10.Neonatal Nursing Care
Physiological Transitioning of the Newborn . . Within 24 hours,
neurologic, renal, endocrine, gastrointestinal, and metabolic functions must be
operating competently for life to be sustained .How well a newborn makes these
major adjustments depends on his or her genetic composition, the competency
of the recent intrauterine environment, the care received during the labor and
birth period, and the care received during the newborn or neonatal period (from
birth through the first 28 days of life). Two thirds of all deaths that occur during
the first year of life occur in the neonatal period. More than half occur in the
first 24 hours after birth
Cardiovascular System
the cardiovascular system Changes are necessary after birth because now the
lungs must oxygenate the blood that was formerly oxygenated by the placenta.
When the cord is clamped, a neonate is forced to take in oxygen through the
lungs. As the lungs inflate for the first time, pressure decreases in the
pulmonary artery (the artery leading from the heart to the lungs). This decrease
in pressure plays a role in promoting closure of the ductus arteriosus, a fetal
shunt.
Respiratory System
All newborns have some fluid in their lungs from intrauterine life that will ease
the surface tension on alveolar walls and allows alveoli to inflate more easily
than if the lung walls were dry. About a third of this fluid is forced out of the
lungs by the pressure of vaginal birth. Additional fluid is quickly absorbed by
lung blood vessels and lymphatics after the first breath. Once the alveoli have
been inflated with a first breath, breathing becomes much easier for a baby,
requiring only about 6 to 8 cm H2O pressure. Within 10 minutes after birth,
most newborns have established a good residual volume. By 10 to 12 hours of
age, vital capacity is established at newborn proportions.
Gastrointestinal System
Although the gastrointestinal tract is usually sterile at birth, bacteria may be
cultured from the intestinal tract in most babies within 5 hours after birth and
from all babies at 24 hours of life. Most of these bacteria enter the tract through
the newborn’s mouth from airborne sources. Others may come from vaginal
secretions at birth, from hospital bedding, and from contact at the breast.
Accumulation of bacteria in the gastrointestinal tract is necessary for digestion
and for the synthesis of vitamin K. The first stool of a newborn is usually passed
within 24 hours after birth. It consists of meconium, a sticky, tarlike, blackish-
, green, odorless material formed from mucus, vernix, lanugo, hormones, and
carbohydrates that accumulated during intrauterine life.
Urinary System
The average newborn voids within 24 hours after birth. A newborn who does
not take in much fluid for the first 24 hours may void later than this, but the 24-
hour point is a good general rule. Newborns who do not void within this time
should be examined for the possibility of urethral stenosis or absent kidneys or
ureters.
Immune System
Because they have difficulty forming antibodies against invading antigens until
about 2 months of age, newborns are prone to infection. This inability to form
antibodies is the reason that most immunizations against childhood diseases are
not given to infants younger than 2 months of age. Newborns do have some
immunologic protection, because they are born with passive antibodies
(immunoglobulin G) from their mother that crossed the placenta. In most
instances, these include antibodies against poliomyelitis, measles, diphtheria,
pertussis, chickenpox, rubella, and tetanus.
Neuromuscular System
Mature newborns demonstrate neuromuscular function by moving their
extremities, attempting to control head movement, exhibiting a strong cry, and
demonstrating newborn reflexes. Limpness or total absence of a muscular
response to manipulation is never normal and suggests narcosis, shock, or
cerebral injury. A newborn occasionally makes twitching or flailing movements
of the extremities in the absence of a stimulus because of the immaturity of the
nervous system. Newborn reflexes can be tested
with consistency by using simple maneuvers. such as Sucking Reflex,
Swallowing Reflex, Palmar Grasp Reflex, Step (Walk)-in-Place Reflex and
Moro Reflex.
Characteristics of Normal Neonate (Full Term)
It is not unusual to hear the comment “all newborns look alike” from people
viewing a nursery full of babies. In actuality, every child is born with individual
physical and personality characteristics that make him or her unique right from
the start
1.Length
The average birth length (50th percentile) of a mature female neonate is 53 cm
(20.9 in). For mature males, the average birth length is 54 cm (21.3 in). The
Physiological Transitioning of the Newborn . . Within 24 hours,
neurologic, renal, endocrine, gastrointestinal, and metabolic functions must be
operating competently for life to be sustained .How well a newborn makes these
major adjustments depends on his or her genetic composition, the competency
of the recent intrauterine environment, the care received during the labor and
birth period, and the care received during the newborn or neonatal period (from
birth through the first 28 days of life). Two thirds of all deaths that occur during
the first year of life occur in the neonatal period. More than half occur in the
first 24 hours after birth
Cardiovascular System
the cardiovascular system Changes are necessary after birth because now the
lungs must oxygenate the blood that was formerly oxygenated by the placenta.
When the cord is clamped, a neonate is forced to take in oxygen through the
lungs. As the lungs inflate for the first time, pressure decreases in the
pulmonary artery (the artery leading from the heart to the lungs). This decrease
in pressure plays a role in promoting closure of the ductus arteriosus, a fetal
shunt.
Respiratory System
All newborns have some fluid in their lungs from intrauterine life that will ease
the surface tension on alveolar walls and allows alveoli to inflate more easily
than if the lung walls were dry. About a third of this fluid is forced out of the
lungs by the pressure of vaginal birth. Additional fluid is quickly absorbed by
lung blood vessels and lymphatics after the first breath. Once the alveoli have
been inflated with a first breath, breathing becomes much easier for a baby,
requiring only about 6 to 8 cm H2O pressure. Within 10 minutes after birth,
most newborns have established a good residual volume. By 10 to 12 hours of
age, vital capacity is established at newborn proportions.
Gastrointestinal System
Although the gastrointestinal tract is usually sterile at birth, bacteria may be
cultured from the intestinal tract in most babies within 5 hours after birth and
from all babies at 24 hours of life. Most of these bacteria enter the tract through
the newborn’s mouth from airborne sources. Others may come from vaginal
secretions at birth, from hospital bedding, and from contact at the breast.
Accumulation of bacteria in the gastrointestinal tract is necessary for digestion
and for the synthesis of vitamin K. The first stool of a newborn is usually passed
within 24 hours after birth. It consists of meconium, a sticky, tarlike, blackish-
, green, odorless material formed from mucus, vernix, lanugo, hormones, and
carbohydrates that accumulated during intrauterine life.
Urinary System
The average newborn voids within 24 hours after birth. A newborn who does
not take in much fluid for the first 24 hours may void later than this, but the 24-
hour point is a good general rule. Newborns who do not void within this time
should be examined for the possibility of urethral stenosis or absent kidneys or
ureters.
Immune System
Because they have difficulty forming antibodies against invading antigens until
about 2 months of age, newborns are prone to infection. This inability to form
antibodies is the reason that most immunizations against childhood diseases are
not given to infants younger than 2 months of age. Newborns do have some
immunologic protection, because they are born with passive antibodies
(immunoglobulin G) from their mother that crossed the placenta. In most
instances, these include antibodies against poliomyelitis, measles, diphtheria,
pertussis, chickenpox, rubella, and tetanus.
Neuromuscular System
Mature newborns demonstrate neuromuscular function by moving their
extremities, attempting to control head movement, exhibiting a strong cry, and
demonstrating newborn reflexes. Limpness or total absence of a muscular
response to manipulation is never normal and suggests narcosis, shock, or
cerebral injury. A newborn occasionally makes twitching or flailing movements
of the extremities in the absence of a stimulus because of the immaturity of the
nervous system. Newborn reflexes can be tested
with consistency by using simple maneuvers. such as Sucking Reflex,
Swallowing Reflex, Palmar Grasp Reflex, Step (Walk)-in-Place Reflex and
Moro Reflex.
Characteristics of Normal Neonate (Full Term)
It is not unusual to hear the comment “all newborns look alike” from people
viewing a nursery full of babies. In actuality, every child is born with individual
physical and personality characteristics that make him or her unique right from
the start
1.Length
The average birth length (50th percentile) of a mature female neonate is 53 cm
(20.9 in). For mature males, the average birth length is 54 cm (21.3 in). The
