Normal newborn needs and care

• Goals of newborn nursing care

  • Promote physical well-being of the newborn by providing comprehensive care
  • Support establishment of a well-functioning family unit by teaching family members how to care for their newborn
• Admission & the First 4 Hours of Life

  1. Prior to birth, review prenatal and labor records to identify risk factors for baby

  2. Have personnel and equipment available at birth to handle any anticipated problems

  3. If baby is term, breathing or crying, and has good muscle tone: immediate skin to skin care is encouraged
• Transition to extrauterine life


  1. The healthy newborn rapidly adapts

  2. Pattern of blood flow changes significantly at birth with multiple shortcuts closing (foramen ovale, ductus arteriosus, ductus venosus) and blood being re-routed to lungs

  3. Provide warmth, open airway, dry and stimulate first, then be ready to support breathing and circulation if not adequate
• Admission procedures

  1. Encourage bonding behaviors and evaluate parents' interaction with newborn

  2. Record Apgar scores, look for obvious physical abnormalities, check for a three vessel cord, weigh, measure, and ID the newborn

  3. A more comprehensive physical exam should occur within 2 hours of birth
• Thermoregulation


  • A newborn (even a healthy, term newborn) has trouble maintaining core body temperature, due to: Large body surface relative to mass, Limited subcutaneous fat, Thinner skin which means blood vessels are closer to surface
  • If a newborn is not kept in a neutral thermal environment he can use more oxygen and energy which can reduce glycogen stores and lead to acidosis
  • Prevent heat loss via convection, radiation, evaporation, conduction
• Promote Thermoregulation


  1. It is important to maintain a neutral thermal environment in order to maintain a newborn's axillary temperature in the optimal range of 36.4-37.2 C (97.5-99 F)

  2. Newborns use thermogenesis to maintain body heat: increased metabolic rate, muscular activity, use of brown fat stored during third trimester of gestation
• Prevent Vitamin K Deficiency Bleeding

  1. Vitamin K (phytonadione) given in vastus lateralis

  2. At birth, the newborn does not have the bacteria in the colon that are necessary for synthesizing fat soluble Vitamin K

  3. Vitamin K helps formation of important clotting factors in the blood

  4. In the U.S., newborns are given a prophylactic dose of vitamin K via IM injection during the first hour of life
• Prevent Eye Infections

  1. Ophthalmic Ointment administered along lower conjunctival surface of each eye

  2. Babies can be exposed to gonorrhea or chlamydia during birth which can lead to blindness

  3. Erythromycin or tetracycline effective against both

  4. Prophylactic treatment is legally required in the U.S.
• Signs of Neonatal Distress

  • Respiratory rate > 60 per minute
  • Grunting
  • Nasal flaring
  • Retractions
  • Cyanosis
  • Pallor
  • Jaundice
  • Lethargy
  • Jitteriness
  • Problems voiding or stooling
  • Hypothermia or hyperthermia
• Initiate First Feeding

  1. The best time to initiate breastfeeding is typically during the during the first hour after birth, while the baby is alert and responsive

  2. Signs of readiness include licking of lips, a hand in or near the mouth, a cry that quiets with rooting or sucking behaviors, active bowel sounds

  3. Teach parents to recognize these subtle clues
• Facilitate Parent/Newborn Attachment

  1. Encourage eye contact with parents during the first hour of life, when newborn is likely to be alert and responsive

  2. Baby's range for best visual acuity is 7-8 inches

  3. You can teach parents to shade the baby's eyes from bright light to encourage eye opening

  4. Delay administration of eye ointment for up to one hour after birth to promote better eye opening
• Bonding with Baby


  1. Initiate skin to skin contact as soon as baby is stable

  2. Encourage parents to speak to baby face to face

  3. Show parents that baby will grasp their finger

  4. Kissing, patting, and gentle massage can comfort the newborn
• Nursing Care after Transition Period

  1. Continue to monitor cardiopulmonary function

  2. Maintain neutral thermal environment

  3. Monitor hydration and nutrition by weighing baby daily and tracking voids and stools

  4. Teach skills such as bulb suctioning, bathing, and umbilical cord care to parents
• Promote Health & Safety

  1. Handwashing essential

  2. Teach parents to report concerns promptly

  3. Keep ID bands on baby and parents

  4. Instruct parents to never leave baby alone in room

  5. Many hospitals use electronic security devices

  6. Only designated personnel can transport newborns
• Nursing Care for Circumcision

  1. Circumcision is an elective surgical procedure often performed on male newborns

  2. The prepuce (foreskin) which covers the tip of the penis is permanently removed for easier cleaning

  3. Analgesia and comfort measures needed during procedure

  4. Monitor frequently following procedure for bleeding, infection, inability to void
• Newborn Screenings and Immunizations

  1. Blood spot and other screenings done prior to discharge: Hearing, Hyperbilirubinemia, Congenital heart disease

  2. Hepatitis B vaccine recommended within 24 hours of birth (10 mcg given IM to vastus lateralis)
• Immunologic adaptations

  • The fetus & newborn's immune system is immature and often fails to recognize and destroy pathogens
  • During pregnancy the fetus has some protection due to active acquired immunity of the mother
  • Some maternal antibodies (IgG) are transferred to the fetus via the placenta, usually during the third trimester or to the newborn in colostrum or breast milk (IGA). This is called passive acquired immunity.
• Signs of Illness in Newborns

  • Temperature > 38 C (100.4 F)
  • Temperature < 36.6 C (97.8 F)
  • More than 1 episode of forceful vomiting
  • Refusal of 2 feedings in a row
  • Lethargy, difficulty in waking baby
  • Bluish discoloration of skin (cyanosis)
  • Absence of breathing (apnea) for > 20 seconds
• Teaching Parents about Newborn Care

  • Car safety
  • Elimination patterns
  • Waking baby
  • Sleep safety
  • Cord care
  • Quieting baby
  • Bulb suctioning
  • Circumcision care
  • When to call the Health Care Provider (HCP)
• Common tests for newborn before discharge

  performed within first 24 hours of life

  • Hearing screen
  • newborn screen- test to rule metabolic and genetic disorders
  • congenital heart disease -pulse ox on right hand and foot, 95% or above is passing
• Why don’t babies shiver?

  Babies produce brown fat which regulates their body temperature, unlike adults, babies burn this brown fat to regulate heat
• How do newborns transfer heat?

  • Convection
  • radiation
  • evaporation
  • conduction
• Strategies to prevent heat transfer through conduction

  • prewarm bed
  • cover scale with blanket
  • position newborn in flexed position
  • place blanket over chemical mattress
  • limit use of hot water bottle
  • educate parents
  • never rapidly warm an infant
• Strategies to prevent heat transfer through convection

  • Increase room temp
  • move away from air conditioning
  • use radiant warmer
  • monitor temp frequently
• Strategies to prevent heat transfer through radiation

  • prewarm incubator
  • Move away from windows
  • use radiant warmer w servo control
  • heat lamps as last result and monitor temp
• Strategies to prevent heat transfer evaporation

  • skin to skin
  • dry/wrap with warm blankets
  • warm room
  • bathe quickly
  • avoid overheating and rapid warming
  • avoid cold stress contributors