MIDWIFERY AND OBSTETRICAL NURSING-I
UNIT 6 - ASSESSMENT AND MANAGEMENT OF NORMAL NEONATES
MINOR DISORDERS IN NEWBORNS
SECTION B
Ms. Sandra John
Apollo CON
Chittoor
ORAL THRUSH
White curd-like plaques on oral buccal mucosa, extends to pharynx if severe.
Adherent and difficult to scrape off.
May affect feeding.
Treatment:
• Miconazole oral gel
• Syrup Nystatin 100,000U qds
• Gentle cleansing of oral cavity after feeds
HYPOSPADIAS
Urethra opens on ventral aspect of penis
Usually associated with chordee (ventral shortening) causing ventral bend in
shaft
Absolute contraindication to circumcision
NEONATAL JAUNDICE
The yellowish discoloration of the neonates skin and mucous membrane due to
excessive accumulation of serum unconjugated bilirubin is called as neonatal or
physiological jaundice.
•Common Causes
Physiologic
Haemolytic
• ABO/RH incompatibility
• G6PD deficiency
Breastmilk jaundice
Breastfeeding jaundice
PROLONGED NEONATAL JAUNDICE
Jaundice beyond
• 14 days in term baby
• 21 days in preterm baby
Some Causes
• Breastmilk jaundice
• Hypothyroidism
• Urinary tract infection
• Biliary atresia
• Neonatal hepatitis
Investigations
Liver function test
Total and direct bilirubin
Blood grouping and typing
Coomb’s test
CBC
NURSING DIAGNOSIS
• Impaired skin integrity related to exposure to phototherapy for a long period of
time.
• Risk for burns, bronze baby syndrome, dehydration related to phototherapy.
• Risk for hyperthermia related to phototherapy exposure.
• Insufficient feeding related to placement of baby under phototherapy.
• Risk for impaired maternal and child bonding related to baby under phototherapy.
• Deficient parental knowledge related to lack of exposure to information/
Misinterpretation or unfamiliarity with information resources.
• Risk for injury related to prematurity, haemolytic disease, asphyxia, acidosis,
hypoproteinaemia, and hypoglycaemia.
Nursing Interventions
• Assess the infant in daylight.
• Assess infant for presence of cephalohematoma and excessive ecchymosis or
petechiae.
• Observe infant on the sclera and oral mucosa, yellowing of skin immediately after
blanching and specific body parts involved.
• Initiate early oral feedings within 4–6 hr following birth, especially if infant is to be
breastfed.
• Keep infant warm and dry.
• Monitor skin and core temperature frequently.
• Note presence/development of biliary or intestinal obstruction.
• Monitor laboratory studies, as indicated: Direct and Indirect bilirubin.
• Monitor, Hb and coagulation profile as per order.
• Initiate phototherapy per protocol using fluorescent bulbs placed above
the infant or bile blanket.
• Document type of fluorescent lamp, total number of hours since bulb
replacement, and the measured distance between lamp surface and
infant.
• Measure quantity of photoenergy of fluorescent bulbs (white or blue
light) using photometer.
• Cover testes and penis of male infant.
• Place Plexiglas shield between baby and light.
• Apply patches to closed eyes; inspect eyes every 2 hr when patches are
removed for feedings. Monitor placement frequently.
• Cleanse the infant’s eyes using sterile water.
• Monitor neonate’s skin and core temperature every 2 hr or more
frequently until stable (e.g., axillary temperature of 97.8°F (36.5°C),
rectal temperature of 98.8°F (37.4°C).
• Regulate incubator/ Isolette temperature.
• Reposition infant every 2-hr appropriate.
• Note colour and frequency of stools and urine.
• Monitor fluid intake and output.
• Weigh infant twice a day.
• Note signs of dehydration (e.g., reduced urine output, depressed
fontanels, dry or warm skin with poor turgor, and sunken eyes).
• Increase oral fluid intake by at least 25% and enteral or parenteral fluids.
• Evaluate appearance of skin and urine, noting brownish black colour.
• Note behavioural changes or signs of deteriorating condition (e.g.,
lethargy, hypotonia, hypertonicity, or extrapyramidal signs).
• Carefully wash perianal area after each passage of stool; inspect skin for
possible irritation or breakdown.
• Bring infant to parents for feedings.
• Encourage stroking, cuddling, eye contact, and talking to infant during
feedings.
• Encourage parents to interact with infant in nursery between feedings
