CARE OF THE NEWBORN

B.M. MOYO
9th FEBRUARY 2015
LEARNING OUTCOMES:
By the end, student midwives should be able to:

 Define a Newborn

 Demonstrate competencies in the immediate &

subsequent care of the newborn

 Apply knowledge of the APGAR score in

determining the condition of the newborn

 Demonstrate appropriate attitudes on the

management of the newborn
DEFINITION
 Newborn: a baby from birth through
the 28th day of life (neonate)
IMMEDIATE CARE
1. CLEAR AIRWAY
 As soon as the head is born, wipe the
mouth, nose & eyes.
 Suction only indicated: if meconium
stained liquor or APGAR score below 6.
2. DRY & STIMULATE THE BABY
 Dry baby next to the mother’s
abdomen so that s/he gets the warmth
from her through heat conduction.

 Place baby on the mother’s abdomen

for skin to skin contact to promote
bonding.
3. CLAMP & CUT THE CORD.
 Cut the cord immediately after initial
drying/warming of a normal healthy
infant.

 Cutting of the cord at this time

facilitates putting the baby skin-to-
skin with the mother & encourages
immediate breastfeeding.
Clamp & cut the Cord cont’
 Put 1st tie/clamp 2cm from stump & 2nd
3cm from 1st tie/clamp.
 The ties should be tightly knotted with
more than one knot.
 Some people use 3 ties to be extra sure
that they do not come off.
 The extra tie should be on the part of
the cord still attached to the baby.
Clamp and cut the Cord cont’
 The attendant should check frequently
that there is no bleeding from the cord in
the 1st day after delivery, especially
during 1st few hrs.

 If there is bleeding, another clean tie

should be applied.
 NB: Bleeding later on from the cord might
indicate an infection & then assistance from a
health professional should be sought.
4. ASSESS THE BABY USING
THE APGAR SCORE
 The APGAR scoring chart is a simple
test to help you decide if a newborn
needs help.
 Look, listen & feel for:

 A – Appearance or colour of the baby

 P – Pulse or heart beat of the baby
 G – Grimace of face or response of baby
when you touch his feet
 A – Activity or muscle tone of arms and legs
 R – Respiration or breathing of the baby
Assess the baby using the Apgar
score cont’
 The quantitative assessment is done at 1
& 5 minutes. Scores obtained will
determine the condition of the baby.
 Highest score for a healthy baby is 10;
the lowest is 0; but in that case the
baby is not breathing & is dead.
 Scores between 7–10 are normal & 0–6
are abnormal requiring resuscitative
measures.
5. MAINTENANCE OF NEUTRAL
THERMAL ENVIRONMENT
 The room should be warm.
 no open windows, room temperature 21 –
23deg C.
6. INITIATION OF BREAST
FEEDING
 Assist mother to initiate breast feeding
within 30min.
 Assist her with position & baby’s
attachment to the breast
7. MONITORING OF THE
NEWBORN
 Every 15min, monitor & record
breathing, colour & bleeding of the
cord.
 E.g. Make this table

Date & Breathing Colour Cord Comments Signature

time (br/min) (Bleeding)
7th Feb 50 Pink Not Baby doing
8am bleeding, fine
well
clamped
8. PREVENTION OF INFECTION
 Maintain clean environment
 Wash hands before & after touching
the baby
 Use aseptic technique in all procedures
to prevent cross infection.
 Perform cord care daily.
 Eye care including prophylactic eye
ointment (tetracycline 1%)
IMMEDIATE CARE cont
 Within the 2hrs of birth, perform initial head to
toe examination of the baby to determine birth
weight & exclude life threatening congenital
abnormalities & birth injuries such as:
 Severe moulding
 Erb’s palsy
 Check reflexes (moro, sucking)
 Cleft lip/palate
 Congenital heart abnormality
 Omphalocele
 Meningocele/spina bifida
 Imperforated anus
SUBSEQUENT CARE
OF THE NORMAL
NEWBORN
Subsequent Care
 Verify the HIV status of mothers &
document.
 Conduct Rapid assessment of the baby
to rule out danger signs.
 Bleeding- stop visible bleeding, give Vit K,
take blood for grp & X match, if in shock,
infuse N/S or R/L 10ml/KG over 10 min,
repeat after 20min if still in shock then give
10% glucose, transfuse blood, O2, warmth
 Shock – infuse IV ½ strength Darrows
20ml/Kg in 1hr then continue with
maintenance volume, warmth, treat sepsis
with benzyl pen & genta
 Respiratory distress – maintain open airway,
O2, antibiotics if indicated.

 Convulsions/seizures – IV line, phenobarb

20mg/Kg or Diazepam 0.2mg/Kg IV/IM. O2,
1ml 50% dextrose, if meningitis or neonatal
tetanus, sedate & antibiotics & ATS for
tetanus.
Perform daily assessment of:
 Behaviour of the  Elimination pattern
baby i.e. crying,
feeding, reaction to
stimuli  Fontanel (bulging,
sunken)
 Colour (eye & skin)
 Weight
 Respirations
 Cord  Vital signs
(bleeding/infection)
DAILY MGT OF THE NEWBORN
 Maintenance of  Immunisation (BCG
clear airway & Polio 0)

 Maintenance of  Maintenance of
warmth safety for the
baby
 Prevention of
infection  Administer ARV
prophylaxis if
 EBF mother is HIV
positive
TEACH & COUNSEL THE MOTHER &
FAMILY ABOUT NEWBORN CARE
 An important part of the help given to
the newborn, mother, & family is
teaching & counselling about newborn
care.
 Explain:
 What care to give
 Why to give the care
 Even if a woman has had a baby before,
there may be new information that can
help her.
Teach & counsel cont...
 When speaking with her, include other
family members such as the
grandmother, mother-in-law, aunt,
sister, and/or husband:
 This gives everyone a chance to hear the
same things the mother hears.
 It also gives the mother and family time to
ask questions.


Teach & counsel cont...
 The mother & family may have other
baby care questions not included below.

 Take time to discuss all the family’s

concerns & questions.

 Below is information to talk about:

Parental education before discharge
 Assess mother’s  EBF
knowledge, social
support & counsel on  Bowel & bladder
the following: function

 Hygiene & warmth  Cord care

 Detection of  Importance of
infection & other immunisation
health problems that
may occur in the  Danger signs
baby
Parental education
a. Warmth
 A newborn needs to be warm especially
for the 1st few weeks of life because
newborns:
 cannot adjust their temperature like adults,
they get cool or warm much more quickly.
 Have small bodies & not able to stay warm
on its own.
 If the newborn gets too cold, s/he can die.
Parental education...Warmth cont...
 Keep the Newborn in close contact
with his/her mother. Skin-to-skin is
best, as in the “Kangaroo Mother Care”
position.
 A study conducted in the United States
showed that immediate, continuous skin-
to-skin contact between mother &
newborn keeps newborns warmer than
using a radiant warmer.
Parental education...Warmth cont...
 The mother is the best incubator
because she keeps the baby at the right
temperature. Also, skin-to-skin with the
mother is the best way to transport a
sick baby.
 If for some reason the newborn &
mother must be separated, be sure the
baby is well wrapped in a dry cloth & has
his/her head covered.
Parental education...Warmth cont...
How the family can keep the newborn warm:

 Keep the room where the newborn stays warm

and free from drafts day and night.

 Dress the baby in warm clothing (the newborn

needs at least 1-2 more layers than an adult).

 Keep the baby’s head covered with a hat or

cloth.
Parental education...Warmth cont...
 Use loose clothing and covers. Tight clothing &
coverings do not keep the baby as warm.

 Put the newborn in bed with the mother for

warmth and breastfeeding.

 Keep the newborn skin-to-skin with the

mother. Use a warm cloth or blanket to cover
them both together. Be sure not to cover the
baby’s face so he can breathe freely.
Parental education...
B. Sleep
 Newborns need sleep. If they are
healthy, they sleep most of the time
between feedings (up to 18 out of 24
hrs).

 They wake up every 2-3 hrs to feed.

During the night the baby may sleep up
to 4 hrs between feeds.
Parental education...sleep cont...
 Newborns wake up a lot at night.
Because of this, a mother needs to rest
or sleep during the day when her baby is
asleep.

 This pattern changes with time & the

baby will begin to sleep more at night &
stay awake more during the day. E.g.
Mostly at 3mos of age
Parental education
C. Loving care
 A newborn cannot survive without loving
care. At birth, he is unable to meet any
of his own basic needs. When a newborn
is hungry, wet, cold, uncomfortable, in
pain or sick, s/he can only cry or send
out other cues.
 Every newborn is different. S/he may
be:
 easily irritated or calm & sleepy
 fussy & hard to satisfy
 happy & easy going
 have loud piercing cry, or a soft, quiet one.

Parental education...loving care cont..
 A mother must get to know her baby’s
personality. His survival depends on her
understanding & responding appropriately to
the signals s/he sends.

 When the baby cries & his needs are met,

s/he learns
 that the world is a safe & loving place
 confidence that s/he can communicate her/his
needs to others &
 trust that someone will care for her/him when s/he
needs it.
Parental education...loving care cont..
 The newborn’s crying should not be
ignored.
 Newborns should always be handled
gently. Mothers learn to do what they
see you doing.
 Handle the baby gently, talk to her/him
in a quiet voice, & observe carefully so
that you can respond appropriately to
her/his needs.
Parental education cont...
D. Protection from Infection
 The system to fight infections is not
mature in a newborn. A newborn can get
infections more easily than an older
child or adult.
 As the baby grows, the infection
fighting system becomes stronger.
 The mother & family need to protect
the newborn from infection at birth & in
the early months of life by:
Parental education ...Protection from
Infect cont...
 Wash hands with soap & running water
before & after touching the newborn.
 Keep fingernails short (germs can live
under the fingernails).
 Do not put anything (dressing or herbal
or medicinal products) on the umbilical
cord.
 Keep the cord clean & dry.
Parental education ...Protection from
Infect cont...
 Wash anything in the home that will
touch the baby e.g. clothing, bedding
 Keep sick children & adults away from
the baby.
 Protect the newborn from smoke in the
air (from cigarettes or a cooking fire)
because this can cause breathing
problems.
Parental education ...Protection from
Infect cont...
 Put the newborn to sleep under an
insecticide- treated bed net to protect
her/him from malaria.

 Breastfeed the newborn exclusively. A

mother’s milk gives infection protection
to her newborn.

 Make sure the baby gets all his

immunizations on time.
Parental education ....
E. Bathing the newborn
 Teach how to wash the newborn. If you
show them how to do this, not just tell
them, they will remember more. You can
also show them how to bathe the
newborn with gentleness while checking
each part of the baby’s body.
 Note: delay bathing for 24 hours and
keep the newborn warm during a bath
 Bathe the newborn in a warm room with
no drafts.
Parental education ...Bathing cont...
 Have everything ready before the bath
so the newborn is not left uncovered for
long.
 Make sure the bath water is warm. Test
the bath water by touching with elbow.
 Wash the face first & the hair last.
Much heat is lost through the head so it
should be bathed last.
Parental education ...Bathing cont...
 Bathe the baby quickly.

 Dry the baby quickly & completely with a warm

towel. Be sure to dry the hair thoroughly.

 Put the baby in skin-to-skin contact with the

mother after the bath & cover them both.
Remember to cover the baby’s head again.

 Wipe the buttocks: can be wiped each time

the baby urinates or has a bowel movement.
Parental education ...Bathing cont...
Bathing Recommendations
 Clean eyes by wiping each one from inner
to outer with a clean cloth.
 Look for signs of infection while you
wash the newborn.
 Skin infection: spread the skin folds to look for
pustules or rashes.
 Cord infection: redness of skin, swelling, pus, or foul
odour around the cord or umbilicus.
 Eye infection: red, swollen eyelids and pus-like
discharge from the eyes.
Parental education ...Bathing cont...
 Wash the baby’s bottom from front to back.

 Never use soap on a newborn’s face, only clean

water.

 Do not clean inside the newborn’s ear canals or

nose, only the outside.

 Do not use baby powders. Powders can be

dangerous to a newborn.

 Be sure to dry inside the skin folds.

Parental education cont...
F. Cord care
 An important way to prevent a newborn
from getting tetanus or sepsis
(generalized body infection).
 Teach & show the mother & family how
to do cord care.
 Putting certain substances on the cord
or covering it with dressings can cause
serious cord infections, such as tetanus
& septicaemia. These infections are
major causes of neonatal death but are
preventable.
Parental education...Cord care cont…
To prevent these infections:
 TTV during pregnancy
 Cut the cord with a sterile instrument or new
clean blade.
 Do not put anything on the cord (no medication or
dressing).
 Keep the cord clean & dry.
 Urine or stool should not touch the cord.
 Wash the cord with soap & water & dry it with a
clean cloth or air-dry it.
Parental education...Cord care cont…
 The cord normally falls off 5-10 days after
birth, leaving the umbilicus to heal.

 Look at the cord & umbilicus for signs of

infection every day until it is dry & healed.
 Signs of infection are: delay in separation, pus
discharge, foul smell, redness & swelling of the
skin around the umbilicus.

 Get medical help right away if you see any of

these signs.
Parental education cont...
G. Immunizations
 Immunizations are given to prevent
illnesses that cause serious problems &
even death.
 The timing of immunizations is
important. The baby should receive
immunizations:
 in the first few days after birth,
 at 6 weeks, 10 weeks, 14 weeks,
 and 9 months. There must be at least 4
weeks between immunizations.
Parental education cont...
H. Breast feeding
 Review the information with the mother
& the family on the following:
 Benefits of Breastfeeding
 EBF
 Starting to Breastfeed
 Continuing to Breastfeed
Parental education cont...
I. Vitamin A
 Because newborns have very small amounts of
vitamin A, breastfed infants depend on
vitamin A in breast milk to meet their
requirements for this vitamin during the first
months of life.

 The amount of vit A in BM depends on the

mother’s vit A level. Vit A helps:
 babies grow & develop well and
 keep mothers & babies from getting infections.
When they do get infections, vitamin A also helps
them recover quickly.
Parental education...Vit A cont...
 Food sources of vitamin A for the mother are:
 red, yellow, & orange fruits
 vegetables (mangoes, papaya, carrots)
 animal sources (egg yolk, liver, cheese, & fish)
 some fats & oils (fish liver oil, palm oil, butter)

 Another source is vit A capsules. Give the

mother a single dose (200,000IU) capsule as
soon after birth as possible but not after 8
weeks postpartum.
Parental education...Vit A cont...
 By 8 weeks postpartum (6 wks for a non-
breastfeeding mother), there is a chance the
mother might become pregnant again.
 Taking a high dose of vit A (i.e., more than
10,000IU per day) in the 1st trimester could harm
her growing foetus.

 For the baby, breast milk is the main source

of vit A. To make sure the baby gets lots of
vit A, encourage every mother to breastfeed
exclusively.
Parental education cont.
J. Safety & security
 Never leave a baby alone on a bed or table
from which s/he can fall.

 Never hold a newborn by his feet with the

head down.

 Breastfeeding mothers should not smoke,

drink alcohol, or take drugs or medications
unless prescribed by health care personnel.
They should also practice safe sex (condom
use, abstinence, or sex only with an HIV-
negative partner who is monogamous).
Any questions?