Matching identification (ID) bands are placed on the newborn’s wrist and ankle and the mother’s wrist in the delivery room. In some hospitals, the partner also receives a wrist band with matching numbers. For security reasons, many hospitals have either an umbilical clamp or ID wrist band with an electronic sensor attached that will sound an alarm if the newborn is taken out of the unit (Figure 10-1). The ID band is checked by the nurse and mother at any time the newborn is separated or returned to the mother and before discharge. The nurse and mother verify the ID bands together.

Birth certificates are completed before the infant is discharged or within 48 hours of birth. Birth certificates include vital data concerning the mother and infant that can be used for research and statistical purposes. Valid information can aid in improving public health strategies and formulating public health action plans. Ninety-nine percent of all births were registered on official birth certificates in 1998 (Northam & Knapp, 2006).

Birth certificate information is sent to the Bureau of Vital Statistics via computer. The data recorded on the birth certificate should be reviewed by the health care provider to increase the validity and reliability of information recorded. Birth certificates are required throughout the life of the child for admission to school, employment, travel, and so forth.

Maintenance of temperature—or thermoregulation—immediately after birth is discussed in Chapters 7 and 9. The technique of assessing temperature is reviewed in Chapter 9. Maintenance of a neutral thermal environment after birth aids the infant in achieving thermoregulation. A neutral thermal environment is maintenance of an environmental temperature at which oxygen consumption is minimal but adequate to maintain body temperature (Kenner & Lott, 2007). Strategies to conserve heat and to prevent cold stress in the newborn are important nursing responsibilities. Cold stress is discussed in Chapter 9.

The American Academy of Pediatrics (1997) defines normal rectal or axillary temperatures to be between 36.5° C and 37.5° C (97.7° F and 99.5° F). Hypothermia is classified as mild if the temperature is 36° C to 36.4° C (96.8° F to 97.5° F), moderate at 32.0° C to 35.9° C (89.6° F to 96.6° F), and severe if less than 32.6° C (90.7° F). Newborns are at greater risk for hypothermia than adults are because they have a higher body surface area to body mass ratio, higher metabolic rate with limited metabolic stores, and immature thermoregulation mechanism.

Although hypothermia can be a sign of a central nervous system (CNS) infection or metabolic anomaly, about 20% of all normal newborns are seen with hypothermia, and about 50% of newborns have one or more episodes of hypothermia in the first 72 hours of life (Li, Sun, & Neubauer, 2004). Hypothermia can cause increased cell metabolism, increased oxygen consumption, hypoglycemia, and other complications in the newborn and should be actively prevented. Strategies to conserve heat and to prevent cold stress are important nursing responsibilities.

In phase 1 care, the newborn is placed in a radiant warmer with a temperature probe on the abdomen until body temperature is stabilized. In phases 2 and 3 care, when the newborn is in the nursery or the mother’s room, the baby’s axillary temperature is recorded every 4 hours (see Skill 9-1). The newborn is wrapped warmly and placed in a bassinet. A hat is placed on the newborn’s head to conserve heat because the head has a large surface area, and the newborn is dressed in a shirt and diaper only. When the newborn’s temperature is stabilized, a bath may be given to remove excess blood and vernix. The bath does not need to remove all vernix because it provides some antimicrobial protection. Until the completion of the initial bath, the nurse should wear gloves and a cover gown when handling the newborn (see Appendices A and B). The room temperature should be maintained at 24° C to 25° C (75.2° F to 77° F). The newborn is weighed and measured on admission to the newborn nursery.

Skin-to-skin contact, with the newborn placed on the mother’s naked chest, has been shown to be an effective temperature stabilizer (Galligan, 2006). The infant is covered with a blanket and may wear a hat. Skin-to-skin (kangaroo care) is effective to warm a hypothermic infant when the mother’s temperature is normal, her skin is dry, and she is relatively comfortable (Figure 10-2).

The newborn should receive vitamin K (phytonadione [AquaMEPHYTON] 0.5 to 1 mg) (see Skill 7-8). It is given intramuscularly in the midanterior thigh (the vastus lateralis muscle) where the muscle development is adequate. Because newborns cannot synthesize vitamin K in the intestines without the presence of bacterial flora, they are deficient in clotting factors, and vitamin K must be administered as a prophylaxis to assist in clotting.

The newborn can acquire an eye infection, such as gonorrhea or chlamydia, when passing through an infected birth canal. Prophylaxis against gonococcal ophthalmia neonatorum, an infection that can cause blindness, is required for all newborns. Erythromycin (Ilotycin) ophthalmic ointment is commonly used for prophylactic eye care because it produces less eye irritation than other eye medications and also destroys the Chlamydia organism. Ideally, a single-unit dose (new tube) of ointment is used. The ointment is placed so that it reaches all areas of the conjunctival sac (see Skill 7-9). It is recommended that eye prophylaxis be administered approximately 1 hour after birth to allow time for newborn-parent interaction without the newborn’s vision being disturbed.

Several pain assessment tools are available:

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