If the mother is HIV positive, the newborn should first be tested for HIV: if the child tests negative for HIV at 5 weeks of birth, he/she can get vaccinated with BCG.
In the case of hepatitis B vaccine, whether the mother or the baby are positive for HIV, the newborn can safely receive this vaccine as soon as possible after birth.
Maternal and neonatal immunization refers to immunization prior to pregnancy, during pregnancy, and during the post-partum period that is intended to provide protection to both the mother and her child.
This is a critical concept, as neonates and premature infants are particularly vulnerable to infections with vaccine-preventable diseases. Additionally, their immature immune systems cannot mount protective immune responses to specific vaccine antigens until several weeks or months after birth. This creates a gap during which newborns are extremely vulnerable.
The following signs should be assessed during each postnatal care contact and the newborn should be referred for further evaluation if any of the signs is present:
- stopped feeding well
- history of convulsions
- fast breathing
- severe chest in-drawing
- no spontaneous movement
- temperature >37.5 or <35.5 °C
- jaundice in the first 24 hours of life, or yellow palms and soles at any age.
The family should be encouraged to seek health care early if they identify any of the above danger signs in-between postnatal care visits.
It is very important to control the temperature of the newborn baby. Cold hands and feets are characteristic of healthy babies; it does not mean that they feel cold.
The permanent proximity of the mother facilitates skin-to-skin contact, a situation favoring the maintenance of the baby's temperature.
It is recommended that bathing be delayed, if possible over 24 hours after birth, and that the environment where the newborn baby is placed be free of air currents.
When there is a medical indication to administer a human milk substitute for a specific situation, it must be prepared under safe conditions.
• Wash hands.
• Boil filtered water (after it begins to boil, wait 15 minutes), and then allow to cool to room temperature.
• Use the quantity of water corresponding to the quantity of feed desired; for every 30 ml of water add one level measure of milk powder.
• Shake the feeding bottle until the powder is totally dissolved.
• Milk should be prepared at the time of each feeding.
Skin irritations can be caused by prolonged contact with urine and feces. To avoid them, the diaper should be changed as often as needed. It is important to clean the baby with water and neutral soap after bowel movements, and to keep the diaper region dry.
• Change diaper frequently.
• Wash the region with neutral soap.
• Keep the skin clean and dry, especially in folds and grooves.
• After washing, dry the area well and powder with dry cornstarch in the affected region.
• Wash the infant’s clothes separately, rather than together with adult clothing.
• Use coconut oil soap or other neutral soap with less acid; do not use bleaches, powdered soaps, softeners with perfume, or bleach solutions (these products have chemicals that contact the baby’s skin, causing allergies).
• After washing, rinse thoroughly so that there is no residue from the cleaning agent on the fabric.
• Hang to dry in the sun (if possible) and iron (to eliminate microorganisms).
To reduce transmission of respiratory viruses during rooming-in and after hospital discharge, provide guidance to health professionals and family members on the following precautions:
• health professionals: disinfect hands before and after contact with patients.
• isolate patients hospitalized with suspicion of respiratory infection, with precautions that include:
· hand washing before and after contact with patients and their personal items;
· use of gloves and apron for contact with patients;
In newly-born babies who do not start breathing despite thorough drying and additional stimulation, positive-pressure ventilation should be initiated within one minute after birth.
- In newly-born term or preterm (>32 weeks gestation) babies requiring positivepressure ventilation, ventilation should be initiated with air,using a self-inflating bag and mask.
- In newly-born babies requiring positive-pressure ventilation, adequacy of ventilation should be assessed by measurement of the heart rate after 60 seconds of ventilation with visible chest movements.
Immediately after birth, it is recommended to dry the baby and check if he/she is breathing or crying. When newborns do not breathe or do not cry spontaneously after complete drying, they should be stimulated by rubbing the back 2 to 3 times before the cord clamping. The drying procedure should be gentle, on the back, with a clean, dry compress.
If after rubbing the back 2 to 3 times the baby does not breathe or cry, clamping of the umbilical cord is recommended to initiate positive pressure-ventilation within the first postnatal minute.