Neonatology & Pediatrics



Dr. R.G Holla
Senior Consultant
Neonetology & Pediatrics
MBBS MD PEDIATRICS, DM NEONATOLOGY Book Appointment With Dr. RG Holla,Neonatologist,Pediatrician


Dr. Sumita Chawla
Senior Consultant
Neonetology & Pediatrics
MBBS MD PEDIATRICS Book Appointment With Dr. Sumita Chawla,Pediatrician


Dr. Anamika Dubey
Senior Consultant
Neonetology & Pediatrics
MD
Book Appointment With Dr. Anamika Dubey,Pediatrician


Dr. Meera Luthra
Senior Consultant
Pediatric Surgeon

Dr. Sarita Sharma
Consultant Pediatrician & Neonatologist
MBBS, MD (Pediatrics, PGIMER, Chandigrah)

Dr. Ashish Guspta
Consultant Pediatrician & Neonatologist

SPECIAL CARE OF NEW BORN BABIES: NEONATOLOGY SPECIALIZES IN FIRST 28 DAYS OF HUMAN LIFE

Neonatology refers to the care of newborn infants due to premature birth, low birth weight, birth defects, heart trouble, lung problems, or other life-threatening conditions. Adiva Hospital, Green Park is home to a state of the art Neonatal Intensive Care Unit (NICU). Our NICU is equipped to care for the tiniest and most critically ill babies, offering the greatest range of neonatal services and support.

Few parents consider the possibility that their baby might need special medical care after birth. Even fewer think about which neonatal intensive care unit (NICU) might care for their baby.

One out of nine mothers do not carry her pregnancy to full term (37 or more weeks), and roughly 20% of babies born in a hospital require some sort of special care in the NICU. We hope that your pregnancy and delivery go smoothly, but if the unexpected should occur, here are some facts you must consider: NICU at Adiva Hospital, Green Park is a busy unit catering to the needs of high risk newborn babies. Care of the NICU babies is in the hands of a senior qualified neonatologist, along with a team of pediatricians, experienced in the care of fragile, sick newborns.

We routinely receive babies weighing less than 1000 grams at birth and have an excellent track record in the intact survival.

CONGRATULATIONS ON YOUR BUNDLE OF JOY! – EXPERTS ADVISE ON GETTING STARTED

It’s a new baby! Motherhood brings with it great responsibility. First time mothers have often been told to forget their own sleep, to eat out of a very limited choice of food, to restrict their daily activities, and have been given many more pieces of such advice.

Here, our experts have tried to explain patterns of behaviour of babies and their needs and how to cope with them. The most important piece of advice anyone can give you is to relax and enjoy God’s best gift to mankind.






APPEARANCE AND BEHAVIOUR OF YOUR BABY
• On the first few days, the baby’s skin may appear reddish and the eyelids may appear swollen and closed.
• The skin may be covered with a layer called vernix, which appears like areas of dry, peeling skin. This protective covering generally comes off by itself when the baby is bathed.
• The umblical cord (navel cord) strarts drying after a few hours after birth and may look shriveled. It usually falls by 7-10 days, although, it may take more or less time.
• Babies can see at work and when awake, enjoy looking at bright colours and familiar faces.
• The hearing of babies is well developed at birth although their response to sound varies
• Most new born babies sleep for 20-22 hours in a day, waking up to feed every 2-4 hours. If a baby sleeps for longer than 2 hours on the first few days, (s)he should be woken up for a feed. The intervals may be increased as the baby grows up.
• Babies tend to be fussy at night and may demand feeds more frequently.
• Following birth, the baby’s head shape may not be perfectly round and returns to normal in a few days.
• The soft spot on the baby’s head (anterior fontanel) remains open till after the first birthday. There is no requirement to apply any oil or massage the area.

BABY’S WEIGHT
All babies tend to lose 5% - 7% of birth weight in the first 2-3 days after birth. This ir normal. They regain this weight within two to three weeks. If the baby does not regain weight, your neonatologist may suggest more frequesnt weight checks.

STOOLS AND URINE
• Babies pass stool with in 24 hours after birth. Initially black and tarry (called meconium), this stool becomes greenish and loose over 2-3 days.
• Thereafter, breastfed babies pass 5-7 loose, yellowish stools in 24 hours. In addition,msyeach time the baby feeds, cries, strains or passes wind, (s)he may leave a small stain on the nappy.
• Some breastfed babies may pass stools infrequently, upto once in a week. As long as the stool is soft and the baby is comfortable and feeding well, this is normal and no treatment is required.
• Most healthy babies will pass urine in the first 48 hours. The baby may cry before passing urine due to iscomfort of full bladder; becomes quiet thereafter.

VAGINAL SPOTTING
• There may be menstrual like bleeding in some baby girls after 3-5 days of birth – this is generally very mild, lasting for 2- 4 days and is normal
• Most baby girls produce a whitish discharge from the vagina. This protects the inner skin and vigorous cleaning or trying to remove it may damage the insides.

HICCUPS AND SNEEZING
• some babies have hiccups, often after taking a feed. place your baby upright on your shoulder and they will gradually disappear. There is no need to give water to the baby.
• Some babies sneeze when the secretions inside the nose become dry and cause irritation. This is not a sign of respiratory infection. Your doctor may prescibe saline nasal drops for the baby.

WELCOMING YOUR BUNDLE OF JOY INTO YOUR HOME: EXPERTS’ ADVICE FOR NEW PARENTS

Introducing the little bundle of joy to your home is a time of caring, of fun, of great responsibility. Various relatives, friends and neighbours often give first time mothers diverse advice on how to care for the baby. Here, our experts have tried to explain what babies need and how to cope with them.

The most important piece of advice anyone can give you is to relax and enjoy God’s best gift to mankind!

THE THREE CHALLENGES A BABY FACES
Your baby has come from a sterile environment to one that is full of germs and dangers. (S)he faces three challenges:
• Infection
• Feeding
• Body Temperature

INFECTION: Babies are very prone to infection. Do you know that they get it from us – from our hands, our breath and our skin. To protect your baby, you could ensure that
• Minimum people handle your baby
• No one with a skin or eye infection, cough/cold or diarrhoea comes near your baby
• No one kisses your baby
• People wash hands with soap and water or use hand sanitizer before touching the baby.

FEEDING: Make sure you give only breastfeeds to your baby. Your family members need to support you in feeding your baby every 2 hours.

BODY TEMPERATURE: Babies lose heat from their body very easily. Make sure that you nurse the baby on your bed so that (s)he gets the warmth from your body.

SETTING UP THE ROOM FOR THE BABY
The ideal room for the baby is one with adequate light, ventilation and warmth. Avoid drafts.
• Restrict the number of people entering the room
• The room should be quiet; no loud noises
• Have the room cleaned twice a day, preferably with wet mopping (pocha). Remove the baby from the room during dusting, sweeping (jhadu) or vacuuming
• Keep pets away from the baby’s room
• Do not allow smoking anywhere in the house
• The fan, cooler or air conditioner may be switched on according to the weather, but the temperature of the room should not fall below 26 C; keep the baby out of the direct air current.
• In winter, if you use a hot air blower; make sure you increase the humidity by keeping a wet towel (or drying the baby’s washed nappies) in front of the blower.

ROOMING IN THE BABY
This means the mother and the baby stay in the same room. Ideally, the baby should sleep in the same bed as the mother for the first few weeks of life.

The mattresses for the baby should be firm. Blankets and wraps should not be fluffy or too soft as these may block the baby’s breathing.

Some brightly colored objects in the direct line of the baby’s vision may help in the development of the baby’s brain and eyes.

Do not keep soft toys, polythene bags, medicines, cosmetics and other potentially dangerous items near the baby.

The baby should always be made to lie down on the back or on his/her side, and never be kept on the abdomen, particularly if unattended.

MASSAGE
Babies love a gentle massage. Make sure the room is warm before taking of his/her clothes. Take a small quantity of oil in your hands and gently apply it on the baby. Do not rub the baby’s skin or manipulate his/her body vigorously.

Never allow a professional ‘malish-wali’ to massage your baby as they are sometimes rough and can cause injury to the baby’s delicate bones. Do not instill oil in the baby’s nostrils, ears, on the cord or genital area.

CORD CARE
The umblical cord of the baby starts drying soon after birth, shrivels and falls off. Research has shown that applying anything to the cord or its base can interfere with the natural process of healing. Make sure that the cord is left open to the air (you should tie the baby’s nappy/diaper below the navel). When the cord separates, a few drops of blood may ooze out from the base – don’t worry, this is normal.

BATHING AND CLEANING THE BABY
Babies enjoy being bathed. You can make bathing, dressing and grooming a pleasurable experience for all.

Baby should be bathed after the cord has separated (till then you may sponge him/her with a towel soaked in warm water).

Make sure the room is warm and does not have any drafts of wind. Keep all items ready before starting to bathe the baby:
• Lukewarm water
• Soap/Shampoo
• Towel
• Fresh dress
• Nappy

You can bathe the baby in a tub specially manufactured for baby bath. It should have a gentle slope so that the baby’s head can be kept higher than the feet.

Alternately, sit on a low stool with the legs out straight. Place the babies on your thighs, with the head towards you. Bathe the baby by gently pouring lukewarm water. Start from the head, avoiding water splashing on the face, nose and eyes. Proceed to the trunk and then to the arms and legs. Finally clean the nappy area, being careful to clean from front backwards. There is no need to clean your baby girl’s genitals from inside. Similarly, in boys, there is no need to retract the foreskin for cleaning.

Do not use soap on the face. A mild soap may be used on the other parts of the body.

As each area is cleaned, pat it dry with a soft towel, before proceeding to the next area.

Once the baby has been bathed and dried, put him/her on the bed and gently put on the clothes, starting with then apply. There is no need to use talcum powder, cosmetics, lotions and creams, unless prescribed by the baby’s doctor.

Do not use kajal on the baby’s eyes. Do not instil oil in the baby’s nose, ears or navel.

CLOTHING
The baby’s clothing should be appropriate for the weather. Put as many layers as you would feel comfortable wearing, and wrap him/her in a sheet over his/her clothing.

Make sure to cover the baby’s head with a cap in cool weather.

Clothing should be soft, easy to put on and remove and should not have pins, tight elastic, zippers or sharp hooks.

The baby’s clothing should be washed separately from that of the rest of the family, with a mild detergent. Do not use antiseptics like dettol for your baby’s clothes.

CRYING
Babies communicate by crying. It is wrong to think that every crying is caused by hunger. Common causes for crying are a wet nappy, uncomfortable or tight clothing, a blocked nose or simply the need for a cuddle. Serious conditions also cause crying – if your baby cries despite attending to his/her needs, or if (s)he cannot be consoled, show him/her to your doctor immediately.

TRADITIONAL PRACTICES TO BE AVOIDED
A number of traditional practices in children have evolved over the years. While most of these are beneficial to the baby, the following practices are harmful and should be avoided:
• Discarding the mother’s first milk or colostrum
• Delaying the first feed
• Feeding the baby water, honey, ghutti, glucose water, cow’s milk, tea, etc.
• Applying kajal to the baby’s eyes
• Using medicines or herbal medicines to quieten a crying baby
• Vigorous massage, especially by professional masseurs (malish-walis)

NEOANATAL JAUNDICE – EVERY BABY WITH JAUNDICE SHOULD BE ASSESSED BY A NEONATOLOGIST
Neonatal jaundice (or ‘baby’ jaundice) is a yellowish discoloration of the eyes and skin that happens in almost every baby. It is caused by “bilirubin” that accumulates in the body because of the immaturity of the baby’s liver. It usually starts on the 2nd or 3rd day, reaches its peak by the fifth to seventh day and then gradually subsides. It is generally harmless if bilirubin levels do not rise too high or too early. Your baby will be regularly examined for jaundice, both in hospital and after discharge.

DANGER SIGNS
Babies are very prone to illnesses and can become very sick in a short period of time. It is important that the disease be recognized and treated early so that the baby can have the best chance of survival. If your baby has any of the danger signs given below, show him/her to a doctor immediately.
• Irritability
• Poor sucking or inability to feed
• Sweating or turning blue while feeding
• Breathing too fast or too slow
• Breathing with a grunting sound
• Chest in drawing while breathing
• Fever
• Weak cry / inconsolable cry
• Blood tinged stool
• Frequent or greenish vomiting
• Bulging soft spot on head
• Boils over the body
• Abnormal jerky body movements/fits
• Lethargic/difficult to arouse
• Discharge from the eyes or swelling of the eyelids
• Decreased urine output (less than 5 times in 24 hours) or very dark urine
• Discharge or foul smell from the umbilicus
• Skin colour appearing blue or pale or increasing yellowness (jaundice)
• Hands and feet feeling cold and clammy or mottled.

EXPERTS SPEAK ON “BREAST FEEDING: BREAST MILK IS THE BEST FOOD FOR YOUR BABY”

Motherhood – at time of great happiness, of caring, but also of great responsibility. First-time mothers have often been told to forget their own sleep, to eat out of a very limited choice of food, to restrict their daily activities, and have been many more pieces of such advice. This is particularly true when it comes to feeding the baby. However, some of this is good advice, some is not.

Here, our experts have tried to answer various questions one may have about breastfeeding. They have tried to explain ways to successfully breastfeed your baby, problems that you may face and how to cope with them.

IMPORTANT FACTS ABOUT BREASTFEEDING

I. Breastmilk - Protective Nourishment
Breastmilk is the best milk for your baby. It provides him/her with all nutrients that his/her body needs in the correct proportions and protects him/her from infection.

II. Breastfeeding – The Health Investment for Life
Exclusive breastfeeding for the first six months of life also protects your baby from high blood pressure, diabetes and heart attacks later in life. Breastmilk contains certain nutrients which help your baby’s brain to grow. You can therefore consider exclusive breastfeeding to be a lifelong health investment for your baby.

III. Breastfeeding Protects You Too!
Breastfeeding also benefits you by protecting you from certain cancers (of the uterus and breast) and also helps you to shed excess weight you have put on during pregnancy.

IV. How to Breastfeed
For successful breastfeeding, you should try to put the baby to the breast as early and as frequently as possible. Doctors and nurses in the labour room and ward will help you to establish this feeding as early after birth of your baby as possible.

While feeding your baby, you should be sitting or lying in a comfortable posture, well supported by cushions and pillows. The baby’s face should directly face the breast and his/her stomach should be facing yours. His/her head and body should be in the same straight line. Touching the nipple to the baby’s cheek will make him/her turn his/her head towards the nipple and open his/her mouth. Put the nipple and areola into the baby’s mouth and allow him/her to suck. The baby’s nose should be kept clear by holding the breast so that (s)he can breathe.

Allow the baby to suck for as long as (s)he wants to (usually 20-25 minutes). Sometimes the baby may appear to sleep although (s)he will keep making sucking movements now and then.

After the baby has been fed, burp him/her.

COMMON QUERIES ABOUT BREASTFEEDING

I. How Do I Know That My Baby Is Well Attached To My Breast?
The following are the signs of good attachment:
• The baby’s face is facing the breast
• The nipple and the most of the areola is inside the baby’s mouth
• The chin is touching the breast
• The nose is not blocked by breast
• You do not feel any pain

II. My Baby Goes To Sleep While Feeding. What Should I Do?
Most babies will close their eyes and appear to sleep after feeding for a few minutes. As long as the baby is making sucking movements in between, there is no need to do anything. If the baby goes to sleep and you feel that (s)he has not fed sufficiently (20-25 minutes), you may gently tickle him/her on the soles of the feet or the ears.

III. How Do I Know That My Baby Is Getting Enough Breastmilk?
A baby who is receiving adequate feeds will
• Sleep for 2-3 hours after a feed
• Make 6-7 wet nappies in 24 hours
• Gain weight

IV. What Care Should I Take Of My Breasts During Feeding?
In order to avoid pain, soreness and cracks in the nipples, the following steps may be helpful:
• Ensure that the baby is attached well to the breasts during feeding
• Wear a bra
• Do not wash or wipe the breasts/ nipples/ areola. Bathing once a day is sufficient.
• Do not apply any ointments to the breast. Instead, apply few drops of your breast milk to the areola and nipple after you feed the baby. You may also apply coconut oil to the nipple after feeding. These should not be cleaned before the next feed.
• While detaching the bay from the breast, you may put a finger into the baby’s mouth from the corner to break the strong seal and open his/her mouth.

V. While Feeding The Bay From One Breast, My Other Breast Stats Leaking Milk. What Should I Do?

It is normal to have a little milk coming out of the other breast while feeding from one breast. Do not switch breasts during feeding. Try to give one complete feed from one breast at one time.

VI. My Milk Was Not Coming Well On The First Two Days After My Baby Was Born. Is This Normal? Do I Need To Give My Baby Any Other Food?

It is normal for most mothers to produce a very small quantity of a thick, creamy milk in the first one or two days after the baby is born. This “milk” is known as colostrum and is very valuable to the baby for improving his/her immunity (resistance against diseases). The quantity that comes is more than enough for the baby and no additional liquids like water, glucose, animal milk, honey, ghutti etc needs to be given.

VII. For How Long Should I Breastfeed My Baby?

Your baby should receive exclusive breastfeeds for the first six month of life (exclusive means that the baby should not be given water even in summer, vitamins, ghutti or any feeds in addition to your milk). Thereafter, your baby’s doctor will advise complementary foods that can be given in addition to breastfeeding. Breastfeeding should be continued for at least one year and if possible for two years.

VIII. Is It OK To Give My Baby A Bottle Once In A While?

Putting any other nipple other than yours into the baby’s mouth creates “nipple confusion” and makes the baby reject the breast over a period of time. Also, bottles, despite all modern techniques and gadgets, are impossible to clean thoroughly. You should therefore avoid using a bottle to feed your baby. If, for some reason, you are not able to breastfeed your baby, the best alternative to a bottle is to feed with a cup and spoon.

IX. I Have Twins. Can I Breastfeed Both Of Them?

Breastfeeding twins require more work, more dedication and can be exhausting, but it can also be twice as rewarding! You may worry you won’t produce enough milk, but remember, increased suckling means increased milk being produced. While feeding twins can lead to sore nipples, proper latching and medical advice can help reduce problems. A flexible feeding schedule is a good idea, and is alternating breasts with every feeding, especially if one twin is a stronger feeder. Eating small meals more often and drinking more water or other fluids helps. Catch up on your sleep when the babies are sleeping. And ask your family to help with the chores as you spend time with your babies.

COMMON PROBLEMS WHILE BREASTFEEDING

ENGORGEMENT
Your breast may get engorged with milk in the first few days after birth. The breast may become hard, swollen and painful. Try to put the baby frequently to the breast for short periods of time or express the milk from the breast by hand or pump. This may be fed to the baby using a cup and spoon. Warm compresses applied to the breast and warm showers may help. Your doctor may also prescribe a medicine to reduce the pain.

SORE NIPPLES
Nipples may get sore or cracked if :
• The baby is not well attached to the breast during feeding.
• Frequent washing or wiping the areola and nipple, especially with soap
• If the baby is forcibly pulled off from the breast while sucking

You can treat sore nipples by expressing the milk from the breast (and feeding it to the baby by cup and spoon), application of breastmilk or coconut oil to the areola and nipple, and medications for pain. Once the nipples start to heal, put the baby to the breast for short periods of time, ensuring that the baby is well attached to the breast.

POSSETTING

Some babies spit out a small quantity of milk during feeding, burping or while being handled. This milk may or may not be curdled. This normal behaviour, known as possetting, does not require any treatment.

CONGRATULATIONS ON YOUR BUNDLE OF JOY! – EXPERTS ADVISE ON GETTING STARTED

It’s a new baby! Motherhood brings with it great responsibility. First time mothers have often been told to forget their own sleep, to eat out of a very limited choice of food, to restrict their daily activities, and have been given many more pieces of such advice.

Here, our experts have tried to explain patterns of behaviour of babies and their needs and how to cope with them. The most important piece of advice anyone can give you is to relax and enjoy God’s best gift to mankind.

APPEARANCE AND BEHAVIOUR OF YOUR BABY
• On the first few days, the baby’s skin may appear reddish and the eyelids may appear swollen and closed.
• The skin may be covered with a layer called vernix, which appears like areas of dry, peeling skin. This protective covering generally comes off by itself when the baby is bathed.
• The umblical cord (navel cord) strarts drying after a few hours after birth and may look shriveled. It usually falls by 7-10 days, although, it may take more or less time.
• Babies can see at work and when awake, enjoy looking at bright colours and familiar faces.
• The hearing of babies is well developed at birth although their response to sound varies
• Most new born babies sleep for 20-22 hours in a day, waking up to feed every 2-4 hours. If a baby sleeps for longer than 2 hours on the first few days, (s)he should be woken up for a feed. The intervals may be increased as the baby grows up.
• Babies tend to be fussy at night and may demand feeds more frequently.
• Following birth, the baby’s head shape may not be perfectly round and returns to normal in a few days.
• The soft spot on the baby’s head (anterior fontanel) remains open till after the first birthday. There is no requirement to apply any oil or massage the area.

BABY’S WEIGHT
All babies tend to lose 5% - 7% of birth weight in the first 2-3 days after birth. This ir normal. They regain this weight within two to three weeks. If the baby does not regain weight, your neonatologist may suggest more frequesnt weight checks.

STOOLS AND URINE
• Babies pass stool with in 24 hours after birth. Initially black and tarry (called meconium), this stool becomes greenish and loose over 2-3 days.
• Thereafter, breastfed babies pass 5-7 loose, yellowish stools in 24 hours. In addition,msyeach time the baby feeds, cries, strains or passes wind, (s)he may leave a small stain on the nappy.
• Some breastfed babies may pass stools infrequently, upto once in a week. As long as the stool is soft and the baby is comfortable and feeding well, this is normal and no treatment is required.
• Most healthy babies will pass urine in the first 48 hours. The baby may cry before passing urine due to iscomfort of full bladder; becomes quiet thereafter.

VAGINAL SPOTTING
• There may be menstrual like bleeding in some baby girls after 3-5 days of birth – this is generally very mild, lasting for 2- 4 days and is normal
• Most baby girls produce a whitish discharge from the vagina. This protects the inner skin and vigorous cleaning or trying to remove it may damage the insides.

HICCUPS AND SNEEZING
• Some babies have hiccups, often after taking a feed. place your baby upright on your shoulder and they will gradually disappear. There is no need to give water to the baby.
• Some babies sneeze when the secretions inside the nose become dry and cause irritation. This is not a sign of respiratory infection. Your doctor may prescibe saline nasal drops for the baby.

WELCOMING YOUR BUNDLE OF JOY INTO YOUR HOME: EXPERTS’ ADVICE FOR NEW PARENTS

Introducing the little bundle of joy to your home is a time of caring, of fun, of great responsibility. Various relatives, friends and neighbours often give first time mothers diverse advice on how to care for the baby. Here, our experts have tried to explain what babies need and how to cope with them.

The most important piece of advice anyone can give you is to relax and enjoy God’s best gift to mankind!

THE THREE CHALLENGES A BABY FACES

Your baby has come from a sterile environment to one that is full of germs and dangers. (S)he faces three challenges:
• Infection
• Feeding
• Body Temperature

INFECTION: Babies are very prone to infection. Do you know that they get it from us – from our hands, our breath and our skin. To protect your baby, you could ensure that
• Minimum people handle your baby
• No one with a skin or eye infection, cough/cold or diarrhoea comes near your baby
• No one kisses your baby
• People wash hands with soap and water or use hand sanitizer before touching the baby.

FEEDING: Make sure you give only breastfeeds to your baby. Your family members need to support you in feeding your baby every 2 hours.

BODY TEMPERATURE: Babies lose heat from their body very easily. Make sure that you nurse the baby on your bed so that (s)he gets the warmth from your body.

SETTING UP THE ROOM FOR THE BABY

The ideal room for the baby is one with adequate light, ventilation and warmth. Avoid drafts.
• Restrict the number of people entering the room
• The room should be quiet; no loud noises
• Have the room cleaned twice a day, preferably with wet mopping (pocha). Remove the baby from the room during dusting, sweeping (jhadu) or vacuuming
• Keep pets away from the baby’s room
• Do not allow smoking anywhere in the house
• The fan, cooler or air conditioner may be switched on according to the weather, but the temperature of the room should not fall below 26 C; keep the baby out of the direct air current.
• In winter, if you use a hot air blower; make sure you increase the humidity by keeping a wet towel (or drying the baby’s washed nappies) in front of the blower.

ROOMING IN THE BABY
This means the mother and the baby stay in the same room. Ideally, the baby should sleep in the same bed as the mother for the first few weeks of life.

The mattresses for the baby should be firm. Blankets and wraps should not be fluffy or too soft as these may block the baby’s breathing.

Some brightly colored objects in the direct line of the baby’s vision may help in the development of the baby’s brain and eyes.

Do not keep soft toys, polythene bags, medicines, cosmetics and other potentially dangerous items near the baby.

The baby should always be made to lie down on the back or on his/her side, and never be kept on the abdomen, particularly if unattended.

MASSAGE
Babies love a gentle massage. Make sure the room is warm before taking of his/her clothes. Take a small quantity of oil in your hands and gently apply it on the baby. Do not rub the baby’s skin or manipulate his/her body vigorously.

Never allow a professional ‘malish-wali’ to massage your baby as they are sometimes rough and can cause injury to the baby’s delicate bones. Do not instill oil in the baby’s nostrils, ears, on the cord or genital area.

CORD CARE
The umblical cord of the baby starts drying soon after birth, shrivels and falls off. Research has shown that applying anything to the cord or its base can interfere with the natural process of healing. Make sure that the cord is left open to the air (you should tie the baby’s nappy/diaper below the navel). When the cord separates, a few drops of blood may ooze out from the base – don’t worry, this is normal.

BATHING AND CLEANING THE BABY
Babies enjoy being bathed. You can make bathing, dressing and grooming a pleasurable experience for all.

Baby should be bathed after the cord has separated (till then you may sponge him/her with a towel soaked in warm water).

Make sure the room is warm and does not have any drafts of wind. Keep all items ready before starting to bathe the baby:
• Lukewarm water
• Soap/Shampoo
• Towel
• Fresh dress
• Nappy

You can bathe the baby in a tub specially manufactured for baby bath. It should have a gentle slope so that the baby’s head can be kept higher than the feet.

Alternately, sit on a low stool with the legs out straight. Place the babies on your thighs, with the head towards you. Bathe the baby by gently pouring lukewarm water. Start from the head, avoiding water splashing on the face, nose and eyes. Proceed to the trunk and then to the arms and legs. Finally clean the nappy area, being careful to clean from front backwards. There is no need to clean your baby girl’s genitals from inside. Similarly, in boys, there is no need to retract the foreskin for cleaning.

Do not use soap on the face. A mild soap may be used on the other parts of the body.

As each area is cleaned, pat it dry with a soft towel, before proceeding to the next area.

Once the baby has been bathed and dried, put him/her on the bed and gently put on the clothes, starting with then apply. There is no need to use talcum powder, cosmetics, lotions and creams, unless prescribed by the baby’s doctor.

Do not use kajal on the baby’s eyes. Do not instil oil in the baby’s nose, ears or navel.

CLOTHING
The baby’s clothing should be appropriate for the weather. Put as many layers as you would feel comfortable wearing, and wrap him/her in a sheet over his/her clothing.

Make sure to cover the baby’s head with a cap in cool weather.

Clothing should be soft, easy to put on and remove and should not have pins, tight elastic, zippers or sharp hooks.

The baby’s clothing should be washed separately from that of the rest of the family, with a mild detergent. Do not use antiseptics like dettol for your baby’s clothes.

CRYING
Babies communicate by crying. It is wrong to think that every crying is caused by hunger. Common causes for crying are a wet nappy, uncomfortable or tight clothing, a blocked nose or simply the need for a cuddle. Serious conditions also cause crying – if your baby cries despite attending to his/her needs, or if (s)he cannot be consoled, show him/her to your doctor immediately.

TRADITIONAL PRACTICES TO BE AVOIDED

A number of traditional practices in children have evolved over the years. While most of these are beneficial to the baby, the following practices are harmful and should be avoided:
• Discarding the mother’s first milk or colostrum
• Delaying the first feed
• Feeding the baby water, honey, ghutti, glucose water, cow’s milk, tea, etc.
• Applying kajal to the baby’s eyes
• Using medicines or herbal medicines to quieten a crying baby
• Vigorous massage, especially by professional masseurs (malish-walis)

NEOANATAL JAUNDICE – EVERY BABY WITH JAUNDICE SHOULD BE ASSESSED BY A NEONATOLOGIST
Neonatal jaundice (or ‘baby’ jaundice) is a yellowish discoloration of the eyes and skin that happens in almost every baby. It is caused by “bilirubin” that accumulates in the body because of the immaturity of the baby’s liver. It usually starts on the 2nd or 3rd day, reaches its peak by the fifth to seventh day and then gradually subsides. It is generally harmless if bilirubin levels do not rise too high or too early. Your baby will be regularly examined for jaundice, both in hospital and after discharge.

DANGER SIGNS
Babies are very prone to illnesses and can become very sick in a short period of time. It is important that the disease be recognized and treated early so that the baby can have the best chance of survival. If your baby has any of the danger signs given below, show him/her to a doctor immediately.

• Irritability
• Poor sucking or inability to feed
• Sweating or turning blue while feeding
• Breathing too fast or too slow
• Breathing with a grunting sound
• Chest in drawing while breathing
• Fever
• Weak cry / inconsolable cry
• Blood tinged stool
• Frequent or greenish vomiting
• Bulging soft spot on head
• Boils over the body
• Abnormal jerky body movements/fits
• Lethargic/difficult to arouse
• Discharge from the eyes or swelling of the eyelids
• Decreased urine output (less than 5 times in 24 hours) or very dark urine
• Discharge or foul smell from the umbilicus
• Skin colour appearing blue or pale or increasing yellowness (jaundice)
• Hands and feet feeling cold and clammy or mottled.

EXPERTS SPEAK ON “BREAST FEEDING: BREAST MILK IS THE BEST FOOD FOR YOUR BABY”

Motherhood – at time of great happiness, of caring, but also of great responsibility. First-time mothers have often been told to forget their own sleep, to eat out of a very limited choice of food, to restrict their daily activities, and have been many more pieces of such advice. This is particularly true when it comes to feeding the baby. However, some of this is good advice, some is not.

Here, our experts have tried to answer various questions one may have about breastfeeding. They have tried to explain ways to successfully breastfeed your baby, problems that you may face and how to cope with them.

IMPORTANT FACTS ABOUT BREASTFEEDING

I. Breastmilk - Protective Nourishment
Breastmilk is the best milk for your baby. It provides him/her with all nutrients that his/her body needs in the correct proportions and protects him/her from infection.

II. Breastfeeding – The Health Investment for Life
Exclusive breastfeeding for the first six months of life also protects your baby from high blood pressure, diabetes and heart attacks later in life. Breastmilk contains certain nutrients which help your baby’s brain to grow. You can therefore consider exclusive breastfeeding to be a lifelong health investment for your baby.

III. Breastfeeding Protects You Too!
Breastfeeding also benefits you by protecting you from certain cancers (of the uterus and breast) and also helps you to shed excess weight you have put on during pregnancy.

IV. How to Breastfeed
For successful breastfeeding, you should try to put the baby to the breast as early and as frequently as possible. Doctors and nurses in the labour room and ward will help you to establish this feeding as early after birth of your baby as possible.

While feeding your baby, you should be sitting or lying in a comfortable posture, well supported by cushions and pillows. The baby’s face should directly face the breast and his/her stomach should be facing yours. His/her head and body should be in the same straight line. Touching the nipple to the baby’s cheek will make him/her turn his/her head towards the nipple and open his/her mouth. Put the nipple and areola into the baby’s mouth and allow him/her to suck. The baby’s nose should be kept clear by holding the breast so that (s)he can breathe.

Allow the baby to suck for as long as (s)he wants to (usually 20-25 minutes). Sometimes the baby may appear to sleep although (s)he will keep making sucking movements now and then.

After the baby has been fed, burp him/her.

COMMON QUERIES ABOUT BREASTFEEDING

I. How Do I Know That My Baby Is Well Attached To My Breast?

The following are the signs of good attachment:
• The baby’s face is facing the breast
• The nipple and the most of the areola is inside the baby’s mouth
• The chin is touching the breast
• The nose is not blocked by breast
• You do not feel any pain

II. My Baby Goes To Sleep While Feeding. What Should I Do?

Most babies will close their eyes and appear to sleep after feeding for a few minutes. As long as the baby is making sucking movements in between, there is no need to do anything. If the baby goes to sleep and you feel that (s)he has not fed sufficiently (20-25 minutes), you may gently tickle him/her on the soles of the feet or the ears.

III. How Do I Know That My Baby Is Getting Enough Breastmilk?

A baby who is receiving adequate feeds will
• Sleep for 2-3 hours after a feed
• Make 6-7 wet nappies in 24 hours
• Gain weight

IV. What Care Should I Take Of My Breasts During Feeding?

In order to avoid pain, soreness and cracks in the nipples, the following steps may be helpful:
• Ensure that the baby is attached well to the breasts during feeding
• Wear a bra
• Do not wash or wipe the breasts/ nipples/ areola. Bathing once a day is sufficient.
• Do not apply any ointments to the breast. Instead, apply few drops of your breast milk to the areola and nipple after you feed the baby. You may also apply coconut oil to the nipple after feeding. These should not be cleaned before the next feed.
• While detaching the bay from the breast, you may put a finger into the baby’s mouth from the corner to break the strong seal and open his/her mouth.

V. While Feeding The Bay From One Breast, My Other Breast Stats Leaking Milk. What Should I Do?

It is normal to have a little milk coming out of the other breast while feeding from one breast. Do not switch breasts during feeding. Try to give one complete feed from one breast at one time.

VI. My Milk Was Not Coming Well On The First Two Days After My Baby Was Born. Is This Normal? Do I Need To Give My Baby Any Other Food?

It is normal for most mothers to produce a very small quantity of a thick, creamy milk in the first one or two days after the baby is born. This “milk” is known as colostrum and is very valuable to the baby for improving his/her immunity (resistance against diseases). The quantity that comes is more than enough for the baby and no additional liquids like water, glucose, animal milk, honey, ghutti etc needs to be given.

VII. For How Long Should I Breastfeed My Baby?

Your baby should receive exclusive breastfeeds for the first six month of life (exclusive means that the baby should not be given water even in summer, vitamins, ghutti or any feeds in addition to your milk). Thereafter, your baby’s doctor will advise complementary foods that can be given in addition to breastfeeding. Breastfeeding should be continued for at least one year and if possible for two years.

VIII. Is It OK To Give My Baby A Bottle Once In A While?

Putting any other nipple other than yours into the baby’s mouth creates “nipple confusion” and makes the baby reject the breast over a period of time. Also, bottles, despite all modern techniques and gadgets, are impossible to clean thoroughly. You should therefore avoid using a bottle to feed your baby. If, for some reason, you are not able to breastfeed your baby, the best alternative to a bottle is to feed with a cup and spoon.

IX. I Have Twins. Can I Breastfeed Both Of Them?

Breastfeeding twins require more work, more dedication and can be exhausting, but it can also be twice as rewarding! You may worry you won’t produce enough milk, but remember, increased suckling means increased milk being produced. While feeding twins can lead to sore nipples, proper latching and medical advice can help reduce problems. A flexible feeding schedule is a good idea, and is alternating breasts with every feeding, especially if one twin is a stronger feeder. Eating small meals more often and drinking more water or other fluids helps. Catch up on your sleep when the babies are sleeping. And ask your family to help with the chores as you spend time with your babies.

COMMON PROBLEMS WHILE BREASTFEEDING

ENGORGEMENT
Your breast may get engorged with milk in the first few days after birth. The breast may become hard, swollen and painful. Try to put the baby frequently to the breast for short periods of time or express the milk from the breast by hand or pump. This may be fed to the baby using a cup and spoon. Warm compresses applied to the breast and warm showers may help. Your doctor may also prescribe a medicine to reduce the pain.

SORE NIPPLES
Nipples may get sore or cracked if :
• The baby is not well attached to the breast during feeding.
• Frequent washing or wiping the areola and nipple, especially with soap
• If the baby is forcibly pulled off from the breast while sucking

You can treat sore nipples by expressing the milk from the breast (and feeding it to the baby by cup and spoon), application of breastmilk or coconut oil to the areola and nipple, and medications for pain. Once the nipples start to heal, put the baby to the breast for short periods of time, ensuring that the baby is well attached to the breast.

POSSETTING
Some babies spit out a small quantity of milk during feeding, burping or while being handled. This milk may or may not be curdled. This normal behaviour, known as possetting, does not require any treatment.

State of the Art Level III NICU

Neonatology refers to the care of newborn infants due to premature birth, low birth weight, birth defects, heart trouble, lung problems, or other life-threatening conditions. Adiva Hospital, Green Park is home to a state-of- the- art Neonatal Intensive Care Unit (NICU).

Our NICU is equipped to care for the tiniest and most critically ill babies, offering the greatest range of neonatal services and support.

Few parents consider the possibility that their baby might need special medical care after birth. Even fewer think about which neonatal intensive care unit (NICU) might care for their baby.

One out of nine mothers do not carry to full term (37 or more weeks), and roughly 20% of babies born in a hospital require some sort of special care in the NICU. We hope that your pregnancy and delivery go smoothly, but if the unexpected should occur, here are some facts you must consider:

NICU at Adiva Hospital, Green Park is a busy unit catering to the needs of high risk newborn babies. .Care of the NICU babies is in the hands of a senior qualified neonatologist, along with a team of pediatricians, experienced in the care of fragile, sick newborns.

We routinely receive babies weighing less than 1000 grams at birth and have an excellent track record in the intact survival. Procedures like exchange transfusion, surfactant administration, neonatal invasive and non-invasive ventilation are performed in the NICU.

Manned by a team of specially handpicked and trained nurses, the nurse patient ratio of the NICU is one of the best in Delhi. Resident doctors with postgraduate qualification in pediatrics are available 24 hours in house to handle emergencies.

The hospital has the whole range of ancillary services including in-house ultrasonography and radiological services and a round the clock laboratory to cater to the needs of these tiny patients. In addition, specialists in various fields like pediatric cardiology, pediatric surgery etc are available on call to attend to babies needing these services.

Doctors Available