nursing care neonate

• Initial physical assessment

  1. General appearance

  2. Vital signs

  3. APGAR scoring (HR, RR, muscle tone, reflex irritability, generalized skin color)
• Baseline measures of physical growth

  1. Weight

  2. Head circumference

  3. Body length
• Neurologic assessment

  1. Newborn reflexes

  2. Gestational age assessment

  3. New Ballard scale
• Preterm or premature

  Born before completion of 37 weeks of gestation regardless of birth weight
• Gestational age categories

  • Late preterm (34 0/7 through 36 6/7)
  • Early term (37 0/7 through 38 6/7)
  • Full term (39 0/7 through 40 6/7)
  • Late term (41 0/7 through 41 6/7)
  • Postterm (42 0/7 and beyond)
• Postmature

  Born after completion of 42 weeks and showing the effects of progressive placental insufficiency
• Fetal growth categories

  • AGA (appropriate for gestational age)
  • LGA (large for gestational age)
  • SGA (small for gestational age)
• Immediate interventions

  1. Airway maintenance

  2. Maintaining adequate oxygen supply

  3. Maintaining body temperature

  4. Initiating nutrition

  5. Promoting parent infant interaction
• Newborn medications

  • Eye prophylaxis to prevent opthalmia neonatroum or neonatal conjunctivitis
  • Vitamin K prophylaxis
  • Hep B vaccine
• Birth injuries

  • Retinal and subconjunctival hemorrhage
  • Soft tissue injuries like erythema ecchymosis petechiae
  • Trauma secondary to dystocia
  • Accidental lacerations
• Hypoglycemia

  Usually defined as blood glucose less than 45, infants at risk are preterm or late preterm SGA or LGA low birth weight infants of mothers with diabetes infants who experience perinatal stress such as asphyxia cold stress or respiratory distress
• Pathologic jaundice

  Disorders exacerbate physiologic processes that lead to hyperbilirubinemia, onset < 24 hrs of age, levels elevate faster and jaundice last longer, more dangerous
• Physiologic jaundice

  Increased bilirubin reabsorption due to delayed bilirubin excretion because of delayed metabolism, frequent and long feedings early are primary prevention
• Breastfeeding-associated jaundice

  Breastfeeding doesn't cause jaundice rather it is the lack of effective breastfeeding that contributes to the hyperbilirubinemia, breastfeeding associated jaundice is early onset and it isn't the breastfeeding but rather the poor breastfeeding that is the problem, breast milk jaundice late onset jaundice and something is wrong with the milk and recommended to stop breastfeeding
• Causes of unconjugated hyperbilirubinemia

  • Rh/ABO incompatibilities
  • Infections
  • Inherited RBC disorders
  • Bruising or internal bleeding
  • Hemangiomas
  • Hypoxia or asphyxia insults
  • Polycythemia
  • Swallowed blood with delivery
  • Delayed feeds and passage of meconium
• Causes of conjugated hyperbilirubinemia

  • Neonatal hepatitis
  • Intestinal obstruction
  • Ischemic necrosis of liver
  • Parenteral alimentation (tube feedings)
  • Metabolic disorders
  • Hematologic disorders
  • Ductal disorders
  • Biliary atresia
  • Tumors of liver and biliary tract
• Hyperbilirubinemia

  When bilirubin exceeds the levels that can be bound and metabolized and it starts to build up in the blood, bilirubin freely crosses the blood brain barrier and at high levels can cause toxicity, acute bilirubin encephalopathy is acute manifestations of bilirubin toxicity, kernicterus is irreversible long term consequences yellow brain from not treated promptly
• Assessing hyperbilirubinemia

  Blanch the skin in natural daylight or observe the sclera, it progresses head to toe, blood sampling with lab draw at 24 hours of age and repeated as indicated by values
• Treating hyperbilirubinemia

  Feedings early and often 8-12hrs/24hrs, phototherapy, blue lights because phototherapy converts bilirubin to photobilirubin which can be excreted in urine bypassing need for liver conjugation, exchange transfusions 85% of neonatal RBCs replaced by donor cells but only in NICU
• Universal newborn screening

  • Mandated by US law usually at 24 hours, early detection of genetic diseases that result in severe health problems if not treated early, newborn hearing screening, screening for critical congenital heart disease (O2 sat on right arm and right leg, results must be greater than 95% and within 3% of each other to pass)
• Intramuscular injections

  Always in the leg for immunizations and medications
• Circumcision

  Policies and recommendations, parental decision, procedure either yellen (Gomco) or Mogen clamp or plastibell device, pain management with sucrose, care of the newly circumcised infant, infection and bleeding main complications
• Behavioral responses to neonatal pain

  • Vocalization or cry
• Physiologic/autonomic responses to neonatal pain

  • Changes in HR, blood pressure, intracranial pressure, vagal tone, RR, oxygen saturation
• Neonatal pain assessment tools

  • Neonatal infant pain scale
  • Premature infant pain profile
  • Neonatal pain agitation and sedation scale
  • CRIES for NICU
• Goals of neonatal pain management

  Minimize the intensity duration and physiologic cost of pain, maximize the neonate's ability to cope with and recover from the pain
• Nonpharmacologic pain management

  • Containment (swaddling)
  • Nonnutritive sucking
  • Oral glucose
  • Skin to skin contact
  • Breastfeeding
• Pharmacologic pain management


  • Local and topic anesthesia
  • Nonopioids analgesia
  • Acetaminophen
  • Opioid analgesia (morphine, fentanyl - watch for respiratory depression)