Role of the paediatrician in the first days of life

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Following delivery of your baby and for the duration of your stay in hospital, a paediatrician will attend to your baby’s well-being. However, I really enjoy a quick visit from an expectant couple prior to the delivery. Very often, parents have read or heard about what is important in the first hours of life and would like to confirm what they believe to be important.

Being able to chat about this and being given the opportunity to relay what I believe is important, helps to set the tone for good communication and to manage expectations.

When does the paediatrician get involved?

Generally speaking, if all goes well during a normal vaginal delivery, your obstetrician and midwife will handle the delivery and take care of you and your baby straight after the birth. The paediatrician will be notified and will perform the newborn check in the hours that follow.

If you are having a caesarean section, the paediatrician is usually required to be present at the delivery. In previous decades, having a caesarean section under anaesthetic placed the newborn baby at risk. Fortunately, anaesthetic techniques have improved and this is no longer as problematic.

Caesarean sections are often performed when the foetus is at risk. A paediatrician is therefore called upon to attend the caesar, so as to intervene should the baby not be in good condition.

My baby is out, what now?

After the delivery of your baby, the obstetrician will leave your baby attached to the placenta and umbilical cord. This practice has been associated with better outcomes not only in premature deliveries but also full-term deliveries. Waiting before cutting the cord allows extra blood to flow from the placenta to your baby and lowers the risk of newborn anaemia and iron deficiency in infancy.

The obstetrician will then cut the cord and hand your baby to the paediatrician or nursing sister. The obstetrician will collect cord blood for thyroid screening, blood grouping (if necessary) and stem cells (if this is your preference).

When do I start skin-to-skin contact?

Controlling your baby’s temperature after birth is something I feel strongly about. Delivery rooms are very often quite cool and this could result in your baby losing temperature quickly. In some countries, delivery rooms are required to be kept at a constant 25°C but this is not always achieved.

To ensure your baby stays warm and to avoid your baby landing in an incubator, I would dry your baby immediately. This will prevent your baby from losing warmth due to being wet. During this process, the umbilical cord will be clamped close to the baby’s body and Dad can be given the opportunity to cut the cord at this moment in time.

I then place the baby on Mommy’s skin covered with a warm towel. This skin-to-skin contact and warm towel will ensure that your baby has a good body temperature and is wonderful for bonding. This is the preferred practice but on occasion, this may not be possible if your baby needs immediate medical care. Should this be the case, you will have plenty of time in the coming days to practice skin-to-skin bonding.

The Apgar score, what is it?

Your baby’s condition will be monitored immediately after the delivery. The Apgar score is used to monitor the baby. The Apgar score is given at 1 minute, 5 minutes and 10 minutes after birth. This simple checklist evaluates your baby’s heart rate, breathing, muscle tone, reflex response and colour.

You will see it recorded as a score out of 10.  Very often we see a lower score at 1 minute and then a great score at 5 and 10 minutes. A low score may indicate that your baby needs a little assistance and this may be in the form of warming in an incubator or being given oxygen.

Are there any other checks?

Over and above the Apgar score the paediatrician will perform a thorough examination of your baby. This examination will include evaluation of all the systems of the body. It is very important to make sure that your baby is normally formed.

I would look your baby in detail. Included in this extensive check are the muscles and bones, fingers and toes, mouth and tongue, ears and eyes, tone and reflexes, heart and lungs, tummy and sexual organs and the list goes on.

When do I start breastfeeding?

An important saying in the paediatric world is “breast is best”. Once all of these checks have been performed, the skin-to-skin contact will be continued and breastfeeding will be commenced. The nursing staff will be supporting you through this process.

What next?

In the days that follow your baby’s birth, I will check the baby daily. At these checks, I will be concerned with your baby’s general well-being including feeding, weight gain and development of jaundice. During your time in hospital, the nursing staff will administer the first batch of vaccinations. This includes the oral polio vaccine and the BCG vaccine against tuberculosis.

From days three to six you may choose to do the Newborn Test (NBT), also known as the Metabolic Screen. Now, it’s home time!

The original version of this article can be found on our expert Dr Maraschin’s website.

Also read:

How I recovered from a C-section