Newborn Care
Includes Newborn Nursing and Parenting
Newborn nursing is both an art and a science. Every moment of newborn care is full of excitement and challenges. It demands compassion, dedication and affection. Neonates with their delicate stature and demanding cry arouse parenting instinct with an instant desire to care for them.
Newborn needs are urgent, continuous, and often unclear
Their subtle signals need to be acknowledged promptly and attended to empathetically. This often causes a lot of physical and emotional stress to newborn care provider. Therefore the psychological make up of parents and other newborn care providers plays a major role in effective newborn parenting. Along with parenting, parents need to be alert about vital functions of newborn babies.
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Newborns' Temperature Maintenance
Temperature maintenance is crucial and forms the basis of newborn care.
What should be the optimal body temperature of a newborn baby?
Axillary / Arm-pit temperatures between 36.4 to 37.0°C (97.0-98.5°F) are the normal limits for newborn's body temperature.
Why are newborn infants at risk for heat loss and hypothermia?
- Their thermo regulatory mechanism is inadequate for their needs.
- Relative to body weight, the body surface area of a newborn infant is approximately three times that of an adult.
- Newborn babies are more prone to loss of body heat.
The estimated rate of heat loss in a newborn is approximately four times that of an adult. This is because, the ability to produce body heat mostly depends on body weight, but heat loss depends on the surface area off the body.
In effort of keeping newborns warm can their temperature rise too high?
Yes it can.
Newborn care givers are alerted by infants' crying much earlier (the green zone in the picture given above) in response to cold stress than to excessive warming. This is because the cold receptors in neonates are located in the skin and the warm receptors in the hypothalamus (Brain growth and development). Therefore in newborn nursing use of nearby heat radiators or hot water bottles to supply additional heat is positively discouraged.
Approved methods of keeping infants warm in normal newborn care
- Immediately after birth and during first couple of weeks:Skin-to-skin contact with the mother, known as kangaroo care, is the optimal method of maintaining temperature in a stable newborn baby.
- How many layers of clothing keeps neonates optimally warm?
The rough judgement is that if a mother is comfortable in her night clothes than the newborn in baby gown and 2 blankets will be warm enough.
Signs to Observe in Newborn Nursing
Respiration rate and rhythm
- Breathing varies between 30-60 times per minute.
- It depends on neonate’s activity status: wakefulness, crying or sleeping.
Heart rate and rhythm
Heart rate denotes the number of beats per minute. In newborn babies, the normal heart rate varies from 90 to 174 beats per minute. It may fall as low as 80 when the baby is asleep or relaxed, and rise up to 200 when she is active, excited or crying. Apart from this natural fluctuations, the heart of neonates beats at a regular rhythm. Irregular heart beats signify heart disease.
Skin Color
- Normally: Light pink.
- Dark pink appearance is usually seen if the body temperature rises; as seen in extra warming or fever.
- Cyanosis is bluish discoloration of the lips and nails of toes and fingers.
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Is my baby feeding adequately?
Breast feeding
- Look for good latching,
- Effective sucking
- Eye to eye contact with the mother.
- Tobacco smoking brings down the quantity and quality of breast milk.
Infants exposed to tobacco experience breastfeeding difficulties.
If you or any of your family member is addicted to tobacco,
here is how you can minimize its harmful effects on your baby. - Intermittent adequate burping.
Hiccups
- Hiccups are normal in newborns.
- They are not the manifestation of any disease process in the neonates.
- Newborn babies develop hiccups especially after a good feed.
Full stomach gets distended with milk and the swallowed air, which irritate the over lying diaphragm (a strong muscle that separates chest cavity from the abdomen cavity).
Urine output
Being vigilant about urine output cannot be overemphasized: It is an important facet of newborn nursing. It determines newborn health and adequacy of infant's daily feed intake.
- A well fed newborn baby should have 5 - 8 wet diapers per 24 hours.
- A newborn should pass urine at least once within 24 hours after the birth. Most babies pass urine just at the time of delivery which goes unnoticed.
- In the first 36 hours of life, normal range of urine flow is about
25-50 millilitres per kilo body weight, that would say minimum of 3 wet diapers in first 36 hours of life. Thereafter the rate of urine flow in a neonate is double or more.
Newborn baby's body measurements
Body weight
Birth weight of a normal full-term baby is approximately 3.2 kilos, the range being 2.8 to 4 kilos. Newborn nurses usually record it within the first hour of life and certainly within first 24 hours after birth.
Newborns loose weight for the first 3 to 7 days of life to the maximum of 10 percent of the birth weight, which they regain rapidly in next 3 to 4 days. This temporary loss of weight is attributed to loss of extra proportion of body water of newly born infant.
During the next 20 days of the neonatal period, newborn baby's weight gain is 10 - 15 grams per day per kilo of the body weight. Consequently, by the end of neonatal phase, a well growing newborn has 500 to 1000 grams of weight gain over and above the birth weight.
Head circumference
For baby at birth it varies from 32 to 35 centimetres, which is about 2 cm. larger than the chest circumference.
Neonate’s body length
- It varies from 42.5 to 52.5 cm.
- Neonate gains about 2 cm. per month for the first 6 months.
For more on Early Development; vital phase of childhood development click
Sleep and activity pattern
Newborn activity
In spite of the common belief that a newborn cannot move on his accord, newborn nursing demands that a newborns are never left unattended at places from where they can fall.
Baby’s vigorous movements create a momentum and you may find him suddenly on the floor. Falls are dangerous for newborns and so is sudden vigorous shaking.
Consolability
- Babies are usually easily consolable during their crying episodes. If not, medical attention is recommended. For more on the subject click Newborn Crying and Consolability
Sleep pattern and posture
Newborn sleep pattern lays the biggest hurdle for newborn nursing.
Association of sleep posture with SIDS and ambiguity of newborn alertness add to parental anxiety. (Passive smoking is also related to SIDS)
Though most newborns sleep 16 to 20 hours of the 24 hours cycle, the mothers are usually severely deprived of sleep. Why? Find your answers in Newborn nursing dilemmas related to newborn sleep
Vomiting
- Vomiting is common in newborns
- Usually it is a normal phenomena if It is occasional & contains only milk and mucus.
- It generally occurs soon after a meal
- Produces a much greater volume than spitting up (regurgitation)
When should a doctor be consulted for vomiting in newborns?
- Yellow bile stained
- Blood stained vomitus
- Immediately after birth bloody vomit could be due to swallowed maternal blood.
- Very forceful vomiting
- Frequent vomiting
- Vomiting in a febrile or otherwise sick baby
- Vomiting associated with excessive crying.
- Associated with poor weight gain.
What are the causes of vomiting in normal newborns?
- Feeding disorder
- Improper burping
- Air swallow
- Over feeding
- Anxiety or depression in the mother
- Gastric outlet obstruction
- For more causes of vomiting in newborn babies click here
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Regurgitation
What is regurgitation?
- Regurgitation is an effortless back flow of feeds from the stomach.
- It is not the same as vomiting.
- It is also known as spitting up.
- The milk that flows out is usually undigested or only partially digested, and is often mixed with sticky secretions of the stomach.
- It is usually not a symptom of a disease.
How can regurgitation be prevented in newborns?
Adequate burping is essential in newborn nursing to prevent frequent regurgitation.
Is regurgitation harmful?
Usually not.
It almost never involves choking, coughing, discomfort, or danger to the infant.
How often and when do babies regurgitate?
- There is no particular time pattern associated with regurgitation tendencies in infants. Babies regurgitate even during their sleep.
- Tendency to regurgitate varies: Some babies bring up more than others.
- Most grow out of it by the time they learn to sit.
However, a few “heavy spitters” continue until much later. - Neonate's spitting up can not be totally overcome even under most diligent newborn nursing.
How can regurgitation be minimized?
- Safe guard your baby from effects of second hand smoke.
- Making feeding time calm and free of distractions.
- Burping the baby intermittently during feeding and after each feed.
- Feeding the infants in semi reclined or sitting position.
- Do not jostle or play vigorously with the baby immediately after feeding.
- Avoid rapid feeding
a.) Feed before an infant gets frantically hungry.
b.) The hole in the nipple in bottle feeding should not be too big, which lets the formula flow too fast.
c.) Too small hole of the nipple in bottle feeding leads to frustration in infants and increases air swallow. The nipple hole is considered to be of a proper size when drops fall spontaneously at slow rhythmic intervals on inverting the bottle. - Sleep posture
a.) Elevate the head of the entire crib with blocks (don’t use a pillow)
b.) Infant should be put to sleep on the back.
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Meconium: Passage of blackish stools
What is meconium?
- Meconium is very dark green colour (blackish) stools (poop), that a newborn baby passes during first 2-3 days of life.
- The blackish stools in first 2 to 5 days of life are normal.
- Meconium consists of antenatal accumulation of bile stained intestinal secretions, intestinal debris and cells.
What are breast milk stools?
- Over 3 to 5 days he breast feeds get adequately established and the accumulated black tarry stools are all passed out, baby passes breast milk stools.
- Due to adequate intake of milk the color of stools changes to pale yellow and the consistency; from soft to slightly watery.
How often should a newborn baby pass stools normally?
The frequency of poops pose a major confusion during newborn nursing: It varies from once in 2 days to 8 times in 24 hours.
Newborn stools that demand medical attention.
- White clay coloured stools.
- Colorless meconium plugs.
- Failure of passage of meconium in first 24 hours.
Umbilical cord care
- Usually umbilical
cord dries
and separates
by eighth day of life. - Umbilicus
heals completely
by 15 days of life.
- Delay of more than 3 weeks
Cord separation after 3 weeks of life should be evaluated by a medical professional; could be associated with underlying immune disorder that interferes with the healing mechanism. - Foul smell from the drying cord
Week unpleasant smell can often be appreciated while the cord is drying, which disappears with adequate cleaning.
Really repulsive foul smell that does not go away even after cleaning should be assessed by a professional newborn nurse or doctor.
Why does umbilical cord need cleaning?
As the cord dries, the tissue fluid seeps out and accumulates around its base. This fluid is rich in nutrients for the bacteriae to grow on. Therefore the cord area should be wiped 3-4 times a day so that it always remains clean and dry.
What is the preferred way of keeping umbilical cord clean?
During routine newborn nursing, sterile water alone is preferred for cleaning of the umbilical cord, its base and the surrounding skin. Entire cord and the surrounding area is wiped with sterile water swab 3-4 times a day.
Some prefer to use mild cleanser with neutral pH (5.5 to 7.0), but they, alcohol and other topical drying agents should be avoided.
- They do not have any additional benefits.
- Do not shorten cord separation time.
- Do not decrease risk of infection.
- Topical antibiotics and antiseptics may actually prolong cord separation.
Care of Baby’s External-Genitals
Female Baby: Vaginal discharge
- Mucoid whitish discharge
It is common during initial couple of weeks of life. It does not signify any abnormality. It just needs to be wiped of by a wet cotton swab. - Blood stained discharge
It is often noticed on 5-7 day of life. It occurs due to withdrawal of mother’s hormones from the baby's blood circulation. The bleeding is never heavy. It is just spotting, which subsides spontaneously in 2 -5 days. It does not need any medical management. - Foul smelling whitish discharge
Indicates abnormality and demands immediate professional attention.
Male baby: Foreskin
- It is normally tight during neonatal period
- Should be left alone during newborn nursing.
- Retracting foreskin is not possible in early infancy
- Any manipulation of foreskin during early infancy can traumatize it.
Bathing a Newborn
Bathing a newborn is best if deferred until 48 to 72 hours after birth. During first 2 - 3 days of life the body temperature of newborns is unstable and abrupt body heat loss can jeopardize baby's well being.
Precautions to be taken while bathing a newborn
- Prevent body heat loss
- Avoid injury to the baby
a.) Can slip from hands due to soap and water effect
b.) Soap irritation in the eyes
c.) Near drowning situation is easy to arise. Guard against it!
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