The neonatal period is defined as the first 28 days of life. Immediately after birth (transition period) and throughout the hospital stay, the infant needs to be assessed. The assessments evaluate the infant’s adjustment to extra-uterine life. The assessment data covers the respiratory system, cardiac, and temperature regulatory mechanisms. The Apgar score is a procedure that provides immediate assessment for the need of resuscitation of the newborn. The five parameters and the scores of each parameter will determine the physiologic state of the newborn. The five parameters are heart rate, respiratory effort, muscle tone, reflex irritability, and color.
The neonatal period is defined as the first 28 days of life. Immediately after birth (transition period) and throughout the hospital stay, the infant needs to be assessed. These assessments evaluate the infant’s adjustment to extra-uterine life.
The neonatal period is defined as the first 28 days of life.
Transition of the newborn in most institutions usually takes place between 4 and 6 hours. The assessment data cover the respiratory system, cardiac, and temperature regulatory mechanisms. Immediately after birth the amniotic fluid is dried from the newborn’s body. Incorporating this procedure prevents heat loss through evaporation (the dissipation of heat as the energy required to vaporize a liquid). To prevent heat loss and maintain body temperature, the newborn is placed on a radiant warmer for assessment of the Apgar score.
The Apgar score is a procedure that provides immediate assessment for the need of resuscitation of the newborn. The five parameters and the scores of each parameter determine the physiological state of the newborn. The five parameters follow:
The Apgar score is a procedure that provides immediate assessment for the need of resuscitation of the newborn.
Heart rate, which is based on auscultation with a stethoscope
Respiratory effort, which is based on the observation of the movement of the chest wall
Muscle tone, which is based on the degree of flexion and movement of the extremities
Reflex irritability, based on the response to gentle taps applied to the soles of the feet
Skin color, described as blue and pale, extremities blue only, or total body pink
These parameters are evaluated at 1- and 5- minute intervals after birth. Each parameter with a perfect score is valued at a 2. Therefore if a newborn meets each parameter with a perfect score and there are 5 parameters, then the Apgar score would be a 10. The overall guidelines indicate severe distress (0-3), moderate distress (4-6), and an infant that adjusted to extra-uterine life immediately (7-10).
After the Apgar score has been completed (usually by the nurse attending the delivery), the newborn’s temperature needs to be assessed (Table 9-1). At birth, the newborn is placed under a radiant warmer to maintain body temperature. After the temperature (usually axillary, 97-99.5°F), the apical heart rate (120-160 beats per minute), and respiratory rate (40-60 beats per minute) are taken, the infant is weighed (normal range, 5½ to 7½ pounds) and measured (normal length, 18-22 inches). Rectal temperatures are usually not done anymore, due to the risk of damage to the rectal lining.
Table 9-1. Four Types of Heat Loss in Newborns
1.
Evaporation: Occurs when heat is lost as water is converted to a vapor.
Example: Immediately after birth the amniotic fluid can elicit evaporation heat loss unless the newborn is immediately dried.
2.
Conduction: Occurs when a warmer object comes in direct contact with a cooler object.
Example: A cold scale, a cold examining table, or an unwarmed incubator
3.
Radiation: Occurs when heat is transferred from the heated body surface (newborn) to cooler surfaces and/or objects not in direct contact with the newborn’s body.
Example: Placing the newborn’s crib against an outside wall, when the inside walls of a home are usually warmer than the outside walls
4.
Convection: Occurs when heat is lost from a warm body surface to cooler air currents.
Example: Placing the newborn in areas such as open doorways or air-conditioning drafts
When these procedures are completed, the newborn may be placed skin-to-skin with the mother. While the mother is holding the infant (skin-to-skin), this is a convenient time to have the newborn breastfeed (if the mother plans on using this method). Because the newborn’s sucking reflex is the strongest right after birth, this is the best time to teach the new mother the proper latching-on method and positioning to breastfeed.
Because the newborn’s sucking reflex is the strongest right after birth, this is the best time to teach the new mother the proper latching-on method and positioning to breastfeed.
Usually during transition the vital signs are taken every hour for the first 4-6 hours. Shortly after birth the newborn’s head and chest circumference are measured. The normal head circumference for a term newborn at birth is 13-15 inches and chest circumference 12-14 inches. The measurement of the chest circumference is valuable as a comparison with the head circumference but is not necessarily by itself. The chest circumference may be equal to the head but should never be larger than the head; if this occurs, the health care provider needs to be alerted.
The normal head circumference for a term newborn at birth is 13-15 inches and chest circumference 12-14 inches.
Once the infant’s vital signs are stabilized, the newborn needs ophthalmic and vitamin K prophylaxis and an admission (first) bath. To prevent gonococcal and chlamydial infections in the newborn, an ophthalmic ointment is given prophylactically. There are several brands used (depending on the institution), for example, erythromycin ointment 0.5%, tetracycline 1%, or silver nitrate solution 1%. All three medications may cause an irritation to the eyes (chemical conjunctivitis), which ceases in 24 hours. Vitamin K (phytonadione 0.5-1 mg) is also administered prophylactically to stimulate the production of vitamin K by the bacteria in the newborn’s intestine. While the newborn is gestating in the uterus and immediately after birth the intestine is sterile, and there is no intestinal flora to produce vitamin K. Soon after birth, when the newborn breastfeeds or ingests infant formula, a bacterial formation stimulates the production of vitamin K to prevent hemorrhagic disorders of the newborn and to promote the formation of clotting factors in the liver. Vitamin K is therefore administered early in the newborn’s life (at least 1 hour after birth) and is given as an intramuscular injection into the vastus lateralis muscle (located in the newborn’s thigh).
When the umbilical cord is cut immediately after birth, it must be assessed for three vessels. There should be two arteries and one vein. The arteries are easily identified because they protrude out from the umbilical cord, are smaller, and have thicker walls, and the vein is easily identified because it has a larger lumen and thinner walls than the arteries. Having only one artery indicates a congenital anomaly, and the health care provider should be immediately notified to provide early treatment if needed. Cord care is implemented soon after birth to prevent infection because the cord stump is a medium for bacterial growth. Many institutions use a drying agent to prevent infections and facilitate drying of the cord.
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