Care of the Newborn

Newborns are one of the most curious and interesting humans you could ever encounter. They continue to become everyone’s joy wherever they go. As their healthcare provider, we are the ones who handled them primarily the moment they were delivered, so it is up to us to give the best primary care to these little angels before we hand them over to their parents.

Assessment for Well-Being

Assessment of the newborn immediately starts the moment he or she is delivered, and there are a lot of standard assessments used to evaluate them rapidly.

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Apgar Scoring

The Apgar scoring is done during the first 1 minute and 5 minutes of life. The heart rate, respiratory rate, muscle tone, reflex irritability, and the color are evaluated in an infant. Apgar score is the baseline for all future observations.

Indicator 0 1 2
A Activity Absent Flexed arms and legs Active
P Pulse Absent Below 100 bpm Over 100 bpm
G Grimace Floppy Minimal response to stimulation Prompt response to stimulation
A Appearance Blue; pale Pink body, blue extremities Pink
R Respiration Absent Slow & irregular Vigorous cry
  • Each parameter can have the highest score of two and the lowest is 0.
  • The scores of the five parameters are added to determine the status of the infant.

Apgar scoring

  • 0-3 points: the baby is serious danger and need immediate resuscitation.
  • 4-6 points: the baby’s condition is guarded and may need more extensive clearing of the airway and supplementary oxygen.
  • 7-10 points: are considered good and in the best possible health.

Respiratory Evaluation

  • With every newborn contact, respiratory evaluation is necessary because this is the highest priority in newborn care.
  • The Silverman and Andersen index can assess respiratory distress and its varying degrees.
  • There are five criteria to evaluate the newborn: chest movement, intercostals retraction, xiphoid retraction, nares dilatation, and expiratory grunt.
  • The highest score for each criterion is 2, and the lowest is 0.
  • The lowest overall score is 0, which indicates that there is no respiratory distress.
  • A score of 4 to 6 shows moderate distress and 7 to 10 indicates severe distress.
  • The scores of the Silverman and Andersen index are opposite the Apgar scoring.

Physical Examination

  • Physical examination is done to detect any observable conditions and physical defects.
  • This assessment is done quickly by the healthcare provider while noting important findings and at the same time avoids overexposing the newborn.
  • The most important assessment before anything else is the respiratory assessment.
  • The newborn’s height and weight can determine their maturity and establish a baseline data of their height and weight.
  • The newborn is weighed daily at exactly the same time to note any abnormal weight loss or gain.
  • Some of the laboratory tests performed for newborns is the heel-stick test for blood studies.
  • Glucose measurement is also possible through the heel-stick test to detect hypoglycemia.
  • The newborns are also subjected to behavioral capacity assessment where term newborns are physically active and emotionally prepared to interact with the people around them than preterm newborns.

Care of the Newborn at Birth

  • Newborn care is immediately done after birth in a separate space near the birthing area.
  • Equipment such as radiant heat table, warm blankets, resuscitation, eye care, suction, weighing scale and equipment for oxygen administration are already prepared and ready to use.
  • Newborn identification and registration is an important step after the immediate newborn care to avoid switching of babies or kidnapping in the healthcare facility.
  • An identification band is placed around the newborn’s arm or leg which contains the mother’s hospital number, the mother’s full name, sex, date, and time of infant’s birth.
  • The newborn’s footprints are then taken and kept for permanent identification.
  • The birth registration of the infant is taken care of by the physician or nurse-midwife who supervised in the delivery.
  • The mother’s name, the father’s name, and the infant’s name and birthdate, as well as the place, are recorded.
  • The newborn’s chart is also a mine of information when it comes to the newborn’s welfare.
  • Essential information such as the time of the infant’s birth, the Apgar score, eye care given, immunizations, and the general condition of the infant must be reflected on the chart.

Care of the Newborn in the Postpartum Period

  • Newborn care varies among cultures and in some areas in the world.
  • During the initial feeding, a term newborn could be fed immediately after birth while a formula-fed one should be fed at 2 to 4 hours of age.
  • Bathing is done an hour after birth to gently wash away the vernix caseosa, and this is done daily.
  • Areas such as the newborn’s face, skin folds, and diaper area are the areas that need washing regularly.
  • The nurse must supervise the bathing together with the parents.
  • The bath water must be pleasantly warm as well as the room to prevent chilling.
  • Bathing should be before feeding and not after it to prevent aspiration and vomiting.
  • Equipment needed during bathing are a basin of water, washcloth, soap, towel, diaper, a clean shirt, and comb.
  • Start bathing the infant from the cleanest area (the eyes) towards the dirtiest area (the diaper area), and soap is never used for the baby’s face, only for the body.
  • Do not soak the cord when you wash the skin around it.
  • Instruct the parents that the sleeping position of the infant must be flat on the back to prevent SIDS, but never place a pacifier on the infant during sleep.
  • During diaper change, the area must be washed and dried well to prevent diaper rash.
  • Petroleum jelly or a mild ointment is applied on the buttocks to avoid accumulation of ammonia and remove meconium.
  • Vaccination for Hepatitis B and Vitamin K administration is also essential in the postpartal period.

Practice Quiz: Care of the Newborn

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Pharmacology: Anti-infective Drugs and Topical Agents (30 Items)

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Pharmacology: Anti-infective Drugs and Topical Agents (30 Items)

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1. What is the highest priority in newborn assessment?

A. Reflex irritability
B. Breathing
C. Skin color
D. Muscle tone

2. A newborn has an Apgar score of 6. What would be the intervention?

A. Nothing should be done; this is a normal score.
B. The newborn should be placed under a radiant warmer.
C. Newborn needs resuscitation.
D. Newborn’s airway needs to be cleared.

3. Why is it important to assess the newborn’s height and weight?

A. To check if the newborn is adapting well to extrauterine life.
B. To check if the newborn has reached maturity.
C. To establish baseline data.
D. B and C

4. Why is newborn identification and registration essential?

A. So the parents can immediately see the baby.
B. To avoid switching of babies or kidnapping.
C. So it could be recognized as a citizen of the state.
D. To let the nurse identify the babies quickly.

5. When is an appropriate time to bathe the newborn? 

A. Immediately after birth
B. After feeding the newborn
C. Before feeding the newborn
D. Upon discharge

Answers and Rationale

1. Answer: B. Breathing

  • B: In every newborn assessment, respiratory evaluation has the highest priority.
  • A: Reflex irritability can still develop in a newborn.
  • C: Acrocyanosis happens in the first few minutes of life.
  • D: Muscle tone can still develop within the first few hours of life.

2. Answer: D. Newborn’s airway needs to be cleared.

  • D: The newborn may need clearing of the airway with this score.
  • A: A score of 7 to 10 would mean that the newborn is normal and adapting well to extrauterine life.
  • B: This is not a part of the interventions in the Apgar assessment, yet could be useful if the newborn is hypothermic.
  • C: A score of less than 4 means the newborn needs resuscitation.

3. Answer: D. B and C

  • D: Both of these are the reasons why the height and weight of a newborn should be taken after birth.
  • A: Height and weight cannot determine if the newborn is adapting well to extrauterine life.

4. Answer: B. To avoid switching of babies or kidnapping.

  • B: A newborn who is already identified has an identification band with the name on it, avoiding switching of babies in the nursery.
  • A: The baby would be brought to the parents following newborn identification and registration.
  • C: This is only one of the requirements of the state.
  • D: Although this is correct, it is not the main reason for the action.

5. Answer: C. Before feeding the newborn

  • C: To avoid aspiration and vomiting.
  • A: The newborn should be bathed one hour after birth.
  • B: Bathing the newborn after feeding could lead to vomiting or aspiration.
  • D: Waiting to be discharged before bathing the newborn is a long time, the vernix caseosa must be gradually removed through gentle bathing.

The care of the newborn starts at the hand of their healthcare providers and must be transitioned properly to their parents for continuity of care. Appropriate education for the parents and immediate family members regarding the dos and don’ts for newborn care should be included in the discharge plan so that when the newborn is already safe at home, there is a guarantee that they are well-cared for by their family members.

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