Essential newborn care Essential care of a normal newborn can be best provided by the mothers under the supervision of nursing personnel. About 80% of newborn babies require minimal care. The normal term baby should be kept with their mother rather than in a separate nursery. Rooming-in promotes better emotional bondage, prevents cross-infection and establishes breast feeding easily. Active participation of mothers in the nursing care of the baby develops self-confidence in her.

1. Essential Newborn Care
Mr. Santhosh.S.U.
Associate Professor & H.O.D.
Department of Child Health Nursing
SCPM College Of Nursing & Paramedical Sciences,
Gonda. U.P.

2. Introduction
• Essential care of normal newborn can be best provided by
the mothers under supervision of nursing personnel.
• About 80% of newborn babies require minimal care.
• The normal term baby should be kept with their mother
rather than in a separate nursery.
• Rooming in promotes better emotional bondage, prevents
cross infection and establishes breast feeding easily.
• Active participation of Mother in nursing care of the baby
develops self confidence in her.

3. Who is a Healthy Newborn ?
• A healthy infant born at term between 38-42 weeks
with an average birth weight of 2.9 kg, cries
immediately following birth, establishes
spontaneous rhythmic respiration & quickly adapts
to the changed environment.

4. Key facts
• Globally 25 Lakh children died in the first month of life in 2018 —
approximately 7,000 new-born deaths every day with about one third
dying on the day of birth and close to three quarters dying within the
first week of life.
(WHO)
• Over 75% of infant mortality cases in Uttar Pradesh occurs during the
first 28 days after birth. And at least 41 of 1000 babies die before
celebrating their first birthday.
• Women who receive midwife-led continuity of care (MLCC) provided
by professional midwives, educated and regulated to internationals
standards, are 16% less likely to lose their baby and 24% less likely to
experience pre-term birth.
(WHO)

5. The 1st 24 hours of Life
• The first 24 hours of life
is a very significant and a
highly vulnerable time
due to critical transition
from intrauterine to
extrauterine life.

6. TYPES OF NEWBORN CARE

7. Immediate Newborn Care
Airway Breathing
Cord
Clamping
Temperature

8. Airway & Breathing
• Suction gently & quickly using bulb syringe or suction catheter.
• Starts in the mouth then, the nose to prevent aspiration.
• Stimulate crying by rubbing.
• Position properly- side lying / modified Trendelenburg.
• Provide oxygen if necessary.
1

9. Cord Clamping
• Clamp the umbilical cord about 3 to
4 cm (1.5 to 2 inch) from your baby's
belly button with a plastic clip, place
another clamp at the other end of
the cord, near the placenta.
• The cord will then be cut between
clamps, leaving a stump about 2 to 3
cm (1 to 1.5 inch) long on your
baby's tummy.

10. Temperature
• Dry immediately
• Place infant in warmer or use droplight
• Keep dry and well-wrapped
• Keep away from cold objects
• Perform procedures in warm, padded surface
• Keep room temperature warm

11. Heat Loss Mechanisms
• Convection – the flow of heat
from the body surface to cooler
surrounding air
– Eliminating drafts such as
windows or air con, reduces
convection
• Radiation – the transfer of heat to
a cooler object not in contact
with the baby
– Cold window surface or air con;
moving as far from the cold
surface, reduces heat loss

12. • Conduction – the transfer of body
heat to a cooler solid object in
contact with the baby
– Covering surfaces with a warmed
blanket or towel helps minimize
conduction heat loss
• Evaporation – loss of heat
through conversion of a liquid to a
vapor
– From amniotic fluid; Newborn
should be dried immediately

13. APGAR Score Dr. Virginea APGAR (1952)
• Assessment done at
1min & 5 min
following delivery
• APGAR scores of 0-3 are
critically low, especially
in term and late-preterm
infants
• APGAR scores of 4-6 are
below normal, and
indicate that the baby
likely requires medical
intervention
• APGAR scores of 7+ are
considered normal
Maximum Score 10

14. CARE IN NURSERY
Admission in
nursery
Observation
and routine
care
Protection
Estimation of
gestational
age
Care of eyes
Care of
umbilical cord
Medication /
Vaccination

15. 1. ADMISSION IN NURSERY:
• All healthy newborn are kept in the delivery
room with their mother to promote immediate
breast feeding and early bonding.
• Common indications for admission of newborn in
the nursery are:
• Respiratory distress
• Poor perfusion or presence of pallor or cyanosis.
• Malformation.
• Need for oxygen therapy.

16. 2.OBSERVATION AND ROUTINE CARE:
• Close observation is done for at least 4-8 hours after
birth.
• Observe for any excessive mucus secretion from the
mouth.
• Any bleeding from the umbilical cord .
• Hourly temperature will be recorded until it
stabilizes and remain above 36 degree Celsius.
• The infant should be examined systematically
beginning from the head followed by inspecting the
whole body to detect any congenital abnormality.
• The baby should be thoroughly observed twice daily
till discharge for early detection of any abnormality.

17. 3. PROTECTION:
• Place the baby under a preheated radiant warmer
immediately following birth.
• Cover the baby with a pre-warmed towel.
• Put the baby close to the mother’s breast
(kangaroo method) .
• Wrap the mother and baby together to prevent
hypothermia.
• Commence early breast feeding.

18. 4. ESTIMATION OF GESTATIONAL AGE:
• Soon after delivery gestational age is
estimated using Ballard Scale.
• A baby delivered at 39 weeks or more
present with following features:
• Sole covered with creases.
• Breast nodule diameter of 7mm.
• Scalp hair–coarse and silky.
• Ear lobule stiffened by thick cartilage.
• In male scrotum is full with testes with
extensive rugae.

19. Assessment of Gestational Age
• Physical Maturity

20. • Neuromuscular Maturity

21. Scoring
Score Wks
5 26
10 28
15 30
20 32
25 34
30 36
35 38
40 40
45 42
50 44

22. Physical maturity
http://www.medcalc.com/ballard.html
19

23. Neuromuscular Maturity
http://www.medcalc.com/ballard.html
17

24. Scoring
http://www.medcalc.com/ballard.html
Score Wks
5 26
10 28
15 30
20 32
25 34
30 36
35 38
40 40
45 42
50 44
19 + 17= 36
36 39 wks

25. 5. CARE OF EYES:
• The eyes of the neonate are cleaned
immediately using sterile moist (normal
saline) swab one for each eye.
• The eye is cleaned from inner canthus to
outer canthus .
• The eyes are checked daily for any
discharge.
• The eyes are cared properly to prevent
them from infections.
• Gentamycin ophthalmic ointment or
erythromycin (0.5%) is applied in the
eyes every 6 hourly as a prophylaxis.

26. 6. CARE OF UMBILICAL CORD:
• The oozing and bleeding is checked for 24 hours.
• The stump of the cord is observed for three
openings of the blood vessels, one vein and two
arteries.
• It is kept exposed to air and allowed to dry to
promote early detachment.
• Topical antibiotics or antibiotics such as triple dye or
Neosporin powder may be applied to reduce
bacterial infection.

27. 7. CLOTHING:
• The dress should be
appropriate for the climate.
• The extremities should be free
for movement.
• A napkin / diaper should be
changed periodically.

28. 8. MEDICATION / VACCINATION:
• A single intramuscular dose of 0.5
to 1 mg of vitamin K is given to all
newborn within 6 hours of birth.
• Prophylactic antibiotics are given.
• OPV Zero Dose, B.C.G and
Hepatitis –B Vaccines given at birth.

29. C. GENERAL CARE:
Care of the
skin
Care of the
genitalia
Infection
control
Adequate
nutrition
Psychological
bonding with
parents

30. 1.CARE OF THE SKIN:
• The neonate skin is delicate.
• The neonate skin is cleaned in
cephalo- caudal direction.
• First the face is cleaned, then scalp
is wiped carefully and quickly.
• While cleaning head and face rest of
the body is wrapped.
• Then rest of the body is washed.

31. 2. CARE OF GENITALIA:
• The genitalia of the female and male
neonate require gentle cleaning.
• Cleansing of the vulva is done from
front- to- back.
• In male neonates, smegma is removed
by cleansing around the glans.
• The parents need explanation about
cleansing of the genitalia.

32. 3.INFECTION CONTROL:
• The neonate defenses against infection are not matured, thus, they are
susceptible to infection.
• In preventing cross infection, the practice of hand washing by all the
personnel in the nursery and delivery room is very important.
• The nurse and care taker wash their hands before and after handling the
neonate.

33. 4.ADEQUATE NUTRITION:

34. 5.PSYCHOLOGICAL BONDING
WITH THE PARENTS:
• Parents should try to have eye-to- eye contact with the
neonate.
• Whenever possible, both parents should develop,
emotional bond with the neonate, by holding the baby
close to the body, cuddling, and through their touch.
• Practice rooming-in to make mother child bonding.

35. DAILY OBSERVATION AND
CARE OF NEWBORN
VITAL SIGNS WEIGHT
GENERAL CHANGES
IN COLOR AND
ACTIVITY
FEEDING STATUS HEAD AND EYES
MOUTH UMBILICAL CORD ELIMINATION BATH
PARENT- INFANT
INTERACTION
VACCINATION AND
IMMUNIZATION
GROSS
ABNORMALITY
REFLEX
BEHAVIOUR
SCREENING OF
THE NEWBORN
DISCHARGE
FOLLOW UP
• THE FOLLOWING SHOULD BE OBSERVED DAILY:

36. Caring for new-borns during
the COVID-19 pandemic
• You have waited nine months for your newborn to
arrive. You ate well, took prenatal vitamins,
attended appointments and did your best to keep
yourself healthy. Now that your baby has arrived,
how do you keep him or her healthy during the
COVID-19 pandemic?

37. Routes of transmission
• Transmission of SARS-CoV-2, the virus that causes COVID-19,
to neonates is thought to occur primarily through respiratory
droplets during the postnatal period when neonates are
exposed to mothers, other caregivers, visitors, or healthcare
personnel with COVID-19.
• Limited reports have raised concern of possible intrapartum
or peripartum transmission, but the extent and clinical
significance of vertical transmission by these routes are
unclear.

38. Care of Newborn with COVID-19
• Newborn care should be as per routine.
• Closely monitor Neonate for symptoms-
• Unstable body temperature,
• low activity or poor feeding, or
• shortness of breath.
WHICH NEONATES TO TEST ?
• Neonates born to mothers with COVID-19 infection within 14
days of delivery or up to 28 days birth.
• Symptomatic neonates exposed to close contacts with COVID-
19 infection.

39. Recommendations during
neonatal resuscitation
• To be performed in a separate adjacent room. If
not possible, at least 2 meters away from delivery
bed.
• Minimum number of personnel (Wearing full PPE).
• Follow standard Neonatal Resuscitation Program
guidelines. If positive-Pressure Ventilation is
needed, self-inflating bag and mask may be
preferred.

40. Infection prevention and control
• Given the paucity of information regarding signs
of COVID-19 in neonates, all neonates born to
mothers with confirmed or suspected COVID-19
should be considered as having suspected SARS-
CoV-2 infection when testing results are not
available.
• Infants with suspected SARS-CoV-2 infection
should be isolated from other healthy neonates
and cared for according to the “Infection
Prevention and Control Recommendations for
Patients with Suspected or Confirmed Coronavirus
Disease 2019 (COVID-19) in Healthcare Settings”.

41. Recommended protection for
Healthcare workers
• Droplet and Contact Precautions: Ensure that encounters
with a newborn are not without basic protection gear,
including gown, gloves, standard mask and face shield or
protective goggles (prescription glasses or sunglasses are not
suitable).
• Airborne, Contact and Droplet Precautions: COVID-19
patients could require bag-mask ventilation, intubation,
tracheal suctioning, nasal cannula oxygen at a flow greater
than 2 litres per minute/kilogram, continuous positive airway
pressure, and/or positive pressure ventilation of any type.
Such equipment can generate patient aerosols.
• As per this recommendation, the attending clinical staff must
wear gown, gloves, an N95 mask with eye protection. They
can also use an air-purifying respirator such as, powered air-
purifying respiratory (PAPR) or controlled air-purifying
respiratory (CAPR), both of which also include protection for
the eyes.

42. Discharge of Newborn from hospital
• Stable neonates exposed to COVID-19 and being
roomed-in with their mothers may be discharged
together at time of mothers’ discharge.
• Stable neonates in whom rooming-in is not possible
because of the sickness in the mother and are being
cared by a trained family member may be discharged
from the facility by 24-48 hours of age.

43. Vaccination of Newborn
• Follow routine immunization policy in healthy
neonates born to mothers with suspected/proven
COVID-19 infection.
• In neonates with suspected/Proven infection,
Vaccination should be completed before discharge
from the hospital as per existing policy.

44. If mom gets COVID-19 and she's breastfeeding,
will it transfer to the baby?
• Breastfeeding has not been linked to transmission
of COVID-19. However, there have been limited
studies. At this time, the virus has not been
detected in breast milk. This does not mean that
it isn't possible. There just isn't sufficient
evidence available at this time to be certain