Chapter 20: The Healthy Newborn

1. Canadian Maternity, Newborn, and Women’s Health Nursing Chapter 20:The Healthy Newborn

2. From Fetus to Newborn • Review of fetal circulation • During fetal life: fetal lungs; two shunts in fetal heart; resistance to blood flow; fetal circulation functions; blood passes through foramen ovale and ductus arteriosus to the fetal aorta; adult PVR low

3. From Fetus to Newborn (cont’d) • Respiratory and circulatory transitions at birth • Respiration: vaginal birth; clamping of umbilical cord; temperature; normal handling and drying • Clear airways: first breaths strong enough to move thick fluids; surfactant deficiency; crackles audible in newborn’s lungs • Blood circulation: foramen ovale; rising oxygen levels

4. Immediate Nursing Management of the Newborn • Prenatal and intrapartal history • Assess prenatal and intrapartal history • Anticipate risk factors • Prepare for resuscitation • Assess during newborn’s first moments

5. Immediate Nursing Management of the Newborn (cont’d) • Immediately after vaginal birth • Provide warmth, clear the airway, and dry the baby quickly and thoroughly • Skin-to-skin contact preferred to maintain warmth

6. Immediate Nursing Management of the Newborn (cont’d) • Immediately after cesarean birth • Follow regular resuscitation and admission procedures • Immediately receive newborn at the radiant warmer; suction, dry, and position baby for further assessment • Apgar scoring

7. Collaborative Care: Immediate Newborn Care • Assessment • Select potential nursing diagnoses • Planning/intervention • Evaluation

8. Early Newborn Care Procedures • Identification • Weight • Measurements • Gestational age assessment • Infant classification • First bath • Medication administration • Full physical examination

9. The Newborn Transitional Period • Behavioural changes • Behavioural states • Behavioural cues • Neonatal sensory abilities • Physiologic adaptations • Thermoregulation • Glucose metabolism

10. The Newborn Transitional Period (cont’d) • Physiologic adaptations (cont’d) • Hematopoietic system • Hepatic system • Gastrointestinal system • Immunologic system • Integumentary system • Renal system

11. The Newborn Transitional Period (cont’d) • Promoting normal transition • Gentle handling • Use of containment • Avoidance of gastric suction • Use of ambient or dim light • Use of axillary temperature

12. The Newborn Transitional Period (cont’d) • Differentiating normal versus abnormal transition • Well newborn:no history of prenatal or intrapartal risk factors • Sick newborn: clear risk factors related to gestational age, size for gestation, and prenatal and/or intrapartal history • At-risk newborn: risk factors related to size for gestation and prenatal and intrapartal history

13. The Newborn Transitional Period (cont’d) • Signs of abnormal newborn transition • Respiratory distress: most common manifestation of abnormal transition • Signs of normal transition • Respiratory distress: expiratory grunting, nasal flaring, and retracting—mild and intermittent—unaccompanied by pallor, heart murmur, lethargy; resolve in first 30 to 60 minutes of life

14. Collaborative Care: The Transitional Period • Assessment • Assess axillary temperature • Assess for jaundice • Document medical record • Notify pediatric provider

15. Collaborative Care: The Transitional Period (cont’d) • Select potential nursing diagnoses • Risk for injury • Risk for imbalanced body temperature • Risk for infection • Risk for impaired skin integrity • Risk for deficient/excess fluid volume

16. Collaborative Care: The Transitional Period (cont’d) • Planning/intervention • Never leave a newborn exposed • Promote thermoregulation • Be aware of prenatal and intrapartal risk factors • Encourage early and effective feeding • Recommend follow-up examination in home or clinic

17. Collaborative Care: The Transitional Period (cont’d) • Evaluation • Axillary temperature range • Maintain newborn with a stable temperature • Maintain blood glucose level of at least 2.5 mmol/L • Document results of bedside screening and laboratory tests

18. Ongoing Assessments • Assess the newborn’s resting position, respiratory status, colour, and state • Record assessments of vital signs and indicators of well-being • Describe interventions and their associated outcomes • Note variations on infant hospital flow sheets

19. Basic Care of the Healthy Newborn • Cultural aspects • Care of the newborn following home birth • Infant security • Temperature assessment • Use of the bulb syringe • Voiding and stools • Diapering • Cord care • Clothing

20. Basic Care of the Healthy Newborn (cont’d) • Wrapping • Holding • Comforting • Parental stress • Sleep positioning and sudden infant death syndrome (SIDS)

21. Basic Care of the Healthy Newborn (cont’d) • Bathing the newborn • Sponge bathing • Never leave the infant alone • Avoid lotions, oils, and talcum powders • After the initial bath, soap rarely needed • Parents must file their fingernails

22. Additional Parent Education • Circumcision • Surgical removal of the foreskin from the end of the penis • Surgical consent is required; risk for bleeding and infection exists • Additional analgesic interventions • Swaddling and padding • Sucrose pacifier • Postoperative care

23. Additional Parent Education (cont’d) • Immunizations • Adverse or allergic reaction may result • Reasons for delay or decision not to give a child a hepatitis B vaccination: • Child has severe allergy to baker’s yeast; life-threatening reaction from previous dose; moderate or severe illness on the day of vaccination

24. Additional Parent Education (cont’d) • Signs of newborn illness • Respiratory distress; abdominal distention • Forceful vomiting that shoots out several inches • Muscle weakness; jitters of the whole body • Watery white or mucus discharge; sticky eyelashes; eye discharge

25. Additional Parent Education (cont’d) • Car seats • Nurse’s role: • Offer advice; provide teaching on safety of the newborn in the car • Provide verbal instructions to parents • In some facilities, nurses play an active role: they place car seat in vehicle and place the infant in the car seat

26. Additional Parent Education (cont’d) • Siblings • Toddlers • Feel jealous and displaced by the new baby; may seek attention by misbehaving or displaying regressive behaviours • Preschoolers • Parents should include preschoolers in preparations for the newborn

27. Additional Parent Education (cont’d) • Siblings (cont’d) • School-age children and adolescents • Parents should schedule special time alone with older siblings, reassuring them with plenty of love and attention • Pet safety • Parents should prepare pets for a new baby’s arrival • Pet may feel jealous and misbehave or act aggressively toward other pets

28. Additional Parent Education (cont’d) • Dangers of secondhand smoke • Passive smoking is harmful to children’s respiratory health; it increases rates of lower respiratory illness, middle ear effusion, asthma, SIDS, and development of cancer in adulthood • Precautions help protect the baby’s health

29. Readiness for Hospital Discharge • Newborn metabolic screening • Purpose: prevent complications of genetic diseases; early identification and treatment • Nurse should understand that metabolic screening tests are not diagnostic • Newborn metabolic screening tests occur before hospital discharge

30. Readiness for Hospital Discharge (cont’d) • Auditory screening • Various causes of hearing loss • Heredity • Very low birthweight • Congenital infections • Ototoxic drugs • Bacterial meningitis

31. Readiness for Hospital Discharge (cont’d) • Post-discharge follow-up • Any newborn discharged before 48 hours of age must be examined again within 48 hours • Frequency of subsequent visits varies for healthy term newborns • Every province mandates healthcare professionals report suspected child abuse • Immunizations are administered according to the childhood immunization schedule

32. Question • Is the following statement true or false: • The acronym APGAR for newborn assessment stands for: • A: Alertness • P: Pulse • G: Gage • A: Activity • R: Respiration

33. Answer False. • APGAR stands for: • A: Appearance (colour) • P: Pulse (heart rate) • G: Grimace (reflex irritability) • A: Activity (muscle tone) • R: Respiration (respiratory effort)

34. Question • Which of the following statements regarding fetus to newborn respiratory and circulatory transitions is not true? • a) Rising oxygen levels cause the foramen ovale to begin to constrict and functionally close by 96 hours of life. • b) Newborns have audible crackles for a short time after birth. • c) Surfactant is essential to normal lung function. • d) Clamping of the umbilical cord causes rapid changes in pulmonary vascular resistance and systemic vascular resistance.

35. Answer a) Rising oxygen levels cause the foramen ovale to begin to constrict and functionally close by 96 hours of life. • Rising oxygen levels cause the ductus arteriosus to begin to constrict almost immediately after birth of a healthy newborn. In most cases, the ductus arteriosus is functionally closed by 96 hours of life.

36. Question • Is the following statement true or false: • Immediately following a vaginal birth, the nurse should not take the healthy newborn to a radiant warmer or another location for observation and admission.

37. Answer True. • Taking a healthy newborn immediately to a radiant warmer or other location for observation and admission is outmoded and hinders attachment. • The nurse can place the baby directly on the mother’s abdomen or chest, covering both with a dry, warm blanket.