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