Newborn care

       

Risk factors for babies needing special care

Table 3.4   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

Table 3.5   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

  • 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

Figure 3.29   

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

Table 3.6   Target oxygen saturations for newborn

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