This section covers the normal care given to a healthy baby after birth. There will be variation if the baby or mother is unwell. For example, a premature or sick newborn may need resuscitation and transfer to the neonatal intensive care unit.
Immediately After Birth
Immediately after being delivered, the newborn will have:
- Skin-to-skin with the mother (usually placed on the mother’s chest)
- Delayed cord clamping (clamping of the umbilical cord is delayed by at least 60 seconds)
- Dried and kept warm
- Feeding is initiated as soon as the baby is alert enough
- Vitamin K injection (subject to parental consent)
- Measured for their birthweight
- Label with their name and details
Vitamin K
Vitamin K is an essential part of normal blood clotting. Newborns have low vitamin K, as it only crosses the placenta very slowly and is found in insufficient amounts in breast milk. All newborns are offered an intramuscular injection of vitamin K in the thigh shortly after birth (some parents may decline). It reduces the risk of vitamin K deficiency bleeding (VKDB), which can involve bruising, umbilical stump bleeding and intracranial haemorrhage.
Alternatively, vitamin K can be given orally. Three doses are given, one at birth, 4-7 days and 4-6 weeks. However, oral vitamin K takes longer to act, and absorption is less reliable (e.g., due to vomiting).
Skin to Skin Contact
Skin-to-skin contact involves putting the baby against the mother’s chest immediately after birth. This has several potential benefits:
- Helps warm the baby
- Facilitates bonding
- Calms the baby
- Improves breastfeeding
Fathers can also be involved and benefit from skin-to-skin contact with the baby, particularly if the mother is unavailable (e.g., after a caesarean section).
Further Management
Further considerations after the immediate postnatal period include:
- Newborn infant physical examination (NIPE) within 72 hours and at 6-8 weeks
- Blood spot test on day 5
- Newborn hearing test within the first few weeks
- Safe sleeping advice (e.g., cot in the same bedroom, sleeping on their back, avoiding smoking, etc.)
- Umbilical cord care (keep clean and dry and wait for it to fall off naturally)
- Midwife home visits
- Health visitor input after being discharged by the midwives
The newborn infant physical examination (NIPE) is performed within 72 hours and again at 6-8 weeks. The purpose is to detect any congenital abnormalities (e.g., birthmarks, heart murmurs, hip instability, or undescended testes) and address any concerns that the parents might have. Referrals are made if necessary.
The Newborn Hearing Screening Programme involves an automated otoacoustic emission (AOAE) test. The process takes a few minutes per ear. An earpiece is inserted into the ear, and clicking sounds are played. The device detects otoacoustic emissions (sounds) that are produced by the cochlea in response to this stimulation. Reduced or absent otoacoustic emissions suggest a possible hearing problem, prompting referral for further testing (e.g., an automated auditory brainstem response test).
Newborn Blood Spot Screening Test
The newborn blood spot test is a heel prick test, taken on day 5, that screens for 9 congenital conditions:
- 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)
- Homocystinuria
Results take 6-8 weeks to come back.
Last updated May 2025
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