The time of birth is one of transition from

intrauterine life to an independent existence and

calls for many adjustments in the physiology of
the baby.

Normal infants are at low risk of developing

problems in the newborn period and, therefore,
require primary care only.

About 80% of all infants are normal

 Weighs more than 2500
grams
 Breathes normally and
regularly
 Has warm trunk and soles
(T= 36.5-37.4° c)
 Pink in color (no central
cyanosis)
 Spontaneous body
movements
 Actively sucks on breast
1. Preparations before delivery

2. Immediate care at birth

3. Care after birth

4. Essential postnatal care

 A clean place / room for delivery at home

 Must be well lighted and ventilated area

 Linen which has been washed and sun-dried

 Clean and boiled water readily available

 Ensure that a DDK (disposable delivery kit) is

available for use at the time of delivery

 A new clean blade/boiled at home Instrument to

cut the cord
 Ensurethat a clean sheet is spread
on the floor

 Roomis kept warm and free of

draught

A trained health personnel should be

contacted before delivery

 Follow the “five cleans” to prevent

infection in the newborn
‘Five cleans’ to prevent infection

NC- Teaching Aids: NNF 7

 Well-lighted,
well-ventilated and warm
delivery room without draughts

 Care
area meant for the baby in the delivery
room should have

(a) Warming device

(b) Clean sterile linen

(c) Cord clamps, cord cutting
instruments, cord tying material, cotton
swabs, gauze pieces.

(d) Oxygen supply, suction device,

resuscitation equipments, laryngoscope,
tape, scissors etc. must be checked well
in advance , ready to use during
emergency situations.
(e) Weighing scales, measuring tapes,
identification tags, clinical
thermometer

(f) A tray of medication may include

spirit, distilled water / normal saline
for cleaning eyes, tetracycline or
erythromycin ointment (based on the
policy of the institution), Vitamin K
and medication needed during
resuscitation
Establishment of respiration

Prevention of hypothermia

Establishment of breastfeeding

Prevention of infection

Identification of at risk newborn

1. Call out the time of birth:

 Important to tell loudly the time of birth &

sex of the baby

 Helps in accurate recording of the time

 Alerts
other personnel in case any help is
needed.
2. Receive the baby onto a warm, clean and
dry towel or cloth on a warm dry surface

 The baby should be delivered onto a warm

and clean towel and kept on the mother's
chest.

 Ifthis is not possible, the baby should be

kept in a clean, warm, safe place close to
the mother.
3. Clamp and cut the umbilical cord

 Theumbilical cord should be clamped after 1 to 3

minutes

 using a sterile, disposable clamp or a sterile tie

 cut using a sterile blade/instrument about 2 cm
(1-inch) away from the skin.
Immediate care of the umbilical cord :Steps:

1. Put the baby on mother’s abdomen or on a

warm, clean and dry surface close to the mother.
2. Put ties tightly around cord at 2 cm and 5 cm
from the abdomen.
3. Cut between the ties with a sterile instrument
4. Observe for oozing blood. If blood oozes, place a
second tie between the skin and first tie.
5. DO NOT APPLY ANY SUBSTANCE TO THE STUMP.
6. DO NOT bind or bandage stump.
7. Leave stump uncovered.
4. Immediately dry the baby with a warm clean
towel or piece of cloth; wipe the eyes.
 The baby should be thoroughly dried to prevent from
getting cold

 Blood or meconium on the baby's skin should be

wiped away

 Vernix (white greasy substance covering the baby's

body) should not be wiped off.

 Vernix helps to protect the baby's skin and gets

reabsorbed very quickly.

 Remove wet linen

•Stimulates the newborn to breathe normally

•Minimizes heat loss

5. Assess the baby’s breathing while drying.

 At the time of drying itself, the baby's

breathing should be assessed.

A normal newborn should be crying vigorously

or breathing regularly at a rate of 40-60 breaths
per minute.

 Ifthe baby is not breathing well, then the steps

of resuscitation have to be carried out
6.Wipe both the eyes

Clean the eyes using sterile

gauze/cotton.

Use separate gauze for each eye.

 Wipe from the medial side (inner

canthus) to the lateral side (outer
canthus).
7. Leave the baby between
the mother’s breasts to
start skin-to-skin care
 Once the cord is cut, the
baby should be placed
between the mother’s
breasts to initiate skin-to-
skin care.

 Helpsin maintaining the

normal temperature & in
promoting early
breastfeeding.
8. Place an identity
label on the baby
 Easy identification
of the baby,
avoiding any
confusion

The label should be

placed on the wrist
or ankle
9. Cover the baby’s head with a
cap & the mother and baby
with a warm cloth.

 Especially if the delivery room

is cold (temperature less than
25 C).

 Since head is the major

contributor to the surface area
of the body, a newborn baby’s
head should be covered with a
cap to prevent loss of heat.
10. Encourage the initiation of
breastfeeding

Breastfeeding should be initiated

with in half an hour of birth in all
babies
11. Quick screening/ Examination
Clinical screening is essential to
identify any life threatening
congenital anomalies or birth injuries.
Single umbilical artery
 Simian crease
 Dysmorphic features
 Asymmetric cry
Excessive drooling of saliva
Patency of orifices (esophagus, anal
opening
1.Warmth
2. Breast feeding
3. Skin care and baby Bath
4. Cord care
5. Care of the eyes.
6. Protection from infection.
7. Vitamin K
8. Observation.
9. Weight recording
10. Immunization
11. Follow up and advice.
 Larger surface area

 Decreased thermal insulation due

to lack of subcutaneous fat

 Reduced amount of brown fat

Nurse the baby in thermo-neutral
environment

The baby should be warm to touch

and soles should be pink
1. At delivery:
 Ensure the delivery room is warm (25° C), no
draughts.
 Dry the baby immediately; remove the wet cloth.
 Wrap the baby with clean dry cloth.
 Keep the baby close to the mother (skin-to-skin)
 Avoid bath . Postpone sponging 24 hours.

2. After delivery:
 Keep the baby clothed and wrapped, head covered.
 Minimize bathing especially in cool weather or for
small babies.
 Keep the baby close to the mother.
 Use kangaroo care
Should be initiated within half an
hour after delivery.

Colostrum feeding should be given.

 Baby should be kept between the mother's
breasts; to ensure early initiation of
breastfeeding.
 Initially, the baby might want to rest and
would be asleep. Rest period may vary from
a few minutes to 30 or 40 minutes
 Check Signs of readiness for feeding
 The baby should be put next to the mother's
breast with mouth opposite the nipple and
areola.
 Baby should attach to the breast by itself
when it is ready.
 Check attachment and positioning
 Once the newborn
shows feeding cues
(e.g. opening of
mouth, tonguing,
licking, rooting),
make verbal
suggestions to the
mother to encourage
her newborn to
move toward the
breast e.g. nudging.
 Check attachment and
positioning when the
baby is feeding
 Let the baby feed for
as long as he wants on
both breasts
 Keep the mother and
baby together for as
long as possible after
delivery
 Delay tasks such as
weighing, etc. until
after the first feed
Practice of nursing babies with their mothers
rather than keeping them in a separate
nursery.
Advantages:
Promotes bonding
Makes exclusive breastfeeding easy
Reduces risk of nosocomial infections
Mother is able to keep a close watch on her
infant.
 Cleanthe baby off blood, mucus and meconium
before presenting to the mother

 Bathing
of babies soon after birth is not
recommended

 Nodip bath until the cord has fallen and the

weight is 2.4 kg.
 Specialattention should be paid to cleaning of
the scalp, skin creases (neck, axillae, groins)
and the diaper area.

 Vigorousattempts should not be made to scrub

off the vernix caseosa which provides a
protective covering to the delicate skin

 Look for superficial infections like pyoderma,

umbilical sepsis, conjunctivitis or oral thrush,
etc. and bring them to the notice of the
physician.
 Umbilical cord is an important portal of entry for
Clostridium tetani.
 Must be inspected after 2 to 4 hours of ligation.
 Bleeding may occur due to shrinkage of cord and
loosening of the ligature.
 Nothing should be applied on the cord.
 Cord must be left open without any dressing.
 Usually falls after 5 to 10 days, may take longer if
it has been kept moist or gets infected
 Inspect for any discharge or infection
 keep clean & dry till complete healing takes
place.
Eyes are cleaned at birth and once
every day using sterile cotton swabs
soaked in sterile water or NS

Separate swab for each eye

Clean from medial to lateral side

Prophylactic eye drops within 1 hour of

birth as per hospital policy
Applicationof kajal or anything else in
the eyes must be avoided

Observe for redness, sticky discharge

Areas with a high incidence of STD such

as gonorrhea, eye drops or ointment
should also be instilled (as per local
guidelines) within one hour of delivery
of the placenta.
 Sepsis is the most important cause of neonatal
death in hospital.
 Normally the newborn is free from harmful
organisms for initial few hours after birth.
 Staff working in health facilities tend to
transmit organisms during routine procedures,
thus leading to colonization of organisms on
surrounding skin of the abdomen, the perineum,
groins and respiratory tract.
 Single MOST IMPORTANT
means of preventing
nosocomial infections.
 VERY SIMPLE and CHEAP.
Hand washing norm
 2 MINUTES, hand washing
(6 steps) to be done
before entering the unit.
 20 seconds hand washing
to be done before and
after touching babies.
Rinsinghands with alcohol is NOT A
SUBSTITUTE for proper hand washing

 No infected person should touch the baby.

 Wet nappies should be changed immediately.

 During the first hour after delivery, the baby
(and the mother) should be monitored every
15 minutes.

 The two most important parameters that need

to be monitored are:

i) Breathing
ii) Temperature or warmth
Check and
record birth
weight

Measurements
Vitamin K 1.0 mg is administered
intramuscularly to all babies
weighing more than 1000 gms

 0.5 mg to babies weighing less than

1,000 gms at birth.
 Well baby clinic
 Assess growth & development
 Early diagnosis and management of
illness
 Health education
 Exclusive breastfeeding for 6 months
 Complementary feeds after 6 months
 Spacing of family
 Follow up visits should be made to
coincide with immunization schedule
Not routinely recommended for all neonates
1. Routine suctioning
2. Early bathing/washing
3. Giving sugar water, formula or other
prelacteals and use of bottles and pacifiers
4. Application of alcohol, medicines and other
susbstances on the cord stump and bandaging
the cord stump or abdomen
 Keep the umbilical stump clean
and dry
 Do not apply anything on the
cord stump
Protect the baby from cold\heat BY
clothing according to climate.
Exclusive breastfeeding till 6
months
Feed the baby on demand day and
night
Do not apply anything in the eyes
 Early identification of disease
(Danger signs)

The infant should be closely watched for

following danger signs which should be
brought to the attention
 Lethargy
 Hypothermia  Bleeding
 Respiratory distress  Yellow palms/ sole
 Abdomen distension  Excessive wt loss
 Failure to pass  Vomiting
meconeum within 24 hrs  Diarrhea
 urine within 48 hrs  Poor feeding
 superficial infections  Drooling of saliva
 conjunctivitis
 Choking during
 pustules,
feeding
 umbilical sepsis or
 Apneic attacks
 oral thrush.
 Cyanosis
 Convulsions