Definition of newborn/neonate:
Infants between birth and first 28 days of life are called newborn babies or neonates.
Introduction to care of newborn babies:
Newborn babies/ Neonates truly constitute the foundation of human life. Just as children are not mini-adults, neonates are not mini-children. They have unique health issues and problems due to structural and functional immaturity of various body organs depending upon their gestational age and birth weight.
Most healthy term neonates can be managed at home under the guidance and supervision of mother or health care professional. On the other hand low birth weight and premature babies are fragile and vulnerable, and they demand high degree of skill and technology in a special care nursery or neonatal intensive care unit (NICU) for their intact survival. The aim and goal of newborn care is not only to reduce neonatal mortality but more importantly to ensure their intact survival.
Basic care of normal newborn babies:
- At birth baby should be received in a sterile sheet, dressed in a frock with open-back and covered adequately depending upon the environmental temperature.
- It is desirable to keep the normal term babies with their mothers rather than in a separate nursery. So that mother can participate in the nursing care of her baby. This infuses self confidence in her and reduces demands on nursing personnel.
- Cross infection is prevented and breast feeding is established easily.
- The baby’s colour, respiration, temperature and umbilical stump should be checked on arrival in the lying-in ward.
- Skin temperature should be recorded twice a day.
Mother’s role in the care of her baby:
The health and survival of the newborn baby depends upon the health status of the mother and her awareness, education and skills in mother craft. Mother is the best primary health worker. She has the advantages of instinct, concern and interest to look after her baby. Mother looks after her baby with love, affection and sense of sacrifice. Early involvement of the mother in the care of her baby is the best way to promote and encourage breast feeding. Mother is the best person to identify minor developmental deviations and early evidences of disease process because she is constantly and closely watching her baby.
All mothers must be emotionally and physically prepared and motivated during pregnancy so that they do not encounter any difficulties to establish successful breast feeding. The inverted and cracked nipples must be managed during pregnancy so that baby is not faced with any mechanical difficulties during breast feeding. The baby should be put straight to the breast as soon as the mother has recovered from the fatigue of labor. The first feed is usually offered within 1 to 2 hours after birth. The colostrums (milk secretions during the first three days of lactation) must never be discarded and all babies should invariably receive it because it is rich in energy, proteins, protective antibodies and cellular elements. The mother must be explained and reassured that the act of sucking is the best stimulus for milk production and the small amount of concentrated milk produced during first two to three days of lactation is adequate to meet the nutritional needs of healthy term babies. During first six months of life the baby should receive exclusive breast feeding and there is no need to give any water even during summer months because all the fluid requirements of the baby are met through milk. The exclusively breast fed babies are likely to have better weight gain because they will drink more milk when thirsty. The child should be on demand feeding and most babies are satisfied with feeds taken every two t three hours. The mother should actively interact with the baby while breast feeding. During first four to six weeks most babies need to be fed round-the-clock and after that gradually the night feed can be reduced to one late night feed and one early morning feed.
Maintenance of Body Temperature:
The body temperature in newborn babies is usually unstable and they are particularly vulnerable to develop hypothermia in winter. The environmental temperature that may feel uncomfortable to an adult may impose serious cold stress to a newborn baby. The baby bath should not be given at birth and delayed till next day when his temperature has stabilized. The child should be kept dried and adequately clothed. The baby should be nursed in close proximity to the mother so that the baby gains heat from maternal warmth. In winter, the linen and clothes of the baby should be pre-warmed. He should be provided with a cap, socks and mittens. The room should be kept warm. The mother and health workers should be trained to assess the temperature of the baby by touch alone. When trunk is warm to touch and extremities are warm and pink it is reassuring that baby is not having any cold stress. The cultural practice of keeping the mother-baby dyad isolated for 40 days is useful and needs to be promoted. It prevents exposure of the baby to cold and safeguards against occurrence of infections. The Ayurvedic oil massage is both culturally and scientifically acceptable as it provides insulation against heat and insensible water loss.
Body massage is culturally accepted and has several scientifically proven benefits. Ayurvedic oil massage of the baby should be postponed till baby is 3 to 4 weeks old and his body weight is more than 3 kg. Most babies enjoy and oil massage, they cry less and sleep better. It improves the circulation and tone of the muscles, gives comfort to the baby, strengthens maternal bonding and provides additional energy to baby because oil can get absorbed from the thin skin of the baby. Oil massage is credited to improve weight gain, reduce stress and enhance immunological functions of the baby. It prevents dryness and chaffing of skin. The massage should be done by using gentle pressure and smooth rhythmical movements by the mother and not by aggressive nurse-aids. Mother must actively interact and talk with her baby during the massage session. It should be a fun both for the mother and her baby.
Skin care and Baby Bath:
The baby must be cleaned off blood, mucus and meconium before he is presented to the mother. Effective cleaning and dry of skin at birth minimizes the risk of potential infection by micro-organisms such as hepatitis-B virus, HIV and herpes simplex virus. He should be bather or sponged next morning using mild Ayurvedic medicated soap and clean lukewarm water. The barrier nursing with separate articles for each baby in their individual lockers is desirable. There should be no centralized bathing of babies as this often results in cross infection. Bathing provides a good opportunity to the nurse and mother to identify any developmental peculiarities and superficial skin infections which should be brought to the notice of the physician. During summer months, the baby can be given a bath. The room should be reasonably warm and free of any draught. Take clean, warm water in a plastic basin. Avoid dip baths till the cord has fallen. Use any mild Ayurvedic medicated soap. The baby should be held over the forearms or over the thighs. During winter months the baby should preferably be sponged rather than bathed to avoid the risk of exposure. After the bath, baby should be given a breast feed. Most babies go to sleep after the ritual of a bath and breast feed.
Care of the Umbilical Stump:
The umbilical cord is an important site for entry of spores of tetanus. The health care personnel must use sterile instruments to cut and clamp the cord to prevent occurrence of tetanus neonatorum. Even when a new razor blade is used for cutting the cord, it should be sterilized before use by boiling for 10 minutes. The cord must be inspected after 2 to 4 hours of birth. Bleeding commonly occurs at this time due to shrinkage of cord and loosening of ligatures. Ligation of cord with a rubber band or disposable slip safeguards against this hazard. Betadine should be applied at the tip and around the base of the umbilical stump daily to prevent colonization. The dressing should not be applied. The cord normally falls after 5 to 10 days but may take longer, if it is dry and shrivelled or when infected.
Care of the Eyes:
Eye should be cleaned daily with sterile cotton swabs soaked in normal saline suing one swab for each eye. It the eyes are sticky 10% solution of sulphacetamide should be instilled in the eyes every two to four hours. Prophylactic instillation of human colostrums into the eyes has been shown to reduce the incidence of sticky eyes. The practice of applying ‘Kajal/Anjan (Collyrium)’ in the eyes is not recommended because it may transmit infection and may even cause lead poisoning.
Dresses for the Baby:
The clothes should be loose, soft and preferably made of cotton. They should be open on the front or back for ease of wearing. Avoid the use of large buttons which may hurt the tender skin of the baby. The nappies should be made of thick, soft and absorbent material in order to readily soak the urine and stools.
Early Detection of Serious Disease:
The nurses and paediatricians should be vigilant in the maternity ward to diagnose neonatal abnormalities at the earliest. Most healthy term babies do not pose any serious health problems except appearance of certain developmental peculiarities and minor problems which need identification, reassurance and advice to the mother. However, when a newborn baby is genuinely sick and refuses to take adequate feeds or manifest any other danger signs he should be considered as seriously ill. The danger signs should be closely watched and brought to the notice k of the consultant.
- Bleeding from any site
- Appearance of jaundice within 24 hours of age or deep jaundice
- Failure to pass meconium within 24 hours and urine within 48 hours
- Vomiting or diarrhoea
- Poor feeding
- Undue lethargy or excessive crying
- Excessive frothiness or drooling
- Choking during feeding
- Respiratory difficulty
- Sudden rise or fall in the body temperature
- Superficial infections/s (conjunctivitis, pustules, umbilical sepsis and oral thrush etc.)
Most babies lose weight during first 2 to 3 days of life. The weight loss varies between 5-8 percent of birth weight. The weight remains stationary during next 1 to 2 days and birth weight is regained by the end of first week. The factors contributing to initial weight loss include removal of vernix, mucus, and blood from skin, passage of meconium and reduction of extracellular fluid volume. Most infants double their birth weight by 4-5 months of age and triple it by their first birth day. It is mandatory that periodic weight record should be taken and charted on Road-to-Health cards during preschool years.
Immunizations and Ayurvedic ‘Suvarna prashan’:
BCG and first dose of OPV and hepatitis B vaccine (HBV) are given at birth or before the baby is discharged from the hospital. The OPV may preferably be given after 3 days because colostrums may interfere with its uptake.
Authentic Ayurvedic classics have promoted ‘Suvarna prashan’ as ‘Strong Vaccination Programme’ for newborn babies. Kashyapa (the greatest Ayurvedic paediatrician) has described that ‘Suvarna prashan’ improves intelligence, metabolism, digestive power and physical strength of newborn babies. It gives long, spiritual and holy life to the babies. It has best rejuvenation action and tone ups the skin. It improves immunity in miracle way so child is prevented from most of the bacterial and viral infections. Regular use of ‘Suvarna prashan’ up to one month from very first day of birth results that the child gets best immunity against diseases. Six months of regular use of ‘Suvarna prashan’ make child very much intelligent, and he can remember all the words hearing by him, means it improves memory and intelligence in so much amount.
Supplements and Follow-up:
Human milk of healthy mothers receiving adequate nutrition and supplements of micronutrients is a complete food to look after all the nutritional needs of their healthy normal weight babies. The infants should be followed up in the Well Baby Clinic for evaluation of their growth and development, immunizations, nutritional advice, early diagnosis of abnormalities and guidance to the parents for the management of day to day problems of their children. When complementary feeds are started after 6 months of age, supplements of vitamins and minerals should be provided.