Care of the Normal Newborn

The umbilical cord clamp can be removed when the cord appears dry, usually at 24 hours.

Umbilical cord care is aimed at reducing the risk of umbilical infection (omphalitis). The umbilical stump should be kept clean and dry; other care varies depending on the birth setting. In a hospital delivery (or properly managed home birth), where the cord is clamped and cut aseptically, dry cord care or cleansing with soap and water is adequate; topical agents do not decrease risk of infection. However, when cord clamping and/or cutting is not aseptic (eg, in some medically underserved countries, precipitous out-of-hospital deliveries), applying a topical antiseptic (eg, chlorhexidine) to the cord reduces the risk of omphalitis and neonatal mortality. The cord should be observed daily for redness or drainage.

Circumcision, if desired by the family, can be safely done, using a local anesthetic, within the first few days of life. The procedure should be delayed if the mother has taken anticoagulants or aspirin, if there is a family history of bleeding disorders, or if the neonate has displacement of the urethral meatus, hypospadias Hypospadias Congenital anomalies of the urethra in boys usually involve anatomic abnormalities of the penis and vice versa. In girls, urethral anomalies may exist without other external genital abnormalities... read more , or any other abnormality of the glans or penis (because the prepuce may be used later in plastic surgical repair). Circumcision is usually delayed until at least after the first void; not voiding within 12 hours of the procedure may indicate a complication.

Circumcision should not be done if the neonate has hemophilia or another bleeding disorder.

Most neonates lose 5 to 7% of their birth weight during the first few days of life, primarily because fluid is lost in urine and insensibly and secondarily because meconium is passed, vernix caseosa is lost, and the umbilical cord dries.

In the first 2 days, urine may stain the diaper orange or pink because of urate crystals, which are a normal result of urine concentration. Most neonates void within 24 hours after birth; the average time of first void is 7 to 9 hours after birth, and most void at least 2 times in the 2nd 24 hours of life.

A delay in voiding is more common among male neonates and may result from a tight foreskin; a male neonate’s inability to void may indicate posterior urethral valves Urethral valves Congenital anomalies of the urethra in boys usually involve anatomic abnormalities of the penis and vice versa. In girls, urethral anomalies may exist without other external genital abnormalities... read more . If an infant has been circumcised, lack of voiding within 12 hours of the procedure may indicate a complication.

If meconium has not been passed within 24 hours, the clinician should consider evaluating the neonate for anatomic abnormalities, such as imperforate anus Anal Atresia Anal atresia is also known as imperforate anus. (Also see Overview of Congenital Gastrointestinal Anomalies.) In anal atresia, the tissue closing the anus may be several centimeters thick or... read more , Hirschsprung disease Hirschsprung Disease Hirschsprung disease is a congenital anomaly consisting of a failure of neuronal colonization (and thus a failure of innervation) of the lower intestine, usually limited to the colon, resulting... read more , and cystic fibrosis Cystic Fibrosis Cystic fibrosis is an inherited disease of the exocrine glands affecting primarily the gastrointestinal and respiratory systems. It leads to chronic lung disease, exocrine pancreatic insufficiency... read more (which can cause meconium ileus Meconium Ileus Meconium ileus is obstruction of the terminal ileum by abnormally tenacious meconium; it most often occurs in neonates with cystic fibrosis. Meconium ileus accounts for up to 33% of neonatal... read more ).