Care of the newborn

Being a parent first time : Taking baby home
Your excitement knows no bound that finally you will be with your baby at home .Your new life as parent has begin and you are not aware how to make arrangements for it ,coz you always want to be the best .

These are some tips which will help you guide through this journey
Getting assistance after birth
Post delivery the time is very hectic . When you are in the hospital ,collect all informations regarding lactation and feeding and newborn care . In the hospital only start brest feeding/bottle feeding . Learn how to hold , burp, change and care for the new addition .

Try to get a home help in the form of baby nurse or any friendly help.
Many time you wont agree to what the friends are saying .Dont dismiss it .Try to confirm with your doctor . If you don’t want much visitors and guests don’t feel guilty in saying no to them . Your baby is more valuable than any other thing in this life .

Taking care of your newborn: Few tips

  • Make sure that the baby is not handled by too many people.
  • Wash your hands and tell other caregivers also to wash there hands whenever they handle the baby as the baby doesn’t have a strong immune system.
  • Always support your baby’s head and neck. Cradle the head when carrying your baby and support the head when carrying the baby upright or when you lay your baby down.
  • Never shake your newborn baby whatever be the circumstance. Shaking vigorously causes bleeding in the brain and even death.Wake up the baby cutely by tickling your baby’s feet or blow gently on a cheek.
  • Make sure your baby is securely fastened into the carrier, stroller, or car seat. Limit any activity that could be too rough or bouncy.
  • Remember that your newborn needs to be handled very softly not roughly.

BABY BATH AT HOME
Sponge bath is done until:

  • The umbilical cord dries & falls off (1-4 weeks)
  • the circumcision heals (1-2 weeks)

Check list before bathing your baby:

  1. a soft, clean washcloth
  2. Baby soap and shampoo (mild & unscented)
  3. towels or blankets
  4. a clean diaper
  5. clean clothes
  6. clean water
  7. clean bath tub

Sponge baths.
Sponge bath is done in a safe flat surface (e.g. a table , counter or floor) in a warm room. Fill bowl /sink with lukewarm water . The baby is undressed and wrapped in a towel. Infants eyes is washed separately with a damp cloth .(or a clean cotton ball) dampened with water only, starting with one eye and wiping from the inner corner to the outer corner. The other eye is washed with another wash cloth . After wetting the cloth and with the help of little soap the face is washed and dried.

Gently wash the babys head by the lather created by a shampoo and subsequently rinse it . Using a wet cloth and soap, gently wash the rest of the baby, paying special attention to creases under the arms, behind the ears, around the neck, and in the genital area. Once you have washed the area ,dry all the body parts and then only make the baby wear the diaper .
Tub baths.

Tub bath is very exciting for the baby . the baby loves playing in the tub but you have to be cautious to make this experience playful and safe . If the baby doesn’t immediately acclimatize to tub bath then make it short and gente and shift to sponge bath in between
In addition to the above list other requirements are :
An infant tub is made up of plastic which fits in the bath tub .
an infant tub with 2 to 3 inches of  lukewarm water (always test the water temperature by feeling it with the inside of your elbow or wrist).  Undress the baby in a warm room . Support the head of your baby with hand and help the baby to get in the water with feet first .

The water in the tub should not be more than 2 to 3 inches deep, and that the water is no longer running in the tub. Speaking to the baby gently, slowly lower your baby up to the chest into the tub. Use a washcloth to wash his or her face and hair. Gently massage your baby’s scalp with the pads of your fingers. When you rinse the soap or shampoo from your baby’s head, cup your hand across the forehead so the suds run toward the sides and soap doesn’t get into the eyes. Gently wash the rest of your baby’s body with water and a small amount of soap.

Throughout the bath, regularly pour water gently over your baby’s body so he or she doesn’t get cold. After the bath, wrap your baby in a towel immediately, making sure to cover his or her head. Baby towels with hoods are great for keeping a freshly washed baby warm.
While bathing your infant, never leave the baby alone. If you need to leave the bathroom, wrap the baby in a towel and take him or her with you.

Neonatal umbilical cord care at home
The mothers should know that umbilical cord stump has to be left dry  and NOTHING IS TO BE APPLIED  on the stump. The diaper should never cover it and it has to be covered by loose cloth or left open . If by any reason it gets soiled then it has to be cleaned with soap and water and dried by a clean dry cloth.

Mothers should check for signs of infection like discharge from the umbiical cord and redness and report to the doctor if they see any changes in it.

Newborn care at home : Ways to ascertain feeding adequacy and weight gain
Babies who are fed adequately are playful ,active and they are satisfied for at least two to three hours post feed . Thy tend to have a sound sleep . Babies tend to pass urine (and stool ) immediately after a feed during the first three months of there life , later on they pass urine 5-6 times in a day .

5 to 7 percent of birth weight is lost during the first 2 to 3 days of life. During the next one to two days  the weight is stationary and later on birth weight is regained by end of first week. You should not monitor birth weight in a neonate in the very early years as it causes unnecessary anxiety and may lead to lactation failure in the mother.

During the first three months normally a baby gains 800 gms per month .The average daily weight gain in term babies is around 30 g, 20g and 10g during the first, second and third, 4-month periods respectively during the first year of life.

TEMPERATURE CONTROL IN NORMAL NEWBORNS
The key to everyday temperature control of the newborn is ensuring warm atmosphere for the baby .All mothers should be explained to keep there baby warm by dressing / wrapping the baby in a dry clean cloth  and cover the head ,feet ,palm with caps, socks,gloves respectively.

The temperature of the baby is monitored by touching the feet of the baby time to time . If the feet  is very cold then the baby needs to be covered and kept in skin to skin contact . If still the temperature is not maintained in one hour then she should see a doctor immediatey.

Mother should ensure that the room is warm in which the baby is residing ; the baby is dressed or wrapped properly (i.e. one more layer than older children/adults);and the baby is sleeping in the same bed as mother at night .
Details about temperature control are discussed in the heading named ‘Thermal protection in neonates’.

Causes of nappy rash?
The main cause of nappy rash is wetness and dampness in the nappy area .
Due to increased frequency of passage of urine and stool by thebaby this area is continuously wet and leaves a lot of moisture  even if you are using a highly absorbent nappy.

The babys skin is very delicate and this moisture irritates the skin . You need to frequently change the nappy . The baby should not be left in a soiled nappy for long. Babies with very sensitive also tend to have frequent nappy rashes .
How to treat nappy rash ?
The rash should subside within three or four days if you follow these simple ways . It’s unlikely to bother you and your baby much.

  1. Always change the nappy frequently and keep the baby clean and dry by not leaving her in a dirty nappy .
  2. Always use fragrance-free and alcohol-free baby wipes (check the label) or a mild, moisturizing  soap. If nothing is available rinse the bottom with plain water and pat it dry .
  3. Try to give the baby long hours of nappy free time , it allows the air to circulate and it aids in healing .Make the baby lie on a clean towel in a warm room. If your baby is old enough to move around, put her down in a room with an easy-to-clean floor.
  4. Take a small amount of coconut oil , barrier cream or ointment before applying a clean nappy This acts as a  protective layer between  baby’s skin and any moisture.

NEWBORN HYGIENE:
Everyday care: Hygiene
Health professionals, mothers, care givers and families should get rid of harmful traditional practices and follow appropriate guidelines.
The baby needs to be kept clean ,whether the baby be bathed daily or not .However, the face, neck, and underarms should be wiped daily. The gluteal region should be wiped whenever it gets soiled.
If the baby is being bathed, make sure that the room is warm; only lukewarm water is used to bathe; and the baby is thoroughly dried and covered with warm clothes immediately after bath. It is important to take additional precautions in case of small babies.
Mothers should be strongly discouraged against applying anything in their babies’ eyes or ears .Whenever you have any questions it is best to ask your health care provider.

Postnatal environment

The postnatal room should have a temperature of  at least 250 C which is required to help keep the baby warm. A radiant heater or warmer or any other device for providing warmth is often needed to maintain the appropriate room temperature particularly in winter months.

A baby and her mother should be kept together since the time of birth to increase the bonding between the mother and child .. This helps in lactation and more skin to skin contact .

Danger signs IN NEWBORNS
It is very much important for the  mothers, care givers and health workers to know about the  (‘DANGER SIGNS’) in a newborn. Early recognition of these signs will help in identifying those babies who need urgent care and treatment and reducing the neonatal mortality rate .

The important danger signs are given below:

  1. Not feeding well
  2. Less active than before
  3. Fast breathing (more than 60 breaths per minute)
  4. Moderate or severe chest in-drawing
  5. Grunting / moaning
  6. Convulsions
  7. Floppy or stiff
  8. Temperature >37.50 C or <35.50 C
  9. Umbilicus draining pus or umbilical redness extending to skin.
  10. More than 10 skin pustules or bullae, or swelling, redness, hardness of skin
  11. Bleeding from stump or cut.

All mothers should be advised about how to recognize the danger signs and to report immediately if their babies develop one or more of them

PREMATURE BABIES : CHALLENGES & CONCERNS
Premature babies are babies that are born between twenty four and thirty seven weeks of pregnancy . If they are born between twenty and twenty four weeks there are very less chances of survival.

Baby weight of a  full term Indian baby weighs 2800 gms on an average. If the baby is born below 2000 gms then the baby may require specialized care. Depending on their general health they are either kept in incubators , NICU or they require care by specially trained staff . Their blood pressure, heart rate, breathing and pulse is monitored closely. They are discharged only when the neonatologist decides that thy are fit to stay at home. Sometimes these children might require  a panel of paediatricians, neonatologists, ophthalmologists and psychologists.

Usually the low birth weights baby respond very nicely and are discharged , but in some cases they might develop a variety of complications .Some of these complications are –

Problems related to breathing :
Small, immature lungs, Weak breathing muscles, A soft ribcage, ‘Stop-breathing’ (apnoea) attacks,  Respiratory distress syndrome , A hole in the membrane around a lung, making it collapse (pneumothorax), Brain damage, Pneumonia are some of the complications who present as breathing difficulties.

Respiratory distress syndrome (RDS)
When the lungs of the baby fail to expand and are collapsed this condition is called RDS or Respiratory Distress Syndrome . This can cause severe respiratory problems in the baby. Babies born before 30 weeks are susceptible to RDS, as they do not produce surfactant naturally.  The treatment of choice for such babis is surfactant administration.

Chronic lung disease
If a baby is born preterm and it still needs oxygen at the time it would be 36 weeks in utero or oxygen is required for more than 28 days post delivery then the child is said to suffer from chronic lung disease (broncho-pulmonary dysplasia or BPD).
The risk factors for developing chronic lung disease are babies born before 28 weeks , on ventilator for long time because of high air pressure required for maintainence to inflate the lungs.

Brain damage
Perterm babies especially those  born before 28 weeks tend to have a much smaller vulnerable ,less developed brain . These kind of babies may have  one or more of several disabilities, including defective eyesight, cerebral palsy and, later in childhood perhaps, clumsiness (dyspraxia), a poor attention span (attention deficit disorder), speech problems and learning difficulties.

Lack of oxygen (hypoxia)
The smaller a baby is, the more likely a lack of oxygen is to damage the brain. Before and during birth, several problems can reduce a baby’s oxygen supply by slowing the placental blood flow to the two arteries in the umbilical cord.

Hemorrhage into the brain and its spaces
It is very common in very premature babies because there blood doesn’t clot as it should.It occurs in one in four born before 25 weeks.Even an extensive bleed sometimes leaves no permanent damage, and many lesser bleeds cause no noticeable problems.

Cerebral palsy
Very low-birthweight babies are the most likely to develop brain damage leading to cerebral palsy, and an ultrasound or MRI (magnetic resonance imaging) scan can identify those most at risk. The severity and signs of cerebral palsy vary, but it usually shows up as stiffness, involuntary movements, or poor co-ordination and balance.

Anaemia
There are no iron stores in preterm babies and so they easily become anemic . This aggravates in babies whose mother bleed from the placenta before labour ,there’s a Rhesus problem . Blood transfusion is the management of choice for such babies.

Retinopathy of prematurity (ROP)
This is seen especially in preterms weighing less than 1000g (2lb 3oz) .These babies are so immature that the tiny blood vessels at the back of their eyes haven’t yet grown . When such a baby starts receiving higher levels of oxygen (either from air or from extra oxygen) than are normal in the womb, the outer, bare areas of each retina produce chemicals which stimulate the blood vessels to grow in the wrong direction .And subsequently it causes retinopathy.

Infection
Premature babies are much more likely to develop infections (for example, pneumonia and gastroenteritis) because their immune systems are relatively immature. Breastfeeding and proper newborn care reduces this risk.

Necrotising enterocolitis (NEC)
Due to reduced blood flow and infection in the bowel the bowel lining is inflamed and destructed which leads to necrotizing enterocolitis. The factors which lead to it are : Shortage of oxygen before birth (for example, with severe pre-eclampsia and an altered blood flow in the umbilical cord). This reduces the bowel’s blood supply (because the body directs blood to the brain to protect it); Prematurity; Low birthweight: four out of five babies with NEC weigh under 2500g (5lb 8oz), and up to 13 per cent of very low-birthweight babies are affected; Formula-feeding
It is a great killer and it  kills one or two in every five affected babies.

BREAST FEEDING
Breast feed vs formula feed

  • Saturated ,unsaturated fat and cholesterol which is an important constituent of brain and nerve tissue all constitute human milk ,this makes the  fat in breast milk more digestible than that in formula feed.
  • The energy produced by breast milk is more efficiently utilised, than that produced by formula.
  • Breast milk has an easily digestible combination with a good reserve of vitamins and minerals in it.
  • It acts as a immunoprotectant  These proteins offer protection against diarrhoea, food allergies and infections. The immunoprotective components of human milk include:
  • Lactoferrin : binds to iron, thus rendering it unavailable to viruses and bacteria.
  • Lysozymes and milk leucocytes: destroy viruses and bacteria
  • Secretory IgA: immunoglobulin that destroys viruses and bacteria
  • Bifidus factor: promotes the growth of beneficial bacteria in the gut and limits the growth of disease-causing bacteria.