Immediate care involves: Drying the baby with warm towels or cloths, while being placed on the mother's abdomen or in her arms. This mother-child skin-to-skin contact is important to maintain the baby's temperature, encourage bonding and expose the baby to the mother's skin bacteria

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• MUKESH SAH, MD
• POST GRADUATE MEDICAL INTERN
IMMEDIATE CARE OF NEWBORN

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Most babies breathe and cry at birth with no help. The immediate
care after birth is simple but important. The baby has just come from
warm quiet uterus. So be gentle with the baby and keep the baby
warm.
IMMEDIATE CARE OF NEWBORN

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 To promote establishment of respiration and prevent from
asphyxia.
 To prevent from hypothermia.
 To prevent from infection.
 To prevent from hypoglycemic shock.
 To promote early and exclusive breast feeding.
OBJECTIVES:

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STEPS OF IMMEDIATE CARE OF THE NEWBOENS

5. 4THCOFFEE 1. DRY AND STIMULATE THE BABY:
• Dry the baby, including the
head, immediately with clean
warm cloth. Rub up and down
the baby’s back. Don’t remove
vernix as it protects the skin and
may help prevent infection.

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2. ASSESS THE BABY’S BREATHING AND COLOR:
• While drying the baby, watch
breathing pattern and color of
baby. The color of lip and
trunk should be pink not pale
or blue.

7. 4THCOFFEE 3. DECIDE IF THE BABY NEEDS AND
RESUSCITATION
• If the baby is not breathing,
is breathing <30 breaths per
minute or is gasping he/she
needs resuscitation. In that
case, quickly clamp or tie and
cut the cord leaving a stump
at least 10cm long for now.
Start resuscitation if needed.

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4. TIE AND CUT THE CORD
• Tie or clamp the cord securely
in 2 places. Put ties tightly
around the cord at 2cm and
5cm from baby’s abdomen.

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• Cut the cord between the ties: Use a new/boiled razor blade or
sterile scissors, use small piece of gauze to cover the part of the
cord to prevent blood splashes. Be careful not to cut or injure the
baby.
• After cord cutting, apply chlorhexidine ointment on cord. Use all
ointment of the tube all over the umbilical stump.

10. 4THCOFFEE 5. PLACE THE BABY SKIN TO SKIN CONTACT
WITH MOTHER
• The warmth of the mother
passes easily to the baby
and helps stabilize the baby’s
temperature.
• Put the baby on mother’s
chest for skin to skin warmth.
• Cover both mother and baby
together with a warm cloth or
blanket.
• Cover the baby’s head.

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6. Put identification tag
• Mention name of the mother,
birth date and time, sex of the
baby in the identification tag.

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7. Have the mother start breast feeding:
• If everything is normal
• Don’t separate the mother and
baby until baby has breastfed.
• Help the mother begin
breastfeeding within the first
hour of birth.

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8. Give eye care
• Shortly after breast feeding
and within 1 hour after birth
give the newborn eye care
with an antimicrobial
medication to protect the baby
from serious eye infection
according to hospital policy.

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• Steps for giving eye care:
Wash your hands.
Use one of these eye care medications; silver nitrate solution 1%
or povidine iodine solution 2.5% or tetracycline 1% eye ointment.
Hold one eye open and allow one drop of medication to full in to
the eye or put a ribbon of ointment along the inside of the lower
eyelid.
Put medicine in next eye also with same steps.

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9. Vitamin ‘K injection
• Vitamin ‘K’ helps the blood
to clot and prevent serious
bleeding. In newborns vitamin
‘K’ can prevent potentially fatal
bleeding disorder called
vitamin ‘K’ deficiency bleeding
also known as hemorrhagic
disease of the newborn.

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• It is method to quickly summarize the health of newborn
• Virginia Apgar, an anesthesiologist at Newyork-Presbyterian
hospital, developed the score in 1952 to quantify the effect of
obstetric anesthesia on babies.
APGAR SCORE

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• The APGAR score is
determined by evaluating the
newborn baby on five
simple criteria on a scale
from zero to two, then
summing up the five values
thus obtained.
• The five criteria are
summarized using words
chosen to form a backronym
(Appearance, pulse, Grimace,
Activity, Respiration)

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• APGAR score is done at 1 minute and 5 minutes after birth.
Maximum APGAR score is 10 and the score of more than 7 is
considered satisfactory and indicates absence of difficulty in
adjusting to extra uterine life.
• Score of 4-6 indicate moderate distress and score of 0-3represent
severe distress.
• Heart rate and respiratory efforts are assessed by auscultation.
• Muscle tone is assessed by passing a nasal catheter and
observing the response.

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PARAMETER 0 1 2
Appearance/
color
Blue, pale Body pink,
Extremities blue
Completely pink
Pulse rate/Heart
rate
Absent <100 >100
Grimace/ Reflex
irritability
No response Grimace Cry, Sneezes
Activity/ Muscle
tone
Limp Some flexion of
extremities
Well flexed
Respiratory effort Absent Irregular, slow Good, Strong cry

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• Tumla shrestha, 2nd edition, “Essential Health Nursing” page no: 72-
73
• Durga subedi, Saraswoti Gautam, Mideifery Nursing part-II, page
no:87-88.
REFERENCE