Nursing Care of a

Family With a
Newborn
The Neonatal Period
Birth - 28 days
Nursing Process Overview for Health
Promotion of the Term Newborn
1. Assessment

2. Nursing Diagnosis

3. Outcome Identification
and Planning

4. Implementation

5. Outcome Evaluation
ASSESSMENT
Review of mother’s pregnancy history, physical examination of the
infant, analysis of laboratory report (Hct, Hgb, Bilirubin & Blood type:
assessment of parent-child interaction.
NURSING DIAGNOSIS
Ineffective airway clearance related to mucus in the airway.
Ineffective thermoregulation related to heat loss from exposure in the
birthing room.
Imbalance nutrition, less than body requirements, related to poor
sucking reflex.
Health-seeking behaviors related to newborn needs.
OUTCOME IDENTIFICATION AND PLANNING
Planning should take into account the newborn’s needs during the
transition period, a mother’s need for adequate rest and parent’s need to
become acquainted with their new child.
IMPLEMENTATION
Role modelling by the nurse during the newborn period is an
effective way to help new parents grow confident with their newborn.
Parents will be observing you closely. Conserving newborn warmth
and energy, to help prevent hypoglycemia and respiratory distress,
should be an important consideration during all interventions.

OUTCOME EVALUATION
Expected outcomes should reveal that a baby’s primary
caregiver is able to give beginning newborn care with confidence.
Infant establishes respirations of 30-60 breaths per min.
Infant maintains temperature at 36.5 – 37.5 ℃
Mother demonstrates competence in caring for newborn.
infant breastfeeds well with a strong sucking reflex.
TheProfile of a
Newborn

“All newborns look alike”

as they say. In actuality,
every child is born with
individual physical and
personality characteristics
that make him or her
unique right from the
start.
VITAL STATISTICS

1. Weight
2. Length
3. Head Circumference
4. Chest Circumference
5. Abdominal Circumference

Be certain all healthcare providers

who care for newborns are aware of
safety issue specific to newborn care
when taking the measurements, such as
not leaving a NB unattended on a bed
or scale and protecting against
hypothermia.
 Plotting Weight in conjunction with height
and head circumference is also helpful
because it highlights disproportionate
measurements that indicates risk conditions.

 For example:
A newborn’s head circumference(HC) may be
too large for his birth weight(BW) and height
causing the care giver to suspect for possible
hydrocephalus.
Birth weight less than 2,500 gms for term infants is
called Small for gestational age. (SGA infant)
Birth weight more than 4000 gms is known as
Large for gestational age. (LGA infant, ex: born
of diabetic)
Appropriate for Gestational Age (AGA infant) –
average weight
Physiologic weight loss of 5-
10% of birth weight (6-10 oz)
during the first 10 days of life
 Reasons for Physiologic
Weight Loss

A. Newborns are no longer under the

influence of salt- and fluid-retaining
maternal hormones.
B. Newborn voids & passes stool.
C. Minimal food intake(BF) because
sucking is not yet established and
colostrum contains less calories than
mature milk.
D. Formula fed NB need time to
establish effective sucking.

Compare the weight of the NB each day

to be certain an infant is not losing more
than 10% of BW, an abnormal loss of
weight may be an indication of an inborn
error of metabolism.(adrenocortical
insufficiency)
 VITAL SIGNS

 Temperature -37.2 degrees C at birth because of warm and

supportive uterus. Temperature will fall almost immediately
to below normal because of :
 1. Heat loss (4 mechanisms )
 2. Newborn’s immature temperature-regulating mechanisms.
Heat loss in the Newborn
1. Convection is the flow of
heat from the newborn’s
body surface to cooler
surrounding air. Eliminating
drafts from windows and air
conditioners will reduce this
heat loss.
2. Radiation is the transfer of
heat to a cooler solid
object not in contact with
the baby such as cold
window or air conditioner.
Heat Loss in Newborn

3. Conduction is the transfer of

body heat to a cooler solid
object in contact with a baby.
Ex: Cold linen, weighing scale

4. Evaporation is loss of heat

through conversion of a liquid to
a vapor. Ex: Newborns are wet
with amniotic fluid. Drying the
infant especially the face and
hair effectively reduces
evaporation. Cover the hair with
a cap.
Newborns can conserve heat
by constricting blood vessels
and moving blood away from
the skin.

Brown fat, a special tissue

found in mature newborns,
helps to conserve or produce
body heat by increasing the
metabolism as well as
regulating body temp. Other
ways to increase MR and
produce heat is by crying and
kicking.
Pulse
FHT averages 110-160 bpm

Immediately after Birth, as

the newborn struggles to
initiate respirations, the heart
rate may be as rapid as
180bpm. (apical heartbeat)

Within 1 hour after birth, as the newborn settles down to

sleep, the heart rate stabilizes to an average of 120-
140bpm.Always palpate the femoral pulses and document
that they are present because absence suggests possible
coarctation(narrowing) of the aorta, which
suggests a cardiovascular abnormality(Lissauer, 2015).
Respiration

First few minutes of life – as high as

90bpm
Over the next hour – 30-60bpm
Respiratory depth, rate, and rhythm –
irregular, short periods of
apnea(without cyanosis) sometimes
called periodic respirations.
Respiratory rate– observed most
easily by watching the movement of
the abdomen because breathing
primarily involves the use of
diaphragm and abdominal muscles.
Coughing, sneezing and gag reflexes
are present at birth to help clear the
airway.
Blood Pressure

BP in NB – approximately
80/46mmHg at birth.
By the 10th day, it rises to about 100/50mmHg-
infant year.
BP measurement in newborns is somewhat
inaccurate due to small size of their arms, it is
routinely measured unless a cardiac anomaly
is suspected.
 Physiologic
Functions –just as
changes occur in vital signs Please watch these videos : Try to
after birth, so do changes in understand the different adaptations before
all major body systems. and after birth of the newborn.

Fetal circulation right before birth:

https://youtu.be/-IRkisEtzsk
 CARDIOVASCULAR
SYSTEM- changes in the Fetal circulation right after birth:
CVS are necessary after https://youtu.be/jFn0dyU5wUw
birth because now, the lungs
are responsible for
oxygenating blood that was
formerly oxygenated by the
placenta. As soon as the
umbilical cord is clamped,
which stimulates a neonate
to take in oxygen through
the lungs, fetal
cardiovascular shunts begin
to close.
The peripheral circulation of a newborn remains
sluggish for at least the first 24 hours which can
cause cyanosis in the infant’s feet and
hands(acrocyanosis) and for a newborn’s feet to
feel cold to touch.

BLOOD VALUES:
Blood volume – 80-110 ml/kg of body wt (300ml)
Hemoglobin – 17-18 g/100 ml of blood(11-12 g/ml adult)
Hematocrit – 45-50% (adult, 36-45%)
RBC – 6 million cells/mm3( adult 3.5-5.5)
WBC – 15,000 to 30,000 cells/mm3 at birth(40t if birth was
stressful.
 Blood Coagulation

 Vitamin K (Phytonadione,
Aquamephyton, Konakion)

 This intervention provides Vitamin

K because he newborn does not
have the intestinal flora to produce
this vitamin in the first week of life
after birth.
 Vitamin K is given to prevent
and treat hemorrhagic disease in
NB(HDN).
 Dosage: 0.5mg to 1.0 mg IM
anterolateral thigh(Vastus lateralis)
The Respiratory System

A first breath is a major undertaking

because it requires a tremendous amount of
pressure for a newborn to be able to inflate
alveoli for the first time.
 At birth, the baby's lungs are filled with fluid.
They are not inflated. The baby takes the first
breath within about 10 seconds after delivery.
This breath sounds like a gasp, as
the newborn's central nervous system reacts to the
sudden change in temperature and environment.

 The cold stimulates skin nerve endings and the

newborn responds with rhythmic respirations.

 A baby born by cesarean birth does not have as

much lung fluid expelled at birth as one born
vaginally and so typically has more difficulty
establishing respiration because excessive fluid
blocks air exchange.

 Any newborn who had difficulty establishing

respirations at birth needs to be examined closely
for a cardiac murmur or any other indication that
he or she still has the patent cardiac structures
from fetal life, especially a patent ductus
arteriosus.(Benitz, 2015)
The Gastrointestinal System(COCA)
MECONIUM – sticky, tart-
like, blackish green
odorless stools formed
from mucus,vernix,
lanugo, hormones and
carbohydrates that
accumulates while in
utero.
TRANSITIONAL stool– on the
2nd or 3rdday of life stool
changes in color and
consistency in response to
the feeding pattern.
Appeared both loose and
green; may resemble
diarrhea to the untrained
eye.
Urinary System
24 hour point is a general rule -

Newborns who do not void within this time

need to be assessed for the possibility of
urethral stenosis or absent kidneys or ureters.

Single voiding is only 15ml.

Daily urinary output – 30-60ml total
Week one – 300ml

Male should void with enough force to

produce a small projected arc.
Females should produce a steady stream, not
just continuous dribbling. Projecting urine
farther than normal may signal urethral
obstruction because it indicates urine is being
forced through a narrow channel.
The Immune System
Newborns have limited immunologic
protection at birth because they are not able
to produce antibodies until 2 months(the
reason most immunizations are not
administered until 2 mos of age).

Newborns are born with passive

antibodies (Immunoglobulin G) passed to
them from their mother that crossed the
placenta. (Antibodies against poliomyelitis,
measles, diphtheria, pertussis, chicken pox,
rubella and tetanus)
Hepatitis B vaccine is administered to
promote antibody formation against the
disease(CDC,2016)
 The Neuromuscular System
Term Newborns demonstrate neuromuscular
function by
reflex actions present at birth and serve the
infant until neuromuscular development is
improved.
Infant reflexes that don’t integrate
successfully can lead to developmental delay.
Absence of reflex activity often indicates
some form of brain damage or CNS
depression.
Newborns are born with built –in instincts
like the primitive reflexes.
Retained primitive reflexes is a sign of
Brain imbalance that can lead to
developmental delays related to disorders
like ADHD, sensory processing disorder,
autism, and learning disabilities.
  Primitive reflexes are the first part of
the brain develop and should only
remain for the first few months of life.

Types of Primitive Reflexes:

Moro/startle reflex– acts as a baby’s
primitive fight or flight reaction. (8wks –
Best method to elicit this 4th month).
reflex: hold a newborn in
supine position and allow the Most important reflex indicative of
head to drop backward about neurological status.
I inch: Response: arms and
legs extends, then swings the If retained beyond 4 months he may
arms into an embrace position
and pulls up the legs against
become over sensitive and over reactive
the abdomen. to sensory stimulus.
 Rooting reflex assists in the
act of breastfeeding and is
activated by stroking a baby’s
cheek, causing her to turn and
open her mouth. This reflex
serves to help newborn find
food.
Disappears at about 6th week
of life.

Palmar reflex is the automatic

flexing of fingers to grasp an
object placed in their palm.
This reflex disappears at about
6wks to 3 months and after it
fades, a baby begins to grasp
meaningfully.
 Tonic Neck Reflex or the
Asymmetrical tonic neck
reflex(ATNR) when the arm and leg on
the side toward which the head is turned
extend, and the opposite arm and leg
contract. Also called the “boxer or
fencing reflex”. Function is not known
but typically disappears between the 2nd
to 3rd month of life.

Deep Tendon Reflexes both patellar

and a biceps reflex are intact in a
newborn. A normal NB can have
hyperreflexia and still be normal but
absent reflexes associated with low
tone and weakness is consistent with
lower motor neuron disorder.
 Landau Reflex when a newborn is
supported in a prone position by a hand,
the newborn should demonstrate some
muscle tone. A newborn may not be able
to lift the head or arch the back in this
position but neither should the infant sag
into an inverted “U” position. The latter
response indicates extremely poor
muscle tone, which needs to be
investigated.
Crawling reflex also known as
symmetrical tonic neck reflex(STNR)
is present briefly after birth and then
reappears around 6-9 months. This helps
the body to divide in half at the midline
to assist in crawling- as the head is
brought towards the chest, arms bend and
legs extend. It should disappear by 11
mos.
 Tonic Labyrinthine reflex
(TLR) is the basis for head
management and helps prepare an
infant for rolling over, creeping,
crawling, standing and walking.

This reflex initiates when you tilt

an infant’s head backwards while
placed on the back causing legs to
stiffen, straighten and toes to
point. Hands also becomes fisted
and elbows bend. It should
integrate gradually as other
systems mature and disappear by
3 ½ old.
 Feeding Reflexes
1. Rooting reflex
2. Sucking Reflex when a newborn’s lips
are touched, the baby makes a sucking
motion to find food. It disappears
immediately if it is never stimulated
such as in a NB with tracheoesophageal
fistula who cannot take in oral fluids.
Diminish about 6 months
3. Swallowing reflex same as in the adult.
Food that reaches the posterior portion
of the tongue is automatically
swallowed. Gag, cough, and sneeze
reflexes are also present in NB to
maintain clear airway.
4. Extrusion Reflex a newborn extrudes
any substance on the anterior portion of
the tongue in order to prevent
swallowing of inedible substances.
OTHER REFLEXES:
Babinski Reflex occurs when
the sole of the newborn’s foot is
stroked in an inverted “J” curve
from the heel upward, a NB fans
the toes (+ Babinski sign).
Remains until 3 months of age.

Plantar Grasp Reflex occurs

when an object touches the sole
of the NB’s foot at the base of
the toes, the toes grasp in the
same manner as the fingers.
Disppears at about 8-9 mos in
preparation for walking.
Reflexes that tests for Spinal cord
integrity

 Magnet Reflex if pressure is applied to the soles of the

feet of a NB lying in a supine position, he or she pushes
back against the pressure.

 Crossed Extension Reflex when the NB is lying supine,

if one leg is extended and the sole of that foot is irritated
by being rubbed with a sharp object, such as a
thumbnail, the infant raises the other leg and extends it as
if trying to push away the hand irritating the first leg.

 Trunk Incurvation Reflex or Spinal Galant Reflex –

when the paravertebral area is stroked, the newborn
flexes his or her trunk toward the direction of the
stimulation.
 The senses of the newborns,
probably are so important for survival,
Senses are already fully developed at birth.

Hearing - recognizes the voice of the

mother and calm to the sound since
they have heard in utero.(25-27wks
AOG hearing is functional). As soon as
the AF drains or is absorbed from the
middle ear by way of the eustachian
tube within hours after birth, hearing
becomes acute.
Vision – a pupillary reflex or ability
to contract the pupil is present from
birth. The fetus has a blink or squint
reflex in response to bright light in
utero by 26wks AOG. Teach parents
that NBs focus best on black and white
objects at a distance of 9-12in.
Touch –the sense of touch is also developed at
birth. Newborns quiet down at a soothing
touch, cry at painful stimuli, and show
suckling and rooting reflexes that are elicited
by touch.

Taste – a newborn has the ability to

discriminate taste because taste buds are
developed and functioning even before birth.
After birth, a baby continues to show a
preference for sweet over bitter tastes.

Smell – as soon as the nose is cleared of lung

and amniotic fluid, the sense of smell is
present. Newborns probably turn toward their
mother’s breasts partly out of recognition of
the smell of breastmilk and partly as a
manifestation of the rooting reflex.
Newborn Assessments for Maturity and
General Well-Being
1. UNANG YAKAP (ENC VIDEO) FOCUSING ON THE NEWBORN
https://youtu.be/AjcoR2tozyQ
2. APGAR SCORING BY: Dr.Virginia Apgar, 1952
https://youtu.be/cQKaTCMFjwc
3. BALLARD’S SCALE ASSESSMENT
https://youtu.be/pRy15YO6hU4
4. PHYSICAL ASSESSMENT OF A NEWBORN
https://youtu.be/cracmPo3iYo
5. BRAZELTON NEONATAL BEHAVIORAL
ASSESSMENT
https://youtu.be/tqc8gKuXs3s
6. CARING FOR YOUR NEWBORN
https://youtu.be/-CWJYxIvoFQ
 Discharge Instructions
Advise the mother to return or go to the hospital
immediately if:
- Jaundice
- Difficulty of feeding
- Convulsions
- Movement only when stimulated
- Fast or slow or difficult breathing
- Temp. > 37.5 C or < 35.5
- Check-up as preferred by AP & immunization
schedule.
- Newborn Screening (RA 9288 “Newborn
Screening Act of 2004”)
 Congenital Metabolic Disorders
(Newborn Screening)

1.Congenital Hypothyroidism (CH)-lack or absence

of Thyroid hormone which is essential for the
physical and mental development of the child(NB
may suffer from growth and mental
retardation)
2. Congenital Adrenal Hyperplasia (CAH)- causes
severe salt loss, dehydration and abnormaly
high levels of male sex hormones in both boys
and girls(may die within 7-14 days)
3. Galactosemia (GAL)-unable to process galactose.
Excessive galactose in the body can cause
problems like liver damage, brain damage and
cataracts.
4. Phenylketonuria (PKU) – NB cannot properly use
one of the building blocks of protein called
phenylalanine. Excessive in the blood causes
brain damage.
5. Glucose 6 Phosphatase Dehydrogenase Deficiency
(G6PD) – the body lacks enzyme called G6PD,
may cause hemolytic anemia resulting from
exposure to oxidatice substances found in drugs,
foods and chemicals.
 CAUTION WITH CLAMPING!

Proper way of clamping the umbilical cord

Reading Assignment:
MCN book by Loanne Flag and Pilliterri
Pages 982-1009

THE APPEARANCE OF THE NEWBORN

SKIN – General inspection of a newborn’s skin includes
color, any birthmarks, and general appearance.
Color – Pink, cyanosis, jaundice, pallor
Birthmarks – hemangiomas(vascular tumors of the skin)
NUTRITIONAL NEEDS OF A NEWBORN
Proper nutrition is essential
for optimal growth and
development , especially in the
first few moths of life because
brain growth proceeds at
such a rapid rate during this
time.
Feeding Newborn extends
beyond physiologic need of
adequate nutrition, it also
fulfills important psychological
needs that enhances
psychosocial development of
the infant.
Nursing Process Overview for
Promoting Nutritional Health
in a Newborn

Assessment
Nursing Diagnosis
Outcome Identification
and Planning
Implementation
Outcome
Evaluation
Assessment
 Mother’s and her partner’s attitudes and
choices about infant feeding.
 Recognizing signs of hunger in their infants.
 Adequate intake by monitoring voiding and
stooling patterns.
Nursing Diagnosis
 Effective breastfeeding related to well-
prepared mother and a healthy newborn who
is able to latch properly and transfer milk
effectively.
 Risk for ineffective breastfeeding related to a
poor latch, or ineffective transfer of milk.
 Imbalance nutrition, less than body
requirements, related to poor newborn
response, poor latch, or ineffective transfer of
milk.
 Risk for impaired parenting related to inability
to exclusively breastfeed the newborn if the
mother’s desire was to exclusively breastfeed.
 Outcome Identification and Planning
 Human milk is the ideal food for newborns. Patient education regarding
infant feeding begins during the prenatal period.
 Expectant parents cannot make informed choice if they are not aware of the
nutritional and health benefits of breastmilk. Parents who choose formula
feeding can practice behaviors, such as skin to skin contact, to promote
bonding. They require instructions on formula preparations, safe feeding
techniques, and appropriate volumes for newborn and infant feeding.

 Implementation
 An intervention related to newborn nutrition is supporting a mother’s choice
of a feeding method and helping her feel confident in her ability to feed her
infant. Provide mothers with information on breastfeeding support groups at
the time of discharge. Mothers may need to see a lactation consultant for
any breastfeeding problems or challenges.
 Outcome Evaluation

This is an important final step to ensure a

newborn receives adequate nutrition because
unforeseen circumstances such as jaundice,
infant tongue-tie, or late preterm delivery may
require the mother to provide expressed
breastmilk until the problem is solved.

Examples:
Mother expresses satisfaction with her
chosen method of newborn feeding.
Newborn wakes for feedings every 2 to 3 hrs
after the first 24 hrs of life.
Nutritional allowances for Newborn

Calories- During growth spurts, more calories are

needed to supply additional energy.
Protein is necessary for the formation of a new cells
to provide for a rapid growth of new cells a well as
maintenance of existing cells.
Fat – Linoleic acid, an essential fatty acid, is
necessary for brain growth and skin integrity in
infants.
Carbohydrates – Lactose, the disaccharide found in
human milk and added to commercial formulas,
appears to be the most easily digested of the
carbohydrates. Improves calcium absorption and
aids in nitrogen retention.
Iron – some women who breastfeed and formula fed
NBs were advised to supplement iron to ensure
infant does not develop Iron-deficiency anemia.
Calcium – is important to the newborn because the
skeleton grows so rapidly.
 Fluid–it is important to maintain fluid
intake in newborns because their
metabolic rate is so high ( and
metabolism requires water). This
requirement can be supplied
completely by breastfeeding or
formula feeding.
 Fruit juice is not recommended for
infants younger than 6 months because
it supplies no protein and if not
pasteurized, can carry infectious
organisms (American Academy of
Pediatrics(AAP), 2012).
 Minerals – A number of minerals are
particularly important to early growth.
 Flouride –is essential for building
sound teeth and for preventing tooth
decay.
 Vitamins – the AAP recommends both
breastfeeding and formula fed infants
to have 400 IU of Vitamin D.
Human milk is the ideal food and the
preferred feeding method for newborns
because it provides antibodies as well as nutrients.
Encourage all mothers to breastfeed by providing
them with knowledge, skill, and support to be
successful.
Breastfeeding infants should be fed when
hunger cues are displayed: rooting, sucking
on fists, clenched fists: these cues may be exhibited
from 90 min to 3 ours after the last feeding. Crying is
the last sign of hunger.
Night feedings will be necessary during
the first 6 to 8 weeks: the fat content of
breastmilk is high in the evening which may help the
infant to consume more calories and therefore feel
more satiated; infants who consume more calories
during the day may be able to have longer stretches
of sleep at night.
If a newborn will be formula fed, be
certain the parents understand how to
prepare the formula.
 Here is an ACRONYM on the Benefits of BREASTFEEDING.

 B- est for baby, also best for mommy

 R-educes the incidence of allergies
 E-economical, no waste
 A-nti-bodies to protect baby against infection
 S-terile and pure
 T-emperature is always ideal
 F-resh milk never goes off
 E-asy to prepare and to digest
 E-radicates feeding difficulties
 D-evelops mother and child bonding
 I-mmediately available
 N-utritionally optimal
 G-astroenteritis greatly reduced
 Tips on Breastfeeding:

1. With a clean washcloth or cotton swabs, wipe your

breasts clean before your baby feeds.
2. Sit comfortably in an upright position.
3. Support your baby's head
4. Guide your nipple towards his mouth. Baby's chin should
be against the breast and his tongue underneath your
nipple. Make sure that he's sucking the whole areola
(darkened area of the nipple).
5.When he's suckling subsides, switch him to other breast
until stops feeding. Next time he feeds, start from the
breast he nursed from last.
6.If your nipples get sore, never wash your nipples with
soap, give a minute for them to be exposed for air dry
7.ALWAYS burp your baby every after feedings.
 Watch the following videos:
1. PHYSIOLOGY OF HUMAN LACTATION
https://youtu.be/vPW0a-_DR3U
2. MEDICAL ANIMATION OF BREASTFEEDING
https://www.stlouischildrens.org/health-resources/pulse/medical-
animation-breastfeeding
3. INITIATION OF BREASTFEEDING
https://youtu.be/l_ArpFS1Ljo
4. BREASTFEEDING AND ITS ADVANTAGES TO THE MOTHERS AND
NEWBORNS.
https://youtu.be/ybSquGsyTko
5. BREASTFEEDING: GETTING A GOOD LATCH EVERY
TIME: https://youtu.be/OUqRVSeBpY8
6. BREASTFEEDING PROBLEMS: INEFFECTIVE BREASTFEEDING
https://youtu.be/XZae0tz8RPE
Discharge Planning for Newborn Nutrition

1. Teaching parents about either breastfeeding or formula

feeding is crucial. Connect the mother to local breastfeeding
support groups in the area.
2. Caution parents not to prop bottles because it increases the
risk of aspiration and otitis media and deprives the infant of
the pleasure of being held for feedings.
3. Review adequate infant intake based on recommended voiding
and stooling pattern as described.
4. Ensure the newborn has follow-up appointment with a
pediatric primary care provider.
5. Empower mother to learn to make decisions regarding feeding
and not to be reluctant to ask for help when they need it.
For any clarification:
you may contact me via MS teams, Messenger: Leizl Lacorte Pepito