pediatrics
Care of the Normal Newborn
Routine Care and Observation of the Newborn
Neonates can be bathed (if the parents wish) once their temperature has stabilized at 37°C for 2 hours. The umbilical cord clamp can be removed when the cord appears dry, usually at 24 hours. Umbilical cord care is aimed at reducing the risk of umbilical infection (omphalitis). The umbilical stump should be kept clean and dry; other care varies depending on the birth setting. In a hospital delivery (or properly managed home birth), where the cord is clamped and cut aseptically, dry cord care or cleansing with soap and water is adequate; topical agents do not decrease risk of infection. However, when cord clamping and/or cutting is not aseptic (eg, in some medically underserved countries, precipitous out-of-hospital deliveries), applying a topical antiseptic (eg,chlorhexidine) to the cord reduces the risk of omphalitis and neonatal mortality. The cord should be observed daily for redness or drainage. , if there is a family history of bleeding disorders, or if the neonate has displacement of the urethral meatus, Hypospadias , or any other abnormality of the glans or penis (because the prepuce may be used later in plastic surgical repair). Circumcision is usually delayed until at least after the first void; not voiding within 12 hours of the procedure may indicate a complication. Circumcision should not be done if the neonate has hemophilia or another bleeding disorder. Most neonates lose 5 to 7% of their birth weight during the first few days of life, primarily because fluid is lost in urine and insensibly and secondarily because meconium is passed, vernix caseosa is lost, and the umbilical cord dries. In the first 2 days, urine may stain the diaper orange or pink because of urate crystals, which are a normal result of urine concentration. Most neonates void within 24 hours after birth; the average time of first void is 7 to 9 hours after birth, and most void at least 2 times in the 2nd 24 hours of life. A delay in voiding is more common among male neonates and may result from a tight foreskin; a male neonate’s inability to void may indicate Urethral valves . If an infant has been circumcised, lack of voiding within 12 hours of the procedure may indicate a complication. If meconium has not been passed within 24 hours, the clinician should consider evaluating the neonate for anatomic abnormalities, such as Anal Atresia , 