Changing The First Nappy

WHAT YOU MAY FIND

5 min read

There are some specific things one can find in a newborn’s nappy, but one does not have to worry about.

Stool

Firstly, and probably most commonly is meconium. Meconium is the newborn's first stool, whilst saying that, one should know that is is not the end product of digested substances. It actually contains thickened bile, shed mucous membranes, with the amniotic swallowed lanugo hair and skin cells, which have gathered in the newborn’s bowl system up until and after birth (1). The first portion of meconium should be passed within 24h and will most likely be completely passed by day 3-5 after birth (2). 70% of newborns pass the meconium within the first 12 hours, the other 30% during the first 48 hours after birth (3). The colour is dark green to blackish, the consistency is tough, sticky and it has no smell, since it does not contain bacteria. If it dries on the newborn’s skin, it can be quite hard to clean off. Sometimes it even makes the nappy stick onto the skin. If this happens, one should get some luke-warm water or some oil and soak the area until it is smooth enough to detach gently. To prevent that, one should change the nappy as soon as one notices meconium inside. 

The transitional stage from meconium to ‘normal’ stool is called transitional stool and appears most likely from day 2-5 after birth (4). It varies in colour from blackish-dark green to ‘greenish and yellowy’ depending on how much meconium is still left in the bowl system and how much milk the newborn has already digested. The consistency is less sticky, with a tendency to be creamier than the meconium. It can start having a smell depending on if the newborn drinks breast milk or formula. 

If a baby is fed breast milk the stool can vary in its colour from gold, yellowy, mustardy to a greenish yellow. The consistency is often thin, but has some part of grainy constancy. It can also have a creamy, pasty consistency. All of these stool types are normal. The smell is now more aromatic, even acidy. The frequency of passing stool can vary from 1-5 times a day up to once a week (5).

If a baby is fed with formula, the stool has a light brown colour and is pulpier, as well as more formed than a breast milk fed stool. The smell is cheesier and sometimes very smelly. A formula fed newborn should pass stool at least once a day, but is also very normal for the baby to pass stool up to 3 times daily (6).

If you find any other colour or colour combination as well as stool consistencies, you should consult your paediatrician.

Urine

One can sometimes find a half 1-cent big orangey spot in the nappy of newborns, due to uric acid salt, which is washed out of the kidney. In pregnancy the uric acid, which is a part of the ruin, deposits in the kidneys and urethra. When the newborn’s renal function increases with more fluid intake after birth, the uric acid salt washes out (7). The amount of urine that a newborn passes shows if the baby is getting enough fluid, as well as if the kidneys and bladder are functioning well. A newborn should pass the first urine within the first 24 hours after birth. With an increasing amount of milk fed a newborn should have 6 to 8 wet nappies by day 3-4 after birth (8).

Girls

Another physiological characteristic one can find when opening a newborn girl’s nappy is vaginal discharge, also called neonatal fluor vaginalis. Mostly, one finds it positioned in front of the opening to the vagina. It has a trick greyish - white colour. This is due to maternal hormones which travel through the placenta to the unborn baby’s system and stimulate its vaginal epithelia. It can last up to 10 days after birth (9). Sometimes this discharge can be slightly blood tinged, but also grossly blooded. This is due to the rapid fall of progesterone, which enables the endometrium cells of the newborns uterus to shed. This is usually seen between day 3-7 after birth and lasts an average of 3 - 4 days (10). Light pink or bloody discharge after day 8 of birth, is very rare and often has a pathological background (11). Studies suggest that visible bleeding is shown in between 3-5% of newborn girls. However, occult  bleeding was shown in 25,4-61,3 %. Over the last decade, studies have also suggested that `neonatal uterine bleeding’ may correlate with early onset of endometriosis, but results are very slim and cohort studies are needed to gain further knowledge (12). One may also notice that the labia majora (outer labia) and the clitoris are swollen; this is also due to hormonal transfer via the placenta to the baby in the womb and will resolve itself a few days after birth.

Boys 

96% of infant boys have a natural foreskin adhesion, which mostly dispatched itself around the age of 3-5 years. It has a specific barrier function for the urethra, as well as the glans penis. By the age of two years 50% and by the age of three years 80% of the natural forsaken adhesion vanish on their own (13). It is not recommendable to pull back the foreskin, since it is very delicate tissue and can be damaged easily. The scar tissue can lead to a phimosis. It is hygienic enough to just clean the penis using water and without pulling back the foreskin (14).