Cord Care

1. Be sure the cord has stopped pulsing for most births.

2. Ensure that there are two clamps on the cord.
3. Hold the section of cord to be cut with a piece of gauze under it.
4. Using sterile scissors cut between the two clamps.
5. Dab excess blood.
6. Place scissors away.

With newborns, the first step in umbilical cord care will be the cutting of the cord.
The umbilical cord will be cut at some point after the birth of your baby.

The umbilical cord will be clamped before it is cut with something to help seal off
the open blood vessels in the cord. This is usually a plastic umbilical cord clamp.
Though it can also be a metal cord clamp or even cord tape.

After the cord has been clamped and cut, it may also be treated. The treatment is
usually in the form of a dye. This dye is used to help protect the cord from
infection, though it is not a mandatory procedure and varies largely by where you
are when you give birth and who is caring for you.

The umbilical cord should be cleaned with either hydrogen peroxide or alcohol.
Which you use will be determined by your practitioner's preference or what you
have handy. Some doctor's and midwives say to start with alcohol and only go to
hydrogen peroxide if you need something more drying.

The first step in actual umbilical cord care is to gather up your supplies. You will
need either cotton swabs or cotton balls and a solution like hydrogen peroxide or
alcohol. It's also handy to have the baby with you. Most parents choose to do cord
care during diaper changes.

Undress your baby, exposing the cord area. Remember these solutions can stain
your baby's clothing. You will dip the cotton swab or cotton ball into the solution
to wet it thoroughly.

A cotton swab is usually the easiest way to clean the umbilical cord. This is
because the cotton swab can reach further into the belly button than a cotton ball
can. When you're cleaning the umbilical cord hold the cotton swab in one hand and
with your other hand either press down on the sides of the umbilical cord stump or
excess skin. This allows greater access to the inside of the cord, where it will stay
"wet" longer.

You should call your baby's doctor or pediatrician if there is a foul odor coming
from the area of the umbilical cord, if there is redness around the cord or if your
baby is running a fever.

A cotton ball is a nice way to clean the cord too. The benefits of the cotton ball are
that it holds more of your cleaning solution. If you're unsure of which to use, you
can always use both. You can either switch off at each cleaning or use both each
time.

The cotton ball is handy if you're leery of cleaning deeply, because you can drip
lots of the cleaning solution into the area of the umbilical cord.

The dirt that you'll get from the cord area when cleaning, particularly with a cotton
swab, can be worrisome. Do not panic. It is normal to have discoloration of the
cotton swab or cotton ball. This photo shows you a normal cotton swab after
cleaning.
 Vaccination and Immunization

Your baby's Immunization

How it is given
age offered
At birth or within
the first month
after birth Hepatitis B vaccine
First dose
(or within the first (HepB)
12 months after
birth for catch up)
At birth Bacille Calmette-
(or within the first Guérin vaccine One injection
2 months) (BCG)
Around 1 to 2
months old
Hepatitis B vaccine
(or at least four Second dose
(HepB)
weeks after the
first dose)
Pneumococcal
Around 6 weeks to
Conjugate Vaccine First dose
2 months old
(PCV-7)
Diphtheria, tetanus, and
whole-cell/acellular
2 months old pertussis (whooping First dose
cough) vaccine
(DTwP / DTaP)
  Oral/Inactivated polio First dose
vaccine
 (OPV / IPV)
Haemophilus
influenzae type B
  First dose
vaccine
(HiB)
First dose
(Depending on the
brand, it is
  Rotavirus vaccine administered either
in two or three
doses, at least four
months apart)
Pneumococcal
4 months old Conjugate Vaccine Second dose
(PCV-7)
Diphtheria, tetanus, and
whole-cell/acellular
  pertussis (whooping Second dose
cough) vaccine
(DTwP / DTaP)
Oral/Inactivated polio
  vaccine Second dose
(OPV / IPV)
Haemophilus
influenzae type B
  Second dose
vaccine
(HiB)
Pneumococcal
6 months old Conjugate Vaccine Third dose
(PCV-7)
Diphtheria, tetanus, and
whole-cell/acellular
  pertussis (whooping Third dose
cough) vaccine
(DTwP / DTaP)
Haemophilus
influenzae type B
  Third dose
vaccine
(HiB)
 For those receiving
it for the first time,
two doses at four
weeks apart are
required. Since the
  Influenza vaccine
flu virus changes
from year to year,
an annual
vaccination is
recommended.
Oral/Inactivated polio
Around 6 to 8
vaccine Third dose
months old
(OPV / IPV)
Around 6 to 18 Hepatitis B vaccine
Third dose
months old (HepB)
Measles, mumps and
Around 9 to 12 rubella (German
First dose +
months old measles) vaccine
(MMR)
Hepatitis A vaccine
12 months old First dose
(HepA)
Pneumococcal
Around 12 to 15
Conjugate Vaccine Fourth dose
months old
(PCV-7)
Around 12 to 18 Varicella (chickenpox)
First dose
months old vaccine
Pneumococcal
Around 15 to 18 Conjugate Vaccine
First dose
months old booster shot
(PCV-7 booster)
Diphtheria, tetanus, and
whole-cell/acellular
pertussis (whooping
  First dose
cough) vaccine booster
shot
(DTwP / DTaP booster)
Oral/Inactivated polio
  vaccine booster shot First dose
(OPV / IPV booster)
 Haemophilus
influenzae type B
  First dose
vaccine booster shot
(HiB booster)
Around 18 to 24 Hepatitis A vaccine
Second dose ++
months old (HepA)
2 years old Typhoid vaccine One injection
  Meningococcal vaccine One injection
Diphtheria, tetanus, and
whole-cell/acellular
Around 4 to 6 pertussis (whooping
Second dose +++
years old cough) vaccine booster
shot
(DTwP / DTaP booster)
Oral/Inactivated polio
  vaccine booster shot Second dose
(OPV / IPV booster)
Measles, mumps and
rubella (German
  Second dose
measles) vaccine
(MMR)
Varicella (chickenpox)
  Second dose
vaccine
 Newborn screening tests
Newborn screening tests look for serious developmental, genetic, and metabolic
disorders so that important action can be taken during the critical time before
symptoms develop/

How the Test is Performed

Blood tests: A health care professional will prick the baby’s heel to obtain a few
drops of blood. The blood is sent to a lab for analysis.

Hearing test: An audiologist will place a tiny earpiece or microphone in the

infant’s ear or stick electrodes on the baby’s head.

How to Prepare for the Test

There is no preparation necessary for newborn screening tests. The tests are
performed when the baby is between 24 hours and 7 days old, typically before the
baby goes home from the hospital.

How the Test Will Feel

The baby will most likely cry when his or her heel is pricked to obtain the small
blood sample. The hearing test should not cause the baby to feel pain, cry, or
respond.

Why the Test is Performed

Screening tests do not diagnose illnesses. They identify which babies need
additional testing to confirm or rule out illnesses. Good screening tests have a low
false-negative rate (if the test is normal, the child should be healthy), but may have
a high false-positive rate (as many affected children as possible should test
positive, even if this means many healthy children also test positive).

If follow-up testing confirms that the child has a disease, appropriate treatment can
be started right away, before symptoms appear.
Screening tests are used to detect a number of disorders, including:

 Amino acid metabolism disorders:

o Arginosuccinic acidemia
o Citrullinemia
o Homocystinuria
o Maple syrup urine disease
o Phenylketonuria (PKU)
o Tyrosinemia type I
 Biotinidase deficiency
 Congenital adrenal hyperplasiaCongenital adrenal hyperplasia
 Congenital hypothyroidism
 Cystic fibrosis (see also: Neonatal cystic fibrosis screeningNeonatal cystic
fibrosis screening)
 Fatty acid metabolism disorders:
o Carnitine uptake deficiency
o Long-chain L-3-hydroxyacyl-CoA dehydrogenase deficiency
o Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency
o Trifunctional protein deficiency
o Very long-chain acyl-CoA dehydrogenase deficiency (VLCAD)
 Galactosemia
 Glucose-6-phosphate dehydrogenase deficiency (G6PD)Glucose-6-
phosphate dehydrogenase deficiency (G6PD)
 Human immunodeficiency disease (HIV)
 Organic acid metabolism disorders:
o 3-Hydroxy-3-methylglutaric aciduria (HMG)
o 3-Methylcrotonyl-CoA carboxylase deficiency (3MCC)
o Beta ketothiolase deficiency
o Glutaric acidemia type I
o Isovaleric acidemia
o Methylmalonic acidemiaMethylmalonic acidemia
o Multiple carboxylase deficiency (MCD)
o Propionic acidemia
 Sickle cell disease and other hemoglobinopathy disorders and traits
 Toxoplasmosis

Note: Normal value ranges may vary slightly among different laboratories. Talk to
your doctor about the meaning of your specific test results.
What Abnormal Results Mean

An abnormal result means that the child should have additional testing to confirm
or rule out the condition.

Risks

Risks for the newborn heel prick blood sample include pain and possible bruising
at the site where the blood was obtained.

Considerations

Newborn testing is critical for the baby to receive treatment that may be life
saving. However, not all disorders that can be detected by the screening tests can
be treated.

Although states do not perform all screening tests, parents can have additional tests

done by qualified laboratories at large medical centers. Private laboratories also
offer newborn screening. Parents can find out about extra newborn screening tests
from their physician or hospital where the baby will be born, as well as through
organizations like the March of Dimes.
 Cold Chain
Vaccines must be stored properly from the time they are manufactured until the
time they are administered. Excess heat or cold will reduce their potency,
increasing the risk that recipients will not be protected against vaccine-preventable
diseases. The system used to keep and distribute vaccines in good condition is
called the cold chain. The cold chain has three main components: transport and
storage equipment, trained personnel, and efficient management procedures. All
three elements must combine to ensure safe vaccine transport and storage.

The cold chain begins with the cold storage unit at the vaccine manufacturing
plant, extends through the transfer of vaccine to the distributor and then to the
provider’s office, and ends with the administration of the vaccine to the
Proper storage temperatures must be maintained at every link in the chain.
*Vaccine is transported in a refrigerated or frozen state, as appropriate (refrigerator
35°– 46°F [2°– 8°C]; freezer 5°F [-15°C] or colder), using an insulated container
or a refrigerated truck.

Importance of Maintaining the Cold Chain

Vaccine Potency
Excessive heat or cold exposure damages vaccine, resulting in loss of potency.
Once
potency is lost, it can never be restored. Furthermore, each time vaccine is exposed
to
heat or cold, the loss of potency increases and eventually, if the cold chain is not
correctly maintained, all potency will be lost, and the vaccine becomes useless.
Excessive heat or cold damage the vaccines.

Storage Conditions
Some vaccines may show physical evidence of altered potency when exposed to
inappropriate storage conditions, such as clumping in the solution that does not go
away when the vial is shaken. Other vaccines may look perfectly normal when
exposed to inappropriate storage conditions. For example, inactivated vaccines
exposed to freezing temperatures (i.e., 32°F [0°C] or colder) may not appear frozen
and give no indication of loss of potency. Therefore, visual inspection of vaccines
is an unreliable method of assuring potency.

Burden of Cold Chain Failure

An estimated 17% to 37% of providers expose vaccines to improper storage
temperatures. Refrigerator temperatures are more commonly kept too cold rather
than too warm.1,2 One study involving site visits showed that 15% of
refrigeration units had temperatures of 34°F (1°C) or lower.2 Out-of-range
temperatures require.

Immediate Action.

Loss of vaccine potency due to improper storage conditions is a costly mistake.

Patients receiving vaccine with decreased potency caused by improper storage
conditions may not be fully protected against the vaccine-preventable disease.