IDENTIFICATION DATA

SUBJECT: - Pediatric nursing

TOPIC:- Immediate new born care

DURATION: - 1 hour

GROUP/CLASS: - 2nd Year GNM nursing

MEDIUM OF INSTRUCTION:- English

A.V.AIDS:- Ppt, Poster, Black board

 OBJECTIVES

GENERAL OBJECTIVE:-

At the end of the teaching the student will be able to understand about immediate new born.

SPECIFIC OBJECTIVE:-

At the end of teaching the students will be able to…

 Define Immediate Newborn Care.

 Describe the steps of Immediate Newborn Care that are-
 Ensure warmth.
 Establish and maintain respiration.
 Cut and clamp the cord.
 Care of skin.
 Care of eyes.
 Prevention of infection.
 Proper observation and documentation.
 Attach identification tag.
 Initiate breast feeding.
 Safe transfer
SR SPECIFIC TIME CONTENT TEACHING/ A.V.AIDS EVALUATION
NO OBJECTIVE LEARNING
ACTIVITY

IMMEDIATE NEW BORN CARE

Definition: Lecture cum Black What is

To Define It refers to the care which is given to the newborn
1 5 min discussion board, Immediate
Immediate immediately after the birth till one hour in labor room
Newborn Care. before the baby is transferred to the post natal ward. ppt Newborn Care?
.
To define the STEPS OF IMMEDIATE NEWBORN CARE
2.. 5 min Lecture cum Poster Which are the
stages of  Ensure warmth. discussion steps of
immediate new  Establish and maintain respiration. immediate new
born care.  Cut and clamp the cord. born care?
 Care of skin.
 Care of eyes.
 Prevention of infection.
 Proper observation and documentation.
 Attach identification tag.
 Initiate breast feeding.
 Safe transfer.
3. To explain 40 min Lecture cum Ppt Which are the
STEPS:
each stage of discussion steps and what to
immediate new do in each stage
born care in  Ensure warmth. of immediate new
detail. In order to prevent hypothermia, Receive the baby onto a born care?
warm, clean and dry towel and place on mother’s chest, If
this is not possible, the baby should be kept in a clean, warm
and safe place close to the mother. The baby should be dried
immediately after birth and covered.

MECHANISM OF HEAT LOSS

 Conduction
 Convection
 Radiation
 Evaporation

Steps to prevent heat loss in labour room

i. Warm delivery room (25°C).

ii. Newborn care corner temperature 30°C.
iii. Drying immediately. Dry with one towel. Remove the
wet towel and cover with another pre-warmed towel.
iv. Skin-to-skin contact between mother and baby.

 Establish and maintain respiration.

The newborn babies cries spontaneously after birth. The

 secretions of mouth and nose should be cleaned to clear
the airway. If the baby is not crying already by this time,
gentle tactile stimulation are provided.
If the child does not cry after tactile stimulation the other
steps of resuscitation should be followed.
Suctioning
 Then open the airway by suctioning the mouth then
the nose by a bulb syringe or oralmouth sucker after
turning the head to one side.
 Evaluate the infant on the basis of three vital signs
 Respiratory effort
 Heart Rate
 Color

 Cut and clamp the cord:

After the birth of the baby the cord has to be clamped and
cut. The cord has to be cut after it has stopped pulsating. The
advantage is that the baby derives about 10 ml of extra
blood, if the cord is cut after after pulsation ceases.

 Care of skin:
The newborn should be gently wiped off blood,
mucous and secretions quickly and then wrapped with dry
sheet. No attempt should be made to wipe off vernix caseosa
from the baby’s body. The practice of bathing the baby at the
time of birth increases the risk of hypothermia. Do not bathe
the baby for 48-72 hours or more after birth depending on
the condition of the baby and hospital protocol.
  Care of eyes:

The eyes are cleaned with sterile normal saline/sterile

water swabs using one for each eye from inner to outer
canthus. If the mother is suspected of suffering from
gonnorrhoea, penicillin ointment or silver nitrate one percent
drops should be instilled into each eye of the baby. The
practice of applying kajal in the eyes is not recommended
because it may cause trauma, transmit infections like
trachoma or may even cause lead poisoning. If the eyes are
sticky they can either be managed by frequent cleaning using
sterile cotton swabs soaked in normal saline or by
instillation of 10% sulphacetamide eye drops every two to
four hours.

 Prevention of infection:

The baby area should be absolutely clean. All the

equipments coming in contact with the newborn should be
sterile. The staff taking care of the newborn should be free
from all infections and they should wash hands thoroughly
before handling the baby. Hand washing is the single most
means of preventing infection in the baby.

 Proper observation and documentation.

APGAR SCORE: Apgar score is a method used to

evaluate the baby at birth. It is checked within 60
seconds after birth and is re - evaluated again at five
minutes. The scoring system was developed by Dr.
 Virginia Apgar in which there are five objective
signs which are evaluated and scored 0, 1 or 2 to
determine the condition of the baby and as a guide to
subsequent care. The signs and their scoring system
are given in below table:

Sign 0 1 2
Heart rate Absent Below 100 Above 100
Respiratory effort Absent Slow Good crying
Irregular
Muscles tone Limp of Some flexion of extremities Well flexed
extremities.
Reflex No response Grimace, sneeze Cough/sneeze
Color Blue/pale Peripheral cyanosis Completely pink

A score of 5 to 10 indicates that the new – born is safe and

requires no special treatment. A score below 5 calls for
immediate attention and assistance along with continuous
observation in the special care nursery. This scoring system
is however not useful in case the baby requires resuscitation
at birth as the first scoring is done at one minute after birth.
The baby should be observed for the presence of life
threatening congenital anomalies and birth injuries,
anomalies such as tracheo-esophageal fistula,
meningomyelocele, cleft lip and cleft palate, and
imperforated anus etc.

 Attach identification tag.

Before the baby is transferred from the delivery room

an identification tag should be placed on the baby’s wrist as
bracelet specifying the name of mother, registration number,
date and time of birth, sex of the baby. In some hospitals
foot or palm prints of the baby are also taken as a part of the
baby’s identification.

 Initiate breast feeding.

For several decades in developed countries the

usual practice was to separate the mother from her
baby soon after birth. After a brief visit with his or
her mother, the baby was transferred to the nursery.
Bottles of water or glucose water were routinely
given for the first and subsequent early feeds.
These unhelpful routines were phased out when
research identifies the beneficial properties of
colostrums. Further changes came with the growing
belief that the early contact between mother and
infant would enhance the mother’s attachment to her
baby. Results of the small controlled trials comparing
early versus late contact, including timing of
breastfeeding, are inconclusive. The implications of
this are that mothers should have contact with their
babies as soon after birth as they wish, and for as
long as they wish.
The breast feeding should be started within the
half an hour after birth.

 Safe transfer: All normal babies are transferred to

the mother and nursed along with her in the postnatal
area. This is called rooming – in. However, babies
requiring special care should be transferred to a
Neonatal Intensive Care Unit (NICU). The babies
requiring to be transferred to the NICU are:
  Babies weighing less than 2000 gm.
 Gestation of less than 35 weeks.
 Severe birth asphyxia
 Abnormal or difficult delivery
 Major congenital malformations
 Rh iso immunization
 Diabetic mother

SUMMARY:
Summarizing the whole topic with discussion.

ASSIGNMENT: Select one newborn from labour room

and write immediate nursing care for that newborn.
 Assessment of Quality of Nursing Care Provided Immediately After Birth At University Hospital

Authors: Neama abd El Fattahand Nagwa A. Zein El Dein

Maternal and Newborn Health Nursing, Faculty of Nursing, Helwan University, Egypt

Pediatric Nursing Faculty of Nursing Menoufia University,Egypt

Abstract: The poor quality of care offered to neonates in hospital has been widely reported. The challenge is now
Therefore to define interventions that might improve this careAim. This study was designed to assess quality of
Nursing care provided immediately after birth for newborn and mothers, Methodology, Descriptive non participatory
Observational research design was utilized at OB- GYN department (Maternity unit) at University hospital in Shebin
El-Kom Menoufiya University, through observational checklist and structured interview questionnaire with a
Convenient nurses in charge in delivery room were chosen by non probability purposive sampling technique. Data
Was entered and analyzed using SPSS-16 Descriptive statistics cross tabulation, correlation and graphs were used to
Illustrate the results.
Results: The findings in this study indicate that nurses have an around average of knowledge
And quality of practice regarding total score of knowledge of birth preparation, initiating attachment and breast
Feeding, While much still needs to be done to improve the quality of maternal and newborn care regarding
Responding to mothers questions, examining baby and mothers before discharge. A combination of factors in this
Study, inhibit the provision of quality care such as educational levels and lack of training courses that nurses
Received: Study, displaying the need for protocols in labour room, and post natal ward. There is no data available
regarding the infection arising from the lack of care immediately after the delivery, since mothers get discharged
within few hours after delivery. However efforts will be taken in future researches to assess the consequences of lack
Of care on neonate’s outcomes.
 PICO FORMET

PROBLEM INTERVENTION COMPARISION OUTCOME

Poor quality of care offered
to neonates in hospital
Nursing care provided
immediately after birth for
newborn and mothers
---- The findings in this study
indicate that nurses have an
around average of
knowledge
and quality of practice
regarding total score of
knowledge of birth
preparation, initiating
attachment and breast
feeding, While much still
needs to be done to improve
the quality of maternal and
newborn care regarding
responding to mothers
questions, examining baby
and mothers before
discharge.