Having brief knowledge regarding immediate care of newborn The time of birth is one of transition from intrauterine life to an independent existence and call for many adjustment in the physiology of the baby. Normal infant are at low risk of developing problems in the new born period and therefore, require primary care only. That’s means the, new born care is comprehensive strategy designed to improve the health of newborn through intervention just soon after birth, in post natal ward and up to 28 days. Essential care of the normal healthy neonates can be provided by the mothers under supervision of nursing personnel or basic or primary health care provider. About 80% of the newborn babies should be kept with their mothers rather than in separate nursery. The immediate care after birth is simple but very important. The baby has just come from warm quit uterus. So be gentle with the baby and keep the warm. DEFINITION- Newborn is the child of the first month of the life and transition of intrauterine life to extrauterine life. Purposes- 1) To establish, maintain and support respiration 2) To prevent injury and infection 3) To provide warmth and prevent hypothermia 4) To identify actual or potential that may require immediate attention

2. IMMEDIATE CARE OF
NEWBORN BABY AT BIRTH
By, Arpita Vilas Gaonkar
Fourth Year Basic B.sc nursing
Br Nath Pai College Of Nursing,
Kudal

3. Introduction
• The time of birth is one of transition from intrauterine life to an independent existence and call for
many adjustment in the physiology of the baby. Normal infant are at low risk of developing
problems in the newborn period and therefore, require primary care only. That’s mean the, newborn
care is comprehensive strategy designed to improve the health of newborn through intervention just
soon after birth, in post natal ward and up to 28 days.

4. Definition
• Newborn is the child of the first month of the life and transition of intrauterine life to extrauterine
life

5. Purposes
1. To establish, maintain and support respiration
2. To prevent injury and infection
3. To provide warmth and prevent hypothermia
4. To identify actual or potential that may require immediate attention

6. Established and maintained cardiorespiratory function

7. Establishment and maintenance of cardiorespiratory function
• The infants respiration on must be established and maintained.
• The baby should cry lustly periodically to create full expansion of the lungs that provides oxygen
for the blood which until birth was supplied through the placental circulation immediate adaptation
must occur at birth for the lung to take over the function of placenta.
• With the first breath, gas exchange is transferred from the placenta to the lungs.

8. Maintained body temperature

9. Maintenance of body temperature
• A newborn temperature should be between 96.8 degree fehrenet and 99.5 degree fehrenet.
• If they are below that range, the baby’s temperature is considered too cold (hypothermia); above
that number is too hot(hyperthermia).
• Additional warming techniques are recommended (eg. Prewarming the delivery room to 26 degree
C, covering the baby in plastic wrapping, placing the baby on an exothermic mattress, and placing
the baby under radiant heat.
• The infants temperature must be monitored closely because of the slight, but described risk of
hyperthermia when these techniques use are in combination.

10. Care of the umbilical cord

11. Care of the umbilical cord
• The umbilical cord is an excellent medium for bacterial growth. Therefore, it is extremely
important to ensure that it is kept clean and dry.
• Umbilical cord of the baby should be clamped 1-3 min after birth of the baby. This allows some
extra blood to flow from the mother to the baby and prevent anemia later in infancy.
• A disposable and sterile cord clamp should be used clamp to cord.
• The cord should be cut with sterile blade. The length of the cord left should be only 3-4 cm. The
clamp or tie should around 2cm from the base of the cord and another 1-2 cm of he cord should be
left beyond the clamp before cutting.

12. Cont….
1. Be gentle. Keep your hands off it, and don’t ever pull on it.
2. Keep the cord clean and dry at all times. Skip the tub and sink and gives your baby sponge
bath instead.
3. Leave the cord alone until it falls off by itself.
4. Fold diapers so that they rest below the cord to shield it from your little one’s pee. You can
look for diapers that have an area cut out for the cord or cut a spot out of a regular diaper.
Just place a piece of tape around it to seal the edges.
5. If your baby has a messy bowel movement and some stool get on the cord, clean it gently
with soap and water.

13. Cont…
• Check the cord often for infection
- blood on the end of the cord
- a white or yellow discharge
- swelling or redness around the cord
- signs that the area around the cord causes your baby pain ( for example, they cry when you touch it )

14. Care of the eye
• Before the eye are open, the lid margins should be cleaned with sterile wet swab, one for each eye
from inner to outer canthus. A drop of freshly prepared silver nitrate 1% or tetracycline 1%
ointment is placed in the eye to prevent ophthalmia neonatorum

15. Care of the eye

16. Examintion of newborn
• This is to ascertain that the baby has not suffered injuries during the birth process, to detect
malformations that require immediate treatment and to assess maturity. Abnormalities found
on examination that require immediate alternation.
• Indication-
• First examination- a detailed one in lab room within 2 hours of birth
• Second examination- before discharge
• Third examination- after 6-8 weeks of neonatal life

17. 1) Initial examination-
• Identification-
• Identify the sex of the infant and verify the records with the correct name, sex, and registration
number
• Gestation age –
• Full term / pre term/ post term

18. • Vital signs
• Respiration- normal value of respiration is 40-60 breaths/ min
• Heart rate- normal value of heart rate is 120-140 beats/min
• Temperature – normal value of temperature is 36.5 - 37.5 degree celcius

19. 2) Physical examination-
- Length- crown to heel length with infant supine /upside down/ with the knees slightly
pressed down maximum leg extension (47-50)
- Head circumference – it measure with a tape measure drawn across the centre of the
forehead and the most prominent portion of the posterior head (33-35)
- Chest circumference – it is measured at the level of nipples and is about 2cm less than head
circumference 30-33
- Weight- average birth weight 2.5-3.5 kg

20. - Upgar score-
• A test developed in 1952 by Dr Virginia apgar. It is also called as babies first test after birth.
Quick assessment of the newborn overall well being. It is used to check baby health. The scored of
scale is 0 to 2, with 2 being the best score
• Result-
• 10 out of 10 is perfect score
• The higher score is better the condition
• A score less than 7 may indicate some medical assistance.

21. - Posture and movements
• Supine position with partial flexion of arms, legs and hand commonly turned a little to one
side. Hip joints are partially abducted.
• Movement is most evident in face and limbs. Unusual movements or lack of movements and
asymmetry should be noted and reported

22. - Skin
• Colour-
• most term newborns have a ruddy complexion because of the increased concentration of red
blood cells in the blood vessels and a decrease in the amount of subcutaneous fat. This ruddiness
fades slightly over the 1st month.
- Cyanosis -
• Peripheral cyanosis - appear due to immature peripheral circulation. This is a normal phenomenon
in the first 24 to 48 hour after birth
• Central cyanosis – indicates decreased oxygenation. It may be the result of temporary respiratory
obstruction or an underlying disease

23. • Vernix caseosa:

24. • lanugo

25. • Desquamation

26. • Milia

27. • Erythema toxicum

28. • Forcep mark

29. • Skin turgor

30. • Mangolian spot

31. - Head
• A newborn’s head appears disproportionately large because it is one fourth of the total length.
• Fontanelles: The anterior fontanelle will be felt as a soft spot. The posterior fontanelle is so small
that it cannot be palpated readily.
• Anterior fontanel- it is formed by the meeting of the frontal, sagittal, and two coronal sutures. This
is roughly in the shape of a diamond and four sutures can felt leading from the anterior fontanel in
four different directions as indicated by the points on the diamond.
• It measures 3-4 cm long and 1.5-2 cm wide and normally closes by the time the child is 18 months
old. Pilsations of cerebral vessels can be felt through it.

32. • Posterior fontanel – the posterior fontanel is formed by the meeting of the sagittal and two
lambdoidal sutures. This is roughly in the shape of a triangle and three sutures can be felt leading
from the posterior fontanel in three different directions as indicated by the points of the triangle. It
is small and normally closes by 6 weeks of age

33. - Eyes:
• Newborn’s usually cry tearlessly because of the lacrimal ducts are not fully mature until
about 3 months of age. Eyes should appear clear without any redness or purulent discharge. we
should observe for subconjunctival haemorrhage, ophthalmia neonatorum etc.

34. - Ears:
• The level of the top part of the external should be on a line drawn from the inner canthus to
the outer canthus of the eye and back across the side of head.
• Ear Cartilage: Pinna firm, cartilage felt along with the edge.
• Ear Recoil: Instant recoil.
- Mouth:
• Mouth should be observed for cleft lip, cleft palate and tongue tie. The palate of newborn
should be intact. Occasionally, one or two small round, glistening, well- circumscribed cysts
(EPSTEIN PEARLS) are present on the palate, a result of the extra load of calcium that was
deposited in utero

35. - Neck:
• The neck of newborn is short, often chubby and creased with skin fold. Head should rotate
freely on it.
- Chest:
• It looks small because the infant’s head is large in proportion. Possible breast engorgement
with possible secretion of thin’ watery fluid popularly termed witch’s milk. Absence of retraction.
•

36. - Abdomen:
• Bowel sounds present within an hour after birth. Edge of the liver usually palpable at 1 to 2
cm below the right costal margin. Edge of the spleen usually palpable at 1 to 2 cm below the left
costal margin.
- Back:
• The spine of newborn typically appears flat in the lumbar and sacral areas. The base of the
spine should be free of any pinpoint openings, dimpling, or sinus tracts in the skin, which would
suggest a dermal sinus or SPINA BIFIDA or occulta, Lumbar hair tuft & haemangioma

37. Exclusive breastfeeding

38. Exclusive breast feeding
• Is the safest, cheapest and best protective food for infants. Superiority of human milk is due to its
superior nutritive and protective value. It is perfect food for infants and provides total nutrient
requirement for first six months of life. It prevents malnutrition and allows the child to develop
fully.
• Early initiation of breastfeeding, within one hour of birth, protects the newborn from acquiring
infection and reduces newborn mortality. It facilitates emotional bonding of the mother and the
baby and has a positive impact on duration of exclusive breastfeeding.
• When a mother initiates breastfeeding within one hour after birth, production of breast milk is
stimulated. The yellow or golden first milk produced in the first days, also called colostrum, is an
important source of nutrition and immune protection for the newborn.

39. Kangaroo mother care
• Caring low birth weight baby is great challenge for the neonatal care unit and the family. Kangaroo
mother care is low cost approach for care of low birth weight baby. This method of care was
introduced and popularized by Dr edger rey in 1978. It was then developed by Dr. Martinez and Dr.
Charpark.
• Definition- KMC is a special way of caring LBW infants by skin to skin contact. It promotes their
health and selling by effective thermal control, breast feeding and bonding. There important aspects
are kangaroo position, nutrition and follow up.
• Kangaroo mother care, which involves skin-to-skin contact, is an intervention to care for
premature or low birth weight infants. The technique and intervention is the recommended
evidence-based care for LBW infants by the World Health Organization since 2003.

40. • Benefits
• 1) It helps in thermal contact and metabolism
• 2) It results in increase duration and rate of breastfeeding
• 3) It satisfies all five senses of infant baby feels warmth of the mother through skin to skin contact,
listen to mothers voice and heart beats sucks the breastfeed, smell the mothers odour and make eye
to eye contact with mothers.
• 4) During kmc the body has more regular breathing and leass disposition to apnea.

41. • 5) Kmc protects against nosocomial infection band reduces incidence of severe illness including
pneumonia during infancy
• 6) Daily weight gain is slightly better with kmc this duration of hospital stay may be reduced.
• 7) Mother feels increased confidence self esteem sense of full fillment and deep satisfaction with
kmc
• 8) Kmc does not require additional staff compared to incubator care.

42. • Procedure-
1) The baby should be placed between the mother breast in an upright position.
2) Baby’s head should be turned of the one side and slightly extended position which help to keep the
airway open and allow eye to eye contact between mother and baby.
3) Baby’s hip should be fixed and abduction in a frog like position.
4) The arm should be fixed and place on mothers chest.
5) Baby’s abdomen should be place at the level of mothers epigastrium

44. Vitamin-k
• Vitamin k prevents neonatal haemorrhage during first few days of life before infant is able to
produce vitamin k. vitamin k is needed for blood to clot normally.
• Babies are born with very small amounts of vitamin k in their bodies which can lead to serious
bleeding problems.
• Research shows that a single vitamin k shot at birth protects your baby from developing dangerous
bleeding which can lead to brain damage and even death.

45. • Administration –
 Term infants (1 mg) – intramuscular
 Preterm infants (0.5 mg)- intramuscular
• Alternative route:
 Oral dose: 2 mg orally at birth
 Repeat dose (2mg) at 3-5 days and at 4-6 weeks of age

47. Neonatal resuscitation

48. Neonatal resuscitation
• Neonatal resuscitation is an intervention after a baby is born to help it breath and to helps its heartbeat.
• Goal –
1. To prevent hypothermia by minimizing heat loss form the baby
2. To establish normal respiration and circulation
• Assess the following parameters at birth in order to decide for the need of resuscitation in each neonates
at birth.
1. Is the baby born at term gestation?
2. Is the baby breathing or crying?
3. Does the baby have good muscle tone ( well flexed posture, moving limbs vigorously, sneezing)?

49. • If the answers to all these question are “ yes” the baby does not need any resuscitation and she/he
should be dried and placed on the mothers chest in skin contact with dry linen (routine care ). The
baby should be observed for breathing, activity, and colour
• If the answer to any of these question is “ no” this baby is in need for resuscitation in the form of
one or more steps

50. 1) Initial steps
2) Positive pressure ventilation
3) Endotracheal intubation
4) Chest compression
5) Administration of medication ( epinephrine and / or volume expanders)

51. Prevention of infection
• Infection is a major cause of morbidity and mortality in the newborn. It can lead to life-threatening
sepsis and accounts for 10% of all neonatal mortality. It may be early-onset (infection arising
within 72 hours of birth) or late-onset (infection arising more than 72 hours after birth). Early-onset
neonatal infection is less common than late- onset neonatal infection but often more severe.
• Pathogens causing infection may be bacteria, viruses, fungi or protozoa. When infection is
suspected, treatment should be initiated immediately. Factors influencing which colonized infant
will experience disease include, prematurity, Underlying illness, Invasive procedures, Inoculum
size, Virulence of the infecting organism, Genetic predisposition, The innate immune system, Host
response, and transplacental maternal antibodies

52. • neonatal infections can be prevented by:
1. Good basic hygiene and cleanliness during delivery of the baby
2. Special attention to cord care
3. Eye care
4. Exclusive breast feeding
5. Avoid unnecessary intravenous fluids needle pricks etc.
6. Hygiene of the baby.

53. 7. Strict procedures for hand washing for all staff and for families before and after handling
babies
8. Strict sterility for all procedures
9. Avoiding incubators (using Kangaroo mother care instead) or not using water for
humidification in incubators (Pseudomonas often colonises in these devices)
10. Clean injection procedures
11. Removing intravenous drips when no longer needed