What are the essential care and management steps for a newborn?

Essential Care and Management Steps for a Newborn

Immediately after delivery, dry and stimulate the newborn for first breath while implementing skin-to-skin contact with continuous monitoring, followed by standardized safety protocols for rooming-in that prioritize airway patency and fall prevention.

Immediate Post-Delivery Care (First Minutes)

Initial stabilization and drying:

• Dry the entire newborn except the hands immediately after delivery to stimulate breathing while allowing the infant to suckle hands bathed in amniotic fluid 1, 2
• Cover the dried body with prewarmed blankets to prevent hypothermia 1
• Assess whether the newborn meets criteria for routine care: term gestation, good muscle tone, and breathing or crying 2

Skin-to-skin contact initiation:

• Place the dried infant skin-to-skin on the mother's chest immediately after birth for all stable newborns 2
• Cover with dry linen to maintain normal temperature 2
• Position the newborn with face visible and airway unobstructed at all times 3
• Provide direct observation of the mother-infant dyad while in the delivery room 3

Critical monitoring parameters:

• Continuous observation by trained staff with frequent vital sign recording 2
• Assess breathing, activity, color, tone, and position to prevent airway obstruction 2
• Use pulse oximetry with neonatal-specific probes if concerns about central cyanosis exist, rather than relying on visual assessment alone 2
• Observe the first breastfeeding session directly 3

Contraindications and High-Risk Situations

Postpone or modify skin-to-skin care when:

• Newborn requires positive-pressure resuscitation 3
• Apgar scores less than 7 at 5 minutes 3
• Medical complications from birth requiring stabilization 3

Postpartum Rooming-In Safety Protocol

Standardized monitoring approach:

• Conduct frequent assessments of the mother-infant dyad with particular attention during nighttime and early morning hours 3
• Monitor higher-risk dyads every 30 minutes during nighttime and early morning hours 3
• Document maternal and newborn assessments and any changes in conditions 3

Fall prevention measures:

• Use fall risk assessment tools for mothers 3
• Implement maternal egress testing, especially if the mother is using medications that may affect stability in ambulating 3
• Review and demonstrate proper use of equipment such as bed rails and call bells with mothers and families 3
• Use patient safety contracts focusing on high-risk situations 3

Safe sleep positioning:

• When the mother is tired or sleepy, move the infant to a separate sleep surface (side-car or bassinet) next to the mother's bed 3
• Never allow bed-sharing when mother is fatigued 3

Breastfeeding Support

Positioning and timing:

• Support cue-based feeding during rooming-in 3
• Breastfeeding is preferred over formula feeding as it decreases gastroesophageal reflux frequency 4
• Avoid overfeeding and provide frequent burping during feeding 4
• Maintain upright positioning in caregiver's arms after feeding 4

Critical Pitfalls to Avoid

Sudden Unexpected Postnatal Collapse (SUPC) prevention:

• SUPC is rare (2.6 to 133 cases per 100,000 newborns) but potentially fatal, with one-third of events occurring in the first 2 hours of life 3
• Many SUPC events are related to suffocation or entrapment during unmonitored skin-to-skin care 3
• Never leave mother-infant dyads unobserved, especially during the first 2 hours and during nighttime hours 3

Airway obstruction prevention:

• Continuously ensure the newborn's face is visible and airway unobstructed during skin-to-skin contact 3, 2
• Assess maternal fatigue periodically and transition infant to separate sleep surface when mother becomes sleepy 3

Environmental safety:

• Avoid secondhand smoke exposure 4
• Ensure proper function of all mother-infant equipment 3