (24 in.) have been reported.
 ANTHROPOMETRIC
ASSESSMENT
 HEAD CIRCUMFERENCE
 Head circumference is measured with a tape measure drawn across the center of the
forehead and then around the most prominent portion of the posterior head (the
occiput).
 In a mature newborn, the head circumference is usually 32.5 to 36 cm (12.7 to 14.1 in.).
 A mature newborn with a head circumference greater than 37 cm (14.8 in.) or less than
32 cm (12.5 in.) should be carefully assessed for neurologic involvement, although some
well newborns have these measurements.
 ANTHROPOMETRIC
ASSESSMENT
 CHEST CIRCUMFERENCE
 Chest circumference is measured at the level of the nipples.
 If a large amount of breast tissue or edema of the breasts is present, this
measurement will not be accurate until the edema has subsided.
 The chest circumference in a term newborn is about 2 cm (0.75 to 1 in.) less than
the head circumference.
NEWBORN REFLEXES
 NEWBORN REFLEXES
 The Neuromuscular System
 Term newborns demonstrate neuromuscular function by moving their extremities, attempting to control
head movement, exhibiting a strong cry, and demonstrating newborn reflexes.
 Limpness or total absence of a muscular response to manipulation is not normal and suggests narcosis,
shock, or cerebral injury.
 A newborn occasionally makes twitching or flailing movements of the extremities in the absence of a
stimulus because of the immaturity of the nervous system; these are common and normal.
 A newborn presenting with hypotonia, lethargy, poor sucking, and seizures may be seen with some
inborn errors of metabolism; this requires urgent attention.
 Newborn reflexes can be tested with consistency by using a number of simple maneuvers.
 Absence of any newborn reflex can be due to central nervous system injury and requires further
evaluation.
 NEWBORN REFLEXES

Blink reflex Step (walk)-in place reflex Magnet reflex

Rooting reflex Placing reflex Crossed extension reflex
Sucking reflex Plantar grasp reflex Trunk incurvation reflex
Swallowing reflex Tonic neck reflex Landau reflex
Extrusion reflex Moro reflex Deep tendon reflex
Palmar grasp reflex Babinksi reflex
 NEWBORN REFLEXES

 The Blink Reflex

A blink reflex in a newborn serves the same purpose as it does in an
adult—to protect the eye from any object coming near it by rapid eyelid
closure.
 Itmay be elicited by shining a strong light such as a flashlight into an
eye.
A sudden movement toward the eye sometimes can elicit the blink
reflex, but this is not as reliable.
 NEWBORN REFLEXES

 The Rooting Reflex

 If a newborn’s cheek is brushed or stroked near the corner of the mouth, the infant
will turn the head in that direction.
 This reflex serves to help a newborn find food; when a breast brushes the
newborn’s cheek, the reflex causes the baby to turn toward the breast.
 The reflex disappears at about the sixth week of life, not coincidentally at the same
time a newborn’s eyes focus steadily so that a food source can be seen.
 NEWBORN REFLEXES
 The Sucking Reflex
 When a newborn’s lips are touched, the baby makes a sucking motion.
 Like the rooting reflex, this reflex also helps a newborn find food.
 The sucking reflex begins to diminish at about 6 months of age.
 It disappears immediately if it is never stimulated such as in a newborn with a
tracheoesophageal fistula who cannot take in oral fluids.
 It can be maintained in such an infant by offering the child a nonnutritive sucking object such
as a pacifier.
 NEWBORN REFLEXES

 The Swallowing Reflex

 The swallowing reflex in a newborn is the same as in the adult.
 that reaches the posterior portion of the tongue is automatically swallowed.
 Gag, cough, and sneeze reflexes also are present in newborns to maintain a clear
airway.
 NEWBORN REFLEXES

 The Extrusion Reflex

 In order to prevent the swallowing of inedible substances, a newborn extrudes any
substance that is placed on the anterior portion of the tongue.
 If newborns are offered solid food before this reflex fades at 4 months, it will look
as if they are rejecting the food.
 Be certain that parents are aware of this reflex in case they offer solid food this
early.
 NEWBORN REFLEXES
 The Palmar Grasp Reflex
 Newborns grasp an object placed in their palm
by quickly closing their fingers on it.
 Mature newborns grasp so strongly that they can
be raised from a supine position and suspended
momentarily from an examiner’s fingers.
 This reflex disappears at about 6 weeks to 3
months of age; after it fades, a baby begins to
grasp meaningfully.
 NEWBORN REFLEXES
 The Step (Walk)-in-Place Reflex
 Newborns who are held in a vertical
position with their feet touching a hard
surface will take a few quick, alternating
steps.
 This reflex disappears by 3 months of age.
 NEWBORN REFLEXES
 The Placing Reflex
 The placing reflex is elicited by touching the anterior lower leg against a surface such as the edge of
a table.
 The newborn makes a few quick lifting leg motions, as if to step onto the table.
 The Plantar Grasp Reflex
 When an object touches the sole of a newborn’s foot at the base of the toes, the toes grasp in the
same manner as the fingers.
 This reflex disappears at about 8 to 9 months of age in preparation for walking.
 NEWBORN REFLEXES
 The Tonic Neck Reflex
 When the arm and leg extend on the side toward which the
head is turned, and the opposite arm and leg contract.
 This posture is most evident in the arms but should not be
totally absent in the legs.
 If you turn a newborn’s head to the opposite side, they may
change the extension and contraction of legs and arms
accordingly.
 It is also called a “boxer” or “fencing reflex.”
 Unlike other reflexes, the purpose or function of this reflex
is not known.
 The reflex typically disappears between the second and
third months of life.
 NEWBORN REFLEXES
 The Moro Reflex

 A Moro (startle) reflex can be elicited with a loud noise or by

jarring the bassinet.

 The most accurate method of eliciting the reflex is to hold a

newborn in a supine position and then allow the head to drop
backward about 1 in.

 In response to this sudden backward head movement, the

newborn first extends arms and legs, then swings the arms into
an embrace position, and pulls up the legs against the abdomen.

 The reflex simulates the action of someone trying to ward off an

attacker and then covering up to protect the body.

 It is strong for the first 8 weeks of life and then fades by the end
of the fourth or fifth month.
 NEWBORN REFLEXES
 The Babinski Reflex

 When the sole of a newborn’s foot is

stroked in an inverted “J” curve from the
heel upward, a newborn fans the toes
(positive Babinski sign).

 This is in contrast to the adult, who flexes

the toes if the foot is stroked this way.

 The reflex remains positive (toes fan) until at

least 3 months of age, when it is supplanted
by the down turning response.
 NEWBORN REFLEXES
 The Magnet Reflex
 If pressure is applied to the soles of the feet of a newborn lying in a supine position, they push back
against the pressure. This and the two following reflexes are tests of spinal cord integrity.
 The Crossed Extension Reflex
 When a newborn is lying supine, if one leg is extended and the sole of that foot is irritated by being
rubbed with a sharp object, such as a thumbnail, the infant raises the other leg and extends it as if
trying to push away the hand irritating the first leg.
 NEWBORN REFLEXES

 The Trunk Incurvation Reflex

 When a newborn lies in a prone
position and is touched along the
paravertebral area on the back by a
probing finger, the newborn flexes the
trunk and swings the pelvis toward
the touch.
 NEWBORN REFLEXES

 The Landau Reflex

 When a newborn is supported in a prone position by a hand, the newborn should
demonstrate some muscle tone.
 A newborn may not be able to lift the head or arch the back in this position but
neither should the infant sag into an inverted “U” position.
 The latter response indicates extremely poor muscle tone, which needs to be
investigated.
 NEWBORN REFLEXES

 The Deep Tendon Reflexes

 Both a patellar and a biceps reflex are intact in a newborn.
 It is important, however, to assess for deep tendon reflexes (such as triceps, biceps, patellar, and
Achilles reflexes) to test for motor and sensory function and balance and coordination.
 Test the sole of the foot for a Babinski reflex.
 Fanning of the toes will occur in an infant younger than 3 months; a downward reflex of the toes
will occur beyond 3 months of age.
 (Some normal infants demonstrate a flaring Babinski response until they are 2 years of age, and in
the absence of other neurologic findings, this is not significant.
 NEWBORN
IDENTIFICATION AND
REGISTRATION
 NEWBORN IDENTIFICATION AND
REGISTRATION
 Newborn identification is an important nursing responsibility.
 Nurses must be certain that the infant has an identification band in place, so medicine administration or
performing procedures can be done safely.
 Identification Banding
 One mainstream form of identification used with newborns is a plastic bracelet or umbilical cord clamp with a
permanent lock that requires cutting to be removed.
 Critical information is printed on the band including the number that corresponds to the birthing parent’s
hospital number; the birthing parent’s name; and the sex, date, and time of the infant’s birth.
 If an identification band is attached to a newborn’s arm or leg, two bands should be used because bands can
slide off easily.
 A newer form of identification band has a built-in sensor unit that sounds an alarm if a baby is transported
beyond set hospital boundaries.
 NEWBORN IDENTIFICATION AND
REGISTRATION
 After identification bands are attached, an infant’s footprints may be taken and thereafter kept with the baby’s
electronic record for permanent identification.
 Babies who are born elsewhere and then admitted to the hospital should have bands applied and their
footprints taken on admission.
 NEWBORN IDENTIFICATION AND
REGISTRATION
 BIRTH REGISTRATION
 The primary care provider who supervised a newborn’s birth has the responsibility to be certain
that a birth registration is filed with the Bureau of Vital Statistics for the state in which the infant
was born.
 The infant’s name, the birthing parent’s name, the nonbirthing parent’s name (if the birthing
parent chooses to include this), and the birth date and place are recorded.
 This official birth information is important for eligibility for school, voting, passports, and Social
Security benefits.
INFANT BATHING
 INFANT BATHING

 Before giving a newborn a bath, make sure their temperature and vital signs are stable.
 It is important for the environment to also be warmed to prevent hypothermia or distress on the newborn.
 There is no need to remove all vernix; in fact, the goal of a first bath is to remove blood and amniotic fluid.
 Babies of parents with HIV infection should have a thorough bath immediately to decrease the possibility of HIV
transmission
 Wear gloves when handling newborns until the first bath to avoid exposing your hands to body fluids such as the
vernix caseosa.
 Plan to help parents give a first bath before (not after) a feeding to prevent spitting up or vomiting and possible
aspiration.
 Check to be certain the parent’s room is warm (about 75°F [24°C]) to prevent chilling.
 Supply bath water at 98°F to 100°F (37°C to 38°C), a temperature that feels pleasantly warm to the elbow or wrist,
plus a washcloth, towel, comb, and clean diaper and shirt.
 INFANT BATHING

 Bathing should proceed from the cleanest parts of the body to the most soiled areas—that is, from
the eyes and face to the trunk and extremities, and last, to the diaper area.
 Wipe a newborn’s eyes with clear water from the inner canthus outward, using a clean portion of the
washcloth for each eye to prevent spread of infection to the other eye.
 Remind parents to wash around the cord with care so that they don’t soak the cord and to give
particular care to the creases of skin where milk tends to collect if the baby spits up after feedings.
 If parents want to use a mild neutral soap for sponging, be sure they rinse well so that no soap is left
on the skin (soap is drying and newborns are susceptible to desquamation) and also to dry well.
 INFANT BATHING

 It’s good for parents to wash the infant’s hair during the bath.
 The easiest way to do this is to first soap the hair with the baby lying in the bassinet.
 Then, hold the infant in one arm over a basin of water as you would a football.
 Pour water from the basin over the hair to rinse.
 Dry the hair well to prevent chilling.
 Inform the parents that lathering and gently massaging all parts of the head
including the soft spots will help prevent buildup of scales.
 INFANT BATHING

 In male infants, the foreskin of the uncircumcised penis should not be forced back while washing the
penis, or constriction of the penis may result.
 Wash the vulva of a female infant, wiping from front to back to prevent contamination of the vagina
or urethra by rectal bacteria.
 Most healthcare agencies do not apply powder or lotion to newborns because some infants are
allergic to these products and breathing in powder can cause respiratory distress (adult talcum
powders contain zinc stearate, which is irritating to the respiratory tract).
 If a newborn’s skin seems extremely dry and portals for infection are becoming apparent because of
cracking in the skin, a lubricant such as Nivea oil, added to the bath water or applied directly to the
baby’s skin, should relieve the condition.
RET DEM? LET’S GO!!!!