Care of the Newborn

Dulce Corazon O. Tan

Observing and Providing Care for the Umbilical Cord
Purpose: To assist the cord in drying and falling off
Steps
1. Identify newborn.
2. Check umbilical clamp placement for tight closure. There should be no
bleeding or discharge from the cord.
3. Keep cord dry and exposed to the air.
4. Assess the cord for presence of vessels.
5. If the cord becomes soiled, a cotton tip swab and warm water gently
washes away the soil. Start from the base of the cord and gently wipe upward
and outward. Lift the cord away from the newborn’s abdomen to facilitate
observation or cleansing of all areas, if needed.
Observing and Providing Care for the Umbilical Cord
Purpose: To assist the cord in drying and falling off
Steps: continuation……
6. Observe cord and abdominal area for redness, discharge, or
foul odor.
7. Sponge-bathe the newborn until the cord falls off; then the
newborn can be submerged in a bath.
8. Diaper newborn, and be sure the upper end of diaper is
folded down below the cord so it does not rub against the cord.
9. Document observations, condition of the cord, teaching of
the parents, and the parents’ response.
 Breastfeeding has many advantages for the newborn:
• Breast milk contains the full range of nutrients that the
newborn needs and in the right proportions. No commercial
formula has the exact nutritional composition of breast milk.
• Breast milk is easily digested by the newborn’s maturing
digestive system.
Breastfeedin • Breast milk does not cause newborn allergies.
g • Breastfeeding provides natural immunity, because the mother
transfers antibodies through the milk. Colostrum is particularly
high in antibodies.
• Breast milk promotes elimination of meconium. Breast-fed
newborns are rarely constipated.
• Suckling at the breast promotes mouth development.
 Breastfeeding has many advantages for the newborn: cont..
• Breastfeeding is convenient and economical.
• Breastfeeding eliminates the risks of a contaminated water
supply or improper dilution.
• Newborn suckling promotes a return of the uterus to its
prepregnant state.
Breastfeedin • Breastfeeding may play a significant role in improving brain
g development of the newborn.
• Breast milk production uses maternal fat stores, which
facilitates maternal weight loss.
• Breastfeeding enhances a close mother-child relationship.
• Breastfeeding may reduce the occurrence of childhood
respiratory disorders and diabetes in the infant (Martin, 2016).
Infectious Diseases, Drugs, and Breastfeeding
1. The only infections that are absolute contraindications to
breastfeeding are those caused by the human
immunodeficiency virus (HIV) and the human T-cell
lymphotrophic viruses (HTLV-1 and HTLV-2), all of which can
be transmitted to the newborn via breast milk.
2. In mothers infected with the herpes simplex virus or the
varicella zoster virus, breastfeeding is contraindicated when
lesions on the breast are present.
Infectious Diseases, Drugs, and Breastfeeding
3. Mothers who have active pulmonary tuberculosis (TB) must be
isolated from their newly born infants, but newborns can be fed
breast milk that is pumped because the breast milk does not contain
the tubercle bacilli.
4. When a daily dose of a medication is administered during
lactation, timing the dose so it is given to the mother immediately
after nursing reduces the effects on the infant.
Infectious Diseases, Drugs, and Breastfeeding
5. Some drugs that should not be given to nursing mothers when safe
substitutes are available include cytotoxic drugs, such as cyclosporine and
methotrexate; drugs of abuse; and radioactive compounds.
6. Some psychotropic drugs and antianxiety drugs may cause adverse effects
in the infant. Bromocriptine and ergotamine, often used to treat migraine
headaches, are contraindicated while breastfeeding. Nursing mothers should
continue to avoid eating fish containing high levels of mercury (Niebyl et al.,
2017).
7. Galactosemia in the infant is a contraindication to breastfeeding.
8. Narcotics, sedatives, anticonvulsives, antihistamines, decongestants,
antihypertensives, antimicrobials, and coffee intake are all considered
generally safe during lactation
 Physiology of lactation Hormonal Stimulation
 The following two hormones have a major role in the production and
expulsion of breast milk:
 • Prolactin, from the anterior pituitary gland, causes the production of
breast milk.
 • Oxytocin, from the posterior pituitary gland, causes the milk to be
delivered from the alveoli (milk-producing sacs) through the duct system to
the nipple (milk ejection, or let-down reflex). The mother usually feels a
tingling in her breasts and sometimes abdominal cramping as her uterus
contracts
 Physiology of lactation Hormonal Stimulation
 The newborn suckling on the breast stimulates
nerve fibers in the areola of the nipple that travel to
the hypothalamus.
 The hypothalamus stimulates the anterior pituitary
to secrete prolactin; this stimulates milk
production and stimulates the posterior pituitary to
release oxytocin, which causes a let-down reflex,
contracting the lobules in the breast and squeezing
milk out into the nipple and to the newborn.
The composition of milk changes slightly from the beginning of a
feeding until the end of that feeding, as follows:
• Foremilk is the first milk the newborn obtains. It is watery and
quenches the newborn’s thirst.
• Hindmilk is the later milk that has a higher fat content. It helps
satisfy the newborn’s hunger. Feedings that are too short do not
allow the newborn to obtain the hunger-satisfying hindmilk.
Phases of Milk Production

Milk production changes after birth in the following three phases:

1. Colostrum
2. Transitional milk
3. Mature milk
• colostrum - secreted by the breasts late in pregnancy, for the first few days
after birth, yellowish fluid is rich in protective antibodies. It provides protein,
vitamins A and E, and essential minerals, but it is lower in calories than milk.
It has a laxative effect, which aids in eliminating meconium.
• transitional milk - emerges approximately 7 to 10 days after birth, as the
breasts gradually shift from production of colostrum to production of
mature milk. Transitional milk has fewer immunoglobulins and proteins but
has an increased lactose (milk sugar), fat, and calorie content.
• Mature milk - is secreted 14 days after birth. Mature human breast milk has
a bluish color, which leads women to think that it is not “rich” enough to
nourish the newborn. The nurse should explain that the apparent “thinness”
of the milk is normal and that the milk contains 20 kcal/oz and all the
nutrients the newborn needs.
• Assisting the mother to breast-feed

• The first nursing session includes the following advantages:

• • Promotes mother-newborn bonding
• • Maintains newborn temperature
• • Newborn suckling stimulates oxytocin release to contract the
mother’s uterus and control bleeding
• Assisting the mother to breast-feed
• The first nursing session includes the following advantages:
• • Promotes mother-newborn bonding
• • Maintains newborn temperature
• • Newborn suckling stimulates oxytocin release to contract the mother’s
uterus and control bleeding
• Galactogogues
• Mothers from many cultures use galactogogues (breast milk
stimulators), and nurses should be aware of these practices.
• Beer, brewer’s yeast, rice, gruel, fenugreek tea, and sesame tea
are commonly used postpartum.
• Garlic eaten by the mother to prevent newborn illness will flavor
her breast milk but will not harm the newborn.
• Cultural practices should be respected.
• Galactogogues
• Mothers from many cultures use galactogogues (breast milk
stimulators), and nurses should be aware of these practices.
• Beer, brewer’s yeast, rice, gruel, fenugreek tea, and sesame tea
are commonly used postpartum.
• Garlic eaten by the mother to prevent newborn illness will flavor
her breast milk but will not harm the newborn.
• Cultural practices should be respected.
• Essential Techniques in Breastfeeding

• • Proper body alignment of newborn

• • Newborn’s mouth is wide open for areola grasp
• • Proper hand position of mother on breast
• • Newborn’s mouth moves in rhythmic motion to compress areola
• • Audible swallow is heard
• • Mother is in relaxed, supported position
• • Room is warm and private
• • Newborn ends feeding relaxed and appears satiated
• • Mother has soft, non-engorged breasts at end of feeding
• Evaluating the Intake of the Newborn
• Signs that breastfeeding is successful include the following:
• • Breast feels firm before feedings and softer after.
• • Let-down reflex occurs – a tingling sensation, with milk dripping from the
breasts – when a feeding is due.
• • Newborn nurses at the breast for 10 to 15 minutes per breast 8 to 10 times
a day.
• • An audible swallow is heard as the newborn sucks.
• • Newborn demands feeding and appears relaxed after feeding.
• • Newborn has six to eight wet diapers per day.
• • Newborn passes stool several times a day.
• Recognizing Hunger in Newborns
• • Hand-to-mouth movements
• • Mouth and tongue movements
• • Sucking motions
• • Rooting movements
• • Clenched fists
• • Kicking of legs
• • Crying (a late sign of hunger; may result in shut-down and poor
feeding if needs are not met)
• The baby-friendly hospital

• A baby-friendly hospital initiative was launched in 1991 by the United

Nations Children’s Fund (UNICEF) and the World Health Association (WHO)
with the goal of supporting and promoting breastfeeding.
• A baby-friendly hospital is defined as a facility that meets specific criteria
and has been recognized by external assessment (Tran, 2017).
• The baby-friendly hospital
• To be recognized as a baby-friendly hospital, a hospital must meet the following
criteria:
• 1. The hospital must have a written breast-feeding policy and must teach related
skills to staff.
• 2. Parents are educated concerning the values and techniques of breastfeeding
before and after delivery.
• 3. Breastfeeding is initiated in the delivery room or is maintained if the mother and
newborn are separated.
• 4. The newborn is fed only breast milk, and feeding on demand is encouraged.
• 5. Mother and newborn room-in 24 hours a day. No pacifiers or artificial nipples are
used.
• 6. Formula samples are not distributed at discharge, and referral to support groups is
offered.
• The sleepy newborn
• Some newborns are sleepy and need to be awakened for feedings until a routine of
feeding on demand is established.

• The fussy newborn

• Some newborns awaken from sleep crying lustily, eliminating the opportunity to
observe for early cues of hunger

• Supplemental feedings and nipple confusion

• Supplemental feedings of formula or water should not be offered to the healthy
newborn who is breastfeeding.
• Breast engorgement
• Early, regular, and frequent nursing helps to prevent breast
engorgement. If engorgement does occur and the breast and areola are
very tense and distended, the mother can pump her breasts to get the
milk flow started and soften the areola. She may use a breast pump or
manual expression of milk. Cold applications between feedings and heat
just before feedings may help to reduce discomfort and engorgement.

• Nipple trauma
• Cracks, blisters, redness, and bleeding may occur. Correct positioning of
the newborn is the best preventive measure. Feeding formula at this
time can worsen the trauma and pain; it is likely to cause engorgement
because less milk is removed. Warm water compresses applied to the
breasts offer some relief. Rubbing a small amount of breast milk into the
nipples may aid healing.
• Special breast-feeding situations
• Multiple Births
• The mother’s body adjusts the milk supply to the greater demand of multiple newborns.
Twins can be fed one at a time or simultaneously. The mother may want to use the
crisscross hold when nursing simultaneously.
• Premature Birth
• Breastfeeding is especially good for a preterm newborn because of its immunological
advantages. If the newborn cannot nurse, the mother can pump her breasts and freeze
the milk for gavage (tube) feedings. When nursing the preterm or small newborn, the
mother may prefer the cross-cradle hold. She holds the newborn’s head with the hand
opposite the breast that she will use to nurse.
• Breast Surgery
• Previous breast surgery for breast augmentation or reduction may influence successful
breastfeeding if the incision was around the areola of the breast, as nerves or lactiferous
ducts may be damaged. A silicone breast implant does not negatively influence
breastfeeding
• Storing and freezing breast milk
a. Breast milk should be used or stored within 1 hour of pumping to avoid the
potential for bacterial contamination.
b. Milk may be safely stored in glass or hard plastic. Leukocytes may stick to the
glass, but they are not destroyed.
c. Milk can be thawed in the refrigerator for 24 hours (best to preserve
immunoglobulins) or by holding the container under running lukewarm water
or placing it in a container of lukewarm water, rotating (not shaking) the bottle
often.
d. Milk can be stored at room temperature for 4 to 6 hours in a tightly capped
container, or in the back of the refrigerator (4° C [39° F]) up to 96 hours (4 days)
without significant changes occurring. It can be stored in the freezer section of
the refrigerator for up to 2 weeks, or in a deep freezer (− 4° C [− 18° F]) for up to
6 months.
• Maternal nutrition
• To maintain her own nutrient stores while providing for the infant, the
mother needs approximately 500 additional calories each day beyond what
her nonpregnant diet provided.
• She should choose foods from each of the following groups in the MyPlate
food guide:
• • Meat, fish, poultry, eggs, beans, and nuts
• • Milk and other dairy products
• • Vegetables
• • Fruits
• • Breads, cereals, and grains
• Weaning
• Gradual weaning is preferred to abrupt weaning, which can cause engorgement, can lead to mastitis, and
can be upsetting to the newborn. There is not a particular “best” time to wean. Even a short period of
breastfeeding provides the newborn with many immunological and digestive advantages.
• The nurse can teach mothers the following tips when they want to wean their newborns:
• Eliminate one feeding at a time. Wait several days and eliminate another one. The
young newborn will need formula from a bottle; the older newborn may be weaned from
the breast to a cup.
• • Omit daytime feedings first, starting with the one in which the newborn is least
interested.
• • Eliminate the newborn’s favorite feeding last. This will often be the early morning or
bedtime feeding.
• • Expect the newborn to need “comfort nursing” if he or she is tired, ill, or
uncomfortable.
• • If the mother must wean abruptly for some reason, breast engorgement is likely to
occur. A supportive bra, ice packs, analgesics, or cabbage leaves applied to the breasts
may relieve discomfort.
• Formula feeding
• Women choose to formula feed for many reasons.
• A. Some are embarrassed by breastfeeding or may have little social support.
B. Others are uncomfortable when they cannot see the amount of milk the
newborn takes at each feeding.
• C. Women who have many other commitments and cannot maintain the
flexibility needed when lactation is established may find that formula
feeding is the only realistic choice.
• D. A few women must take medications or may have other illnesses that
make breastfeeding unwise.
• Common formulas are available in three forms:

• • Ready-to-feed, either in cans or in glass bottles

• • Concentrated liquid
• • Powdered
• Ready-to-feed formulas require no dilution. Diluting them with water
reduces the amount of nutrients the infant receives and can be dangerous.
Ready-to-feed formula for home use comes in bottles and cans. The mother
should wash the can’s lid and open it with a freshly washed can opener. She
then pours the approximate amount the infant will take at a feeding into a
bottle and caps the bottle.
• Concentrated liquid formula also comes in a can. After washing the can and
opening it, the mother pours recommended proportions of concentrated
liquid formula and tap water into the bottles and caps them. The usual
proportions are one part concentrated liquid formula plus one part tap
water. Water for formula dilution does not need to be boiled unless its safety
is questionable. Well water, natural spring water, and natural mineral water
should not be used for formula preparation due to the mineral sodium or
nitrate content.
• Powdered formula is a popular choice for nursing mothers who want to feed
their infant an occasional bottle of formula. It is also less expensive than
ready-to-feed liquid formulas. The parent measures the amount of tap
water into the bottle and adds the number of scoops recommended for that
quantity. Sterilization is not required unless the quality of the water is in
doubt.
• Bottle Feeding the Newborn
• Purpose
• To provide necessary nutrients for growth and development
• Steps
• 1. Wash hands.
• 2. Identify newborn.
• 3. Verify formula prescribed and expiration date on the bottle.
• 4. Change diaper and provide cord care.
• 5. Wash and sanitize hands.
• 6. Select an appropriate nipple. Crosscut nipple offers rapid feedings; single-hole nipple
offers regular milk flow; preemie nipple offers softer nipple that requires less sucking
effort from the newborn.
• 7. Open bottle (you should hear a “pop” to indicate bottle was previously unopened);
place selected nipple on the bottle and tighten securely. Use room-temperature formula.
• Bottle Feeding the Newborn
• 9. Touch newborn’s lips with nipple and gently insert nipple along newborn’s tongue.
Hold bottle so nipple is always full of formula.
• 10. Feed newborn slowly. Stop to “burp or bubble” newborn after feeding 1 to 1.5 ounces
(30 to 45 mL) and at end of feeding.
• 11. If formula runs out of the side of the mouth during newborn feeding, the nipple holes
may be too large. The nipple should be discarded and replaced with a different one.
• 12. To burp the newborn, sit the newborn on your lap with his or her body leaning slightly
forward. Support the head and gently pat the middle or upper back.
• 13. Place the newborn in the crib on his or her side or back after feeding.
• 14. Leftover formula should be discarded, because microorganisms from the newborn’s
mouth grow rapidly in warm formulas.
• 15. Document the amount taken; type of formula; any regurgitation; sucking strength;
and parent teaching that was provided.
• Newborn discharge care
• Discharge planning for the newborn begins at birth. Because of short stays after birth,
the nurse must teach the parents how to care for their newborn at every opportunity.
Discharge teaching will then be more of a summary than an attempt to crowd all
teaching into a short time. Most newborns are checked by a health care professional at
birth and before discharge. The newborn is assessed at this early check for jaundice,
feeding adequacy, urine and stool output, and behavior. If the newborn is discharged
before 72 hours of age, the AAP recommends that a follow-up visit be scheduled within 2
days of discharge to assess the newborn for jaundice, because the bilirubin level usually
peaks between 3 and 5 days of age.
• Newborn discharge care

• Newborns are usually seen again at 6 to 8 weeks after birth to begin well-baby care.
When providing discharge teaching, the nurse should emphasize the value of these visits.
It should be explained that immunizations can be administered to prevent many
illnesses. The health care provider assesses the newborn for growth and development,
nutrition, and any problems the parents or newborn are having. Teaching parents about
the newborn’s upcoming needs (anticipatory guidance) helps them to plan ahead to
prevent injuries and to promote healthy growth and development.