Easter College

DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

NNCM 107 LEC NOTES National Health Goals dealt directly with the NB period:

THE NEWBORN  Increase of at least 75% the proportion of

mothers who breastfeed their babies in the
A. The Profile of a Newborn:
early postpartal period from a baseline of 64%
Physiologic Function and Appearance
 Increase to at least 50% the proportion of
Objectives:
women who continue breastfeeding until their
 Describe the normal characteristics of a term babies are 5- 6 months old from a baseline of 29
newborn. %

 Use critical thinking to analyze ways that the Benefits of Breastfeeding

care of a term newborn can be more family
Best for baby, best for mommy
centered.
Reduces the incidence of allergies
 Assess a newborn for normal growth and
development. Economical

 Formulate nursing dx r/t NB or the family of the Antibodies to protect baby against infection
NB
Sterile and Pure
 Identify expected outcomes for a NB and family
Temperature is always ideal
during the first 4 weeks of life
Fresh milk never goes off
 Plan nursing care to augment development of a
NB, such as ways to aid parent-child bonding Easy to prepare and to digest
 Implement nursing care of a NB Eradicates feeding difficulties
 Evaluate outcome criteria for achievement and Develop mother and child bonding
effectiveness of care
Immediately available
 Identify areas r/t NB assessment and care that
could benefit from additional nursing research / Nutritionally optimal
application of evidenced-based practice Gastroenteritis greatly reduced
 Integrate knowledge of NB G and D and ______________________________________________
immediate care needs with the nursing process ______________________________________________
to achieve quality maternal and child health ______________________________________________
nursing care. ______________________________________________
Newborn ______________________________________________

 A.k.a “neonate” ______________________________________________

______________________________________________
 Undergoes profound/ intense physiologic ______________________________________________
changes at the moment of birth ______________________________________________
______________________________________________
 Within 24H: complete functioning: Neurologic,
renal, endocrine, GI, and metabolic ______________________________________________
______________________________________________
sustain life
______________________________________________
❖ Neonatal Period ______________________________________________
______________________________________________
______________________________________________
______________________________________________ ______________________________________________
______________________________________________ ______________________________________________

pg. 1
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 Easter College
DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

Other Advantages of BF

 It contains ideal electrolytes and mineral

composition for human infant growth

 It is high in lactose- an easily digested sugar

(rapid brain growth)

 The ratio of cysteine to methionine in BM

favors rapid brain growth in early months.

 It contains more linoleic acid- an essential acid

for skin integrity

 It has less Na, K, Ca and P

 It has better balance of trace elements like Zn.

 BF helps prevent excessive weight gain in

infants

Advantages for a Mother

 Serve a protective function in preventing

breast cancer.

 Release of oxytocin from the posterior pituitary

gland aids in uterine involution.

 Successful BF can have an empowering effect,

because it is a skill only a woman can master.

 It reduces the cost of feeding and preparation

time.

 It provides an excellent opportunity to enhance

a true symbiotic bond between mother and
child.

Nursing Responsibilities:

a) Beginning Breastfeeding- should begin soon

after birth (woman is still in the birthing room
while infant is in the first reactivity period)

❑ Let-down reflex:  Breastmilk Transition:

- Oxytocin is released from the PPG as the NB infant 1. Colostrum: First 2 – 4 days: ↓ CHO, ↓ Fat,
sucks at the breasts causing the collecting sinuses ↑ CHON, ↑ Fat-soluble vitamins
(lactiferous sinuses) of the mammary gland to - thin, watery, yellow fluid composed of protein,
contract milk moves forward through the sugar, fat minerals, vitamins and maternal antibodies.
nipples.
- easy to digest and capable of providing
- Oxytocin causes smooth muscle contraction adequate nutrition
(Uterine) prevents excessive bleeding; aids in
uterine involution 2. Transitional Milk: 4 – 14 days:

↑ lactose, ↑ minerals, ↑ water-soluble vitamins

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 Easter College
DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

3. Mature Milk: beyond 14th day: c)Provide immediate support if problems arise
↑ CHO, ↑ Fats, ↓ CHON
d) Provide information regarding techniques for
b) Provide information regarding lactation and proper burping the breast-fed baby
positioning techniques.
- It is helpful to burp NB after they have
• Before BF- mother performs handwashing emptied the first breast and again after the total
feeding

- Placing the baby over one shoulder and gently

patting or stroking the back; laying the baby prone
across the lap

e) Support for a mother who is breastfeeding multiple

infants.

- Provide support by ensuring that they drink

adequate fluid and help them to organize their time.

- assure women that the average woman can

easily produce enough milk to feed multiple infants.

f) Prevent or relieve engorgement.

• REPUBLIC ACT No. 10028 * Engorgement- breast distention, accompanied

by hardness, tenderness, and perhaps heat in their
• AN ACT EXPANDING THE PROMOTION OF breasts. The skin appears red, tense, and shiny.
BREASTFEEDING, AMENDING FOR THE
PURPOSE REPUBLIC ACT NO. 7600, OTHERWISE - caused by vascular and lymphatic
KNOWN AS “AN ACT PROVIDING INCENTIVES congestion arising from an increase in the blood and
TO ALL GOVERNMENT AND PRIVATE HEALTH lymph supply to the breasts.
INSTITUTIONS WITH ROOMING-IN AND
Nursing interventions:
BREASTFEEDING PRACTICES AND FOR OTHER
PURPOSES” 1) Empty the breasts of milk by having the infant
suck more often, or at least continue to suck as
• Be it enacted by the Senate and House of
much as before.
Representatives of the Philippines in Congress
assembled: 2) Good breast support from a firm-fitting bra
helps prevent a pulling, heavy feeling
• Section 1. Short Title. – This Act shall be known
as the “Expanded Breastfeeding Promotion Act 3) Apply warm packs to both breasts or standing
of 2009”. under a warm shower for a few minutes before
feeding, combined with massage to begin milk
• Section 2. Section 2 of Republic Act No. 7600 is
flow.
hereby amended to read as follows:
4) Manual expression or the use of a breast pump
• Sec. 2. Declaration of Policy. – The State adopts
to complete emptying of the breasts after the
rooming-in as a national policy to encourage,
baby has nursed.
protect and support the practice of
breastfeeding. It shall create an environment g) Promote healing of sore nipples.
where basic physical, emotional, and
- Painful nipples result from the strong sucking
psychological needs of mothers and infants are
action of a newborn.
fulfilled through the practice of rooming-in and
breastfeeding.

• Observe proper position when BF

pg. 3
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 Easter College
DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

- It can be worsened by:

1) Improper positioning of an infant (failure to grasp the

areola as well as the nipple)

2) Forcefully pulling an infant from a breast

3) Allowing an infant to suck too long at a breast after

the breast is emptied

4) Permitting a nipple to remain wet from leaking milk

Nursing interventions:

1) Encourage a mother to position her baby

slightly differently for each feeding.

2) Advise to expose nipples to air by leaving her

bra unsnapped for 10 to 15 minutes after
feeding.

3) Discourage the use of plastic liners that come

with nursing bras; it is preferable to have air
always circulating around the breasts.

4) Apply vitamin E lotion after air exposure may

toughen the nipples and prevent further
irritation.

5) Applying a few drops of breast milk to the

nipples after feeding and gently massaging it
into the areola.

6) Advise women not to use a hand pump with

sore nipples, because the pressure may cause
fissures to worsen.

h) Anticipate potential problems and suggest methods

for resolving them
i) Provide information on supplemental feedings.

j) Provide information for a mother who works outside

the home.

k) Provide information on weaning

pg. 4
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 Easter College
DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

Formula Feeding d) Use a comfortable chair (as does a nurse who feeds
babies) and adequate time (at least half an hour) to
a) Preparing for formula feeding
enjoy the process and not rush the baby.
* Commercial Formulas

TYPES:
e) Hold the baby with the head slightly elevated.
Milk based- formulas are used for the average newborn

Soy based- devised for infants who are allergic to cow’s

f) Ensure the nipple is kept filled so that the baby is
milk protein
sucking milk, not air.

** casein hydrolysate formulas have protein

particles too small to be recognized by the immune
system g) Babies in the early weeks should be bubbled
(burped) after every ounce of milk taken. The
technique is the same as that used for breastfed
Elemental (fat, protein, and carb hydrate content is infants.
modified, such as in lactose-free formula)

Reminders!
h) Do not to prop up bottles, because babies:
 Parents should be advised to purchase types
with added iron to ensure that their newborn
receives enough of this element to prevent iron-
deficiency anemia (Marotz, 2009)
i) Do not to put a baby to bed with a bottle of formula,
 Formulas for term newborns contain 20 cal/oz because this can lead to “baby-bottle syndrome,” or
when diluted according to directions (the same cavities of the lower teeth
number of calories as breast milk).

 4 forms of commercial formulas

• Powder that is combined with water

• Condensed liquid that is diluted with an

equal amount of water

• Ready-to-pour type, which requires no

dilution

• Individually prepackaged and prepared

bottles of formula

b) Provide information regarding formula

preparation

c) Provide information regarding feeding techniques

- warm and cooled formula

- take precaution in warming the formula

milk stored in bottles.
pg. 5
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 Easter College
DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

Signs of a Well-fed Baby: Causes:

a) No salt and fluid-retaining maternal

hormone influence
a) Steady weight gain of 150-240 g/ week during
the 1st 6 months to120 g/week at the end of 1 b) Diuresis
year
c) Passing out of meconium
b) Normal growth and development pattern
d) Limited caloric intake until about the 3rd
c) Happy, active and contented when awake day of life

d) Regular and undisturbed sleep  Breastfed NB: regains weight within 10 days

e) Has normal bowel movements and elimination  Formula fed newborns: gains within 7 days

National health goals continued……  Weight Gain among NB: about 2lbs per month
(6-8 oz per week) for the 1st 6 months of life.
 Increase to 70% the percentage of healthy full-
term infants who are put to sleep on their  Weight Gain:
backs from a baseline of 35%
 BW doubles at 5 to 6 mos and triples at
 Increase to 60% from a baseline of 43% the 1 year.
number of women who breastfeed exclusively
 2 yrs of age: 4x the BW
until their infant is 3 months of age; from 13%
to 25% or those who breastfeed exclusively  Infants generally gain approximately 20-
until 6 months. 25 g/ day or 150- 210 g/ week during
the 1st 5 months of life
 Increase to at least 75% the proportion of
parents and caregivers who use feeding  3years: 5x BW
practices that prevent baby-bottle tooth
decay.  5 years: 6x BW

 Reduce neonatal mortality rate to no more  7 years: 7x BW

than 2.9 per 1000 live births from a baseline of  10 years: 10x BW
4.8 per 1000 live births

VITAL STATISTICS: WEIGHT

Abnormal Findings:
 Varies among race, nutritional, intrauterine and
genetic fxs present during pregnancy ▪ Low birth weight/ SGA: <2,500 grams

 Arbitrary lower limit of normal for all races: 2. ▪ Very low birth weight: <1,500 grams
5kg (5.5 lbs.) ▪ Extremely low birth weight: <1,000 grams
 Normal Birth weight range: 2500 g- 4000 g (5 lbs ▪ BW > 4000 g is known as Large for Gestational
8 oz- 8 lbs 13 oz) Age (LGA) infant.
 Average: 3500 g ▪ Weight loss of more than 10%
 Birth weight of 4.7 kgs: macrosomic; associated Importance:
with DM
 Identify NB who are at risk because of their
 Physiologic Weight Loss small size
 5- 10% of NB BW is lost for the 1st few  Separates small for gestational age (SGA- NB
days of life who have suffered IUGR) from preterm infants
 6-10 oz weight loss (infants who are healthy but small only because
they were born early)
pg. 6
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 Easter College
DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

 Establishes a baseline for future evaluation.

 Good determinants of health and normal

nutrition (together with height)

VITAL STATISTICS: HEAD CIRCUMFERENCE

 Normal Measurement: 33-35 centimeters (13-

Nursing Considerations in weighing NB: 14 inches)

 The HC is usually greater than the chest

circumference by 2 centimeters.
 Undress NB infants before weighing.
 Head circumference is measured with a tape
 Keep a protective hand over an infant on an measure drawn across the center of the
infant scale (hovering but not touching) forehead and around the most prominent
 Always cover scales with scale paper before portion of the posterior head
weighing  It is ¼ of the total body length
 The same weighing scale should be used every  1st 4 mos: HC increases by ½ inch a month and
time the infant’s weight is measured ¼ inch a month in the next 8 months.
 Plotting BW in a neonatal graph helps to
identify NB at risk because of their small or too
large size  The ff are changes in the HC:

 Weight should be compared with height and  At birth, HC may be equal or greater
head circumference to see any disproportions than the CC due to molding
that indicates risk conditions  After 2-3 days, HC is greater than the CC
VITAL STATISTICS: LENGTH by 2-3 cms

 Average birth length (50th percentile): 53 cms  After 6 months, HC is = to CC

(20.9 inches)  After 1 year, HC is < than CC
 Normal Range: 46-56 centimeters

Nursing Considerations in taking NB length:

 Measure from top/ crown of the head to heel

using a tape measure.

 One person should hold the infant in place

while the other completes the measurement

pg. 7
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 Easter College
DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

Abnormal Findings: ➢ transfer of body heat to a cooler solid object in

contact with a baby.
 HC < 32 centimeters = microcephaly in term
infants ➢ a baby placed on a cold counter or on the cold
base of a warming unit quickly loses heat to the
 HC that is 4 centimeters and greater than CC or
colder metal surface.
more than 37 centimeters = neurologic px
(Hydrocephalus) ➢ Nsg Axn: Covering surfaces with a warmed
blanket or towel helps to minimize conduction
VITAL STATISTICS: Chest Circumference
heat loss.
 Term newborn: about 2 cm (0.75 to 1 in) less
than the head circumference
c) Evaporation
 measured at the level of the nipples.
➢ loss of heat through conversion of a liquid to a
 A CC < than 30 cm indicates prematurity.
vapor.
 An enlarged heart may make the left side of the
➢ Nsg Axn:
chest larger.
➢ dry newborns as soon as possible (face,
hair, head)
VITAL STATISTICS: Abdominal Circumference
➢ Covering the hair with a cap after drying
 Approximately the same as the CC it further reduces the possibility of
evaporation cooling.
 Measured just above the umbilicus
➢ Be certain to remove any wet blankets
used to dry the infant immediately
VITAL STATISTICS: Vital Signs- TEMPERATURE ➢ place the infant on a warm, dry blanket
 The temperature of NB: about 99° F (37.2° C) at ➢ Drying and wrapping newborns and
birth placing them in warmed cribs, or drying
 Temperature fluctuates during the first few them and placing them under a radiant
hours post-birth heat source

 The temperature of birthing rooms,

approximately 68° to 72° F (21° to 22° C) adds to d) Radiation
heat loss
➢ transfer of body heat to a cooler solid object
4 Mechanisms of heat loss among NB not in contact with the baby, such as a cold
a) Convection window or air conditioner and examination
tables near the NB.
➢ is the flow of heat from the newborn’s body
surface to cooler surrounding air. ➢ Nsg Axn:

➢ The effectiveness of convection depends on the ➢ Move the infant far from the cold
velocity of the flow (a current of air cools faster surfaces as possible helps reduce this
than nonmoving air). type of heat loss.

➢ Nsg Axn: Eliminate drafts from NB loss heat easily because….

windows or air conditioners a) Immature temperature regulating system
reduces convection heat loss.
b) Very little amount of subQ fats to provide heat
b) Conduction in their body.
➢
pg. 8
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 Easter College
DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

c) Little ability to conserve heat by changing HYPERTHERMIA

posture and inability to adjust own clothes in
 NB are also at risk of hyperthermia (T= >37. 5̊ C)
response to thermal stress.
CAUSES:
d) They tend to take on the temperature of their
environment ✓ Too hot external environment
NB conserve heat by: ✓ Too many covers/ clothes on baby
a) constricting blood vessels ✓ Infection
b) moving blood away from the skin S/Sx:
c) Burning brown fat, a special tissue found in  Irritability/ fussy
mature newborns, that helps to conserve or
produce body heat by increasing metabolism.  Abdomen and extremities are warm to touch

NB Produce Heat by:  Red, flushed skin

a) Increasing muscular activity (kicking and crying)  Hot and dry skin
increase metabolic rates  Lethargy
HEAT
 Stupor; at risk for convulsions (41 ̊ C)
b) Burning brown fat- present only in NB; forms at
17 weeks of gestation; the less mature the Interventions:
infant, the less brown fat  Place NB in a cool environment (25-28 ̊ C)
HYPOTHERMIA  Keep away from sources of heat (direct
➢ Occurs when body temperature drops below sunlight)
36.5 ̊C  Undress the NB partially or fully, if necessary.
➢ The NB infant is most sensitive to hypothermia  Measure the T ̊ q 1̊ until within the N range
during the stabilization period
 Sponge the baby if T ̊ > 39 ̊C. Do not use cold/
Effects of Hypothermia ice water.
 Acidosis  If the NB has been under a radiant warmer,
 Hypoxemia reduce the T ̊ setting until it becomes N

 Hypoglycemia  Examine for signs of infection

Immediate interventions for hypothermia:

✓ Remove wet cloth Vital Signs- Heart Rate

✓ Place the baby under heat source  The heart rate of a fetus in utero averages 120
to 160 beats per minute (bpm).
✓ Encourage BF
 Immediately after birth, as the newborn
✓ Start oxygen administration if the baby has struggles to initiate respirations, the heart rate
respiratory distress or cyanosis may be as rapid as 180 bpm.
✓ Notify the physician  HR: determined by listening for an apical
heartbeat for a full minute

 Within 1 hour after birth, as the newborn

settles down to sleep, the heart rate stabilizes
to an average of 120 to 140 bpm
pg. 9
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 Easter College
DEPARTMENT OF NURSING
Easter School Road, Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2011@gmail.com

 HR of a newborn: often remains slightly Signs of Respiratory Distress

irregular because of immaturity of the cardiac
 Nasal flaring
regulatory center in the medulla.
 Chest retraction, indrawing of the chest when
 During crying: HR may rise to 180 bpm.
breathing
 Sleep periods: HR can decrease during sleep,
 See-saw respiration
ranging from 90 to 110 bpm.
 Cyanosis other than the hands and feet

 Respiratory grunting- noisy respirations

Vital signs: Blood Pressure
 Adventitious breath sounds in NB
 At birth: The BP of NB is approximately 80/46
mm Hg. • Rhonchi
 By the 10th day of life : rises to about 100/50 • Rales
mm Hg.
• Stridor
 BP tends to increase with crying (and a
newborn cries when disturbed and manipulated • Wheezing
by such procedures as taking blood pressure). • Grunting
 A Doppler method may be used to take blood • Absent/ diminished breath sounds
pressure. Hemodynamic monitoring is helpful
when continuous assessment is necessary.

 AbN finding:

 Calf systolic pressure 6-9 mmHg less

than the systolic pressure in the UE may
be indicative of coarctation of the aorta

NOTE: For an accurate reading, the cuff width used

must be no more than two thirds the length of the
upper arm or thigh.

Vital Signs: Respiration

 RR ranges to an average of 30 to 60 breaths per

minute when the newborn is at rest.

 periodic respirations - Respiratory depth, rate,

and rhythm are likely to be irregular, and short
periods of apnea (without cyanosis) which last
less than 15 seconds are normal.

 RR: observed thru’ watching the movement of a

newborn’s abdomen, because breathing
primarily involves the use of the diaphragm
and abdominal muscles

 NB are obligate nose breathers.

pg. 10
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