Care Of Newborn Baby: The care at birth has a major influence on the survival, future health and well-being of a newborn infant.
Immediate care of a normal newborn at the time of birth: As soon as baby is born you need to perform following activities.
- Call out the time of birth and sex of the baby: And show the baby to the mother.
- Deliver the baby on the mother’s abdomen. in a prone position with face to one side.
- If the baby is not crying or not breathing: Resuscitation the newborn. the procedure of resuscitation is given.
- If the baby is crying: delay cord clamping for 1–3 mins before cutting.
- Dry baby with a pre-warmed towel while over mother’s breast: immediately dry the baby but if secretions or present suction first and then dry (This will prevent aspiration as drying itself is stimulation for a baby to breath). Remember to suction mouth first and then nose to prevent aspiration blood or meconium on the baby’s skin should be wiped away, however, the white greasy substance covering the baby’s body (Vernix) should not be wiped off. Because this Vernix helps to protect the baby’s skin and gets reabsorbed within few hours.
- Wipe both the eyes with sterile swab: Clean the eyes using sterile gauze/ cotton. Use separate gauze for each for each eye. Wipe from the medial side (inner canthus) to the literal side (outer canthus).
- Encourage Breastfeeding: Breastfeeding should be initiated within half an hour birth in all babies.
Check cord for any oozing of blood:
- Place and identity wrist band on the baby: This helps in easy identification of the baby and avoiding any confusion the level should we placed on the wrist or ankle.
- Give the baby and injection of vitamin k
- Weigh the baby and record the weight.
- Check for any congenital malformations.
Important keys points:
- Cover the baby’s head with a cap and cover the mother and baby with a warm cloth/sheet: Both the mother and the baby should be covered with a warm cloth, especially if the delivery room is cold (temperature less then 25°C). Since head major contributor to the surface area of the body a new born baby’s head should be coverage with a cap to prevent loss of heat.
- The labour room must be warm (maintain room temperature in the range 25-28°C) to avoid hypothermia.
- Assess the baby’s breathing, if the baby is not breathing or has difficulty in breathing initiate resuscitation.
- Dose of vitamin K in neonates with birth weight less than, 1000g — 0.5 mg IM.
- Dose of vitamin K in neonates with birth weight more than, 1000g — 1.0 mg IM.
Routine care at birth:
Following steps are important for providing routine care to Newborn at birth.
Ensuring Warmth: (Warm chain).
A baby’s skin temperature falls within seconds of being born. If the temperature continuous to fall the baby will become ill and may even die. This is why a baby must be dried immediately after birth and delivered into a warm towel or peace off cloth, and loosely wrapped before we end place naked between the mother’s breasts or over abdomen.
Keeping the baby between the mother’s breasts ensures that the baby’s temperature is kept at the correct level for as long the skin contact continuous. This first skin to skin contact should last uninterrupted for at least one hour after birth or until after the first breastfeed. The mother and baby should be covered with a warm and dry cloth, especially if the room temperature is lower than 25°C you should maintain warm chain. Means that the temperature maintenance a continuous process starting from the time of the deliveri and continued till the babies discharge from the hospital. The components of warm chain are summarised below.
- Ensure delivery room is warm 25°C with no draughts of air.
- Dry the baby immediately remove the wet cloth.
- Cover the baby with clean dry cloth.
- Keep the baby in skin to skin contact with mother on chest or abdomen.
- Postpone bathing even for a week.
- Keep the baby clothing and wrapped with the heat covered.
- Avoid bathing especially in cool weather or S for small babies.
- Keep the baby close to the mother.
- Use Kangaroo care for stable LBW babies and for re-warming stable bigger babies.
- Show the mother woh to avoid hypothermia how to recognise it, and how to re-warm a cold baby. The mother should aim to ensure that the baby’s feet are warm to touch.
Manitaining Normal breathing:
You should ensure to assess breathing of baby at the time of drying. If the Baby is crying vigorously or breathing at adequately (chest is rising smoothly at a rate of 40 to 60 times per minute) then no intervention is needed. however if the baby is not breathing or is gaping then baby may need initial steps of resuscitation, positive pressure ventilation etc.
The breastfeeding is initiated within half an hour to 1 hour after birth. During the initial skin to skin contact position after birth the baby should be kept between the mothers breasts. This would ensure early initially, baby normally rests and would be asleep. This rest period may vary from a few minute to 30 or 40 minutes (remember each baby is different and this period might vary) befor the baby shows signs of wanting to breastfeeding. After this period the baby will usually open his/her mouth and start to move the head from side to side, he may also begin to dribble. These signs indicate the baby is ready to breastfeeding. Baby may also try reaching the breast by making directed movements called ‘Breast Crawl’ the mother should be helped in feeding the mother and the baby once the baby shows these signs. You should keep both the mother and the baby in a comfortable position. The baby will be put next to the mother’s breast with his mouth opposite to the nipple and areola. The baby should attach to the breast by itself when it is ready. When the baby is breastfeeding attachment and positioning should be checked and help the mother to breastfeed her baby accurately and adequately. If in the initial first feeding session baby does not latch, don’t give any liquid other than breast milk (or Colostrum) even if baby doesn’t feed. Most of the babies are ready to take feed with in 30 minutes to one hour.
Prevention of infection: Maintain Clean Clain:
Babies are secure when they are in mother’s womb. However after birth, they have to be protected from the adverse environment of the surroundings. Cleanliness at delivery reduces the risk of infection for the mother and baby especially neonatal sepsis and tetanus. Cleanliness requires mother’s families and health professionals to avoid harmful traditional practices, and prepare necessary materials. Hand washing is the single most important step to be emphasised to both family members and health care workers.
Similar to warm chain, clean chain, has to be followed both at the time of delivery and then till the time of discharge to protect the infant from infections.
Clean delivery “WHO” six clean steps:
- Clean attendant’s hands (washing soap).
- Clean delivery surface.
- Clean cord-cutting instrument.
- Clean string to tie cord.
- Clean cloth to cover the baby.
- Clean cloth to cover the mother.
- All caregivers should wash hands before handling the baby.
- Feed only breast milk.
- Keep the cord clean and dry, do not apply anything.
- Use a clean absorbent cloth as a diaper /napkin.
- Wash your hands after changing diaper/ napkin.
- Keep the baby clothed and wrapped with the head covered.
Cord and Eye Care:
We will begin with cord care.
The umbilical cord can be clamped-cut and tied (according to local custom) while the baby is on the mother’s abdomen or on a warm, clean and dry surface. The steps of clamping cutting, the cord and it’s care after cutting are given below.
Care Of the umbilical cord:
- Put the baby on mother’s abdomen or chest or on a warm, clean and dry surface close to the mother.
- Change gloves, if not possible, wash gloved hands.
- Put ties (using a sterile tie) tightly around cord at 2cm and 5cm from the abdomen.
- Cut between the ties with a sterile instruments etc.
- Remove blood or meconium by wiping with clean cloth.
- Observe for oozing blood. If blood oozes, place a second tie between the skin and first tie.
- Do not apply any substance to the stump.
- Leave stump exposed and nothing should be applied or placed on it.
- If stump is soiled wash it with clean water and dry with a cloth.
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By GS India Nursing………..!!