CARE OF MOTHER, CHILD, ADOLESCENT • Clamp the cord at 2 cm above the baby’s base using the

PEDIATRICS plastic cord clamp

• Apply the 2nd clamp at 5 cm above the baby’s base or 3 cm
THE NEWBORN (NEONATE) above the 1st clamp using the metal cord clamp
• Cut the cord about 1 cm above the 1st plastic cord clamp
- Ideally, do not place betadine or alcohol – discourage
THE UNANG YAKAP STRATEGY: ESSENTIAL applying
INTRAPARTAL NEWBORN CARE (EINC) • Inject 10 IU of oxytocin to the mother’s arm to promote
• The Unang Yakap strategy or Essential Intrapartal uterine contractions and avoids further bleeding
Newborn Care (EINC) was developed by the Department • While maintaining skin to skin contact, deliver the placenta
of Health of the Philippines upholds evidence-based • Examine the mother’s perineum and vulva for tears
standards set by the World Health Organization
• The baby will start licking movements, which will indicate
- Administrative order 2009-0025
that the baby is ready for breastfeeding
- Ideally, should have full implementation; however,
• Nudge breast to the baby to initiate rooting reflex
not all hospitals do not implement this strategy
• After first breastfeed, carry out the eyecare procedure and
• Development goal: reduction of newborn deaths
administer vaccines needed
• The newborn stays with the mother throughout the hospital
PREPARATION OF MATERIALS
stay to increase bond and promote breastfeeding
• 2 pairs of surgical gloves for obstetrician
- Exclusive breastfeeding for 6 months and may be
• 1 pair of surgical gloves for the pediatrician continued until 2 years of age or beyond
• 2 warm blankets • After at least 6 hours, the baby may be washed
- 1st for drying the baby
- 2nd for covering and warmth
4 IMPORTANT POINTS OF EINC
• Bonnet 1. Immediate and thorough drying
• Cord care set 2. Skin to skin contact
• Erythromycin 3. Properly timed cord clamping
• Vitamin K 4. Non-separation because of breastfeeding
• Hepatitis B shot
DEVELOPMENTAL TASKS OF A NEWBORN
STEPS FOR EINC BIOLOGIC TASKS
• 5 second count handwash and antisepsis • Establishing and maintaining respiration
• Double gloving step • Circulatory changes
• Once the baby is out of the perineum, note the time of birth • Regulation of body temperature
and the sex of the baby • Ingesting, retaining, and digesting nutrients
- Should be announced so that people are aware and to • Elimination of waste
prevent the chances of baby switching
• Regulation of weight
• Towel the baby with the first linen and dry for 30 seconds
- Dry the whole body except for the hands to enhance
BEHAVIORAL TASKS
breastfeeding relationship
• Establishing a regulated behavioral tempo independent of
• Do not wash the baby within the first 6 hours of life – may
the mother
lead to hypothermia and infection
• Processing, storing, and organizing multiple stimuli
• Do a rapid assessment
• Establishing a relationship with caregivers the environment
• Remove the wet cloth
• Initiate skin to skin contact – baby prone on the mother’s
abdomen or between the mother’s breasts TRANSITION PERIOD AFTER DELIVERY
- Allowed prone position because the mother’s FIRST PERIOD OF REACTIVITY
breathing initiates the breathing of the baby 1. FIRST STAGE: lasts up to 30 minutes after birth; the most
- Prone helps get rid of body fluids important stage to perform the Unang Yakap
- Side-lying position for the baby is also allowed 2. SECOND STAGE: lasts up to 2-4 hours
- The primary purpose of the skin to skin contact is to
create a bond between the mother and child SECOND STAGE OF REACTIVITY
- Skin to skin contact decreases chances of developing • Lasts about 2-5 hours
infection, hypothermia, and hypoglycemia • When the mother and baby are not able to bond at the first
• Place bonnet and second linen on baby’s back to promote period of reactivity, bonding between the mother and child
warmth and avoid hypothermia may be done during this period
• Remove first set of gloves to maintain sterility
• Allow the cord pulsations to stop without milking the cord
- Wait 3 minutes if it does not stop sooner

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PHYSIOLOGIC STATUS OF SYSTEMS INTRAUTERINE CIRCULATION: LOWER EXTERMITIES
A. RESPIRATORY SYSTEM • From the placenta, oxygenated blood enters the
• Onset of breathing initiated by chemicals (decreased PO2 umbilical vein to the ductus venosus; and to the
and increased PCO2) and thermal factors (cold receptors) inferior vena cava
- CHEMICAL FACTORS: the fetal lungs do not • From the fetal heart, right atrium to the left atrium
function as an organ for oxygenation intrauterine; the through the foramen ovale
placenta is responsible for oxygenation inside • From the left atrium, goes to the left ventricle to the
o Once the baby is delivered, the expansion of aorta to the descending aorta
lungs begins • Back to the placenta
o The baby should cry to promote the expansion
of lungs INTRAUTERINE CIRCULATION: HEAD & UPPER
- THERMAL FACTORS: the placenta’s temperature is EXTREMITIES
warmer than the temperature extrauterine; so • Unoxygenated blood enters the superior vena cava to
healthcare practitioners promote a warm environment the right atrium to the right ventricle to the pulmonary
to prevent hypothermia artery should supply blood to the lungs
• Tactile stimulation • Pulmonary artery is connected to the aorta through the
• Fetal lung fluid is removed during normal process of labor ductus arteriosus
and delivery • Descending aorta back to the placenta via the
- During normal delivery, the compression of the umbilical arteries
thorax evacuates fetal lung fluid
C. THERMOREGULATION
B. CIRCULATORY SYSTEM • Most critical next to respiration
• Transition from fetal circulation to postnatal circulation • Temperature at birth is usually 37.2 degrees celcus
through functional closures of the fetal shunts: • Factors that predispose the newborn in heat loss
- FORAMEN OVALE: opening between the right - Large surface relative to his weight
atrium and the left atrium - Thin layer of subcutaneous fats; newborns have really
- DUCTUS VENOSUS: blood vessel that connects the thin skin, which makes them prone to hypothermia
umbilical vein to the inferior vena cava; bypasses the - Newborn’s mechanism of producing heat
liver - Non-shivering thermogenesis (NST): newborns do
- DUCTUS ARTERIOSUS: the opening between the not express cold and shivering; the client will be
pulmonary artery and the aorta making use of other mechanisms to conserve heat,
- UMBILICAL ARTERIES: two arteries that carry such as vasoconstriction and metabolism of brown
oxygenated blood away from the heart adipose fats
- UMBILICAL VEIN: one vein that carries
unoxygenated blood back to the heart 4 PROCESSES OF HEAT LOSS
1. CONVECTION: flow of heat from body surface to
cooler or ambient air
2. RADIATION: loss of heat from the body surface to
cooler solid surfaces not in direct contact but in
relative proximity to each other
3. EVAPORATION: loss of heat that occurs when a
liquid is converted to a vapor
4. CONDUCTION: loss of heat from the body surfaces
in direct contact

D. HEMATOPOIETIC SYSTEM
• The blood volume depends on the placental transfer
• 80-110 ml/kg BW is the average blood volume (300 mL)

Hemoglobin (Hbg) 17-18 g/dL

Hematocrit (Hct) 45-50%

Red blood cells (RBC) 6M/mm3

White blood cells (WBC) 15,000-30,000/mm3

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E. FLUID & ELECTROLYTE BALANCE G. RENAL SYSTEM
• Fetus is 73% water while an adult is 58% water • Unable to concentrate urine and cope with the fluid and
• Has more extracellular fluids than adults electrolyte imbalances
• Newborns are more prone to dehydration, acidosis, and • Should urinate within 24 hours
overhydration • Total urine output = 300 mL by the end of the first week
• Bladder involuntary empties with a volume of 15 mL,
F. GASTROINTESTINAL SYSTEM approximately 20 voids
• The GI tract is usually sterile at 24 hours of life • Urine is colorless, odorless, and has a specific gravity of
- Does not allow the growth of microorganisms, 1.008-1.010
including the normal flora that are needed by the body
- Vitamin K is necessary for blood clotting factors H. INTEGUMENTARY SYSTEM
• Enzymes are available to catalyze proteins and simple • Epidermis and dermis loosely bound and are very thin
carbohydrates but not complex carbohydrates and fats • Eccrine glands functional at birth
because of the absence of the pancreatic enzymes • Apocrine glands remain small and non-functioning
• Liver is the most immature of all GI organs (jaundice,
bleeding, edema, hypoglycemia) I. MUSCULOSKELETAL SYSTEM
• Salivation at 2-3 months • The skeletal system contains larger amounts of cartilage
• Stomach capacity = 60-90 mL (around 2-3 oz per feeding) than ossified bones, which make them more prone to
• Changes in the stool pattern injuries

STOOL CHARACTERISTICS J. IMMUNE SYSTEM

TIME STOOL CHARACTERISTIC • Limited immunologic protection until about 2 months
• Born with passive antibodies (immunoglobulin G)
1st 24 hours Meconium: greenish to black in • Includes antibodies against poliomyelitis, measles,
color, which is pasty diphtheria, pertussis, chicken pox, etc.
The combination of sloughed off
GI mucosa and swallowed K. ENDOCRINE SYSTEM
maternal blood • Effect of the maternal sex hormones evident in newborns

2nd to 3rd day Transitional stool: greenish and L. NEUROLOGIC SYSTEM

seedy • Primitive reflexes
• Myelination follows the principles of growth and
4th day BREAST FED BABIES: 3-4x development
golden to light yellow, loose,
sour smelling, non-irritating to NEONATE REFLEXES
the skin 1. BLINKING
FORMULA FED BABIES: 2-3x 2. ROOTING
pale yellow soft but formed stool 3. SUCKING
with noticeable odor and 4. SWALLOWING
irritating to the skin 5. EXTRUSION
6. PALMAR GRASP
VARIATIONS 7. STEP / WALK-IN-PLACE
• BRIGHT GREEN: for those placed under phototherapy 8. PLACING
for jaundice 9. PLANTAR GRASP
- In phototherapy, the male genitalia must be 10. TONIC NECK / FENCING / BOXER
covered to avoid the risk of infertility 11. MORO
- Causes the bilirubin to be more soluble for 12. BABINSKI
excretion 13. MAGNET
• WITH MUCUS: may be related to milk allergy, lactose 14. CROSSED EXTENSIPN
intolerance, or other irritants 15. TRUNK INCURVATION
- The most hygienic way of disposing phlegm is 16. LANDAU
by swallowing it 17. DEEP TENDON
• CLAY COLORED / GRAY STOOL: with bile duct
obstruction see table: neonate reflexes
• BLOOD-FLECED: with anal fissure; blood-tinged
stool that is fresh red blood
• BLACK, TARRY STOOL: intestinal bleeding and
should be inspected
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SENSORY FUNCTIONS HOW TO PROVIDE WARMTH
HEARING • Dry the newborn’s skin
• Functional at 25-27 weeks AOG reacts to sound once the • Wrap using warm soft blanket
amniotic fluid has been drained from the middle ear • Use of preheated bassinet or crib, radiant warmer,
• Most developed sense intrauterine droplight or floor lamp

VISION INITIAL ASSESSMENT OF CONDITION

• Structurally incomplete and completes at around 6 years AGPAR SCORING
• Tear glands do not begin to function until 2-4 weeks of age • Was developed by Dr. Virginia Agpar in 1952
• At birth, visual acuity of a newborn is between 20/100 and • Done on the 1st minute, 5th minute, and 10th minute of life
20/400 – the client will not be able to appreciate features • The highest score you can get is 9
• Cannot follow objects past midline - Because you can not obtain the pink coloration of the
• Focuses best on black and white colors at 9-12 inches baby, which occurs after 30 minutes
- Best colors you can offer to the newborn are red, • Based on the 5 parameters ranked in order of importance
black, and white to stimulate the vision - Appearance
- Pulse
TOUCH - Grimace
• Most developed sense extrauterine - Activity
• Face, mouth, hands, and soles are the most sensitive parts - Respiration
• Babies appreciate different textures

TASTE
• As the ability to discriminate taste, the newborn shows
preference for sweet over bitter tastes
• Follows the taste of breastmilk or milk formula

SMELL
• Present as soon as the nose is clear of lung and amniotic
fluid
• Reacts to strong odors

PRINCIPLES OF IMMEDIATE CARE

AIRWAY PATENCY
• Most critical adjustment a newborn must make at birth

TECHNIQUES TO MAINTAIN PATENT AIRWAY

• Wipe off mouth and nose with sterile gauze
• Suctioning with the use of rubber bulb syringe or
suction catheter
- Suction the mouth first before the nose because
newborns are obligatory nasal breathers usually
up to 4 months of age
- To prevent aspiration of secretions in the mouth;
nasal secretions are not as quantifiable compared
to the secretions of the mouth
- Suctioning up to 5-10 seconds only
• Positioning
- For Unang Yakap, the baby must
- Side-lying position
- Head to the side to prevent

HEAT PRODUCTION
• Non-shivering thermogenesis
• Metabolism of brown adipose fat (also known as vest fats)
• Gluconeogenesis

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