BASIC NEEDS OF A BABY AT BIRTH

• I. Ensuring Warmth
• ii. Establishing Normal breathing
• iii. Mother's milk
• iv. Prevention of infection
WARMTH
AT DELIVERY
• Ensure the delivery room is warm (25° C).
• Dry the baby immediately
• Cover the baby with clean dry cloth
• Keep the baby in skin to skin contact with mother on chest or
abdomen
• Postpone bathing/sponging
• AFTER DELIVERY
• Keep the baby clothed and wrapped with the head covered
• Avoid bathing
• Keep the baby close to the mother
• Use kangaroo care for stable LBW babies
• Show the mother how to avoid hypothermia, how to recognize it, and
how to re-warm a cold baby.
PREVENTION OF INFECTION
‘CLEAN CHAIN’
1. Clean delivery (WHO’s six cleans)
• Clean attendant's hands (washed with soap)
• Clean delivery surface
• Clean cord- cutting instrument
• Clean string to tie cord / cord clamp
• Clean cloth to cover the baby
• Clean cloth to cover the mother
2. After delivery
• All caregivers should wash hands before handling the baby
• Feed only breast milk
• Keep the cord clean and dry; do not apply anything
• Use a clean absorbent cloth as a diaper/napkin
• Wash your hands after changing diaper/napkin.
• Keep the baby clothed and wrapped with the head covered
IMMEDIATE CARE OF THE NORMAL
NEWBORN AT BIRTH
1. Call out the time of birth.
2. Deliver the baby onto a warm, clean and dry towel or cloth and keep
on mother's abdomen or chest (between the breasts).
3. Wipe both the eyes separately with sterile swab/cotton
4. Clamp and cut the umbilical cord after 1 minute ,if baby breathing
well.
5. Immediately dry the baby with a warm clean towel or piece of cloth.
6. Assess the baby's breathing while drying.*
7. Leave the baby between the mother's breasts to start skin-to-skin care
for at least an hour.
8. Cover the baby's head with a cap. Cover the mother and baby with a
warm cloth.
9. Place an identity label/band on the baby.
10. Encourage mother to initiate breastfeeding (within half an hour of
birth).
 MONITORING THE BABY IN THE FIRST HOUR
FOLLOWING DELLIVERY
• Breathing
• Temperature
• Colour
What to look for?
• Breathing- Listen for grunting; Look for chest in-drawing and fast
breathing
• Warmth- Check to see if baby's feet are cold to touch
• Color- Evaluate the color of the trunk and extremities
 CARE OF BABY IN SPECIAL
SITUATIONS

Caesarean section, instrumental delivery

• Skin-to-skin contact and breastfeeding in difficult deliveries
• Breastfeeding can begin as soon as the mother is comfortable and able to
respond to her baby.
• It does not have to be delayed
• A mother who was given a general anesthetic agent should begin skin-to-
skin contact as soon as she is able to respond to her baby.
• This may be initiated within one hour of birth
• A mother who has had an epidural (spinal) anesthesia may be able to
start skin-to skin contact very soon after surgery
• These mothers will need additional assistance in positioning and
attaching the baby comfortably.
• Breastfeeding in lying down position may be more comfortable in the
first days
HIV and newborn care at birth

1.Standard safety precautions must be followed as with any other delivery.

2. Baby can have immediate skin-to-skin contact as any other mother and
baby.
3. Exclusive breast feeding is the recommended feeding choice in their first
6 months, irrespective of the fact that the mother is on ART early (or)
infant is provided with prophylaxis for 6 weeks.
4. If mother chooses replacement feeding, prepare formula for the first few
feeds. Ensure it is safe ,affordable and sustainable for family.
5. All other care (including cord care and eye care) remains the same.
6. Give oral nevirapine for six weeks to the neonate as per national policy
CARE AFTER BIRTH
The postnatal environment
• Ensure that the room is warm with air currents
• Keep mother and baby close together in same room and same bed
• Provide bed nets to sleep
Breastfeeding

• Support exclusive breastfeeding day and night.

• Ask the mother if there is a breastfeeding difficulty.
• If the mother reports a breastfeeding difficulty, assess breastfeeding
and help her with attachment and positioning.
CORD CARE
• Wash hands before and after cord care.
• Put NOTHING on the stump.
• Fold nappy (diaper) below the level of the stump.
• If stump is soiled, clean and dry it thoroughly
• Look for signs of infection (daily) - Pus discharge from the cord stump
- Redness around the cord especially if there is swelling - High
temperature (more than 37.5°C) or other signs of infection
• Explain to the mother that she should seek care if the umbilicus is red
or draining pus or blood
HYGIENE
• Wash the buttocks when soiled. Dry thoroughly.
• Use cloth diaper on baby's bottom to collect stool. Dispose off the
stool. Wash hands after disposing.
• Do not apply ‘ Kajal’ on eyes
DANGER SIGNS
• Not feeding well
• No movement
• Fast breathing (more than 60 breaths per minute)
• Moderate or severe chest in-drawing
• Jaundice on day 1 or palms or sole stained yellow any age
• Abnormal movements
• Fever (temperature >37.5°C)
Preparing for discharge
• Ensure immunization
• Check if the baby is fit for discharge
1. Feeding well (suckling effectively) at least 8 times in 24 hours
2. No danger signs
3. Mother is confident to take care of baby
4. Understands the need for follow up and danger signs when to report
early
5. For small baby below 2500gms: feeding well and gaining weight
adequately
BREAST FEEDING
• Feeding of babies and young children with breast milk
• It should be commenced immediately after birth
TYPES OF BREAST MILK
1. Colostrum
• It is secreted during the first three days following the delivery
• It is thick, yellow and small in quantity
• It contains more amount of protein, antibodies and fat soluble
vitamins
2. transitional milk
• It follows colostrum and secrets during first two weeks of postnatal
period
• It has increased fat and sugar
3. Mature milk
• It is secreted usually from 10 to 12 days following delivery
• It is watery but contains all the nutrients for the optimal growth of the
baby
4. Foremilk
• It is secreted at the start of regular feeding
• It is more watery and contains proteins, sugar, vitamins and minerals
5. Hind milk
• It is secreted towards the end of regular feeding contains more fat and
energy
Adequacy of breast feeding
• Audible swallowing
• Let down sensation in mothers breast
• Wide open mouth with complete areola in
• Baby sleeps well and does not cry frequently
• Good weight gain
ADVANTAGES
• Lower the risk of respiratory tract infections and diarrhoea
• Lower the risk of asthma, allergies etc..
• Improves cognitive development
• Prevents obesity
• Helps in uterine shrinkage, weight loss, reduce post partum depression
• It delays return of menstruation
• Prevents ca breast, CVD, rheumatoid arthritis
Feeding of low birth weight (LBW) and sick newborns

• Inability to suck effectively

• Inability to co-ordinate sucking and swallowing

 METHODS OF FEEDING
WEIGHT GESTATIONAL WEEKS PREFFERED FEEDING
<1200 <28 Iv fluids initially then initiate
OG feeds
1201-1500 28-34 Most babies accept paladai or
spoon feeding some might
require OG
1501-2500 34-37 Most babies would accept
breastfeeding while some
might need paladai feeds.

>2500 >37 breastfeed as normal birth

weight babies but with
monitoring
Paladai feeding
• The infant should be awake and held sitting semi-upright on the
caregiver's lap, and wrapped to provide support and to keep the arms
out of the way
• Put a measured amount of milk in the paladai
• Hold the paladai so that the pointed tip rests lightly on the infant's
lower lip
• Tilt the paladai to pour a small amount of milk into the infant's mouth
• Feed the infant slowly
• Make sure that the infant has swallowed the milk already taken before
giving any more

• When the infant has had enough, he or she will close his or her mouth
and will not take any more. Do not force-feed the infant

• To estimate the amount of milk taken, subtract the milk left in the cup
from the original amount. Also subtract the estimated spillage, if any

• Wash the spoon /paladai with soap and water .Then put in boiling
water for 20 minutes to sterilize before next use
OROGASTRIC TUBE FEEDING
OLDER CHILDREN
1. Tip of nose to bottom of ear lobe to xiphisternum
2. Bridge of nose to ear lobe to mid point between xiphisternum and
umbilicus
NEONATE
3. tip of nose to ear lobe to mid point between xiphisternum and umbillicus
4. Bridge of nose to ear lobe to mid point between xiphisternum and
umbillicus
5. Angle of mouth to tragus the to mid point between xiphisternum and
umbillicus
 CARE OF AT-RISK AND SICK NEONATES
At risk newborn Sick newborn
Weight 1500-2499g
Weight <1500g

Babies with moderate or severe Temperature<36 despite warming for 1

hypothermia and responding to warming hour

Cried late (>1min) but within 5 minutes of Cried after 5 minutes of birth
birth
Sucking poor, but not absent
Absent sucking

Depressed sensorium, but is arousable Not arousable

Respiratory rate over 60 per minute, but no Respiratory rate >60 with chest
chest retractions retraction
Jaundice present, but no staining of palms/soles Jaundice on palms and soles

Presence of any one of the following: - Diarrhea or vomiting

Presence of two of the following
or abdominal distension
Umbilicus draining pus or pustules on skin Diarrhea or vomiting or abdominal distention
Fever
Umbilicus draining pus
Multiple skin pustule
fever

Central cyanosis
Apnea or gasping
Convulsion
Bleeding
Major malformations
What care the provided to the baby at the
health facility
• Warmth

• Stabilization

• Feeds

• Specific therapy

• Monitoring

• Reevaluation

• communication
Specific therappy

• Doctor will order for the first dose of antibiotics:

• Inj. Ampicillin 50 mg/kg IV stat, Inj. Gentamicin 2.5 mg/kg IV stat

• Vitamin K and anticonvulsants, if indicated Oxygen may be started in

a baby with respiratory distress or central cyanosis.
Monitoring

• Temperature
• Convulsion
• Sucking
• Bleeding
• Sensorium
• Diarrhea
• Respiration
• Vomiting
• Apnea
• Abdominal distension
• Cyanosis
• Capillary refill time
Communication

• Explain condition of the baby, reassure parents

• Explain need for referral, if doctor feels that baby cannot be managed

• Explain care during transport Doctor will write a precise note.

• Organize transport
IF BABY IS NOT BREATHING/CRYING
1. Cut the cord immediately and place the baby under radiant warmer
2. Provide initial steps
a. Dry
b. Position
c. Clear airway as necessary (it may involve suctioning the trachea to
remove meconium)
d. Tactile stimulus to stimulate the baby to breathe, reposition the head to
maintain an open airway.
e. Evaluate respiration and heart rate of the baby after 30 seconds of initial
steps.
• The initial steps of resuscitation are discussed below:

• Dry the baby thoroughly under the radiant warmer and remove wet linen.

• Place the baby on its back

• Position the head so that it is slightly extended (to open the airway)

• Place a folded piece of cloth under the baby's shoulders to help maintain
this position (the folded cloth should not be too thick or thin-this may
cause over extension or flexion which will close the airway)

• Suction first the mouth and than the nose(Remember 'M' comes before 'N’)
• After inserting a laryngoscope, use a 12 F or 14 F suction catheter to clear the
mouth and posterior pharynx so that glottis can be visualized Insert an
endotracheal tube into the trachea and attach a suction source to the
endotracheal tube through a special aspirator device.
• Apply suction for several seconds when the tube is in trachea and continue
suction while withdrawing
• In case bradycardia is encountered the resuscitation should take priority over
suction of trachea
• The safe and appropriate methods of providing tactile stimulation are: Gently
flicking or slapping the soles
• Gently rubbing the back, trunk and the extremities of the baby
• Any form of stimulation will initiate breathing, if baby is in primary apnoea.
• Therefore 1 or 2 flicks or slaps to the sole or gently rubbing the back once or
twice is sufficient.
• Evaluate respiration and heart rate of the baby after 30 seconds of
initial steps
• al steps What to do if the heart rate or respiration is abnormal
• Free-flow Oxygen
• IF THE BABY IS NOT BREATHING: PROIVDE POSITIVE PRESSURE
VENTILATION
• ASSEMBLING EQUIPMENT
• TESTING EQUIPMENT
• HOW TO VENTILATE THE BABY
1. Re-check the baby's position.
2. Reposition the baby so that the neck is slightly extended.
3. Put the folded piece of cloth under the baby's shoulders at this time.
4. Place the correct sized mask on the baby's face so that it covers the baby's
chin, mouth and the nose.
5. Hold the mask in place gently but firmly.
6. Keep the head in position.
7. Squeeze the bag attached to the mask with the thumb and two fingers so as
to cause adequate chest rise.
8. Squeeze and release the bag two or three times.
9. Watch the baby's chest as the bag is squeezed. Does it rise as the bag is
squeezed?
10. If the baby's chest is rising, the ventilation pressure is probably
adequate.
11. If the baby's chest is NOT rising, there can be one of the problems
given below, do the following steps
Use oxygen if available (preferabely through air oxygen blender),if not use room air.
13. Ventilate at a rate of 40 breaths per minute. Squeeze the bag(ventilate) at 40 times a minute until the baby
starts crying or breathing. Provide uninterrupted effective ventilation for 30 seconds and assess for spontaneous
breathing and heart rate. If spontaneous breathing present and heart rate is 100 or more, then gradually
discontinue
Effective ventilation will promote increase in heart rate and spontaneous breathing, improvement in color and
muscle tone. Count out loud. SQUEEZE-count a loud' one hundred and one, SQUEEZE one hundred and two,
SQUEEZE one hundred and three, SQUEEZE……..'and continue until you reach 'One hundred and twenty'(i.e. For 30
seconds).
14. After 30 seconds of bag and mask ventilation, reassess respiratory efforts, heart rate every 30 seconds (oxygen
saturation may be monitored continuously if available) and look for the following signs of improvement: i. Is the
baby crying?-If yes, STOP ventilation ii. Is the baby breathing regularly at >30 breaths per minute?- If yes, STOP
ventilation iii. Does the baby have 'in-drawing' of the chest wall(skin between the ribs' sucked' in wards making the
ribs very prominent)?- If NO, then STOP ventilation (chest indrawing indicates that the baby is still having difficulty
in breathing and hence need support for breathing), can continue with CPAP or free flow of oxygen. The other signs
of improvement are improving color and muscle tone.
15. What is to be done if there is no improvement after 30 seconds? i. If facilities/manpower are available: reassess
after every 30 seconds until the baby is breathing spontaneously. In the mean time, shout for help and also arrange
for referral to a higher centre. ii. If PPV is prolonged over several minutes place an oro-gastric tube to prevent
distention of stomach with air which may interfere with ventilation iii.During transport, ensure that the baby's
temperature is maintained and breathing is supported by bag and mask ventilation (with or without oxygen). iv.
The procedure of bag and mask ventilation should be continued until the baby establishes spontaneous breathing;
however, if there are no signs of life(breathing/heartrate) even after 20 minutes of birth, ventilation may be
stopped.