Chapter 22: The Normal Newborn: Nursing Care

Cardiorespiratory transition and maintenance receive significant focus, with detailed examination of airway management techniques and recognition of respiratory compromise indicators including rapid breathing, audible grunting sounds, and intercostal muscle retractions. Thermoregulation emerges as a fundamental nursing priority, as newborns lose heat through evaporation, conduction, convection, and radiation at rates that necessitate deliberate intervention. Cold stress in vulnerable newborns can trigger metabolic complications including hypoglycemia and respiratory depression, making thermal management through skin-to-skin contact, appropriate swaddling, and radiant heat devices critical nursing responsibilities. The chapter addresses hepatic adaptation challenges, particularly glucose homeostasis monitoring and hyperbilirubinemia surveillance using transcutaneous or laboratory measurements, with frequent feeding emphasized as both a hypoglycemia prevention and bilirubin elimination strategy. Safety protocols receive rigorous attention, including strict identity verification systems to prevent infant misidentification, security measures against abduction, and infection control practices centered on hand hygiene and timing of first baths. Management of circumcision is thoroughly addressed, covering anesthesia options such as dorsal penile nerve blocks and oral sucrose administration, procedural equipment choices, and postoperative wound care monitoring. Parent education topics integrated throughout include supine sleeping positioning for sudden infant death syndrome prevention, structured tummy time to reduce flattening of the skull, and proper umbilical stump hygiene. The chapter concludes with discharge planning essentials including hepatitis B vaccination, newborn hearing assessment, and expanded metabolic screening panels that identify treatable genetic metabolic disorders early in life.