Neonatal Care

Definition

Neonatal care refers to that care given to the newborn infant from the time of delivery through about the first month of life. The term "neonate" is used for the newborn infant during this 28-30 day period.

Purpose

The purpose of neonatal care in the delivery room and newborn nursery is to:

• Assess and evaluate the newborn as s/he transitions from intrauterine life to extrauterine life.
• Evaluate and monitor the newborn system-by-system for normal versus abnormal functioning, providing maintenance of normal and potential treatment of abnormal findings.
• Foster bonding between infant and parent/s.
• Provide a safe environment at all times.

Description

Neonatal care begins as soon as the baby is born. In fact, suctioning of the nose and mouth may take place as the baby is in the process of being delivered—with the head out, and while the mother is taking a pause before the next push. In utero the infant is swimming in amniotic fluid. As he or she comes down the birth canal, the contractions exert pressure on the body and push some of the amniotic fluid out of the lungs . It is this fluid that is suctioned out during those first few moments. Shortly after delivery, the umbilical cord is clamped and then cut. Shortly after clamping, the cord will be checked for the presence of two arteries and one vein. Once the cord is clamped, the baby must breathe and function independently from the mother. The first few breaths cause several internal changes to occur. These will be discussed in the Results section below.

Because of the internal environment, the baby is very wet when born. Drying the baby off right away is critical, as the baby can lose considerable body heat through evaporation, convection, radiation, and conduction. This is especially true of the head, which has a large surface area in relation to the rest of the body. Also, head hair retains considerable moisture if not well dried. A cap placed on the head once it has been dried helps to maintain body temperature. The nurse may place the newborn on the mother's skin while drying the skin, both to begin the bonding process as well as to allow the mother's body heat to warm the infant. The rubbing that takes place to dry the infant provides tactile and sensory stimulation. The neonate may cry, bringing more oxygen into the lungs. A certain amount of pressure is needed in the heart and lungs in order to convert from fetal circulation to neonatal circulation. A color change is noticeable as the infant's skin changes from a bluish hue to pink. In some circumstances, oxygen from a mask may be placed near the mouth while the infant is being dried off to increase the initial intake of oxygen. Once dry, the infant is wrapped in several warm receiving blankets and may be placed at the mother's breast for an initial breastfeeding. If the mother will not be breastfeeding, she may choose to hold the newborn at this point.

The first breastfeeding helps to trigger the involution process of the uterus, as it stimulates the production of natural oxytocin, which helps the uterus contract. Also, in the first hour or so after birth, the neonate is usually quite alert, unless the mother was given pain medications late in labor.

While the infant is being dried off, the mother is delivering the placenta. The amniotic fluid is clear, perhaps tinged with blood . If it appears murky in any way, the baby most likely had a bowel movement during the stressful labor and delivery process. This first bowel movement is called meconium. If present in the amniotic fluid, it is possible that the infant inhaled some into its lungs. This is called meconium aspiration. The neonate with meconium in the amniotic fluid may be intubated to avoid aspiration. Meconium aspiration can lead to tachypnea (rapid respirations) and also pneumonia , and may require the neonate to spend some time under observation in the neonatal intensive care unit (NICU), instead of being kept with its mother. As the infant is being suctioned, assessed and dried, it may be placed in a slight Trendelenburg position, depending on the hospital. This downward slant of about 10 degrees allows gravity to assist in draining mucous.

At one and five minutes after birth the neonate is assessed for Apgar scores. The infant's heart rate, respiratory effort, muscle tone, reflex, irritability, and color are each given a score of 0, 1, or 2. Each score is then added together for a highest possible score of 10. The normal range is 7-10. It is rare to receive a 10, as some cyanosis in the hands and feet (called acrocyanosis) is quite normal.

In the birthing room a rapid physical examination is performed to assess any gross abnormalities as well as any heart-related problems, and to determine the need for any immediate intervention. The spine will be assessed, and should be free of any openings or dimpling. It will be flat, as the lumbar and sacral curves develop later when the child learns to sit and walk. A more detailed examination will take place about 24 hours later. The umbilical cord and placenta will also be examined for any abnormalities. Any medications given to the mother during labor and delivery are recorded in the neonate's chart, as the medication could affect the infant's respirations and its own ability for tissue oxygenation. The physician or nurse-midwife will also make sure the entire placenta has been expelled to avoid the risk of infection for the mother due to any retained tissue.