Newborn care
Risk factors for babies needing special care
Serious problems for these babies include
- Hypothermia (baby gets cold easily)
- Respiratory distress (difficulty or increased work of breathing)
- Hypoglycaemia (low blood glucose)
Normal observations for newborn baby
Immediate care after birth
Do first
- Leave baby skin-to-skin on mother’s chest/abdomen for as long as possible — encourage early breastfeeding
- If not skin-to-skin — wrap baby warmly AND put beanie on head — see Keeping baby warm after birth
Do not rush to weigh baby — wait until after first breastfeed
Feeding guidelines
- Do not breastfeed at this time and medical consult about other forms of nutrition if baby
- Is sick
- Less than 35 weeks gestation
- Is very small — less than 1.8kg
- Has respiratory distress or needing oxygen
- Needed 'full' ABC resuscitation at birth
- Mother HIV positive
- Encourage breastfeeding if
- More than 35 weeks gestation
- Normal RR
- Alert and active
Check
- Axillary Temp (under arm) every 15 minutes — never rectally
- Check tone, colour and response to stimulation
- Heart rate and O₂ sats
- Use pulse oximeter with infant probe — put on right hand or wrist — hands or feet may be too cold for good reading
- If no oximeter — check baby’s heart rate with stethoscope and watch baby's colour — look at mouth, lips, mucous membranes
- Record heart rate, RR, respiratory effort, O₂ sats, every 5 minutes for 30 minutes THEN every 15 minutes
- If any of signs of respiratory distress OR looks centrally cyanosed (mouth, lips, mucous membranes pale or blue) — apply oxygen
straight away — see Do — if respiratory distress
- BGL using heel-prick blood
- If BGL less than 2.6mmol/L — treat hypoglycaemia (low blood sugar) straight away — see Do — if hypoglycaemia
- If umbilicus bleeding — check clamp is on properly
Do
- Trim cord if necessary
- Clamp remaining cord with plastic cord clamp 4–5cm from abdomen — Figure 3.29
- Make sure it is snapped shut
- Remove metal cord clamp put on after birth
Trim cord 1–2cm above plastic clamp — Figure 3.29 or at length requested by mother or support person
Do — if respiratory distress (breathing problems)
- Give oxygen until target O₂ sats met — Table 3.6 if
- Working hard to breathe (using accessory muscles, nasal flaring)
- RR less than 35 or more than 60 breaths/min
- Apnoea (stops breathing for more than 15 seconds)
- If O₂ sats reaches target — gradually reduce amount of oxygen
- If O₂ sats falls below target — specialist consult
- If apnoea (breathing irregular with long pauses) — stimulate baby to breathe by rubbing gently — do not undress baby
- If this doesn't work or baby too weak or too tired to keep breathing — see Newborn resuscitation flowchart straight away
Do — if hypoglycaemia (low blood glucose) — BGL less than 2.6mmol/L
If at risk but well — safe to breastfeed — see Feeding guidelines
- Encourage baby to breastfeed or give hand expressed colostrum/breast milk
- Repeat BGL in 30 minutes
- If still less than 2.6mmol/L — medical consult
- Consider giving expressed breast milk or infant formula
- Consider glucose gel — 0.5ml/kg (15g glucose in 37.5g oral gel)
If unwell — not safe to breastfeed — see Feeding guidelines
- Do not breast or bottle-feed due to risk of aspiration
- Medical consult — doctor should talk to paediatrician
- If doctor not available within 30 minutes — clinic staff to contact paediatrician
- Put glucose gel on inside of cheek (buccal mucosa) — 0.5mL/kg (15g glucose in 37.5g oral gel)
- Repeat BGL in 30 minutes. If still less than 2.6mmol/L — medical consult again
- Continue giving glucose gel
- If BGL remains less than 1 or baby has fit — consider glucagon IM — 100–300microgram/kg
Ongoing care
- If mother positive for hepatitis B (HbsAg), hepatitis C or HIV and baby more than 32 weeks gestation — before giving injections, wash injection site with warm water, dry thoroughly (keep warm)
- Give vitamin K IM
- 1mg (0.1ml) for baby weighing 1.5kg or more
- 0.5mg (0.05ml) for baby weighing less than 1.5kg
- Give Hepatitis B immunisation birth dose
- Check baby has name bands on wrist and ankle
- If stable — measure weight, length and head circumference
- Record if baby passes urine or meconium
- If mother has history of substance misuse — watch for symptoms of withdrawal in baby
- Fill in birth registration forms
If mother and baby stay in community
- Encourage mother to breastfeed baby on demand
- Talk with Public Health Unit about BCG vaccination
- Talk with mother about care of umbilicus
- Clean with water and dry with towel or cloth
- Keep nappy away from cord until it separates
- If signs of infection or any problems — come to clinic straight away
Follow-up
- After 24 hours — see Postnatal care of baby
- Review baby daily for first week