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First Few Days After Birth

by Deborah M. Consolini, MD

Mother and baby spend a day or two in the hospital during which time new parents are taught to feed, bathe, and dress the baby and become familiar with the baby's activities, cues, and sounds.

Before being discharged from the hospital, parents are taught about routine aspects of care regarding the umbilical cord, circumcision, skin, urine and bowel movements, and weight.

Umbilical cord

The plastic cord clamp on the umbilical cord is removed within 24 hours after birth. The stump should be kept clean and dry. The stump falls off on its own in a week or two. Rarely, the umbilical cord can become infected, so any signs of redness, swelling or discharge should be checked by the doctor.

Circumcision

Circumcision, if desired, usually is done within the first few days of life, often before the newborn is discharged. The decision about having a newborn circumcised usually depends on the parents' religious beliefs or personal preferences. The main medical reason for circumcision is to remove an unusually tight foreskin that is obstructing the flow of urine. Although circumcised males also have a lower risk of cancer of the penis and urinary tract infections, these risks can be minimized with proper hygiene.

About 2 to 20 boys per 1,000 have some complication, usually minor bleeding or local infection. However, serious infection, scarring, and, very rarely, accidental amputation of the penis tip can occur. An equal number of uncircumcised males require a circumcision later in life.

Circumcision should not be done if the boy has not urinated or has a bleeding disorder or if the penis is abnormal in any way, because the foreskin may be used for any plastic surgical repair that may be needed later. Circumcision must be delayed if, during the pregnancy, the mother had been taking drugs that increase the risk of bleeding, such as anticoagulants or aspirin. The doctor waits until all such drugs have been eliminated from the newborn.

Skin

Most newborns have a mild rash sometime during the first week after birth. The rash usually appears in areas of the body rubbed by clothing—the arms, legs, and back—and rarely on the face. It tends to disappear without treatment. Applying lotions or powders, using perfumed soaps, and putting plastic pants over the diapers are likely to make the rash worse, especially in hot weather. Dryness and some skin peeling often occur after a few days, especially in the creases at the wrists and ankles.

Newborns who are otherwise normal may develop a yellow color to their skin (jaundice) after the first day. Jaundice occurs because the newborn's liver needs to shift from functioning inside the womb to functioning outside the womb. However, jaundice that appears before 24 hours of age is of particular concern and may indicate more serious problems (see Jaundice in Newborns). If the newborn develops jaundice, the doctors usually do a blood test to measure the level of bilirubin, which is the main pigment in bile. If the level of bilirubin is above a certain point, treatment with phototherapy, in which the newborn is placed without clothes under bright lights, is begun. The lights may be needed for 2 days to a week.

Urine and bowel movements

In the first 2 days, urine produced by a newborn is concentrated and often contains chemicals called urates, which can turn the diaper orange or pink. If a newborn does not urinate within the first 24 hours of life, the doctor tries to find out why. A delay in starting to urinate is more common among boys.

The first bowel movement is a sticky greenish black substance called meconium. Every baby should pass meconium within the first 24 hours after birth. If a baby does not do so, the doctor may do tests to determine whether there is a problem. Occasionally, for instance, a birth defect may cause a blockage of the intestines.

Weight

Most newborns lose 5 to 7% of their birth weight during the first few days of life, mostly because fluid is lost in urine and also because meconium is passed. Newborns return to their birth weight in about 2 weeks if they are breastfed and in about 10 days if bottle-fed. After that, they should gain about 20 to 30 grams (1 ounce) each day for the first few months. Infants should weigh twice their birth weight by about 6 months of age.

Discharge From the Hospital

In the United States, infants are commonly discharged from the hospital within 24 to 48 hours. Infants who are discharged within 48 hours should have a check up with a doctor 2 to 3 days later. Infants who are discharged after 48 hours have a check up at 2 weeks of age or sooner if they have any specific problems (such as poor feeding, constipation, diarrhea, or jaundice).

A pediatrician typically discharges infants from the hospital. Before the infant is discharged, parents are given clear information regarding when to call the pediatrician's office. For example, parents should immediately call the pediatrician if their infant has fever (temperature should be taken rectally), respiratory distress, loss of appetite, bilious vomiting (vomiting greenish yellow material), or a blue discoloration of the skin (cyanosis).

Once home, having a new baby in a household requires a great deal of adjustment for all involved. For a household that has had no children, changes in lifestyle may be dramatic. When other children are present, jealousy can be a problem. Preparing other children for the new baby and being careful to pay attention to them and include them in caring for the baby can ease the transition. Pets may also need some extra attention to help them adjust to the baby. In some cases, keeping pets away from the baby may be necessary.

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