Essential Newborn Care

Introduction

Care of the newborn at birth is primarily aimed at helping the newborn to adapt to the extra-uterine environment. Physiological adaptation includes:

• . Initiating respiration and oxygenation of the arterial blood
• . Temperature adaptation
• . Initiation of feeding.

Preparing for birth

• Make sure that the following things are available for the newborn:
• Two clean and warm towels/cloths for keeping the baby warm; one for drying and wrapping the baby initially, the other one for covering the newborn to prevent heat loss
• The room where the delivery takes place should be clean, warm, well-lighted and ventilated, but draught-free
• Ensure the "five cleans during" delivery have soap, water, new razor blade , a clean plastic sheet and
•   A clean piece of thread.
• . A clean delivery kit for cord care
• . An oral mucus extractor
• . A blanket
• . A watch to note the time of delivery.

Routine care at birth

·         Over 90% of newborns do not require any active resuscitation at birth. Efforts are directed to maintain asepsis and prevent infection of the newborn, prevent hypothermia and keep the airways patent.

Asepsis

·         Wash your hands with soap and water when preparing for the birth. Use gloves. Deliver the newborn under aseptic conditions. Note the time (hour and minute) of birth.

Clamping of the cord

·         The umbilical cord should be clamped 2-3 minutes after the neonate is delivered completely.

·         Wait till the cord has stopped pulsating before clamping and cutting it. This will result in an extra amount of blood being transfused in the neonate and prevent neonatal anaemia.

·         However, early and immediate clamping of the cord is recommended in newborns with severe birth asphyxia, cord around the neck and rhesus iso-immunization.

Care of the cord

• The umbilical cord must be cut with a pair of sterile scissors/blade 3.5 cm from the abdominal skin surface. Note the following:
• Nothing needs to be applied to the cord .The cord is frequently infected because many mothers apply substances which may not be clean. The cord will dry and fall off on its own.
• Tell the mother to prevent the cord from getting soiled with the newborn.s urine or faeces.
• The mother should wash her hands with soap and water after cleaning the baby every time it passes Stools.
• Inspect the cord for bleeding 2 hours after tying.
• Do NOT apply anything on the stump; keep the cord clean and dry.
• Inspect for discharge or infection till healing occurs.

Maintaining the body temperature

• Newborns may be hypothermic at birth. Hypothermia is a body temperature of <36 °C.
• How to measure body temperature in the newborn
• The simplest way to measure body temperature in a newborn is by placing a thermometer in the axilla of the child. The thermometer should be kept for at least 5 minutes before taking the reading off the thermometer. The normal temperature of the baby is between 36.5ºC and 37ºC. Axillary temperature is comparable to rectal temperature and is safer (less chances of injury and / or infection)
• Hypothermia results in increased oxygen consumption and hypoxaemia, increased glucose consumption, and hypoglycaemia and metabolic acidosis. Hypoxaemia and hypoglycaemia can result in death of the newborn. Among survivors, it can lead to permanent impairment of the brain resulting in developmental handicaps.
• Heat loss at birth can be prevented by the following simple interventions:
• Receive the baby in a dry, warm, clean towel. Dry the baby well. While drying, make sure that the head is in a neutral position, neither too flexed nor too extended. Discard the wet towel immediately and wrap/cover the baby (except for the face and upper chest), in a fresh, clean dry towel. The baby should be kept wrapped during the assessment, and suction ventilation applied (if required) to prevent heat loss.
• Wrap the baby in loose multiple layers of light but warm cloth. Blood, meconium and some of the vernix will have been wiped off during drying at birth. The remaining vernix does not need to be removed as it is harmless, may reduce heat loss and is reabsorbed through the skin during the first few days of life.
• Place the baby near a source of warmth. A normal baby, who is crying well after birth, can be placed in skin-to-skin contact with the mother.s abdomen and covered with a dry cloth. The maternal body heat will provide the extra warmth required. It is also an additional assurance to the mother of the baby.s well-being.
• In a PHC setting, additional heat can be provided by placing the baby under a source of heat such as a lamp with a 200 Watt bulb or under a radiant warmer.
• Ensure that during and after the delivery, no fans are running in the delivery room, and no windows are open through which air currents blow into the room.
• While the baby needs to be kept clean, discourage the mother from giving a bath to the baby on the first day after birth. The mother or the birth attendant can clean the baby by wiping with a soft moist cloth. When the baby is given a bath, it should be done quickly in a warm room, using warm water.

Airways and breathing

• If the baby is crying and the breathing is normal, then there is no need for resuscitation. Provide normal
• care and clear the upper airway by wiping the nose and mouth of the baby and removing the secretions
• present therein. If the baby is not crying, assess the breathing; if the chest is rising symmetrically and the
• respiratory rate is >30/minute, no immediate action is needed. Remember, occasional gasps are not
• considered breathing.

Care of the skin

• Clean the blood, mucus and meconium on the baby before presenting it to the mother. Bathing babies
• soon after birth is not recommended. Postpone the first bath for the next day. Ensure that the baby.s
• temperature is normal before giving a bath to the baby.

Care of the eyes

• The eyes should be cleaned at birth and once every day using sterile cotton swabs soaked in sterile water
• or normal saline. Each eye should be cleaned using a separate swab. The routine use of local antiseptic
• drops for prophylaxis is not recommended.

Feeding

• Initiate breastfeeding within half an hour of a normal delivery. Ensure that the baby is suckling well. If suckling is poor, ensure correct positioning and attachment of the baby to the breast

Apgar score

• The Apgar score of the baby indicates his/her well-being. It should be calculated at 1 minute and at 5 minutes after birth.
• An Apgar score of >7 is considered satisfactory.