Management of New born

Presented By: Riya Patel Shukal

M.Sc (OBGYN)
Introduction

❖ Essential care of the normal healthy neonates can be best provided by the mothers
under supervision of nursing personnel. About 80% of newborn baby’s require
minimal care.
❖ The normal term baby should be kept with their mother rather than separate
nursery. Rooming in promotes better emotional bondage, prevents cross infection
and established breast feeding easily.
❖ Mother participates in nursing care of the baby and develops self confidence in her.
❖ Nursing care of healthy new born baby after birth should be provided as immediate
care of neonate and daily routine care .
IMMEDIATE BASIC CARE OF NEWBORN

❖ As majority babies cry at birth and take spontaneous respiration, no

resuscitation required at birth in about 95-98% neonates.
❖ These healthy normal neonates need only warmth, breast feeding, close
observation for early detection of problems and protection from infections and
injuries.
❖ After cutting the umbilical cord aseptically the baby should be kept dried,
wrapped with dry and warm cloth, examine thoroughly and quickly to assess
normal characteristics, to detect congenital malformation and then put the
mother’s breast.
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❖ Identification tag to be tied to the mother and baby.

❖ Recording to be done accurately about the event of the birth of the
baby (especially birth date, time, sex, examination findings or
presence of any problem etc) in the delivery record sheet.
❖ The mother and baby should transfer to ward usually after 1 hour of
observation in the delivery room and when the condition permits.
❖ Sick or at risk neonates need special care in special setting
APGAR SCORE CRITERIA
Daily routine care of neonate

❖ The major goal of nursing care of the newborn is establish

and maintain homeostasis i.e. stability in the normal
physiological status.
Warmth

❖ Warmth is provided by keeping the baby dry with adequate clothing.

❖ Baby should be kept to the side of the mother, so that the mother’s
body temperature can keep the baby warm.
❖ Baby can be placed in skin to skin contact with mother (kangarooing)
to maintain temperature of infant and facilitate breast feeding.
❖ Bathing at first day is avoided to prevent hypothermia.
Breast Feeding

❖ The baby should be put to mother’s breast within half an hour of birth as soon
as possible .
❖ The mother has recovered from exertion of labour . Colostrums feeding must
be offered.
❖ Mother should be informing about the importance and techniques of breast
feeding.
❖ Demand feeding should be encouraged.
❖ Exclusive breast feeding procedure should be explained to the mother and
family members
Baby Friendly Hospital Initiative
(BFHI)

❖ The Baby-friendly Hospital Initiative (BFHI) was launched in 1991 by UNICEF

and the World Health Organization, it has served as a motivating force for
maternity facilities around the world to implement policies and practices that
support breastfeeding.
❖ The Baby-friendly Hospital Initiative (BFHI) seeks to provide mothers and
babies with a good start for breastfeeding, increasing the likelihood that babies
will be breastfed exclusively for the first six months and then given appropriate
complementary foods while breastfeeding continues for two years or beyond.
Goals of BFHI

❖ To transform hospitals and maternity facilities through implementation of the

“Ten steps”.
❖ To end the practice of distribution of free and low cost supplies of breast-milk
substitutes to maternity wards and hospitals.
Ten Steps of Breast Feeding

1. Have a written breastfeeding policy that is routinely communicated to all health

care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within a half-hour of birth. This Step is now
interpreted as: Place babies in skin-to-skin contact with their mothers immediately
following birth for at least an hour. Encourage mothers to recognize when their
babies are ready to breastfeed and offer help if needed.
Ten Steps Of Breast Feeding

5. Show mothers how to breastfeed, and how to maintain lactation even if they
should be separated from their infants.

6. Give newborn infants no food or drink other than breast milk, unless medically
indicated.

7. Practise rooming-in — allow mothers and infants to remain together — 24 hours

a day.

8. Encourage breastfeeding on demand.

Ten Steps Of Breast Feeding

9. Give no artificial teats or pacifiers (also called dummies or soothers) to

breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer

mothers to them on discharge from the hospital or clinic.
Skin Care and Baby Bath

❖ The baby must be cleaned off blood, mucus and meconium.

❖ No vigorous attempts should be met to remove the vernix caseosa, as it provides
protection to the delicate skin.
❖ Baby bath can be given in the hospital by using warm water in a warm room gently
and quickly.
❖ Bathing should be avoided in open place.
❖ During winter months the baby should have sponge bath rather than deep bath to
avoid hypothermia.
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❖ Use of olive oil or coconut oil can be allowed after 3-4 weeks of age.
❖ Oil massage improves circulation and muscle tone.
❖ Oil massage should be given before the bathing.
❖ Exposure to morning sunrays is an important source of vitamin D and warmth.
❖ The talcum powder should be applied over the axillae , groins and buttocks.
Care Of Umbilical Cord

❖ The umbilical cord is cut about 2-3 inches from the navel with aseptic precaution
during delivery and tied with cotton thread or disposable plastic clip.
❖ The cord must be inspected for bleeding afterwards which commonly occurs due to
shrinkage of cord and loosening of ligature.
❖ No dressing should apply and the cord should be kept open and dry.
❖ Normally it falls of after 5-10 days. Application of triple dye or junction violet is not
advocated as a routine any more.
Care Of Eyes

❖ Eye should be cleaned at the birth and once every day using sterile cotton swabs
soaked in sterile water .
❖ Each eye should be cleaned using a separate swab.
❖ Application of kajal in the eyes must be avoided to prevent infection or lead
poisoning.
❖ The eye should be observed for redness , discharge or the excessive tearing for
early detection of problems and prompt management.
Clothing Of The Baby

❖ The baby should be dressed with loose, soft and cotton cloths.
❖ Large buttons synthetic frock and plastic or nylon napkin should be
avoided.
❖ A triangular shaped soft, absorbent cloth should be used as napkin.
❖ The cloths should not be tight especially around the neck or abdomen.
❖ In winter woolen clothing should be used.
General Care

❖ The new born should be kept with the mother for continues rooming in a well
ventilated room.
❖ Baby be should handled with gentle approach after hand washing.
❖ No infected person should take care or touch the baby.
❖ Baby should allow to sleep in a supine position which can prevent sudden
infant death syndrome.
❖ General cleanliness is to be maintained and surrounding to be kept clean.
❖ Wet nappies should be change immediately.
Observation

❖ The baby should be thoroughly observed twice daily for early detection of any
abnormalities.
❖ Temperature, pulse, respiration, feeding behavior, stool, urine and sleep
pattern should be assessed .
❖ Mouth, eyes, cord, and skin should be looked for any infections.
Weight recording

❖ Assess daily weight gain in healthy term babies which is about 30gm/day.
❖ Most infants double their weight by 4-5 months but in first week of life there is
physiological loss of body weight because of removal of vernix, mucus, blood,
passage of meconium and reduction of extracellular blood volume & also due to
adaptation to new environment.
❖ With adequate breast feeding majority of babies regain the weight within 7-10 days
of birth.
Immunization

❖ within first week of life.

❖ The mother should be informed about national immunization schedule and
explanation should given about important of complete immunization and all possible
reaction following vaccines.
❖ In institutional deliveries all neonates should be immunized with BCG vaccine and
zero polio.
❖ In outside or home deliveries the BCG and OPV should be given
Follow up & Advice

❖ Each infant should be followed up, at least once every months for first 3 months and
subsequently 3 months interval till one year of age.
❖ Follow up is necessary for assessment of growth and development, early detection
and management of health problems.
❖ Health education should be given regarding exclusive breast feeding, warmth,
hygiene, rooming in, clothing, immunization and follow up.
❖ Harm full cultural practices should be discouraged.
❖ Care at home should be discussed and demonstrate to the mother and family.
Rooming in

Rooming in: A hospital arrangement where a mother/baby pair stay in the same
room day and night, allowing unlimited contact between mother and infant.
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❖ Routine separation should be avoided.

❖ Separation should only occur for an individual clinical need.
❖ If separation of a mother and her infant is required because of a medical situation,
document the reason for this separation in the mother/baby record