The Normal Newborn: Needs and Care

Assessment Data: Condition of the Infant

• Apgar scores at 1 and 5 minutes

• Resuscitative measures

• Physical examination

• Vital signs

• Voidings

• Passing of meconium

Newborn Care

Assessment Data: Infant Complications

• Excessive mucus

• Delayed spontaneous respirations or responsiveness

• Abnormal number of cord vessels

• Obvious physical abnormalities

Assessment Data: Labor and Birth

• Duration and course

• Status of mother and fetus

• Analgesia or anesthesia

Assessment Data: Labor and Birth Complications

• Prolonged rupture of membranes

• Meconium-stained amniotic fluid

• Nuchal cord

• Precipitous birth

• Use of forceps or vacuum extraction assisted device

• Fetal distress

Assessment Data: Maternal Complications

• Preeclampsia

• Spotting

• Illness

• Recent infections

• Rubella status

• Serology results

Assessment Data: Maternal Complications (continued)

• Hepatitis B screen results

• Exposure to group B streptococci

• History of maternal substance

• Human immunodeficiency virus (HIV) test result

Assessment Data: Family

• Parents’ interactions with their newborn

• Their desires regarding infant care

• Information about other children in the home

• Available support systems

• Patterns of interaction within each family unit

Physiologic Alterations

• Respiratory distress

• Pallor

• Hypothermia

• Alterations in feeding and elimination

Nursing Care: Assessment

• Airway clearance

• Vital signs

• Body temperature

• Neurologic status

• Ability to feed

• Evidence of complications

Nursing Care: Assessment (continued)

• Review of prenatal and birth information

• Gestational age

• Newborn’s adaptation to extrauterine life

• Weight and measurement

• Vital signs every 30 minutes

• Assessment of Hct or blood glucose if warranted

Admission Procedures

• Newborn bath

• Vitamin K

• Eye prophylaxis

• Observation for distress

• Initiate feeding

• Facilitate parental-infant attachment

Daily Assessments

• Vital signs

• Weight

• Overall color

• Intake and output

• Umbilical cord

• Circumcision

Daily Assessments (continued)

• Newborn feeding

• Attachment

Daily Newborn Care

• Assist with feedings

• Thermoregulation

• Skin care

• Cord care

• Prevention of infection

• Security

Common Concerns

• How to pick up a newborn

• Holding and feeding the infant

• Changing the diaper

• Interpreting newborn cues

• Bathing the newborn

Common Concerns (continued)

• Cord and circumcision care

• Normal voiding and stooling pattern

Circumcision using the Yellen or Gomco clamp. A, The prepuce is drawn over the cone

The clamp is applied. Pressure is maintained for 3 to 4 minutes, and then excess prepuce is cut away .

Circumcision using the Plastibel. The bell is fitted over the glans. A suture is tied around the bell’s rim, and the excess prepuce is cut away. The plastic rim remains in place for 3 to 4 days until healing

occurs. The bell may be allowed to fall off; it is removed if still in place after 8 days.

Parent Education

• Periods of reactivity and expected newborn responses

• Normal physical characteristics of the newborn

• The bonding process• The infant’s capabilities for interaction • The role of touch in facilitating parent-

infant interaction• Comforting techniques

Parent Education (continued)

• Progression of infant behaviors

• Information about available educational materials and support

Family Education

• Newborn care videos

• Newborn care classes

• Individual instruction

• Observation of parent-infant interaction

• Role modeling

Discharge Education

• Safety measures

• Voiding and stool characteristics

• Circumcision care

• Cord care

• Waking and quieting the newborn

• Car safety

Discharge Education (continued)

• Immunizations

• Signs of illness

Signs of Illness

• Temperature above 38oC or below 36.6oC axillary

• Continual rise in temperature

• Forceful or frequent vomiting

• Refusal of two feedings in a row

• Difficulty in awakening baby

• Cyanosis with or without a feeding

Signs of Illness (continued)

• Absence of breathing longer than 20 seconds• Inconsolable infant or continuous high-pitched

cry• Discharge or bleeding from umbilical cord,

circumcision, or any opening • Two consecutive green watery or black stools, or

increased frequency of stools• No wet diapers for 18 to 24 hours• Fewer than 6 to 8 wet diapers per day after 4

days of age• Development of eye drainage