In this Hospital da Luz podcast, listen to the advice of neonatology specialists Ana Berdeja and Graça Henriques , from the Hospital da Luz pediatrics team. Google | iTunes | Spotify It is in the hospital that mother and child have the appropriate conditions to be assisted in the time of delivery and right after birth. There, they can count with a multidisciplinary team ready to intervene, comprising the anaesthesiologist, the obstetrician, the paediatrician and the nurse. But as soon as the baby is born, it is natural for parents to be assailed by doubts and questions about a reality that is totally new for them. The essential advice: keep calm and ask for help whenever necessary. That is exactly what health professionals are here for. Even before the delivery, parents can schedule a prenatal consultation with the paediatrician that will afterwards follow the baby. This is an excellent opportunity for the physician to get to know the parents, clarify many doubts and share contacts. The evaluation of the newborn in the delivery room As soon as the baby is born, the pediatrician carries out a global evaluation of his physical condition. In this first evaluation, the so-called Agpar test, the pediatrician assigns a score to 5 parameters (heart rate, respiratory rate, muscle tone, reflexes and skin colour). The test is done one minute after birth and then five minutes after birth, where the baby should have an Agpar above 7 – which means that he will not have problems resulting from delivery. Parents should be aware that 90% of babies are born with no problem. The other 10% that are not born in such perfect conditions, must be helped immediately in order to prevent sequels. If the baby is born crying, appears rosy and manifests good vitality, it means he is fine – and is immediately put in skin-to-skin contact with the mother. The evaluation by the pediatrician will be repeated 24 hours after birth. The first hours of life The screenings While the baby is in the hospital with his mother, the pediatrician does three screenings to the newborn: Hearing screening; Congenital heart disease screening (heart disorders); Red reflex screening (to detect vision deficit or retinal alterations, for instance). Estes são os rastreios recomendados e que permitem fazer um diagnóstico precoce de alguma doença e desde logo adotar a terapêutica adequada. Jaundice Jaundice is a yellowing of the skin and eyes revealing a high level of bilirubin in the blood of the baby – is one of the situations that sometimes obliges to extend the stay of the baby in the hospital, causing some anxiety in parents. About 50% of the babies have jaundice, but usually it is the so-called physiologic jaundice, having no relevance. The pathologic jaundice, that requires the paediatrician to intervene, is less frequent, but not very serious. When the values of bilirubin (that causes jaundice) are high, the baby must be submitted to phototherapy and stays in hospital for more 24 to 48 hours, in most cases, and the situation is solved. Breastfeeding Breast milk is the best milk possible for the baby. It should be considered that every baby has his own rhythm, which is perfectly natural: there are babies that are born and breastfed right afterwards, seeming to be born “already in the know”, while others are slower and have more difficulty. In fact, in the first days of life, the baby feeds very little, because the first milk of the mother is what we call the colostrum, a high-concentrated and not so liquid milk, and mothers cannot tell if the baby has fed enough. The production of a more abundant and concentrated milk by the mother, occurs around the third/fourth day of life of the baby. It is important not to have rigid ideas and be aware that every baby and mother have to adapt to each other. We are often asked if the baby should feed for 10 minutes or 25/30 minutes and if he should be fed on one or both breasts. Well, that varies considerably from baby to baby. If the child is actively suckling for 15 minutes, maybe that is enough to be satisfied and well-fed, but if he makes long breaks or falls asleep frequently, for instance, he needs more time. And the change from one breast to the other depends on the capacity of the baby to empty the breast. Babies should be woken up to feed every 2 hours or 2 and a half hours, never exceeding 4 hours, in these first weeks of life. After seeing the paediatrician and if the baby is comfortable during the night, that period could be extended and the process should be of gradual adaptation. When the baby goes home It is very important to schedule a consultation with the paediatrician between the 10th and 15th day of life of the baby. In day by day with the baby, there are some situations to consider and be prepared to face. If you feel that you need help, there is a Nursing Consultation of Support to Newborns, ensured by neonatology nurses that can do house calls. Hiccups, sneezing, spitting up and breathing Hiccups are perfectly normal in a newborn and are related with the way the baby breathes in quite quickly, when he is suckling. Sneezing is normal and doesn’t mean that the baby has a cold. It is by sneezing that the baby eliminates impurities through the nose, being important to keep the nasal cavities cleared, as 80% of the baby’s breathing happens via nose. Spitting up or regurgitating is also not alarming. If the stomach is full and if he has swallowed some air, it is natural for the baby to spit up after feeding. Breathing in newborns suffers alteration over time. Babies usually breathe “in rounds”: a quite quick breathing, followed by pauses (that can sometimes last up to 20 seconds), then resuming rapid breathing. Those pauses have nothing of pathologic. Warning signs Parents should be alert to symptoms that might indicate that the baby is not well. There, they should contact the paediatrician immediately or even go to an emergency service in the following situations: The baby moans or has difficulty breathing; Fever; Jet vomiting; Umbilical cord stump smelling bad; Unspecific signs of distress. Cramps If the baby cries intensely, scrunches his legs towards the abdomen and produces a lot of gas, that means he has stomach cramps. These are not the manifestation of a disease; they result from the abnormal accumulation of gas in the immature intestine of the newborn. Usually, they arise around three weeks of life and last until two/two and a half months – and the situation should be handled with patience and tranquillity. There are some measures that can be taken to alleviate the cramps: Check if the baby has his nose clear; When breastfeeding, check if the baby is latching on the breast properly (if the nipple is well adapted to the mouth of the baby, otherwise he will swallow more air); or when the baby is bottle fed, check if the bottle teat is full of milk (otherwise, the baby will also swallow more air); Softly massage the baby abdomen, scrunch and stretch his legs. There is medication that can help, but it requires medical prescription. The bath The bath should be a moment of pleasure and share between the mother/father and the baby. It can be given every day, if it is a pleasure for the newborn. When it is a situation provoking anxiety and stress for parents, it is preferable to give bath day in day out. The bath contributes to relax the baby; therefore, it should be given by the end of the day. It can happen before or after the meal – it’s irrelevant –, but it is known that if we move the baby too much after feeding, he will be more likely to spit up. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
