IMMEDIATE CARE OF THE BABY AT BIRTH

1) INITIATION AND MAINTAINANCE OF RESPIRATION

• Breathing is the first function to be established in the
newborn.

• The lungs in utero are solid because they have not been
inflated and aerated.

• At term, the alveolar cells secrete a substance called

surfactant which prevents the wall of the alveoli from
collapsing/adhering.

• Breathing is initiated in response to lack of oxygen and

high level of Co2 in the bloodstream which stimulate the
respiratory centre in the medulla oblongata.
• Once the infant’s head emerges, the health care provider
sunctions the nose and the mouth of the infant to clear the
oral respiratory passages for the first breath.

• The impact of cool air on the face and the handling of the
limbs and body make the baby to cry.

• The healthy baby cries almost as soon as he is born.

• The airway can be cleared with the use of a mucus extractor or

connected to a sunctioning machine.

• It is important to aspirate the oropharynx first so that when

the baby gasp as his nasal passage are aspirated, mucus and
other materials are not drawn down into the respiratory tract
 ASSESSMENT OF THE BABY USING APGAR SCORE

• The Apgar score is a standardized method of evaluating

the newborn’s condition immediately after delivery.

• Five objective signs are measured: heart rate, respiratory

effort, muscle tone, reflexes response to stimuli and
colour.

• The score is obtained 1 minute after birth and again after 5

minutes.
• The baby receive a total score ranging from 0– 10.

• The midwife will make an assessment of the baby at1

minute after birth and repeat assessment after 5 mins.
• A score of 8 to 10 indicate a newborn in good
condition.

• If the Apgar score is below 7, resuscitative

measures may be given.
2. PROVISION OF WARMTH
• While the baby is being attended to, baby must
not be allowed to become chilled.

• The thermal centre does not function well at

birth, hence baby loses much heat by
evaporation from his wet skin as amniotic fluid
evaporate from the skin.

• Assisting the newborn to maintain body

temperature is a major focus of initial respiration.
• In addition to heat loss by evaporation, further heat will
be lost by conduction when the baby is in contact with
cold surfaces by radiation to cold surfaces and cold
object in the environment.

• Heat is also lost by convection, caused by current of

cool air passing over the body surface.

• The room in which the baby is born should be 21.10C.

• The baby can be placed skin to skin on mother’s

abdomen, and should be cleaned and wrapped well
beside the mother.
3. INITIATON OF BREAST FEEDING
• Baby should be put to breast immediately after delivery,
this aids involution of the uterus.

• Oxytocin is released from the posterior pituitary gland

during breast feeding which aids involution.

• Mother is encouraged to put baby to breast early because

of the secretion of colostrum which help in growth and
contain antibodies which confers immunity on the baby
for the first few months of life
 EXAMINATION OF THE NEWBORN
Assessment of the new-born could be;
• General/Physical Examination (Head to Toe).
• Neurological Examination.
It is considered essential that the baby is examined by a midwife, if
defects are identified, medical assistance can be obtained early.
Prior to examining the baby;
• The midwife should wash her hands to prevent infection

• Her hands should be warm to prevent chilling of the baby.

• During examination, baby should be naked in a warm drought

free environment. There should be sufficient light to allow the
midwife to see clearly.

• The baby should be examined from head to toe.

THE HEAD
• Average head circumference is 34cm.

• The baby’s head should be examined for excessive moulding

and caput suceedaneum which arise during difficult labour
and can suggest the possibility of intracranial injury

THE EYES
• The eye is observed for any abnormality e.g eye discharge.

• Nystagmus is not uncommon in normal babies (an

involuntary rapid movement of eyeball)
MOUTH
• It should be inspected in a good light to observe abnormalities
like cleft lip, cleft palate.
• The mouth may be drawn to one side due to facial paralysis.

• It is also inspected for ‘tongue tie’-this is when the frenulum

of the tongue is attached almost to the tips.
TEETH
• Although very rare, some babies are born with the two lower
incisors. They are sometimes soft and loose and are easily
extracted.
THE ARMS AND HANDS
• The infant should be moving both arms freely and if not, the
question of fracture, dislocation or paralysis must be
considered
• Examine equality, fingers should be counted, any extra
digit should be tied/ligated, this will eventually fall off by
necrosis.
• Webbed finger is rare and if it occur are operated on,
some months later.
THE BODY
• The cord should be examined for oozing and another
clamp is applied if necessary.
• Note whether it has two arteries. In some cases, a single
artery is present and is often associated with other fetal
abnormalities eg Down’s syndrome
THE EXTERNAL GENITALIA
• The external genitalia should be examined carefully, if the
sex is not apparent, the paediatrician will initiate
investigation.
THE ANUS
• The anus should be observed for any sign of imperforation.

• The temperature should be taken rectally, gentleness is necessary

to avoid injury.
THE BACK
• The back is inspected for any sign of spinal bifida and the hips for
signs of dislocation
THE LEGS
• Fractures are rare. The legs should be examined for talipes and
congenital dislocation of the hips should be recognised early so
that correct treatment is given as soon as possible.

• The legs may appear to be bent but this is normal. The toes should
be counted, webbed toes are not common.
SPECIAL SENSES
• Taste – The lips and tongue are very sensitive. The
sense of taste is very well developed but babies
seem to prefer sweeter food.
• Hearing – The ability to discriminate between
sounds is not developed for 2-3 months.
• Sight – True vision is not present at birth. At one
month, they look forward to a bright light.
• The eyes do not focus properly for some week and
squint may persist for as long as 6 months.
• Tears are not present unless the eyes are
inflamed. Smiles and tears appear as from 4 or
6weeks.
INITIAL NEWBORN EVALUATION
• Respirations – 36 – 60c/m
• Apical pulse – 120 – 160b/m
• Temperature – 36.50c/97.80F
• Baby’s weight - 3.2kg

IDENTIFICATION OF THE NEWBORN

• It is essential that babies born in the hospital are
readily identifiable from one another.
• Various methods of identification include ; name
bands, which should contain family name, sex of
infant, date and time of birth.
ADMINISTERING MEDICATIONS
• Within one hour of birth, vitamin k and
prophylactic eye medication are routinely
administered to the newborn.

• IM vitamin K is given because the newborn is

at risk of bleeding.

• Newborn has low prothrombin level

 NEUROLOGICAL EXAMINATION OF THE NEWBORN

• This is the newborn’s reflexes assessment done to

evaluate neurologic function and development.

• Absent or abnormal reflexes in a newborn,

persistence of a reflex past the age when the reflex is
normally lost, or return of an infantile reflex in an
older child or adult may indicate neurologic
pathology.

• Reflexes commonly assessed in the newborn include;

Moro, sucking stepping, tonic neck, rooting, Babinski,
palmar grasp and plantar grasp reflexes
• 1) Moro-Reflex: This reflex occurs in response to a
sudden stimulus. It can be elicited by holding the
baby at an angle of 450 and then permitting the head
to drop by 1 or 2cm.

Response: The newborn will throw the arms outward

and flex the knees; the arms then return to the chest.
• The fingers also spread to form a ‘C’. The newborn
initially appears startled and then relaxes to a normal
resting position.

• The reflex is symmetrical and is present for the first 8

weeks of life.
• Absence of the mono- reflex may indicate brain damage or
immaturity.
• Persistence of the reflex beyond the age of 6 month
suggestive of mental retardation.
2) ROOTING REFLEX: This is elicited by stroking of the
cheek or side of the mouth.
• Response: The newborn should turn toward the side
that was stroked and should begin to make sucking
movements.
3) SUCKING AND SWALLOWING REFLEX: It is well developed
in normal babies and are coordinated with breathing.
• When baby is put to the breast, he sucks and
swallow breast milk.
• This is essential for safe feeding and adequate
nutrition.
4) GAG, COUGH AND SNEEZE REFLEXES.
• This reflex protect the infant from airway
obstruction specifically;

• when something irritating is swallowed or a

bulb syringe is used for suctioning (gagging
and coughing),

• or an irritant is brought close to the nose

(sneezing).
5) BLINKING AND CORNEAL REFLEXES
• This protects the eyes from trauma. They are elicited
by attempting to put a finger into baby’s eye and also
penetrating bright light
• Response: Baby blinks .
6) GRASP REFLEXES
• The newborn exhibits two grasp reflexes: palmar
grasp and plantar grasp.
• The palmar grasp reflex is elicited by placing a finger
on the newborn’s open palm.
• The baby’s hand will close around the finger.
• Attempting to remove the finger causes the grip to
tighten.

• Newborns have strong grasps and can almost be

lifted from a flat surface if both hands are used.

• The grasp should be equal bilaterally.

• The plantar grasp is similar to the palmar grasp.

• Place a finger just below the newborn’s toes. The

toes typically curl over the finger
(G) Palmar grasp. (H) Plantar grasp.
7) WALKING AND STEPPING REFLEXES
• Assess the stepping reflex by holding the
newborn upright and inclined forward with
the soles of the feet touching a flat surface.

• Response: The baby should make a stepping

motion or walking, alternating flexion and
extension with the soles of the feet.
WALKING AND STEPPING REFLEX
8)TONIC NECK REFLEX
• The tonic neck reflex resembles the stance of a fencer and is often
called the fencing reflex.
• Test this reflex by having the newborn lie on the back.

• Turn the baby’s head to one side.

• The arm toward which the baby is facing should extend straight
away from the body with
the hand partially open,

• whereas the arm on the side away from the face is flexed and the
fist is clenched tightly.

• Reversing the direction to which the face is turned reverses the

position
TONIC NECK REFLEX
9)The truncal incurvation reflex (Galant reflex)
• It is present at birth and disappears in a few days to 4 weeks.

• With the newborn in a prone position or held in ventral

suspension, apply firm pressure and run a finger down either
side of the spine.

• This stroking will cause the pelvis to flex toward the

stimulated side.

• This indicates T2–S1 innervation.

• Lack of response indicates a neurologic or spinal cord problem

The truncal incurvation reflex (Galant reflex)
10) BARBINSKI REFLEX
• The Babinski reflex should be present at birth and
disappears at approximately 1 year of age.

• It is elicited by stroking the lateral sole of the

newborn’s foot from the heel toward and across the
ball of the foot.

• The toes should fan out.

• A diminished response indicates a neurologic

problem and needs follow-up
BARBINSKI REFLEX
SUMMARY OF NEWBORN REFLEXES (APPEARANCE
AND DISAPPERANCE)