The document covers essential newborn care practices, including management at birth, neonatal resuscitation, and addressing common neonatal problems. It highlights the high neonatal mortality rate in India, with leading causes being infections, asphyxia, and prematurity, and emphasizes the importance of skilled care during delivery and early breastfeeding. Key practices include maintaining cleanliness, preventing hypothermia, and ensuring timely medical evaluations for congenital anomalies.

1. TOPICS
 Care of newborn at birth.
 Resuscitation of newborn at birth.
 Care of newborn in the postnatal ward.
 Problems with breast feeding.
 Stabilization of a sick newborn before
referral.
 Transportation of sick newborn.
 Common neonatal problems and their
management
 Demonstrations

2. CARE OF NEWBORN
AT BIRTH
DR.DIPANGKAR HAZARIKA
ASSISTANT PROFESSOR OF PEDIATRICS
JORHAT MEDICAL COLLEGE

3. NEWBORN HEALTH IN INDIA
 2.5 crore births per year
- Accounts for 20% of global births
 9 lakh die in neonatal period
- Accounts for about 25% of global deaths
Teaching Aids: ENC

4. NEONATAL MORTALITY RATE (NMR)
 Current (NFHS-3):39/1000 live births (2005-06)
Teaching Aids: ENC
Neonatal
mortalit
y
68%
Rest
32%
Infant deaths
NFHS-3
2005-06
Neonatal
mortality
52%
Rest
48%
Under-five mortality
NFHS-3
2005-06
Accounts for almost 2/3rd of IMR & ½ of U5-MR

5. NMR - STATE WISE
NMR is not uniform across the country
India Ke TN Hr HP Pb Kn JK Mh Gj WB Bi AP Rj MP Or As UP
0
5
10
15
20
25
30
35
40
45
50
39
11.5
19.1
23.6
27.3 28
28.9
29.8
31.8
33.5
37.6
39.8 40.3
43.9
44.9 45.4 45.5
47.6
NMR
Teaching Aids: ENC

6. CAUSES OF NEONATAL DEATHS
Infections, asphyxia and prematurity are the
leading causes of neonatal deaths
Source: ICMR, 2006
Asphyxia
21%
Infection
s
33%
Prematur
ity
15%
Malforma
tions
5%
Others
11%
Not
establishe
d
15%
Teaching Aids: ENC

7. TIMING OF NEONATAL DEATHS
Nearly 3/4th of neonatal deaths occur within 7
days, mostly during first 24 hours
Teaching Aids: ENC
Week 4
Week 3
Week 2
Day 7
Day 6
Day 5
Day 4
Day 3
Day 2
Day 1
Week 1
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%
4.2%
8.7%
13.8%
3.0%
2.7%
5.6%
5.6%
10.2%
6.7%
39.5%
73.3%
Timing of neonatal deaths

8.  About 50% of deliveries occur at home
 Only 46.6% attended by skilled birth attendants*
 Higher the institutional births, lower is the NMR
PLACE OF BIRTH
* doctors, nurses, and midwives
Teaching Aids: ENC
State Institutional
births
NMR
Kerala 99.3 11.5
Uttar Pradesh 20.6 47.6

9. DECLINE OF NMR
 Rapid decline in
eighties
 69 in 1980
 53 in 1990
 Stagnation since
nineties
 48 in 1995
 44 in 2000
 39 in 2005-06
NMR Trends
0
10
20
30
40
50
60
70
80
1980 1985 1990 1995 2000 2005-06
1980 1985 1990
1995 2000 2005-06
Teaching Aids: ENC

10. WHY STATIC NMR?
 Govt. programmes focused mainly on post neonatal period
- Diarrheal Disease Control
- ARI
- Immunization
 Focus of essential newborn care component was on a limited number of
government facilities
 Lack of skilled persons for managing newborns
Teaching Aids: ENC

11. WHY CARE AT BIRTH IS
IMPORTANT?
 Right care at birth reduces the risk of
complications.
 Physiological adaptation at birth includes:
- Temperature adaptation
- Initiation of respiration and oxygenation of
the arterial blood
- Initiation of feeding

12. Normal Newborn Care 12
WHAT ARE THE ESSENTIAL NEWBORN CARE
 Clean childbirth and cord care to prevent
infection.
 Thermal protection to prevent hypothermia
 Initiation of breathing and resuscitation
 Early and exclusive breastfeeding

13. KEY PRINCIPLES
 Anticipate
 Prepare
 Universal precautions

14.  Anticipate
 Prepare
 Universal precautions

15.  Anticipate
 Prepare
 Universal precautions

16.  Anticipate
 Prepare
 Universal precautions

17.  Anticipate
 Prepare
 Universal precautions

18. PROVIDE WARMTH

19. PROVIDE WARMTH

20. PREPARING FOR BIRTH
 Two or more clean and warm towels or cloths.
 A draught free delivery room.
 Temperature of at least 25-28°C.
 Soap, water, clean gloves, cotton, gauze and a
clean labour table for delivery.
 A clean delivery kit .
 Self inflating bags and masks .
 A suction device ( mucus extractor).
 A radiant warmer, if available.
 A blanket.
 A clock/watch to note the time of delivery.

21. ASSESSMENT AT BIRTH
Assess by checking whether:
1. Term gestation?
2. Amniotic fluid clear?
3. Breathing or crying?
4. Good muscle tone?
 If YES provide routine care.
 If answer to any question is NO then proceed
for resuscitation.

23. Thin,
transparent
skin in preterm
infants

25. ROUTINE CARE AT BIRTH
 Over 90% of newborns do not require any active resuscitation.
Efforts are directed to
- Prevent infection
- Prevent hypothermia
- To keep the airway patent.
Steps of routine care:
 Asepsis: Wash hands with soap and water. Use gloves. Deliver the
baby under aseptic conditions maintaining six “cleans”.
 Baby should be placed onto its mother’s abdomen. If not possible
keep the baby next to the mother on a clean surface.

26. ROUTINE CARE
 Dry with a warm clean towel .
 Wipe the mouth and nose with
a clean cloth.
 Do not wipe off the white
greasy substance.
 Tie the cord with a clean
thread, or a sterile cord clamp.
 Examine quickly for
malformations/ birth injuries.
 Leave the baby between the
mother’s breasts to start skin
to skin care.
Dry the baby immediately after birth

27. ROUTINE CARE
 Cover the baby’s head
with a cloth.
 Cover the mother and
baby with a warm cloth.
 Place an identity label on
the baby.
 Note the time of birth
 Give Inj. Vit K 1 mg IM.
 Start breast feeding as
soon as possible. Immediate
skin-to-skin
contact &
breastfeeding

28. Teaching Aids: ENC
NC-
Ensure skin to skin contact after birth
28

29. Teaching Aids: ENC
NC-
Baby shows feeding cues…
29

30. Teaching Aids: ENC
NC-
..and is ready for breastfeeding
30

31.  Check whether baby passed urine and meconium
on table or not.
 Helps to reduce unnecessary referal.
 Normally baby should pass urine by 48 hours and
stool by 24 hours of birth.

32. WHAT PRACTICES INTERRUPT THE TIME THE MOTHER AND
BABY MAY SPEND TOGETHER IMMEDIATELY AFTER BIRTH?
 In the 1st
two hours after it is not necessary to:
1. Weigh or measure the baby.
2. Bathe the baby.
3. Give the baby any other food apart from breast milk.
4. Give the baby to anyone apart from the mother.
However normal culture practices should be respected.
5. A newborn baby should not be given bath for at least
24 hours after birth.

33. 33
ROUTINE CARE: PREVENTION OF INFECTION
 Principles of cleanliness at childbirth
 Clean hands
 Clean perineum
 Nothing unclean introduced vaginally
 Clean delivery surface
 Cleanliness in cord clamping and cutting
 Cleanliness for cord care

34. ‘Six cleans’ to prevent infection

35. Prevention of infections:
After delivery
1. - Hand washing before handling the baby
2. - Exclusive breastfeeding
3. - Keep the cord clean and dry; do not apply anything
4. - Use a clean cloth as a diaper/napkin
5. - Hand washing after changing diaper/napkin
Teaching Aids: ENC
NC- 35

36. Normal Newborn Care 36
IMMUNIZATION
 BCG vaccinations.
 Single dose of OPV at birth or within two weeks of
birth.
 HBV vaccination as soon as possible.

37. 37
ROUTINE CARE: THERMAL PROTECTION
 Newborn physiology
 Normal temperature: 36.5–37.5°C
 Hypothermia: < 36.5°C
 Stabilization period: 1st 6–12 hours after birth.

38.  Chances of hypothermia increase when
1. Cold delivery room., post natal ward and home environment.
2. Open window, broken glass, frames.
3. No heater in winter
4. No room thermometer
5. Giving early bath.
6. Running ceiling fan
7. Not drying the baby immediately after delivery.
8. Nor drying the head
9. Baby left on or in a wet cloth
10. Separating mother and baby and then not covering the baby
with sufficient covers.
11. Not breast feeding soon after birth

39. How to determine the room temperature?
 It is not possible to accurately guess the temperature of a
delivery room or any other room.
 It is better to have a room thermometer, and the reading should
be between 25-30℃.
If a room thermometer is not available what may make you think
the room is cold-
 You will feel cold.
 You need to wear a jacket
 You feel draught
 Babies feel cold to touch
 Mothers tell you they are cold.

40. PREVENT HYPOTHERMIA
4 ways a newborn may lose
heat to the environment
 Newborn baby’s temperature
falls within seconds of birth.
 4 ways of losing heat-
Radiation, convection,
evaporation and conduction.

41. PREVENT HYPOTHERMIA
Method of heat loss Prevention
Evaporation: Wet baby Immediately after birth dry the
baby with a clean, warm, dry
cloth
Conduction: Cold surface, e.g.
weighing scale etc.
Put the baby on the mother’s
abdomen or on a warm surface.
Convection: cold draught Provide a warm, draught free
room for delivery at ≥ 25 °C
Radiation: Cold metallic
surroundings
Keep the room warm

42. PREVENTIVE MEASURES
 Provide a warm, draught free room for delivery at 25-30°C.
 Receive the baby in a dry, warm, clean towel. Dry well.
 Discard the wet towel immediately and wrap/cover the
baby (except face and upper chest) in a fresh, clean dry
towel.
 Place the baby near a source of warmth.
- A normal baby, who is crying well after birth, can be
placed in skin to skin contact with the mother’s abdomen
and covered with a dry cloth.
- Place the baby under a source of heat such as a lamp
with a 200 Watt bulb or under a radiant warmer.

43. PREVENTIVE MEASURES
 Delay the first bath to beyond 24 hours period.
 Instead baby can be cleaned by wiping with a soft moist
cloth.
 When bath is given, it should be done quickly in a warm
room, using warm water.
 Do not remove the vernix.
 Give to mother as soon as possible , as skin-to-skin contact
in first few hours after childbirth
 Promotes bonding
 Establish early breastfeeding

44. Normal Newborn Care 44
BREATHING INITIATION AND
RESUSCITATION
 Spontaneous breathing (> 30 breaths/min.) in most
newborns
 Gentle stimulation, if at all required.
 Newborn resuscitation may be needed
 Depressed newborn.
 Thick meconium stained amniotic fluid and baby
depressed.
 Preterm babies.

45. Once the baby is born asses baby’s breathing at the time of
drying:
 If the baby is crying vigorously or breathing adequately, air
entry on both sides of the chest is equal and the respiratory
rate between 30-60 per minute, then no intervention is
needed.
 If the baby is not breathing or gasping, then skilled care in
the form of positive pressure ventilation etc. (i.e.
RESUSCITATION) would be required
Teaching Aids: ENC
NC-
Helping the baby breathe
45

46. Normal Newborn Care 46
EARLY AND EXCLUSIVE BREASTFEEDING
 Best practices
 No pre-lacteal feeds or other supplement
 Giving first breastfeed within one hour of birth
 Breastfeeding on demand
 Psycho-social support to breastfeeding mother

47. CORD CARE
Clamp 1 minutes after neonate is
delivered completely.
Early and immediate clamping in
- Severe asphyxia, cord around the
neck, rhesus iso-immunization.
Apply a tie tightly around cord at 2- 3
cm from the abdomen
Observe for oozing blood 2 hours
after ligation, if blood oozes, place
a second tie between the skin and
first tie.
Do not apply any substance to the
stump; keep the cord clean and
dry.
Inspect for discharge or infection till
healing occurs.
Binding, use of powders and traditional
practices like application of cow dung,
broken glass or herbs are harmful and
should be discouraged!

49. CORD CLAMPING

50. CORD CLAMPING

51. UMBILICAL CORD AT 7 DAYS
(CORD STUMP)

52. Examine Cord for presence
of 3 vessels and document
 2 arteries and 1 vein

53. EXAMINATION AT BIRTH OR SOON AFTER
 Look for life threatening congenital anomalies ‘-
1. Diaphragmatic hernia (present with respiratory distress
with scaphoid abdomen) .
2. Neural tube defects, B/L choanal atresia
3. Esophageal atresia with TEF (excessive salivation and
mucus discharge from mouth).
4. Gastrochisis and exomphalos.
5. Urethral obstruction, anal atresia.
6. Bile stained persistent vomitus suggest intestinal
obstruction
 Assess the gestational age.
 Take the weight.

54. Congenital Diaphragmatic Hernia
Diagnosis: chest x-ray
• Loops of bowel in the chest
• Mediastinal shift
• Absent lung markings

55. 55
TRACHEO-ESOPHAGEAL FISTULA

56. TracheoEsophageal Fistula
5 Types
Gregory GA, ed, Pediatric Anesthesia, 3rd
edition,
1996
7.7% 0.8% 86% 0.7% 4.2%

57. Gastroschisis

58. Omphalocoele

59. Gastroschisis Omphalocoele

60. EXAMINE FOR MALFORMATIONS
 Identify life threatening congenital anomalies.
 location and patency of all the orifices to rule out TEF and
imperforate anus.
Examine:
 The spine for dimples, tuft of hair (spina bifida occulta) or
cystic swellings (spina bifida cystica)
 Genitalia: In boys, confirm that both testicles have
descended into the scrotum.
 Inspect the perineum and check anus for position and
patency.

61. EXAMINE THE HEAD
•Huge encephalocoele. Head is
disproportionately small
Cephalhaematoma limited to the
right parietal region

62. EXAMINE EYES AND FACE
 Examine eyes for ocular anomalies .
 Examine the face for dysmorphic features and normal
movements
 Examine lips and palate for clefts
Bilateral cleft lip and palate.
Also note purulent left eye
discharge
Facial asymmetry due
to left facial palsy

63. EXAMINE ABDOMEN
Large omphalocoele.
Surounding erythema indicates
cellulitis.
Spina bifida

64. TAKE HOME MESSAGE
 Prepare two 1X1 meter size clean cloth in advance.
 Dry the baby immediately after birth.
 Check whether baby passed urine and meconium on table
during delivery.
 Start breast feeding as soon as possible after birth.
 Inj. Vitamin K IM at birth, reduce early HDN.
 Examine all orifices at birth, their position and patency.
 Examine the spine