This presentation is on newborn care/neonatal care. This presentation is made to take a training session for nurse and paramedic.

2. Objectives
• Introduction
• Definitions
• Components of essential newborn care
• Elaboration of each component
• Recognitions minor physical peculiarities and
problems
• Discharge and follow up
• Key message

3. Introduction
• Birth- crucial period of transition from in utero dependent life
to extra utero independent existence.
• Effective care reduce neonatal mortality and morbidity.

4. Definitions
• Neonatal period – First 28 days of life.
• Perinatal period – 22 weeks of gestation
to 7 days after birth.
• Early Neonate –Birth to first 7 days of
life.
• Late Neonate –After 7 days – 28 days of
life.
• Term – Baby born after 37 completed
weeks up-to 42 completed weeks of
gestation.
• Preterm – Baby born before 37
completed weeks of gestation Post.

5. Definitions Continued…
• LBW - < 2500gm
• Vlbw - < 750
• Micropreemie -<500
• SGA - BW < 10th centile
• AGA - Bw 10th - 90th
• LGA - Bw > 90th

6. Normal Neonate
• Birth weight > 2500 g.
• Gestation > 37 weeks.
• Birth weight between 10th to 90th percentiles on a
standard intrauterine growth chart.
• No need of resuscitation at birth.
• Absence of maternal illness or any adverse
intrapartum event.
• No postnatal illness such as respiratory distress,
sepsis, hypoglycemia or polycythemia or requiring
admission in neonatal unit.

7. Components Of Essential Newborn
Care at Birth
• Preparedness
• Immediate basic care
• Prevention of hypothermia
• Establishment of breast feeding
• Postnatal care
• Prevention of infection
• Detection of danger signs

8. • Proper newborn corner -in delivery room (DR) and
maternity operation theatre (MOT).
• Go through maternal history ( any chronic illness, any
medications).
• Anticipate high risk newborn.
• Trained health personnel should present before
delivery.
• Attending personnel should document the baby
details (time of birth, weight, gender and any other
relevant information in all cases).
Care at Birth
Preparedness

9. Newborn Corner

10. 5C-Asepsis Concept of “Clean Chain”
• Clean hands – wear gloves.
• Clean surface- clean and sterile
towel to dry and cover the baby.
• Clean cord-cut umbilical cord
by a clean & sterile blade/scissor.
• Clean tie/thread for cord.
• Do not apply anything to the
cord.
• Universal precaution should be
apply in every delivery.

11. • Newborn Care Corner(NBCC)
NBCC is a space within the delivery room in any health facility
where immediate care is provided to all newborns at birth. This area
is MANDATORY for all health facilities where deliveries are
conducted.
• Newborn Stabilization Unit(NBSU)
NBSU is a facility within or in close proximity of the maternity
ward where sick and low birth weight newborns can be cared for
during short periods. All FRUs/CHCs1 need to have a neonatal
stabilization unit, in addition to the new born care corner.
• Special Newborn Care Unit(SNCU)
SNCU is a neonatal unit in the vicinity of the labor room which will
provide special care(all care except assisted ventilation and major
surgery) for sick newborns. Any facility with more than 3,000
deliveries per year should have an SNCU (most district hospitals
and some sub-district hospital would fulfill this criteria).

12. What Care/Protection does a baby
need just after birth?
• A newborn needs care of
breathing (Protection from
Hypoxemia).
• Care of temperature (Protection
from Hypothermia).
• Care of feeding (Protection
from Hypoglycemia).
• Care of skin, cord and eye
(Protection from Infection and
sepsis).

13. How to identity a baby with Birth
Asphyxia/Hypoxemia/Inadequate
breathing/Respiratory Distress?
• If a new born is not crying.
• If a new born is having a breathing rate of < 30 per
minute.
• Noisy Breathing like Grunting.
• Chest Retraction, nasal flaring and Cyanosis, the baby
is said to be in respiratory distress.
• All neonates can show a periodic breathing pattern
defined as apnoea of less than 5 seconds. Apnoea of
more than 15 seconds may be seen in preterm babies.

14. How to care for breathing?
• Crying is the first sign of breathing.
• If baby is crying, Receive the baby in a dry, clean,
warm towel.
• Put the baby over mother’s abdomen.
• DRY the baby but don’t wipe off VERNIX.
• Replace the wet towel and wrap the baby with second
clean, dry and warm towel.
• Cut the cord within 1-3 minutes.

15. Golden 1 Minute Resuscitation
• Establishing of breathing is the most prior action to take
after delivery of baby.
If a baby is not crying or not breathing well:
Step-1(a):Look for Meconium, if meconium is absent,
dry the baby.
Drying up by clean cloth stimulates and helps in
initiation of breathing.
During drying baby gets stimulated to start
crying/breathing.

16. Golden 1 Minute
Step-1(b):If meconium is present, Gentle suction is done to
remove mucus and amniotic fluid from mouth and nose
with the help of manual mucus sucker.
If baby is not crying now:
Step-2:
• Cut the cord,
• Place on flat, firm, warm surface,
• Provide warmth,
• Position the baby with neck slightly extended (helps in
drainage of secretion),
• Suction of mouth and then nose,
• Stimulate and reposition.
Step 1 to 2 should happen in 30 seconds.

17. Golden 1 Minute Continued….
• If baby doesn’t cry after step-2, go to step-3.
Step-3: It should happen in next 30 seconds and
resuscitation becomes necessary to prevent hypoxemia,
brain damage and death if natural breathing fails to
establish.
• Resuscitation requires more active measures.
• Repeat suction.
• Reposition the baby.
• Apply bag and mask ventilation for 30 seconds.
If breathing doesn’t start
• Call for help
• Continue bag & mask ventilation.
• Add Oxygen

18. Newborn Resuscitation

19. Immediate Care at Birth
• Establish- airway, breathing, circulation, temperature
• Receive baby in pre-warm linen
• Clamp cord by sterile
• Gender identification by mother
• Take anthropometry, wipe baby and transfer to another prewarm linen
• Foot print on paper, identification tag to baby
• Vitamin K, immunization
• Clothing of baby and put under radiant warmer/ rooming in with mother

20. Timing and Method of Umbilical Cord
Cutting and Clamping
• Should be clamped after birth at 1- 3mins (FBNC) .
• Tie cord with a clean thread, rubber band or a sterile cord
clamp , clamp should be applied 2-3 cm away from the
base, stump should be away from genitalia.
• The stump should be free of any application (antiseptic
etc.).

21. Apgar Score
• Apgar score should be recorded at 1 and 5 min.
• Apgar score has a limited value for initiating
stabilization and prediction of subsequent outcomes.
• However it does predict mortality on short term and help
defining the need for nursery admission.

22. Identification
• Each infant must have an
identity band with mother’s
name, hospital regn.no.,
gender and date & time of
birth, birth wt. of infant.
• If footprints of baby is
taken, quality of print
should be good and
hygiene to be maintained.
The footprints should
always be taken on the
mothers case record also.

23. Identification of Sick
Neonates
• Babies with Birthweight
< 1800 g.
• Babies with major
congenital
malformations.
• Babies with asphyxia
(Needing post-
resuscitation care).
• Babies with breathing
difficulty.

24. Cleaning The Baby
• All infants should be cleaned at birth with a clean,
sterile cloth to remove blood clots and/or meconium
on the body.
• NO attempt to remove vernix from the body by any
means, as it can result in trauma to skin.

25. Weight Recording
• All infants should be weighed at least within one hour of birth
on a scale with at least 5 gm sensitivity.
• The weighing scale must be periodically calibrated.
• Single-use paper towel or a sterile cloth towel should be placed
on the weighing scale beneath the infant.

26. Vitamin “K”, Immunization
• Vitamin K should be administered IM on the
antero-lateral aspect of the thigh using a 26
gauze needle (1/2inch) and 1ml syringe.
• Dose to be used is 0.5 mg for babies weighing
less than 1000 g and 1.0 mg for those weighing
above a 1000 gm at birth .
• Birth dose of BCG, OPV, hepB

27. Prevention of Hypothermia
• Provision of warmth to prevent hypothermia is one of the
cardinal principles of newborn care.
Can lead to-
– Hypoglycemia, bleeding diathesis
– Pulmonary hemorrhage, acidosis, apnea.
– Respiratory failure, shock
– Even death.

28. Method of Heat Loss

29. Measurement of Temperature
• Axillary temp. routinely recommended.
• safe, hygienic and ease for early detection of hypothermia.
• The core– peripheral temp. difference of more than 3.5º suggests
sepsis
• Rectal temp
– Recorded in mod. to severe hypothermia.
– Measures core temp.
– Carries risk of perforation.

31. Tepm. Maintenance-Concept of
“Warm Chain”
“Warm chain” is a set of ten interlinked procedures carried out at birth and
later, which will minimize hypothermia in all newborns.
• Warm delivery room (26-28 deg celsius)
• Warm resuscitation.
• Immediate drying
• Skin-to-skin contact between baby and the mother.
• Breastfeeding.
• Bathing and weighing postponed.
• Appropriate clothing and bedding.
• Mother and baby together.
• Warm transportation.
• Training/awareness-raising of healthcare provider.

32. Prevention of Hypothermia-in DR
• The delivery room should be warm (at least 26-28⁰c) and free from draft of
air.
• Warmer on for at least 20 mins.
• Infant should be received in a pre-warmed sterile linen sheet.
• Dried thoroughly including the head and face areas.
• Wet linen should not be allowed to remain in contact with infant.
• Infant should be placed in skin-to-skin (STS) contact with mother
immediately after birth (on abdomen)

33. Initiation of
Breastfeeding
When to start
• Should be initiated at the
earliest possible time
irrespective of mode of
delivery.
• With-in half an hour in
normal delivery, within 1
hour in cesarean section.
Position of mother
• Any position in which
mother is comfortable.

34. Concept of Golden Hour

35. Kangaroo Mother Care (KMC)
• Technique used in LBW babies wherein the neonate is held,
skin-to-skin, with mother or any other adult caretaker.
• Should be given to all these babies whenever and wherever
possible for maximum duration of time (and at least 1 hour).
KMC helps in
(1) Better thermal protection of neonates
(2) Increasing milk production
(3) Increasing the exclusive breastfeeding rates.
(4) Reducing respiratory tract and nosocomial infections.
(5) Improving weight of the baby.
(6) Improving emotional bonding.
(7) Reducing hospital stay.

36. KMC

37. When to Start KMC- The Baby
• The baby must be able to breathe on
its own.
• The baby must be free of life-
threatening disease or
malformations.
• The ability to coordinate sucking
and swallowing is not essential,
other methods of feeding can be
used until the baby can breastfeed.
• Kangaroo mother care can begin at
birth, after initial assessment and
any basic resuscitation.

38. Rooming In
• No indication for separating a normal infant from the mother for
routine observation in nursery, irrespective of mode of delivery.
• During initial couple of hours after birth, infants are awake & very
active (utilized for bonding and initiation of breastfeeding).

40. Clinical Screening for Malformation
• Inspect the cut end of the cord for number of vessels -
Two umbilical arteries and one umbilical vein.
• Examine for esophageal patency.
• Rule out anal artesian by inspecting the anal opening
at the normal site.
• Examine oral cavity to exclude cleft palate.
• Examine the back for any swelling or anomaly.

41. POSTNATAL CARE

42. Care in Post Natal
Wards
Baby should be observed in the post
natal Ward at least twice daily.
• Following should be taken care of:
– Maintenance of temperature.
– Exclusive breast feeding.
– Cord care.
– Eye care.
– Weight.
– Evaluation for jaundice.
– Passage of urine & stool.
– Common developmental &
physiological variations
– Danger signs.
– Counseling of the mother &family.

43. Exclusive Breastfeeding
Mother should be advised to:
• On demand feeding both during day and night for atleast 15-
20 mins.
• One breast to be completely emptied during each feed before
baby is put to the other breast.
• Do not give any pre-lacteal feeds like ghutti, tea, sugar water,
jaggery, honey etc.

44. Colostrums
• Highly concentrated milk.
• Produced during first 2-3 days.
• Anti infective properties
Must be fed to the baby

45. Correct Positioning
• Wash hands.
• Be comfortable.
• Relax your shoulders.
• Head and body in
straight line.
• Whole body supported.
• Nose to nipple.
• Tummy to tummy.
• Support your breast and
thumb is on top and
• fingers are below the
breast.

46. • Attachment
to breast.
• Effective
Suckling.

47. Signs of Good & Poor Attachment

48. Cord Care
• Umbilical stump
should be kept dry and
devoid of any
application.
• Bleeding may occur
due to shrinkage of
cord and loosening of
the ligature.
• The nappy should be
folded well below the
umbilical stump.
• Umbilical discharge/
redness/sepsis

49. Eye Care
• Eyes of the infant must
be cleaned with a
sterile swab soaked in
normal saline or sterile
water.
• Clean from inner to
outer canthus and use a
separate swab for each
eye.

50. Oil Application
• Oil application is a
low cost traditional
practice well
ingrained in Indian
culture.
• Prevent heat loss in
preterm baby.
• However, a paucity
of data still exists as
to what oil should
be used for this
purpose .

51. Bathing
• Routine bathing in the hospital should be avoided in
view of risks of cross infection and hypothermia.
• The infant can be sponged, as required. Infant can be
bathed at home once discharged from the hospital.

52. Bathing Continued…
• Traditional practices like kajal, surma , putting oil in
ears, giving prelacteal feeds like honey, sugar water
should be discouraged.
• No use of any powder, baby cream.
• Healthy newborns should be made to sleep on their
back

53. Weight Record
• Healthy term babies lose weight
during the first 2 to 3 days of life
(up to 5 to 10 % of the BW)
• Weight remains stationary during
next 1-2 days and birth weight is
regained by the end of first
week.
• Delayed feeding and
unsatisfactory feeding schedule-
excessive weight loss.
• Pre terms experience 2-3% weight
loss daily up to a maximum of 10-
15%. Any weight loss >5% in a
24-hour period is abnormal.
Preterm newborn should regain
birth weight by 10-14 days of
age.
• The average daily weight gain
in term babies is around 20-30
g/ day.

54. Vomiting
• Many normal babies
regurgitate or spit out some
amount of milk regurgitation
or vomiting.
• Seen soon after feeds.
• Due to faulty technique of
feeding and aerophagy.
• Proper advice regarding
feeding and burping, must be
imparted to all mothers.
• If the vomiting is persistent,
projectile, or bile stained, the
baby should be further
investigated.

55. Stool Pattern

56. Excessive Cry
• Babies cry when they are
hungry or in discomfort.
• Discomfort due to sensation of
a full bladder before passing
urine, painful evacuation of
hard stools or mere soiling by
urine and stools.
• Persistent crying needs
examination and detailed
evaluation for inflammatory
conditions and other causes.

57. Danger Signs in Newborn

58. Evaluation of
Jaundice
• All infants must be
examined for the
development and
severity of jaundice
twice a day for first
few days of life.
• Visual assessment in
daylight.

59. Clinical Criteria to Assess Jaundice

60. Development Variations and
Physiological Conditions
• Mastitis Neonatorum.
• Peeling skin.
• Milia.
• Mongolian spots.
• Epstein pearls.
• Sub-conjunctival
hemorrhage.
• Erythema toxicum.
• Sucking callosities.
• Tongue tie.
• Non retractable
prepuce.
• Hymenal tags.
• Umblical hernia

61. Mongolian Spots
• Blue to blue-black
macules occur
anywhere on the
body, mostly on the
back and buttocks.
• Caused by the
deposition of
melanin.
• Usually disappear
within 6 months – 2
years

62. Erythema Toxicum
• Erythematous rash with a
central pallor.
• Begins on face and spreads
down to the trunk and
extremities in about 24 hours.
• Differentiated from pustules
which need treatment.
• Disappears spontaneously after
two to three days.
• The exact cause is not known.
• Usually develop 2 – 3 days
after birth.
• Spares palms and soles.
• Lesions seem to migrate by
disappearing within Hrs and
then reappearing elsewhere.

63. Milia
• Multiple 1- to 2-mm
yellowish white cystic
lesions.
• Affect 40% of newborns.
• Found most commonly
over the cheeks, forehead,
nose, and nasolabial folds
due to blocked sebaceous
glands.
• Resolve spontaneously

64. Epstein Pearls
• These are white spots, usually one on either side of
the median raphe of the hard palate. Similar lesions
may be seen on the prepuce. They are of no
significance

66. Normal Peeling
• Dry skin with peeling and
exaggerated transverse sole
creases is seen in all postterm
and some term babies.
• Usually occurs after 24-36
hours.
• Will resolve spontaneously
and does not need any
creams, oil, ointment or
lotions.
• Excessive peeling is seen in
pathological conditions like
placental
dysfunction,congenital
syphilis and candidiasis
SSSS.

67. Sucking Callosites
• Button like, cornified
plaques over centre of
upper lip.
• No significance.
• Friction of repeated
sucking.
• Resolves spontaneously

68. Staphylococcal
Pustulosis
• Usually at 3-5 days.
• Discrete pustules with
erythematous base.
• Diaper area, periumbilical,
neck, lateral aspect of chest.
• More than 10 pustules is a
danger sign.
• T/t- betadine cleaning.
• Systemic antibiotics
Screen for sepsis

69. Subconjunctival
Hemorrhage
• Newborns often have
small, bilateral
hemorrhages,
presumably from the
pressure of uterine
contractions.
• Normal finding.
• The blood gets
reabsorbed after a few
days without leaving
any pigmentation.

70. Natal Teeth
• Erupted teeth at birth.
• Usually lower incisors.
( Neonatal teeth: Erupt
during 1st month).
• Removed- when it
affects normal breast
feeding or when the
teeth are Loose (risk of
aspiration)

71. Breast
Engorgement
• Bilateral fullness of
breasts in both sexes.
• Overlying skin shows
no signs of redness,
warmth or tenderness.
• The condition resolves
spontaneously in days
to weeks.
• No intervention is
required.

72. Vaginal Bleeding
• Menstrual like vaginal
bleeding may due hormonal
withdrawal.
• Occur in about ¼ female
babies after 3-5 days of birth.
• The bleeding is mild and
lasts for 2-4 days.
• Additional vit k is not
needed.
Mucoid vaginal secreations
Most female babies have thin
grayish white.

73. • Umbilical
Hernia
• Tongue Tie
• Sacral Dimple

74. Non retractable prepuce:
• normally non retractable in all male newborn
• should not be diagnosed – phimosis.
• No forcibly retracting the foreskin.
Hymenal tags :
• Mucosal tags at the margin of hymen seen in
2/3rd of female infants

75. When Should Normal Newborn be
Discharged
Ideally infant should be discharged
after 72-96 hours once all the
following criteria are fulfilled:
• Infant is free from any illness
including significant jaundice.
• The infant has been immunized.
• Adequacy of breastfeeding has
been established.
• This must be assessed in all
infants and the same
• would be indicated by passage of
urine at 6 to 8
times/24 hr, onset of transitional
stools, baby
sleeping well for 2-3 h after
feeding.

76. When Should Normal
Newborn be Discharged
Continued…
• Every infant should have a
routine formal examination
before discharge
• Examination performed
with infant naked and in
optimum light in presence
of mother using a checklist
.
• Mother should be provided
ample opportunity to ask
questions and clarify her
doubts.
• Measure weight at
discharge

77. Advice on Discharge
• Exclusive breast feeding.
• Immunization.
• Follow up.
• Danger signs
– Difficulty in feeding.
– Convulsions.
– Lethargy.
– Fast breathing.
– Severe chest indrawing.
– Temp >37.50C and <
35.50 C

78. Follow Up
• Each baby should be
followed in well baby clinic
for assessment of growth
and development,early
diagnosis and management
of illnesses and health
education of the parents.
• It is preferable that every
baby is seen and assessed by
a health worker at each
immunisation visit.
• The developmental
assessment should be
organised both in
community and the facility

79. Any
questions?

80. All those things concludes my presentation.
Thank You
all
for patience hearing…