Prematurity

Screening tests are required for the following conditions:
- Inborn errors of metabolism and heart diseases. The tests should be carried out with a dried blood spot sample (heel prick), within 24 to 36 hours of birth. The number and type of diseases that should be screened depends on the screening package offered in each country.
- Critical congenital heart disease. This should be tested with pulse oximetry within 24 hours of birth.
Neonates requiring supplementary oxygen should be screened after 24 hours of being clinically stable, in ambient air.

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.
 

For all neonates it is recommended topical ocular prophylaxis for the prevention of gonococcal (Neisseria gonorrhoeae) and chlamydial (Chlamydia trachomatis) ophthalmia neonatorum.

The following are recommendations to consider when hospital discharge after neonatal admission, and even if the baby was born healthy and at term:
· avoid exposing the patient to crowds of people;
· avoid passive exposure to smoke from parents and other family members;
· limit contact between newborns and infected people as much as possible.
If parents and close caregivers present signs of flu or a cold:
· increase personal hygiene precautions, including hand hygiene;
· put a mask or a handkerchief over the mouth and nose while caring for newborns;

After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
If birth is at home, the first postnatal contact should be as early as possible within 24 hours of birth.
At least three additional postnatal contacts are recommended for all mothers and newborns, on day 3 (48–72 hours), between day 7–14, and 6 weeks after birth.

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).

• Choose a location for the bath without drafts, during the warmest part of the day.
• Have all necessary items ready in advance and close at hand: towel, soap, clothes, diaper, blanket.
• Bathe daily or more than once a day, if necessary (if the newborn is restless, crying, hot, feverish...).
• Do not use alcohol in bath water; it dries the skin and irritates the mucous membranes. and it is dangerous.
• Do not use lotions, perfumes, talcum powder, or ointments.
• Dry skinfolds thoroughly.