In the normal newborn, respirations are usually established within one minute after birth; often within the first few seconds. A lusty cry usually accompanies good respiratory effort. Newborn respirations should be quiet; with no evidence of dyspnea or cyanosis.
Cyanosis may be apparent in the hands and the feed (acrocyanosis); circumoral cyanosis (around the mouth) and may persist for an hour or two ater birth, but should subside.
Neonates breath through the nose (obligate nosebreathers), consequently nasal obstruction for mucus will lead to respiratory distress.
Closure of the openings in the heart are necessary for fetal circulation (ductus arteriosus, foramen ovale, and ductus venosus). Circulatory changes are not always immediate and complete, and may take several days to be so. Often this period of time is called transitional circulation.
BODY TEMPERATURE AND HEAT PRODUCTIION
Body temperature may drop to 94 degrees F(34.4 degrees C) OR EVEN AS LOW AS 92 DEGREES F (33.3 DEGREES C) AFTER BIRTH UNLESS THE INFANT IS ADEQUATELY PROTECTED.
Heat is generated immediately by shivering. The infant's shivering is characterized by an increase in muscular activity, restlessness, and crying.
the head may appear elongated at birth, usually molding disappears within 24-48 hours. this occurs due to abnormal fetal posture in utero and pressure during passage through the birth canal.
This is due to edem of the scalp due to the pressure occurring at the time of delivery. It will usually disappear within 1-2 days.
This is a collection of blood between the periosteum and the skull. This also can result from trama during labor and delivery. This blood is absorbed into the body in a few weeks after birth.
Average circumference of the full-term neonate is usually 34.2 cm; usual variation ranges between 32-36 cm. The head circumference is approximately 2-3 cm greater than the chest circumference.
Extremes in size may indicate microcephaly, hydrocephaly or increased intracranial pressure.
The fontanel is palpated for size and tension. An increase in tension may indicate increasing intracranial pressure or hydrocephaly. A decrease in tension (sunken fontanel) may indicate dehydration or shock.
The newborn nervous system is immature and characterized by being startled and with poor nervous control, the chin quivers, and the lower extremities have tremors that are of short duration.
Babinski sign is present and is considered a normal finding until 1 year of age. Babinski sign is the dorsiflexion of the big toe and fanning of the other toes.
Intactness of the newborn nervous system is indicated by the state of alertness, resting posture, cry, and quality of muscle tone and motor activity.
Physiologic jaundice occurs on the second or third day of life due to an increase in serum bilirubin level. Due to the lack of intestinal synthesis of viotamin K as a result of insufficient bacterial flora in the GI tract.
Administration of vitamin K (o.t to 1.0 mg IM) is ordered to prevent complications.
Stools are of a meconium nature (sticky, black, odorless, sterile stool which occurs within the first 24 hours after birth). If no stool is passed, then the possibility of an imperforate anus may exist.
Stools change according to the infant's feeding.
Transitional stools occur between the second and fourth day. It consists of part meconium and part milk, greenish brown or greenish yellow in color; it is loose and often contains mucous.
Stools of the brteast fed infant are golden yellow in color, a pasty consistency, and occur more frequently than stools of fromula fed infants.
The stools of formula fed infant are dryer and more formed with a paler color.
MOST NEWBORNS VOID WITHIN THE FIRST 24-48 HOURS AFTER BIRTH
With the newborn 30-60 cc are voided per day during the first two days of life. thereafter it is followed by 200 cc per day by the end of the first week.
The infant voids an average of 2 to 6 times per day increasing up to 10 to 15 times per day.
Vernix caseosa is a white cheesy-like material covering the skin at birth and is particularly noted in the folds and creases.
Petechiae are pinpoint bluish discolorantions on the skin(primarily the face) as a result of pressure from delivery; may see bruising of tissues.
Lanugo downy, fine covering of hair that may be present on the shoulders, back, ear lobes, and forehead. This disappears during the first week.
Milia are poipoint white bumps seen over the brtidge of the nose and on the cheeks during the first 2 weeks of life.
erythema toxicum are splotchy, pink, papular rash appearing anywhere on the body; disappears within the first few days of life. No treatment is necessary for this.
Mongolian spots are bluish, darkened pigmented areas een on the back or buttocks or dark skinned infants that usually disappears by school age.
Hemangiomatous area "stork bites" are areas on the upper eyelids, between the eyebrows, upper lip or at the nape of the neck which are light red in appearance; these will fade and disappear between one and two years of age.
All infants' eyes are blue or slate blue at birth, and become their permanent color at age 3 months. tears usually do not develop until 3 to 4 months. Sudden loud noises may elicit a startle response.Smell is developed at birth and the infant is able to differentiate between pleasant and unpleasant tastes. The mouth is the most sensitive area. The infant searches for food when their cheek is touched as well as begins sucking movement when lips are touched.
the newborn assumes the position of comfort, which is usually the position he/she assumed in utero.
A normal palmar crease is present while a simian cease is indicative of Down's syndrome. The spine is straight and flat when in the prone position.
During the first 4 hours after birth, the priority nursing goals are to maintain a clear airway, maintain a clear airway, maintain a neutral thermal environment, prevent hemorrhage and infection and initiate bathing and oral feedings.