NURSING CARE OF
The first week of life
is the most critical period in the life of an infant. The expert obstetric care
is scarce and the home environment conditions in which baby is born are usually
To establish and maintain cardiopulmonary functions.
To maintain body temperature.
To avoid infections.
For satisfactory feeding regime.
For early detection and treatment of congenital and acquired
I Immediate care
II Routine care
Immediate basic care of
neonates at birth includes maintenance of temperature, establishment of airway,
initiation of breathing and maintenance of circulation.
As majority babies cry
at birth and take spontaneous respiration. No resuscitation is required at
birth for about 95 to 98% neonates. Establishment and maintenance of cardio
respiratory function (ex. breathing) is the most important thing. The chest
movement of the baby is primary and everything else is secondary.
Airways should be
cleaned of mucus and other secretions by gentle suction
require more active measures such as suction, application of oxygen mask,
integration and assisted respiration.
It is an useful
quantitative assessment of neonates condition at birth, especially for the
respiratory, circulatory and neurological status.
Care of umbilical cord
Care of the eyes
Care of the skin
The major goal of
nursing care of the new born, infant is to establish and maintain homeostasis.
Warmth is provided by
keeping the body dry and wrapping with adequate clothing. It can be placed in
skin to skin contact with mother to maintain temperature. (Auxillary temp 36.50
C – 37.60C)
Care of Umbilical Cord
The umbilical cord is
cut about 2-3 inches from the naval with aseptic precautions during delivery
and tied with sterile cotton thread or disposable plastic clip. The cord must
be inspected for infection.
Eyes should be cleaned with sterile cotton swabs soaked is sterile
water or normal saline.
Observe the eyes for
redness, sticky discharge or excessive tearing for early detection of problems
and for prompt management.
The baby must be cleaned off blood, mucous and meconium by gently
wiping before he or she is presented to the mother.
During hospital stay ‘no bath’ reduces the incidence of neonatal
infections. No vigorous attempt should be made to remove the vernix caseosa.
The baby should be put to the mother’s breast within half an hour
of birth or as soon as possible.
No prelactal feeds to be given and colostrums feedings must be
Educate the mother about breast feeding techniques.
Initially the feeding should be given in short interval of 1-2
hours and then every 2-3 hours. Most babies regularize their feeding pattern by
the end of first week.
During hospital “No bath”
Baby bath should be given with warm water in warm room
Baby should be dried immediately from head to toe and wrapped in a
dry warm towel.
Use of olive oil or coconut oil can be allowed after 3-4 weeks of
Exposure to sunlight is an important source of vitamin D and
The baby should be dressed with loose soft and cotton clothes.
The clothes should not be too tight around the neck or abdomen.
Clothes should be cleaned with light detergent and washed properly
and sun dried.
Baby should be handled with gentle approach after proper hand
No infected person should handle.
Baby should be allowed to sleep in supine position.
Average daily weight gain in healthy, new born baby increases
about 30g/day in the first month of life.
It is about 20g/ day in second month and 10g/day afterwards during
the first year of life.
Most infants double their birth weight by 4-5 months.
All neonates should be immunized with BCG, ‘O’ dose OPV and
‘hepatitis B’ vaccine at birth.
Mother should be informed about the recommended National
practices are forms of actions in certain communities. A large number of
customs and cultural practices are found for mother and child. Harmful practices
should be avoided. The examples are
Use of cow dung or mud on umbilical cord
Discarding colostrums and delayed breast feeding. Prelactal feeds
like gold rubbed in water, honey, sugar water, distilled water and donkey’s
Neglecting female new born emotionally and nutritionally
Instillation of oil into eye and ears before bath
Using grape water or bonnison
Giving opium and brandy
Using feeding bottles
Application of kajal in the new born eyes
It means that a new born
has great chances of complication because of the mother during labour or birth.
The basic criteria for
identifying these babies include
Birth weight less than 2.5 kg – preterm or small for date. Weight
below 70% expected weight
failure to gain weight during 3 successive months
Twins, Birth order 5 and more
Artificial feeding , Children with diarrhoea
Congenital disorders like down’s syndrome
Apnoea or asphyxia