Nursing Care for the Term Infant

A newborn, also called a neonate, is an infant that's less than 28 days old; and is considered a term newborn once they reach 37 weeks of gestation. As the nurse, you’ll collaborate with the registered nurse, or RN, to support the newborn’s adaptation to extrauterine life, by monitoring their temperature as well as the adaptations of their cardiovascular and respiratory systems.

Now, one of the major adaptations a newborn infant must make is establishing thermoregulation, which is the ability to balance heat loss and heat production with the goal of maintaining a steady core temperature. Keep in mind that newborns don’t have a lot of subcutaneous fat to help keep them warm, so be sure to keep them wrapped in a warm blanket. And because their heads provide a relatively large surface area for heat loss, put a cap on their head.

Other steps you can take to prevent heat loss include keeping their diaper area dry to prevent heat loss by evaporation; avoid placing them on cold surfaces to prevent heat loss by conduction; ensuring they are not exposed to drafts to prevent heat loss by convection; and ensuring they are not placed next to a window to prevent heat loss by radiation. Also, be sure to measure the newborn’s temperature regularly, which should be between 97.1 F, or 36.2 C, and 99.8 F, or 37.7°C, and notify the RN if the infant is not able to maintain their temperature within the expected range.

Next, auscultate the newborn’s apical pulse and remember to listen for a full minute. It’s a good idea to check this first when the infant is in a quiet state. Note their heart rate and rhythm, and keep in mind that it’s not uncommon for newborns to have a murmur during the first 48 hours of life, as the ductus arteriosus shunt closes. A term newborn’s heart rate normally varies between 110 and 160 beats per minute, but it can rise to 180 beats per minute when they’re crying or drop as low as 80 beats per minute during deep sleep. A consistently high or low heart rate should be reported to the RN.

Then, monitor perfusion by palpating pulses, which should be equal bilaterally, and test capillary refill. To test capillary refill in newborns with lighter skin gently press down on their forehead or chest until the area blanches, and then release it. In newborns with darker skin, assess capillary refill on the palms of the hands or soles of the feet. Normally, color should return within three seconds.