Early Care of the Newborn

Early care of newborns after birth involves supporting cardiorespiratory function and thermoregulation, monitoring for problems that need immediate intervention, and administering prophylactic medications.

Okay so, you can quickly assess the newborn immediately after delivery by using the APGAR score to determine when cardiorespiratory support interventions are needed.

The APGAR score is calculated 1- and 5-minutes following birth, and consists of these five parameters: Appearance, or skin color; Pulse; Grimace, or the newborn’s reaction to stimulation; Activity, or the amount of flexion and movement; and Respiration, or the strength of their respiratory effort.

Each parameter is scored 0, 1, or 2 for a total of 10 possible points. Scores 7 and above are normal and require no special intervention.

A score below 7 requires interventions Interventions such as tactile stimulation, oxygen administration, and other resuscitation efforts, as well as repeat scoring every 5 minutes.

If the newborn is having difficulty clearing secretions from their airway, you should position them on their back, with their head in a neutral position, and use a bulb syringe to suction their mouth first, and then their nose.

You’ll also support the newborn’s thermoregulation, which is the ability to maintain a steady core temperature by balancing heat loss with heat production.

You can help prevent heat loss by establishing a neutral thermal environment, or NTE. Be sure the delivery room is warm and free of drafts; and immediately after birth, dry the newborn with warm linens to remove amniotic fluid.

You’ll also perform your initial assessments under a radiant warmer; and then, you can either wrap them in a warm blanket and place a warm hat on their head, or initiate skin-to-skin contact with the mother.

Now, a common problem in the newborn period is jaundice, also known as hyperbilirubinemia, which can cause yellowish pigmentation of the skin, sclera, and mucous membranes.

This is because newborns typically have a higher amount of bilirubin in their systems and their ability to metabolize and eliminate bilirubin is still developing.

Normally, physiologic jaundice is usually not present until at least 72 hours after birth and it typically resolves on its own within two weeks.

So, for most newborns, you’ll visually assess for jaundice every 12 hours by blanching the skin on their nose or sternum and looking at their sclera; and you’ll obtain either a transcutaneous bilirubin, or TcB or a serum bilirubin, or TSB, at 24 to 48 hours after birth.

Since the expected level varies with age in hours, you’ll plot the results on an hour-specific graph, such as the BiliTool, to track any rise in the newborn’s bilirubin level.

Now, risk factors for hyperbilirubinemia include Rh or ABO incompatibility, gestational diabetes, preterm birth, or birth injuries like a scalp hematoma or bruising.

When these risk factors are present, you’ll monitor the newborn more closely since they’re at risk for developing severe hyperbilirubinemia that can evolve into kernicterus, or bilirubin-induced neurological dysfunction.

Your interventions for a newborn with hyperbilirubinemia will depend on its severity, and can include encouraging frequent feedings, as well as instituting phototherapy, which helps the bilirubin in the skin to absorb the light and convert into a more water-soluble form to be excreted through urine and stool.

You’ll also monitor the newborn for hypoglycemia, or low blood glucose. Most newborns will have enough glucose available to keep their blood glucose stable during the early hours after birth.

However, some newborns are at increased risk for hypoglycemia, including premature newborns; newborns who have been stressed by cold, infection, or lack of oxygen; or newborns with high insulin levels, like those born to a mother with diabetes.

For newborns at risk, you’ll watch closely for signs of hypoglycemia such as temperature instability, lethargy, jitteriness, or apnea, and follow your facility protocol to perform glucose monitoring and maintenance with feedings or IV dextrose.

Now, there are some routine medications you’ll administer when providing early newborn care. During the first hour of life, you’ll perform neonatal eye prophylaxis by administering erythromycin ophthalmic ointment to the lower conjunctival sac of each eye.

This will help prevent ophthalmia neonatorum, which is an eye infection that’s most commonly caused by Neisseria gonorrhoeae or Chlamydia trachomatis.

These bacteria are usually transmitted to the newborn during a vaginal delivery, and can cause conjunctivitis that can manifest as eye redness, edema, and purulent discharge; in severe cases blindness can occur.

Another routine medication is vitamin K1, or phytonadione, which is a fat-soluble vitamin that helps regulate blood coagulation.

Newborns are especially susceptible to vitamin K deficiency because they don’t yet have the gastrointestinal microbial flora needed to synthesize vitamin K, and their immature liver is less able to produce coagulation factors.

This leads to impaired coagulation and potential hemorrhage. Typically, you’ll administer vitamin K intramuscularly, or IM, within 6 hours of birth in the vastus lateralis muscle.

During administration, remember to provide comfort measures such as nonnutritive sucking or oral sucrose, and monitor for bleeding, edema, inflammation, or rash at the injection site after administration.

Alright, as a quick recap… Early care of newborns after birth involves supporting cardiorespiratory function and thermoregulation, monitoring for problems that need immediate intervention,