Integrated Maternal and Newborn Care Basic Skills Course ...

• Temperature: Take the axillary temperature of the baby with a clinical thermometer cleaned
with an alcohol swab (normal = 36.5-37.5 °C) at least once in the six hours. At other times,
at least verify the body temperature by touching the abdomen, palms, and soles and ensure
that they are all warm. If they are cold, recheck axillary temperature. If the palms and soles
are cold or blue, it suggests that the baby is
not warm enough. If the abdomen is cold, it
suggests an even more severe
hypothermia. Rewarm the baby, preferably
by placing in skin-to-skin contact with the
mother’s chest and covering the baby with
layers of clean cloth and a blanket. If,
however, this does not warm the baby, it
represents a serious danger sign that
necessitates urgent referral.
• Monitoring for danger signs: These signs,
adapted from research studies, are noted in
the adjacent box and described in greater
detail in the session on major neonatal
infections or “sepsis.”
• Assess for major defects that need special
inputs. Asses for these defects if they have
not been monitored soon after birth:
o cleft lip and palate (needs additional
support for feeding and may need
feeding of expressed breast milk with a
cup/spoon)
o esophageal atresia (usually associated
with excessive secretion in the mouth)
o ‘open’ spinal defects
o imperforate anus
Danger Signs
• Sucking poor or weak or not
sucking at all
• Inactivity/lethargy/moving only on
stimulation
• Fever/body too hot or
hypothermia/body too cold
• Rapid breathing/difficulty in
breathing
• Convulsions
• Persistent vomiting/abdominal
distension
• Severe umbilical infections
(redness/swelling surrounding the
umbilicus and/or foul smell with or
without pus)
The first five signs are the most important.
Although all the danger signs have been
listed for completeness, the last three
more often appear later in the postnatal
period. Related to the cord, on the first day
or two look particularly for oozing of blood/
bleeding for which the cord must be retied
properly.
If the baby is normal and no danger signs are noted, provide any routine care due and reassure
the mother. If there are any problems/danger signs take the necessary steps promptly.
In this period the baby continues to need basic care such as temperature maintenance, cord
care, cleanliness, steps for prevention of infection, and exclusive, frequent breastfeeding on
demand. Administer the first vaccines such as a dose of oral polio vaccine, BCG, and hepatitis
B based on the recommendations of the Ministry of Health.
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Integrated maternal and newborn care
Basic skills course