CARING THE BABY

Universal neonatal screening for eye anomalies is recommended. This should be accompanied by diagnostic and treatment services for infants in whom an abnormality is detected.
An estimated 1.14 million children aged 0-15 years are blind or have severe visual impairment due to eye conditions. The main causes of blindness are congenital and developmental cataracts, corneal scarring, congenital ocular anomalies, retinal dystrophies, glaucoma, and retinopathy of prematurity.

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.
 

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

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.

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