NEONATAL PERIOD

BY: KAREN C. SANITA RN, RM,

MSN
 NEWBORN
Neonatal period – the time
from birth through the first 28
days of life.
Main Goal: to establish and maintain
homeostasis

OBJECTIVES:
Establishment and maintenance of respiration
 Stabilization and maintenance of body
temperature
 Prevention of infection and injury
 Provision of optimal nutrition
 Identify potential and actual problems
 The
1 24 hours
st

of Life

The first 24 hours of life is a very

significant and a highly vulnerable time
due to critical transition from intrauterine
to extrauterine life
Delivery Room Care
Check Airway

Initiate Breathing

Prevent Heat Loss

Appraise Clinically
*APGAR SCORE

03/02/25
5
CARE OF THE NEWBORN
Immediate
Care of the
Newborn
•Airway
•Breathing
•Temperature
 PRINCIPLES OF NEWBORN
CARE
1. ESTABLISH AND MAINTAIN A PATENT AIRWAY
Never stimulate a baby to cry unless secretions
have been drained out.
Mucus should be suctioned from a newborn’s
mouth by a bulb syringe as soon as the head is
delivered.
As soon as an infant is born, he/she should be
held for a few seconds with the head slightly
lowered for further drainage of secretion.
 SUCTION SECRETION
Suction the newborn properly:
Turn the baby’s head to one side
Suction gently and quickly.
Prolonged and deep suctioning of the
nasopharynx during the first 5 – 10
seconds of life will stimulate the vagus
nerve ( located in the esophagus ) and
may cause bradycardia.
 Airway & Breathing
Suction the mouth first
before the nose. When
suctioning the nose, the
stimulation of the nasal
mucosa will cause reflex
inhalation of pharyngeal
material into the trachea
and bronchi, causing
aspiration.
To test for patency of the airway occlude
one nostril at a time.
If the newborn struggles when a nostril has
been occluded, additional suctioning is
indicated.
Remember: newborns are nasal breathers.
Record the first cry.
2. Keep the newborn warm.
Maintain appropriate body
temperature. Chilling will increase the
body’s need for oxygen.
The newborn suffers large losses of
heat ( cold stress ) because he is wet
at birth, the delivery room is cold, he
does not have enough adipose tissues
and does not know how to shiver.
Temperature
Dry immediately
Place on an infant warmer or use
droplight
Wrap warmly with blanket
Body temperature and heat
production
. Loss of Body Heat:
a. Evaporation
b. Convection
c. Conduction
d. Radiation
Body temperature may drop to 94°F (34.4°C) or
even as low as 92 ͦ F (33.3 °C) after birth unless
the infant is adequately protected.
 LOSS OF HEAT
Convection – the flow heat to a cooler
body surface to cooler surroundings.
Eliminating drafts such as from
windows.

.
CONVECTION
LOSS OF HEAT
Radiation – transfer of body
heat to a cooler solid objects
not in contact with a baby such
as a cold winter, air
conditioner.
RADIATION
 HEAT LOSS
Conduction – the transfer of body
heat to a cooler solid in contact
with a baby. Example : baby place
in a counter.
CONDUCTION
HEAT LOSS
Evaporation – loss of heat through
conversion of a liquid to a vapor.
Production of body heat
Heat generated immediately by
shivering;
Infant shivering is characterized by
increased muscular activity, restlessness
and crying.
Effect of chilling on the neonate.
(a) Increased heat production leads to
increased oxygen consumption.
(b) Increased oxygen consumption utilized
glucose and fats.
(c) When heat production is high, caloric
need is high.
(d) Tendency to develop metabolic acidosis
occurs.
EFFECTS OF COLD STRESS
Metabolic acidosis – brought about by
accumulation of fatty acids because of
the breakdown of brown fat as a result
from the infant’s way of increasing
metabolism to produce heat ( low pH
- low HCO3 )
Hypoglycemia – due to the use of
glucose stored as glycogen ( low sugar)
NURSING MANAGEMENT IN KEEPING
THE NEWBORN WARM:

Dry the newborn immediately with dry

cloth (do not remove vernix caseosa) so
that no body heat is loss by evaporation.
Wrap the newborn with a warm blanket
but not too tight so as not to compromise
respiratory effort.
KEEP THE NB WARM
Lay infant on his side in a warmed
bassinet or place under a droplight or
infant warmer
Place a head cap to conserve heat
especially if they are in an open crib.
All nursing care should be
accomplished as quickly as possible to
minimize exposure of the infant.
Weight/ Anthropometric
Measurements
VITAL STATISTICS/ ANTHROPOMETRIC
MEASUREMENTS

Weight – newborn should be weighed nude and

without a blanket in the delivery room or nursery
room.
Average weight – 6 to 7.5 lbs / 2.5 – 3.5 kgs /
2500 – 3500 gms.
lower limit of normal is 2.5 kgs ( 5.5 lbs ).
Less than this weight, the child is termed low birth
weight and is given high – risk priority status.
Weighing a neonate or infant
 Special baby scale should be
used (electronic or balance)
 The baby should be
measured naked
 The scales should be set into
zero s
 Accurate measurement
should be noted

30 03/02/25
PHYSIOLOGIC WEIGHT LOSS of 5 to 10 % ( 6-10 oz )
during the first few days after birth is normal because the
newborn:
- Is no longer under the influence of maternal hormones.
- Already voids and passes out stools
- If breastfed, intake is limited by the relatively low caloric
content of colostrum until about the third day of life
- Because of the time needed to establish effective
sucking.
infant will begin to gain about 2 lbs/month (6 to 8
oz/wk ) for the first 6 months of life.
 2. LENGTH – average 50 cms (20 in.)
lower limit 46 cms (18 in )

 Accurate measurement
relies on measurement
in the supine position
 A special measuring
cradle is used
 The head is placed with
the apex of the scalp
against one end
 The hips, knees and feet
are held in the neutral
position and the foot
plate is brought up to
the plantar surface

Measuring the height of a baby

33 03/02/25
3. HEAD CIRCUMFERENCE – average 34 – 35 cm. Measured with a
tape measure drawn across the center of the forehead and most
prominent portion of the posterior head.

 A soft tape measure (cm)

is carefully used to
encircle the head in its
maximum diameter
 Wrap the tape snugly
around the widest
possible circumference of
the head (1-2 fingers
above the eyebrows).
 The tape should pass
over the occipital,
parietal and frontal
head circumference prominences
34 03/02/25
4. CHEST
CIRCUMFERENCE –
average 32 – 33 cm
or 2 cm less than the
head circumference.
Fully remove the
baby’s clothes to
expose the mid chest.
Securely wrap the
tape around the
widest possible
circumference of the
chest at the level of
the nipple.
5. ABDOMINAL
CIRCUMFERENCE –
average 32 – 33 cm.
Place the
measuring tape
around the baby’s
abdomen just above
the umbilical level
Vital Signs
VITAL SIGNS

Temperature – the baby’s normal temperature

range:
Axilla= 97.5-99.3 F (36.5 to 37.4 C)
Rectal= 100.2 F or less (37.9 C)

Pulse – 180 beats/min immediately after birth,

because the neonate struggles to initiate
respirations
Average: 120 – 140 beats/min average heart rate
an hour after birth when it stabilizes.
 Heart is irregular because of immaturity of the
cardiac regulatory center in the medulla
Respiratory rate – 80 breaths/min
immediately after birth.
30 – 60 breaths/min when it stabilizes.

Blood pressure – approximately 80/46

mmHg at birth.
By 10th day, it rises to about 100/50 mmHg.
PROPER IDENTIFICATION
OF THE NEWBORN
Footprints is taken and
kept in the chart as a
way to identify a
newborn.
Note: please observe
hospital policy on
taking footprints
 Proper Identification
Attach ID bracelet with
a number that
corresponds to the
mother’s hospital
number, mother’s full
name, sex/gender of the
baby, date, and time of
birth.
Place on baby’s ankle
Care of the Newborn
In the Nursery
 Cord Care
•Inspect for the presence of 2
arteries and 1 vein.
•Suspect a congenital anomaly if
blood vessels are not complete.
• Do not disinfect with alcohol.
• Keep it dry and do not cover
 BATHING
INITIAL OIL BATH is
done to cleanse the
baby from blood and
mucus then followed
with warm bath
DO NOT remove vernix
caseosa
Dry infant, wrap with
blanket, and keep
him/her warm under
infant warmer or drop
light.
Note: observe hospital
protocol regarding oil
and warm bath
ADMINISTER EYE CARE
Crede’s prophylaxis – prophylactic
treatment of the newborn’s eyes
against gonorrheal conjunctivitis also
known as “ophthalmia neonatorum”,
which the baby acquires as he passes
through the birth canal of a mother
who has untreated gonorrhea.
 PROCEDURE:
Wipe the face dry
Shade the eyes from light
and open one eye at a time
by exerting gentle pressure
on the upper and lower lids.
Apply
Erythromycin/Terramycin
ophthalmic ointment or
Silver nitrate from inner to
outer canthus of the eye.
Antibiotic ointments
eliminate the organism of
Gonorrhea and Chlamydia
as well.
 VITAMIN K
Administration of
Vitamin K facilitates
production of the
clotting factor, thus
preventing bleeding.
Method: Aquamephyton
1mg (Phytomenadione),
a synthetic Vitamin K is
injected IM into the
lateral aspect of anterior
thigh (vastus lateralis)
Dosage: 0.1 ml or 1 mg
Route: IM
Document birth record
Continue physical
assessment
APGAR SCORE
Immediate Assessment of
The Newborn
APGAR SCORE – standardized
evaluation of the newborn’s condition.
Done at 1 minute after birth to
determine the general condition and
then at 5 minutes to determine how
well the newborn is adjusting to
extrauterine life.
 Major Time Frames
1. Immediately after birth then repeat
after 5 mins.
2. Within the 1st 4 hours after birth
3. Prior to discharge
The following points/parameters
should be considered in obtaining
an APGAR Score:
Heart Rate – auscultation of the
newborn’s heart (APICAL PULSE) ,
observing and counting the pulsations
of the cord at the abdomen if the cord
is still uncut at one minute after birth.
Respiratory Effort – a mature newborn
usually cries spontaneously at about
30 seconds after birth. At one minute,
the infant is maintaining regular
although rapid respirations.
 APGAR SCORE
Muscle Tone – newborn hold the extremity
tightly flexed, simulating their intrauterine
position which is FLEXION. They should
resist any effort to extend their extremities.
Reflex Irritability – response to a suction
catheter or response to having the soles of
the feet slapped.
Color – all infants appear cyanotic at birth
and grow pink with or shortly after the first
breath.
 APGAR Scoring System

A ctivity/ Muscle Tone

P ulse/ Heart Rate
G rimace/ Reflex Irritability/
Responsiveness
A ppearance/ Skin Color
R espiration/ Breathing

1 2 3 4 5
INDICATORS 0 1 2

APPEARANCE Pale; Blue Pink body, bluish Pink all over

extremities the body
(Acrocyanosis)
PULSE Absent Below < 100 bpm More than >
100 bpm

GRIMACE No response Weak cry, Cough, sneeze,

grimace loud strong cry

ACTIVITY Limp flaccid Some flexion of Well flexed

extremities extremities extremities

RESPIRATION Absent Weak cry Good strong

cry
SCORE INTERPRETATION NURSING INTERVENTION
7 TO 10 Well baby or good and in No resuscitation needed
the best possible health
4 TO 6 At risk or guarded and may Requires resuscitation if necessary
need more extensive Suction secretions
clearing of the airway and Dry immediately
supplementary oxygen
Ventilate until stable
Careful observation

0 TO 3 Sick baby or in serious Intensive resuscitation

danger and needs ET/ Ambu bag
immediate resuscitation Ventilate with 100% O2
CPR
Maintain body temperature
CHARACTERISTICS OF A NEWBORN
General Appearance
Position – full term
infants assume an
attitude of flexion
Activity – may range
from forceful crying to a
deep sleep
Skin – sensations of
touch, pressure,
temperature and pain
are present soon after
birth
SKIN
Color – ruddy ( reddish) complexion
because of the increased
concentration of RBC in blood vessels
and a decrease in the amount of
subcutaneous fat which makes the
blood vessels more visible.
This ruddiness fades slightly over the
first month.
 ACROCYANOSIS
 Bluish discoloration of
palms of hands & soles of
feet (ACROCYANOSIS)
 Pink skin on one side and blue on the
other, as if some stricture were
cutting off circulation.
 The newborn’s hands and feet are
likely to appear cyanotic from
immature peripheral circulation.
 This is a normal phenomenon during
the first 24 to 48 hours after birth.
 Due to immature peripheral
circulation
 Exacerbated by cold temperatures
 PHYSIOLOGIC JAUNDICE
Yellowish
discoloration of the
sclera, skin and
mucous membrane.
This occurs
approximately 50 – 70
% of all newborns
during the 2nd and 3rd
day of life and
subsides by the 2nd
week of life.
Causes
Breakdown of RBC – forms a fat
soluble indirect bilirubin which cannot
be excreted by the kidney.
PHYSIOLOGIC JAUNDICE
Immaturity of the liver function –
cannot yet produce the enzyme
glucuronyl transferase responsible for
converting indirect bilirubin to direct
bilirubin in order to be excreted.
HARLEQUIN SIGN – a neonate who has been
lying on his side will appear red on the
dependent side of the body and pale on the
upper side as if a line had been drawn down
the center of the body, because of immature
circulation.
Texture – slight desquamation for the first 2 to
4 weeks of life.
Skin turgor – good elasticity.
Vernix caseosa –
a white cream-
cheese-like
substance that
serves as a skin
lubricant.
Milia – pinpoint size
white spots seen on the
nose and chin due to
obstruction of the
sebaceous glands
may disappear by 2 to 4
weeks of age as the
sebaceous glands
mature and drain.
Erythema Toxicum -
a newborn rash usually
appears on the 1st to 4th
day of life.
It begins with a papule,
increases in severity to
become erythema by
the 2nd day, then
disappears by the third
day.
It is sometimes called a
fleabite rash because
the lesions are so
minuscule.
Lanugo – is the fine downy hair that
covers a newborn’s shoulders, back, and
upper arms.
The immature newborn has more lanugo
than the mature infant.
Disappear within 1 – 2 weeks of life.
Hemangiomas – are
vascular tumors of the skin.
The three types of
hemangiomas are:
 1. Nevus flammeus – is a
muscular purple or dark red
lesion
 it is sometimes called a port-
wine stain because of its deep
color.
 These lesions generally appear
on the face and thighs, and may
be removed surgically.
 2. Strawberry hemangiomas –
these are elevated areas formed
by immature capillaries and
endothelial cells.
 Formation is associated with high
estrogen levels of pregnancy.
 Application of cortisone may
speed their disappearance by
interfering with the binding of
estrogen to its receptor sites.
3. Cavernous
hemangiomas – these are
dilated vascular spaces.
They are usually raised and
resemble a strawberry
hemangioma in appearance.
Cavernous hemangiomas
may bleed internally, leading
to hyperbilirubinemia or
anemia.
Mongolian spots – slate
gray patches across the
sacrum or buttocks and
consist of collection of
pigment cells. They
disappear by school age
without treatment.
Forceps marks –
these are circular or
linear contusion
matching the rim of the
blade of the forceps on
the infant’s cheeks or
forehead.
Disappears in 2 to 3
days along with the
edema that
accompanies it.
Head – a newborn’s head is
disproportionately large about ¼ of the
total length.
Fontanelles – spaces
or openings where the
skull bones join.
Anterior fontanelle – is
at the junction of the
two parietal bones
and the two frontal
bones. It is diamond
shaped and measures
2 - 3 cm in width and
3 – 4 cm in length.
Normally closes at 12
– 18 months of age.
Posterior
fontanelle – is at
the junction of the
parietal bones and the
occipital bone. It is
triangular and
measures about 1 cm
in length, closes by the
end of the second
month.
Molding – the part of the
infant’s head that engages
the cervix is molded to fit the
cervix contours and appears
prominent and asymmetric.
Restored to its normal shape
within a few days of birth.
Caput
Succedaneum – is
the edema of the scalp
at the presenting part of
the head.
Edema will gradually be
absorbed and disappear
about the 3rd day of life.
Cephalhematoma
– is a collection of
blood between the
periosteum of the
skull bone and the
bone itself caused
by a rupture of a
periosteum capillary
due to the pressure
of birth.
It takes weeks for it
to be absorbed.
 INDICATORS CAPUT SUCCEDANEUM CEPHALHEMATOMA

Definition Edema of the scalp Collection of blood

Location presenting of the head Between the periosteum of

the skull bone

Extent of involvement Both hemisphere confined to an individual

bone/does not cross
suture lines
Cause pressure (as in prolonged Pressure (rupture of
labor capillaries)

Period of absorption laboron or about the 3rd takes several weeks

(most significant day
differences

Treatment none support of anxious parents

Craniotabes – is a localized softening of
the cranial bones. The bone is so soft, it
can be indented by the pressure of an
examining finger. The bone returns to
normal contour when the pressure is
removed.
 EYES
 Eyes – vision is present as
evidence by blinking reflex.
However, limited to focusing
at a fixed point of 6 – 8
inches.
 Usually cry tearlessly because
the lacrimal ducts are not fully
mature at birth.
 Iris are gray and blue. They do
not assume their permanent
color until the child is about 3
months of age.
 Cornea should be round and
proportionate in size to that of
an adult eye.
 Pupil should be dark.
Edema is often present
around the orbit or on the
eyelids and remain for the
first 2 – 3 days until the
kidneys are capable of
evacuating fluid
efficiently.
 EARS
Ears – hearing is
present as soon as
amniotic fluid drains
or is absorbed from
the middle ear by way
of the Eustachian tube
within hours after
birth.
External ear not
completely formed as it
will be eventually, and
pinna tends to bend
easily.
The level of the top part
of the external ear
should be a line drawn
from the inner canthus
to the outer canthus of
the eye and back across
the size of the head.
NOSE
Nose – may appear large for the face.
MOUTH
 Mouth – should open evenly
when the baby cries.
 Palate should be intact.
 Presence of Epstein’s pearl one
or two small round glistening,
well – circumscribed cysts are
present on the palate; a result
of the extra load of calcium that
is deposited in utero.
 Sense of taste is more highly
developed than sight or
hearing.
 He accepts sweet fluids and
resists acid, sour, or bitter ones.
NECK
Neck – it is short and
chubby, creased with
skin folds and head
rotate freely.
Neck is strong enough
to support the total
weight of the
newborn’s head, but
in sitting position a
newborn makes a
momentary effort at
head control.
When lying prone, newborn can raise
their heads slightly. If they are pulled
into a sitting position from a supine
position, their heads will lag
considerably; however, again they
should make some effort to control and
steady their heads as they reach the
sitting position.
CHEST
Chest – appears small in
proportion to infant’s
head.
Breasts may be engorged
in both male – female,
and may secrete a thin
watery fluid called
witch’s milk. Disappears
in 2 – 4 weeks.
Chest should be
symmetrical.
ABDOMEN
Abdomen – contour of
the newborn abdomen
is slightly protuberant.
Presence of bowel
sounds within an hour
after birth.
Liver, spleen, and
kidneys are palpable
at birth.
Normally dome –
shaped.
 ANOGENITAL AREA
 The anus of the newborn must
be inspected to be certain that
it is patent and not covered by a
membrane (imperforate anus)
which can be determined by
inserting a rectal thermometer
into the rectum at birth.
 Take note of the time
meconium is first passed, it
should be within the first 24
hours of life.
 Meconium- Sticky, tarlike,
blackish-green, odorless
material
 Male genitalia

Scrotum may be
edematous and
rugated, maybe
deeply pigmented in
black or dark –
skinned neonates.
Both testes should be
present in the
scrotum.
Assess for
undescended testes
Positive cremasteric reflex – this is a deep
tendon reflex elicited by stroking the internal side
of the thigh.
As the skin is stroked, the testes on that side move
perceptively. This is a test for the integrity of spinal
nerves T8 through T10. The response maybe
absent in newborns less than about 10 days old.
Penis of newborns appears small. The urethral
opening must be inspected that should be at the
tip of the glands.
The prepuce (foreskin) should be examined to be
certain it is not stenosed.
•
Female genitalia

Vulva may be swollen because of the action

of maternal hormones.
Mucus vaginal secretions is present, which
is sometimes blood-tinged
“Pseudomenstruation ” due to hormonal
withdrawal.
Back
The spine of a newborn
appears flat in the lumbar
and sacral areas.
Newborn normally assumes
the position maintained in
utero, in which typically, the
back is rounded and the
arms and legs are flexed on
the abdomen and chest.
 Extremities

Arms and legs appear

short.
Hands are plump and
clinch into fists
Should move symmetrically
Fingernails are soft,
smooth, and are usually
long enough to extend over
the fingertips.
With good muscle tone,
arms always remain in a
flexed position
Palm of hands should have three creases
Legs are bowed as well as short
Soles of the feet appears to be flat because
of an extra pad of fat in the longitudinal
arch.
Presence of crisscrossed lines on the sole
of the foot.
THANK YOU AND
GOD BLESS