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SECTION IV: PERINATAL CARE


IMMEDIATE CARE OF THE NEONATE

The newborn infant should be given to the mother within an hour after birth so that the process of mother-infant bonding and lactation can be established early.

Unnecessary separation of mother and infant should always be avoided. Rooming in should be part of hospital policy as it enables a mother to respond to her baby and feed him on demand. This helps bonding and breastfeeding. The midwife should do the following on delivery of the infant:

  • Note time of birth
  • Clamp, ligate and cut umbilical cord
  • Ensure a clear airway
  • Determine Apgar score – (scores of seven (7) or less at 1 minute and 5 minutes indicate need for resuscitation and medical attention)
  • Dry and keep infant warm
  • Swab eyes with sterile swabs.
  • Give vitamin K (1mg intramuscularly) immediately after birth.
  • Weigh baby
  • Help the mother to initiate breastfeeding




NEW BORN

Examination at Birth

It is important that the newborn be carefully examined as soon as possible after birth, primarily for the detection of any life threatening abnormalities, evidence of trauma, and for evaluating the infant’s ability to adjust to extra uterine life.

This includes:

  • Note the general appearance
  • Record – weight, crown-heel length, head circumference
  • Examine the newborn along the cephalo-caudal route looking especially for the following abnormalities:

Head

Circumference more than or less than the normal range (34-35 cm), Caput and Moulding, Cephalhaematoma (blood collection under the scalp)

Face

Abnormal facial appearance e.g. features of Down syndrome

Skin Colour

Cyanosis, jaundice, birth marks, petechiae

Posture

Abnormal movement, flaccid or spastic muscle tone

Fontanelles

Abnormal size, tension or width of sutures

Eyes

Haemorrhages, cataracts (congenital), discharge

Mouth

Cleft palate, asymmetry of mandible

Neck

Sterno-mastoid swelling, goitre, brachial fistula

Chest

Abnormal respiratory movement and rate, costal recession, asymmetry, grunting on auscultation, abnormal breath sounds, irregular heart sounds, displaced apex beat, position of maximal heart sounds

Abdomen

Distention, umbilical abnormalities

External Genitalia

Undescended testes, hydrocoele, hypospadias, intersex conditions

Anus

Imperforate and/or displaced anus

Hips and Limbs

Congenital dislocation of the hips, subluxation of the joints, club feet, asymmetry of limbs

Spine

Spina bifida, asymmetry, scoliosis, sacro-coccygeal tumour, midline sinuses etc




SUBSEQUENT CARE OF THE NEWBORN

Environment

  • Keep the baby in a clean, safe environment. Keep the infant warm.


Prevention of Infection

  • Wash hands before and after handling baby.
  • Commence vaccination with BCG and Hepatitis B, if mother was positive for Hepatitis B surface antigen


Observe the Following Daily

  • Skin for infection
  • Eyes and skin for jaundice and infection
  • Stools

NOTE that in breast fed infants, stools may be frequent (after every feed) and loose. Foul smelling, watery, bloody stools are abnormal.


Feeding

  • Remind the mother about the key infant feeding areas covered during the antenatal period
  • Continue to build confidence and provide support to the mother as needed
  • Where there are medical reasons to warrant alternative feeding, the mother (and father) should be instructed on how to prepare and administer alternative feed safely. This should be done privately and away from the general ward area.


Ensure that before a woman leaves the hospital facility she can demonstrate the following:

  • How to bathe the baby
  • How to clean the cord
  • How to wash hands
  • How to care the nipples
  • How to position baby at the breast
  • How to recognize that baby is attached well
  • How to express breast milk by hand
  • How to cup feed safely


Frequency of Visits by Nursing Personnel

  • Visit the mother and baby once every other day for at least three visits. Visit more often as required. Visit at the time convenient to both mother and mid-wife.


Recordkeeping

  • Keep records of observations made.


Nutritional Needs of the Neonate

  • Breast milk is recommended. Put baby to breast as soon as possible after delivery – within one hour. There is no need to give water or glucose feeds before the baby is breastfed.
  • Give expressed breast milk to babies who are unable to suckle the breast. Do not give artificial milk if breast milk is available and is not contraindicated.
  • Bottle feeding should be discouraged.


Indication for referrals of Neonates to Medical Officer/Hospital

  • Birth weight <2.5kg or >4.2kg.
  • Birth Asphyxia. Apgar score 7 or less in 5 minutes.
  • Respiratory distress, cyanosis.
  • Jaundice or pallor of mucous membranes.
  • Born to mother with history of previous children with jaundice requiring exchange transfusion or phototherapy.
  • Congenital malformation e.g. meningomyelocoele.
  • Poor feeding or lethargy.
  • Vomiting, excessive mucus.
  • Abdominal distension.
  • Born to a diabetic mother.
  • Born to a Rhesus negative mother.
  • Born to a mother VDRL or HIV positive.
  • Born to a mother with sickle cell disease.
  • Born to a mother with fever during labour, foul smelling liquor.
  • Born to mother with rupture of membranes longer than 24 hours.

Each child should have a referral form with assessment, history, care given, history of feeding, passage of stools, etc. A blood sample (clotted specimen) of the mother should also accompany child.


Referral to Social Worker

Neonates born to mothers with the following problems should be referred:

  • Mother with a psychiatric history
  • Mother who is an alcoholic and/ or other drug addict
  • Mother less than seventeen years old
  • Evidence of poor socioeconomic circumstances, which may inhibit proper diet and hygiene
  • Suspicion of domestic abuse

Caribbean Public Health Agency © 2014