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|title = Neonatal care (Navajata shishu paricharya)
|title = Neonatal care (Navajata shishu paricharya)
|titlemode=append
|titlemode=append
|keywords=Neonatal care (Navajata shishu paricharya) ,General aspects of neonatal care in Ayurveda, care of healthy newborn, ancient resuscitation measures (prana pratyagamana vidhi),Cutting of umbilical cord, Examination of newborn baby,protective measures, Recommendations for the neonatal care unit or child nursery, breast feeding, Recommendations regarding the bed and fabrics used for the child, selection of toys,Evaluating a sick newborn, Diseases of newborn and their management
|keywords=Neonatal care (Navajata shishu paricharya) ,General aspects of neonatal care in Ayurveda, care of healthy newborn, ancient resuscitation measures (prana pratyagamana vidhi), Cutting of umbilical cord, Examination of newborn baby, protective measures, Recommendations for the neonatal care unit or child nursery, breastfeeding, Recommendations regarding the bed and fabrics used for the child, selection of toys, Evaluating a sick newborn, Diseases of newborn and their management
|description= Neonatal care in Ayurveda includes immediate care and general care of newborn babies along with proper examination, diagnosis and management of diseases if any.
|description= Neonatal care in Ayurveda includes immediate care and general care of newborn babies along with proper examination, diagnosis and management of diseases if any.
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|image_alt=carak samhita
|type=article
|type=article
}}
}}
The care of a newborn is termed as “Navajata shishu paricharya” in Ayurveda. ‘Navajata shishu’ is a newborn baby, and ‘paricharya’ indicates the care and necessary management protocols.The atmosphere and surroundings change from intrauterine dependent life to independent external life after birth.The child has to adapt to the new changes quickly. It is essential to take care of newborns until the body systems are well adopted and developed to survive in the new world. Ayurveda classical texts include the methods and practices followed for newborn care in ancient times.The ancient practices include use of available natural resources. Hence, they can be practiced with cost effectiveness and least medical equipments.Though the principles of care are same, the contemporary practices have changed significantly with advances in medical technology.This article deals with the analysis of these practices along with their contemporary views.
<div style="text-align:justify;">
The care of a newborn is termed as “Navajata shishu paricharya” in [[Ayurveda]]. ‘Navajata shishu’ is a newborn baby, and ‘paricharya’ indicates the care and necessary management protocols. The atmosphere and surroundings change from intrauterine dependent life to independent external life after birth. The child has to adapt to the new changes quickly. It is essential to take care of newborns until the body systems are well adopted and developed to survive in the new world. [[Ayurveda]] classical texts include the methods and practices followed for newborn care in ancient times. The ancient practices include use of available natural resources. Hence, they can be practiced with cost effectiveness and the least medical equipments. Though the principles of care are same, the contemporary practices have changed significantly with advances in medical technology. This article deals with the analysis of these practices along with their contemporary views.
</div>
{{Infobox
{{Infobox
|label5 = Affiliations
|label5 = Affiliations
|data5 = <sup>1</sup> Department of Kaumarabhritya, AIIA , New Delhi, <sup>2</sup>[[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar,
|data5 = <sup>1</sup> Department of Kaumarabhritya, AIIA , New Delhi,
<sup>2</sup>[[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar,
<sup>3</sup> Department of Kaumarabhritya, ITRA, Jamnagar.
<sup>3</sup> Department of Kaumarabhritya, ITRA, Jamnagar.
}}
}}
==Care of healthy newborn==
==Care of healthy newborn==
A normal newborn is born at term with birth weight between 2,500 g and 3500 g, without any breathing difficulty, major congenital malformations, or any birth injuries. The goals of neonatal care in all medical systems are uniform:
<div style="text-align:justify;">
a) Ensure successful transition from fetal to neonatal life.
A normal newborn is born at term with birth weight between 2,500 g and 3500 g, without any breathing difficulty, major congenital malformations, or any birth injuries. The goals of neonatal care in all medical systems are uniform:
b) Initiate and accustom the child to external stimuli of all kinds.
c) Clean the oral cavity of the child to clear the airway (wiping, anointing).
a) Ensure successful transition from fetal to neonatal life.
d) Maintain the body temperature of the newborn.
e) Proper and hygienic clamping and severing of umbilical cord.
b) Initiate and accustom the child to external stimuli of all kinds.
c) Clean the oral cavity of the child to clear the airway (wiping, anointing).
d) Maintain the body temperature of the newborn.
e) Proper and hygienic clamping and severing of umbilical cord.
f) Ensure earliest possible initiation of breastfeeding.
</div>
==Immediate care of newborn==
==Immediate care of newborn==
In the classical literature of Ayurveda, the immediate procedures similar to resuscitation methods are described as the measures to re-establish and maintain vital energy (prana). It is recommended for every newborn irrespective of their vital status at the time of birth. [Cha.Sa. [[Sharira Sthana]] 8/42].
<div style="text-align:justify;">
In the classical literature of [[Ayurveda]], the immediate procedures similar to resuscitation methods are described as the measures to re-establish and maintain vital energy (prana). It is recommended for every newborn irrespective of their vital status at the time of birth. [Cha.Sa.[[Sharira Sthana]] 8/42].
In contemporary views, if the baby is born at full term with a good tone and normal respiration (or healthy cry), only routine care needs to be given. The baby is to be kept dry, warm, and with airways clear. If, the baby does not satisfy the criteria of term tone and breathing, he/she has to be in the the warmer area and subjected to a neonatal resuscitation algorithm.
</div>
=== Ancient resuscitation measures (prana pratyagamana vidhi)===
=== Ancient resuscitation measures (prana pratyagamana vidhi)===
<div style="text-align:justify;">
The principle behind these procedures is the stimulation of sense organs. The activation of the brain centers through sensory stimuli to initiate motor activity, especially breathing.
The principle behind these procedures is the stimulation of sense organs. The activation of the brain centers through sensory stimuli to initiate motor activity, especially breathing.
Rubbing stones at the base of the ears is the first step in immediate care. [Cha. Sa. [[Sharira Sthana]] 8/42] Hymns to be uttered in the right ear of the neonate are also mentioned. [A. Hr. Uttara Sthana 1/3]. These are the forms of auditory stimuli.
Rubbing stones at the base of the ears is the first step in immediate care. [Cha. Sa. [[Sharira Sthana]] 8/42] Hymns to be uttered in the right ear of the neonate are also mentioned. [A. Hr. Uttara Sthana 1/3]. These are the forms of auditory stimuli.
Sprinkling or washing the face with cold or hot water in accordance with the climate; (i.e., cold water is for hot climate and hot water for cold climate) is advised. Fanning the child using a fan made of straw, grass, and bamboo is also recommended. [Cha. Sa. [[Sharira Sthana]] 8/42].
Sprinkling or washing the face with cold or hot water in accordance with the climate; (i.e., cold water is for hot climate and hot water for cold climate) is advised. Fanning the child using a fan made of straw, grass, and bamboo is also recommended. [Cha. Sa. [[Sharira Sthana]] 8/42].
Pouring of lukewarm medicated oil ‘Bala taila’ followed by gentle massage is performed to relieve the stress caused by labor. [Su. Sa. Sharira Sthana 10/12], [A.Hr. Uttara Sthana 1/1] These can be considered measures to generate tactile stimuli and maintain proper thermo-regulation. They also resist the contact of the umbilical stump with water, hence reducing the possibility of microbial overgrowth.
Pouring of lukewarm medicated oil ‘Bala taila’ followed by gentle massage is performed to relieve the stress caused by labor.[Su. Sa. Sharira Sthana 10/12], [A.Hr. Uttara Sthana 1/1] These can be considered measures to generate tactile stimuli and maintain proper thermo-regulation. They also resist the contact of the umbilical stump with water, hence reducing the possibility of microbial overgrowth.
Rubbing stones on the base of the ears and sprinkling water on the face is expected to stimulate the vestibulocochlear nerve and facial nerve.
Rubbing stones on the base of the ears and sprinkling water on the face is expected to stimulate the vestibulocochlear nerve and facial nerve.
These procedures are to be done till the child starts breathing independently.
These procedures are to be done till the child starts breathing independently.
</div>
===Cleaning of channels and orifices===
===Cleaning of channels and orifices===
<div style="text-align:justify;">
Once the child starts breathing properly, cleaning the external orifices and bathing of the child is to be done. Cleaning of the orifices is done by wiping with cotton wrapped around the fingers. The nails of the caretaker shall be trimmed to prevent any skin injury to the newborn. While cleaning the oral cavity, the direction shall be from palate to lips. Then the buccal cavity shall be cleaned from throat to tongue. [Cha.Sa.[[Sharira Sthana]] 8/42]
Once the child starts breathing properly, cleaning the external orifices and bathing of the child is to be done. Cleaning of the orifices is done by wiping with cotton wrapped around the fingers. The nails of the caretaker shall be trimmed to prevent any skin injury to the newborn. While cleaning the oral cavity, the direction shall be from palate to lips. Then the buccal cavity shall be cleaned from throat to tongue. [Cha.Sa.[[Sharira Sthana]] 8/42]
In modern pediatric practice, the cleaning of the airway is done by inserting a laryngoscope. Clearing the mouth and posterior pharynx is done by using a suction catheter under direct vision in case of visible obstruction of the airway of the neonate with respiratory distress syndrome.
In modern pediatric practice, the cleaning of the airway is done by inserting a laryngoscope. Clearing the mouth and posterior pharynx is done by using a suction catheter under direct vision in case of visible obstruction of the airway of the neonate with respiratory distress syndrome.
The patency of these orifices and the presence of any congenital abnormality are also examined while cleaning.
The patency of these orifices and the presence of any congenital abnormality are also examined while cleaning.
</div>
===Therapeutic emesis===
===Therapeutic emesis===
<div style="text-align:justify;">
Administration of ghee mixed with rock salt to induce emesis is recommended. [Cha. Sa. [[Sharira Sthana]] 8/43]. This emesis is targeted to eliminate accidentally swallowed or aspirated amniotic fluid, especially meconium-stained (ulba).
Administration of ghee mixed with rock salt to induce emesis is recommended. [Cha. Sa. [[Sharira Sthana]] 8/43]. This emesis is targeted to eliminate accidentally swallowed or aspirated amniotic fluid, especially meconium-stained (ulba).
Currently, this procedure is not generally practiced. In the case of meconium aspiration, it is recovered by slow suction by a suction device connected with the endotracheal tube inserted into the trachea.
Currently, this procedure is not generally practiced. In the case of meconium aspiration, it is recovered by slow suction by a suction device connected with the endotracheal tube inserted into the trachea.
</div>
===Application of oil on head (shiro pichu)===
===Application of oil on head (shiro pichu)===
<div style="text-align:justify;">
Application of cotton soaked in ghee or medicated oil with Sida cordifolia (bala) over the vertex of the newborn is practiced. [Su. Sa. Sharira Sthana 10/12] The covering of anterior fontanels (where there could be open intracranial sutures at birth) using oil or ghee smeared tampons act as a protective mechanism to the open sutures. It also optimizes the heat regulation mechanism. At this point, examination of fontanels is also performed.
Application of cotton soaked in ghee or medicated oil with Sida cordifolia (bala) over the vertex of the newborn is practiced. [Su. Sa. Sharira Sthana 10/12] The covering of anterior fontanels (where there could be open intracranial sutures at birth) using oil or ghee smeared tampons act as a protective mechanism to the open sutures. It also optimizes the heat regulation mechanism. At this point, examination of fontanels is also performed.
</div>
===Cutting of umbilical cord===
===Cutting of umbilical cord===
The time of cutting and clamping the umbilical cord is crucial for the health of the newborn. In Ayurveda, cutting of the umbilical cord is recommended only after the baby become stable in the external environment. [ A.Hr. Uttara Sthana 1/5-6] World Health Organization recommends delayed umbilical cord clamping i.e., at least one minute after birth for better health and nutritional outcomes of the mother as well as the baby.
<div style="text-align:justify;">
The time of cutting and clamping the umbilical cord is crucial for the health of the newborn. In [[Ayurveda]], cutting of the umbilical cord is recommended only after the baby become stable in the external environment. [ A.Hr. Uttara Sthana 1/5-6] World Health Organization recommends delayed umbilical cord clamping i.e., at least one minute after birth for better health and nutritional outcomes of the mother as well as the baby.
The cord is cut at a point 16 cm (eight angulas) away from the umbilicus. The cord is held gently and firmly on both sides of the point and carefully cut using scissors (ardhadhara) made up of gold, silver, iron, or similar metals. The proximal end of the cut umbilical cord is tied with a thread, and the other end of the thread should be tied loosely around the neck of the child. [Cha. Sa. Sharira Sthana 8/44] Tying a knot on the cord using a thread before cutting, and then attaching it to the neck after cutting the cord, is also desirable.[Su. Sa. Sharira Sthana 10/12], [A.Hr. Uttara Sthana 1/5-6] Now a days, umbilical cord clamp is used for this purpose.
The cord is cut at a point 16 cm (eight angulas) away from the umbilicus. The cord is held gently and firmly on both sides of the point and carefully cut using scissors (ardhadhara) made up of gold, silver, iron, or similar metals. The proximal end of the cut umbilical cord is tied with a thread, and the other end of the thread should be tied loosely around the neck of the child. [Cha. Sa. Sharira Sthana 8/44] Tying a knot on the cord using a thread before cutting, and then attaching it to the neck after cutting the cord, is also desirable.[Su. Sa. Sharira Sthana 10/12], [A.Hr. Uttara Sthana 1/5-6] Now a days, umbilical cord clamp is used for this purpose.
In modern obstetrical practices, early clamping and cutting of the umbilical cord was a practiced as a part of active management of third stage of labour. But recent studies suggest that it may be harmful to the baby. Delayed clamping helps in reducing incidence of anaemia, intraventricular haemorrhage, and the need for transfusion for hypovolaemia and anaemia, except in the case of growth restricted babies who are already at risk of hypoxia induced polycythaemia.
In modern obstetrical practices, early clamping and cutting of the umbilical cord was a practiced as a part of active management of third stage of labour. But recent studies suggest that it may be harmful to the baby. Delayed clamping helps in reducing incidence of anaemia, intraventricular haemorrhage, and the need for transfusion for hypovolaemia and anaemia, except in the case of growth restricted babies who are already at risk of hypoxia induced polycythaemia.
</div>
===Diseases due to improper cutting of the umbilical cord===
===Diseases due to improper cutting of the umbilical cord===
<div style="text-align:justify;">
Due to improper handling of the umbilical cord, abnormal conditions of cord stump are described.
Due to improper handling of the umbilical cord, abnormal conditions of cord stump are described.
• Vertically swollen (ayama uttundita)
• Horizontally swollen (vyayama uttundita)
• Vertically swollen (ayama uttundita)
• Combination of both (ayama vyayama Uttundita)
• Formation of circular mass or ring around the umbilicus (pindalika)
• Horizontally swollen (vyayama uttundita)
• Swollen at margins and depressed at centre (vinamika)
• Undue and prolonged increase in size (vijrmbhika) [Cha.Sa. Sharira Sthana 8/61]
• Combination of both (ayama vyayama Uttundita)
• Formation of circular mass or ring around the umbilicus (pindalika)
• Swollen at margins and depressed at centre (vinamika)
• Undue and prolonged increase in size (vijrmbhika) [Cha.Sa. [[Sharira Sthana]] 8/61]
When the umbilicus becomes inflated due to [[vata]] [[dosha]], the condition is known as “nabhitundi”. [A.S.Uttara Sthana 2/51]
When the umbilicus becomes inflated due to [[vata]] [[dosha]], the condition is known as “nabhitundi”. [A.S.Uttara Sthana 2/51]
There are other conditions wherein the umbilicus gets suppurated (nabhipaka), umbilical edema (nabhishotha), raised umbilicus (unnata nabhi), depressed umbilicus (anunnata nabhi), etc.
There are other conditions wherein the umbilicus gets suppurated (nabhipaka), umbilical edema (nabhishotha), raised umbilicus (unnata nabhi), depressed umbilicus (anunnata nabhi), etc.
Management:
• Dusting (avachoornana) with powdered drugs or ash of goat manure.
'''Management:'''
• Anointment (lepana) of thick paste of medicines along with jiggery.
• Pouring (parisheka) of the decoction or oil processed with Glycyrrhiza glabra Linn (yasti), Symplocos racemosa (lodhra), Curcuma longa (nisha), and Panicum frumentaceum (shyamaka) or dusting using the powder made out of the same drugs is done as per the clinical condition of umbilicus.
• Dusting (avachoornana) with powdered drugs or ash of goat manure.
• In nabhitundi, [[vata]] alleviating measures like oleation (sneha), sudation (sweda), application of poultice(upanaha) should be done.
• A combination of Symplocos racemosa (Lodhra), Glycrrhiza glabra (Madhuka), Aglaia elaeagnoidea (Priyangu), Cedrus deodara (Suradaru), and Curcuma longa (Haridra) shall be used as a powder for dusting and oil made of their pastes shall be used for pouring.
• Anointment (lepana) of thick paste of medicines along with jiggery.
• Pouring (parisheka) of the decoction or oil processed with Glycyrrhiza glabra Linn (yasti), Symplocos racemosa (lodhra), Curcuma longa (nisha), and Panicum frumentaceum (shyamaka) or dusting using the powder made out of the same drugs is done as per the clinical condition of umbilicus.
• In nabhitundi, [[vata]] alleviating measures like oleation (sneha), sudation (sweda), application of poultice(upanaha) should be done.
• A combination of Symplocos racemosa (Lodhra), Glycrrhiza glabra (Madhuka), Aglaia elaeagnoidea (Priyangu), Cedrus deodara (Suradaru), and Curcuma longa (Haridra) shall be used as a powder for dusting and oil made of their pastes shall be used for pouring.
General measures to alleviate [[vata]] and [[pitta]] are to be administered in cases of diseases due to improper cutting of the umbilical cord. [A.S.Uttara Sthana 2/51]
General measures to alleviate [[vata]] and [[pitta]] are to be administered in cases of diseases due to improper cutting of the umbilical cord. [A.S.Uttara Sthana 2/51]
In modern practices also, the umbilical cord is maintained clean and dry. Spirit is used for cleaning. No local antiseptics are used as routine care. The stump falls off in 7 to 10 days. Neonatal omphalitis, umbilical hernia, umbilical granuloma, umbilical polyp, umbilical cyst, etc. are common disorders of the umbilicus.
In modern practices also, the umbilical cord is maintained clean and dry. Spirit is used for cleaning. No local antiseptics are used as routine care. The stump falls off in 7 to 10 days. Neonatal omphalitis, umbilical hernia, umbilical granuloma, umbilical polyp, umbilical cyst, etc. are common disorders of the umbilicus.
==Examination of newborn baby==
==Examination of newborn baby==
Ayurveda recommends the examination of the newborn for the signs indicative of life span. Specific features of different body parts are given. These indicate good health and life span. [Cha. Sa. Sharira Sthana 8/51] It is given in the table below.
Ayurveda recommends the examination of the newborn for the signs indicative of life span. Specific features of different body parts are given. These indicate good health and life span. [Cha.Sa.[[Sharira Sthana]] 8/51] It is given in the table below.
Sl No. Organ Signs of good life span
Sl No. Organ Signs of good life span
1. Hair Soft, sparse, unctuous, deep-rooted, black
1. Hair Soft, sparse, unctuous, deep-rooted, black