Paediatrics: Routine care of the newborn

Routine care of the newborn

Routine measurements

·  Measure within 1hr of birth:

·  Weight (term mean 73.5kg);

·  Head circumference (mean 735cm);

·  Body length (mean 750cm).

Usually babies are not weighed again until day 3–5 and then alternate daily whilst they remain in hospital. It is normal to lose weight after birth due to water loss, but weight loss should not exceed 10% of birth weight. Birth weight should generally be regained by day 7. Subsequent mean growth is 20–30g/day until age 6mths.

Vitamin K (phytomenadione)

To prevent haemorrhagic disease of the newborn, vitamin K₁ is routinely given within 48hr of birth.

Dose 1mg IM (preferred) in term infants or alternatively 2mg orally on days 1 and 7, and, if breastfeeding, also on day 28.

Cord care

Immediately after birth clamp the cord with a purpose-made device. Keep the umbilicus clean and dry. Antibiotic powders or sprays are not rou-tinely required. The cord usually detaches after 7–10 days. If umbilical granulomas develop, clean with alcohol wipes and consider chemical cau-tery (silver nitrate stick).

Thermal care

Babies should be delivered in a warm room, rapidly dried with a warm towel, and then immediately wrapped or placed skin to skin on the moth-er’s front and then covered with a warm towel and a hat.

Routine observations

Record soon after birth and then daily whilst in hospital. Mean pulse is 120–160beats/min, respiratory rate 35–45breaths/min, and temperature 36.9*C. Infants should be nursed in an ambient temperature of 20– 22*C.

Bathing

Not required until day 2 or 3. Use tepid water. Genitalia should be cleaned superficially only. Do not retract foreskin; it is attached to the glans.

Biochemical screening

In the UK, all infants should undergo a screening heel prick blood test placed on a specific card between day 3 and 10 (‘Guthrie’ test). Regional variation exists, but commonly screened diseases include:

·  Phenylketonuria (i phenylalanine); congenital hypothyroidism(i TSH); cystic fibrosis (i immune-reactive trypsin).

·  Medium chain acetyl-CoA deficiency.

·  Sickle cell disease.

·  Positive tests require follow-up and more detailed testing.

Newborn hearing screening

All infants in the UK will have their hearing screened (otoacoustic emis-sion—OAE) within the first 4wks of life. Automatic auditory brainstem re-sponse (AABR) testing is carried out if any uncertainty in OAE response.

Neonatal immunization

In several countries hepatitis B immuniza-tion of all newborns is recommended. In the UK, immunization is only offered to infants of seropositive mothers. Similarly, in the UK, Bacille Calmette–Guérin (BCG) should be offered to babies born to parents of ethnic groups or communities with a high incidence of close contact with a sputum-positive case for tuberculosis (TB).