Health professional

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

After birth, breastfeeding is initiated by the newborn if he/she is in direct and uninterrupted skin-to-skin contact with the mother for at least one hour after birth.

Bathing should be delayed to after 24 hours of birth. If this is not possible at all due to cultural reasons, bathing should be delayed for at least 6 hours. Appropriate clothing of the baby for ambient temperature is recommended, this should be 1–2 layers more than adults and a hat.
The mother and baby should not be separated and should stay in the same room 24 hours a day

Clean, dry cord care is recommended for newborns born in health facilities, and at home in low neonatal mortality settings.
Daily chlorhexidine (4%) application to the umbilical cord stump during the first week of life is recommended for newborns who are born at home in settings with high neonatal mortality (neonatal mortality rate >30 per 1000). Use of chlorhexidine in these situations may be considered only to replace application of a harmful traditional substance
 

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 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.

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;

Mothers with normal babies (including those born by caesarean section) should stay with them in the same room day and night, from the moment they come to their room after delivery (or from when they were able to respond to their babies in the case of caesareans) except for periods of up to an hour for hospital procedures.
This practice rooming-in should start no later than one hour after normal vaginal deliveries. Normal postpartum mothers should have their babies with them or in cots by their bedside unless separation is indicated for medical reasons.

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.