After completion of this session the participant should be able to:
The vast majority of newborns require no intervention at birth other than routine normal care. If this is done well, it vastly reduces the likelihood of problems. Most newborn’s should be transferred to the post-natal wards for rooming-in with their mothers. These babies still need to be monitored because they are at continued risk of hypothermia and feeding difficulties during the first few days of life. These babies can also become sick and develop danger signs. The mother-infant pair needs counselling and appropriate treatment when required. Newborns born in health facilities should not be sent home in the crucial first 48 hours of life.
A postnatal room should be kept warm with no draughts from open doors or windows. A temperature of at least 25°C is required to help keep baby warm. A mother and her baby should be kept together from birth if possible. This helps the mother form an early close loving relationship (bonding), she can also respond quickly when her baby wants to feed, which helps establish breast feeding and reduces breast feeding difficulties (1).
Review the labour and birth record to identify risk factors or any events during the birth that may be important in the management of the mother and the baby.
Health care professionals should discuss a mother’s progress with breastfeeding within the first two days after delivery to assess if she is on course to breastfeeding effectively.
Term babies should pass meconium by 24 hours of birth. Passage after 24 hours is NOT NORMAL and needs evaluation by a clinician.
Urine should be passed by 48 hours. It is NOT NORMAL if not passed by 48 hours.
Babies who develop jaundice within the first 24 hours after birth should be evaluated
| Key facts for providers – Routine care of the term newborn | |
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Keep mother and baby together if possible Encourage unrestricted frequency and duration of breastfeeding Assess breastfeeding in terms of position and attachment Tetracycline Eye Ointment (TEO) should be administered to both eyes once after birth according to national guidelines Vitamin K should be administered to all newborns (1mg IM to term infants) |
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After ensuring the baby is dry and warm, and the eyes are clean, apply chlorhexidine (CHX) to the tip of the cord, the stump and around the base of the stump. (Apply CHX once within 24 hours after the birth, but preferably in the first 2 hrs.) A full examination of the newborn must be done on admission, at 24 hours and at discharge from the post-natal ward HIV and VDRL exposure status must be known and acted on if exposed BCG vaccine should be administered to all newborns Oral polio vaccine should be administered to all newborns |
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| Key facts for providers - How to examine the newborn |
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Do on day zero (on admission) to the post-natal ward, at 24 hours and at discharge
Head to toe |
The following signs should be assessed during each postnatal care contact, and the newborn should be referred for further evaluation if any of the following danger symptoms or signs are present:
| Key facts for providers and mothers/guardians - Danger symptoms or signs |
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At each post-natal contact, parents should be offered information and guidance to enable them to care for their baby.
Key facts for providers and mothers/guardians | |
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Warmth |
Appropriate clothing of the baby for ambient temperature is recommended. This means 1-2 layers of clothes more than adults, and use of hats/ caps |
Skin |
Babies are not bathed routinely in the hospital to prevent complications like hypothermia and infection, they may however be sponged with lukewarm water. |
Cord Care |
Chlorhexidine is applied once after birth. After this instruct the mothers not to apply anything to the cord but keep clean and dry |
Nappy rash |
Prevent with frequent nappy changes and cleansing and exposure of the perineal area in order to reduce babies’ contact with faeces and urine. Cleansing agents should not be added to bath water nor should lotions or medicated wipes be used. When required, the only cleansing agent that should be used is mild non-perfumed soap. Cloth nappies are preferred to plastic nappies. |
Thrush |
If thrush is identified in her baby, the breast feeding woman should be offered information and guidance about relevant hygiene practices. Symptomatic thrush (difficulty feeding) requires antifungal treatment. |
Jaundice |
Parents should be offered information about jaundice including: 50% of newborn and 80% of preterm have some jaundice. It may be normal or abnormal. Normal or physiological jaundice occurs around 3-4 days after birth. The mother of a breastfed baby who has signs of jaundice should be actively encouraged to breastfeed frequently, and the baby awakened to feed if necessary. Breastfed babies with jaundice should not be routinely supplemented with formula, water or dextrose water. Parents should be advised to contact the health care professional if their baby’s jaundice is worsening, or if their baby appears unwell in any way. If jaundice remains after 14 days in an otherwise healthy baby it should be evaluated. |
Weight Loss |
Weight loss of 10% in the first days of life is normal. Most term infants regain their birth weight by 10-14 days. |
Hygiene |
Advise mother to wash hands with soap and water after using the toilet and after cleaning the baby. |
| Danger signs | Remind mother about danger signs and care seeking. |
Correct planning of discharge from the hospital is very important for the newborn. Infants who are discharged from the hospital should return for follow-up care to the nearest health facility. Communicate with the health personnel who will be responsible for follow-up care by writing in the health passport.
Key facts for providers and mothers/guardians - Discharge
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