Integrated Maternal and Newborn Care Basic Skills Course ...

o Where possible note the axillary temperature with a thermometer leaving it in place
for 4 minutes. The normal temperature is 36.5-37.5 °C. (The thermometer should be
clean and wiped with at least an alcohol swab to prevent cross infection. Storing in
liquid antiseptics should be done only if they are changed frequently. Otherwise there
is a risk of infections with Pseudomonas. It is not recommended to take rectal
temperature as a routine as it is associated with a higher risk of infection and
trauma.)
o In the newborn infant, both fever and low body temperature outside the normal range
of 36.5-37.5 °C are danger signs.
• Assess respiration: Normal respiratory rate is 30-60 breaths/minute. Although breathing
can be somewhat irregular with short pauses, there should be no apnea which is defined
as cessation of breathing lasting for more than 20 seconds or of a shorter duration
associated with cyanosis, pallor, or bradycardia, with heart rate less than 110/minute.
The normal heart rate ranges between 110-160 beats/minute, with the lower rates when
the baby is asleep and the higher rates when the baby is active or crying. There should
be no:
o flaring of the nostrils
o grunting
o increased respiratory rate above 60/minutes
o severe subcostal retractions
• Look for abdominal fullness.
• Examine the umbilical cord, taking care to lift it to see the base/umbilicus. Check for pus
discharge, redness, swelling, foul smell.
Take the Baby’s Weight
• Place a clean cloth or paper on the baby scale pan.
• Adjust the weight so it reads “zero” with the paper/cloth on it.
• Place the baby over a paper or a cloth. If cloth, fold it to cover the body of the baby.
• Note the weight when the baby and pan are not moving.
• Never leave the baby unattended on the scale.
• Write down the weight of the baby in the mother/baby and ward records based on
recommendations of the Ministry of Health.
• The normal weight range is 2.5-4 kg. Low birth weight is below 2.5 kg.
Examine the Newborn
In general newborn babies are examined from head to toe and front to back.
Head
• Note the general shape of the head and inspect the scalp for cuts or bruises from
forceps or vacuum. Elongated or asymmetrical shape may be due to molding during
birth.
• Palpate the anterior fontanel and check for any bulging.
• Caput succedaneum is a soft swelling over the part of the head that presented first. It
disappears by 48 hours.
164
Integrated maternal and newborn care
Basic skills course