Newborn Care, Safety, and Injury Prevention

Question 1

What is circumcision? what is the global circumcion rate?

Answer 1

Circumcision is a surgical procedure in which the prepuce, an epithelial layer covering the penis, is separated from the glans penis and excised which permits exposure of the glans (Ladewig, London & Davidson, 2010

1/3 males - 37%-39%

Question 2

What factors typically influence the decision for circumcision?

Answer 2

Factors include social, cultural, and religious factors
Belief that ‘everyone does it’ – family does it – ‘matching’ the father

Question 3

Characteristics of seborrheic dermatitis?

Answer 3

The lesions are characteristically thick, adherent, yellowish, scaly, oily patches that may or may not be mildly pruritic. Diagnosis is made primarily on the basis of the appearance and the location of the crusts or scales.

Question 4

What factors contribute to diaper rash?

Answer 4

Various factors contribute to diaper rash, including infrequent diaper changes, diarrhea, use of plastic pants to cover the diaper, or a change in the infant’s diet, such as when solid foods are added.

Question 5

What should the hot water temp be set at for baths? How do you/should you check the water temp?

Answer 5

Be sure that your hot water heater is set at 49°C (120°F) or less. Always check bath-water temperature with your elbow before putting your baby in the bath.

Question 6

What is SIDS What is it caused by?

Answer 6

By definition,suddeninfantdeathsyndrome (SIDS) is thesuddendeathof aninfantunder the age of 1 year.

Current evidence explains SIDS as a disorder arising from a combination of environmental, genetic, and metabolic factors.

Question 7

What are some methods a parent can do to help relive a baby from crying to reduce the risk of shaken baby syndrome (THI)?

Answer 7

-Wrap orswaddle your baby.

-Sucking sometimes helps babies to calm and relax. Encourage your baby tobreastfeedoroffer a pacifier.

-Soft music, white noise or a gentle shushing noise can soothe some babies.
Many babies are soothed by motion

-Turn off the lights and keep surroundings quiet. Too much stimulation can often trigger crying or make it worse.

-Check to see if your baby needs something—a diaper change, a feeding, relief from being too hot or too cold, or attention for a fever.

-Hold your baby. This will not spoil him. However, some babies do not like being passed from person to person.

Question 8

What is the goal of umbilical cord care?

Answer 8

The goal of cord care is to prevent or decrease the risk for hemorrhage and infection.

Question 9

What are some SIDIS safe sleep guidelines?

Answer 9

Always place infant on back to sleep

In crib with firm flat mattress, no gaps between mattress and sides, free of soft bedding, toys, bumper pads or pillows

Do not share a bed with infant

Prevent exposure to tobacco smoke pre and post birth

Overheating is a risk factor

Can swaddle infant and lay on back to sleep

Discontinue swaddling once infant tries to turn over

Parents should share a room with the infant for the first 6 months

Question 10

What are the 4 key points for washing newborn/infant hair?

Answer 10

1.) Do not use running water to wash hair as temperature could change suddenly.

2.) Area over the fontanels CAN be washed

3.) Wash the head/hair before or after the body to prevent heat loss

4.) A mild soap or shampoo should be used

Question 11

How should you wash cloth diapers?

Answer 11

Use fragrance-free detergents to wash cloth diapers

Question 12

What are the 7 guidelines for newborn/infant bathing?

Answer 12

1.) Move from cleanest areas to the most soiled area

2.) Wipe each eye from the inner to outer canthus

3.) Use corner of the washcloth to wash ears

4.) Use plain, warm water for the face, and can use a mild non scented soap for rest of bath

5.) Wipe the gums after each feeding with a soft cloth

6.) Leave residual vernix on the skin allowing it to wear off with normal care and handling

7.) Immersing the infant (keeping the shoulders covered) results in less heat loss and crying

Question 13

What are the 5 things that patients should be taught in regards to circumsion?

Answer 13

1.) Takes 7-10 days to heal

2.) Gently wash penis with warm water after each diaper change

3.) Put petroleum jelly on incised area as directed by physician

4.) Fasten diaper loosely

5.) A thin yellow film will form over incision area – this is normal – leave it.

Question 14

What is shaken baby syndrome, now referred to as

Answer 14

Traumatic Head Injury due to Child Maltreatment
OR
THI-CM

Question 15

When seborrheic lesions are present what is the treatment directed at?

Answer 15

When seborrheic lesions are present, the treatment is directed at removing the crusts.

Question 16

What is the circumcision rate in Alberta?

Answer 16

According to the Public Health Agency of Canada (PHAC), rate of circumcision in Alberta is 44%

Question 17

What should we try to avoid or at least have minimized during all procedures?

Answer 17

During all procedures, heat loss must be avoided or at least minimized for the newborn.

Question 18

What is seborrheic dematits? When is it more common to occur?

Answer 18

Seborrheic dermatitis is a chronic, recurrent inflammatory reaction of the skin.

The cause is unknown, although it is more common in early infancy, when sebum production is increased.

Question 19

How long does a rash need to be persistent in origin for it to require treatment?

Answer 19

A rash that persists for more than 3 days may be fungal in origin and will need to be treated

Question 20

What bathing methods/techniques are recommended? Why?

Answer 20

Although the sponging technique may be used, bathing the newborn by immersion or swaddled bathing results in less heat loss and less crying and is thus recommended even with the umbilical cord still intact.

For immersion bathing, the newborn is placed in warm water (38°C [100.4°F]) deep enough to cover the shoulders, but not the head and neck.

Swaddled bathing is a type of immersion bathing in which the newborn is swaddled in a blanket or towel and immersed in a tub of warm water. One body part at a time is unwrapped and washed (AWHONN, 2018).

Question 21

Where does seborrheic dermatitis most commonly occur?

Answer 21

It occurs most commonly on the scalp (cradle cap) but may involve the eyelids (blepharitis), external ear canal (otitis externa), nasolabial folds, and inguinal region

Question 22

What can be given to a child post circumcision for pain management?

Answer 22

Oral acetaminophen may be administered before the procedure and every 4 hours thereafter (as ordered by the health care provider) for a maximum of five doses in 24 hours or a maximum of 75mg/kg/day.

Question 23

What are the 6 steps involved in collecting a sample for metabolic newborn screening?

Answer 23

1.) Wash hands

2.) Explain to parents what you are doing

3.) Warm heel first with a cloth soaked in warm water wrapped around foot or use of a disposable heel warmer

4.) Clean area with skin antiseptic and allow to dry

5.) Restrain infant foot and then puncture correct site using a spring-loaded automatic puncture device

6.) Pain can be managed with having parent hold infant, breastfeeding, or using sugar drops

Question 24

What program is used to educate new parents infant crying and the dangers of shaking a baby?(What is each component of it (6 of them)).

Answer 24

P = Peak of crying. Your baby may cry more each week—the most at 2 months, then less at 3 to 5 months.

U = Unexpected. Crying can come and go and you don’t know why.

R = Resists soothing. Your baby may not stop crying, no matter what you try.

P = Pain-like face. Crying babies may look like they are in pain, even when they are not.

L = Long lasting. Crying can last as much as 5 hours a day, or more.

E = Evening. Your baby may cry more in the later afternoon and evening.

Question 25

What is the most common minor complication of circumsion?

Answer 25

The most common minor complications associated with circumcision are bleeding and infection

Question 26

How long does diaper rash typically last for?

Answer 26

Although diaper rash can be alarming to parents and annoying to babies, most cases resolve within a few days with simple home treatments. There are instances when diaper rash is more serious and requires medical treatment.

Question 27

What is Positional plagiocephaly?

Answer 27

A flattened area that may develop on the back of the head when infants are left supine while awake or in an infant seat for prolonged periods of time, rather than on their tummy

Question 28

What does infant cord care involve? (7 things)

Answer 28

1.) Clean cord with plain water and a q-tip

2.) Assess for signs of infection – redness, swelling, exudate, pain in area

3.) Notify healthcare provider if any signs of infection noted

4.) Use an absorbent gauze to remove excess moisture

5.) Roll diaper below umbilicus

6.) Allow area to air dry

7.) The area may be loosely covered with clothing

Question 29

What type of pain management is typically administered/done for circumsion?

Answer 29

Three types of anaesthetics are used in newborns undergoing circumcision: ring block, dorsal penile nerve block (DPNB), and topical anaesthetic such as eutectic mixture of lidocaine and prilocaine (EMLA) (prilocaine-lidocaine).

Nonpharmacological methods such as concentrated oral sucrose, non-nutritive sucking, and swaddling may be used to enhance pain management. Pain during circumcision is most effectively managed using a combination of pharmacological and nonpharmacological measures.

Question 30

What is the decision for circumcision typically based on?

Answer 30

Most parent’s decisions regarding circumcision are based on social rather than medical reasons.

Question 31

When can the cord clamp be removed?

Answer 31

The cord clamp may be removed when the cord is dry, in about 24 to 36 hours, although this is not routine practice in all hospitals. Some institutions send the newborn home with the clamp still in place and it will fall off when the cord falls off. It is important to ensure that if a cord clamp remover is used, it is disinfected between uses.

Question 32

What is THI defined as?

Answer 32

THI-CM is defined broadly to include traumatic injury to the head (skull and/or brain and/or intracranial structures), which may also be accompanied by injury to the face, scalp, eye, neck or spine, as a result of the external application of force from child maltreatment” (Public Health Agency of Canada, 2020).

Question 33

how is the diaper area cleansed/washed?

Answer 33

Plain water with mild soap is used to cleanse the diaper area; if baby wipes are used, they should be unscented and contain no alcohol. The baby’s skin should be allowed to dry completely before applying another diaper.

Question 34

What is the recommended time frame for collecting blood samples for newborn metabolic screen?

Answer 34

The recommended time frame for collecting blood samples for newborn screening is between 24 and 48 hours

Question 35

When will the stump of the umbilical cord fall off? How long can it take for it to occur? what may be seen in the umbilicus separation?

Answer 35

The stump of cord will fall off in
10-14 days

although it can take up to 3 weeks for this to occur.

Some dried blood may be seen in the umbilicus at separation.

Question 36

What may form in the diaper area that is normal? How long will it take for it to disappear?

Answer 36

Uric acid crystals in the diaper area is normal and will go away within the first week

Question 37

How can cradle cap be avoided? What should the nurse discuss with parents?

Answer 37

Cradle cap may be prevented with adequate scalp hygiene. Frequently, parents omit shampooing the infant’s hair for fear of damaging the “soft spots,” or fontanels.

The nurse should discuss how to shampoo the infant’s hair and emphasize that the fontanel is like skin anywhere else on the body—it does not puncture or tear with mild pressure.

Question 38

What is an effective method for the prevention of Positional plagiocephaly?

Answer 38

When the baby is awake, “tummy time” can be provided under parental supervision so that the infant may begin to develop appropriate muscle tone for eventual crawling; this tummy time is also effective in the prevention of a misshaped head (positional plagiocephaly

Question 39

What is the purpose of facilitating universal metabolic newborn screening?

Answer 39

The purpose of Universal Newborn Screening is to facilitate early recognition and treatment of several disorders before the onset of symptoms.

Question 40

What are recommendations for preventing SIDS?

Answer 40

The PHAC guideline recommends placing the infant to sleep in the supine position to prevent SIDS (The prone position has been associated with an increased incidence of SIDS)

Other recommendations for preventing SIDS include ensuring a smoke-free environment (before and after birth), providing a safe crib environment (no toys or loose bedding), room sharing for 6 months, avoiding instances of theinfantbeing overheated, and no sleeping in waterbeds or on sofas.

Breastfeeding and pacifier use may also decrease the rate of SIDS.

In addition, co-bedding practices may contribute to unintentional suffocation caused by entrapment or overlaying, often occurring when theinfantis sharing a sleep surface with an adult or another child (PHAC et al., 2022).

Question 41

When diaper rash occurs, what is helpful to use for treatment?

Answer 41

When diaper rash occurs, it is helpful to use emollients, creams, or other protectants such as zinc oxide ointment to restore skin integrity while providing some protection from the irritants of urine and stool (Visscher et al., 2015).

Question 42

What are the 4 purposes of newborn/infant baths?

Answer 42

It provides opportunities for

(1) cleansing the newborn,

(2) observing the newborn’s condition,

(3) promoting comfort, and

(4) promoting parent–child–family interaction.

Question 43

What are the 5 reasons post-circumcision parents should call the MD?

Answer 43

1.) If baby has a fever

2.) If there is severe swelling and redness; a red streak on the shaft of the penis; or a thick, yellow discharge

3.) Bleeding or has a bloodstained area larger than the size of a quarter on a diaper or on the circumcision site dressing

4.) Baby is very fussy or cranky, has a high-pitched cry, or refuses to eat

5.) The baby has not passed urine within 12 hours after the circumcision was completed.

Question 44

What protocol determines the the technique for routine cord care?

Answer 44

Hospital protocol determines the technique for routine cord care.

Question 45

What are some ways you can soothe a baby?

Answer 45

1.) Different methods work some of the time, none will work all of the time

2.) Check if baby is hungry, or needs diaper change

3.) Hold and cuddle baby, talking and singing to baby

4.) White noise - vacuum clener

5.) Car ride

6.) Change position

7.) Repetitive noise - music, tapping, heartbeat

8.) Rhythm of sounds or touch - music, poems, gentle patting

Question 46

When bathing a child, what is NEVER used?

Answer 46

Never use baby powder

Question 47

How do you care for an uncircumcised penis?

Answer 47

Wash with water

Do not pull the foreskin back as it will bleed

(Boys do not need to pull their foreskin back until

*For parents who decide not to have their newborn son circumcised they need to be taught to clean the penis with soap and water and to not retract the foreskin until it is easily done, often not until the child is 3 or 4 years old and sometimes not until the child is an adolescent.

Question 48

what are 5 ways in which you can avoid diaper rash?

Answer 48

1.) Change baby’s diaper as soon as wet or soiled.

2.) After using wipes, allow area to air dry

3.) Expose bottom to air several times a day (tummy time)

4.) If baby has a rash, wash with plain water rather than using wipes

5.) Use a zinc-based barrier creme

Question 49

during a newborn/infant bath what should be done to ensure the baby temp stays stable?

Answer 49

-Wash hair separately from the body

Before – wash hair, dry it and then apply cap prior to bathing infant body

After – dry infant, wrap in towel or receiving blanket, and then wash infant’s hair, drying well after with a towel and applying cap