The term newborn is used for a just born child. Newborns range in age from time of birth to about 2 months post birth. All neonates require the essential newborn care within the first 28 days of life whether they are born healthy or unhealthy. It includes appropriate preventive care, routine care, transition and care of sick babies.
A healthy child completes its term within 38 to 42 weeks, has an average weight, cries immediately after birth, establishes rhythmic respiration and quickly adapts to the external environment. Doctors have to consistently monitor the health of a newborn to determine their health status.
The specialists perform an APGAR Score test as soon as the child is born to check whether the newborn requires the extra medical assistance.
APGAR scoring is as follows:
|Appearance (skin colour)||Blue, pale||Body pink, extremities blue||Completely pink|
|Pulse (heart rate)||absent||slow (<100)||<100|
|Grimace (reflex)||no response||grimace||cry|
|Activity (muscle tone)||flaccid||some flexion||active movements|
|Respiration||absent||slow, irregular||good crying|
Scores are between 0 and 10 where 10 is the highest. Scores 7 and above is considered a healthy child.
WHO guidelines for care of newborn immediately after birth
- Immediate drying and additional stimulation: The specialist should gently wipe the head and skin of the newborn to remove blood, mucus and muconium before presenting to mother. If a newborn does not breathe spontaneously after thorough drying, the doctors should stimulate by rubbing the newborn’s back 2-3 times before clamping the cord. Maintaining the body temperature and keeping the newborn warm extremely necessary.
- Routine nasal or oral suction is required for newborns that do not breathe on their own or if their airway is full of secretions. This suctioning helps to clear amniotic fluid in the airway. This procedure need not be performed for newborns who can breathe on their own.
- Late cord clamping (performed within 1 to 3 minutes after birth) should be done for all births while performing simultaneous essential care. Early cord clamping is recommended only if neonate is asphyxiated
- Skin to skin contact within the first hour of life: Newborns without complications must have skin-to-skin contact with mother so as to prevent hypothermia and to boost breast feeding
- If mother and child are stable physically and emotionally, then the child should be kept near breast to try breast feeding
- All newborns should receive 1mg of Vitamin K intramuscularly after birth (within an hour of birth) to prevent neonatal hemorrhage.
WHO guidelines for postnatal care:
- The WHO recommends three postnatal contacts between mother and newborn after birth. 1st contact on Day 3 from delivery, 2nd between Days 7-14 and 3rd contact 6 weeks after birth.
- The family has to regularly assess the following signs :a) is not feeding well, b) convulsions, c) fast breathing, d) severe chest in drawing, e) no spontaneous movement, f) temperature >37.5 degree Celsius or <35.5 degree Celsius, g) jaundice in first 24 hours. Family must visit the doctor if any of the signs is seen.
- All babies should exclusively breastfeed for first 6 months.
- Umbilical cord must be cleaned with chlorhexidine (4%) during the first week of life. The blood is collected from the cord for analysis and sent to lab to check for Rh blood type, hematocrit and possible cord blood gases.
- A newborn’s eyes must be cleaned once daily with sterile cotton swabs.
- Anthropometric measurements: Weight, length, head circumference and chest circumference should be measured at regular intervals. Average daily weight gain is about 30g/day in 1st month, 20g/day in 2nd month and 10g/day afterwards during 1st
- Use of olive oil/coconut oil can be allowed after 3-4 weeks as oil massage improves blood circulation and muscle tone.
- Exposure to sunrays especially early in the morning is important for Vitamin D and warmth.
- All infants must receive first dose of Hepatitis B soon after birth, preferably within 24 hours.
- Oral polio vaccine, including a birth dose is recommended in all polio-endemic countries and in high-risk countries.
- All infants should receive a dose of BCG vaccine
Care of preterm and low birth weight newborn:
- Low birth weight newborns (<1200g) who don’t have complications should have skin-to-skin contact with mother to prevent hypothermia
- Kangaroo Mother Care (KMC) is recommended at for the routine care of newborns weighing 2000g or less at birth. KMC promotes emotional bonding, and establish breast feeding.
Newborn care is best provided by mother along with primary healthcare supervision. 80% of newborn babies should be with their mother rather than in a separate nursery. The family must assess the temperature, pulse, respiration, feeding behaviour, stool, urine, weight and sleep pattern of the newborn’s and should inform any change to the healthcare provider/pediatrician.
Dr. Aparna Mishra is a practicing dentist with over 11 years of experience. Her interests include writing especially literature writing.