Routine Care of the Neonatal Unit
| Site: | EHC | Egyptian Health Council |
| Course: | دلائل الاجراءات التمريضية لقسم حديث الولاده |
| Book: | Routine Care of the Neonatal Unit |
| Printed by: | Guest user |
| Date: | Tuesday, 5 May 2026, 11:39 PM |
Description
"last update: 20 January 2025" تحميل الدليل
- Prepared by
NICU guide
Under supervision
- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council
Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate
Prepared by
|
Title |
Name |
NO. |
|
Dean Of Faculty Nursing, Professor of Medical and Surgical Nursing, Tanta University |
Dr Afaf Abdel Aziz Abdel Aziz Basal |
1 |
|
Professor Of Critical Care Nursing |
Prof.Dr/Zeinab Hussain Ali |
2 |
|
Professor And Head of the Department of Medical Surgical Nursing. Faculty-. Benha University |
Amal Said Taha Refaie |
3 |
|
Supervisor Of the Education Sector at Port Said University |
Amal Ahmed Khalil Morsy |
4 |
|
Professor Of Medical Surgical Nursing- Faculty of Nursing- Cairo University |
Dr. Hanan Ahmed Al Sebaee |
5 |
|
Head of central administration on secondment at MOHP |
Dr Neveen ab drab al0nabi Mohamed |
6 |
|
Director Of Primary Health Care Nursing Department at MOHP. |
Maysa Hosny Ahmed Tammam |
7 |
|
Supervisor Of Technical Education- EHA |
Nancy Alaa Eldeen Abd-Elbaset Ali |
8 |
|
Supervisor Of Nursing Services Development- EHA |
Sherien Mohamed Saad |
9 |
|
Assistant Professor of Maternity and Neonatal Health Nursing - Faculty of Nursing- Ain Shams University |
Assist.Perof. Dr./Heba Mahmoud Mohammed |
10 |
|
General manager of general administration of health institutes affairs |
Dr Mai Galal Ibrahim Al-Assal |
11 |
|
Participants |
||
|
Professor of Obstetrics and Gynecology Nursing |
Dr. Nagat Salah Shalabi Salama |
12 |
|
member of the Nursing administration at EHA, port said branch |
Mrs. Shaima Abdel Basset Ibrahim Salim |
13 |
|
member of the Nursing administration at EHA, port said branch |
Mrs. Hoda Al-Sayd Muhammad |
14 |
|
member of the Nursing administration at EHA, port said branch |
Mrs. Walaa Ahmed Ali |
15 |
|
member of the Nursing administration at EHA, port said branch |
Mrs. Omnia Abdel Qader Muhammad |
16 |
|
member of the Nursing administration at EHA- South Sinai branch |
Mrs. Yasser Abdel Karim Omar Abdel Jawad |
17 |
- Newborn Bathing
Purpose:
- To ensure the cleanliness of the newborn
- To stimulate blood circulation
- To provide comfort and relaxation
Important Points Regarding Newborn Bathing:
- The newborn’s condition should be assessed, and body temperature should be stable before giving a bath. A bath can be given 4-6 hours after birth.
- A newborn weighing less than 1200 grams should not be bathed; instead, the face and diaper area should be wiped with a soft, warm towel inside the incubator during routine daily care.
- A full bath is given three times a week, but if the newborn's skin turns blue or muscle tone is weak, the bath should be avoided, and the doctor must be informed.
- The bath should be given before feeding the newborn.
- The bath can be done in front of the mother, if possible, so she can learn the steps, especially if it is her first child.
- The entire bath process should take between 3 to 5 minutes at most.
Required Materials:
Before starting the bath, ensure the following items are
prepared:
✔ Baby bathtub or a large bowl
✔ Mild baby soap or antibacterial soap or baby shampoo
✔ 2 large towels and 2 medium towels
✔ Thermometer to check the water temperature
✔ Small basin with warm water
✔ Small pieces of cotton
✔ Clean diaper
✔ A container with warm water at a temperature of 37-40°C
✔ 70% ethyl alcohol
✔ Baby oil or diaper rash cream, if needed
✔ Waste bin
Bathing Procedures:
First: Bathtub Bath
Precautions Before Starting:
- Ensure the newborn's vital signs are stable.
- Warm the room.
- Close windows and doors to prevent drafts and avoid opening them during the bath.
- Ensure adequate lighting to observe the newborn’s skin color.
- Prepare all materials before taking the baby out of the incubator.
- Turn on the warming device and place a sterile towel on it.
Note: It is preferable to weigh the newborn without clothes just before the bath to minimize exposure to cold.
Bathing Steps:
✔ Fill the baby tub or large bowl halfway with
warm water and check the temperature with a thermometer.
✔ Wash hands routinely and wear clean gloves, then
proceed to clean the diaper area first.
✔ Wrap the newborn's head and body with a large towel
and carry them out of the incubator if their condition allows.
✔ Test the water temperature using the wrist.
✔ Hold the newborn face-up, supporting the head and
torso properly.
✔ Clean each eye separately using a small cotton piece
soaked in warm water, wiping from inner to outer corners, then dry using
the same method.
✔ Clean each nostril separately with a small cotton
piece moistened with warm water.
✔ Move the towel slightly to expose the ear and wipe
the outer part without letting water enter the ear to prevent
infections.
✔ Wet your hands with warm water and wipe the face
(forehead, cheeks, chin), then dry with a small towel.
✔ Unwrap the towel from the head and body, then
gradually lower the newborn into the tub.
✔ Wet the head, apply a small amount of shampoo,
and gently massage the scalp, including behind the ears and neck
folds.
✔ Rinse the hair, around the ears, and neck folds with
water.
✔ Dry the hair, around the ears, and neck folds with a
towel.
✔ Apply a small amount of shampoo to clean the chest,
belly, and arms, paying special attention to the underarms, then
rinse well.
✔ Apply shampoo to the lower body, including
the legs and genital area. Pay special attention to skin folds
between the thighs, then rinse well.
✔ Turn the newborn on their belly to clean the back
and buttocks, then rinse well and return them to their original position
(face-up).
✔ After the bath is complete, let the newborn briefly
float supported in the water for a few seconds to allow muscle movement
and relaxation.
✔ Lift the newborn from the tub and wrap them in a large
towel, then place them under the warmer to complete drying.
✔ Complete nursing care procedures (apply baby oil or
cream, care for the umbilical cord, and apply eye drops).
Final Steps:
✔ Return the newborn to the incubator, wearing a clean
diaper.
✔ Clean and store all equipment properly.
✔ Record the following observations:
- Bath time
- Skin color
- Any visible abnormalities
- Umbilical cord condition, if present
- Any discharge from the genital area or rectum
Second: Sponge Bath (Using a Soft Towel)
In the first few days of life, when the newborn’s condition is unstable or until the umbilical cord falls off, a sponge bath is recommended. This involves using a soft towel or sterile cotton moistened with warm water (40°C) to gently wipe the baby’s body from top to bottom, without rubbing vigorously, as the newborn's skin is very delicate. Pay special attention to skin folds, then dry the newborn thoroughly with a dry towel.
Steps:
✔ Wipe each eye separately using a small piece of
sterile cotton soaked in warm distilled water, wiping from inner to
outer corners, then dry using the same method. Observe the eyes for redness
or discharge.
✔ Wipe the forehead, cheeks, and chin, then dry.
✔ Wipe each nostril and ear separately with a small
piece of cotton moistened with warm water.
✔ Wipe and dry the head, then the rest of the body,
paying attention to skin folds.
- Umbilical Cord Care
Purpose:
To keep the umbilical stump clean and prevent infection.
Required Materials:
✔ 70% ethyl alcohol
✔ Sterile basin
✔ Sterile gauze
✔ Sterile dressing
✔ Gloves
✔ Clean diaper
Steps:
✔ Wash hands routinely.
✔ Prepare materials.
✔ Soak sterile gauze in 70% ethyl alcohol in a sterile
basin.
✔ Place the newborn on their back and open the diaper.
✔ Wear gloves.
✔ Inspect the umbilical cord for discharge, bleeding,
redness, or foul odor, and report any abnormalities to the doctor.
✔ Hold the umbilical stump upright (without pulling).
✔ Clean the sides of the stump from top to bottom
in one direction.
✔ Clean the base of the stump using a circular
motion in one direction.
✔ Apply drops of alcohol over the umbilical stump.
✔ Leave the stump exposed to air to dry.
✔ Fold the diaper below the stump to keep it outside
the diaper.
✔ Dispose of used materials properly.
✔ Wash hands and record observations (date, time, and
any abnormalities).
- Diaper area care
Purpose:
To maintain the newborn’s hygiene and prevent diaper rash and infections.
Required Supplies:
Ensure all necessary supplies for changing the diaper are within reach, including:
- Several large cotton pads soaked in warm water
- Several large dry cotton pads
- A clean diaper
- Zinc oxide cream or rash treatment cream, if needed
- Latex gloves
- Sterile under pad
- Waste bin with red biohazard bag
Procedure:
- Wash hands routinely.
- Prepare all necessary tools.
- Undo the adhesive tape of the diaper.
- Put on gloves.
- Hold the newborn by the feet and lift the pelvic area; remove the diaper and observe the urine and stool for color, odor, and quantity.
- Inspect the diaper area for signs of inflammation, redness, or discharge.
- Use a warm wet cotton pad to clean the genital area **from front to back**, toward the anus.
- For female infants, pay special attention to cleaning between the labia.
- For uncircumcised males, gently retract the foreskin and clean underneath carefully to prevent adhesions—this should be done daily.
- Use another wet cotton pad to clean the skin folds in the diaper area of any remaining discharge.
- Dry the skin thoroughly using a dry cotton pad.
- Apply protective or rash treatment creams if necessary.
- Fold the used diaper inward with the soiled side inside and secure it with the tape before disposing of it in the red biohazard bag.
- Put on a clean diaper and secure it gently with the adhesive tape, avoiding pressure on the infant’s abdomen or thighs.
- Change the bed linen if needed.
- Remove gloves and wash hands routinely.
- Wrap the infant and place them back in their bed.
- Daily Nursing Care
Includes:
- Monitoring vital signs and growth measurements
- Hygiene care, including:
- Bathing - Diaper area care
- Umbilical cord care
- Skin care
- Eye care
- Providing special care
- Feeding the newborn
- Proper positioning
- Cleaning and disinfecting equipment, supplies, and linens
Preparation for Daily Nursing Care:
- Routine handwashing
- Prepare all equipment and ensure they are functioning properly:
- Measuring tape
- Thermometer and stethoscope
- Stopwatch
- Sterile cotton and gauze
- 70% Ethyl alcohol
- Zinc oxide cream (as prescribed)
- Gloves
- Bathing supplies
First: Vital Signs Monitoring
- Always measure vital signs when the infant is calm for accuracy.
- Includes: temperature, heart rate, respiratory rate, and blood pressure.
- Respiratory rate should be counted **before touching** the infant.
- Vital signs should be taken every 3 hours before feeding if the baby is stable or as directed by the physician.
Second: Growth Measurements
- Weight: Measured every 24 hours if the infant weighs less than 1000g and documented in the growth chart.
- Length: Measured weekly.
- Head circumference: Measured weekly or as ordered.
- Abdominal circumference: Measured every 24 hours or as per physician's instructions.
- Clean tools and return them to storage.
- Routine handwashing.
Third: Newborn Hygiene Eye, Mouth, and Face Cleaning: Done during routine care or when necessary.
Bathing:
- Do not use soap on the face.
- Full body bath 3 times a week (every other day).
**In Incubator: **
- Infants under 1200g or those unstable should not be removed from the incubator; use a soft cloth moistened with warm water to clean the face and diaper area.
**Outside Incubator: ** Bathing is allowed if:
- Infant is stable in bed/incubator
- Not receiving IV fluids
- No open wounds (including the umbilical stump)
**Bathing Precautions: **
- Use a disinfected plastic basin (one per infant).
- Ensure air conditioners and drafts are off during bathing.
- Ideal time: 9:00 AM alongside weight check and linen change.
- After bathing, disinfect tools and return them to their places.
- Record any abnormal signs and notify the physician.
Umbilical Cord Care
- Routine handwashing and alcohol rubbing, followed by sterile gloves.
- Keep the umbilical stump **exposed to air**; fold the diaper below it.
- Clean with 70% alcohol at each diaper change.
- If soiled, clean with warm water before applying alcohol.
Diaper Area Care
- Provided every 3 hours before feeding or when needed.
- Keep the area dry and treat rashes promptly.
Fourth: Skin Care
- Skin must be clean and completely dry.
- Assess skin every 12 hours and document findings.
- Full body washing or disinfectant soaps are not required during routine care.
- Avoid procedures that may damage the skin (e.g., aggressive drying, adhesives).
**Cannula Insertion: **
- Ensure insertion site is visible.
- Use minimal tape for infants <1500g.
**Cannula Monitoring: **
- Monitor hourly for swelling, redness, or leakage.
**Cannula Removal: **
- Remove if inflammation is present.
- Use alcohol-soaked cotton under the adhesive to reduce discomfort.
**Post-removal Care: **
- Apply warm compress and elevate the limb if swollen.
**Electrode Pads: **
- Change every 72 hours.
- Proper placement:
- White: right side - Black: left side
- Green & Red: lower abdomen
- Avoid placing pads on nipples
**Pulse Oximeter Probe: **
- Change site every 4 hours.
Fifth: Eye Care
- Use **sterile cotton and distilled water**, one wipe per eye, from inner to outer corner.
- Dry similarly, and apply prophylactic eye drops.
- Prevent contamination from suction catheters or respiratory secretions.
Sixth: Specialized Care for Preterm Infants
- Based on the infant’s condition: - Temperature regulation
- Suctioning - Blood glucose testing
- Laboratory testing - Oxygen therapy
Seventh: Feeding
- Wash hands routinely.
- Monitor for vomiting; note volume, consistency, and color; inform physician.
- Aspirate stomach contents pre-feeding and document.
- Measure abdominal circumference at the umbilical level before feeding.
- Assess abdomen: soft or distended.
- Monitor bowel movement frequency and stool consistency.
- Monitor urine output.
- Encourage nurse
-infant bonding during feeding.
- Position infant on the **right side** post-feeding to prevent aspiration.
- Record feed times and volumes.
- Report signs of feeding intolerance (e.g., vomiting, abdominal distention, >30% residuals). - Clean and disinfect feeding tools.
- Wash hands again.
**Note: ** Avoid moving the infant after feeding to reduce risk of vomiting.
Eighth: Infant Positioning
- Place a roll under shoulders to keep airway open.
- Position preterm infants in fetal
-like position inside nest.
- Change position every 2 hours:
- Side to side
- Back with head gently turned sideways
- Rotate the entire body, not just the head, to maintain alignment.
**Note: ** Avoid prolonged positioning on the same side of the face to prevent pressure on the ear and potential necrosis.
Ninth: Equipment & Linen Disinfection
- Clean and disinfect incubators, ventilators, and other equipment after each use and between patients.
- Routinely replace and sterilize devices for long-term neonates.
- Items in contact with skin or mucous membranes must be sterilized between uses.
- Incubators must be cleaned daily with **warm distilled water**.
- Linens should be sterile and changed daily or when soiled.
- Mattresses should be wiped with disinfectant during linen changes.
- Wear gloves and wash hands during linen changes.
- Soiled linens should be placed in a covered container and transported to laundry.
- Never use contaminated linens to clean incubators; use sterile towels moistened with distilled water.
- Retinopathy of Prematurity (ROP)
Definition:
ROP is a disorder affecting premature infants involving abnormal blood vessel growth in the retina, potentially leading to vision loss.
Causes:
- Premature birth
- Low birth weight
- Oxygen deficiency
- Bright light exposure
Symptoms:
- Visual difficulties
- Abnormal eye movements
- Strabismus (crossed eyes)
Diagnosis:
Eye exams using specialized equipment, possibly MRI or other imaging.
Treatment:
- Continuous monitoring
- Laser therapy to eliminate abnormal vessels
- Medications as needed
Prevention:
- Quality prenatal care
- Managing chronic conditions
- Intensive neonatal care