CARE OF THE NEWBORN

DEFINITION

• Newborn usually refers to a baby from birth to about

2 months of age
 IMMEDIATE CARE OF THE NEWBORN

• Care at Birth
• Care in Nursery
 CARE AT BIRTH:
• Soon after the delivery of the baby, it should be
placed on a tray covered with clean dry linen with
the head slightly downward (15°). It facilitates
drainage of the mucus accumulated in the
tracheobronchial tree by gravity. The tray is placed
between the legs of the mother and should be at a
lower level than the uterus to facilitate gravitation
of blood from the placenta to the infant
• Air passage (oropharynx) should be
cleared of mucus and liquor by gentle
suction.
• Apgar rating at 1 minute and at 5
minutes is to be recorded.
• Clamping and ligature of the cord
• The cord is clamped by two Kocher’s forceps, the near one is
placed 5 cm away from the umbilicus and is cut in between.
• Two separate cord ligatures are applied with sterile cotton
threads 1 cm apart using reef-knot, the proximal one being
placed 2.5 cm away from the navel.
• Squeezing the cord with fingers prior to applying ligatures or
plastic cord clamps, prevents accidental inclusion of
embryonic remnants.
• The cord is divided with scissors about 1 cm beyond
the ligatures taking aseptic precautions so as to
prevent cord sepsis. Presence of any abnormality in
cord vessels (single umbilical artery) is to be noted
• The cut end is then covered with sterile gauze
piece after making sure that there is no bleeding.
• Delay in clamping for 2–3 minutes or till cessation
of the cord pulsation facilitates transfer of 80–100
mL blood from the compressed placenta to a baby
when placed below the level of uterus.
• This is beneficial to a mature baby but may be
deleterious to a preterm or a low birthweight baby
due to hypervolemia and hyperbilirubinemia.
• But early clamping should be done in cases of Rh-
incompatibility (to prevent antibody transfer from
the mother to the baby) or babies born asphyxiated
or one of a diabetic mother.
 CARE IN NURSERY:

• Admission in Nursery—All healthy newborns

are kept in the delivery room with their
mother to promote immediate breastfeeding
and early bonding. Common indications for
admission of the newborn in the nursery
are: prematurity, respiratory distress, poor
perfusion or presence of pallor or cyanosis,
malformation and need for O2 therapy.
• Routine Nursery Care—The newborn is examined
systematically and assessment of the gestational age is
done.
• Infant’s weight, fronto-occipital circumference (FOC) and
length are recorded. On these basis, the newborn is
classified as average for gestational age (AGA), small for
gestational age (SGA) or large for gestational age (LGA).
• The normal skin temperature in the neonate is 36.0–
36.5°C (96.8–97.7°F).
• Normal core (rectal) temperature is 36.5–37.5°C
(97.7–99.5°F).
• Axillary temperature may be 0.5–1.0°C lower.
• Consequences of hypothermia are:
• (a) DIC,
• (b) Pulmonary hemorrhage,
• (c) Shock,
• (d) IVH,
• (e) Increased mortality.
The measures to prevent heat loss are:
(i) Place the baby under a preheated (36.5°C) radiant
warmer (servo-control) immediately following delivery,
(ii) Dry baby immediately after birth,
(iii) Cover baby (including the head) with a pre-warm towel,
(iv) Put baby close to mother’s breast (Kangaroo method),
(v) Wrap the mother and baby together, and
(vi) Commence early breastfeeding
 DAILY OBSERVATION AND CARE

• Rooming-in: Soon after birth, if mother is fit, baby is

kept in a cot by the bedside of mother. This
establishes mother-child relationship. Mother also
learns the art of baby care.
• Baby bath: Routine bath is delayed until the baby is able
to maintain the body temperature and has started
breastfeeding. The excess vernix, blood or meconium are
wiped off from the skin using sterile moist swabs and then
make the skin dry by using a soft towel. The water for
baby bath should be at body temperature (> 97.5°F) and a
separate bathtub should be earmarked for each baby.
• Umbilical cord care: It is kept exposed to air and
allowed to dry to promote early detachment. Topical
antiseptics or antibiotics such as triple dye or
Neosporin powder may be applied to reduce
bacterial colonization.
• Routine medications: A single intramuscular dose of
0.5–1 mg of vitamin K is given to all newborns within
6 hours of birth. This prevents vitamin K deficient
bleeding.
• Eyes are kept clean with cotton wool soaked with
sterile normal saline as a prophylaxis against
ophthalmia neonatorum (chlamydia, gonococcus).
Erythromycin ointment (0.5%) bilaterally in the
conjunctival sac or tetracycline (1%) ointment may be
used.
• Immunization and vaccines: Hepatitis B vaccine is
given at birth. Other vaccine information is given to
the parents.
• Screening of the new-born: Commonly done
screening tests are: (A) Glucose screening and detect
hypoglycaemia especially for infants of diabetic
mothers, SGA and LGA infants;
• (B) Bilirubin screening
• (C) Other metabolic screen depending on need (e.g.
galactosemia).
• Assessment of vital signs: Respiratory rate, heart
rate, axillary temperature are recorded every 6–8
hours in baby’s chart.
• Each urine and stool output is recorded. Most of the
newborns pass urine by 24 hours and meconium by
48 hours of life.
• Daily weights are recorded.
• Feedings: The frequency, duration and volume of
each feed is important for newborn’s growth and
development. The infant should be put to breast as
soon as possible after delivery.
• Feeding is allowed on demand (demand feeding).
Usually it is 8–12 times per day.
• Discharge: Each infant is evaluated carefully to
decide the optimal time of discharge.
• The following infants may be discharged by 48 hours
of age: Vaginal delivery, gestational age > 38 weeks,
singleton birth, birth weight—AGA, normal vital
signs, passed urine and stool, initial immunization
done, successful feedings and normal on physical
examination
• Follow-up of newborns should be organized
depending upon the risks of feeding problems,
infections, hyperbilirubinemia or other issues.
• During follow-up, the newborn is assessed for
weight, hydration, infection and for any new
problem.
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