Routine care of the newborn
·
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.
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.
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).
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.
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.
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.
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.
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.
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).
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