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The Normal Newborn, Assessment, Care, Feeding

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The Normal Newborn:
Assessment, Care, Feeding
пЃєPresented by,
пЃєJoy Haskin, RN, MS
Joke for the day….
Should children witness
childbirth?
TERMS:
пЃєNeonatal Period:
пЃєBirth --> 28 days of life
пЃєTerm Infant:
пЃє38 - 42 weeks of gestation
пЃєTransition Period: Phases of instability
during the first 6-8 hours after birth
Viability
пЃєCapacity to live outside of the uterus about 22 to 24 weeks since the last
menstrual period, or fetal weight greater
than 500 g.
пЃєIn the past was 28 weeks - with
technology and advancements this is
becoming shorter and shorter…...
Physiologic Changes of the NB to
adjust to extrauterine life:
What happens during birth to the neonate?
Circulatory:
пЃєTransitional Circulation = acrocyanosis
пЃєPeripheral circulation = sluggish
пЃєHigh: RBC 4.8-7.1; Hgb 14-24; Hct 44-64
пЃєWBC 18,000 @ birth; 23-24,000 @ 1 day
пЃєCoagulation: Vit K dependent clotting
factors are decreased.
пЃєPlatelet counts ok (150,000-350,000)
Respiratory
пЃєBefore birth O2 needs met by placenta
пЃєL/S ratio should be > 2:1
пЃєAfter delivery need mature lungs that are
vascularized, have surfactant and sacules
- usually adequate by 32-35 weeksпЃёat term the lungs hold approx. 20 ml of fluid/kg
пЃєWhat initiates respiration?
Periodic Breathing -vsApnea
пЃєApnea: no breathing for periods of
greater than 15 seconds should be
evaluated.
Periodic Breathing:
Notify MD if resp < 30 or > 60
Gastrointestinal System
пЃєImmature at birth, reaches maturity at 23 years of age
пЃєplace food at back of tongue
пЃєsucking becomes coordinated @32 wks
пЃєlittle saliva until 3 months of age
пЃєbowel sounds after 1 hour of birth
Gastrointestinal
(continued)
пЃєNB have difficulty digesting complex
starches and fat
пЃєAbdomen becomes easily distended after
eating
пЃєInitial fecal material = meconium
пЃєNo normal flora at birth in GI system to
synthesize Vit. K
Immune System
пЃєLimited specific and Non-specific
immunity at birth
пЃєpassive immunity(from mom- IgG) for the
first 3 months of life ~ this will be
reduced if baby is born premature
пЃєbreastfeeding = ^ passive immunity (IgA)
Temperature Regulation
пЃєNon-Shivering thermogenesis:
пЃєbrown fat is the primary source of heat
production. Brown fat is broken down into
glycerol & fatty acids producing heat.
пЃєBrown fat is found @ the nape of the
neck, axillae, around the kidneys and in
the mediastinum.
пЃєSlightly warmer to touch than nml skin.
Cold Stress
пЃєAn increase in the metabolic rate
associated with non-shivering
thermogenesis --> increased O2 demands
and caloric consumption
It’s important to provide a neutral
thermal environment to prevent
metabolic acidosis and prevent depleted
brown fat.
Kidneys and Urination
пЃє92% of all healthy infants void in the first
24 hrs of birth
пЃєinitial urine:cloudy, scant amounts, uric
acid crystals-> reddish stain on diaper
пЃєKidneys not fully functional until child is 2
years of age.
Hepatic Function
пЃєLiver produces substances essential for
clotting of blood.
пЃєStores needed iron for the first few
months. Preterm & small infants have lower iron stores than
full term and heavier infants. (full term infants stores last 4-6 mo)
пЃєNB at risk for Physiologic Jaundice
after 24 hours of age, d/t increased
breakdown of RBC’s and immature liver
functioning.
Increased Bilirubin Levels
пЃє Jaundice in the 1st day is NOT normal
пЃєBilirubin level greater than 12 at any
time needs further attention
пЃєMaternal causes of increased bilirubin
levels in the NB: epidural use, oxytocin
induced labor, infection, hepatitis
пЃєEthnic Influences: Asian infants levels
may be double other ethnic groups.
Kernicterus
пЃєComplication of neonatal
hyperbilirubinemia --> encephalopathy
пЃєbasal ganglia and other areas of the brain
and spinal card are infiltrated w/ bilirubin
(produced by the breakdown of
hemoglobin -> levels of 20 - 25 or more).
пЃєPoor prognosis if untreated.
Neurologic
пЃєAll neurons are present, but many are
immature:
пЃєuncoordinated movements
пЃєpoor muscle control
пЃєstartle easily
пЃєtremors in extremities
Weight Loss
пЃєIt is normal for the newborn infant to
loose 5-10% of weight in the first 4 to 5
days of life.
Infants at Risk
“RED FLAGS” after birth include:
пЃєgagging --> turning blue (esp. after fdg)
пЃєgeneralized cyanosis
пЃєweak cry
пЃєgrunting or respiratory distress
пЃєdecreased or absent movements
пЃєexcessive twitching or trembling
пЃєOTHERS>>>>>
Nursing Diagnosis:
пЃєIneffective Airway Clearance R/T
excessive oropharyngeal mucus
пЃєIneffective Thermoregulation R/T
newborn transition to extrauterine life
пЃєHigh Risk for infection R/T maturational
factors, immature immune system
пЃєPC: Hypoxemia PC: Hyperbilirubinemia
пЃє(W) Beginning Integration of NB into
Family Unit
Nursing Care to Meet NB
Needs
пЃєPrevent infection:
пЃєhandwashing, stay away from large
groups or ill individuals, prophlactic
agents (EES, cord care, bathing)
пЃєVernix
пЃєBreastfeeding
Warmth
пЃєBath after temperature is stable
пЃєwarmer/isolette/bundle
пЃєhat
пЃєkeep out of drafts
пЃєskin to skin
Position of sleep/prevent
SIDS
пЃєBack to sleep
пЃєfeet to foot of bed
пЃєno stuffed animals or excessive blankets
in bed
don’t cover head in stroller
don’t keep house too warm
пЃєNo smoking around infant
Cleanliness
пЃєNo tub baths until cord off and healed
пЃєclean around organs of elimination and
mouth after soiling to prevent skin break
down
пЃєdaily head to toe bath not necessary
OK to clean and touch the “soft spot”
пЃєfold diapers away from umbilicus
пЃєNEVER leave child alone in tub!!
Research and Cord Care
1,811 NB’s- 2 groups - one receiving cord
care with alcohol and one group not:
пЃє* equal # infections in infants who
received and did not receive cord care
пЃє*cord separation ~ alcohol use: 9.8 days
–no alcohol used: 8.16 days
Carseats
“AS a condition for licensure, public and
private hospitals, birth centers, and clinics
must have a written policy on the
dissemination of child passenger restraint
system information to parents or the
person to whom the child is released”
(SB503 REQ)
Genital Care
пЃєMale Infant: if penis is uncircumcised
DO NOT RETRACT THE FORESKIN--“leave it alone”
пЃєFemale Infant: wipe front to back. If
“smegma” has accumulated in the labial
folds it can be carefully removed
Infant Feeding
пЃєWhy may a mother decide to Breast
Feed?
пЃєDiscussion
Formula feeding
пЃєWhy may a mother decide to formula feed
her infant?
пЃєDiscussion
Frequency of Feedings
пЃєBreastfeeding: successful latch-on and
feeding should occur every 1.5 to 3 hours
daily.
пЃєFormula Feeding: 3-4 oz every 3-4
hours for full-term babies.
пЃєBaby should have 6-10 wet diapers/day
calculate amnt of formula mult. baby’s
wt in lbs by 2 then 3, this is oz per day.
пЃє (EX: 8lb. Baby~ 8 X2 = 16; 8 x3 = 24 therefore 16-24oz of
formula per day is needed for adequate nutrition)
Nursing Diagnosis
пЃєEffective Breastfeeding
пЃєRisk for Altered Nutrition (more or less
than body requirements) R/T (insufficient
caloric intake or excessive caloric
intake)
Circumcision
пЃєElective Procedure
пЃєNot pd for by medi-cal
пЃєDecision made based on tradition,
religion, culture, or personal factors
пЃєVALUE
пЃєOPPOSITION
Procedure
пЃєUsually delayed 12 to 24 hours until NB is
stabilized
пЃєDo not feed 1 hr prior to procedure
пЃєConsent required from one parent
пЃєMethods: Gomco or Plastibell
пЃєRestraint required
пЃєAnesthetic is physician dependent
After Care
пЃєComfort measures
пЃєkeep wound clean and dry (warm water)
пЃєck urination w/in 12 hrs after procedure
пЃєmonitor for bleeding
пЃєs/s of infection will not occur immediately
after procedure
Periods of Reactivity
пЃєREVIEW
пЃє1st period of reactivity:after birth of baby, bursts
of rapid movements. Quiet times during this
period are ideal for breastfdg & interacting
пЃєDeep Sleep - lasts 60-100 minutes
пЃє2nd period of reactivity: occurs 4-8 hrs after
birth lasts 10 min to several hours. Periods of
tachycardia & tachypnea. Increased muscle
tone, skin color, mucus production, pass
meconium
The end….
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