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The neonatal period is the first 28 days of life, which means that infants can be referred to as neonates until the end of the fourth week after birth. The highest chance of death occurs within this period of life, particularly during the first week. For this reason, newborn infants are thoroughly examined just after birth, at which time most medical conditions are already present and noticeable by doctors. Both babies with health conditions and premature infants are usually placed in the neonatal intensive care unit, or NICU, to be monitored and treated. Despite the name of the unit, treatment in the NICU may last longer than the neonatal period for babies that are seriously ill or very premature.
Nearly every hospital examines newborns in the delivery room immediately after birth to make sure that they are healthy. The weight, length, head circumference, pulse, and temperature are frequently recorded right away, and any abnormalities that are observed at that time are noted. Newborns are also given an Apgar score, which can be anywhere from zero to ten, depending on the scores given for skin color, pulse rate, muscle tone, breathing, and reflex irritability. Each of these five traits can be scored from zero to two and then added up, and the test is given at both one and five minutes after birth. Scores below seven may indicate a need for some time spent in the NICU during the first day of the neonatal period, while scores below four usually signal a need for a longer stay in the hospital.
More than one third of deaths in children occur in the neonatal period, and about three quarters of those fatalities happen during the first week. For this reason, not only is extra medical care crucial during the neonatal period, but so is prevention of the conditions that commonly lead to infant death. For example, mothers who are able to give birth in a sanitary environment, get a tetanus vaccination, and provide antibodies to their newborn by exclusively breastfeeding tend to have lower rates of infant death during the neonatal period. Additionally, babies born in an environment with access to antibiotics or extra care in the case of low birth weight tend to have lower mortality rates. About three quarters of child deaths are due to malaria, diarrhea, preterm birth, neonatal sepsis, pneumonia, and asphyxia during delivery, which makes access to adequate healthcare crucial during the beginning stages of life.
@ElizaBennett - I don't necessarily dispute your facts, but you have to admit that in this country, home birth remains something of a niche market. Most women will want to go to the hospital.
I had a friend who had actually toyed with the idea of a home birth before an ultrasound revealed that her baby would be born with heart problems and require surgery shortly after birth. Then, the question was which hospital to choice, because they are not all created equal! First, she had to find one with the right kind of NICU - well-equipped enough to handle her sick baby. Not all hospitals have NICUs at all, and they are rated by level (I think she needed
Then, she wanted to find one that was respectful of mother-baby bonding during the neonatal period - that would encourage kangaroo care, breastfeeding, etc. Fortunately, she lives near a big city and she did have a choice of two hospitals. The one she chose was over an hour from her home, but since she was having a scheduled c-section because of baby's condition, it was less of an issue. Happily, baby is doing well now!
I just want to emphasize that a "sanitary environment" *can* be your own home! Yes, even if you have not recently scrubbed every surface with bleach.
Hospitals are, indeed, kept very clean, but they are also full of sick people. The result can be hospital-born infections like MRSA; very, very rarely, these can infect women and babies who were not previously sick. Your own home is not kept to the same standards of cleanliness, of course, but you are used to all the germs present there. You are unlikely to get an infection from the same bugs you are around all the time.
Some studies will show an increate in neonatal mortality for home births, but these have
not adequately separated accidental or unplanned home births (which can, indeed, be very dangerous) from planned home births. A planned home birth usually involves a healthy, low-risk mom and baby and a skilled attendant who is trained to assess the baby and provide emergency medical care if necessary.
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