TOPIC: ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC){OLD}ESSENTIAL MATERNAL

NEWBORN CARE (EMNC) (NEW)

LEARNING OBJECTIVES:
1. Perform immediate assessment of an example pregnant client shown in video in labor
2. Classify the Essential Maternal Newborn Care (EMNC)
3. Perform the proper steps in the actual delivery of newborn using the online video presentation /link
4. To deliver time-bound core intervention in the immediate period after the delivery of the newborn
5. Monitor during labor process with the use of partograph using video presentation
6. .Practice how to deliver the baby and placenta correctly and aseptically using available material at
home
7. Provide immediate care of the newborn using the online video and checklist
8. Perform thorough assessment of the actual postpartum client and her
newborn based on the video and checklist
9. Evaluate the outcomes of care provided to the client

Essential Intrapartal and Newborn Care (EINC):

The EINC practices are evidenced based standards for safe and quality care of birthing mothers and their
newborns, within the 48 hours of intrapartum period (labor and delivery) and a week of life for the
newborn.
It is a package of evidenced-based practices recommended by the Department of Health (DOH),
Philippine Health Insurance Corporation (PhilHealth), and the World Health Organization (WHO) as the
standard of care in all births by skilled attendants in all government and private settings.
It is a basic components of DOH’sMaternal. Newborn and Child Health and Nutrition (MNCHN) strategy.
Essential lntrapartum and Newborn care (EINC) is the standard of care in all births by skilled attendants
in all government/private settings.
The EINC practices for newborn care constitute a series of time bound. Chronologically ordered;
standard procedures that a baby receives at birth.

At the heart of the protocol are 4 time-bound interventions:

1) immediate drying;
2) skin-to-skin contact followed by clamping of the cord after 1-3 minutes;
3) non-separation of baby from mother
4) breastfeeding initiation
Why is there a need for Essential Newborn Care Protocol?

The wide variations in newborn care practices in health facilities, both government and private,
and also the proper sequence or order of newborn care services need to be standardized based on
current evidences that show reduction in neonatal mortality and morbidity.

This is to achieve the United Nations Millennium Development Goal 4 of Reducing Under 5 Child
Mortality (through reduction of neonatal deaths).

Essential Intrapartum and Newborn Care (EINC) Evidence-based Standard Practices .

The EINC practices are evidenced-based standards for safe and quality care of birthing mothers
and their newborns, within the48 hours of Intrapartum period (labor and delivery) and a week of life for
[Link] and field tested by international and local experts, EINC practices reflect current
knowledge.

EINC distinguishes the necessary practices in the delivery and care for the newborn and the
mother, from the unnecessary. In December 2009, the Secretary of the Department of Health Francisco
Duque signed Administrative Order 2009-0025, which mandates implementation of the EINC Protocol in
both public and private hospitals. Likewise, the UnangYakap campaign was launched.

The EINC practices during Intrapartum period

 Continuous maternal support, by a companion of her choice, during labor and delivery
 Mobility during labor – the mother is still mobile, within reason, during this stage
 Position of choice during labor and delivery
 Non-drug pain relief, before offering laboranesthesia
 Spontaneous pushing in a semi-upright position
 Episiotomy will not be done, unless necessary
 Active management of third stage of labor (AMTSL)
 Monitoring the progress of labor with the use of partograph

Government and international Support

Since 2010, WHO supports the DOH in changing practices for safe and quality care of mothers
and newborns for all practitioners and health [Link] was initially implemented in 11 selected
government hospitals collectively representing about 70,000 annual live births (around 3% of all national
live births). USAID also provided support through the Joint Programme on Maternal and Neonatal Health
(JPMNH).

PREPARATION:

Materials needed -in linear sequence

 2 Pairs of gloves
 2 Dry linens
 Bonnet
 Oxytocin injection
 Plastic clamp
 Iinstrument clamp (#1 straight Kelly clamp)
 Scissors
 2 Kidney basins
PREPARATION:

1. Prepares decontamination solution by mixing part 5% chlorine bleach to 9 parts water to make 0.5%
chlorine bleach to 9 parts water to make 0.5% chorine solution.

2. Change chlorine solution at the beginning of each day or whenever prior to woman’s transfer to the
delivery room
3. Ensures that mother is in her position of choice while in labor (Dorsal Lithotomy)
4. Ask the mother if she wants to drink or void
5. Communicates with the mother. Inform her of the progress of labor, give assurance and

PARTOGRAPH

The partograph is a graphical presentation of the progress of labour, and of fetal and maternal condition
during labour. It is the best tool to help you detect whether labour is progressing normally or
abnormally, and to warn you as soon as possible if there are signs of fetal distress or if the mother’s vital
signs deviate from the normal range. The partograph is a tool for monitoring maternal and fetal
wellbeing during the active phase of labour, and a decision-making aid when abnormalities are detected.
It is designed to be used at any level of care. Its central feature is a graph used to record the progress of
cervical dilation, as determined by vaginal examination. Start the graph at 5 cm of dilation, and 3
contractions every 10 minutes. In certain situations, e.g. induction of labour, it is started at 4 cm of
[Link] are plotted on the graph each time they are checked:

Maternal indicators:

• Vital signs (heart rate, blood pressure and temperature)

• Time of spontaneous or artificial rupture of the membranes
• Uterine contractions (number per 10 minutes and duration)
• Urine output
• Drugs administered (oxytocin, antibiotics, etc.)

Fetal indicators:

• Fetal heart rate/FHR

• Amniotic fluid (colour, odour and quantity)- clear/yellowish= normal; green/brown= meconium
• Descent of the fetal head and head moulding
 WOMAN ALREADY IN THE DELIVERY ROOM

PREPARATION FOR DELIVERY

6. Checks the temperature in delivery room area to be 25-28 `C . Eliminates air draft

7. Asks woman if she is comfortable in the semi-upright position (The fault position of the delivery table)
8. Ensure the woman’s privacy
9. Removes all jewelry then wash hands thoroughly observing the WHO 1-2-3-4-5 procedures
10. Prepares a clear, clean newborn resuscitation area. Checks the equipment if clean, functional within
easy reach.
11. Arranges materials/supplies in a linear sequence
- 2 gloves,2 dry linen, bonnet, oxytocin injection, plastic clamp, instrument clamp, scissor, 2 kidney
basins

IN A SEPARATE SEQUENCE FOR AFTER THE 1ST BREASTFEED:

 Eye ointment
 Stethoscope
 Vitamin K injection
 Hepatitis vaccine
 BCG Vaccine
 Dry and wet cotton balls

12. Cleans the perineum with antiseptic solution

[Link] hands and put on 2 pairs of sterile gloves aseptically (if same worker handles perineum and
cord)

AT THE TIME OF DELIVERY

14. Encourages woman to push as desired

15. Drapes the clean , dry linen over the mother’s abdomen or arms in preparation for drying the baby
 16 Applies perineal support and did controlled delivery of the head

Modified Ritgen’smanuever is done by covering the anus with sterile towel and exert upward and
forward pressure on the fetal chin while exerting gentle pressure with two fingers on the head to
control the emerging head.

This will not only support the perineum, thus the also favor flexion so that the smallest
suboccipitobregmatic diameter of the fetal head is presented.

Ease the baby’s head out and immediately wipe the nose and mouth of secretions to establish a patent
airway (REMEMBER: the first principle in the care of the newborn is to establish and maintain a patent
airway) The head should be delivered in between contractions.

16. Calls out time of birth and sex of the baby

Take note of the exact time of delivery of the baby, proper sex identification. Allowing the
mother to see the status of the baby.

18. Informs the mother of outcome

 MECHANISMS OF LABOR (CARDINAL MOVEMENTS)

 Engagement
This is when the largest diameter of the fetal head descends into the maternal pelvis.

The term engagement is referring to the widest part of the fetal head successfully negotiating its way
down deep into the maternal pelvis. Engagement is identified by abdominal palpation, where the fetal
head is 3/5th palpable or less.
 Descent
The fetus descends into the pelvis. In the primigravida this is likely to occur from 38 weeks gestation
onwards, in a multigravida woman, this may not occur until labour is established.
Descent is encouraged by:
 Increased abdominal muscle tone
 Braxton hicks in late stages of pregnancy
 Fundal dominance of the uterine contractions during labour
 Increased frequency and strength of contractions during labour
As the head descends, it moves towards the pelvic brim in either the left or right occipito-transverse
position (this means the occiput can be facing the left side or right side of the mother’s pelvis).
 Flexion

As the fetus descends through the pelvis, fundal dominance of uterine contraction exerts pressure down
the fetal spine towards the occiput, forcing the occiput to come into contact with the pelvic floor. When
this occurs the fetal neck flexes (chin to chest) allowing the circumference of the fetal head to reduce to
sub-occipitobregmatic (9.5cm). In this position, the fetal skull has a smaller diameter which assists
passage through the pelvis.

 Internal Rotation
The pelvic floor has a gutter shape with a forward and downward slope, encouraging the fetal head
to rotate from the left or right occipito-transverse position a total of 90-degrees, to an occipital-anterior
(occiput facing forward) position, to lie under the subpubic arch.

With each maternal contraction, the fetal head pushes down on the pelvic floor. Following each
contraction, a rebound effect supports a small degree of rotation. Regular contractions eventually lead
to the fetal head completing the 90-degree turn.

This rotation will occur during established labour and it is commonly completed by the start of the
second stage. Further descent leads to the fetus moving into the vaginal canal and eventually, with each
contraction, the vertex becomes increasingly visible at the vulva.
 Crowning

When the widest diameter of the fetal head successfully negotiates through the narrowest part of
the maternal bony pelvis, the fetal head is considered to be ‘crowning’. This is clinically evident when
the head, visible at the vulva, no longer retreats between contractions. Complete delivery of the head is
now imminent and often the woman, who has been pushing, is encouraged to pant so that the head is
born with control.

 Extension

Extension of the presenting [Link] occiput slips beneath the suprapubic arch allowing the head to
extend. The fetal head is now born and will be facing the maternal back with its occiput anterior.

 External Rotation/Restitution

Because the shoulders at the point of the head being delivered are only just reaching the pelvic floor
they are often still negotiating the pelvic outlet and the fetus may naturally align its head with the
shoulders. This is called restitution and visually you may see the head externally rotate to face the right
or left medial thigh of the mother.
 Expulsion

Downward traction by the healthcare professional will assist the delivery of the anterior shoulder below
the suprapubic arch. This is followed by upward traction assisting the delivery of the posterior shoulder.
The fetal body will be delivered by the contractions, the health professional’s role is only to assist safe
negotiation of this last stage.

As the head rotates , deliver the anterior shoulder by exertinh a gentle downward push and
then slowly give an upward lift to deliver the posterior [Link] supporting the head and the
neck, deliver the rest of the body. The infant is grasped around the back with the left hand, and the right
hand is placed, near the vagina under the baby’s buttocks, supporting the infant’s body.

Immediately after the delivery of the newborn should be held below the level of the mother’s
vulva for a few minutes to encourage flow of blood from the placenta to the baby.

The infant held with his head in a dependent position (head lower than the rest of the body) to
allow for drainage of secretions.

REMEMBER: Never stimulate a baby to cry unless you have drained him out of his secretions
first.
 Mechanism of Labor

FIRST 30 SECONDS

[Link] dries the baby for at least 30 seconds , starting from the face and the head, going down
to the trunk and extremities while performing a quick check for breathing.

1-3 MINUTES

20. Remove the wet cloth

[Link] the baby in skin to skin contact on the mother’s abdomen or chest
[Link] baby with the dry cloth and the baby’s head with a bonnet .This prevents hypothermia,
infection, and hypoglycemia

23. Excludes a second baby by palpating the abdomen in preparation for giving oxytocin
24. Uses wet cloth to wipe the soiled gloves. Gives oxytocin within one minute of baby’s birth. Disposes
of wet cloth properly
25. Removes the first gloves and decontaminate them properly ( in 0.5% chlorine solution for at least 10
minutes)
26. Palpates umbilical cord to check for pulsations
Do not milk the cord towards the baby– After the 1st clamp, you may“ strip ” the cord– After the 1st
clamp , you may “strip” the cord of blood before applying the 2nd clamp– Cut the cord close to the
plastic clamp so that there is no need for a 2nd “trim”– Do not apply any substance onto the cord
27. After pulsation stopped, clamps cord using the plastic clamp or cord or tie 2 cm. From the
[Link] anemia and protects against brain hemorrhage in premature newborn.

28. Place the instrument clamp 5 cm. From the base

29. Cut near plastic clamp (midways)
30. Performs the remaining steps of the AMTSL (Active management of the third stage of labor)

Waits for strong uterine contractions then applies controlled cord traction and counter traction on the
uterus , continuing until placenta is delivered

-Massages the uterus until firm and contracted

PLACENTAL DELIVERY

The third stage of labor refers to the period following the completed delivery of the newborn until the
completed delivery of the placenta. Relatively little thought or teaching seems to be devoted to the third
stage of labor compared with that given to the first and second stages.

The placenta is a unique organ of pregnancy that nourishes your baby. Typically, it attaches to the top or
side of the uterus. The baby is attached to the placenta via the umbilical cord. After your baby is
delivered, the placenta follows. This is the case in most births. But there are some exceptions.

Delivery of the placenta is also known as the third stage of labor. Delivery of the entire placenta is vital
to a woman’s health after giving birth. Retained placenta can cause bleeding and other unwanted side
[Link] this reason, a doctor will examine the placenta after delivery to ensure that it is intact. If a
piece of placenta is left in the uterus, or the placenta doesn’t deliver, there are other steps a doctor can
take.

The following 3 classic signs indicate that the placenta has separated from the uterus :

A. The uterus contracts and rises.
B. The umbilical cord suddenly lengthens.
C. A gush of blood occurs.

Two types of placental separation:

A. Duncan’s Method

B. Shultz Method

Schultz Method- Shiny side

- Placenta separates in the centre and folds in on itself as it descends into the lower part of uterus
(80%).Fetal surface appears at vulva with membranes trailing behind
- Minimal visible blood loss as retroplacental clot contained within membranes (inverted sac)

Duncan Method - Dirty side

- It is the separation starts at the lower edge of placenta lateral border separates (20%).
- maternal surface appears first at vulva. Usually accompanied by more bleeding
from placental site due to slower separation and no retro placental clot.

 Tract the cord slowly , winding it around the clamp until placenta sponatneously comes out,
rotating it slowly so that no membranes are left inside the uterus, a method called Brandt
Andrews Maneuver.

31. Inspects the lower vagina and perineum for lacerations/ tears and repaired lacerations /tears as
necessary
32. Examines the placenta for completeness and abnormalities
 Active management:

 Involves an injection of a drug called syntocinon or ergometrine in your thigh soon after your
baby’s born.
 It speeds up the delivery of the placenta – it usually happens within 30 minutes of having your
baby. Your midwife will push on your uterus and pull the placenta out by the umbilical cord.
 You’ll have the umbilical cord cut between one and five minutes after you give birth.
 Early cord clamping reduces the amount of blood your baby gets from you at birth by about
20%. But this also makes it less likely they’ll get neonatal jaundice that needs treatment.
 It lowers the risk of heavy blood loss.
 It might make you feel sick or vomit, and can increase your risk of high blood pressure.

33. Cleans the mother , flushes perineum and applies perineal pad/ napkin/ cloth
34. Checks baby’s color and breathing checks that mother is comfortable, uterus contracted and firm
35. Disposes of the placenta in a leak proof container or plastic
36. Decontaminates (soaked in 5% chlorine solution)( instruments before cleaning decontaminates 2 nd
pair of gloves before disposal , starting that decontamination lasts for at least 10 minutes.
37. Advices mother to maintain skin to skin contact. Baby should be in prone position on mother’s chest
in between the breasts with head turned to one side.
Continuous non-separation of newborn and mother for early breastfeeding protects infants from
dryingfrom infection.

15 TO 90 MINUTES

38. Advices mother to observe for feeding cues and cited examples of feeding cues

Look for signs of good attachment and suckling:

− Mouth wide open
− Lower lip turned outward
− Baby’s chin touching breast
− Suckling is slow, deep with some pauses
− If the attachment or suckling is not good, try again and reassess. 

39. Supports mother, instructs her on positioning and attachment

40. Wait for full breastfeed to be completed. The first feed provides colustrum.

41. After a complete breastfeed, administer eye ointment (first do thorough physical examination , then
give vitamin K and Hepatitis and BCG injection)

Eye ointment application

Vitamin K injection

Hepa B vaccine injection

42. Advises (optional delayed ) bathing of baby.
43. Advices breastfeeding per demand
44. In the first hour, check the baby’s breathing and color, and check mother’s vital signs and massages
the uterus every 15 minutes and document
45. In the second hour, checks mother - baby dyad every 30 minutes to I hour
Mother-baby dyad care, including skin-to-skin contact of healthy infants and mothers, is an important
component of maternal-newborn care. Beginning at birth, mothers and newborns should be viewed as a
unit with no disruption of the parent-infant relationship.

[Link] and completes all records

POSTPARTUM PERIOD

 Immediately after delivery of a baby, the mother is monitored for at least 1 hour. If an
anesthetic was used during delivery or if there were any problems during delivery, she may be
monitored for several hours after delivery, usually in a well-equipped recovery room with access
to oxygen, intravenous fluids, and resuscitation equipment.

 Staff members check the mother’s pulse rate and temperature. Normally, within the first 24
hours, the mother’s pulse rate (which increased during pregnancy) begins to decline toward
 normal and her temperature may increase slightly, usually returning to normal during the first
few days. After the first 24 hours, recovery is rapid. They make every effort to minimize the new
mother’s pain and the risk of bleeding and infection.

Bleeding

 Minimizing bleeding is the first priority. After delivery of the placenta (afterbirth), a nurse may
periodically massage the mother’s abdomen to help the uterus contract and remain contracted,
thus preventing excessive bleeding.

 If needed, oxytocin is given to stimulate contraction of the uterus. The drug is injected into a
muscle or given intravenously as a continuous infusion until the uterus is contracted.

 If women lose a lot of blood during and after delivery, a complete blood count is done to check
for anemia before they are discharged.

Urination

 Urine production often increases greatly, but temporarily, after delivery. Because bladder
sensation may be decreased after delivery, hospital staff members encourage a new mother to
try to urinate regularly, at least every 4 hours. Doing so avoids overfilling the bladder and helps
prevent bladder infections. Staff members may gently press on the mother’s abdomen to check
the bladder and determine whether it is being emptied.

 Occasionally, if the new mother cannot urinate on her own, a catheter must be inserted
temporarily into the bladder to empty the urine. Hospital staff members try to avoid using an
indwelling catheter (a catheter that is left in the bladder for a period of time). This type of
catheter increases the risk of bladder and kidney infections.

Defecation

 The new mother is also encouraged to defecate before leaving the hospital. But because
hospital stays are so short, this expectation may not be practical. Doctors may recommend that
if she has not defecated within 3 days, she take laxatives to avoid constipation, which can cause
or worsen hemorrhoids. If the rectum or muscles around the anus were torn during delivery,
doctors may prescribe stool softeners.

 Opioids, which are occasionally given after cesarean delivery to relieve severe pain, can worsen
constipation. So if an opioid is needed, the lowest effective dose of such drugs is used.

Diet and exercise

 A new mother can have a regular diet as soon as she wants it, sometimes shortly after delivery.
She should get up and walk as soon as possible.A new mother can start exercises to strengthen
 abdominal muscles, often after 1 day if delivery was vaginal and later if it was cesarean. Curl-ups
with bent knees, done in bed, are effective. However, most women are too tired to start
exercising so soon after delivery.

Before discharge

 Before a new mother leaves the hospital, she is examined. If mother and baby are healthy, they
commonly leave the hospital within 24 to 48 hours after vaginal delivery and within 96 hours
after a cesarean delivery. Sometimes discharge is as early as 6 hours if no general anesthetic was
used and no problems [Link] mother is given information about changes to expect in her
body and measures to take as her body recovers from having a baby. Regular follow-up visits are
scheduled, usually starting at 6 weeks after delivery. If delivery was cesarean or if problems
occurred, the first visit may be scheduled sooner.
References:

Department of Health. (2009, December 1). UnangYakap:EssentialNewborn Care [Video]. Government

[Link]://[Link]/unang-yakap

Greek Medics (June 2018). Mechanism of Labor and Fetal Position- OSCE GUIDE [Video].Youtube.

[Link]

Medical Aid Films - Films For Life. (2013, September 11). How to use a partograph to assess women in
labour [Video].[Link]://[Link]/watch?v=hTh5MJFzgPY

Pilliteri, A. (2009). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family
(Maternal and Child Health Nursing). LWW; Sixth, North American edition.

Tan, T. (2015). Performance Evaluation Tool/Manual Procedure.

University of Nottingham Division of Midwery (2010).Mechanism of labor[Video].

[Link]://[Link]/watch?v=2kM35XMMiPk

World Health Organization (2009).Newborn Care Until the First Week of life. [File].Government
[Link]://[Link]/wp-content/uploads/2014/09/[Link].
 Immediate Care of the Newborn in the Delivery room

Learning Objectives:

 Understand about the care of newborn (i.e. immediate and routine care)
 Discuss about warmth, care of skin, eyes, and care of cord etc.
 Discuss about immunization and breast feeding.
 Explain about the follow up care and general observation of the newborn.
 Use relevant data and information to develop appropriate essential newborn recommendations.

A. Principle No. 1:

Establish and maintain a patent airway.

1. The newborn’s position should be one which promotes the drainage of secretion (head lower than the
rest of the body), except when there are signs of increasing intracranial pressure.
(e.g. shrill, high-pitched cry; vomiting; tense, bulging anterior fontanelle; abnormally large head) in
which case, the head should be positioned higher than the rest of the body.
2. Suction the newborn properly.
a. Turn the baby’s head to one side
b. Suction gently and quickly – prolonged and deep suctioning of the nasopharynx during the first 5-10
minutes after birth will stimulate the vagus nerve (located in the esophagus, and cause bradycardia.
c. Suction the mouth first before the nose – suctioning the nose causes reflex inhalation of the
pharyngeal secretions into the trachea and bronchi, thus causing aspiration. Suction mouth first so as to
remove the pharyngeal secretions.
d. To test for patency of the airway, occlude one nostril at a time. (Remember: Newborns are nasal
breathers.) If the newborn struggles when a nostril is occluded, additional suctioning is indicated.

B. Principle No. 2:

Maintain appropriate body temperature.

Newborn suffers large losses of heat because he is wet at birth, the Delivery Room is cold, and he does
not have enough subcutaneous tissues to keep him warm and he does not know how to shiver. (Heat
production is accomplished primarily by non-shivering thermogenesis, the major energy source for heat
is his brown fat.
Measures to maintain appropriate body heat:
Effects of cold stress:
a. Metabolic acidosis – one of the ways by which heat is produced is by increasing metabolism. When
this occurs, fatty acids accumulate because of the breakdown of brown fat (seen only in term newborn,
preemies have less)
b. Hypoglycemia – due to the use of sugar stored as glycogen.
Dry immediately and wrap warmly
Put under a droplight or as in a Kraisselman radiant warmer
C. Principle No. 3:

Assess the newborn carefully:

1. Apgar score – standardized evaluation of the newborn. It is done at one minute after birth to
determine his general condition at birth and then at five minutes to determine how well the newborn is
adjusting to extrauterine life discovered by Virginia Apgar.

Apgar Scoring

 The most critical observation is the heart rate.

 The general attitude of the newborn at birth is that of flexion.
 Body pink, extremities blue (called acrocyanosis) is normal during the first 24 hours of life
Interpretation:

0 – 3: the baby is in serious danger and needs immediate resuscitation

4 – 6: the baby’s condition is guarded and needs more extensive clearing of the airway

7 – 10: the baby is at his best possible health

2. Silverman-Anderson scale – index of respiratory distress (score of 0 is an indication of good

respiratory function)

 Grunting sound of air pushing past partially closed glottis, heard during inspiration
 Retractions: sternal and intercostals; due to use of accessory muscles to aid in breathing.
 Flaring nares: due to newborn’s efforts to lessen resistance in narrow nasal passages.
 Seesaw respirations: Flattening of chest with inspiration and bulging of abdomen, caused by the
utilization of abdominal muscles during prolonged, forced respiration.
D. Principle No. 4

 Identify the newborn

Identification of the neonate should be done in the delivery room before transferring to the
nursery. Footprints are said to be the best form, although identical ID bands for both baby and mother
will suffice.

Anthropometric measurements:

- Weight- lower limit for expected birthweights for all NB is -2.5(5.5 lb) to 3.4 kg. (7.7 lb).
Average birth weight for mature female NB is 3.4 kg (7.5 lb) & mature male is 3.5 kg. (7.7
lb).Macrosomic - 4.7 kg (10 lb) is unusual.
th
- Length – average birth length of a mature 50 percentile female neonate -49 cm. (19.2 in.),
mature males- 50cm (19.6 in.). The lower limit – birth length- 46(18 in.). Rare cases- 57.5 cm (24
in.). Head circumference- mature NB- 34 to 35 cm (13.5-14 in.).Greater than 37cm. (14.8 in.) or
less than 33cm. (13.2 in.) should be carefully check for neurological [Link] is measured
with a tape measure drawn across the center of the forehead and around the most prominent
potion of the posterior head(occiput).

- Chest Circumference- 2 cm. (0.75 to 1 in.) less than the head circumference- measured at the
level of the nipples – Normal 32 to 33 cm.

Vital Signs:

- Temperature – 99 ⁰F (37.2 ⁰ C) at birth.

- Temperature of the delivery / birthing rooms 68 ⁰F to 72 ⁰ F (21 ⁰C to 22 ⁰C).
Newborns lose heat by 4 separate mechanisms:

 Convection
 Conduction
 Radiation
 Evaporation

- Pulse – heart rate inside the utero averages 110 to 160 beats per min. Immediately after birth
HR may be rapid as 180beats pm. An hour after birth as the NB settles down to sleep, HR
stabilizes to an average of 120 to 140 [Link]-first few minutes of life maybe as high as
90 breaths /m. As respiratory activity is established & maintained, average is 30 to 60breaths/m.
watching the abdomen
th
- Blood pressure- approximately 80/46 mm Hg at birth. 10 day rises to 100/50mm hg. BP of NB
is somewhat inaccurate so it is not routinely measured unless cardiac anomaly is suspected.
- Doppler method may be used to take BP.

Medications:

 Crede’s Prophylaxis- apply tetracycline 1% or erythromycin 0.5% ophthalmic ointment at the

conjunctival sac to prevent OphthalmiaNeonatorum (neonatal conjunctivitis) when the mother
has gonorrhea or chlamydial infection.
 Vitamin K – 1.0 mg (0.1ml) for weight more than 1500gms. IM at left vastuslateralis – for
premature- 0.5 mg (0.05ml) less than 1500grams, given to help blood clots or prevent bleeding.
 Hepatitis B Vaccine- IM at right vastuslateralis- upper outer portion of the thigh 0.5 ml. BCG
vaccine – 0.05 ml. intradermal, right deltoid region of the arm.
References:

Gardner, S., & Snell, B. (2016). Care of the Well Newborn. Jones & Bartlett Publishers.

NursingSOS (2018, June 6). APGAR Score: Newborn Nursing Assessment [Video].
[Link]://[Link]/X48lqTNUTQk

Identify the newborn.

Identification of the neonate should be done in the delivery room before transferring to the nursery.
Footprints a