Chapter 18 Nursing Management of the Newborn

Typically newborns are classified according to gestational age as:

-Preterm or premature: born prior to 37 completed weeks' gestation, regardless of birth weight. -Term: born b/w 38 and 42 weeks' gestation -Postterm or postdates: born after completion of 42 weeks gestation. -Postmature: born after 42 weeks and demonstrating signs of placental aging.

What two medications are commonly ordered during the immediate newborn period?

1. vitamin K (The AAP recommends that vitamin K be administered to all newborns soon after birth in a single intramuscular dose of 0.5-1 mg). 2. eye prophylaxis with either erythromycin or tetracycline ophthalmic ointment (Erythromycin 0.5% ophthalmic ointment or tetracycline 1% ophthalmic ointment in a single application is given within an hour or two of birth)

Newborn VS: HR/Pulse

110-160; can increase to 180 during crying

Newborn VS: Respirations

30-60 breaths/min at rest; will increase with crying

Newborn VS: BP

50-75 mm Hg systolic; 30-45 mm Hg diastolic BP is usually not assessed unless there is a clinical indication or low Apgar scores. If assessed, an oscillometer is used.

How is length of a newborn measured?

A disposable tape measure or a built-in measurement board is located on the side of some scales can be used. Length is measure from the head of the newborn to the heel with the newborn unclothed. Place the newborn in a supine position and extend the leg completely when measuring length. Expected range of length of a full-term newborn: usually 17-22 inches. Average length: 20 inches

What happens immediately after birth to maintain air patency?

A newborn is suctioned to remove fluids and mucus from the mouth and nose. Typically the mouth is suctioned first with a bulb syringe then the nose to prevent aspiration of fluid into the lungs by an unexpected gasp.

Apgar parameters and scoring:

A: Appearance (color) P: Pulse (HR) G: Grimace (reflex irritability) A: Activity (muscle tone) R: Respiratory (respiratory effort) Each parameter is assigned a score ranging from 0-2 points. A score of 0 points indicates an absent or poor response; a score of 2 points indicates a normal response. A normal newborn's score should be 8-10 points. The higher the score indicates the better condition of the newborn.

When is the Apgar assessment performed?

At 1 minute and 5 minutes after birth; and additional Apgar assessment is done at 10 minutes if the 5-minute score is less than 7 points.

How often are VS obtained in newborn?

Generally VS are taken: -On admission to the nursery or in the labor and birth room after the women/parents are allowed to hold and bond with newborn. -Once every 30 minutes until newborn has been stable for 2 hours. -Then once every 4-8 hours until discharge.

Why is the gestation age assessment important?

It allows the nurse to plot growth parameters and to anticipate problems related to prematurity, postmaturity, and growth abnormalities.

Newborns can be classified by their birth weight regardless of their gestational age:

Low birth weight: >2500 g or >5.5 lb Very low birth weight: >1500 g or >3.5 lb Extremely low birth weight: >1000 g or >2.5 lb

How is head circumference measured?

Measure the circumference at the head's widest diameter (the occipitofrontal circumference). The average newborn head circumference is; 13-15 inches. Head circumference may need to be remeasured at a later time if the shape of the head is altered from birth.

Why is vitamin K given to newborns?

Newborns are at risk for vitamin K deficiency and subsequent bleeding. Vitamin K promotes blood clotting by increasing the synthesis of prothrombin by the liver. A deficiency delays clotting and might lead to hemorrhage. The bacteria of the intestine produce vitamin K in adequate quantities; however, the newborn's bowel is sterile so vitamin K is not produced in teh intestine until after microorganisms have been introduced such as the first feeding.

How is weight of a newborn measured?

Newborns are weighed using a digital scale that reads in grams. The term newborn weighs in a range of: 2500-4000 g or 5 lb 8 oz to 8 lb 14 oz. Average weight: 7.5 lb

Newborn VS: Temperature

Normal axillary temp: 97.7-99.5°F

How is the HR obtained?

Obtain an apical pulse by placing the stethoscope over the fourth intercostal space on the chest and listen for a full minute. Note rate, rhythm, and abnormal sounds such as murmurs. The HR is 120-160 typically. Sinus arrhythmia is a normal finding.

How is chest circumference measured?

Place a flexible or paper tape measure around the unclothed newborn's chest just below the nipple line without pulling it taut. Average chest circumference: 12-14 inches (30-36 cm); generally equal to or about 2-3 cm less than head.

RAPP

The RAPP assessment provides a method to swiftly evaluate the newborns condition so that decisions can be made regarding newborn stability. R- Respiratory A- Activity P- Perfusion P- Position

Where does the initial newborn assessment occur?

The initial newborn assessment is completed in the birthing area to determine whether the newborn is stable enough to stay wit the parents or whether resuscitation or other immediate interventions are necessary.

Why is eye prophylaxis administered to a newborn?

To prevent ophthalmia neonatorum which can cause neonatal blindness. Usually contracted during birth when the baby is in contact with vaginal discharge of the mother infected with gonorrhea and chlamydia. Most often both eyelids become swollen and red with purulent discharge.