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Normal Newborn careNeonatal care
Islamic University
Nursing College
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Introduction:
1. Definition of neonatal period:
A period
from birth 4 weeks postnatal.
After the initial observation for
neonatal condition requiring immediate
intervention, the baby is sent to the
normal newborn nursery or maternity floor for
the purpose of follow up and
stabilization.
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The role of the neonatal
nurse inside the normal
newborn nursery or
maternity floor:
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Admission Care:The role of the nurse is:- To carry out good interpersonal communication.
- To take complete history about the mother and neonate.
- To be sure that the neonate has identification band.
- To perform complete physical assessment (General appearance, V.S, Gestational age assessment).
- Prevention of hemorrhage (administer vit K if not given in the delivery room).
- Documentation.
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Assessment:
The initial assessment:
APGAR scoring systemPurpose: Is to assess the newborn´s immediate
adjustment to extra uterine life.
To be done at 1 & 5 minutes.
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Transitional assessment
(Periods of reactivity):
I) First period of reactivity: Stage 1: during the first 30 min. through
which the baby is characterized as
Physiologically unstable ( ), very alert, cries
vigorously, may suck a fist greedily, & appears
very interested in the environment.
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Stage 2: It lasts for about 2-4 hours,
through this period; all V.S & mucus
production are decreased. The newborn is in
state of sleep and relative calm.
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II) Second period of reactivity: It lasts for
about 2-5 hours, through which the newborn is
alert and responsive, heart & respiratory rate,
gastric & respiratory secretions are increased
& passage of meconium commonly occurs.
Following this stage is a period of
stabilization through which the baby
becomes physiologically stable & a
hesitant pattern of sleep and activity.
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passage of meconium
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Assessment of Gestational age:(High-risk neonate)
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Systematic Physical examination:- Growth measurements- Vital Signs- General appearance:
. Posture: Flexion of head & extremities, taking them toward chest & abdomen
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Head Circumference
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Posture
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. Skin:
General description:
At birth:
Color: bright red.
Texture: soft and has good elasticity.
Edema: is seen around eye, face, and scrotum
or labia.
Cyanosis: of hands & feet (acrocyanosis)
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General description of the skin
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Acrocyanosis
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1. Vernix Caseosa: Soft yellowish cream
layer that may thickly cover the skin of the
newborn, or it may be found only in the
body creases and between the labia.
The debate of wash it off or to keep it.
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Vernix Caseosa
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2. Lanugo hair:
- Distribution: The more premature baby is,
the heavier the presence of lanugo is.
- It disappears during the first weeks of
life
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Lanugo hair
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3. Mongolian spots:
Black coloration on the lower back, buttocks,
anterior trunk, & around the wrist or ankle.
They are not bruise marks or a sign of
mental retardation, they usually
disappear during preschool years without
any treatment.
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Mongolian spots
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Mongolian spots
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Mongolian spots
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4. Physiological Jaundice: will discussed later in
details.
5. Milia:
- Small white or yellow pinpoint spots.
- Common on the nose, forehead, & chin of the
newborn infants due to accumulations of secretions
from the sweat & sebaceous glands that have not yet
drain normally.
They will disappear within 1-2 weeks, they should not
expressed.
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Physiological Jaundice
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Physiological Jaundice
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Milia
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6. Head:
The Anterior fontanel: is diamond in shape, located
at the junction of 2 parietal & frontal bones. It is 2-3
cm in width & 3-4 cm in length. It closes between 12-
18 months of age.
The posterior fontanel: is triangular in shape,
located between the parietal & occipital bones.
It closes by the 2nd month of age.
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Fontanels should be flat, soft, & firm. It bulge
when the baby cries or if there is increased in
ICP.
Two conditions may appear in the head:
Caput succedaneum & Cephalhematoma
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Caput succedaneum• An edematous swelling on the presenting portion of the scalp of an infant
during birth, caused by the pressure of the presenting part against the
dilating cervix. The effusion overlies the periosteum with poorly defined
margins.
• Caput succedaneum extends across the midline and over suture lines.
Caput succedaneum does not usually cause complications and usually
resolves over the first few days.
• Management consists of observation only.
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Caput succedaneum
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Caput succedaneum
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Cephalhematoma:
Cephalhematoma is a subperiosteal collection of
blood secondary to rupture of blood vessels
between the skull and the periosteum, in which
bleeding is limited by suture lines (never cross the
suture lines).
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Cephalhematoma
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7. Eyes:- Usually edematous eye lids
- Gray in color. True color is not determined until the
age of 3-6 months.
- Pupil: React to light
- Absence of tears
- Blinking reflex is present in response to touch
- Can not follow an object (simple fixation on
objects).
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Eyelid Edema
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Dysconjugate Eye Movements
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Subconjunctival Hemorrhage
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Congenital Glaucoma
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Congenital Cataracts
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8. Ears:
Position:
Startle Reflex:
Pinna (صيوان االدن) flexible, cartilage present.
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Normal Ears
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Ear Tag
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9. Nose:
Nasal Patency:
Nasal discharge –
thin white mucous
Normal Nose
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Dislocated Nasal Septum
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10. Mouth & Throat:
- Intact, high arched palate.
- Sucking reflex – strong and coordinated
- Rooting reflex
- Gag reflex
- Minimal salivation
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11. Neck:
Short, thick, usually surrounded by skin
folds.
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System assessment of the
neonates:
1. Gastrointestinal System:
Mouth should be examined for
abnormalities such as cleft lip and/or cleft
palate.
Epstein pearls are brittle, white, shine spots
near the center of the hard palate. They mark
the fusion of the 2 hollows of the palate. If
any; it will disappear in time.
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Cleft Palate
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Cleft Lip
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Cheeks: Have a fat appearance due
to development of fatty sucking pads
that help to create negative pressure
inside the mouth which facilitates
sucking.
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Epstein Pearls & cheeks
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Normal Tongue Ankyloglossia
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Ankyloglossia
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Gum: May appear with a quite irregular
edge.
Sometimes the back of gums contain whitish
deciduous teeth that are semi-formed, but
not erupted
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Irregular edges with Natal Teeth
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Natal Tooth
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12- Abdomen
• Cylindrical in Shape
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Normal Umbilical Cord
• Bluish white at birth with 2 arteries & one vein.
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Meconium Stained Umbilical Cord
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13. Circulatory system:
Heart:
Apex- lies between 4th & 5th inter-costal
space, lateral to left sternal border.
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14. Respiratory system:
• Slight substernal retraction evident during inspiration
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15. Respiratory system Cont.:
• Xiphesternal process evident.
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16. Respiratory system Cont. :
Respiratory is chiefly abdominal
Cough reflex is absent at birth, present by 1-
2 days postnatal.
Possible signs of RDS are:
- Cyanosis other than hands & feet.
- Flaring of nostrils.
- Expiratory grunt-heard with or without stethoscope.
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17. Urinary System:
Normally, the newborn has urine in the
bladder and voids at birth or some hours
later.
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Female genitalia Cont.
• Labia & Clitoris are usually edematous.
• Urethral meatus is located behind the clitoris.
• Vernix caseosa is present between labia
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Normal Male genitalia
• Urethral opening is at
tip of glans pens.
• Testes are palpable in
each scrotum.
• Scrotum is usually
pigmented, pendulous
& covered with rugae.
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18. Endocrine system:
Swollen breasts:
Appears on 3rd day in both sex, & lasts
for 2-3 weeks and gradually disappears
without treatment.
N.B: The breasts should not be expressed as this
may result in infection or tissue damage.
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Infantile menstruation
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19. The Central Nervous system:
Reflexes:
Successful use of reflex
mechanism is a strong evidence of
normal functioning CNS.
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Reflexes
• Moro Reflex
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Extremities
• Nail beds pink
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Extremities Cont.
• Meconium Stained
fingernails
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Extremities
• Creases on anterior two thirds of sole.
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Common feet abnormalities
• Club Feet
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Immediate Care of the Newborn:
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Immediate Care of the
Newborn:
1. Clear airway.
2. Established respiration.
3. Maintenance of body
temperature.
4. Protection from Hge.
5. Identification.
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APGAR ScoreScore / Item 2 1 zero
Heart beats > 100 b/min
Strong
< 100 b/min
Or weak beats
No heart beats
Cry & breathing Strong crying weak crying / irregular breathing
No cry / breathing
Color Pink body & face
Pink body & blue extremities
Pale or blue body
Movement & tone
Active Some movements Flaccid
Grimace Try to keep cath. away
Grimace of face No response
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The Four modalities by which the infant lost
his/her body temperature:
1- Evaporation:
Heat loss that resulted from expenditure of internal
thermal energy to convert liquid on an exposed
surface to gases, e.g.: amniotic fluid, sweat.
Prevention:
Carefully dry the infant after delivery or after bathing.
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2- Conduction: Heat loss occurred from direct contact between body surface and cooler solid object.
Prevention: Warm all objects before the infant comes into contact with them.
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3- Convection:Heat loss is resulted from exposure of an infant to direct source of air draft.
Prevention:· Keep infant out of drafts· Close one end of heat shield in incubator to reduce velocity of air.
4- Radiation: It occurred from body surface to relatively distant objects that are cooler than skin temperature.
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التعليميه األهداف :تابع
ومتي .3 وكيف أبجار لمقياس المكونه العناصر معرفة
أهميته إدراك ثم ومن إستخدامه .يتم
السري 4. بالحبل العنايه كيفية .معرفة
علي 5. اإلطمئنان فور للمولود الروتينيه العنايه تقديم
. الطبيعيه معدالتها حول الحيويه العالمات ثبات
إعطاء 6. في المبكر البدء ومميزات أهمية إدراك
. , المولود أ لألم بالنسبه سواء الطبيعيه الرضاعه
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*) General management:
1- Infant should be warmed quickly by wrapping in a
warm towel.
2- Uses extra clothes or blankets to keep the baby warm.
3- If the infant is in incubator, increase the incubator’s
temperature.
4- Use hot water bottle (its temperature 50 °C).
5- Food given or even intravenous solution should be
warm.
6- Avoid exposure to direct source of air drafts.
7- Check body temperature frequently.
8- Give antibiotic if infection is present.
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Thank you