Medical and Special Care of Newborn
The first week of life is the most crucial period in the life of an infant. In India, 61.3 percent of all infant deaths occur within the first month of life. Of these, more than half may die during first week of birth. This is because the newborn has to adapt itself rapidly and successfully to an alien external environment. The risk of death is the greatest during the first 24-48 hours after birth.
To promote adequate oxygenation
· To prevent hypothermia
· To promote early breastfeeding
· To prevent neonatal infections
· To identify at risk newborn
· To facilitate stabilization of the newborn
The first cry of the baby after birth is the sign of respiration. All babies should cry immediately after birth. If the baby doesn’t cry, it needs immediate attention of the health care personnel. As soon as the baby is born, the airway should be cleared of mucus and any other secretions within the labour room. Then continuous monitoring of respiration and heart rate is done for every 15 minutes for first 2 hours or till adaptation to external environment. Positioning the baby with its head extended may help in the drainage of secretions. A gentle suction in the mouth first and nostrils second can facilitate removal of secretions and amniotic fluid. Resuscitation is necessary for babies who do not breathe within a minute.
The APGAR score is taken at 1 minute and again at 5 minutes after birth. It requires immediate and careful observation of the Appearance, Pulse, Grimace, Activity and Respiration. Each sign is given a score of 0, 1 or 2. It provides an immediate estimate of the physical condition of the baby. A perfect score should be 9 or 10. A score below 5 needs prompt action.
Body heat is lost from the newborn by four ways. They are as follows:-
· Convection- Leaving the baby in a draught (Cool air)
· Radiation – If the baby’s head is not covered, the body heat is able to pass into surrounding air.
· Conduction – Leaving the baby on a cold surface
· Evaporation – Baby not dried after birth the amniotic fluid evaporate by using by body heat.
The body temperature below 36.5°C is known as hypothermia.
Provide skin to skin contact to the baby if possible
If skin-to-skin contact is NOT possible:
• Wrap the baby in a clean dry warm cloth
• Mummify the baby
• Cover the baby’s head with cap.
• Assess warmth every 4 hours by touching baby’s feet
• Keep the room warm
• Remove all wet cloths
• Rooming in. The mother should be encouraged to keep the baby with her.
It should be initiated as early as possible after birth. The first milk which is called “colostrum” is the most suitable food for the baby during early period because it is rich in anti-infective factors. It contains high concentration of protein and other nutrients the baby needs.
The stump is kept dry and clean. Nothing should be applied over stump. Bandages should not be applied. Fold diaper below stump. If the stump is wet, wash with clean water and soap, dry with clean cloth. Usually the stump will fall in 7-10 days time. If umbilicus is red or draining pus or blood, the mother should be advised to see the health worker.
Eyes of the babies are cleaned from inner canthus to outer canthus using sterile wet gauze or cotton in the hospital and with a clean cloth at home. Nothing should be poured into the eyes of the newborn unless medically indicated.
Vitamin K injection: Vitamin K injectioning is given intra muscularly to prevent bleeding.
Care of Skin: It is advisable to postpone the formal bath to the second week. However sponge bath may be given after 24 hour of birth.
Urine and meconium: Check for passage of urine and meconium.
Immunization: Hepatitis B vaccine and zero doses of OPV and BCG is given immediately. Thereafter, the child should be immunized on specific dates.
· Giving prelacteal feeds soon after birth like sugar water or honey or donkey milk, jaggery water.
· Discarding the colostrums (the first milk secretion from the mother)
· Applying ashes or soot or powder or dry cow dung on the umbilical cord of the baby.
· Applying kajal on the baby’s face to prevent bad eye
· Tying black thread or bangles to the baby’s hand or leg to prevent bad eye.
· Exposing baby to a “holy” smoke (Sambirani) after bath.
· Giving home remedies for digestion like vasambu
· Pouring of oil into eye or ear.
· Blowing of nose and ear during bath
These are danger signals to be identified at newborn. Presence of one or more of these sings is an indication for prompt evaluation and treatment.
· Feeding difficulty
· Persistent vomiting
· Fast breathing (more than 60 breaths per minute)
· Hypothermia (temperature less than 35.5°C
· Hyperthermia or Fever,Temperature more than 37.5°C
Fatigue yellowish discoloration