Management of the Newborn

As pediatricians, we try our very best to be present during every birth of a newborn baby. This is because, we know that the most critical period in a newborn is the first twenty four hours after birth. 

It is good practice that we have to know the maternal history of the mother prior to delivery, like:
-the age and the parity of the mother
-the blood type
-history of illnesses during pregnancy
-intake of any medications during pregnancy
-and the course and manner of delivery

All of these are essential to the overall assessment of the newborn.

At the delivery room, the radiant warmer should be prepared so as to give warmth to the newborn. 

There must be a functioning suction machine, a full oxygen tank, ambu bag with newborn mask, intubation sets with endotracheal tubes appropriate to the size of the newborn, warm dry towels to wipe the baby dry and functioning suction bulb.

The immediate care of all newborn babies include the following:
-initial care
-clinical appraisal
-resuscitation
-temperature regulation
-and physical examination.

Initially, gentle suctioning of the baby’s mouth and nostrils is done to clear the secretions. The nose is suctioned last in order to avoid a sudden inspiratory gasp or the stimulation of the gag reflex which may result in the aspiration of the amniotic fluid in the mouth. 

Suctioning of the nose can also check on the patency of the posterior nares.

In doing clinical appraisal, we use the APGAR Score. It is recorded at 1 minute and again at 5 minutes. 

With depressed infants, the scoring is continued every five minutes as needed. Babies with a score of 7-10 at 1 minute are considered vigorous, a score of 4-6 are moderately depressed, and a score of 0-3 are severely depressed. 

The 1 minute scoring gives the clue for immediate interventions and resuscitation and the score at 5 minutes is more valuable in predicting mortality and the neurologic outcome of the surviving infants at one year.

APGAR Score is explained below including what it stands for:
* A-appearance ( color) whether the baby is blue, pale or pink
* P-pulse ( heart rate), this is the most important parameters in the Apgar scoring. It should be between 100-160/ minute
* G-grimace  ( slapping the sole of the foot) either no response, grimace or cry, cough or sneeze
* A-activity ( muscle tone) either baby is limp, some flexion or active motion
* R-respiratory effort, either no respiration, slow or irregular and or good strong cry

Once the newborn is assessed by the pediatricians and is stable, then, routine newborn care will be given. The routing care includes the following:
– anthropometric measurements
– giving of Vitamin K
– giving of Hepatitis B vaccine
– giving of eye prophylaxis
– giving of BCG vaccine
– and the most important is the initiation of “Unang Yakap”.

It is also salient to include the following parameters:
– newborn screening test
– newborn hearing test
– and Cyanotic Congenital heart disease screening.