WELCOME TO NEONATAL CARE.

DR.MAHESWARI JAIKUMAR

NEED FOR ESSENTIAL NEW BORN CARE.

Birth Asphyxias

Hypothermia

Neo natal jaundice

Infections

Low Birth Weight

Faulty Feeding Practices

Faulty Nursing Practices

Others

ESSENTIAL NEWBORN CARE

Essential New born care includes,

•Care of the newborn at birth.

•Provision of warmth.

•Prevention of infection.

•Care of LBW & Sick New born.

•Early identification of newborns requiring referral.

EXAMINATION OF THE NEW BORN AT BIRTH.

•Identify malformations.--- hydrocephalus, meningomyelocele,imperforate anus.

•Observe the breathing pattern.—

• The normal resp rate of the newborn is 30-40/min, rarely 60/min.

• The newborn may exhibit “PERIODIC BREATHING”.

• Resp rate increases following breast feeding,therefore the nurse ensure that resp rate is assessed at the right time.

The resp rate is considered as abnormal if,

•RR > 60/min.

•There are intercostal & subcostal retractions.

•Associated with apnoea which is accompanied by cyanosis or heart rate <100 bpm.

CARE AT BIRTH.THE DELIVERY ROOM SHOULD BE CLEAN.

THE FOLLOWING FIVE CLEANS ARE TO BE PRACTICED.

•Clean hands.

•Clean surface.

•Clean Scissors/blade.

•Clean Cord tie.

•Clean cord stump.( No application on the cord ).

PROVISION OF WARMTH.

•Receive the New Born in a dry, prewarmed & clean cloth.

•Place the baby under a source of warmth (200 watt bulb).

•Dry the New Born immediately after the birth.

•Do not remove vernix.

•Keep the baby wrapped in clean dry cloth.

•Place the baby in close contact with the mother.

•Ensure that no fans are running in the delivery room no windows are left open.

CORD CARE•The umbilical cord must be cut with a sterile scissors/blade.

•The cord is cut about 2.5 cms from the abdominal skin surface.

•The cord should be tied with a sterile cord tie.

•Inspect the stump for bleeding.

•If bleeding is detected apply another cord tie.

The cord should be left dry without antiseptics or dressing.

EYE CARE

•The eyes should be cleaned with clean cotton swabs.

•Use separate swabs for each eye.

•The eyes should be cleaned from medial to lateral.

•There is no need of using prophylactic eye applications.

RECORDING BIRTH WEIGHT

•The weight of all the babies should be recorded at birth.

•LBW babies need special care.

INITIATING BREAST FEEDING•Breast feeding should be initiated with ½ an hour of birth.

•The staffs in the delivery room must ensure that the baby is put to the breast.

•Initiation of breast feeding aids in uterine involution,& decreases the possibilities of PPH.

•The baby is benefited by the provision of nutrition & immunity Including maternal bonding.

•Discourage any kind of prelacteal feeds.

EXAMINATION OF THE NEWBORN AT BIRTH

Following are to be examined in a newborn.

•Identification of malformations.

•Breathing pattern.

•Respiration.

•Heart rate.

•Assessing the perfusion.

•Colour.

Identification of malformations.

Examine babies for, malformations ------

•Hydrocephalus.

•Meningomyelocele.

•Imperforate anum.

•A child with malformation needs to be referred for further treatment.

Breathing Pattern.

•The normal RR of a NB – 30-40/min.(60-ocassionally).

•NB may exhibit “PERIODIC BREATHING”.

•RR may increase soon after of during feeding.

•Respiration is considered to be abnormal when RR ->60/min.

•There are intercostal & subcostal retractions.

•Associated with apnoea accompanied by cyanosis or HR <100 bpm.

Heart Rate

•The normal HR of a NB is 100-160 bpm.

•Values <100, >160 are considered abnormal.

•If the heart rhythm is regular the heart rate may be counted for 6 sec & multiplied by 10 to

obtain HR.

Assessing perfusion.

•Gently apply pressure over the neonate’s sole or the sternum with thumb for 15 sec & release & observe the time for the capillaries to refill to eliminate the blanching caused by the pressure.

•The normal capillary refill time is is less than 3 sec.

•It is prolonged in shock & hypotension & in hypothermia.

Colour.

•The normal NB is pink.

•The baby appears pale in anemia.

•The baby appears yellow in jaundice.

•The baby is blue in cyanosis.

PREVENTION OF HYPOTHERMIA.

•Body temp < 36.C is stated as hypothermia.

•Hypothermia can be prevented by,

•Maintaining the baby in close contact with the mother.

•Observing sufficient, appropriate clothing.

•Maintenance of the room temp.

•The room should be free of draughts.

Management of a hypothermic baby.

•HYPOTHERMIA MUST BE IMMEDIATELY TREATED.

•Re warm the baby by placing under a heat source – 200 w bulb placed 45 cms above the baby or radiant warmer.

•If the baby does not begin to normalize refer the baby & ensure that the baby is kept in contact with attendant to prevent further hypothermia during transport.

PREVENTION OF INFECTION.•Infants succumb to infection quickly.

•Administer TT immunization to the mother .

•Practice clean delivery practices.

•Hand washing by the attendants & nurses.

•Usage of pre sterilized gloves during delivery process.

•Cut the cord using sterilized scissors, & keep the cord dry.Do not apply any thing to the cord.

•Promote exclusive breast feeds & avoid pre lacteal feeds.

•Persons with skin infections & respiratory infections should avoid handling the baby.

•In case if institutional deliveries – OPV, BCG should be administered.

CARE OF LOW BIRTH WEIGHT BABIES.

•The prevalence of LBW babies in India – 35%.

•They are associated with high risk of mortality & morbidity.

•LBW – babies whose birth weight is < 2500 gms.

•The principles of LBW babies include, prevention of hypothermia, provision of exclusive breast feeding, prevention of infection.

•Some LBW babies are pre term babies.

IDENTIFICATION OF PRE TERM BABIES.

THE PHYSICAL EXAMINATION FINDINGS INCLUDE,

•Sole creases are absent or present only in the anterior 1/3 of the sole.

•The breast nodule is less than <5 mm in diameter.

•The ear does not recoil immediately on folding.

•The hair are fine & wooly.

•In males testis is not full y descended in to the scrotum, & in the female babies the vaginal opening is exposed & clitoris is prominent.

PREVENTION OF HYPOTHERMIA

•Room in the baby with the mother & keep them in skin to skin contact.

•Keep the baby dry & clothe adequately.

•Keep the room warm & free from draughts.

•Additional heat can be provided by placing 100-200 watt bulb placed about 18” from the baby.

•Record the temperature of the baby atleast 3-4 hrly to ensure that the baby’s temp is kept between 36.5.C & 37.5.C.

FEEDING

•All babies including LBW babies must be fed only breast milk.

•Avoid pre lacteal feeds.

•Initiate early breast feed.

•Pre term babies must be fed frequently.

•If required EBM must be given.

•Dis courage bottle feeds.

PREVENTION OF INFECTION.

•LBW babies are pre disposed to infections, utmost care must be taken to prevent infections.

•Individuals with resp infections, skin infections must stay away from the baby.

•Avoid all sorts of contamination.

•Avoid pre lacteal feeds.

•Wrap the baby in clean dry linen .

•Immunize the babies as per immunization schedule.

•Maintain environmental hygiene.

NORMAL PHENOMENA AFTER BIRTH.

Certain adaptive changes take place during the first 7 days of birth, these are termed as NORMAL PHENOMENA . The mother & the care taker must be re assured.

MECONIUM PASSAGE.•Me conium is the first stool of NB.

•It is dark, greenish black & sticky in nature.

•Me conium is made up of intra uterine swallowed amniotic fluid, intestinal secretions & shed epithelial cells.

•Me conium is first passed with in 24 hrs of birth.

•Some fetus pass in utero.

•Non passage of me conium is a cause for concern. It may suggest imperforate anus.Such a case should be refered.

PASSAGE OF URINE.

•New borns usually pass urine in the delivery room soon after the birth or with in 24 -48 hrs.

•Non passage of urine is abnormal & requires referral.

•A normal NB would pass urine 6 -7 times / day.

•Some NB may cry just before passage of urine.

TRANSITIONAL STOOLS.•Following the passage of me conium the NB continues to pass dark greenish sticky stools 3-4 times a day for the next 2-3 days.

•This is followed by change in the characteristic of the stool.

•This is termed as transition stool.

•The stool is greenish yellow.increased frequency of the stools – 25 times a day.

•Loose watery in consistency.

•Or the child may pass once in 5-6 days / or 5-6 times in a day. ( there is no associated blood, mucus & is not associated with dehydration ).

VOMITING

•SOME NB. MAY FREQUENTLY VOMIT MUCOID SECRETIONS DURING THR FIRST DAY.

•This is due to swallowed amniotic fluid.

•Baby should be properly burped after the feed.

•Abnormal vomiting is present in case of intestinal obstruction, in such cases the vomiting is persistent, bile or blood stained & projectile in nature.

MONGOLIAN SPOT

•Are bluish black patches of pigmentation especially over the sacral & buttock areas.

•Mongolian spots may be seen in trunk & extremities.

•The pigmentation will disappears by 6 months of age

ERYTHEMA TOXICUM

•Erythematous rashes may appear on the 2nd or 3rd

•It begins from the face & spreads to the trunk, extremities over the next 24 hrs.

•It disappears spontaneously with in 2-3 days.

VAGINAL DISCHARGE & BLEEDING.

•Female babies have thin mucoid secretions from the vagina.

•Clean the secretion with water & keep the place dry.

•Pseudo mensturation occurs in few babies after 3-5 days.

•Keep the genitalia clean & dry

MASTITIS.•Breast engorgement may occur on the third or fourth day.

•This phenomenon is due to trans placental transfer of maternal hormones.

•Local massage & fomentation must be avoided.

•Re assure the mother.

PHYSIOLOGICAL JAUNDICE.

•Refers to jaundice appearing after 24 hrs of birth.

•Peak level of bilirubin exceeds upto 15 mg/dl.

•Jaundice decreases by 7 – 10 days of life.

•High levels of bilirubin >20 mg /dl are associated with a risk of brain damage.

CEPHALOHEMATOMA.

•Some babies have big swelling over the scalp.(catputsuccedaneum).

•This is due to pressure over the presenting part.

•Cephalohematoma (SUB PERIOSTEAL HAEMMORHAGE) APPEARS AFTER 2-3 DAYS.

•Cephalohematoma is usually associated with anemia or jaundice.

HYDROCEPHALUS.

Requires medical intervention.