Oxford Handbook of Midwifery (123 page)

Contraindications

Follow-up

Intrauterine device

cycle pattern, in order for the doctor or nurse/midwife to calculate and

fit the IUD
, in good faith
, e.g. up to day 20 in a 28-day cycle.

Pre-insertion infection screen

Follow-up

1
Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit (2009).
New Product Review (October 2009) Ulipristal Acetate (ellaOne
^®
)
. London: Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit.

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Part 6
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Care of the newborn

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Care of the newborn
‌

Chapter 23

577

Examination of the newborn: monitoring progress
578

Reflexes in the newborn
580

Screening tests
581

Growth
582

Minor disorders of the newborn
586
Neonatal temperature control
588
Hypoglycaemia
592

Advice to parents: reducing the risk

of sudden infant death syndrome
594

Bed sharing
596

Neonatal infection
598

Neonatal jaundice
604

Vomiting in the newborn
610

Metabolic disorders and the neonatal blood spot test
614

Developmental dysplasia of the hip (DDH)
620

Birth injuries
622

Congenital abnormalities
624

Heart murmurs in the newborn
626

Management of the small for gestational age baby
628

Management of the preterm baby
634

Respiratory distress syndrome in the newborn
640

Respiratory problems in the newborn
644

Neonatal abstinence syndrome
648

Safeguarding children
650

CHAPTER 23
Care of the newborn

578‌‌

Examination of the newborn: monitoring progress

The purpose of the examination of the newborn is to monitor the normal progress of the baby and for early detection of deviations from normal.

During the examination advice can be given to the parents about minor disorders (b see Minor disorders of the newborn, p. 586) and safe baby care practice, such as the correct amount and type of clothing and bedding needed and correct sleeping position, to reduce the risk of sudden infant death syndrome (SIDS). Information can also be gained about the baby’s overall feeding and sleeping pattern.

The midwife will monitor and record the following information.

• With the mother’s permission the baby should be undressed and examined in a draught-free environment. Care is taken not to expose the baby longer than necessary and he/she should be re-dressed as quickly as possible to maintain body temperature.
  
• Colour: the baby should not be pale, cyanosed, or jaundiced. The skin is inspected for rashes and spots.
  
• Temperature: the chest and back should feel warm. If the hands and feet are cool mittens and bootees can be put on.
  
• Respirations: should be regular, up to 40 per min with no dyspnoea or expiratory grunt.
  
• Muscle tone should be neither floppy nor stiff.
  
• The eyes, nose, and mouth should be inspected for discharge or other signs of infection.
  
• The umbilicus is inspected for signs of cord separation and advice given
  about washing the umbilicus as part of the daily bath. The cord may
  

  need to be cleaned during the nappy change and warm tap water is sufficient for this purpose. The cord usually separates during the first 10 days of life.
  

• The nappy area is inspected for signs of rashes and the mother can be asked whether the baby is passing urine and stools regularly.
  
• The baby should pass urine during the first 24h after birth and then urine output is governed by the baby’s intake of food and fluid. Wet nappies signify a good fluid intake.
  
• The first stools will be meconium, a soft black sticky substance which accumulates in the gut in fetal life. Passage of meconium confirms the patency of the lower gut.
  
• After a few days of feeding the stools change colour to green/brown as the milk starts to be digested. Passage of a changing stool confirms the patency of the upper digestive tract.
  
• Yellow stools confirm that milk is being fully digested. A breastfeeding baby may pass stools several times per day or only once every few days depending on its intake. Formula-fed babies should pass stools each day.
  
• Weight should be recorded on the 10th day to ensure the baby has regained its birthweight. Weight recording between birth and the 10th day would be performed if there were any other concerns about the baby’s progress. Evidence-based local midwifery guidelines on weighing should be followed.
  

  MONITORING PROGRESS
  

  579
  

  

  If the mother expresses any concerns that the baby is not progressing as expected, advice should be given and the baby re-examined later the same day. A baby showing signs of illness such as lethargy, poor tone, breathing or feeding difficulties, needs to be referred to a paediatrician as a matter of priority.
  

  CHAPTER 23
  Care of the newborn
  

  580‌‌
  

  Reflexes in the newborn
  

  Reflexes are incorporated into the neurological examination performed by the paediatrician or suitably trained midwife following birth. Reflexes are involuntary reactions to external stimuli such as touch, sound, and light. Certain stimuli evoke specific reactions that give reassurance regarding normal neuromuscular development. Inborn reflexes are move- ment patterns that develop during fetal life and are crucial for survival of the newborn. All reflexes have their own time span—an infant exhibiting reflexes after this time indicates neurological impairment.
  

  Common reflexes observed in the newborn infant
  

• Rooting reflex
  : a very common reflex observed by midwives. When the cheek is brushed lightly with the finger, a soft object or the nipple, the baby’s head will turn to the side being stimulated and he or she will open their mouth wide. A mother wishing to breastfeed will be advised to use this reflex to encourage the baby to open the mouth to receive the nipple and ensure successful attachment to the breast.
  
• Grasping reflex
  : stroking or applying pressure to the palm of the hand will result in the baby making a clenched fist. This reflex is very strong in the newborn baby. A weak reflex may indicate neurological disturbance.
  
• Sucking reflex
  : when the root of the baby’s mouth is touched with a clean finger or a teat, the baby spontaneously starts to suck. This
  

  response begins at about 32 weeks’ gestation, but is not fully developed until 36 weeks’ gestation. Therefore premature babies may well have a weak sucking reflex.
  

  •
  Moro reflex
  : also known as the ‘startle’ reflex. This reflex is initiated by
  

  startling the baby, usually by supporting the baby supine on the hand and forearm. When the baby is relaxed the head is suddenly dropped back a few centimetres. The baby then flings his or her arms open, with the hands open and fingers curled in slightly. This is followed by drawing the arms back towards the chest in an embrace like position. This may be accompanied by the baby grimacing or crying. This reflex may also be stimulated by sudden noise.
  

• Walking or stepping reflex
  : the significance of this reflex is not fully understood. When the baby is held under the arms in an upright position over a flat surface, the baby will make stepping movements forwards.
  
• Tonic neck reflex
  : with the baby lying on his or her back, when the head is turned to one side, one arm and leg are extended in the direction that the baby’s head is facing. The opposite arm and leg are in a flexed position.
  
• Babinski reflex
  : stroking the sole of the foot from heel to toe will result in the baby’s toes fanning out and the foot turns inwards. This reflex is present until the age of 2 years.