The care of new born are those specific care given to a new born immediately after delivery. This care helps the child to immediately adapt to extra uterine life.
Care of New Born Baby
The components of this care include;
1. Clearing of Airways:
This involves establishment of respiration
- if the baby did not establish respiration or cry very well after birth the airway is cleared using mechanical mucous extractor or ambu suction.
- Wipe the child’s nose and mouth at the time of birth of the head.
- Hold the child’s head down to drain immediately after birth while gently compressing the throat towards mouth to milk out secretions.
- Place the baby with the head turns to one-side and the bed tilted to aid drainage of mucous.
2. Separate Mother From Child:
This involves cutting the umbilical cord.
- Clamp the cord in two places and cut between.
- Ensure the baby does not bleed to death.
3. Establish Respiration:
Sometimes after clearing the airway, respiration still does not occur spontaneously, in this case the child should be stimulated to cry
- Perform gentle rubbing of the child’s back
- Repeat suctioning of the nose with soft catheter.
- Do mouth to face respiration to prevent asphyxia neonatorum.
- If the condition is still bad perform other resuscitative measures.
4. Identification of the new born:
The baby should be identified for legal purposes.
- Show the baby to the mother to identify the sex.
- Attach an identification bracelet or band bearing the mother’s name and sex of the baby to the baby’s wrist or ankle.
5. Assessment of Baby’s Condition:
This involves the assessment and scoring of the baby’s characteristic features or activities known as APGAR scoring in accordance with the baby’s response to the following factors;
- Heart rate.
- Respiration effort.
- Muscle tone.
- Response to stimulus.
- Colour
A score of 0,1 or 2 is awarded to each of the above factors and assessment is done at first minute after birth and repeated after 5 minutes.
The overall score is 10.
A score between 7 and 10 is normal.
A score between 5 and 7 is mild asphyxia.
A score between 4 is severe asphyxia.
6. Establishment of Bonding:
Bonding is a term used to describe parent-child relationship. It is done in the following ways;
- Place the baby on the mother’s abdomen after birth.
- Allow the mother to touch the baby.
- Put the baby to breast to suck.
7. Provision of Warmth and Comfort:
This helps the baby to adapt to the new environment.
- Clean and wrap the baby immediately after delivery with a dry sterile towel and place the baby in a warm cloth to provide warmth and prevent chills.
- Place the well wrapped baby on the mothers abdomen or chest.
- Put baby in a warm baby cloth.
8. Maintenance of Hygiene:
One hour after birth, after allowing the baby to rest from stress of labour, the nurse tries to maintain the baby’s hygiene
- Clean the baby with oil to remove vernix caseosa.
- Re-ligate the cord with another cord clamp then trim off the excess to leave about 4-6cm long.
- Carry out thorough head to toe examination to exclude any congenital abnormalities.
- Bath baby and dress according to weather.
- Clean the cord with 70% methylated spirit.
- Transfer baby and mother to postnatal ward if their conditions are alright.
Read Also: Methods of Placenta Delivery
Admission and Reception in the Post Natal Ward:
Receive the baby into the post natal ward in an already made warm cloth.
Observation:
- Check temperature, apex beat and respiration every four hourly.
- Observe the colour, response to stimuli and rate of cry. High pitched cry denotes intracranial injury.
- Check intestinal obstruction.
- Record all observation.
Nutrition:
- Encourage and maintain exclusive breastfeeding.
- The baby should be fed 8-10 times daily and above as demand increase.
- Wind the baby(rub the back) after each feeding.
- During feeding observe the baby’s eagerness and reluctance to feed.
- During feeding observe suckling and swallowing reflex.
- Note the frequency at which the child demand for food.
- Abnormal feeding behaviour may signify cerebral damage, congenital abnormalities or illness.
Bowel and Bladder Care:
- Observe the bowel actions for frequency of stooling, abnormality of the gastro—intestinal tract and inborn errors of metabolism.
- Observe the frequency of urination and the characteristics of urine.
- Normally babies may pass urine and stool immediately after birth and after each food.
Care of the Cord:
- This should be cleaned daily with 70% methylated spirit with open method of dressing as many times as necessary a day.
- Continue the cleaning until the cord separates.
- Observe for signs of infection or bleeding.
- If bleeding occurs re-ligate and report infection to appropriate authority for treatment.
Daily Personal Hygiene:
- Bath the baby at least once daily, if the temperature is normal.
- If the weather is cold perform top and tail (clean baby with warm wet towel)
- Change the baby’s diapers when soiled and always make the baby comfortable.
Weighing:
- Weigh daily on alternate days.
- Record the degree of weight gain or loss.
- The baby looses weight on the first 2 days after birth.
Examination of New Born:
This is done within the first 24hours of birth, after the first 1 hour in order to allow the baby to rest from the strain of labour.
This involves head to toe examination to determine the maturity of the baby, detect or exclude any congenital abnormality and confirm patency of orifices.
Care and Advice Before Discharge:
When all is well with the baby and mother, they are discharged on the first or second day after birth.
- Give appropriate immunization at birth.
- If a baby girl perform ear piercing.
- If it is a baby boy tell them when to come for circumcision.
- Advice on the importance of child welfare.
- Give appointment for 6 weeks post natal examination.
- Fix time for home visit, to see how the mother is caring for the child.
Characteristics of a Normal New born Baby in the Care of New Born
- Weight 2700-3800g
- Has average height (crown heel length) of 50 cm
- Has occipital frontal circumference of 35cm
- Has some vernix caseosa on his body.
- Has many creases on the palm s of hands and sole of feet.
- The nails are fully formed and adhere to the tips of the fingers.
- The hairs are soft and silky.
- The eye lashes and brow are fully formed.
- The cartilage of the ear is well formed.
Neurological Reflexes to Look For In The Care of New Born
1. Moro Reflex:
This is a vestibular reflex which is the best known neonatal primitive reflex, elicited in response to sudden stimulus.
- Hold the baby in supine position at angle 45 degrees on the examination surface with the trunk and head supported below.
- Allow the head and shoulder to suddenly fall back.
- The baby responds by abduction and extension of hands with fingers fanned and sometimes accompanied by tremor.
- The reflex is symmetrical and it is present for the first 8 weeks of life.
If asymmetric moro response is seen, it may be an indicative for fracture of the humerus or clavicle or brachial plexus palsy.
The absence of moro reflex may be an indicator for brain damage or immaturity.
The persistence of the moro-reflex beyond the age of 8 month is a suggestive of mental retardation.
2. Rooting Reflex:
If you touch the side of the lip of the baby with your finger and move it away from the lip, the head and mouth will turn towards the finger. The mouth also opens in readiness to suck.
This reflex disappears about 3-4 months of age.
3. Sucking and Swallowing Reflex:
These are well developed in a normal baby and are coordinated with breathing.
The reflexes are elicited when a finger or a nipple is placed in the baby’s mouth.
This is essential for safe feeding and adequate nutrition.
4. Gag, Cough and Sneeze Reflex:
These protect the baby from airway obstruction
5. Blinking and Cornea Reflex:
This occur when the baby’s eyes are stimulated by sudden loud voice. These protect the eyes from trauma.
6. Palmar Grasp and Plantar Reflexes:
The palmar grasp is elicited by placing a finger or pencil in the palms of the baby’s hand, the baby grasp it firmly.
The plantar grasp is elicited by stroking the base of the tonus then the toes coil up
7. Automatic Walking and Stepping Reflexes:
When you support the baby in an upright position with his feet touching a flat surface, the baby stimulates walking if held with the tibia in contact with the edge of a table.
The baby will step up unto the table.
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