Initial Care of the Newborn

ByDeborah M. Consolini, MD, Sidney Kimmel Medical College of Thomas Jefferson University

Last full review/revision September 2019 by Deborah M. Consolini, MD 

 

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The successful transition of a fetus, which is immersed in amniotic fluid and totally dependent on the placenta for nutrition and oxygen, to a crying, air-breathing baby is a source of wonder. Healthy newborns (age birth to 1 month) and infants (age 1 month to 1 year) need good care to ensure their normal development and continued health.

Immediately after the normal delivery of a baby, the doctor or nurse gently clears mucus and other material from the mouth, nose, and throat with a suction bulb. The newborn is then able to take a breath. Two clamps are placed on the newborn's umbilical cord, side by side, and the umbilical cord is then cut between the clamps. The newborn is dried and laid carefully on the mother's abdomen with skin-to-skin contact or on a sterile, warm blanket. Not all deliveries follow a standard pattern.

For example, some women need to have a cesarean delivery or have complications of labor and delivery. In some cases, the newborn requires some special attention by the medical staff after birth.

 

Cutting the Umbilical Cord

Soon after a baby is born, two clamps are placed on the umbilical cord, and the cord is cut between the clamps. The clamp on the cord's stump is removed within 24 hours after birth. The stump should be kept clean and dry. Doctors no longer recommend applying alcohol or other antiseptic solutions to the stump. The stump falls off on its own in a week or two.

The doctor examines the newborn for any obvious abnormalities or signs of distress. A full physical examination comes later (typically within 24 hours of birth). The newborn's overall condition is recorded at 1 minute and at 5 minutes after birth using the Apgar score. A low Apgar score is a sign that the newborn is having difficulty and may need extra assistance with breathing or blood circulation. Once the newborn is stable, the nurses obtain the head circumference, weight, and length (see also Physical Growth of Infants and Children).

Keeping the newborn warm is critical. As soon as possible, the newborn is wrapped in lightweight clothing (swaddled), and the head is covered to reduce the loss of body heat. A few drops of an antibiotic, such as erythromycin, tetracycline, or silver nitrate or, in some countries, povidone iodine, are placed into the eyes to prevent infection from any harmful organisms that the newborn may have had contact with during delivery.

Immediately after a normal birth, the parents are encouraged to hold their newborn. Some experts believe that early physical contact with the newborn helps establish bonding. However, parents can bond well with their newborn even when the first hours are not spent together. The mother and newborn usually recover together in the delivery room. If the delivery is in a birth center, the mother, father or mother's partner, and newborn remain together in the same room. Mothers who are breastfeeding put their newborn to their breast within the first 30 minutes after delivery.

Breastfeeding stimulates oxytocin, a hormone that helps the mother's womb to heal and promotes development of the milk supply. Once transported to the nursery, newborns are placed on their back in a small crib and kept warm. Because all babies are born with low levels of vitamin K, a doctor or nurse gives an injection of vitamin K to prevent bleeding (hemorrhagic disease of the newborn).

Table

Apgar Score

 

 

About 6 hours or more after birth, newborns are bathed. The nurse tries not to wash off the whitish greasy material (vernix caseosa) that covers most of the newborn's skin because this material helps protect against infection.