Maternal & Newborn Nursing

THE NEW BORN

A. CARE OF THE NEWBORN IN THE DELIVERY ROOM

1. Maintain patent airway a. Drain secretions
   • Put the baby in a trendelenburg position for drainage except when signs of increase ICP are observed: bulging fontanel's, high-pitched cry (earliest sign), vomiting (surest sign), increase BP, decrease PR, decrease RR. b. Suction newborn
   • Suction the mouth first before the nose to prevent aspiration
   • Suctioning should be gentle to prevent laryngospasm
   • It should not be more than 1 minute otherwise, it will stimulate vagus nerve causing bradycardia.
   • Occlude one nostril at a time to test for patency since newborns are nasal breathers c. Observe characteristics of respirations

2. Administer oxygen as needed
   • Oxygen concentration should be <40% to prevent retinal scarring which may lead to blindness (retrolental fibroplasia).
   • Oxygen is best administered thru a tent
3. Keep the newborn warm
   • The body temperature of the newborn at birth is 37.2 C (99 F). Shortly after birth, it falls below normal because of the immature temperature-regulating mechanism and heat loss. In addition, the cold temperature of the delivery room contributes to this.
   • A newborn losses heat thru the following mechanisms:
     • Conduction: heat is transferred to a cooler solid object in contact with the body
     • Convection: heat flows from the body surface to a cool surrounding air
     • Evaporation: heat loss thru conversion of liquid to vapor (wet skin).
     • Radiation: heat is transferred to a cooler solid object but not in contact with the body

• Subcutaneous fats to act as insulators. Shivering is also not present at birth because of this, they are prone to cold stress which may cause metabolic acidosis as fatty acids accumulate due to the breakdown of brown fat
• Dry newborn immediately
• Wrap in a blanket
• Place under a radiant warmer or isolette with a temp of 33-34 C.
• Place under a droplight which should be 12-18" far from the newborn

4. Take the Apgar score

• Done at 1 minute after birth to know the conditions of the newborn. Then at 5 minutes after to determine how well the newborn is adjusting to extra uterine life.

Administer Vitamin K Vitamin K is normally synthesized in the presence of bacterial flora in the intestines. Since newborn's intestines are still sterile, Vitamin K is administered to facilitate production of clotting factor thus, preventing hemorrhage. Vitamin K (1 mg) is injected into the vastus lateralis (IM). This site is preferred because gluteal muscles of children below 12 months who have not yet learned how to walk are still not fully developed.