We end this study session with a reminder about essential newborn care, which you should conduct with all babies, regardless of whether they have any signs of asphyxiation. When the baby's umbilical cord is cut, there are many physiological changes inside the baby's body to allow it to make the necessary adaptation to life outside its mother. It is generally tougher to survive in the outside world than in the relative safety of the uterus, so we need to provide basic care to the newborn to help it resist some potential health risks listed in Box 7.1.
Box 7.1 Health risks to newborns
Newborns need additional care to prevent:
- Spontaneous bleeding, usually from the gastrointestinal tract, due to Vitamin K deficiency
- Bleeding due to birth trauma (usually manifested late after delivery with swelling over scalp that requires immediate referral)
- Eye infections due to Chlamydia trachomatis and Neisseria gonorrhea (bacteria which are common causes of sexually transmitted infections; the baby can acquire these infections as it passes through the birth canal)
- Some vaccine preventable diseases such as poliomyelitis and tuberculosis
- Hypothermia (becoming too cold)
- Hypoglycaemia (low blood glucose level)
- Mother-to-child transmission of HIV, if the mother is HIV-positive.
Vaccine preventable diseases are discussed in detail in the Communicable Diseases Module, Study Sessions 3 and 4.
Prevention of mother-to-child transmission (PMTCT) of HIV is covered in the Antenatal Care Module, Study Session 17; the drugs and procedures for PMTCT are given in the Communicable Diseases Module, Study Session 27.
With the health risks in Box 7.1 in mind, make sure that you give all newborn babies the following essential care:
- Tie the umbilical cord two finger-widths from the baby's abdomen and place a second tie two finger-widths away from the first one. Cut the cord between the first and second ties. Check that the umbilical cord stump is not bleeding and is not cut too short
- Apply tetracycline eye ointment once only, to prevent eye infections.
- Inject vitamin K (1 mg, intramuscularly) into the front of the baby's mid-thigh to prevent spontaneous bleeding.
- Give the first dose of oral polio vaccine and BCG vaccine (against tuberculosis) according to the guidelines in the Ethiopian Expanded Programme of Immunization (EPI).
- The body temperature of the newborn must remain above 36oC. Place the baby on the mother's abdomen in skin-to-skin contact with her, where it can breastfeed. Cover them both with a blanket and put a warm hat or shawl over the baby's head.
- Ensure that the baby is suckling well and the mother's breast is producing adequate milk. If breastmilk is not preferred, make sure that adequate replacement feeding is ready. Initiate early and exclusive breastfeeding unless there are good reasons to avoid it, e.g. in an HIV-positive mother.
- The baby should get preventive treatment to protect it from HIV if its mother is HIV-positive.
The vaccination schedule for all the vaccines in the EPI are described in full in the Immunization Module.
You will learn all about breastfeeding in the Postnatal Care Module. Breastfeeding and HIV are covered in the Communicable Diseases Module, Study Session 27.