Immediate care of newborn

The care of a newborn baby immediately after birth holds profound significance. The initial hour post-birth significantly shapes the infant’s survival, future health, and overall well-being. During this crucial period, health workers assume a vital role. The care they administer in this timeframe plays a critical role in averting complications and securing the newborn’s survival.

Objectives

1. To facilitate the initiation of respiration and prevent asphyxia.
2. To maintain a stable body temperature.
3. To safeguard against injuries and infections.
4. To identify congenital abnormalities and offer necessary treatments.
5. To encourage early and exclusive breastfeeding.
6. To prevent hypoglycemic shock.
7. To promote overall neonatal health.

Eight steps for new born care

Step 1 – Dry, stimulate, and wrap the baby:

• Gently dry the baby’s head and entire body using a clean, warm cloth.
• Rub the baby’s back up and down.
• Remove wet clothing and discard them. Wrap the baby in a clean, dry, and warm cloth.

Step 2 – Assess breathing and colour:

• Check the baby’s breathing normal or signs of trouble (not breathing).
• Assess the baby’s colour, observing for a pink, grey, blue, or pale.

Step 3 – Determine the need for resuscitation:

• Evaluate the baby’s breathing rate, checking if it falls below 30 breaths per minute, if there is gasping, or if there is no breathing.
• If the baby requires resuscitation, proceed with performing resuscitation measures.

Step 4 – Tie and cut the cord:

• Position the first clamp or tie approximately one to two fingers’ width (about 5cm) away from the baby’s abdomen.
• Place the second clamp or tie about four fingers’ width away from the baby’s abdomen. Cut the cord between the two ties.
• Avoid placing any substances onto the cord or stump.

Step 5 – Initiate skin-to-skin contact with the mother:

• Place the baby on the mother’s chest in skin-to-skin contact.
• Ensure the baby’s head is covered.
• Wrap both the mother and baby together with a warm cloth or blanket.

Step 6 – Have a woman start breastfeeding within the first hour of birth:

• Assist the mother in positioning the baby correctly for breastfeeding.
• Verify a proper attachment during breastfeeding.
• Assess the baby’s effective sucking.
• Do not impose any time limits on the baby’s breastfeeding duration.

Step 7 – Provide eye and cord care:

• Administer eye care if deemed necessary using normal saline or cooled boiled water within the first hour after birth. This eye care helps shield the baby from potential serious eye infections.
• Apply Chlorhexidine ointment (Nabhi malam) around the umbilical cord to promote hygiene and care.

Step 8 – Explain both normal and abnormal findings to the mother and family:

• If the baby is in a normal condition, keep the baby with the mother.
• If any abnormalities are identified, refer the baby to an appropriate healthcare facility with special instructions and ensure proper follow-up.

Examination of new born baby

Examination of a newborn baby involves a comprehensive assessment from head to toe.

Purpose

• To evaluate the newborn’s condition and provide appropriate care as required.
• To identify potential congenital abnormalities.
• To detect signs of illness and birth injuries and initiate timely treatment.
• To measure and document body temperature.

Equipment

• Thermometer set
• Weighing scale
• Tape measure
• Stethoscope
• Baby’s chart or card
• Torch light
• Babies clothes
• Pen

Procedure

1. Explain the procedure to the mother and its purpose. Prepare the necessary equipment.
2. Ensure the room is prepared, clean, and warm. Wash your hands and dry them.
3. Place the neonate in a supine position on the examination table under the infant warmer.
4. The surface should be clean and warm, allowing the mother to observe the procedure. Carefully observe the baby from head to toe. Check the colour of the skin for pinkness or signs of cyanosis.
5. Observe the movement of the limbs.
6. Assess the baby’s cry, noting whether it’s normal or feeble.
7. Check the neonate’s vital signs against the normal values:

• Temperature should range from 97.9°F to 98°F.
• Pulse rate should be between 120 and 160 beats per minute.
• Respiratory rate should be within 36 to 60 breaths per minute.
• Weight should fall within the normal range of 2.5 to 3 kilograms.
• Measure the height, including head and chest circumference:
• Height should be between 48 and 50 cm.
• Head circumference should be around 32 to 34 cm.
• Chest circumference should measure 30 to 32 cm.

Head to toes examination of new born

Head:

• Note the shape and size of the head.
• Assess the fontanelles (soft spots), sutures, and signs of moulding.
• Check for any swelling, signs of skull fracture, hydrocephalus, or microcephaly.

Eye:

• Examine the eye’s colour and look for any signs of jaundice, discharge, edema, or hemorrhage.

Ear:

• Inspect the ears for their structure and lining, checking for any discharge or abnormalities.

Mouth:

• Observe for cleft palate, harelip, and the presence of deciduous teeth.
• Note the presence of thrush (white patches in the mouth) and assess for tongue tie.

Nose:

• Evaluate the nose’s structure and septum for any irregularities.

Neck:

• Check for congenital goiter or any other abnormalities in the neck area.

Chest:

• Assess the rate and rhythm of respiration.
• Listen for lung sounds and heart sounds.
• Observe chest movement during respiration and inspect for any enlargement of the breasts.

Abdomen:

• Examine the size, shape, and distention of the abdomen.
• Assess respiration in this area and examine the condition of the umbilical cord.
• Listen for bowel sounds during auscultation.

Examine the extremities in detail:

Arms:

• Assess arm movements for both arms, checking for dislocation, fracture, paralysis, and range of motion.

Legs:

• Evaluate the hips for signs of dislocation and assess hip movement.
• Check for any presence of extra fingers.
• Observe for conditions like talipes (clubfoot) and other abnormalities.

External Genitalia:

• In male babies, look for signs of congenital hydrocele, phimosis of the penis, and absence of testes.
• For female babies, examine the labia majora covering the labia minora, and check for any unusual discharge.

Rectum:

• Examine the rectum for patency.
• Note the passage of meconium (first stool).
• Check for conditions like imperforate anus or fistula.

Back:

• Examine the back to detect any signs of spinal bifida or vertebral dislocation and fracture.

Evaluate Neurological Responses:

• Assess the Moro reflex, rooting reflex, grasp reflex, stepping reflex, sucking and tonic neck reflex, and pupillary reflex, among others.

Documentation and Reporting:

• After completing the examination, ensure proper recording and reporting of your findings.

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