Immediately after birth

• Keep baby warm
• Skin-to-skin contact is important for establishing breast feeding
• Well growth term infants have little calorific intake in the first 24 hours
• Allow attachment
  • Babies often very alert immediately after delivery
  • Hormonal and emotional response to infant

Vitamin K

• Babies are born with a deficiency of vitamin K
• Vitamin K given in the newborn period given to prevent haemorrhagic disease of the newborn, which is a disorder of clotting (vitamin K dependent)
• IM preferred by clinicians, some parents might prefer oral

Out of the delivery room

• Initiate breast feeding or bottle feeding as soon as the baby is alert enough
• The first bath is usually delayed until this baby is warm and stable; can wait days without any issues
• Screening tests
  • Newborn examination - within 72 hours
  • Universal hearing screening
  • Hip screening - clinical exam, USS if risk factors present
  • Blood spot screening - taken on day 5
    • Sickle cell disease
    • Cystic fibrosis
    • Congenital hypothyroidism
    • Phenylketonuria
    • Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
    • Maple syrup urine disease (MSUD)
    • Isovaleric acidaemia (IVA)
    • Glutaric aciduria type 1 (GA1)
• Infection screen - based on maternal history
  • Hep. B - consider immediate vaccination/immunoglobin
  • Hep. C
  • HIV
  • Syphilis
  • TB
  • Group B streptococcus
• Early warning systems: anticipatory methods used to monitor babies at risk e.g. newborn early warning score
• Vaccination
  • Maternal pertussis and influenza vaccines
  • Routine vaccination schedule
  • Consider other vaccines - Hep. B at birth, BCG in first month - depending on risk factors

Management of a sick newborn

Initial management

• Stabilise temperature - 36.5-37.4℃
• Airway and breathing - gentle support (e.g. open airway), consider oxygen as needed