Despite precautions, a serious umbilical infection-omphaLitis-sometimes develops. In a German study of more than 750 newborns with aseptic cord care, 1.3 percent sufered such infections (Kapellen, 2009). he most likely ofending organisms are StaphyLococcus aureus, Escherichia coLi, and group B streptococcus. Typical signs of cellulitis and stump discharge usually aid diagnosis. Mild erythema and some bleeding at the stump site with cord detachment is also common, but some cases present with no outward signs.
In 2016, 81 percent of U.S. newborns were initially breastfed, 52 percent were still breastfed at 6 months, and 31 percent at 1 year (Centers for Disease Control and Prevention, 2016). According to the American College of Obstetricians and Gynecologists (2017 e), exclusive breastfeeding is preferred until 6 months. In many hospitals, breastfeeding begins in the delivery room. Most term newborns thrive best when fed 8 to 12 times daily for approximately 15 minutes each episode. Preterm or growth-restricted newborns require feedings at shorter intervals. Breastfeeding is discussed further in Chapter 36 (p. 656).
Because most neonates actually receive little nutriment for the first 3 or 4 days of life, they progressively lose weight until the flow of maternal milk is established or other feeding is instituted. Preterm neonates lose relatively more weight and regain their birthweight more slowly. Conversely, growth-restricted but otherwise healthy newborns regain their initial weight more quickly than those born preterm. With proper nourishment, birthweight of term newborns usually is regained by 10 days.
For the irst 2 or 3 days after birth, the colon contains sot, brown-green meconium. his consists of desquamated epithelial cells from the intestinal tract, mucus, epidermal cells, and lanugo (fetal hair) that have been swallowed along with amnionic luid.
The characteristic color results from bile pigments. During fetal life and for a few hours after birth, the intestinal contents are sterile, but bacteria quickly colonize the bowel contents.
Meconium stooling is seen in 90 percent of newborns within the irst 24 hours, and most of the rest within 36 hours. Usually, newborns irst void shortly ater birth but may not until the second day. Meconium and urine passage indicates patency of the gastro intestinal and urinary tracts, respectively. Failure of the newborn to stool or urinate ater these times suggests a congenital defect, such as Hirschsprung disease, imperforate anus, or posterior urethral valve. Ater the third or fourth day, as a result of milk ingestion, meconium is replaced by light-yellow, soter, homogenous feces.
Between the second and fifth day of life approximately one third of all neonates develop physiological jaundice of the newborn. It has special significance considering most hospitals have policies for early discharge. Guidelines regarding standard phototherapy equipment and monitoring, as well as treatment recommendations per gestational age, hour of life, and risk factors are used (Bhutani, 2011; Maisels, 2009). Hyperbilirubinemia is discussed further in Chapter 33 (p. 626).