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NEWBORN CARE 101

December 15, 2017

NEWBORN CARE 101

Nothing is more exciting (and perhaps more terrifying) than taking a brand new little baby home for the first time. In order to ease your mind—and hopefully allow you to truly enjoy those early days and weeks with your newbie—we’ve prepared some notes on important newborn stuff as it relates to the healing and care of the umbilical cord, circumcision aftercare, and what to know about jaundice. Of course we’ll also make note of when or if it’s time to call in the pediatrician.

UMBILICAL CORD CARE

As you may know, the umbilical cord helps baby get the nutrients they need from mom. Baby and mom’s blood don’t actually ever mix; everything is transferred through the placenta and umbilical cord. And babies don't breathe in the womb, of course, since they are living in the amniotic fluid, so they get all their oxygen and nutrients through their mom.

When baby is born though, they no longer need the placenta and so the cord needs to be cut. Baby starts breathing and feeding outside the womb now so there is no need to remain literally attached to momma.

DELAYED CORD CLAMPING

A common thing to consider today is something called delayed cord clamping. This is when you wait 30-60 seconds to cut the cord so that all the blood can finish transferring. This helps babies with their red blood cell count, reduces risk of anemia, and is especially helpful for premature babies. Some providers will actually wait for the cord to stop pulsating before cutting. This is a great idea and something you can ask your doctor for unless of course there is any trouble during birth with mom or baby, then your doctor will want to cut the cord more quickly.

THE BELLY BUTTON

The first day or two after the cord is cut and clamped, it will still be squishy, and after a few days it’ll get black, dried, and crunchy. This is completely normal and it can take 7-14 days for  that remaining bit to fall off on its own. When the cord comes off baby now has a belly button!

The number one priority when the cord is still attached is to keep that area dry. It can be a challenge with diapers, especially on very small babies, so you may need to fold the diaper down and inwards to reduce chance of rubbing and irritation. Also, folding the top of the diaper inward helps keep urine and poo in; no one wants that stuff having any extra chance of escaping!

Avoid full submersion baths right away. Instead, a sponge bath is a great option. Be cautious of the cord area and be sure to pat it dry. Ideally, we want this area to stay as dry as possible until the little bit that remains falls off on its own.

When the cord does fall off you might see a spot or two of blood, which is totally normally. You might also see light yellow, white, or clearish discharge. That’s also normal and should stop or go away after a couple of hours.

There’s also something called umbilical granuloma, which can sometimes look kind of scary as it often presents as a red puckering or skin tag. This is rare but it is normal and it often resolves on its own. If it doesn't go away or you want to be proactive it can also be easily removed by your pediatrician at a later time. There are no nerve endings in the umbilical granuloma so it is not painful to remove, if it doesn’t self-resolve.

Some things to look out for and call the doctor about include:

  • Significant redness around the umbilical cord area, especially if that gets worse over time
  • Hot to the touch
  • Baby is irritated/sensitive to touch in that area with a fever over 100.4 (time to call the pediatrician)
  • Purulent drainage (or pus), like snot or boogers but coming from the umbilical cord
  • Foul smell from that area (again, call the doc ASAP)
CIRCUMCISION CARE

Some religions require that a baby boy be circumcised. This can also be a cultural practice, though it is not as common as it once was since the evidence for circumcision being medically beneficial is minimal.

Having said that, circumcision has been thought to help with cleanliness and foreskin infections, something many medical professional insist good hygiene is often adequate for keeping at bay.

THE FIRST 24 HOURS

It’s important to make sure that baby has peed within 24 hours of circumcision because if we’ve mess with the plumbing we want to make sure the pipes still work! This can sometimes delay leaving the hospital as the doctor may want to make sure everything is working properly.

The doctor will likely dress the wound with petroleum jelly and gauze—be sure to check with your doctor on if they want you to redress it or only put some petroleum jelly on for the first few days. It really can vary by doctor. Either way you want to be sure it remains clean, washing away any pee or poop that might get on there and cause irritation or infection.

BLEEDING & SWELLING

The tip of the penis will of course be red, raw, and there may even be a few drops of blood - which is normal. But there should never be more than a quarter drop size of blood. Any more than that would be concerning so this would be a time to call your doctor, for sure!

You might also see little white dots on the tip, which is granulated tissue and that’s the skin at the circumcision site healing. Not to worry, that’s normal! This is a sign that things will start looking better soon, too.

The area may also swell a little bit at first but it should begin going down within a day or two.

THE DIAPER

Try to avoid allowing the diaper to stick to the area. This can be incredibly painful for baby so if it does happen be sure to use warm water and to very gently pull the stuck diaper portion off.

You may also wish to keep the diaper loosely fitted for a few days so that it doesn’t create too much discomfort or pressure on the area. However, for the first day or two it’s okay if the diaper is a bit tighter as that can sometimes create “good” pressure on the wound.

Pro Tip: Use two diapers! You can actually sneak some ice between two diapers to help with swelling and healing. The first diaper can be a bit loose and the second one a little tighter.

The padding of two diapers can actually help too if their squirmy legs accidentally bump the newly sensitive area.

MANAGING DISCOMFORT

If baby seems extremely uncomfortable you may also consider Tylenol (ask your MD first) and/or incorporating the 5S’s to help soothe baby.

Some warning signs to look out for:

  • Swelling doesn’t go down, or it goes down and then swells back up
  • Yellow discharge or drainage for more than a week
  • Foul smells
  • Fever over 100.4
  • Persistent redness after 4-5 days
  • Crusty or fluid-filled sores
  • Difficulty urinating
JAUNDICE

Jaundice is caused by the buildup of bilirubin which is produced by the liver when it processes old dead red blood cells.

Any seasoned parents out there will know that a baby’s first poop is almost like tar, black and sticky. This is called meconium and is so black because it’s got a lot of dead red blood cells in it that have been building up for the last 9 months! This sticky meconium poop can take a few days for the baby to pass out as their digestive tract gets working; because of this delay, there can be a buildup of dead red blood cells which may lead to jaundice.

IT’S RELATIVELY COMMON

Jaundice happens to about 60% of newborns and usually resolves itself within 2-3 weeks. It’s most common in babies whose sibling had jaundice, babies of East Asian descent, or babies that come out with bruises (sometimes from bumping against mom’s pelvis during birth). It can also happen more often to babies who are breastfed because sometimes it takes a few days for the breast to begin producing enough milk to get everything moving for baby.

TREATMENT

Jaundice is easily treated and while still at the hospital your doctor will check baby for it several times before going home. It’s also routinely checked for during the first few visits to the pediatrician.

Often, as jaundice progresses, you can actually see it move from head to toe and it’ll often get worse before it gets better. If your doctor has been monitoring babies jaundice levels, the only time to really worry is if it suddenly and severely gets worse or if you see yellow in the whites of babies eyes. This is especially worrisome if baby is also super sleepy and more difficult to wake up even during diaper changes or for feedings. If this happens, definitely call the doctor!

The best way to help baby work through jaundice is to get them eating and pooping, eating and pooping, eating and pooping. We’re talking 8-12 feedings per day (if by breast) and a bit fewer if by bottle.

If needed, the doctor may require baby to get phototherapy (think baby sun tanning) at the hospital.

NOTEWORTHY

Occasionally jaundice can make baby lethargic or sleepy. Be wary of this excessive sleepiness as it could be a more severe case that (in rare situations) can  cause brain damage and/or deafness! So don’t hesitate to call the doctor!

WHEN TO CALL THE DOC

While most umbilical cord care, circumcision aftercare, and jaundice are all totally manageable, as noted above, there are times where you should definitely call the doctor. Even outside of these instances, here are signs and things that warrant a call to the doc:

  • Any signs of infections, including any redness, pus, inflammation, foul smells, or specifically if baby is irritated when touching belly button or post circumcision site.
  • Yellow discharge for more than a week, swelling beyond day one, crusty fluid filled sores at the circumcision site.
  • If baby is super lethargic or hard to wake or has yellow in the whites of the eyes (from extremely high jaundice levels).
  • Dehydration. A way to tell if baby is experiencing dehydration is if he’s not peeing regularly. A general rule of thumb is that on day one (after birth) baby should pee once, day two he should pee twice, day three should have three pees, and so on until day five. By day five baby should consistently have 5-6 wet diapers a day. If that is the case and then suddenly they’re back down to 1-2 wet diapers a day, this is a sign of dehydration. Any signs of consistent diarrhea is also concern for dehydration.
  • In the very rare instance you see colorless, white, chalky poop, this is totally not normal, and you should contact your doctor ASAP.
  • Thrush. Thrush is a buildup of yeast that can be passed easily from baby to mom. A common sign is a white film on baby’s tongue or inside of their mouth but it can also cause burning, itching, and pain in mom’s nipples. It’s super common but can be annoying to get rid of!
  • When you first bring baby home you’re still getting to know them but if there are any clear or immediate changes that are severely different than their “norm” then you may wish to reach out to your doctor. When in doubt, never hesitate to call your doctor! They expect to hear from new moms frequently if needed!

Check out Nurse Melissa's live broadcast about these topics:




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