This document provides guidance on newborn care and management. It discusses immediate newborn care steps like drying and warming the baby. It outlines the criteria for a normal healthy newborn and basic newborn needs like temperature regulation and breastfeeding initiation. The document also covers newborn resuscitation procedures if breathing issues arise, including steps for bag and mask ventilation and chest compressions. Potential risk factors for breathing problems and ensuring proper equipment is emphasized.

1. THE NEWBORNCARE/MANAGEMENT
BY:
MS. LAMNUNNEM HAOKIP
SENIOR TUTOR/LECTURER
OBG NSG.DEPT.
SSNSR, SU

2. INTRODUCTION
• The first hour after birth has a major influence on the survival, future
health, and well being of a newly born infant. The health workers have an
important role at this time. The care they provide during this period is
critical in helping to prevent complications and ensuring survival. All
mothers need help, support, and advice in the initial few days after
delivery to ensure proper care of their newly born baby.

3. NORMAL NEWBORN
A baby is considered as healthy when it completes the following
criteria:
Born full term ( between 38 to 42 weeks)
Average birth weight ( 2.5 to 3.5 kgs)
Cries immediately after birth
Length ( 50 – 55 cms)

4. IMMEDIATE NEWBORN CARE
The steps to be undertaken at the time of birth for all babies (including those who
need resuscitation)are:
Call out the time of birth.
Deliver the baby onto a warm, clean and dry towel or cloth and keep on mother's
abdomen or chest (between the breasts).
Check the Airway, Breathing and Circulation.
Wipe both the eyes separately with sterile swab.

5. Clamp and cut the umbilical cord after 1 minute ,if baby breathing well.
Immediately dry the baby with a warm clean towel or piece of cloth.
Assess the baby's breathing while drying.
Leave the baby between the mother's breasts to start skin-to-skin care for at
least an hour.
Cover the baby's head with a cap. Cover the mother and baby with a warm cloth.
Place an identity label/band on the baby.
Encourage mother to initiate breastfeeding (within half an hour of birth).

6. BASIC NEEDS OF BABY AT BIRTH
The four basic needs of ALL babies at the time of birth (and for the first few weeks
of life) are:
Maintenance of temperature
Establishment of open airway and circulation
Identification of newborn
Vitamin K injection
Initiation of breastfeeding

7. Warmth
Immediate drying of infant with warm clean sheet and shifting baby under
radiant warmer.
Skin to skin contact
Cover neonate head
Rooming in
Establishment of open airway and circulation
Suctioning of baby’s mouth and nose
Wipe the mucus
Position the baby

8. Apgar scoring : total score = 10
No depression: 7-10
Mild depression: 4-6
Severe depression: 0-3

9. Newborn Identification
Identification bracelet with number on both baby and mother
Vitamin K Injection
Term infants (1mg) – IM
Preterm infants (0.5mg) – IM
Alternative route
Oral dose: 2 mg orally at birth
Repeat dose (2mg) at 3-5 days and 4 weeks of age.

10. Breastfeeding
Mother should be encourage to breastfeed the baby once the baby airway and
breathing is clear-within half and hour after delivery in NVD, and 1 and half hour
after delivery in C-section.

11. Daily routine care of newborn
The majority of complications of the normal new-born may occur during the first 24
hours or within 7 days. So, close observation is important for health and survival of
the new-born baby
The major goals:
Establish and maintain homeostasis
Stability of normal physiological status

12. The daily routine care of the neonates are as follows:
Warmth
Breastfeeding
Skin care and baby bath
Care of umbilical cord
Eye care
Clothing
Observation
Anthropometric measurement
Immunization
Follow up and advice

13. Harmful traditional practices which is
harmful to the baby
Use of unclean substance – cow dung, mud in umbilical cord.
Immediate bathing
Use of prelacteal feeds
Application of kajal on the newborn eyes
Instillation of oil drops into ears, eyes.
Use of pacifiers

14. NEWBORN RESUSCITATION
Newborn resuscitation revives or restores breathing and life from the state of
asphyxia. Only 9-10% babies require NBR.
Shortly after childbirth, significant physiological adaptation occurs in both the mother
and baby. Transition from fetal to neonatal life turns successful with complex
interaction between the following systems:
Respiratory system
Cardiovascular system
Thermoregulatory system
Immunologic system

15. Check the following during pre-preparation half an hour prior to delivery:
Masks of two sizes ‘0’ and ‘1’ must be available
Self-inflating resuscitation bag (Ambu bag)
Oxygen cylinder with an oxygen reservoir (if available) to increase oxygen supply
to the baby

16. Risk factors for breathing problems at birth
Anticipate that baby may have birth asphyxia or difficulty in breathing if these
risk factors are present:
Pre-term birth
Born after a long traumatic labour
Born to mothers who received sedation during the late stages of labour
Born to eclamptic mother
Born with tight loop of cord around the neck/IUGR babies
Mother had APH

17. Steps of Newborn Resuscitation (Manually)
Put the baby on mother’s abdomen immediately after birth in a prone position
with face to one side.
Assess breathing. If baby is not crying/breathing (with or without meconium),
immediately suction the mouth then the nose with a suction device.
Introduce tubing for suction up to 5 cms in mouth and 1-2 cm in nose. Be gentle
and careful to use suction only while withdrawing the tube.
Dry the baby, remove wet towel, wrap in another dry warm towel and see if baby
is breathing or not

18. If the baby starts breathing proceed for rest of the steps of ENBC
or
If the baby is not breathing, call for help, quickly clamp and cut the cord
and give the baby to the helper to proceed for NBR .
Place the baby under the ready radiant warmer and stand towards the
head of the baby, remove the towel covering the baby so that the chest is
exposed

19. NEWBORN RESUSCITATION BY PPV
Position the baby:
• Place the baby on its back
• Place a towel/a rolled cloth under the baby’s
shoulders to position head in the sniffing
position by slightly extending the neck
Clear airway:
• Suction the mouth first and then the two
nostrils one by one, using mucus extractor or
mechanical suction and tubing, 5 cms in mouth
and 1-2 cms in nose

20. Stimulate to breathe :
• Provide tactile stimulation by gently rubbing the
newborn’s back twice or by flicking/tapping the
soles of the feet.
Reposition:
• Reposition the shoulder roll as it would have
moved.
• Reposition the baby again by keeping the neck
and head in slight extended position

21. Check the following before beginning ventilation:
• Select a mask of appropriate size. It should cover the mouth, nose and tip of the
baby’s chin, but not the eyes
• Fit it to the self-inflating resuscitation bag (Ambu bag)
• Availability of Oxygen cylinder with an oxygen reservoir (if available) to increase
oxygen flow to the baby

22. Attach the mask of appropriate size to the Ambu bag and apply on the baby to start
bag and mask ventilation for 30 sec

23. Frequency of squeezing the bag:
During initial stages of resuscitation, ventilation must be given at a rate of 40–60
breaths per minute. To help maintain this rate, try saying to yourself:
• Squeeze------- Two-------Three------- Squeeze…
• If you squeeze the bag and release while you say, ‘Two, three,’ you will probably
find you are ventilating at a proper rate

24. Assess breathing again after 30 seconds of bag and mask ventilation
If baby is not breathing well-call for help, continue bag and mask ventilation, and
start oxygen @ of 5 litres/minute
Assess heart rate by feeling the umbilical cord pulse or listen to the heart beat
with a stethoscope for 6 seconds while you stop ventilation for this time.
If cord pulse is not felt, listen for heart beat over the chest with stethoscope and
count it for 6 sec X 10 to get the rate/min

25. CARDIOPULMONARY RESUSCITATION IN
NEWBORN
If the baby respiration rate does not increased to >60 bpm, then chest compression
or CPR can be given as the baby might have gone into cardiac arrest.

26. CPR STEPS
Call out for help
Remove all he dangerous items/objects around
Place the baby in prone position with head slightly tilted.
Place two fingers in the centre of the chest
Compress atleast 1/3 the depth of the chest i.e 1.5 inches

27. Perform 30 hard and fast compression
Your beat should be around 100 beats per minute

28. After 30 compressions, open the airway by tilting the head of the baby back and
lifting the chin.
Cover the nose and mouth with your mouth making a tight seal.
Deliver 2 breaths, each ventilation should last about 1 second.
Make sure the baby’s chest moves or recoil after ventilation, if not reposition the
head.
Breath should be given 3 – 5 seconds interval
For a single rescuer, the compression and ventilation is 30:2, for more rescuer it
should be 15:2.

30. Ensure what not to do during newborn
resuscitation
Routine aspiration (suction) of the baby’s stomach at birth
Postural drainage
Squeezing the chest to remove secretions from the airway
Routinely giving injection sodium bicarbonate to newborns
Rubbing vigorously or slapping the baby
Routine suctioning of the breathing or crying baby