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Immediate care of the newborn

  • Procedure

Dry, place skin to skin, clamp the cord without hurry, score the Apgar, identify, give the prophylaxes and start breastfeeding in the first hour.

Updated

What it is

Immediate newborn care supports the baby's adaptation to life outside the womb. If the baby is born well, it is dried on the mother's abdomen, stays skin to skin, the cord is clamped late and breastfeeding starts during that contact. The prophylaxes, measurements and full examination wait until after the first hour, within the mother's sight. If the newborn does not breathe, neonatal resuscitation starts per the current guideline.

Indications

  • Every birth in the facility, vaginal or by caesarean.
  • Vigorous newborn: immediate care next to the mother.
  • Newborn who does not breathe or has poor tone: neonatal resuscitation starts and the routine steps wait.

Contraindications and precautions

  • Delivery room at 23 to 26 °C to prevent hypothermia.
  • Routine airway suctioning is not recommended: only for thick meconium, blood or pus that obstructs, or respiratory depression from those causes.
  • Immediate or early clamping only in the situations the protocol defines, such as placental abruption or bleeding placenta praevia.
  • Handle the cord with sterile gloves.

Equipment

  • Dry, warm cloths or towels (at least two) and a cap.
  • A heat source and neonatal resuscitation equipment, checked and ready.
  • Clamps and sterile material for the cord, and a cord tie.
  • Identification band, clock and record form.
  • Eye prophylaxis and vitamin K per the institutional protocol.

Step by step (and why)

  1. Prepare the room, the warmth and the resuscitation equipment before the birth — resuscitation is never improvised.
  2. Dry the newborn on the mother's abdomen, head and face first — drying warms and stimulates breathing.
  3. Replace the wet cloth with a dry, warm one and put on a cap — the head loses a lot of heat.
  4. Watch breathing or crying and tone; if the baby does not breathe, start resuscitation — this is the priority.
  5. Clamp the cord late once it meets the criteria — improves the baby's iron stores.
  6. Keep skin-to-skin contact and support the start of breastfeeding — helps temperature, glucose and bonding.
  7. Score the Apgar at 1 minute and at 5 minutes — shows how the baby is adapting and whether help is needed.
  8. Put the identification band on in front of the mother — prevents identity errors.
  9. After the first hour, give umbilical care, eye prophylaxis and vitamin K per protocol, and record it all — prevents infection and bleeding.

Complications

  • Hypothermia from incomplete drying, wet cloths or separation from the mother.
  • Breathing difficulty or depression at birth that needs resuscitation.
  • Hypoglycaemia, jaundice or birth injuries: looked for in the exam in the first hours.
  • Misidentification if the band is put on away from the mother or with incomplete data.
  • Bleeding from the cord stump if the tie is not secure.

Next step: when to call for help

  • Call at once if the newborn does not breathe, has poor tone or an Apgar below 7 at 5 minutes.
  • Call for grunting, nasal flaring, retractions, central cyanosis, low temperature that does not improve or cord bleeding.
  • Call if the mother has positive results for syphilis, HIV, hepatitis B or toxoplasma, or there is a risk of neonatal infection.
  • Next step: vital signs every 6 hours for the first 24 hours and a full medical exam within the first 4 hours.

Test yourself

Think of the answer, then tap the question to see it.

Which five signs does the Apgar score assess, and when?

Heart rate, breathing effort, muscle tone, reflex irritability and colour, at 1 minute and at 5 minutes.

What does WHO recommend about the timing of cord clamping?

Delayed clamping, no earlier than 1 minute after birth.

Why is the newborn dried straight after birth?

Because it prevents heat loss and stimulates breathing.

When are the prophylaxes given to a healthy newborn?

After the first hour of skin-to-skin contact, within the first 90 minutes and within the mother's sight.

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Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta Integral de Atención para la Promoción y Mantenimiento de la Salud y de la Ruta Integral de Atención en Salud para la Población Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants (e-Library of Evidence for Nutrition Actions) (World Health Organization, 2014); Apgar score (MedlinePlus, U.S. National Library of Medicine, 2024); WHO urges quality care for women and newborns in critical first weeks after childbirth (World Health Organization, 2022).

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Representative model, for educational purposes only.