View original document

The full text on this page is automatically extracted from the file linked above and may contain errors and inconsistencies.

Standards and Recommendations
For Hospital Care
Of Newborn Infants


Prem ature

Bureau Publication 292

United States Department o f Labor
Children’s Bureau
I U 5 '<? o 1
Federal Reserve Bank of St. Louis

11 0



Collegesiatij , ftras

U nited S tates D epartment of L abor ,
C hildren ’s Bureau ,

Washington, March 5, 1943.
M adam : There is transmitted herewith a bulletin, Standards and Rec­

ommendations for Hospital Care of Newborn Infants, Full-Term and
The bulletin was written by Dr. Ethel C. Dunham and Dr. M arian M.
Crane of the Division of Research in Child Development of the Children’s
Bureau, under the general supervision of Dr. Katherine Bain, director of
that Division. The manuscript was reviewed by three committees of
physicians; namely, the Bureau’s advisory committee of obstetricians, its
advisory committee of pediatricians, and the American Academy of Pedi­
atrics committee on'the fetus and newborn infant.
Respectfully submitted,
K atharine F. L enroot, Chief.
Hon. F rances Perkins,
Secretary of Labor.

u n it e d st a t e s
g o v e r n m e n t p r in t in g o f f ic e



For sale by the Superintendent of Documents, U. S. Government Printing Office
Washington, D. C. - Price S cents
Federal Reserve Bank of St. Louis

Standards and Recommendations for Hospital
Care of Newborn Infants
In the present war emergency provision of adequate hospital care for new­
born infants is becoming more and more of a problem. With the increasing
demand for hospitalization of maternity cases, especially in defense areas,
hospital nurseries are overcrowded, with a resulting increase in the hazards
to the infants The fate of newborn infants depends largely upon the
medical and nursing care they receive, and, on account of the wartime
shortage of professional personnel, it is becoming increasingly difficult for
many hospitals to maintain the high standards that have been developed in
recent years for the care of newborn infants.
To assist hospitals in modifying some of their procedures while maintaining
the recognized standards, this pamphlet presents a statement of such stand­
ards, representing in general the consensus of present pediatric opinion, along
with certain recommendations that may be helpful in the hospital’s efforts
to maintain these standards under wartime conditions.
The standards presented here are not minimum standards, pointing out
the least that can be done for infants in hospital nurseries without jeopardiz­
ing their lives. Rather they are standards pointing out the type of care for
such infants that will best safeguard their health.
It is realized that many hospitals may not be able to attain all these stand­
ards at once, especially during the wartime emergency. It is expected,
however, that such hospitals will find this statement of standards useful in
evaluating their present methods of care and the adequacy of their equip­
ment and in setting a goal for future attainment.

The medical staff for the nursery service should be so organized that it
will be the duty of one physician, or a committee of physicians, to maintain
standards for the care of all newborn infants.' Close cooperation should be
maintained between the physicians caring for the mothers and those caring
for the infants.
A physician with special training and experience in the care of newborn
infants should serve as chief physician to the nursery service. He should
visit the nursery at regular intervals, should be available for consultation,
and should conduct ward rounds and staff conferences in relation to prob­
lems concerning the newborn infants. With the cooperation of the obstetric
Federal Reserve Bank of St. Louis



service, he should outline a plan for care, the details of which should be made
available in written form for the use of physicians and nurses. He will be
responsible for analysis of records to determine the causes of morbidity and
mortality among both full-term and premature infants; for making such
data available promptly to the hospital authorities; and for holding regular
clinical-path ological conferences.There should be at least one physician, preferably a resident physician,
assigned to the nursery, who will be on call day and night. He should visit
the nursery at least once a day.
A physician should examine each infant on admission to the nursery and
before discharge, and at other intervals as indicated. Careful records of
each infant’s clinical course should be kept.

If the quality of nursing care is to be maintained in spite of war-emergency
conditions, it is necessary that hospitals study and evaluate their nursing
procedures with a view to making the most economical use of nursing time
without lessening the adequacy of the care given.
The procedures described in this bulletin have been planned in an effort
not only to improve the care given to newborn infants but also to promote
economy in the use of nursing time. It is hoped that many hours of such
time will be saved through the recommended modifications in procedure,
such as omitting from the delivery-room routine the weighing, measuring,
and oiling of the infant; omitting the bath for the first week or 10 days of
the infant’s life; lengthening the intervals between weighing; reducing
the number of garments put on the infant; substituting care at the individual
bassinet for the use of common bathing and dressing tables; and assigning
nonprofessional duties to workers other than nurses.
The staff1of the nursery unit should be under the supervision of a graduate
nurse with advanced training in the care of newborn full-term and prema­
ture infants. The less well qualified the staff, the greater the need for
expert supervision.
It is recommended—
That all graduate and student nurses and auxiliary workers, before
being assigned to a nursery unit, should have had supervised pediatric
experience, and should have demonstrated aptitude for such work.
That the care of premature infants be entrusted to graduate nurses only,
or, if this is not possible, only to student nurses who have had training
in the care of such infants.
1 In the preparation of standards and recommendations with regard to the nursing staff the following publica­
tions have been consulted: M anual of the Essentials of Good Hospital Nursing Service (1942, 202 pp.) and
Administrative Cost Analysis for Nursing Service and Nursing Education (1942, SO pp.), both published by
the American Hospital Association and the National League of Nursing Education, New York, and Distribution
of Nursing Service During W ar (1942, 23 pp.), published by the National Nursing Council for W ar Service,
New York.
Federal Reserve Bank of St. Louis



That graduate and student nurses and auxiliary workers assigned to the
care of newborn infants have no other patients—adults or children—under
their care.
That no one—graduate or student nurse or auxiliary worker—be
assigned to the care of newborn infants (1) unless approval of such assign­
ment has been given by the hospital’s employee-health service, or, in the
absence of such a service, by a physician authorized by the hospital to
approve such assignments, and (2) unless the worker’s previous assignment
has been on a noninfectious service.
Graduate nurses.—Efforts should be made to staff the nursery unit in such
a way that the proportion of graduate nurses to other workers—student
nurses and auxiliary workers—will be as large as possible.
Day and night, there should be at least one graduate nurse with advanced
training and experience in the care of newborn full-term and premature
infants assigned exclusively to the care of such infants or the supervision of
their care.
Student nurses.—If student nurses are assigned to the care of newborn
infants they should have had previous supervised pediatric experience.
Auxiliary workers.—Although the ideal nursery staff is made up of either
all graduate nurses or graduate nurses assisted by student nurses, the present
war situation has made it necessary to consider supplementing the services
of graduate and student nurses with those of auxiliary workers.
It is recommended that auxiliary workers, compensated or uncompen­
sated, be assigned so far as possible to nonprofessional duties. If assigned
to the care of newborn infants they should have had instruction and super­
vised experience in the nursing care of children, during which time they
should have demonstrated ability, interest, and a sense of responsibility.
Their duties should be clearly defined; they should be adequately supervised,
and the work assigned to them should be commensurate with their training.
In planning for the use of part-time workers it should be remembered that
the fewer the workers that enter a nursery the less is the danger of intro­
ducing infection.
Ratio of nurses to infants and hours of nursing care.—At least 3 hours of nursing
care per 24 hours should be provided for full-term infants and 6 hours for
premature infants. This will require that at all times, day and night, nurses
(or nurses and auxiliary workers) be provided in the ratio of at least one for
each eight full-term infants and at least one for each four premature infants.

In every hospital with a maternity service there should be provided at
least one nursery for well infants and at least one separate nursery, the so1 The term “ nursery unit” is used here to include the nursery or nurseries proper and all accessory rooms adja­
cent to them and used in conjunction with them. The term “ nursery” is used solely for a room in which infants
are housed.
Federal Reserve Bank of St. Louis



called “ suspect nursery,” for infants under observation either because they
have been exposed to infection or because it seems likely that they are devel­
oping an infectious condition. Except in small hospitals, in which fewer
than four premature infants are expected to be under care at one time,
there should be at least one separate nursery for premature infants. Pro­
vision should be made also for space remote from the nursery unit for the
care of infants who are ill and for infants who, though not born in the
hospital, are admitted in the early weeks of life.

Size and Construction
It is recommended that each nursery house relatively few infants (1) be­
cause it is recognized that individual care of each infant is desirable and
that the smaller the number of infants that are cared for in a given space the
less the danger of infection and (2) because the fewer the number of indi­
viduals entering a given room the lower the bacterial count of the air.
For these reasons a standard has been set of one nursery for each eight
full-term infants, the maximum number that one nurse can care for satis­
factorily. (See Nursing service, p. 2.)
Since premature infants require more nursing care than full-term infants,
a standard has been set of one nursery for each four premature infants, the
maximum number that one nurse can care for satisfactorily.
In small hospitals, in which it is anticipated that less than four premature
infants will be under care at any one time, space for premature infants
should be provided in the nursery for full-term infants, rather than in a
separate nursery. Suitable environmental temperature and humidity may
be maintained for these infants by use of incubators or heated bassinets.
The suspect nursery should contain not more than three bassinets. One
bassinet in the suspect nursery should be provided for each five bassinets in
the nursery for well full-term infants. (Even the smallest hospital should
have at least two bassinets for suspect cases.)
The suspect nursery should be completely separated from the nurseries
for well infants.
For the care of infants that are ill, isolation facilities should be provided
in a part of the hospital remote from the maternity unit. Even in small
hospitals the suspect nursery should not be used for infants who have con­
ditions that have been definitely diagnosed as infectious.
The nurseries for full-term and for premature infants should be located
near the maternity ward, but out of line,of traffic from other services.
There should be outside windows to admit daylight and sunlight. Pro­
vision should be made for controlling the sunlight in hot seasons and hot
In the planning of a nursery consideration should be given to the amount
of air space and floor space needed for the proper care of each infant.
The floor space should be sufficient (1) to permit each bassinet to be
separated from any other bassinet and from any wall or partition; (2) to
Federal Reserve Bank of St. Louis



provide room for the needed furniture and other equipment, including that
needed for bedside care of each infant; and (3) to permit attendants to give
bedside care to each infant and to pass easily from bassinet to bassinet.
It is recommended—
That the total nursery space be adequate to provide an average per infant
of 300 cubic feet of air space and 30 square feet of floor space.
That bassinets be separated by partitions forming cubicles, each cubicle
sufficiently large so that the bassinet will stand at least 6 inches from any
wall or partition and so that there will be at least 2 feet of floor space
beside each bassinet to permit bedside care. Even if the bassinets are not
separated by partitions, these same space measurements are recommended.
T hat aisle space at least 2 feet wide—preferably 3 feet—be planned, to
provide a passageway for attendants.
For each suspect nursery, a minimum of 40 square feet and 400 cubic
feet should be provided for each bassinet. This will give adequate space
not only for bedside care but for bedside treatment.

Control of Atmospheric Conditions
Adequate ventilation and control of temperature and humidity contri­
bute to the welfare of newborn infants, especially premature ones. The
ideal arrangement is complete air-conditioning.
It is recommended that the nurseries be equipped with complete airconditioning; that is, controlled temperature, humidity, and air motion;
that the air be filtered and that it be sterilized by ultraviolet light or by
some other method.
In plans for new hospitals, if installation of air-conditioning is not
possible at the time of construction, space for ducts at least should be
provided, so that later installation of air-conditioning will be facilitated.
In the absence of air-conditioning, windows or air ducts must be depended
upon as the source of fresh air, and they should be so arranged that there
will be circulation of air without drafts around bassinets. The air current
should be directed so that it will not strike the infants. Partitions forming
cubicles should reach only part way to the ceiling so as to allow for ven­
tilation. There should be thermostatic control of room temperature.
Sterilization of air at entrances to cubicles provides added protection. For
premature infants, who require relatively high temperature and humidity,
the environment may be controlled by the use of specially equipped

Walls, Ceilings, and Floors
The walls, ceilings, and floors of the nurseries and accessory rooms should
be constructed of nonabsorbent material that can be washed, and it is
preferable to have all corners rounded to facilitate washing. Sound­
proofing is desirable. As was previously stated, it is recommended that
partitions be placed between bassinets and that the partitions in non-air
Federal Reserve Bank of St. Louis



conditioned nurseries should reach only part way to the ceiling so as to
allow for ventilation. A section of each partition, extending about 18 to
24 inches above the bassinet level, should be transparent in order to permit
the nurse to view all the bassinets from her station.
A viewing window should be provided between each nursery and the
nurses’ station, and one between each nursery and the corridor so that
relatives may see the infants without coming in contact with them.

Furnishings and Equipment
Bassinets.—Each bassinet should be of the type that consists of a single
metal stand with a steel-band basket, which is removable to facilitate
Bedside tables.—A bedside table with a drawer and a lower compartment
with a shelf and a: door should be furnished for each bassinet, to serve as
a work table and as a cabinet for storage of a 24-hour supply of equipment
needed for care of the infant. The top of the table should be about 16
inches by 20 inches.
Lavatories.—In each nursery there should be a lavatory with hot and cold
running water. Faucets should have knee or foot control.
Diaper cans.—In each nursery there should be at least one metal sanitary
can for diapers, with the top controlled by foot pedal. Removable paper
bags for lining this can should be provided.
Linen hampers.—In each nursery there should be at least one hamper
with removable bag, for soiled linen other than diapers.
Incubators.—Nurseries where premature infants are expected to be cared
for should have incubators. The incubators may be either commercial or
home-made. They should conform to specifications that have been
prepared by the National Bureau of Standards and the Children’s Bureau.3

Accessory Rooms
Chartroom.—The chartroom should serve as a “control station” ; that is, it
should be so situated that it serves as the main entrance from »the corridor
into tjhie nurseries for well infants.
A viewing window between the chartroom and each of the nurseries
adjoining it should be provided.
The nurse’s desk should be so placed that she will be in a strategic position
in relation to the viewing windows and the door from the chartroom to the
Nurses' work space.—The nurses’ work space is a combined supply and
utility room. In smaller hospitals the work space may be a part of the
chartroom. In larger hospitals a separate workroom should be provided.
Its minimum equipment should be: A sink, an instrument sterilizer, a bottle
war mer, a table or shelf, and a cupboard.
3 Dunham, Ethel C., M. D.; H. C. Dickinson, Ph. D.; Grace J. Gowens; and Juanita W itters: Incubators for
Premature Infants. American Journal of Public Health, vol. 30, no. 12 (December 1940), pp. 1415-1421.
Federal Reserve Bank of St. Louis



Examining room.—In order that traffic into the nursery may be reduced to
a minimum, it is recommended that an anteroom be equipped as a physi­
cians’ examining room.
Between the examining room and the nursery there should be a sliding
window or a Dutch door, with a shelf or table in front of the opening
to serve as an examining table upon which the nurse places the infant.
This will permit the physician to examine the infant without going into the
The examining room should be well lighted, preferably with natural light
in the daytime, and it should be provided with a lavatory, a table for use as
an examining table, and a desk.
Treatment room.—In smaller hospitals the examining room may serve also
as the treatment room.
In larger hospitals a separate room outside of the nursery unit should be
provided as a treatment room for infants other than suspect or isolation
cases. This room should be furnished with a treatment table, a lavatory, a
small instrument sterilizer, and a cabinet for supplies. It is assumed that
solutions and other supplies used in giving treatments will be requisitioned
from the general hospital supply room and that instruments and needles
suitable for use in treating infants will be made available.
Demonstration room.—Facilities should be provided so that the nurses can
instruct mothers, before discharge to their homes, in methods of feeding,
bathing, and dressing their infants. In larger hospitals a demonstration
room should be provided for this purpose. In smaller hospitals demonstra­
tions may ,be given in the nursery, in front of the viewing window, to the
mothers seated in the corridor. The nurse’s instructions may be made
audible to the mothers by means of a loud speaker.
Milk room.—The location of the milk room and the supervision of the work
of making up the feedings will vary with the type of hospital, its personnel,
and its special administrative problems. Under any circumstances it is
essential that a separate room be provided for preparing the milk mixtures
and that this room be used for no other purpose. The milk room should be
situated where the danger of contamination is least and where the most
adequate supervision can be given, by a dietitian or nurse who is experi­
enced in milk-room procedures. If the hospital has a dietitian it may be
best to locate the milk room near the general diet kitchen and to have the
preparation of the milk mixtures supervised by the dietitian.
It is recommended that the milk room be divided into two sections by
a partition in which there is a Dutch door, a sliding window, or a sterilizer
with doors on each side. This permits the exclusive use of one section of
the room for receiving and washing glassware and other utensils used in
feeding the infants, and of the other for sterilizing the utensils and for
preparing and storing milk and milk mixtures. There should be two Dutch
doors on the corridor side of the milk room, one for each of the two sections
of the room; one of these doors is for receiving used bottles, the other for
distributing sterile feedings.
Federal Reserve Bank of St. Louis



The minimum equipment of the milk room should be: A refrigerator, a
sink, a lavatory, sterilizers, a device for cooling the bottles of milk mixture
after sterilization, cupboards, and a work table; all these should be so con­
structed that they can be readily washed.
Milk-room procedure should be carried out with strictly aseptic technique.
Milk mixtures should be poured into sterile bottles. It is recommended
that nipples and nipple caps be put onto the bottles in the milk room and
that final sterilization of the milk mixtures in the bottles be done by auto­
claving. Cooling should be rapid and should be complete before the bottles
are placed in the refrigerator. The temperature inside the refrigerator
should be between 40° and 45° F.
Nurses and others working in the milk room should wear gowns and
surgical caps. It is best that these workers have no other responsibility
besides their work in the milk room. During the entire period that these
workers are assigned to milk-room duty they should have no contact with
patients that have infectious conditions.

The nursing procedures to be followed in the care of the infants should be
planned jointly by the medical and nursing staffs and should be available
in written form to attending and resident physicians and to nurses.
The superintendent of nurses should have the responsibility for seeing
that the technique of caring for the infants is carried out.
Certain recommendations in regard to the basic principles of care are
made here with full recognition of the considerable diversity of opinion that
exists with respect to some of the details of technique.

Delivery-Room Care
The care that the newborn infant receives at the moment of birth and in
the period after birth while he is still in the delivery room plays an important
role in his future well-being. The abrupt change from uterine to extrauterine environment requires major adjustments in the infant’s circulatory
and respiratory systems during the period immediately after birth. Proper
delivery-room care, aimed at prompt initiation and maintenance of respi­
ration and carried out in such a way as to conserve the infant’s body heat,
will facilitate these adjustments.
Preparation for care of the infant in the delivery room should include
provision of adequate personnel as well as of suitable environment and

It is recommended—
That a nurse trained in the care of newborn infants be assigned to the
delivery room, to have as her sole responsibility the care of the infant.
T hat a physician trained in the care of newborn infants be on emergency
call at all times and be present in the delivery room during premature and
other abnormal deliveries.
Federal Reserve Bank of St. Louis



Environment and Equipment
The delivery room should be warm, and the temperature should be
maintained at the level considered by the medical staff to be optimum for
mother and infant. In addition, the following equipment should be always
ready in advance:
A smooth flannel blanket, in a sterile package, warmed and ready to receive the
infant at birth. A heat lamp on a standard is helpful in keeping the infant warm.
A safe, suitable type of suction device for cleaning the infant’s upper respiratory
tract of mucus and other fluid.
An oxygen tank with mechanism for measuring and controlling the amount of gas
and with a suitable mask or other device for administering oxygen to an infant.
Equipment suitable for clamping, cutting, and tying the umbilical cord and for
dressing it. It is recommended that the clamping of the cord be delayed until
pulsation has ceased, so that the infant may receive the full complement of placen­
tal blood.
Some type of heated bed or incubator— warmed in advance. (See p. 6.)
Provision for prophylactic treatment of the infant’s eyes.
A supply of vitamin K for parenteral use.
Some device for identifying infants before they leave the delivery room— beads,
footprinting equipment, or other.

It is recommended that the weighing, measuring, bathing, and oiling
of the infant be omitted as part of the delivery-room routine. Any of these
procedures that the medical staff considers desirable may be carried out
later in the nursery after the infant’s temperature has become stabilized.
Weighing may be necessary to determine an infant’s need for special

Transit From Delivdry Room to 7Nursery .
Provision should be made for keeping the infant warm and protected
from exposure to infection during transit from delivery room to nursery.
It is recommended that a heated bed or a warm carrier (sometimes called
a “ hand ambulance”) be used for transfer of the infant. If the infant is
carried by a nurse he should be wrapped in a warm blanket and the nurse
should wear a mask and a gown.
An elevator when used by an attendant transporting an infant should be
free of other passengers.

’ Nursery Care
The amount of space needed for the care of the infant is discussed under
Nurseries, page 3.
Control of temperature and relative humidity.
It is recommended that the temperature of the nurseries for full-term
infants be controlled at about 80° F., day and night, and that the relative
humidity be about 50 percent.
Federal Reserve Bank of St. Louis



For premature infants higher temperature and greater relative humidity
may be required. A separate air-conditioned nursery is desirable, but if
this is not to be had, proper environmental conditions may be obtained for
them by the use of incubators. It is recommended that before an incubator
is made or selected, the specifications published by the National Bureau of
Standards and the Children’s Bureau be consulted. (See footnote 1, p. 6.)

Observation and Examination
The newborn infant should be seen by the head nurse as soon as he is
admitted to the nursery. Observations of his condition, as indicated by
color, breathing, activity, evidence of bleeding, and so forth, should be made
without removing him from his crib.
A physician should see at once every premature infant and any infant in
whom the nurse has observed any abnormality.
Every infant should receive a complete examination by a physician as
soon as, in his judgment, the infant’s general condition warrants it. The
examination should be conducted in such a way that the infant’s body heat
will be conserved.
It is recommended—
T hat full-term infants be examined by the physician in an anteroom to
the nursery, especially equipped for examinations.
That premature infants be examined by the physician in the nursery, the
infant remaining in the heated bassinet or incubator during the examina­
tion. If treatment of a premature infant is necessary, this also should be
done with the infant remaining in the heated bassinet or incubator, if possible.

Special Measures To Protect Infant From Infection
The infant should be cared for in such a way as to guard him against
infection. No infant born outside the hospital should be admitted to the
nursery for infants born in the hospital. Visitors should be excluded fr o m
the nursery.
It is recommended that care be given to each infant at the bedside, with
strict aseptic technique. Common bathing and dressing tables should not be used.
Hand'washing technique.
Strict hand-washing technique should be maintained by physicians and
nurses. Hands should be washed with soap and running water before and
after handling, diapering, or feeding each infant. It is especially important
that the nurse wash her hands after diapering the infant and before feeding
him. If this technique is to be carried out it is essential that lavatories be
conveniently located inside each nursery as well as in each service room.
Gown, cap, and mask technique.
Gowns. A gown should be worn by anyone working in the nursery.
Fresh gowns should be provided daily.
Federal Reserve Bank of St. Louis



Caps.—If the use of caps is required by the medical staff, they should
completely cover the hair.
Masks.—If the use of masks is required by the medical .staff, they should
be so made that they are effective in preventing droplet infection and they
should be changed frequently—at least every 2 hours.
Suspect cases.
Any infant who has such symptoms of infection as loose stools, frequent
stools, or fever, or who has eye, skin, vaginal, or other infection, should be
removed to the suspect nursery without delay. The head nurse should
have the authority to order this on her own responsibility. If the infant
is found to have an infectious condition, he must be transferred promptly
to an isolation nursery elsewhere, in the hospital.
Ritual circumcisions.
Provision should be made to have ritual circumcisions performed else­
where than in the nursey unit. Aftercare should be given in the suspect
nursery because of danger of infection.

General Care
Care of skin.
The proper care of the skin of newborn infants is important in preventing
infection. At present the consensus seems to be that the less manipulation
the less danger of infection. It is recommended that no water or oil bath
be given during the first week or 10 days after birth, and it may be wise to
postpone the premature infant’s bath for considerably longer. The vernix
may be gently wiped away from the folds of the infant’s skin with warm sterile
mineral oil on sterile cotton or soft sterile gauze. Each time the diaper is
changed, sterile oil should be applied to the soiled or wet areas of the skin.
The oil for the infant’s skin should be kept in a sterile glass container.
Before oil is applied, a small amount should be poured into a dish into
which a piece of cotton can be dipped easily. Any oil remaining after use
should be thrown away.
Care should be exercised to keep the cord dressing and umbilical area
sterile. The binder used to hold the cord dressing in place should be made,
of soft, sterilized gauze.
Diapers and other clothing.
It is recommended that only one piece of clothing besides the diaper be
worn—a gown open in the back—cotton in summer, flannel in winter.
The diaper should be of soft material.
For premature infants under suitable environmental conditions, the same
type of gown should be used. Diapers should not be used for premature
infants; a small pad of absorbent cotton or disposable tissue, covered with
gauze, should be placed under the infant to serve as a diaper.
A 24-hour supply of clothing should be kept at the bedside.
Federal Reserve Bank of St. Louis



A 24-hour supply of bed pads, sheets, and blankets should be kept at the
Taking infant’s temperature.
It is recommended that each infant’s thermometer be kept at the bedside
in a suitable container.
It is recommended that consideration be given by the medical staff to
taking the temperature by axilla in suitable cases.
It is recommended that in suitable cases (normal infants) the temperature
be taken not oftener than twice a day.
Weighing infant.
Each infant should be weighed in his blanket at the bedside. The scale
pan should be freshly covered with paper for each infant. It is recom­
mended that the scales be kept on a table with wheels, so that they may be
moved easily from bassinet to bassinet.
It is recommended that well infants be weighed daily for the first 4 days;
then only every other day, or, in some cases, only twice a week.

It is recommended that efforts be made to have every mother of a fullterm infant nurse him. The efforts should include encouraging the moth­
er’s cooperation, withholding artificial feeding eve» in the presence of early
weight loss (provided this is not excessive), giving only water until the
mother’s milk begins to come or until it is evident that the mother is not
going to be able to supply an adequate amount of breast milk.
It is recommended that no premature infant be put to the breast without
an order from the resident physician. It is recommended that for prema­
ture infants every effort be made to maintain the mother’s milk supply and
to have the infant nurse as soon as he is physically able.
Whenever any infant is being fed from a nursing bottle the bottle should be held,
not propped.
Technique of breast feeding.
Preparation of mother.—It is recommended that the nursing mother wear a
nightgown that opens in front; that her hands be washed with soap and
water before nursing and her breast be washed before and after nursing;
that the baby lie on a clean paper or cotton towel during nursing; that all
visitors, even members of the family, be excluded while the mother is nursing
the infant.
Transportation of infant to mother.—The infant should be wrapped in a
blanket and carried to the mother by a nurse who wears a gown and a mask,
or wheeled in his own bassinet.
Expression of breast milk.—If an infant cannot nurse, particularly a prema­
ture infant, the mother’s milk should be expressed and fed to him. Since
Federal Reserve Bank of St. Louis



opinions vary in regard to techniques for expressing breast milk and for
storing it, those approved by the medical staff should be set down in writing
and closely followed.
Milk mixtures.
The formula for the milk mixture ordered by the physician for each infant
should be in writing, and any changes should also be in writing.
The 24-hour supply of milk mixture should be stored in the milk room.
The bottles for each feeding, with sterile nipples and sterile caps on them,
should be sent to the nursery from the milk room at the feeding hours.
Milk mixtures should not be poured into nursing bottles from a larger
utensil in the nursery or in the workroom.
There should be provision for warming the bottles in the nursery unit.
Nipples should not be handled by the nurse who feeds the infants.
Used bottles, nipples, and caps should be returned to the milk room after
each feeding.
Drinking water.
It is recommended that sterile water be given to normal infants between
feedings at least twice a day; in very warm weather oftener.
Equipment for special treatments.
It is essential that a suitable suction device, a supply of oxygen, and
suitable apparatus for administering oxygen, be always at hand.
It is recommended that special needles, tubing, glassware, and other
equipment suitable for use for newborn infants be kept in the workroom in
sterile packages, ready for emergency use for infusions, transfusions, lumbar
punctures, and so forth.
Clean linen should be delivered to the nursery unit each morning in an
amount to last 24 hours.
It is recommended that the supply of linen for each infant be prepared
in th'e laundry in three packages: (1) diapers, (2) bed clothes, (3) clothing.
Fresh sterile oil should be supplied daily in small glass sterilized containers.
C leaning T^ursery U n it
No dry dusting or cleaning in a nursery unit should be allowed; walls,
floors, and ceiling, as well as furniture and other equipment, should be
washed. Maids should wear gowns, caps, and masks while cleaning.
C are o f Soiled L in en
It is recommended—
T hat soiled diapers be placed in a special diaper can, separate from the
hamper for soiled clothing and bed linen.
Federal Reserve Bank of St. Louis



That all soiled linen be collected at least twice a day—preferably oftener.
That the diaper can and the soiled-linen hamper be put outside the nur­
sery by the nurse so that the collector need not enter the nûrsery.
That diapers and other soiled linen be taken to the laundry without being
removed from their respective containers.
That diapers and other soiled nursery linen should be washed separately
from each other and from other hospital linen. Special care is needed in
the washing so that the garments will remain soft and will be free from any
substance that might irritate the infant’s skin, such as strong soap or
Rules for laundering— making up' the packages, sterilizing (preferably by auto­
clave), and delivering them to the nursery— should be worked out with the medical,
nursing, laundry, and administrative staffs of the hospital. (See also Supplies, p. 13.)

It is recommended—
That there be a clinical record for the infant, separate from the mother’s.
That the mother’s hospital number be entered on the infant’s record so
that information pertinent to the infant’s welfare will be available in
regard to the circumstances of pregnancy, labor, and delivery.
That complete daily records of the infant be kept—medical and nursing.

Preparation for Discharge
Before she leaves the hospital the mother should be instructed in regard
to the care of her infant, including maintenance of her breast-milk supply.
For mothers who need such services, arrangements should be made with a
public-health-nursing agency for early and continued instruction of the
mother at home.
Consideration should be given to the home situation (including a visit
to the home if necessary), in regard to such matters as—
The health of the other persons living in the home.
Whether the mother will be able to care for the infant herself.
Whether the housing arrangements are suitable for care of the infant.
Whether the parents are financially able to provide proper food,
clothing, and other essentials for the infant.
If the home situation is unsuitable for the infant, arrangements should
be made with a family-service agency or other agency to assist in preparing
the home for the infant and to help in making necessary adjustments.
If, after discharge from the hospital, the infant is not to continue under
the care of the same physician who cared for him in the hospital, the family
physician or a community agency should be notified that the infant is to
be discharged, so as to insure continuous medical supervision for the
infant, including supervision of diet and hygiene, and medical care.

Federal Reserve Bank of St. Louis