Immediate Care of the Newborn at the Delivery Room
1. Establishment of the respiration
a. With head extension, clear the mouth and nose to prevent meconium aspiration
b. After expulsion
• Place on slight Trendelenburg position (10-15 degree angle) to drain secretions
• Suction briefly:gently from the mouth to the nose, bulb syringe for shallow suctioning
2. Keep warm
a. Dry and wrap newborn to prevent heat loss
b. The newborn’s high temperature at birth is 36.5-37.2C
c. Drops quickly at birth because of losing heat by the process of:
*evaporation
*conduction
*convection
*radiation
3. APGAR Scoring
A score is given for each sign at one minute and five minutes after the birth. If there are problems with the baby an additional score is given at 10 minutes. A score of 7-10 is considered normal, while 4-7 might require some resuscitative measures, and a baby with apgars of 3 and below requires immediate resuscitation.
Sign 0 Points 1 Point 2 Points
A Activity (Muscle Tone) Flaccid Some flexion Well flexed
P Pulse Absent Below 100 bpm Above 100 bpm
G Grimace (Reflex Irritability) No Response Grimace Sneeze, cough, pulls away
A Appearance (Skin Color) Blue-gray, pale all over Acrocyanosis Completely pink; ruddy
The Term Paper on Neurological Disorders Of The Newborn
When anyone plans on having a baby, one of the first things that comes to mind is the hope that the child will be born healthy. It is a perfectly reasonable desire, but what happens when the child is born with a neurological disorder? Neurological disorders in infants are a major concern in today’s society and methods of treatment need to be developed further. This paper will discuss some of the ...
R Respiration Absent Slow, irregular (60 breaths per minute)
Silverman-Anderson Scoring System
Score 0 1 2
• Chest movement synchronized lag on inspiration see-saw movement
• Intercostal Retractions none just visible marked
• Xyphoid Retractions none just visible marked
• Nasal Flaring none minimal marked
• Expiratory Grunting none stethoscope only naked eye and ear
0-no respiratory distress
4-6-moderately depressed
7-10-severely depressed
4. Proper Identification
a. Bracelets foot tags can be used
b. FOOTPRINTING- best way to identify
c. Identification is done before baby is separated to mother
5. Check for:
a. Gestational age
b. Birth injuries
c. Congenital defects
d. Gross anomalies
In most health care facilities, the delivering physician or nurse-midwife hands the newborn to the nurse moments after birth to begin care. Be certain to don gloves to care for newborns to avoid touching the vernix caseosa as part of following universal precautions. Holding a warm, sterile blanket, grasp the infant through the blanket by placing one hand under the back and other around a leg. Newborns are slippery because they are wet from amniotic fluid and the vernix.
Keep Newborn Warm
• Rub infants dry so that little body heat is lost by evaporation. Then swaddle them loosely with the blanket in order that respiratory effort is not compromised, and lay them on their side in warmed bassinet or unwrapped on a radiant heat table. To help conserve heat, place a cap on the infant’s head and be certain all nursing care is accomplished as quickly as possible, with minimal exposure of the newborn to chilling air. Any extensive procedures, such as resuscitation, should be done under a radiant heat source to reduce heat loss.
• As soon as it is apparent the infant is breathing well, ask which parent wants to hold the child and place him or her in the parent’s arm. This helps conserve heat as well as encourage bonding. If a mother wishes to begin breastfeeding immediately after birth, she can be encouraged to do so.
• Reassess a newborn’s temperature. Axillary temperatures are recommended for newborns to prevent bowel perforation. During the first day of life, a newborn’s temperature is usually taken every 4 hours. Thereafter, unless it is elevated or subnormal, or the infant appears to be in distress, once a day while in a health care facility is enough.
The Term Paper on Sudden Infant Death Syndrome
Sudden Infant Death Syndrome Sudden infant death syndrome (SIDS) is an incident of sudden and absolutely unpredictable death, mostly during sleep, of an apparently healthy infant under one year. SIDS is also called as crib death or cot death, and it may become a subject of real fear for parents of a little baby. SIDS happens with one baby per 500 and remains the leading reason of infant death in ...
Promote Adequate Breathing Pattern and Prevent Aspiration
• Mucus should be suctioned from a newborn’s mouth by a bulb syringe as soon as the head is born. As soon as the baby is born, he or she should be held for a few seconds with the head slightly lowered for further drainage of secretions. It is important that mucus be removed from the mouth and pharynx before the first breath to prevent aspirations of the secretions.
• When an infant is born with meconium-stained amniotic fluid, it is important that the infant be not only suctioned but also intubated so that deep tracheal suction can be accomplished before the first breath. This action prevents meconium, which is very irritating to lung tissue from being drawn into the lungs with the first breath.
Record the First Cry
• A crying infant is a breathing infant, because the sound of crying is made by a current of air passing over the larynx. Vigorous crying also helps to blow off the extra carbon dioxide that makes all newborns slightly acidotic and thus helps to correct this condition. Although gentleness is necessary to make an infant’s transition from intrauterine life to extrauterine life as untraumatic as possible.
• It is important to note what time of after birth the child first grasped and cried and whether he or she was able to maintain respirations unaided. The newborn who does not breathe spontaneously or who takes a few quick gasping breaths but is unable to maintain respirations needs resuscitation as an emergency measure. An infant with grunting respirations needs careful observation for respiratory distress syndrome.
Inspect and Care for umbilical cord
• The umbilical cord pulsates for a moment after the infant is born as a last flow of blood passes from the placenta into the infant. Two Kelly clamps are then applied to the cord about 8 in from the infant’s abdomen, and the cord is cut between the clamps. The infant cord is then clamped again by cord clamp, such as Hazeltine or a Kane clamp. The Kelly clamp on the maternal end of the cord should not be released after cord cutting; otherwise, blood still remaining in the placenta will leak out. This loss is not important, because the mother’s circulation does not connect to the placenta.
The Term Paper on Infant and Child Development
This assignment will critically review Howlett, Kirk and Pine’s (2011) study, which aims to investigate whether attendance of gesturing classes affects parental stress. Howlett et al. , (2011) attempt to examine claims, advertised by commercial products, that believe attending gesturing classes can improve child-parent communications, thus reducing parental stress. Participants gave demographic ...
• Inspect the infant’s cord to be certain it is clamped securely. If the clamp loosens before thrombosis obliterates the umbilical vessels, hemorrhage will result. The number of cord vessels should be counted and noted immediately after cutting of the cord. Cords begin to dry almost immediately, and by the time of the infant’s first thorough physical examination in the nursery, the vessels may be obscured.
• Within a few minutes after the cord is cut, assess the cord for possible bleeding; apply antibiotic ointment or triple dye as required by agency policy to help reduce infection. Until the cord falls off, at about 7th to 10th day of life, the infant should be sponge bathed rather than immersed in a tub of water. Be certain the diaper is folded below the level of the umbilical cord so that when it becomes wet, the cord does not become wet also.
• After the cord falls off, a small, pink, granulating area about a quarter of an inch in diameter may remain. This should also be left clean adn dry unitl it has healed (about 24 to 48 hours).
If it has remained as long as a week, it may require cautery with silver nitrate to speed healing.
Administer Eye Care
• Although the practice may shortly become obsolete, every state requires newborns receive prophylactic treatment against gonorrheal conjunctivitis of the newborn. Such infections are acquired from the mother as the infant passes through birth canal.
• Silver nitrate is the drug that was exclusively used for prophylaxis in the past; today, erythromycin ointment is the drug of choice. Erythromycin ointment has the advantage of eliminating not only the organism of gonorrhea but that of chlamydia as well.
• To instill ointment, the face of the newborn should be dried first with a soft gauze square so that the skin is not slippery. The best procedure to open a newborn’s eyes is to shade them from the overhead light and open one eye at a time by pressure on the lower and upper lids. Use an individual tube or package of ointment to avoid transmitting infection from one neworn to another. With one eye open, squeeze a line of ointment along the lower conjunctival sac from the inner canthus outward, then close the eye to allow the ointment to spread across the conjunctiva
The Term Paper on Respiratory Distress in Newborn
Respiratory problem are often the case in newborns. It accounts for nearly half of neonatal deaths. Research by Kumar & Bhat (1996, p. 93) states that Respiratory Depression (RD) is a common neonatal problem that generally occurs in preterm infants due to surfactant deficiency which relates to antenatal history of immature lung development and term infants of diabetic mothers. To describe some ...
http://www.scribd.com/doc/16221362/Immediate-Care-of-the-Newborn
Cervix
Immediately after birth, a uterine cervix is soft and malleable. Both the internal and external os are open. Like contraction of the uterus, contraction of the cervix toward its prepregnant statebegins at once. By the end of 7 days, the external os has narrowed to the size of a pencil opening; the cervix feels firm and nongravid again.
In contest to the process of involution, in which the changes consist primarily of old cells being returned to their former position by contraction, the process in the cervix involves the formation of new muscle cells. Like the fundus the cervix does not return to its prepregnancy state. The internal os closes as before, but after the vaginal birth the external os usuallyremains slightly open and appears slitlike or stellate (star shaped), whereas previously it was round.
Vagina
After a vaginal birth, the vagina is soft, with few rugae, and its diameter is considerably greater than normal. The hymen is permanently torn and heals with small, separate tags of tissue. It takes the entire postpartal period for the vagina to involute (by contraction, as with the uterus) until it gradually returns to it approximate prepregnancy state.
Perineum
Because of the great amount of pressure experienced during birth, the perineum feels edematous and tender immediately after birth. Ecchymosis from ruptured capillaries may show on the surface. The labia majora and labia minora typically remain atrophic and softened after birth, never returning to their prepregnancy state.
Systemic Changes
The same body systems thatvwere involved in pregnancy are also involved in postpartal changes as the body returns to its prepregnancy state.
Hormonal System
Pregnancy hormones begin to decrease as soon as the placenta is no longer present. Levels of human chorionic gonadotropin (hCG) and human placental lactogen (hPL) are almost negligible by 24 hours. By week 1,progestin, estrone,and estradiol are all at prepregnancy levels. Estrol may be elevated for an additional week before it reaches prepregnancy levels. Follicle-stimulating hormone (FSH) remains low for about 12 days and then begins to rise as a new menstrual cycle is initiated.
The Term Paper on Abraham Lincoln 5 Border State
Lincoln, Abraham, 16 th president of the United States, who steered the Union to victory in the American Civil War and abolished slavery. Lincoln was born on February 12, 1809, near Hodgenville, Kentucky, the son of Nancy Hanks and Thomas Lincoln, pioneer farmers. At the age of two he was taken by his parents to nearby Knob Creek and at eight to Spencer County, Indiana. The following year his ...
