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The Merck Manual--Second Home Edition logo
 
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Chapter 263. Normal Newborns and Infants
Topics: Introduction | Initial Care | Physical Examination | First Few Days | Feeding | Stools and Urine | Sleeping | Physical Development | Behavioral, Social, and Intellectual Development | Promoting Optimal Development | Preventive Health Care Visits | Vaccinations
 
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Initial Care

Immediately after a baby is born, the doctor or nurse gently clears mucus and other material from the mouth, nose, and throat with a suction bulb. The newborn is then able to take a breath. Two clamps are placed on the newborn's umbilical cord, side by side, and the umbilical cord is then cut between the clamps. The newborn is dried and laid carefully on a sterile warm blanket or on the mother's abdomen.

click here to view the figure See the figure Cutting the Umbilical Cord.

The newborn is then weighed and measured. The doctor examines the newborn for any obvious abnormalities or signs of distress; a full physical examination comes later. The newborn's overall condition is recorded at 1 minute and at 5 minutes after birth using the Apgar score. A low Apgar score is a sign that the newborn is having difficulty and may need extra assistance with breathing or blood circulation. However, contrary to what people may think, babies with low Apgar scores are not more likely to develop certain problems, such as cerebral palsy or permanent disabilities.

Keeping the newborn warm is critical. As soon as possible, the newborn is wrapped in lightweight clothing (swaddled), and the head is covered to reduce the loss of body heat. A few drops of an antibiotic are placed into the eyes to prevent infection from any harmful organisms that the newborn may have had contact with during delivery.

The mother, father, and newborn usually recover together in the delivery room. If the delivery is in a birth center, the mother, father, and newborn remain together in the same room. If the mother is breastfeeding, she puts the infant to her breast within the first 30 minutes. Once transported to the nursery, the newborn is placed on his side in a small crib and kept warm. Placing the baby on his side prevents fluid or mucus from blocking the airway and impeding breathing. Because all babies are born with low levels of vitamin K, a doctor or nurse administers an injection of vitamin K to prevent bleeding (hemorrhagic disease of the newborn).

About 6 hours or more after birth, the newborn is bathed. The nurse tries not to wash off the whitish greasy material (vernix caseosa) that covers most of the newborn's skin, because this material helps protect against infection.

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