essential newborn care, careduring 1st-2hr of life
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Care to the new born child Care to the new born child within 1-2 hours of birth of a within 1-2 hours of birth of a
childchild
Dr Rakesh KumarAsst. professor
Dept of pediatricsN.M.C.H, Patna
Definition Definition
Newborn Period - birth up to the 27th completed day
(total of 28 days)
Essential Newborn Care Course- Covers essential interventions in the
1st hours after birth until the first week of life
- Emphasizes the need for a package /bundle of interventions
Definitions contd…Definitions contd… Preterm Baby: A baby who is born before 37 weeks(259 days).
Low Birth Weight(LBW): A baby weighing <2.5 kg.
Very low birth weight (VLBW): wt. < 1.5 kg
Extremely low birth weight (ELBW): w < 1.0 kg
Neonate: A baby who is ≤ 4 weeks or 28 days.
Early Neonatal Period(< 7 days).
Late Neonatal Period(7-28 days).
Infant: A child who is less than 1 year or 365 days.
Millennium Development Millennium Development Goal (MDG) 4Goal (MDG) 4
The fourth Millennium Development Goal (MDG 4) aims to reduce the 1990 mortality rate among under-five children by two thirds.
Millennium Development Goals adopted by the United Nations in 2000 aim to decrease child deaths worldwide by 2015.
Key facts about neonatal Key facts about neonatal mortalitymortality
Every year nearly 41% of all under-five child deaths are among newborn infants, i.e. the neonatal period.
75%of all newborn deaths occur in the first week of life.
In developing countries nearly half of all mothers and newborns do not receive skilled care during and immediately after birth.
Key facts contd….Key facts contd….Up to two thirds of newborn deaths
can be prevented if known, effective health measures are provided at birth and during the first week of life.
Of the 8.2 million under-five child deaths per year, about 3.3 million occur during the neonatal period.
The majority - almost 3 million of these - die within one week and almost 2 million on their first day of life.
Key facts contd….Key facts contd….An additional 3.3 million are
stillborn.A child’s risk of death in the first
four weeks of life is nearly 15 times greater than any other time before his or her first birthday.
Almost 3 million of all the babies who die each year can be saved with low-tech, low-cost care
Neonatal mortality :-Neonatal mortality :-Birth process was the antecedent cause
of 2/3 of deaths due to infections◦Lack of hygiene at childbirth and during
newborn period◦Home deliveries without skilled birth
attendantsBirth asphyxia in developing countries
◦3% of newborns suffer mild to moderate birth asphyxia
◦Prompt resuscitation is often not initiated or procedure is inadequate or incorrect
Neonatal mortality :Neonatal mortality :Hypothermia and newborn
deaths◦Significant contribution to deaths in
low birth weight infants and preterm newborns
◦Social, cultural and health practices delaying care to the newborn
Ophthalmia neonatorum is a common cause of blindness
Neonatal mortality: Neonatal mortality: Low birth weight
◦An extremely important factor in newborn mortality
Place of childbirth◦At least 2 out 3 childbirths in developing
countries occur at home◦Only half are attended by skilled birth
attendants◦Strategies for improving newborn health
should target Birth attendant, families and communities Healthcare providers within the formal health
system
Essential Newborn Care Essential Newborn Care InterventionsInterventions
Clean childbirth and cord care◦Prevent newborn infection
Thermal protection◦Prevent and manage newborn
hypo/hyperthermiaEarly and exclusive breastfeeding
◦Started within 1 hour after childbirthInitiation of breathing and
resuscitation◦Early asphyxia identification and
management
Contd…Contd…Eye care
◦Prevent and manage ophthalmia neonatorum
Immunization◦At birth: bacille Calmette-Guerin (BCG)
vaccine, oral poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine (WHO)
Identification and management of sick newborn
Care of preterm and or low birth weight newborn
Cleanliness to Prevent Cleanliness to Prevent InfectionInfection
Principles of cleanliness essential in both home and health facilities childbirths
Principles of cleanliness at childbirth◦Clean hands◦Clean perineum◦Nothing unclean introduced vaginally◦Clean delivery surface◦Cleanliness in cord clamping and cutting◦Cleanliness for cord care
Infection prevention/control measures at healthcare facilities
Thermal Protection of Thermal Protection of neonateneonate
Newborn physiology ◦Normal temperature: 36.5–37.5°C◦Hypothermia: < 36.5°C◦Stabilization period: 1st 6–12 hours after
birth Large surface area Poor thermal insulation Small body mass to produce and conserve heat Inability to change posture or adjust clothing to
respond to thermal stress Increase hypothermia
◦Newborn left wet while waiting for delivery of placenta
◦Early bathing of newborn (within 24 hours)
Hypothermia prevention Hypothermia prevention in newbornin newborn
Deliver in a warm roomDry newborn thoroughly and wrap in dry,
warm clothKeep out of draft and place on a warm
surfaceGive to mother as soon as possible
◦ Skin-to-skin contact first few hours after childbirth
◦ Promotes bonding◦ Enables early breastfeeding
Check warmth by feeling newborn’s feet every 15 minutes
Bathe when temperature is stable (after 24 hours)
Early & exclusive breast Early & exclusive breast feedingfeedingEarly contact between mother and
newborn ◦Enables breastfeeding◦Rooming-in policies in health facilities prevents
nosocomial infectionBest practices
◦No prelacteal feeds or other supplement◦Giving first breastfeed within one hour of birth◦Correct positioning to enable good attachment
of the newborn◦Breastfeeding on demand◦Psycho-social support to breastfeeding mother
Neonatal resuscitation if Neonatal resuscitation if neededneededSpontaneous breathing (> 30 breaths/min.)
in most newborns◦ Gentle stimulation, if at all
Effectiveness of routine oro-nasal suctioning is unknown◦ Biologically plausible advantages – clear airway◦ Potentially real disadvantages – cardiac
arrhythmia◦ Bulb suctioning preferred
Newborn resuscitation may be needed◦ Fetal distress◦ Thick meconium staining◦ Vaginal breech deliveries◦ Preterm
Eye Care To Prevent or Eye Care To Prevent or Manage Ophthalmia Manage Ophthalmia
NeonatorumNeonatorumOphthalmia neonatorum◦Conjunctivitis with discharge during
first 2 weeks of life◦Appears usually 2–5 days after birth◦Corneal damage if untreated ◦Systemic progression if not managed
Etiology◦N. gonorrhea
More severe and rapid development of complications
30–50% mother-newborn transmission rate◦C. trachomatis
Eye Care To Prevent or Eye Care To Prevent or Manage Ophthalmia Manage Ophthalmia
NeonatorumNeonatorumProphylaxis◦Clean eyes immediately◦1% Silver nitrate solution
Not effective for chlamydia◦2.5% Povidone-iodine solution◦1% Tetracycline ointment
Immunization Immunization BCG, OPV, HBVBCG vaccinations to all neonate.Single dose of OPV at birth .HBV vaccination as soon as
possible.
Clinical assessmentClinical assessmentAfter delivery of the baby and in the absence of any immediate problems, essential newborn care begins with a thorough general clinical assessment.
This should be done on all infants soon after birth to detect signs of illness and congenital abnormalities.
Clinical assessmentClinical assessmentFirst steps and appearanceFirst steps and appearanceStart by congratulating the mother on the
arrival of her new baby and ask if she has any concerns. The mother is usually the first person to notice any problems.
Ask about feeding and the passage of urine and stools. The infant should pass meconium (the first black, tarry stools) within 24 hours of birth.
General observation: inspect colour, breathing, alertness and spontaneous activity.
Well infants have a flexed, posture. Partially flexed posture is found in hypotonia or prematurity
Clinical assessmentClinical assessmentExamine skin for prematurity or Examine skin for prematurity or dismaturitydismaturity
Clinical assessmentClinical assessmentSkin: some common normal Skin: some common normal findingsfindings Vernix caseosa: a cream/white cheesy material
on the skin at birth which cleans off easily with oil.
Lanugo; fine downy hairs seen on the back and shoulders especially in preterm infants.
Milia: pinpoint whitish papules on nose and cheeks due to blocked sebaceous glands.
Mongolian blue spots: grey/bluish pigment patches seen in the lumbar area, buttocks and extremities in dark skinned babies.They usually disappear by one year.
Capillary heamangiomas (“stork bite” naevi): red flat patches which blanch with gentle pressure. Commonly occur on upper eyelids, forehead and nape of the neck.
Erythema toxicum: small white/yellow papules or pustules on a red base seen on face, trunk and limbs. Develop 1 – 3 days after birth and usually disappear by one week
Clinical assessment- colorClinical assessment- colorNote palor or plethora
Cyanosis: the baby should be uniformly pink
◦ Blueness of the hands and feet (peripheral cyanosis) may be due to cold extremeties.
◦ Blueness of the mucous membranes and tongue is central cyanosis and is usually due to lung or heart problems
Bruising (ecchymosis) is common after birth trauma. Unlike cyanosis, bruising does not blanch on gentle pressure.
Clinical assessment - Clinical assessment - jaundicejaundiceJaundice is common in the first
week of life and may be missed in dark skinned babies
Blanch the tip of the nose or hold baby up and gently tip forward and backward to get the eyes to open.
Teach mother to do the same at home in the first week and report to hospital if significant jaundice is observed.
Clinical assessmentClinical assessmentHeadHeadAfter these general observations,
examine the infant starting with the head and moving down the body.
Observe the size and shape of the head (micro- or macrocephaly; cephalhaematoma)
Check the anterior and posterior fontanelles and that the skull sutures feel normal
Form and position of ears (low set ears occur in chromosomal abnormalities, e.g. Down syndrome)
Clinical assessmentClinical assessment
Eyes and faceEyes and faceExamine eyes for ocular
anomalies and check for red reflex using the ophthalmoscope (to exclude cataract)
Examine the face for dysmorphic features and normal movements
Examine lips and palate for clefts
Clinical assessmentClinical assessment
Cardiovascular and Cardiovascular and respiratoryrespiratory
Feel femoral and radial pulses for volume, rate and rhythm.
In aortic coarctation, femoral pulse is reduced, absent or not synchronous with radial pulse.
If child is sick, measure blood pressure. Locate the apex beat and listen to the heart sounds for
murmurs.Count the respiratory rate
◦ normal 30 – 40 breaths/min in term infants
◦ faster in preterms.
◦ > 60 / minute abnormal
Observe for respiratory distress: nasal flaring, intercostal and subcostal recession.
Clinical assessmentClinical assessment
AbdomenAbdomen Inspect the umbilical cord for presence
of 2 arteries and a vein. Abnormal components may be a pointer to the presence of intra-abdominal anomalies e.g. renal.
Look for umbilical abnormalities, e.g. hernia, omphalocoele, exompholos
Gently palpate the abdomen
◦the liver may be palpable upto 2cm below the costal margin
Clinical assessmentClinical assessment
Spine and genitaliaSpine and genitalia
Examine:The spine for dimples, tuft of hair
(spina bifida occulta) or cystic swellings (spina bifida cystica)
Remove the diaper to examine the genitalia. In boys, confirm that both testicles have descended into the scrotum.
Designate the infant’s sexInspect the perineum and check
anus for position and patency (can be done by gently checking rectal temperature)
Clinical assessmentClinical assessment
Dysmorphic featuresDysmorphic features
Examine hands. Note single palmar crease in chromosome abnormalities.
Inspect the feet. Note effects of foetal posture should be noted.
Check hips for dislocation
Limitation of limb movements occurs in fractures and nerve injury
Clinical assessmentClinical assessmentRoutine measurementsRoutine measurementsMeasure: Weight
◦ normal 2.5 – 3.99kg
Length
◦ normal 48 – 52cm
Occipitofrontal circumference (OFC)
◦ normal 33 – 37cm
Thank you
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