Managment Of Sick Newborn
-
Upload
dang-thanh-tuan -
Category
Health & Medicine
-
view
4.187 -
download
0
description
Transcript of Managment Of Sick Newborn
Managing Low Birth Weight and Sick Newborns
Advances in Maternal and Neonatal Health
2 Managing Low Birth Weight and Sick Newborns
Session Objectives
To define essential elements of the care of sick newborns, including neonatal resuscitation
To discuss best practices and technologies
3 Managing Low Birth Weight and Sick Newborns
Management of Newborn Illness
Education of mothers to recognize danger signals
Working with families to develop complication plan for newborns
Early recognition and appropriate management of newborn illness
4 Managing Low Birth Weight and Sick Newborns
Minimum Preparation for ANY Birth
The following should be available and in working order:
Heat source
Mucus extractor
Self-inflating bag of newborn size
2 masks (for normal and small newborns)
1 clock
At least one person skilled in newborn resuscitation present at birth
5 Managing Low Birth Weight and Sick Newborns
Essential Care for All Newborns
Most newborns breathe as soon as they are born and only need:
A clean and warm welcome
Vigilant observation
Warmth
To be observed for breathing
To be given to the mother for warmth and breastfeeding
6 Managing Low Birth Weight and Sick Newborns
Immediate Care of the Newborn: Warmth
Lay newborn on mother’s abdomen or other warm surface
Immediately dry newborn with clean (warm) cloth or towel
Remove wet towel and wrap/cover newborn, except for face and upper chest, with a second towel/cloth
7 Managing Low Birth Weight and Sick Newborns
Immediate Care of the Newborn: Warmth (continued)
Blood on newborn is not a risk to newborn, but is a risk to caregiver
Bathe after 24 hours
In areas with high HIV prevalence, consider bathing earlier to reduce risk of maternal-fetal transmission, and to reduce risk to caregiver and to other newborns
8 Managing Low Birth Weight and Sick Newborns
Immediate Care of the Newborn
Assess breathing
Keep head in a neutral position
IMMEDIATELY assess respirations and need for resuscitation
9 Managing Low Birth Weight and Sick Newborns
Signs of Good Health at Birth
Objective measures
Breathing
Heart rate above 100 beats/minute
Subjective measures
Vigorous cry
Pink skin
Good muscular tone
Good reactions to stimulus
• Most important measure is whether newborn is breathing
• Assessing all of above delays resuscitation, if it is necessary.
10 Managing Low Birth Weight and Sick Newborns
Birth Asphyxia
Definition: Failure to initiate and sustain breathing at birth
Magnitude:
3% of 120 million newborns each year in developing countries develop birth asphyxia and require resuscitation
An estimated 900,000 of these newborns die as a result of asphyxia
11 Managing Low Birth Weight and Sick Newborns
Steps in Resuscitation
Anticipate need for resuscitation at every birth, be prepared with equipment in good condition
Prevent of heat loss (dry newborn and remove wet clothes)
Assess breathing
Resuscitate:
Open airway
– Position newborn– Clear airway
Ventilate Evaluate
WHO 1998.
12 Managing Low Birth Weight and Sick Newborns
Assess Breathing
Newborn crying?
Yes No
Provide routine care
• Chest is rising symmetrically
• Frequency >30 breaths/min.
• Not breathing/ gasping
• Breathing < 30 or > 60 breaths/ min.
Immediately start resuscitation
Provide routine care
13 Managing Low Birth Weight and Sick Newborns
Open Airway
Position newborn on its back
Place head in slightly extend position
Suction mouth then nostrils
WHO 1998.
14 Managing Low Birth Weight and Sick Newborns
Ventilate
Select appropriate mask size to cover chin, mouth and nose with a good seal
Squeeze bag with two fingers or whole hand, look for chest to rise
If chest not rising:
Reposition head and mask Increase ventilation Repeat suctioning
WHO 1998.
15 Managing Low Birth Weight and Sick Newborns
Evaluate
After ventilating for about 1 minute, stop and look for spontaneous breathing
If no breathing, breathing is slow (< 30 breaths/ min.) or is weak with
severe indrawing
If newborn starts crying/breathing spontaneously
Continue ventilating until spontaneous
cry/ breathing begins
• Stop ventilating• Do not leave newborn• Observe breathing• Put newborn skin-to-skin
with mother and cover them both
16 Managing Low Birth Weight and Sick Newborns
Harmful and Ineffective Resuscitation Practices
Practices to be avoided include:
Routine aspiration of the newborn’s mouth and nose as soon as the head is born
Routine aspiration of the newborn’s stomach at birth
Stimulation of the newborn by slapping or flicking the soles of her/his feet: only enough stimulation for mildly depressed-delays resuscitation
Postural drainage and slapping the back: dangerous
WHO 1998.
17 Managing Low Birth Weight and Sick Newborns
Squeezing the chest to remove secretions from the airway
Routine giving of sodium bicarbonate to newborns who are not breathing
Intubation by an unskilled person
Some traditional practices:
Putting alcohol in newborn’s nose Sprinkling or soaking newborn with cold water Stimulating anus Slapping newborn
Harmful and Ineffective Resuscitation Practices (continued)
WHO 1998.
18 Managing Low Birth Weight and Sick Newborns
Infection Prevention for Resuscitation
Handwashing
Use of gloves
Careful suctioning if using a mucus extractor operated by mouth
Careful cleaning and disinfection of equipment and supplies
Do not reuse bulb—difficult to clean, poses risk of cross infection
Correct disposal of secretions
19 Managing Low Birth Weight and Sick Newborns
Documentation
Details of the resuscitation to be recorded include:
Identification of newborn
Condition at birth
Procedures necessary to initiate breathing
Time from birth to initiation of spontaneous breathing
Clinical observations during and after resuscitation
Outcome of resuscitation
In case of failed resuscitation, possible reasons for failure
Names of healthcare providers involved
20 Managing Low Birth Weight and Sick Newborns
Post-Resuscitation Tasks:Successful Resuscitation
Do not separate mother and newborn
Leave newborn skin-to-skin with mother (kangaroo care)
Measure temperature, count breaths, observe for indrawing and grunting
Encourage breastfeeding within 1 hour after birth
21 Managing Low Birth Weight and Sick Newborns
Inform patients fully
Provide counseling, as needed
If culturally appropriate, allow parents private time with dead newborn
Burial should be arranged according to regulations and parents’ wishes
Post-Resuscitation Tasks:Unsuccessful Resuscitation
22 Managing Low Birth Weight and Sick Newborns
Policy Decisions for Resuscitation
Guidelines on when to start:
Apparently stillborn newborn Malformations:
– Lethal– Less severe malformations
Extremely low gestational age Guidelines on when to stop:
20 minutes
23 Managing Low Birth Weight and Sick Newborns
Principles of Success
Readily available personnel
Skilled providers
Coordinated team
Resuscitation tailored to newborn response
Available and functioning equipment
Avoidance of harmful and ineffective practices
Follow rules for infection prevention
24 Managing Low Birth Weight and Sick Newborns
Care of the Low Birth Weight Newborn
Birth weight = Gestation duration + intrauterine growth
Most low birth weight newborns in developing countries are term or near term (Small for gestation age)
Increased risk of hypothermia and poor growth
25 Managing Low Birth Weight and Sick Newborns
Care of the Preterm Newborn
Associated problems with prematurity:
Feeding Respiratory Jaundice Intracranial bleed
26 Managing Low Birth Weight and Sick Newborns
Principles of Management for Low Birth Weight and Preterm Newborns
Warmth
Feeding
Detection and management of complications (e.g., resuscitation, assisted respiration)
27 Managing Low Birth Weight and Sick Newborns
Warmth
As for all newborns:
Lay newborn on mother’s abdomen or other warm surface
Dry newborn with clean (warm) cloth or towel
Remove wet towel and wrap/cover with a second dry towel
Bathe after temperature is stable
28 Managing Low Birth Weight and Sick Newborns
Warmth: Problem with Incubators
Potential source of infection
Often temperature controls malfunction
Often share incubator for more than one newborn
Need alternative method: kangaroo care
29 Managing Low Birth Weight and Sick Newborns
Feeding
Early and exclusive breastfeeding
Breastmilk = best nourishment
Already warm temperature
Facilitated by kangaroo care
30 Managing Low Birth Weight and Sick Newborns
Definition of Kangaroo Care
Early, prolonged and continuous skin-to-skin contact between a mother and her newborn
Could be in hospital or after early discharge
31 Managing Low Birth Weight and Sick Newborns
How to Use Kangaroo Care
Newborn’s position:
Held upright (or diagonally) and prone against skin of mother, between her breasts
Head is on its side under mother’s chin, and head, neck and trunk are well extended to avoid obstruction to airways
Newborn’s clothing:
Usually naked except for nappy and cap May be dressed in light clothing Mother covers newborn with her own clothes and added
blanket or shawl
32 Managing Low Birth Weight and Sick Newborns
How to UseKangaroo Care (continued)
Newborn should be:
Breastfed on demand Supervised closely and temperature monitored regularly
Mother needs lots of support because kangaroo care:
Is very tiring for her Restricts her freedom Requires commitment to continue
33 Managing Low Birth Weight and Sick Newborns
Effectiveness of Kangaroo Care
Randomized controlled trial
Conducted in three tertiary and teaching hospitals in Ethiopia, Indonesia and Mexico
Study effectiveness, feasibility, acceptability and cost of kangaroo mother care when compared to conventional methods of care
Cattaneo et al 1998.
34 Managing Low Birth Weight and Sick Newborns
Benefits of Kangaroo Care
Is efficient way of keeping newborn warm
Helps breathing of newborn to be more regular; reduce frequency of apneic spells
Promotes breastfeeding, growth and extra-uterine adaptation
Increases the mother’s confidence, ability and involvement in the care of her small newborn
Seems to be acceptable in different cultures and environments
Contributes to containment of cost— salaries, running costs (electricity, etc.)
deLeeuw et al 1991; Karlsson 1996; Lamb 1983; Ludington-Hoe et al 1993; Ross 1980.
35 Managing Low Birth Weight and Sick Newborns
Summary
Skilled attendant
Equipment available and working
Begin resuscitation immediately
Ventilate Reassess frequently Kangaroo care once successful
36 Managing Low Birth Weight and Sick Newborns
References
Cattaneo et al. 1998. Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings. Acta Paediatr 87: 976–985.
de Leeuw R et al. 1991. Physiologic effects of kangaroo care in very small preterm infants. Biology of the Neonate 59: 149–155.
Karlsson H. 1996. Skin-to-skin care: heat balance. Arch Dis Child 75:F130–F132.
Lamb ME. 1983. Early mother-neonate contact and mother-child relationship. J Child Psychol Psychiatry 24(3): 487–494.
Ludington-Hoe SM et al. 1994. Kangaroo care: Research results, and practice implications and guidelines. Neonatal Network 13(1): 19–27.
Ross GS. 1980. Parental responses to infants in intensive care. The separation issue re-evaluated. Clin Perinatol 7: 47–60.
World Health Organization (WHO). 1998. Basic Newborn Resuscitation: A Practical Guide. WHO: Geneva.