Routine care of the neonate

Z76.2

For the comprehensive management of the newborn refer to the most recent Newborn Care Charts.

GENERAL MEASURES

Routine care for baby after delivery

  • Dry the baby thoroughly at birth
  • If there is meconium, clear the airway first
  • If baby is not crying
    • Clear airway, stimulate
    • If baby not breathing well, clamp and cut the cord and start resuscitation (see Neonatal resuscitation )
  • If the baby is crying and breathing well
    • Place on mother’s chest, keep warm and check breathing
    • Clamp and cut cord after 1 minute.
    • Monitor with mother and initiate breastfeeding.

Check and record the Apgar score:

Apgar score 0 1 2
Heart rate Absent < 100/min > 100/min
Respiration Absent Slow or irregular Good, crying
Muscle tone Limp Slight flexion Active, moves
Response to
stimulation 		No response Grimace Vigorous cry
Colour Blue or pale Body pink, limbs blue Pink all over

Check baby from head to toe including baby’s back

  • Check weight and head circumference
  • If any of the following, provide immediate management (see Care of sick and small neonates ) and refer to a neonatal unit:
    • Grunting or chest indrawing
    • Less than normal movements
    • Central cyanosis
    • Major congenital abnormality
    • Fast breathing
    • Head circumference > 39cm
    • Abnormal tone (floppy/stiff)
    • Birth weight < 2.5 kg

Identify the infant at risk or needing special treatment

  • Birth weight < 2.5kg.
  • Mother diabetic.
  • Suspected chorio-amnionitis (membranes ruptured for > 18hours, offensive liquor at birth).
  • Mother syphilis positive (partially treated or untreated or treated < 1 month before delivery).
  • Neurological or congenital problem.
  • Mother HIV infected.
  • Hospital stay> 3 days after delivery.
  • Infant not breastfed.
  • Mother blood group O and/or rhesus negative.
  • Mother on TB treatment
  • Possible social problem (mother has died or is ill, teenage caregiver, social deprivation).

Initiate bonding and feeding

  • Place the baby skin-to-skin with mother and initiate breastfeeding immediately.

Identify and record

  • Formally identify the baby with the mother.
  • Place a label with the mother’s name and folder number, baby’s sex, time and date of birth on the baby’s wrist and ankle.
  • After giving vitamin K and chloramphenicol eye ointment, give the baby back to the mother, unless there is a reason for the baby to be transferred to a neonatal unit.

MEDICINE TREATMENT

Bleeding prophylaxis Z29.2

  • Vitamin K, IM, 1 mg immediately after birth routinely.
    • Administer in the antero lateral aspect of the mid-thigh.

Neonatal conjunctivitis prophylaxis Z29.2

  • Chloramphenicol ophthalmic ointment 1%, applied routinely to each eye after birth.

Routine EPI immunisation:

  • BCG vaccination, intradermal, once neonate is stable. (Z32.2)
  • bOPV (polio vaccine), oral, once neonate is stable. (Z24.0)

No baby must be sent home without immunisation.

REFERRAL

Refer to a neonatal unit if:

  • Baby needed resuscitation.
  • Apgar score < 8 at 5 minutes.