Care of Newborn

Partners in Global Health Education
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
Care of the newborn

infant
Variations exist from place to
place in the care of the newborn
infant. However, although often
neglected, their basic needs are
the same.
Infants who are unwell or have
congenital abnormalities fall short
of the mothers expectation of a
beautiful bundle of joy. All
mothers require urgent and
sensitive counselling.
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
For more information about the authors and reviewers of this module,
click here
How should I study this

module?
This self-directed learning (SDL) module has been

designed primarily for medical students but may also
be of use to healthcare providers especially at the
primary care level.
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
Answer the MCQ at the end to assess your learning.
7.
Routine care
8.
Cord care
9.
Thermal
control
You should research any issues that you are unsure

about. Look in your textbooks, access the on-line
resources indicated at the end of the module and
discuss with your peers and teachers.
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
We suggest that you first read the learning outcomes

and try to keep these in mind as you go through the
module slide by slide and at your own pace.
Finally, enjoy your learning! We hope that this module

will be easy to study and complement your learning
about newborn care from other sources.
Learning outcomes
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
After studying this module, you should be able

to
Describe the routine clinical assessment of
newborn infants
Describe some common congenital
abnormalities
Describe the essential elements of the
routine management of newborn infants
including hygiene, cord care, feeding and
rooming-in
Describe what routine immunisations are
required during infancy
Discuss what information is required by
mothers prior to discharge
Clinical assessment
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
After delivery of the baby and in

the absence of any immediate
problems, essential newborn
care begins with a thorough
general clinical assessment.
This should be done on all
infants soon after birth to detect
signs of illness and congenital
abnormalities.
The following slides describe the
assessment that should be
performed routinely in all infants.
This initial assessment should
indicate where more detailed
clinical assessment is required.
A resident doctor washing her hands up to

the elbows prior to examination
Hand washing with soap and water before and after a baby
is handled goes a long way in reducing the risk of infection
Clinical assessment
First steps and appearance

1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Start by congratulating the

mother on the arrival of her new
baby and ask if she has any
concerns. The mother is usually
the first person to notice any
problems.
Ask about feeding and the
passage of urine and stools.
The infant should pass
meconium (the first black, tarry
stools) within 24 hours of birth.
General observation: inspect
colour, breathing, alertness and
spontaneous activity.
Well infants have a flexed,
posture. Partially flexed posture
is found in hypotonia or
prematurity
Well term infant showing typical well flexed

posture
Note the abduction of the hips in this

partially flexed preterm infant (froglike
posture)
Clinical assessment
Examine skin for prematurity or dismaturity
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
Thin,
transparent
skin in preterm
infants
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Wrinkled peeling skin of

dysmaturity in an IUGR infant
Pale pink skin of a term infant (hair

shaved to site IV line)
Clinical assessment
Skin: some common normal findings

1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Vernix caseosa: a cream/white cheesy material on the

skin at birth which cleans off easily with oil.
Lanugo; fine downy hairs seen on the back and shoulders
especially in preterm infants.
Milia: pinpoint whitish papules on nose and cheeks due to
blocked sebaceous glands.
Mongolian blue spots: grey/bluish pigment patches seen in
the lumbar area, buttocks and extremities in dark skinned
babies.They usually disappear by one year.
Capillary heamangiomas (stork bite naevi): red flat
patches which blanch with gentle pressure. Commonly
occur on upper eyelids, forehead and nape of the neck.
Erythema toxicum: small white/yellow papules or pustules
on a red base seen on face, trunk and limbs. Develop 1
3 days after birth and usually disappear by one week.
Clinical assessment
Colour
1.
Introduction
Note palor or plethora
2.
How to use
module
3.
Learning
outcome
Cyanosis: the baby should

be uniformly pink
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Blueness of the hands and

feet (peripheral cyanosis)
may be due to cold
extremeties.
Blueness of the mucous
membranes and tongue is
central cyanosis and is
usually due to lung or heart
problems
Bruising (ecchymosis) is
common after birth trauma.
Unlike cyanosis, bruising
does not blanch on gentle
pressure.
A Caucasian infant with marked

central cyanosis
Clinical assessment
Jaundice
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
Jaundice is common in the first week

of life and may be missed in dark
skinned babies
Blanch the tip of the nose or hold

baby up and gently tip forward and
backward to get the eyes to open.
Teach mother to do the same at

home in the first week and report
to hospital if significant jaundice is
observed.
Blanching the tip of the nose
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Two infants with jaundice; note yellow sclerae
Clinical assessment
Head
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
After these general observations,

examine the infant starting with
the head and moving down the
body.
Observe the size and shape of
the head (micro- or
macrocephaly;
cephalhaematoma)
Check the anterior and posterior
fontanelles and that the skull
sutures feel normal
Form and position of ears (low
set ears occur in chromosomal
abnormalities, e.g. Down
syndrome)
Cephalhaematoma limited to
the right parietal region
Huge encephalocoele. Head

is disproportionately small
Clinical assessment
Eyes and face

1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
Examine eyes for ocular anomalies and check for

red reflex using the ophthalmoscope (to exclude
cataract)
Examine the face for dysmorphic features and
normal movements
Examine lips and palate for clefts
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Bilateral cleft lip and palate. Also

note purulent left eye discharge
Facial asymmetry due to

left facial palsy
Clinical assessment
Cardiovascular and respiratory

1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Feel femoral and radial pulses for volume, rate and

rhythm.
In aortic coarctation, femoral pulse is reduced, absent
or not synchronous with radial pulse.
If child is sick, measure blood pressure.
Locate the apex beat and listen to the heart sounds
for murmurs.
Count the respiratory rate
normal 30 40 breaths/min in term infants
faster in preterms.
> 60 / minute abnormal
Observe for respiratory distress: nasal flaring,

intercostal and subcostal recession.
Clinical assessment
Abdomen
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Inspect the umbilical cord for

presence of 2 arteries and a
vein. Abnormal components
may be a pointer to the
presence of intra-abdominal
anomalies e.g. renal.
Look for umbilical

abnormalities, e.g. hernia,
omphalocoele, exompholos
Gently palpate the abdomen

the liver may be palpable
upto 2cm below the costal
margin
the lower pole of the right
kidney may also be
palpable
Large omphalocoele. Surounding

erythema indicates cellulitis.
Clinical assessment
Spine and genitalia

1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Examine:
The spine for dimples, tuft of
hair (spina bifida occulta) or
cystic swellings (spina bifida
cystica)
Remove the diaper to examine
the genitalia. In boys, confirm
that both testicles have
descended into the scrotum.
Designate the infants sex
Inspect the perineum and check
anus for position and patency
(can be done by gently checking
rectal temperature)
Spina bifida cystica
Clinical assessment
Dysmorphic features
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
Inspect the feet. Note effects of

foetal posture should be noted.
6.
Skin
Check hips for dislocation
7.
Routine care
8.
Cord care
9.
Thermal
control
Limitation of limb movements

occurs in fractures and nerve
injury
Examine hands. Note single

palmar crease in chromosome
abnormalities.
Short stuby fingers and single
palmar crease of Down syndrome
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Talipes affecting the left leg
Clinical assessment
Routine measurements
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Measure:
Weight
normal 2.5 3.99kg
Length
normal 48 52cm
Occipitofrontal
circumference (OFC)
normal 33 37cm
Measurement of OFC using a

non-stretchable tape measure
Routine care of the well

newborn
1.
Introduction
2.
How to use
module
3.
Learning
outcome
Any problems identified during the initial assessment will

need specific management. However, newborn infants
are a highly susceptible group and high-quality routine
care prevents a multitude of problems. The major
elements of routine care include:
4.
Clinical
assessment
Cord care
5.
Appearance
Thermal control
6.
Skin
24 hour rooming in
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Feeding
Click on the links for more

information on these
important elements of routine
care
Immunization
Maternal education on hygiene and every other aspect
of routine care
Hand washing with soap and water every time a baby is
handled goes a long way in reducing the risk of infection!
Quiz: Concerning care of the newborn
Write T or F on the answer sheet. When you have completed

all 5 questions, click on each box and mark your answers.
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
a.
Nursing a newborn with the mother

rather than in the nursery predisposes
the child to infections
b.
Hand washing with soap and water

before handling a newborn
significantly reduces the risk of
infection in the baby
c.
Fortified infant formula is superior to

mothers breast milk in a sick term
newborn
d.
Newborn babies cannot be kept warm

without the use of incubators
e.
Jaundice cannot be detected early in

dark skinned babies
Click to reveal
correct answers
a
b
c
d
e
Sources of information
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Pocket book of Hospital care for children;

guidelines for the management of common
illnesses with limited resources. WHO
http://www.who.int/child-adolescent-health
/publications/CHILD_HEALTH/PB.htm
Essential newborn care
http://www.who.int/reproductive health/publications/
Nelson Textbook of Pediatrics: 16th Edition.
Richard E. Behrman Robert Kliegman, Hal B.
Jenson (Editors),

Care of Newborn

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Care of Newborn

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Partners in Global Health Education

Care of the newborn

Partners in Global Health Education

How should I study this

This self-directed learning (SDL) module has been

Answer the MCQ at the end to assess your learning.

You should research any issues that you are unsure

We suggest that you first read the learning outcomes

Finally, enjoy your learning! We hope that this module

After studying this module, you should be able

After delivery of the baby and in

A resident doctor washing her hands up to

First steps and appearance

Start by congratulating the

Well term infant showing typical well flexed

Note the abduction of the hips in this

Wrinkled peeling skin of

Pale pink skin of a term infant (hair

Skin: some common normal findings

Vernix caseosa: a cream/white cheesy material on the

Note palor or plethora

Cyanosis: the baby should

Blueness of the hands and

A Caucasian infant with marked

Jaundice is common in the first week

Blanch the tip of the nose or hold

Teach mother to do the same at

Blanching the tip of the nose

Two infants with jaundice; note yellow sclerae

After these general observations,

Huge encephalocoele. Head

Eyes and face

Examine eyes for ocular anomalies and check for

Bilateral cleft lip and palate. Also

Facial asymmetry due to

Cardiovascular and respiratory

Feel femoral and radial pulses for volume, rate and

Observe for respiratory distress: nasal flaring,

Inspect the umbilical cord for

Look for umbilical

Gently palpate the abdomen

Large omphalocoele. Surounding

Spine and genitalia

Spina bifida cystica

Inspect the feet. Note effects of

Check hips for dislocation

Limitation of limb movements

Examine hands. Note single

Talipes affecting the left leg

Measurement of OFC using a

Routine care of the well

Partners in Global Health Education

Any problems identified during the initial assessment will

Click on the links for more

Quiz: Concerning care of the newborn

Write T or F on the answer sheet. When you have completed

Nursing a newborn with the mother

Hand washing with soap and water

Fortified infant formula is superior to

Newborn babies cannot be kept warm

Jaundice cannot be detected early in

Pocket book of Hospital care for children;

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