Pediatric Nursing

Skills
Mary Lourdes Nacel G. Celeste, R.N., M.D.
Nursing Care
of a
Newborn
Newborn or neonate – a baby
in the neonatal period (the
first 28 days of life)

MLNG CELESTE, RN, MD 3

IMMEDIATE CARE OF THE NEWBORN
(EXISTING/ OLD PROTOCOL)
• Purpose: To support the infant in adjusting to extra-
uterine life
• Admission of newborn in the nursery is the initial
step taken after birth and removal from the delivery
room to protect and safeguard the newborn in the
nursery environment.

MLNG CELESTE, RN, MD 4

 Nursing Care Objectives
• Maintain an environment as germ free as possible.
• Provide careful observation of the newborn especially during
the first 24 hours.
• Maintain a warm environment, with as little constraint of
activities as possible.
• Observe accurate identification of the infant by assuring
identification bracelet is in place from the delivery room and
crib is correctly labeled.
• Maintain a constant temperature.
• Assist in the early establishment of the mother-child
relationship.
• Perform complete physical assessment.
MLNG CELESTE, RN, MD 5
 Equipment:
• Balanced weighing scale
• Blankets/ linen
• Rectal thermometer
• Bathing materials
• Identification bracelet/ ID band/ wrist
band
• Suction catheter Fr.6, 8 or 10
• Suction Machine
• Suction bulb (rubber extractor)
• Stamp pad or ink pad
• Crib/ Isolette/ Basinette
• Drop light or radiant warmer
• Tape measure
• Povidone Iodine
• Isopropyl alcohol
• Cotton balls
• Umbilical cord clamps
• Scissors
• Ophthalmic ointment
• Vit K
• 1 ml syringe
MLNG CELESTE, RN, MD 6
MLNG CELESTE, RN, MD 8
MLNG CELESTE, RN, MD 9
MLNG CELESTE, RN, MD 10
 Establish and Maintain Respiration

1.   Suctioning
- Turn head to one side
- Suction gently and quickly
- Suction the MOUTH first
before the nose
*bulb syringe
*mechanical suction machine
- Test patency of the airway
- Proper position
a. Ensure an open airway.
b. Do not hyperextend head
- place neonate supine
- head slightly extended

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• Suction gently and quickly (5 to 10 seconds).
• Prolonged and deep suctioning of the nasopharynx during the
first 5 to 10 minutes of life will stimulate the VAGUS NERVE
(located in the esophagus) and cause bradycardia.

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 POSITIONING OF THE NEWBORN
• The position when suctioning should be one that promotes
drainage of secretions –

HEAD LOWER THAN THE REST OF THE BODY

BUT C.I. if there are signs of increased ICP:
head should be higher than the rest of the body
• Vomiting
• Bulging, tense fontanels
• Dilated scalp veins
• Abnormally large head
• Increased BP
• Decreased PR and RR
• Widening pulse pressure
• Shrill, high-pitched cry- late sign

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 Nursing Interventions
Immediate Care of the Newborn
STEPS and SCIENTIFIC PRINCIPLES/ RATIONALE

1. Immediately after delivery, blot

infant dry while placing him/ her
in a radiant warmer. Minimize
heat loss by evaporation, acidosis
and hypoxia. If present, these are
increased by cold stress.

MLNG CELESTE, RN, MD 14

2. Place infant in Trendelenburg.
Gravity aids in drainage of mucus and fluid from the naso-oral
cavity.

MLNG CELESTE, RN, MD 15

3. Clean the airway passages. Aspirate mucus from
mouth and pharynx with suction catheter¸ low
vacuum and gentle manipulation required.
This is an urgent duty that must be done without
delay. Stimuli may produce laryngeal spasm or cause
pharyngeal edema.
• If the baby inhales into its bronchioles mucus and
amniotic fluid which may be present in the pharynx,
atelectasis or pneumonia may occur.

MLNG CELESTE, RN, MD 16

 Methods of Clearing the Airway

a. By suction bulb or rubber extractor, suction the

mouth (first) and the nose even before the chest is
delivered.
To clear airway passage, thus, initiating respiration

b. Hold the baby upside down or with the head lower than
the body, with the head slightly extended for a few
seconds before laying baby on the crib.
To allow any fluid in the trachea to drain out, thus,
ensuring patent airway.

MLNG CELESTE, RN, MD 17

c. By suctioning the airway passage from mouth and pharynx
and the nose with suction catheter, low vacuum and gentle
manipulation is required. This is done especially if the mucus
is thick and cannot be drained out when the baby is held
upside down.
• The infant cannot breathe if the airway is plugged with
mucus, and if inhaled into the lungs its tenacious consistency.
Prevents the alveoli from becoming inflated and its irritant
propensity is likely to cause pneumonia. Suctioning must be
done with caution because excessive suction may cause
oxygen deprivation which will lead to bradycardia. Vigorous
suctioning will irritate the mucous membrane leaving portal
open for entry of infection

MLNG CELESTE, RN, MD 18

Suctioning

MLNG CELESTE, RN, MD 19

MLNG CELESTE, RN, MD 20
 APGAR SCORING

• Determine the Apgar score at delivery and then again 5

minutes after delivery.

• Five (5) vital signs are each given a score of 0, 1 or 2 points:

color, respiratory effort, heartbeat, muscle tone and reflex
response.
• Evaluate infant’s condition by the APGAR Scoring system.
Observe at 1 and 5 minutes after birth.

MLNG CELESTE, RN, MD 21

 APGAR SCORE
0 1 2
Appearance Blue/Pale Acrocyanosis Pink; Ruddy

Pulse Absent < 100 > 100

Grimace None Weak cry Good cry

Activity Flaccid Some flexion Well flexed

Flex/ext
Respiration Absent <30 >60

MLNG CELESTE, RN, MD 22

A ppearance (color) – least important
P ulse rate - most important
G rimace (reflex activity); irritability
A ctivity (muscle tone)
R espiration

MLNG CELESTE, RN, MD 23

Central cyanosis

Acrocyanosis

MLNG CELESTE, RN, MD 24

• This is a means of standardizing the method of evaluating and
recording the condition of the baby, in numerical terms at 1
minute after birth and at 5 minutes. Reflects infant’s condition
and, if present- degree of asphyxia.
• 1st minute- to determine the cardiorespiratory, nervous
functioning on the first minute and on the 5th minute after
birth to determine the adjustment to the new environment.
• The score at 5 minutes gives a more accurate prediction
regarding survival: A low score at 5 minutes being more
serious than a low score at 1 minute. Notify pediatrician if the
score is 6 or under at 5 minutes.

MLNG CELESTE, RN, MD 25

 Apgar Scoring System

1st minute: general condition

(NEURO/RESPI/CIRCULATORY CHECK)

5th minute: adjustment to extrauterine life

MLNG CELESTE, RN, MD 26

 APGAR Scoring

NURSING ACTION
1. Apgar score of 7 – 10 indicates infant’s condition is good.
• No special procedures necessary.

2. Apgar score of 4 – 6 means that the infant is in fair condition;

baby may have moderate central nervous system depression,
some muscle flaccidity, cyanosis and poor respiratory effort.
Air passage may be closed; Oxygen is given.

3. Score of 0 – 3 indicates that the infant is in extremely poor

condition. Notify pediatrician. Resuscitation is required
immediately.

MLNG CELESTE, RN, MD 27

a. Insert endotracheal tube and begin ventilation with oxygen.
b. Apply ECG and monitor the heart rate. If there is no audible
heart rate, begin cardiac massage.
Irreversible brain damage and cell death may occur unless
circulation is restored immediately.
c. After initial resuscitation, maintenance electrolytes are added
to parenteral fluids.
d. Transfer infant to intensive care nursery.
For continued observation and monitoring

MLNG CELESTE, RN, MD 28

MLNG CELESTE, RN, MD 29
• 4. Provide identification of the baby; include mother’s name,
infant’s sex, time and date of delivery, type of delivery, and
attending physician.
• To ensure proper identification of the infant

• The agencies have different methods of identification and

system of checking the names.
a. Wrist name tape
b. String of letters in china beads.
• Prints of infant foot, palms and fingers or index finger. Print
placed on the same form.
• Prints of infant’s foot, palms, and fingers are positive means of
identification, if they are clear enough to make the fine ridge
detail on the baby’s skin legible.

MLNG CELESTE, RN, MD 30

• Identification
1. Apply I.D. band or bracelet to infant’s arm/ wrist;
include mother’s name, hospital number, infant’s sex,
and time and date of birth.
2. Apply bracelet with the same information to mother’s
wrist.
3. If hospital policy indicates, take prints of infant’s foot
(palms and fingers, and mother’s palms and fingers).

MLNG CELESTE, RN, MD 31

Proper Identification

– done in D.R. before being brought to the Nursery

a.    Footprints – most reliable 

b.    ID bands – ankle, wrist

c. Birthmarks

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• Ensure newborn’s proper identification
• Footprint newborn and fingerprint mother on
identification sheet per agency policies and
procedures
• Place matching identification bracelets on
mother and newborn.
• REMEMBER! ID band must be checked and
compared to the mother’s band each time the
baby is brought into the mother’s room.

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MLNG CELESTE, RN, MD 34
MLNG CELESTE, RN, MD 35
MLNG CELESTE, RN, MD 36
• Mother – infant bonding
• If the condition of mother and infant is satisfactory,
assist mother to hold infant. (This helps promote a
positive mother-child relationship and allays mother
anxiety).

MLNG CELESTE, RN, MD 37

* Note that ID bands of mother and baby are
matched.

MLNG CELESTE, RN, MD 38

 Transfer to Nursery

• Transfer infant to nursery in

warm blanket or in a heated
bassinet. (This reduces heat
loss).
• Provide nursery personnel
with written record of birth
information and check
infant’s identification. (This
ensures continuity of care).

MLNG CELESTE, RN, MD 39

 ADMISSION TO THE NURSERY

1. Assess condition of the baby, especially appearance,

respiratory effort, activity and color, as well as the
cord. Observe for any congenital abnormalities and any
trauma which may have been incorrect during the birth
process. To evaluate and provide prompt nursing action

2. Check information band which includes sex, name of

mother, date and time of birth, type of delivery, and
attending physician. To ensure accuracy of information

MLNG CELESTE, RN, MD 40

 3. Take accurate initial weight.
• Loss of fluids will result in weight reduction. A loss of
several ounces (6-10 oz) or 5-10% of total body weight
is lost during the first weeks of life so that an initial
weight is taken to serve as a baseline data for future
evaluation.The decrease in weight is due to
a) loss of tissue fluid
b) deficient food and fluid intake
c) the loss of meconium and urine.
When milk supply becomes adequate, a slow steady
increase in weight occurs.

MLNG CELESTE, RN, MD 41

MLNG CELESTE, RN, MD 42
4. Check temperature per rectum initially. After the initial
measurement, temperature is usually taken per axilla. If
any resistance is met, the thermometer should not be
forced into the rectum. Notify physician for imperforate
anus and no passage of meconium for 24 hours.
To provide greater accuracy and to ensure patency of
the anus When stabilized, temperature is 36.5 – 37.5C.
To prevent rectal perforation

MLNG CELESTE, RN, MD 43

5. Perform the initial skin cleansing of the newborn.
• (Sponge bath/ Oil bath/ Tub bath)

MLNG CELESTE, RN, MD 44

 BATHING

MLNG CELESTE, RN, MD 45

6. Cord dressing. Observe
aseptic technique.
Assess:
a. parts of the cord- AVA 1
vein, 2 arteries
b. bleeding during the first 24
hours
c. infection after 24 hours
d. congenital weakness like
umbilical hernia or
omphalocele
This might lead to
omphalangia/ omphalitis.

MLNG CELESTE, RN, MD 46

Initial Cord Dressing

CORD: 2 A + 1 V
*Practice aseptic technique
Apply cord clamp to prevent
bleeding
Application of antiseptic solution
Povidone iodine
70% alcohol
to prevent Tetanus Neonatorum and
Omphalitis (streptococcal and
staphylococcal infections)
Signs of Omphalitis:
*Reddening of the area
*Fever
*Discharge and foul smell

Application of sterile cord clamp to prevent bleeding within the 1st 24

hours
** The cord will fall off after – 7-10 days
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MLNG CELESTE, RN, MD 49
 7-10 days
Will fall-off

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MLNG CELESTE, RN, MD 51
7. Administer Vitamin K intramuscularly.
GIT of the newborn is initially sterile. So there are
no bacteria to synthesize Vitamin K which will lead
to decreased clotting factor and increased bleeding
tendency.

To prevent transient deficiency of Coagulation

factors
II, VII, IX, X

1 mg Aquamephyton (Phytonadione) – term

0.5 mg - preterm

MLNG CELESTE, RN, MD 52

MLNG CELESTE, RN, MD 53
8. Eye Care (Crede’s prophylaxis)

Silver Nitrate AgNo3 1% 1-2 gtts into each eye but

this causes CHEMICAL CONJUNCTIVITIS
Ophthalmic drops
- lower conjunctival sac
- wash with sterile NSS after 1 minute
to prevent chemical conjunctivitis

To prevent gonorrheal conjunctivitis or ophthalmia

neonatorum-
MLNG CELESTE, RN, MD 54
b. Ointment • Erythromycin
Ophthalmic ointment 1 - pull eyelids
cm from inner to downward
outer canthus - 0.5 - 1 cm
Terramycin - Inner to outer
Gentamycin canthus
Chloramphenicol - Wipe excess away
Erythromycin
MLNG CELESTE, RN, MD 55
Eye / Crede’s prophylaxis
MLNG CELESTE, RN, MD 57
9. Initiate measurement.
The baby is measured from the vertex to the heels.
Average length= 19 -21 inches or 50 cm
Head circumference (HC) = 33-35 cm or 13-14 in
Chest circumference (CC) = 31-33 cm or 12-13 in

Length is considered to be a more reliable criterion of

gestational age than weight. Length increases an inch per
month for the next 6 months which is the most rapid
growth.

MLNG CELESTE, RN, MD 58

MLNG CELESTE, RN, MD 59
 

MLNG CELESTE, RN, MD 60

MLNG CELESTE, RN, MD 61
10. Provide warmth.
The baby should be dried and received onto a
warm blanket, one of which is wrapped over his
head. The infant is usually placed in a pre-
heated, temperature controlled environment.
To keep the baby warm
Heat regulation in the newborn is unstable and
because of the low metabolic rate and the
absence of subcutaneous fat, heat production is
poor .
The baby can lose heat by evaporation if wet. He
will lose a lot of heat if the head which is one
quarter ¼ of the area of the baby is wet and
exposed.

MLNG CELESTE, RN, MD 62

11. Place infant in a crib/ bassinet on his side slightly
lowered (10-15 degrees), except when positive for
intracranial pressure.
To facilitate gravitational drainage of remaining fluid
because the infant’s nose, throat and lungs have been
filled with amniotic fluid prior to birth

12. A droplight is placed on the side of the crib/ bassinette/

isolette.
To provide warm and comfort

MLNG CELESTE, RN, MD 63

MLNG CELESTE, RN, MD 64
MLNG CELESTE, RN, MD 65
 Congenital hip
dysplasia/dislocation
• 0.1% of infants
• with a predilection for females to males of 5:1
• infants with a family history (first-degree relative affected) of
CHD, the incidence is 10 times higher
• also higher in infants born in the breech position and infants
with certain other congenital abnormalities, including
torticollis, clubfoot, metatarsus adductus, and hyperextension
of the knee

MLNG CELESTE, RN, MD 66

Congenital Hip Dislocation

MLNG CELESTE, RN, MD 67

 ORTOLANI’S TEST
• In this maneuver, the infant is examined in the supine position.
• The examiner holds the infant's pelvis with one hand to stabilize it
during manipulation.
• The examiner then slowly and gently ABDUCTS the infant's
opposite hip with the other hand, pulling the femur forward and
using the greater trochanter as a fulcrum.
• In the infant with an unstable hip, the examiner will feel a sudden
shifting sensation and may hear or feel a "clunk" simultaneously
as the hip reduces anteriorly.

MLNG CELESTE, RN, MD 68

Ortolani test

MLNG CELESTE, RN, MD 69

 BARLOW TEST
• In this maneuver, the infant is examined in the supine
position.
• The examiner holds the infant's pelvis with one hand to
stabilize it during manipulation.
• With the other hand, the examiner holds the infant's
opposite hip in the ADDUCTED, flexed position while
exerting gentle pressure over the lesser trochanter.
• In the infant with an unstable hip, a similar "clunk" may be
felt as the hip subluxes posteriorly.

MLNG CELESTE, RN, MD 70

Barlow test

MLNG CELESTE, RN, MD 71

A. Ortolani’s
test
B. Barlow’s Test

* Assessment
on the R and
L hips may
be done
simultaneous MLNG CELESTE, RN, MD 72
MLNG CELESTE, RN, MD 73
 Suctioning
It is the method for removing excessive secretions from the
airway. Suction maybe applied to the oral, naso-pharyngeal or
tracheal passages.

Purpose:
To provide patent airway by keeping it clear of excessive
secretions.

Equipment:
Suction source
Suction catheter with vent
Connecting tube
Sterile distilled water
Sterile towel
Sterile gloves
Collection bottle
Padded tongue blades MLNG CELESTE, RN, MD 74
Procedure:

Preparatory phase
Gather equipment, including extra catheter of the appropriate size.
Connect the collection bottle and tubings to the vacuum source.
Establish the need for suctioning by observing respiration and
auscultating lungs.
Wash hands thoroughly.
Turn on suction to check the system and regulate pressure if
indicated.
Fill basin with sterile distilled water.
Position child on his side with his head slightly lower, If necessary,
seek an assistant to help maintain the child in this position.
Attach the catheter to the suction tubing using gloves when handling
the catheter.
Place the catheter tip in the basin and draw sterile distilled water
through it.

MLNG CELESTE, RN, MD 75

Performance Phase
Use padded tongue blades to separate the teeth if necessary.
Leave the vent open into air and introduce the catheter into the
area that is to be suctioned. Area may include the cheeks,
back of mouth, beneath the tongue. Avoid any
overstimulation of the gag reflex.
Occlude vent with thumb and slowly withdraw the catheter while
rotating it between the thumb and forefinger. If the catheter
“grabs”, remove the thumb to stop the suction.
Dip the catheter in and out of the basin drawing sterile distilled
water through it to clean it.
Repeat steps 1-4 as necessary, suctioning not longer than a few
seconds at a time and allowing 1-3 minutes between
suctioning periods unless an abundance of secretions make
this impossible.

MLNG CELESTE, RN, MD 76

Follow-up phase:
Turn off suction source, detach the catheter from the tubing and
wrap tubing in a sterile towel. Discard the disposable
catheter.
Make the infant comfortable and give mouth care.
Assess the effectiveness by observing respirations and
auscultating the lungs.
Record the following:
amount, color and consistency of secretions
coughing
dyspnea
cyanosis
frequency of suctioning
any bleeding
response of child to suctioning
Empty and rinse collection bottle before it fills completely an at
the end of each tour of duty.

MLNG CELESTE, RN, MD 77

 Weighing the Infant
Definition: Obtaining the infant’s daily weight, in pounds or
kilograms and evaluate fluid loss and infant progress.

Rationale for the implementation of nursing action:

• Provide a basis for future evaluation
• Determine the infant’s progress

Nursing objectives:
• Accurately weigh the infant and record the weight daily.
• Call major discrepancies in weight, failure to gain, to the
attention of the physician
• Keep the parents actively involved in the patient’s care by
keeping them informed of the daily weights.

MLNG CELESTE, RN, MD 78

Equipment:
Balanced scale, with tray, Paper or cloth protectors
Steps:
• The newborn must be weighed at approximately the same time
each day.
• The nurse washes her hands before and after handling a baby.
• The scoop basket or scale tray should have protective cloth or
paper.
• Wearing no clothes, the infant is placed on the covered scale tray.
The infant must never be left on the scale.
• The nurse may use one hand to set the balance and determine the
weight, however, the other hand must ge dept over the infant.
This hand should be an inch away from the infant, but not
touching.
• After weighing, the infant is dressed and returned to crib.
• Record the infant’s weight.

MLNG CELESTE, RN, MD 79

 Cord Care
Definition: Care of the remaining umbilical stump on newborn
infant.

Terminology:
• Wharton’s Jelly- gelatinous substance in the umbilical cord.
• Clamp- mechanical device for the compression of vessels
• Ligature- a binding tie of thread or wire
• Umbilical cord- a string like structure connecting the infant to
the placenta

Rationale for the implementation of nursing action:

• Ligate and seal cord to prevent hemorrhage or infection
• Keep the cord clean and dry.

MLNG CELESTE, RN, MD 80

Nursing Objectives:
• prevent infection and hemorrhage
• facilitate the cord dropping off
• alleviate the mother’s fears about the cord

Equipment:
Isopropyl alcohol, 70%

Optional:
dry dressing
antibiotic ointment or medication
culture equipment
MLNG CELESTE, RN, MD 81
Steps:
• Careful handwashing before caring for the area is important.
• Milk the cord towards the baby.
• Clamp/ Tie the cord 1 inch (or longer; depends on hospital
policy) from the base either with cord clamp, cord string or
rubber securely.
• Cut the remaining cord 1 cm. above the clamp/tie.
• Clean the base of the umbilical cord inward going outward in
a unidirection with 70% alcohol.
• Clean the cord with alcohol from the base going upward.
• Alcoholize the cord above the clamped/cut line.
• Keep cord dry and expose to air.

MLNG CELESTE, RN, MD 82

 Bathing the infant
• Daily cleansing of the infant

Types:
1. Tub bath- use of a baby tub instead of a washbasin. It is done
with the infant in a supported reclining position in the water.
Newly circumcised babies should not be bathed in a tub
until healing is complete as well as babies whose umbilical
stump has not dropped off.

2. Sponge bath- use of a wash basin filled with warm water to

sponge the infant clean. It is done with the infant lying in
the crib and a basin of water nearby.

MLNG CELESTE, RN, MD 83

MLNG CELESTE, RN, MD 84
Terminology:
• Cradle cap/Seborrheic dermatitis is a common scalp condition
of early infancy characterized by dirty-looking adherent,
yellow scaling and peeling of the scalp due to sebaceous gland
secretions.
• Diaper rash/Diaper dermatitis is caused by irritations from
urine and stool or from laundry products. If the stool and or
urine is irritating and the diaper is not changed immediately,
the buttocks may become red, and then shine and raw.
• Intertrigo occurs where two surfaces of skin are in contact e.g.
behind the ears, creases of the neck, axillae and groin and
under the scrotum in males. It usually occurs where there is
moisture from sweat urine feces or milk which has dripped
into a fold of skin.
• Miliaria (prickly heat) is caused by superficial bacterial action
after excessive sweating during hot weather or fever. The
signs are small erythematous papules and vesicles, which
cause itching.
MLNG CELESTE, RN, MD 85
Rationale for the Implementation of Nursing Action
• Promote cleanliness of infant
• Provide an opportunity to observe growth and
development.
• Give the infant the opportunity to exercise.

Nursing Objectives:
• Avoid instilling fear of bathing in the infant, use gentle
treatment.
• Report/record any unusual conditions noticeable while
bathing
• Avoid any drafts or unnecessary exposure of the infant
• Use proper equipment and supporting hold, so infants will
not slip from hands.

MLNG CELESTE, RN, MD 86

Equipment:
• Washbasin or baby tub
• Washcloth
• Towel
• Soap
• Folded diaper
• Infant gown/shirt
• Linen
• Blanket
• Soft brush
• Receptacle for soiled clothing
• Adult gown

MLNG CELESTE, RN, MD 87

 Tub bath
Steps:
• Bathing should take place prior to, not after feeding
• The room should be warm, and free from drafts. The nurse
should not have to interrupt the bath to close a door.
• Assemble all equipment, clothing and linen needed.
• Bath water should be around 37-38 C, a temperature that is
pleasantly warm to the elbows or wrist.
• Place infant on a clean towel or linen on a table or counter of
comfortable height a washbasin or bathtub nearby.
• Remove infant’s gown/shirt and diaper, Wrap the infant.
Safely place out of reach of the baby.
• Wash eyes first with clear water and different portions of the
washcloth for each eye from the inner aspect outward.

MLNG CELESTE, RN, MD 88

• The face is washed in clean water too, gently with washcloth.
• The ears are washed next and gently cleaning the external ears
and behind the ears.
• The newborn is swaddled in a dry blanket leaving only the
head tilted slightly downward.
• Place cotton balls on both ears or apply pressure behind the
wars by placing thumb finger on one ear and ring and middle
fingers on the other ear.
• Wash infant’s hair with soap or shampoo while infant is lying.
A very soft brush may be used even on the soft spot.
• Hold the infant in one arm over the basin or tub as you would
a football and lower him into the bathwater to rinse him off.
Baby infant on his back, dry the hair well and comb.

MLNG CELESTE, RN, MD 89

• With head hyperextended, wash under the chin and pay
particular attention to folds of neck.
• Soap entire body including extremities and genitalia and anus,
paying particular attention to folds and creases. Pick him up
by sliding one hand under the baby’s neck and shoulders and
other hand under the buttocks or between the legs, then gently
lifting him from the crib to the tub bath.
• Place infant in a supported reclining position by placing one
hand at the back of the neck. Rinse him off very well.
• Dry the infant and wrap in a dry towel or linen
• The umbilical stump is cleansed with 70% alcohol with the
use of cotton balls.
• The infant is dressed, diapered. The bed is changed and the
infant is left in a position on his side.

MLNG CELESTE, RN, MD 90

MLNG CELESTE, RN, MD 91
Initial Feeding

1-6 hours after birth

CS : Breastfeed after 4 H
NSD : Breastfeed asap

1 oz of sterile water

Subsequent feeding – by demand

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• May breastfeed immediately after birth
– Philippine Milk Code EO 51 : Promote breastfeeding
– Rooming-in Act of 1992 RA 7600 : promotes breastfeeding
and requires immediate rooming-in of the newborn

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 Newborn Screening Act of 2004

REPUBLIC ACT NO. 9288

“…ensure that every baby born in the Philippines

is offered the opportunity to undergo newborn
screening and thus be spared from heritable
conditions that can lead to mental retardation and
death if undetected and untreated.”

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 NEWBORN SCREENING

C
1. Congenital Hypothyroidism ( CH )
2. Congenital Adrenal Hyperplasia (CAH)

P
3. PHENYLKETONURIA (PKU)

G
4. G6PD DEFICIENCY
5. Galactosemia

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 NB screen

• Should be done after 24-48 hours of life

• After the infant is fed
• done through extraction of blood in the heel of the foot

PEDIATRIC NURSING MLNGC,MD, RN

96
Disorder Screened Effect of disorder Benefit if screened &
treated

CH Severe mental normal

Congenital retardation
Hypothyroidism
CAH Death Alive and normal
Congenital adrenal
hyperplasia
GAL Death, cataract Alive and normal
Galactosemia
PKU Severe mental Normal
phenylketonuria retardation
G6PD Severe anemia, Normal
kernicterus

PEDIATRIC NURSING MLNGC,MD, RN

97
 1. CONGENITAL HYPOTHYROIDISM

Dx: low T3 T4, inc TSH

Mx: synthetic thyroid hormone

Nsg Care: Assist parents administer drugs

PEDIATRIC NURSING MLNGC,MD, RN

98
 Congenital hypothyroidism

PEDIATRIC NURSING MLNGC,MD,

After 2-3 mos RN
of treatment
99
 2. CONGENITAL ADRENAL HYPERPLASIA

  -inability to synthesize cortisol >>> inc ACTH >>> stimulate

adrenal glands to enlarge >>> inc androgen

S/sx: masculinization, sexual precocity

Mx: Steroids to decrease stimulation of ACTH

PEDIATRIC NURSING MLNGC,MD, RN

100
 3. G6PD DEFICIENCY
Glucose 6 phospate dehydrogenase deficiency
- reduction in the levels of the enzyme G6PD in RBC leads to
hemolysis of the cell upon exposure to oxidative stress

Dx: blood smear – heinz bodies

rapid enzyme screening test, electrophoresis

Mx: avoid drugs ie ASA, sulfonamides, antimalarials, fava beans

  

PEDIATRIC NURSING MLNGC,MD, RN

101
 4. GALACTOSEMIA

(-) enzyme that converts galactose to glucose

Galactose 1 phosphate uridyltransefrase

S/sx: wt loss, vomiting, hepatosplenomegaly, jaundice

and cataract

Dx: Beutler test

Tx: decrease lactose – soy based formula

regulate diet

PEDIATRIC NURSING MLNGC,MD, RN

102
 5. PHENYLKETONURIA (PKU)
- Deficient or absent phenylalanine hydroxylase w/c
converts phenylalanine to tyrosine

S/sx: mental retardation, musty odor of urine, blond hair,

blue eyes

Dx: Guthrie bld test

Tx: decrease phenylalanine (Lofenalac)

regulate diet

PEDIATRIC NURSING MLNGC,MD, RN

103
PEDIATRIC NURSING MLNGC,MD, RN
104
PEDIATRIC NURSING MLNGC,MD, RN
105
 CPT
Chest Physiotherapy

Description:
a. percussion and vibration over the thorax to loosen
secretions in the affected area of the lungs

PVD
PERCUSSION
VIBRATION
POSTURAL DRAINAGE

MLNG CELESTE, RN, MD 106

 POSTURAL DRAINAGE

Description
a. Postural drainage uses gravity to drain secretions from
segments of the lungs.

INTERVENTIONS
b. Position the client properly
c. Maintain position 5 to 20 minutes.

MLNG CELESTE, RN, MD 107

MLNG CELESTE, RN, MD 108
 CONTRAINDICATION

a. Unstable vital signs

b. Increased intracranial pressure

MLNG CELESTE, RN, MD 109

 Percussion
• done by striking the chest wall in a rhythmic fashion
with cupped hands or a mechanical device over the
lung segments (lobes) to be drained

• flex and extend the wrist so the chest is cupped or

clapped in a painless manner

MLNG CELESTE, RN, MD 110

 Vibration
• applying manual compression with oscillation (back
and forth motion) or tremors (shaking) to the chest
wall during exhalation phase of respiration

MLNG CELESTE, RN, MD 111

THANK YOU.

MLNG CELESTE, RN, MD 112