NEEDS FOR NEWBORN:

INTRODUCTION:
Essential care of normal healthy neonates can be best provided by the mothers under
supervision of nursing personnel or basic/ primary health care providers. About 80% of the
newborn babies should be kept with their mothers rather than in a separate nursery.
DEFINITION:
Essential Newborn Care (ENC) is care that every newborn baby needs regardless of
where it is born or its size. ENC should be applied immediately after the baby is born and
continued for at least the first 7 days after birth. Many ENC interventions are simple and can
be provided by a Skilled Birth Attendant (SBA) or a trained Community Health Worker
(CHW) or Traditional Birth Attendant (TBA) or by a family member supporting the mother
in a health facility or at home. 
PURPOSES:

 To make sure baby is thriving

 Early detection of problems or danger signs
 Helping the mother to meet the baby’s basic needs –warmth, feeding, infection
prevention
 Baby breast feed within 1st hour
 Advising and encouraging mother rot breast feed exclusively
 Advising mother and family Members about danger signs and baby care
 Treatment of key problems such as asphyxia and sepsis
 Making plans for continuing care immunizations and growth monitoring
COMPONENTS:

 Immediate newborn care

 Newborn care during the first day
 Care of newborn during the first 28 days
STEPS FOR NEEDS OF NEWBORN CARE:
1. Immediate care
2. Newborn care during the first day
3. Daily assessment and care of the baby during 28 days

1. IMMEDIATE CARE:
o Immediate newborn care is based on the knowledge of midwife of his transitional
requirement and capabilities.
o Chance of heat loss by convection, conduction, radiation and evaporation- so optimal
thermal environment in delivery room.eg switch of the fan –convection
o Closing curtains-radiation

 Airway and Breathing

 Suction gently & quickly using bulb syringe or suction catheter
 Starts in the mouth then, the nose to prevent aspiration
 Stimulate crying by rubbing
 Position properly- side lying / modified t-berg
 Provide oxygen when necessary

 Temperature
 Dry immediately
 Place in infant warmer or use droplight
 Wrap warmly
 APGAR Scoring:
 Standardized evaluation of the newborn
 Perform 1 minute and 5 minutes after birth
 Involves (5) indicators:
o Activity
o Pulse
o Grimace
o Appearance
o Respirations

 Healthy newborn: 7-10 at both 1 and 5 minutes .

 Moderately depressed newborn : 3-6 ( Need resuscitation )
 Severely depressed newborn : 1-2 ( Intensive resuscitation )
2. NEWBORN CARE DURING THE FIRST DAY:
Components:
 Anthropometric Measurements
 Bathing – Oil bath/ warm water bath
 Cord Care
 Dressing/ Wrapping - mummified
 Eye prophylaxis – Crede’s
 Foot printing / Identification
 Get APGAR score – 1 & 5 mins
 HR, RR, Temp, BP
 Injection of Vitamin K
Components:
1. Proper identification –tag/bracelet

 After delivery, gender should be determined

 Pertinent records should be completed including the ID bracelet
 Before transferring to nursery, ID tag should be applied.
2. Bathing: Oil bath/ Warm water bath

 Oil bath or complete warm water bath

 From cleanest to dirties part
 DO NOT remove vernix caseosa vigorously

3. Cord Care/ Dressing

 The cord is clamped and cut approximately within 30 seconds after birth.
 In the delivery room, the cord is clamped twice about 8 inches from the abdomen and
cut in between. When the newborn is brought to the nursery, another clamp is applied
½ to 1 inch from the abdomen and the cord is cut at second time.
 The cord and the area around it are cleansed with antiseptic solution. The manner of
cord care depends on hospital protocol. What is important is that the principles are
followed. Cord clamp maybe removed after 48 hours when the cord has dried.
 The cord stump usually dries and falls within 7 to 10 days leaving a granulating area
that heals on the next 7 to 10 days.

4. Measurements

 Weight: 
 The average daily wt gain for healthy term babies is about 30gm/day in the first
month of life
 it is about 20gm/day in second month
 10gm per day afterwards during the first year of life.

 Length: (from top of head to the heel with the leg fully extended)
 Average range: 18-22 inches (46-56 cm)
 Anthropometric measurements
o Head circumference: 
 Head circumference (repeat after molding and caput succedaneum are resolved).
Average range: 33 to 35 cm (13-14 inches) Normally, 2 cm larger than chest
circumference Place tape measure above eyebrows and stretch around fullest part of
occipital at posterior fontanel.
o Chest circumference (at the nipple line): 
 Average range: 30-33 cm (12-13 inches) Normally, 2 cm smaller than head
circumference Stretch tape measure around scapulae and over nipple line.

5. Crede’s Prophylaxis
 It is part of the routine care of the newborn to give prophylactic eye treatment against
gonorrhea conjunctivitis or ophthalmic neonatorum. Neisseria gonorrhea, the
causative agent, may be passed on the fetus from the vaginal canal during delivery.
This practice was introduced by Crede, a German gynecologist in1884. Silver nitrate,
erythromycin and tetracycline ophthalmic ointments are the drugs used for this
purpose.
  Erythromycin or tetracycline Ophthalmic Ointment:
 These ointments are the ones commonly used now days for eye prophylaxis because
they do not cause eye irritation and are more effective against Chlamydia
conjunctivitis.
 Apply over lower lids of both eyes, then, manipulate eyelids to spread medication
over the eyes.

6. Vitamin K Administration
 The newborn has a sterile intestine at birth, hence, the newborn does not possess the
intestinal bacteria that manufactures vitamin K which is necessary for the formation
of clotting factors.
 This makes the newborn prone to bleeding. As a preventive measure, 0.5 (preterm)
and 1 mg (full term) Vitamin K is injected IM in the newborn’s vastus lateralis
(lateral anterior thigh) muscle.

7. Foot printing/ marking

8. Vital signs
a. Temperature:
 Site: Rectal
 Duration: 3 mins
 Normal Range: 36.5 – 37.6 C
 Stabilizes within 8-12 hrs
b. Pulse:
 Awake: 120 – 160 bpm—120 – 140 bpm
 Asleep: 90-110 bpm
 Crying: 180 bpm
 Rhythm: irregular, immaturity of cardiac regulatory center in the medulla
 Duration: 1 full minute, not crying
 Site: Apical
c. Respiration:
 Rate: 30-60 cpm
 Duration: 1 full minute
d. Blood pressure:
 NOT routinely measured UNLESS in distress or CHD is suspected
 At birth: 80/46 mmHg*
 After birth: 65/41 mmHg*

9. Dressing/ wrapping
 The baby should be dressed with loose, soft & cotton cloths. The frock should be
open on the front or back for easy wearing.
 Large button, synthetic frock and plastic or nylon napkin should be avoided.

3. CARE OF NEWBORN DURING THE FIRST 28 DAYS

 Daily routine care of neonates:

The majority of complication of the normal newborn may occur during first 24 hours
or within 7 days. So close observation & daily essential routine care is important for health &
survival of the newborn baby.

The major goals:

  Establish & maintain homeostasis
 Stability of normal physiological status

 The daily routine care of the neonates are as follows:

 Warmth
 Breastfeeding
 Skin care & baby bath
 Care of umbilical cord
 Care of the eyes
 Clothing of the baby
 General care
 Observation
 Taking anthropometric measurement
 Immunization
 Follow up & advice

1. WARMTH:
Warmth is provided by keeping the baby dry & wrapping the baby with adequate
clothing in two layers, ensuring head & extremities are well covered. Baby should kept by the
side of the Mother.

2. BREAST FEEDING:

 Breastfeeding The baby should be put to the mother’s breast within half an hour of
birth or as soon as possible the mother has recovered from the exertion of labour.
 Breast feeding must be initiated as soon an possible to prevent neonatal
hypoglycemia. As soon as the mother has recovered from the fatigue of labor,
preferably within half an hour of birth, the baby should
 Be put to breast. The baby must receive colostrums secreted during first 2-3 days
birth. Colostrum is rich in protective antibodies so provides passive immunity to the
baby and it also has high nutritive contents.

3. SKIN CARE & BABY BATH: 

The skin should be cleaned off blood, mucus & meconium by gentle wiping before
he/she is presented to the mother. Baby bath can be given at the hospital or home by using
warm water in a warm room gently & quickly.
First Bath: Once a baby's temperature has stabilized, the First bath can be given.

4. CORD BLOOD COLLECTION

Make sure cord blood is collected for analysis and sent to laboratory for checking of:
Rh Blood type, Hematocrit & possible cord blood gases.

5. CARE OF THE UMBILICAL CORD

 Keep the cord stump clean and dry.
 Topical application of antiseptics is usually not necessary unless the baby is living in
a highly contaminated area.

6. CARE OF THE EYES: 

Eyes should be clean at birth & once in everyday using sterile cotton swabs soaked in
sterile water or normal saline. Separate swabs for each eye.
7. CLOTHING OF THE BABY: 
 The baby should be dressed with loose, soft & cotton cloths. The frock should be
open on the front or back for easy wearing.
 Large button, synthetic frock and plastic or nylon napkin should be avoided.

8. GENERAL CARE: 
 Rooming –in
After the baby is transferred to the post natal ward, he should be nursed in a
bassinet the mother’s bed. This is called rooming-in.
It has the following advantages-

 Promotes early initiates of breast feeding.

 Provides opportunity for mother-baby interaction and bonding.
 Relieves mother’s anxiety related to where about of the bady.
 Gentle approach
 Aseptic technique
 Sensory stimulation
 Tender& loving care

9. OBSERVATION: 

 The baby should be kept in continuous observation twice daily for detection of any
abnormalities.
 A daily routine examination should be done till the mother and baby is discharged
from the hospital.
 The nurse should carefully watch for the following danger signs and report
immediately to the physician.

This danger signs are-

 Failure to pass meconium within 24 hours of birth.

 Failure to pass urine within 48 hours of birth.
 Bleeding from any side.
 Failure to take feed.
 Excessive crying or undue lethargy.
 Jaundice within 24 hours of birth (Pathological Jaundice)
 Hypothermia or Hyperthermia
 Seizures
 Persistent vomiting or diarrhea
 Breathing difficulty
 Evidence of superficial infection like oral thrush, conjunctivitis, umbilical cord
infection, pustules on skin etc.
 Apart from observation the baby for the above stated danger signs, the baby should be
weighed daily at same time. Also monitor vital signs regularly.

10. ANTHROPOMETRIC MEASUREMENT: 

 Measure weight
 length
 Head circumference
 Chest circumference
11. IMMUNIZATION: 

Newborn should be immunized with BCG vaccine & ‘0’ dose of ‘OPV’. Hepatitis ‘B’
vaccine can be administered at birth as first dose & other two doses in one month & 6 months
of age.

12. FOLLOW UP & ADVICE: 

 Each infant should be followed up, at least once every month for first 3 months
subsequently 3 month interval till one year of age.
 The period when mother is in post natal ward can be utilized for teaching the mother
about all aspects of baby care.
 Parents are taught to observe the child’s daily behaviour related to feeding, sleep,
activity, cry, elimination etc.
 Parents need to be told about – holding the baby, baby bath, eye and cord care,
feeding and nutritional supplements, immunization, prevention from infection and
follow up.
 The parents should be educated about the danger signs in the baby, which if present
require immediate hospitalization.

HARMFUL TRADITIONAL PRACTICES FOR THE CARE OF NEONATES:

 Use of unclean substance such as cow dung, mud on umbilical card,

 Immediate bathing,
 Use of prelacteal feeds,
 Application of kajal in the newborn eyes,
 Instillation of oil drops into ears & nostrils,
 During bathing the baby use of unhygienic herbal water,
 Use of pacifiers,
 Introduction of artificial feeding with diluted milk,
 Giving opium & brandy to neonates
 Use of readymade expensive formula foods.