CARING THE BABY

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.

It is essential to ensure that all newborns are routinely monitored for the development of jaundice and that serum bilirubin should be measured in those at risk:
• in all babies if jaundice appears on day 1
• in preterm babies (<35 weeks) if jaundice appears on day 2
• in all babies if palms and soles are yellow at any age
Term and preterm newborns with hyperbilirubinaemia should be treated with phototherapy or exchange transfusion guided by the following cut-off levels of serum hyperbilirubinaemia shown in the table.

Stopping neonatal resuscitation is recommended in the following situations:
In newly born babies with no detectable heart rate after 10 minutes of effective ventilation
In newly born babies who continue to have a heartrate below 60/minute and no spontaneous breathing after 20 minutes of resuscitation

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.

Immediately after birth, it is recommended to dry the baby with a clean, dry compress, check that he/she is breathing or crying and place him/her on the skin of the mother's abdomen while waiting for the delayed clamping of the umbilical cord.
Routine nasal or oral suction should not be done for newborns who start breathing on their own after birth, unless secretions are observed. Suctioning of mouth or nose is not recommended in neonates born through liquor with meconium who start breathing on their own, nor tracheal suctioning