The Normal Newborn
The newborn period extends from birth to 4 weeks (28 days). Under the newborn Screening Act (R.A.
9288), the newborn is a child from the time of complete delivery to 30 days old. It is so called the
neonatal stage. The newborn infant is called the neonate.
I. IMMEDIATE CARE IN THE DELIVERY ROOM
A. ESTABLISH RESPIRATION
1. Clear the neonate’s air passages with extension of the fetal head, even before the chest is born.
Rationale: With expulsion, thoracic pressure or ‘squeeze’ is released, causing the newborn to cry; crying
with mucus still in the newborn’s mouth and nose can cause aspiration of mucus and meconium, resulting in
meconium aspiration.
Safety alert: Never stimulate the newborn to cry prior to clearing of his air passages.
2. Wipe off mucus from mouth to nose; suction the mouth gently and then the nose using the bulb syringe.
Rationale: Mouth-to-nose suctioning prevents the stimulation of the sensitive nerve receptors in the nasal
mucosa, which can cause the newborn to gasp for breath, thereby favoring the reflex inhalation of
pharyngeal secretions into the trachea and bronchi causing aspiration. The use of a bulb syringe guarantees
shallow suctioning. Shallow suctioning prevents stimulation of the vagus nerve, which could result in
laryngospasm, bradycardia and even cardiac arrest.
3. Suction briefly. Suctioning time is 5 to 10 seconds in full-term and low-risk newborns and less than 5
seconds in preterm and other high-risk newborns.
Rationale: Brief suctioning prevents breathlessness.
4. After expulsion, place the newborn in a slight Trendelenburg position (10 to 15 degrees angle head down.)
Rationale: The number one reason for proper positioning of the newborn at birth is for the drainage of
nasopharyngeal secretions. This position will also prevent abdominal contents from compressing the
diaphragm, which can compromise breathing.
5. Oxygenate the newborn between suctioning time; suctioning the newborn may necessitate oxygenating
him.
Rationale: Applying oral and nasal suction does not only clear mucus or secretions, but also air, thus the
need to oxygenate in between suctionings. Oxygenation is not routine in the admission care. When properly
used, oxygen may cause retrolental fibroplasia, or neonatal blindness, because of oxygen toxicity.
Asphyxia neonatorum is the failure to initiate breathing in the first 60 seconds of life commonly due to
clogged air passages. In order to prevent and manage asphyxia, ensure a patent air first.
B. KEEP THE NEWBORN WARM
1. Dry and wrap the newborn to prevent heat loss.
Rationale: The newborn’s temperature at birth is even higher than that of his mother’s (which is -37.5°C), but it starts
dropping continuously thereafter.
2. Processes of Heat Loss
a. Evaporation: loss of heat as water evaporates from the infant’s body. To prevent loss of heat by evaporation, dry him
right away at birth.
b. Convection: loss of heat to the cool air. To prevent loss of heat by convection, wrap him and promote flexion to
minimize body surface exposed to cool air, avoid unnecessary exposure when performing procedures.
Adaption/Sign 0 1 2
Heart Rate Absent Slow, less than 100 BPM Over 100 BPM
Respiratory effort Absent Slow, irregular; weak cry Good, lustry
Muscle tone Flaccid, limp Some flexion of extremities Acute flexion; active
movement
Reflex irritability No response Grimace; weak cry Vigorous cry; sneezing
Color Blue, pale Acrocyanosis: body pink, Pink completely
extremities blue
C. Conduction; loss of heat to cool surface in direct contact. To prevent heat loss by conduction, do not
put the newborn on cold, unlined surfaces, such as the weighing scale.
D. Radiation: heat loss due to a cool surfaces not in contact with the body, like wall, floors, ceiling.
Most of the newborns heat is lost by radiation, To prevent heat loss by radiation wrap the infant. The
use of a droplight nearby while rendering the newborn immediate care.
3. There is no shivering in the newborn . When he is exposed to a cold stress , he produces heat by:
a. Burning brown fat- Brown fat is located around the scapula, sternum, kidneys, and adrenals.
This is easily burned and produces a lot of heat in the process.It is a major source of heat production; if
in excess, it may result metabolic acidosis.
b. Increasing activity / metabolism . This process utilizes more oxygen which may result in
respiratory distress and hypoglycemia.
C. Perform Apgar Scoring
1. This is scoring method that gives a numerical expression of the newborns adaptation to extra uterine
life perform at 1 and 5 minutes after birth.
a. 1- minute scoring: detects the cardio-respiratory function of the newborn, his general condition
and need for resuscitation.
b. 5- minute scoring: detects the newborns adjustment to the new environtment; detect prognosis.
IN NURSING CRE PLANNING use the INTERPRETATION of APGAR SCORE
0-3 : Poor
: Needs resuscitation
4-6 : Fair
: May need suctioning and oxygenation
: Condition guarded
8-10 : Good
: No signs of immediate distress
: Needs only admission care, no special care
D. Perform Proper Identification
1. The best way to identify is by means of footprinting of the newborn and fingerprinting of the
mother or ID bands, bracelets or foot tags may be enough. The identification bracelets should contain:
a. mothers name
b.mothers hospital number
c. date and time and sex and name of the attending physician.
