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Four unique anatomic features
Initiation of first breath is due to the integrated activity of several stimuli:
- Cord occlusion
- Thermal stimuli
- Evaluation tool only! Intervention should start prior to 1 minute as needed.
Done at 1 and 5 minutes and 10 mins if APGAR at 5 mins < 7
- 0 to 3 indicate severe distress
- 4 to 6 indicates moderate difficulty
- 7 to 10 indicates that the newborn is having minimal or no difficulty adjusting to extrauterine life
Thermoregulation - 4 Mechanisms of Heat Loss
- Evaporation - dry
- Radiation - hat, dry linen, warm blanket
- Convection - delay the bath
- Conduction - place skin to skin
Skin Color - Pale
-pale color may result of decreased concentration of RBCs, poor oxygenation or hypothermia.
Skin Color - Plethoric
-ruddy color results from increased concentration of RBCs (polycythemia) and limited subcutaneous fat deposits.
Skin Color - Acrocyanosis
-common in newborn, localized (blue-gray coloration) of hands and feet
-poor peripheral circulation, resulting in vasomotor instability and capillary stasis.
-most noticeable when newborn is cold.
Skin Color - Mottled
-lacy pattern of dilated blood vessel under the skin.
-result of general circulation fluctuations or when newborn is cold.
-may last several hours or weeks, can come and go periodically.
Normal Heart Rate Range
- 110 to 160 bpm
- Normally the heart has a toc-tic sound.
- 90% of all murmurs are transient and considered normal. Half disappear by age 6 months.
Respirations - Normal Respiratory Rate
> 30 and < 60 bpm
- Respirations are diaphragmatic, with associated rising and falling of abdomen.
- Breath sounds are heard better when the newborn is crying.
Normal Cry Sounds
- Cry-strong, lusty and medium pitched.
- High pitched, shrill cry may indicate neurologic disorders or hypoglycemia
Hypoglycemia - Risk Factors
- Less than 37 Weeks gestation
- Gestational Diabetes or Infant of Diabetic Mother
- Five minute APGAR <6
- Unstable transition period
- First detectable on face where skin overlies cartilage and mucous membranes
- Occurs in 50-60% of term newborns
- Blanch tip of nose, forehead or gum line, area appears yellowish immediately after blanching
- Pathologic within 24hrs or persisting for > 7 days
- Physiologic after 24 hrs
- Providing a protective environment is key responsibility of nurse
- Prevention of infection, careful identification procedures, transporting via bassinet, protection from abduction
Newborn Feeding Readiness (Hunger Cues)
- Rapid eye movement under lids
- Sucking movements
- Hand to mouth movements
- Body movements
- Small sounds
When to Initiate Newborn Feeding
- Assess newborn breathing, suck & swallow
- Breastfeeding - immediately after birth within first half hour
- Bottle feeding - when newborn shows cues
- Feed early, especially if newborn at risk for hypoglycemia
>90th % for weight
- Increase risk of birth trauma, hypoglycemia, hypocalcemia, hyperbilirubinemia, meconium aspiration, and polycythemia.
<10th % for weight
- Increase risk of hypoglycemia, asphyxia, respiratory distress syndrome, meconium aspiration, intrauterine infection, and hyperbilirubinemia
Advantages of Breast Milk for Baby
Antibodies—Protects against infections
Decreases risk of allergies
Essentials for growth
Protects against obesity
Enhances cognitive development ( 8 IQ pts)
Decreases risk for Diabetes
Decreases risk of Sudden Infant Death Syndrome (SIDS)
Advantages of Breast Milk for Mother
Uterine involution / Delays fertility
Speeds weight loss
Decreases risk of certain cancers
Convenience-perfect temperature, no preparation
Cost savings-no formula, bottles/nipples
Psychological-M-B attachment and an increased feeling of well-being related to release of oxytocin/prolactin
Why Human Milk?
- Optimal growth and development
- Reduced risk of disease - Decreased risk of contamination of formula or from bottles
- Improved health of the mother
- Personal and national economic benefits
Breast Milk - Colostrum
- First 2-3 days
- Gold or yellow, Thick
- Colostrum amount matches the size of the newborn's stomach
- High protein content due to increased immunologic content; high levels of antibodies—passive immunity
- Establishes normal GI track flora
- Helps eliminate bilirubin as it has a laxative effect
Breast Milk - Transitional Milk
3-4 days to 2 weeks
Higher concentration of fat, lactose, water-soluble vitamins
Breast Milk - Mature Milk
- After 2 weeks
- 10% solids (carbs, proteins, fats) for energy and growth
- 90% water for hydration
- 20 kcal/oz
Factors Inhibiting Let Down of Breastmilk
- Lack of privacy
- Lack of confidence
Steps to Latch On
Positioning, pillows, pillows and more pillows
Get mom and baby comfortable
Stimulate rooting reflex
Baby to open mouth WIDE
Baby to latch onto the nipple + areola, not just the nipple
Teach proper breast support (C-hold)
Encourage comfort in handling the breast and moving the baby
Assess for nipple comfort after latch on
Consider offering both breasts - ?
Burp between breasts
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