Newborn Baby Care In Hospital: Important Procedures Doctors and Nurses Perform After Birth

The birth of a newborn is a life-changing event for every parent. While parents prepare to care for the newborn, the transition to life outside the mother's womb is also a challenging period for the baby. Outside the womb, the environment is precarious, making the newborn vulnerable to diseases and infections. According to the World Health Organization (WHO) guidelines for healthcare professionals, immediate care of the newborn is crucial for their survival, development, and future health.

Immediate care of a newborn baby

Soon after the baby is delivered in the hospital, a quick examination is done by the doctor or the paediatrician:

• The airway is checked for any signs of obstruction.
• Any mucus or other material in the nose or mouth is suctioned with a suction pump.
• The umbilical cord is clamped and cut with sterile equipment.
• A nurse will weigh the baby, take measurements such as length and head diameters, and enter them in the birth record.

After the newborn's overall condition is assessed, the nurse will wipe the baby clean and dry with sterile towels and hand them to the mother. The baby is placed near the mother's breast or on her abdomen. This is to ensure skin-to-skin contact with the mother, which helps maintain body temperature, encourages bonding, and soothes the baby. The first hour or two after birth is also the best time to begin breastfeeding. This initial feeding helps stimulate breast milk production. It also causes contraction of the mother's uterus, which can help prevent excessive bleeding.

"Breast milk is the most important food for a newborn. Current guidelines recommend exclusive breastfeeding for a minimum of six months, and it can be continued till the child is 2 years old. Breast milk contains all the elements required to protect babies in early infancy from several diseases, and it provides protection to the child in later stages from chronic diseases as well. In circumstances when a mother is unable to provide breast milk, infant formula can be given to newborns." - Dr Anibha Pandey, Paediatrician & Neonatologist, Apollo Cradle Royale, Nehru Place, New Delhi

Newborn baby's health evaluation

Apgar scoring, or the Apgar test, is the first medical examination conducted to assess the overall condition. The following signs are evaluated at one minute and five minutes after birth: heart rate, respiration, appearance or skin colour, muscle tone, and reflex response. Each is given a score of 0, 1, or 2. A total score of 7-10 is considered normal. An Apgar score of 4-6 may need oxygen support or careful monitoring. Newborns with a score of 0 to 3 require immediate medical attention.

Physical examination of the newborn

1. Vital signs: Temperature, heart rate, and respiratory rate are checked.
2. Measurements: The nurse measures the baby's length from head to toe and measures the head circumference.
3. Birth weight: The baby is weighed immediately after delivery, and the birth weight is recorded.
4. Skin: The skin is examined for bluish discolouration, a sign of poor blood circulation.
5. Head and neck: The doctor examines the infant's head shape, soft spots on the skull, face, and neck for any swelling, bleeding, or deformities. This can either be due to the pressure during a vaginal delivery or a birth defect.
6. Heart and lungs: The chest is auscultated for any heart murmurs or abnormal breathing sounds.
7. Abdomen and genitals: The abdomen is palpated to check the size, shape, and position of internal organs. The doctor ensures that there are no defects in the genitourinary and rectal openings.
8. Extremities: The arms and legs are checked for any physical or functional defects.

"To understand about the milestones and development of a baby, regular visits to a paediatrician is required. During the visits, the paediatrician does developmental assessments, and diagnoses any delay in the baby's development." - Dr Anibha Pandey, Paediatrician & Neonatologist, Apollo Cradle Royale, Nehru Place, New Delhi

Baby care in the hospital

After an examination to confirm that the newborn is fit and healthy, hospitals should ensure immediate care as follows:

Sterile environment 

The baby has come out of a conditioned environment and is exposed to all possible infections. The newborn is highly vulnerable to infections from the external environment; therefore, sterilised cloths for wiping the baby and sterilised baby clothes become extremely critical.

Cord care

The baby's umbilical cord stump must be clamped.  It should be kept absolutely clean and dry, as infection rates are high in this area.

Eye care

Eye drops in both eyes to prevent bacterial infection.

Providing warmth to the newborn

• Upon birth, the baby is completely covered with amniotic fluid and, therefore, can easily become cold. Drying the baby with a soft, preferably sterilised towel, and using warm blankets and heat lamps can help prevent heat loss.
• Kangaroo care is a method in which the infant is held in skin-to-skin contact with the mother soon after birth to stabilise body temperature. This position allows the baby to get the desired warmth from the mother. This not only reduces crying but also helps in successful breastfeeding.
• Caregivers must ensure that the head and toes are always well covered, as maximum heat loss occurs in these areas.

Bath

Once the newborn's temperature gets stabilised, the baby is ready for their first bath.

One important delivery-room procedure is to place an identification tag on the wrists of both the baby and the mother, containing the infant's name and details. This is checked by the nurse each time the baby is carried from or brought back to the mother's bedside.

"The room temperature for newborns should be between 26 and 28 degree Celsius. They should be kept indoors during hot days and breastfed on demand. Their urine output should be a minimum six times during the day and the body temperature should be around 36-36.5 degree Celsius. They should be dressed in soft cotton clothes and covered with a cotton sheet."
- Dr Anibha Pandey, Paediatrician & Neonatologist, Apollo Cradle Royale, Nehru Place, New Delhi

Newborn babies who need intensive care are often admitted into a special area of the hospital called the neonatal intensive care unit (NICU). The NICU is staffed by trained medical practitioners who have access to advanced medical equipment to provide specialised care for newborn babies in the hospital. Babies who are born premature or with life-threatening disorders are the ones who often get placed in the NICU for intensive care.

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