Society whether it is America, Russia, Germany, France, India–welcomes a newborn. When a baby is born everyone would like to hold and cuddle the little one. The whole world around the baby is transformed into baby language.
The Newborn’s week was celebrated from November 15th to 21st, 2000. During this week the neonates planned to rally together to fight for their birth right.
Neonates are babies aged between 0 to one month. The normal gestation period of pregnancy is 37 weeks. How must the newborn baby be looked after? Two factors contribute to the concept of neonatal care at birth and at home: If the mother delivered the baby normally and whether on time? What was the baby’s weight at birth? In developed countries most neonates are born premature but have normal birth weight, while in developing countries like India, babies are born at Term but have low birth weight.
Due to low birth weight, most Indian babies suffer from what is called Intra Uterine Growth Retardation, says Pediatrician Dr. Ashish Bavdekar. The broader classification is guided in this manner:
- Small for Gestation Age (SGA): Babies who have low birth weight (2.5kgs)
- Appropriate for Gestation Age (AGA): Babies who have normal birth weight (2.5–3.5kgs).
- Large for Gestation Age (LGA): Babies who are too large at birth (3.5–4.0kgs). A baby can be LGA irrespective of prematurity and birth weight factors. The LGA baby may be large because both parents may be big; but the LGA factor could be problematic if the mother suffers from diabetes.
At 0–1month of age the baby is prone to infection as it has low immunity (its body does not have enough antibodies to fight the infection). Medication in such cases is given intravenously.
In western world babies do not suffer from malnutrition like in India. Therefore the western parameters of prematurity cannot be adapted in our country as our problems are entirely different, states Dr. Bavdekar.
At Birth
At birth the Neonatalogist checks whether the baby’s ABC is fine.( Airway, Breathing and Circulation). Smaller the baby the longer he takes to breathe on his own. If the baby has low birth weight he is admitted to the Neonatal Intensive Care Unit where his condition is monitored till such time that the neonatalogist has confirmed that the baby is fine. This could last from 1 to 15–20 days. The newborn is also admitted to the ICU if there are complications at birth such as obstructed stomach which may cause the child to go through surgery.
Bathing
After the baby gives out a lusty cry it is given his first bath to wash away the mother’s secretion that is all over its body. The baby is then wrapped in soft cloth to keep warm and then handed over to his mother.
After Birth
Newborns should not be given a bath regularly as they are sensitive to extreme temperature changes. The room should be warm and in winter give your baby a bath later in the day. Bathing the baby is a cultural activity. Each region has its own baby bathing styles, handed down by grandma. Perfumes like camphor can be used. You can also use massage oils. Oils will help your baby grow better. But don’t put oil or anything into the baby’s nose, ear or mouth or rub oil on its umbilical chord. Do not apply kajal, as it is likely to irritate the little one’s eyes.
The best manner to bathe your baby: Gently place the newborn in a tub of warm water with his head held up. Wash the baby externally with a mild soap. Use a clean towel to dab your baby dry. Do not rub with towel, as his skin is sensitive. Wrap your baby with clean and warm cotton clothing immediately. This is essential as there is a chance for your baby to get hypothermia.
Your newborn can develop a skin condition called cradle cap or seborrhic dermatitis on the scalp due to poor hygiene. Some babies get it, some don’t. It can be treated by your pediatrician.
If your baby is on breast milk you don’t need to supplement him with top milk. The baby usually needs a stimulus to start suckling on the breast. Mother’s milk is the ideal food for a new born as it contains many ingredients that we still do not know about, apart from the essential proteins, fats and carbohydrates. Cholesterol in the mother’s milk is rich in antibodies and nutrients that prevent infection and nutritional disorder, according to pediatrician Dr. Ram Dongade.
The First Feed
The newborn has to be breast–fed every two–three hours. Normally a baby is fed within half to one hour after birth. When a low birth weight baby is admitted in ICU, the mother expresses her milk, which is kept in a container. The mother’s milk is then fed to the newborn intravenously or via naso–gastric tube (NGT) from nose to stomach with the help of syringe.
If your baby is of normal weight, you can usually start feeding the newborn within 24–48 hours.
Sometimes due to a difficult delivery the mother may take longer to lactate. In this case other formulas like tinned milk can be used. Care must be taken that the baby is fed the milk hygienically. In case of caesarian delivery, lactation is encouraged as soon as the mother recovers from the effects of anesthesia. This generally can take 48–72 hours.
It is not necessary to wake up your baby for a feed. Your baby will wake you up instead! Normally a baby sleeps for 5–6 hours between feeds. The intervals between feeds will grow longer as the baby grows. If the baby is small he/she will have a smaller stomach, therefore the interval between feeds will be shorter. As compared to breast–fed babies those taking top milk are more prone to suffering from diarrhea and sepsis. Breast milk is your baby’s only diet till he/she is four months old.
Weight
If your baby is breastfed he is getting enough nutrition. It is normal for your baby to lose ten per cent of birth weight during day 1 to 10 of life. During this time your newborn will throw up all the secretions, which it doesn’t require now. It is important that your baby must start regaining weight by day 20.
Diapers
Every time the baby wets and passes stools, the diaper should be changed. The baby’s skin is soft. When it is exposed to urine, which is excreted material, it can cause skin rash or eczema on your baby’s buttock. To ease the discomfort due to nappy rash you can apply a good baby lotion or baby cream on the area. If the irritation due to nappy rash doesn’t ease in a couple of days, consult your doctor.
The baby must pass urine and stool within 24–48 hours of its birth. Refer to a doctor if this is not so. If your baby is passing urine frequently, it indicates that he/she is getting sufficient breast milk, informs Dr. Dongade. It is normal even if the baby doesn’t pass stools in the beginning. It is normal for the baby to pass one to even 15 stools in a day. In the first two–three days, the stools are meconium (black stools that stick to the diaper). From the third day onward, the baby’s stools will be a little watery. This is not diarrhea. These are known as Transition stools.At the end of the first week the newborn passes stools, which are golden in color and semi–solid form (i.e. if the baby is breast–fed. If the baby is on formula food the stool will be formed.). It is best advised to consult your pediatrician if your baby’s stool has blood or is green in color.
Your newborn’s bedroom must be well ventilated. Keep the bedding dry in baby’s bed or crib. Change your baby’s bed sheet and pillow cover everyday. Your newborn is likely to become cranky if he is feeling hot or wet.
Do not let people who are ill hold your baby. The baby is likely to catch an infection easily.You can take your baby outside, though it is not advisable to take a newborn to a crowded place such as a party or on a visit to a relative at least till the baby has taken its vaccinations.
During 0–2 weeks of birth the newborn must be given Hepatitis–B and BCG vaccinations and 0ral–Polio drops. Tetanus dose is also given to the mother while she is pregnant so the fetus does not get any infections. Once the baby is on his own, the tetanus dose is repeated in Triple Vaccination i.e. Diphtheria + Pertusis (for whooping cough and cold) + Tetanus at six weeks after birth.
A Healthy Baby
Every two out of three babies suffer from neonatal jaundice, which develops on day 3 and is likely to subside by day 7–10 of life in normal baby and day 15 in a pre–term baby. If your baby’s jaundice persists after 15 days it is pathological jaundice and must be looked into by the pediatrician.
Babies admitted into the ICU are considered high–risk cases and need constant monitoring. In the ICU, the physical and mental development, visual and hearing (jaundice can cause hearing defects!) senses are checked to ascertain whether the newborn is developing normally and turning normally. For other problems, such as when the baby does not cry at birth or the baby could be suffering from convulsions or the newborn has stiffness in limbs, he has to be treated specifically under the care of specialists. Some infections are related to birth e.g. a mother who has malaria or typhoid while she is pregnant can pass it on to the neo–natal at birth.
Mortality Factology
In western countries Infant Mortality Rate (IMR) varies between 7–8 per cent. In India, the Infant Mortality Rate is very high due to high Neonatal Mortality Rate (NMR) and varies state–wise, states Dr. Bavdekar. According to a three–year field trial during a neo–natal care program in rural India the intervention reduced deaths of newborns from bacterial infections by 76 per cent. The data also indicated that septicemia, meningitis and severe pneumonia (the three together are termed as sepsis) were the most common cause of neonatal mortality in these areas. Emphasis on early detection and treatment of those infections was found the best way to counter increasing rate of newborn mortality.
Public awareness campaigns in urban and rural areas in the country must address the fact that mother’s health and newborn’s health are related, states Dr. Dongade. The programs must also stress on the importance of hygiene, he adds. It is essential that non–governmental and governmental agencies mobilize resources to reduce the incidence of stillborn babies as well the high mortality rate in live births. At least for the sake of ensuring good neonatal health and the vision of a healthy tomorrow for every infant.
When did you deliver your Baby?
- Premature delivery: Less than 37 weeks.
- Normal delivery: At 37 weeks.
- Mature delivery: At 37–40 weeks.
- Post–mature: At 40 weeks or more.
- Low birth weight: Less than 2.5kgs.
- Normal birth weight: 2.5kgs.
- A baby looses his umbilical chord on day 5–6.
- Crying is good for lungs and heart.
- Height is 50cms at birth (approx). Height increases variably and must be 68cms at six months and 75cms at one year.
- Weight must double by five months and triple by one year.
- Babies in India are said to cross most milestones (like social smile, turning, rolling, crawling, sitting, talking, walking) faster than counterparts in the western world.