ho 3 essential newborn care 06may2013
DESCRIPTION
Essential Newborn Care -TRANSCRIPT
Essential Newborn Care - Evidence into
Practice
5/6/2013
Prepared by Team EINC for APDCN Faculty 1
Essential Newborn Care:
From Evidence to Practice
Ma. Lourdes Imperial, MD, FPSNbM
Co-Convener, Essential Intrapartum and Newborn Care
Objectives
By the end of this session, the learner should
• be able to discuss the problem of child mortality focusing on neonatal mortality
• know preventive interventions to address the above
• be able to discuss the immediate newborn care practices that save lives
MILLENNIUM
4 5
0
10
20
30
40
50
60
70
80
1988 1993 1998 2003 2008
• 1988-1998: 40%
• 1998-2008: 20%
• Neonatal mortality hasn’t improved
Under Five MR
Neonatal MR
DHS 88, 93, 98, 03, 08
<5 year old and Neonatal Mortality
# o
f dea
ths
per
1000
live
birt
hs
Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
Major Causes of Under Five Deaths Western Pacific Region - 2010
Prematurity 27%
Asphyxia 26%
Infection (Sepsis+Pneumonia) 10%
Congenital Anomalies 9%
Neonatal Tetanus 2%
Diarrhea 2%
Other Conditions
Causes of Neonatal Deaths, 2010
Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
Essential Newborn Care - Evidence into
Practice
5/6/2013
Prepared by Team EINC for APDCN Faculty 2
0
5
10
15
20
25
30
35
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
3 out of 4 newborn deaths occur in the 1st week of life
Day of Life
# o
f d
eath
s p
er 1
000
live
bir
ths
NDHS 2003, special tabulations
Majority of newborns die due to stressful events
or conditions during labor, delivery and the
immediate postpartum period Preventive Interventions
Breastfeeding 13%
Insecticide-treated materials 7%
Complementary Feeding 6%
Zinc 4%
Clean delivery 4%
Hib Vaccine 4%
Water sanitation, hygiene 3%
Antenatal Steroids 3%
Newborn temperature management 2%
Vitamin A 2%
Tetanus Toxoid 2%
Nevirapine and replacement feeding 2%
Antibiotics for premature rupture of membranes 1%
Measles vaccine 1%
Antimalarial intermittent preventive treatment in pregnancy <1%
The Lancet Child Survival Series. Lancet 2003; 362: 65–71
What Can We Do to Save Newborn Lives?
This was considered and handled as a hospital infection control problem
Large NCR Hospital partially
closed for cleanup
25 babies reportedly died due to infection
How much colostrum did the cases receive?
Environmental cultures positive
Delaying Initiation of breastfeeding
increases risk of infection-related death Nepal 2008 N = 22,838 breastfed babies
0
1
2
3
4
5
<1 1-24 24-48 48-72 >72
Re
lati
ve
Ris
k
Hours after Birth
Mullany LC, et al. JNutr, 2008; 138(3):599-603.
Essential
Newborn Care
Protocol was
developed to
address these
issues
What Immediate
Newborn Care
Practices Save Lives?
Essential Newborn Care - Evidence into
Practice
5/6/2013
Prepared by Team EINC for APDCN Faculty 3
Antenatal Steroids Antenatal Steroids Betamethasone
12 mg IM q 24 hrs x 2 doses May be the preferred drug – less PVL
Dexamethasone 6 mg IM q 12 hrs x 4 doses
Have dexamethasone available in the E-cart
No additional benefit to using higher or more frequent doses
Prednisone, methylprednisolone, cortisol are unreliable
Every Newborn Has Needs
To breathe normally
To be warm
To be protected
To be fed
Providing Warmth:
Check the Environment
Check temperature of the delivery room*
Ideal temp: 25 – 28°C
Check for air drafts
Turn air conditioner off at time of delivery
*non-mercury thermometer
After a baby is born, what should be
the first action performed?
• Clamp and cut the cord A
• Dry the baby B
• Suction the baby’s mouth and nose C
• Do foot printing D
Immediate Thorough Drying Immediate drying: Stimulates Breathing
Prevents hypothermia
Hypothermia can lead to Infection
Coagulation defects
Acidosis
Delayed fetal to newborn circulatory adjustment
Hyaline membrane disease
Brain hemorrhage Tunell R., in Improving Newborn Health in Developing Countries, A. Costello and D. Manandhar, Editors. 2000,
Imperial College Press: London, UK. p. 207-220; TollinM,etal.. Cell Mol Life Sci 2005
Essential Newborn Care - Evidence into
Practice
5/6/2013
Prepared by Team EINC for APDCN Faculty 4
Immediate Thorough Drying
Dry the newborn thoroughly for at least 30 seconds
Do a quick check of breathing while drying
>95% of newborns breathe normally after birth
Follow an organized sequence
Wipe gently, do not wipe off the vernix
Remove the wet cloth, replace with a dry one
Drying should be the first action,
IMMEDIATELY
for a full 30 seconds unless the infant is both
floppy/limp and apneic
Immediate Thorough Drying
If baby not breathing, STIMULATE by DRYING!
Do not slap, shake or rub the baby
Do not ventilate unless the baby is floppy/limp and not breathing
Do not suction unless the mouth/nose are blocked by secretions
Unnecessary Suctioning
Of the 455 who were already breathing
94.9% suctioned once
84.0% suctioned more than once
Likelihood of UNNECESSARY suctioning
With training in Neonatal Resuscitation – 2.5 times
With training in Pediatric Resuscitation – 2.2 times
Prepared by Team EINC for APDCN Faculty
During drying and stimulation of the baby,
your rapid assessment shows that the baby
is crying.
What is your next action?
• Suction the baby’s mouth and nose A
• Clamp and cut the cord B
• Do skin-to-skin contact C
• Do early latching on D
Skin-to-Skin Contact General perception is purely for mother-baby
bonding
Other benefits:
B – breastfeeding success
L – lymphoid tissue system stimulation
E – exposure to maternal skin flora
S – sugar (protection from hypoglycemia)
T - thermoregulation
Moore E, et al. Cochrane Rev. 2007 Jul 18;(3). Anderson GC, et al. Cochrane Rev 2003;(2).
Brandtzaeg P. Ann N Y AcadSci 2002;964:13–45
Essential Newborn Care - Evidence into
Practice
5/6/2013
Prepared by Team EINC for APDCN Faculty 5
Early Skin-to-Skin Contact If breathing or crying: Position prone on the
mother’s abdomen or chest
Cover the newborn
Dry linen for back
Bonnet for head
Temperature Check Room: 25-28 °C
Baby: 36.5 – 37.5 °C
When should the cord be
clamped after birth?
• When the cord pulsations stop A
• Between 1 and 3 minutes B • Not less than 1 minute in terms
and preterms not needing PPV C
• All of the above are appropriate D
Properly-Timed Cord Clamping
• No significant impact on
incidence of Post-Partum
Hemorrhage
• Prevents anemia in both term and preterm
babies
• Prevents bleeding n the brain in premature
babies
Properly-Timed Cord Clamping
When preparing for delivery, don 2 pairs of gloves after thorough handwashing
Remove the first set of gloves
Palpate the umbilical cord
Wait 1-3 minutes or until cord pulsations have stopped.
Properly-Timed Cord Clamping
Clamp again at 5 cm from the base
•Cut the cord close to the plastic clamp
•Clamp cord using a sterile plastic clamp or tie at 2 cm from the umbilical base
2 cm 3 cm
Essential Newborn Care - Evidence into
Practice
5/6/2013
Prepared by Team EINC for APDCN Faculty 6
Care of the Cord
• Do not milk the cord towards the baby
• Observe for the oozing of blood. If blood oozes, place a second tie between the skin and the clamp
• DRY cord care is recommended • Do not apply any substance onto the cord
• Do not use a binder or “bigkis”
Bathing the Baby in the First
6 Hours is Protective.
TRUE FALSE
Washing
Vernix
protective barrier to E.coli and Group B Strep
Early washing
Hinders crawling reflex
Can lead to hypothermia
infection, coagulation defects, acidosis, delayed fetal to newborn circulatory adjustment, hyaline membrane disease, brain hemorrhage
Prepared by Team EINC for APDCN Faculty
What is the approximate capacity of a
newborn’s stomach?
A
B C
D
How long after birth is a
newborn ready to breastfeed?
•immediately A
•5-9 minutes B
•10-19 minutes C
•20-60 minutes D
Non-separation of Newborn from
Mother for Early Breastfeeding
Weighing, bathing, eye care, examinations, injections should be done after the first full breastfeed is completed
Postpone bathing until at least 6 hours
Essential Newborn Care - Evidence into
Practice
5/6/2013
Prepared by Team EINC for APDCN Faculty 7
Non-separation of
Newborn from
Mother
Never leave the mother and baby unattended
Monitor mother and baby q15 minutes in the first 1-2 hrs. Assess breathing and warmth.
Breathing: listen for grunting, look for chest in-drawing and fast breathing
Warmth: check to see if feet are cold to touch if no thermometer
Early and
Appropriate
Breastfeeding
Initiation
Leave the newborn between the mother’s breasts in continuous skin-to-skin contact
The baby may want to rest for 20-30 mins and even up to 120 minutes before showing signs of readiness to feed
Early and Appropriate
Breastfeeding Initiation
Health workers should not touch the newborn unless there is a medical indication
Do not give sugar water, formula or other prelacteals
Do not give bottles or pacifiers
Do not throw away colostrum
Let the baby feed for as long as he/she wants on both breasts
Help the mother and baby into a comfortable position
Observe the newborn
Once the newborn shows feeding cues, ask the mother to encourage her newborn to move toward the breast
Early and Appropriate
Breastfeeding Initiation
Breastfeeding Cues • eye movement under closed lids
• alertness, movements of arms and legs
• tossing, turning or wiggling
• mouthing, licking, tonguing movements
• rooting
• changes in facial expression
• squeaking noises or light fussing
!
Crying is a late sign of hunger
After delivery, mother is moved onto a stretcher with her baby and transported to Recovery Room, mother-baby ward or private room
Breastfeeding support is continued
Support Continued and
Exclusive Breastfeeding
Essential Newborn Care - Evidence into
Practice
5/6/2013
Prepared by Team EINC for APDCN Faculty 8
Counsel on positioning
Newborn’s neck is not flexed or twisted
Newborn is facing the breast
Newborn is close to mother’s body
Newborn’s whole body is supported
Support Continued and
Exclusive Breastfeeding
Counsel on attachment and suckling Mouth wide open Lower lip turned
outwards Baby’s chin touching
breast Suckling is slow,
deep with some pauses
Support Continued and
Exclusive Breastfeeding
Proper Breastfeeding Hold
Look for a quiet place
Find a most relaxed position for mother
Provide adequate back support
Support feet
Do not hunch shoulders
Do not “scissor” the breast
Cradle Hold
Cross Cradle Hold Cradle vs. Cross Cradle Hold
Essential Newborn Care - Evidence into
Practice
5/6/2013
Prepared by Team EINC for APDCN Faculty 9
Underarm Hold
Football hold
Baby is held like a
clutch bag
Nose further away
from the breast
Baby’s trunk is
secure beside
mother’s trunk
Breastfeeding after Cesarian Delivery
Side-Lying Position Side-Lying Position
E.O. 51 and its rIRR: The DON’Ts
Gifts of any sort Samples or products covered under the Milk Code Posters, other promotional materials or direct
promotions of products covered under the code within your Health Facility, Community, Barangays, Events, etc.
Sponsorships without permission from FDA Endorsements of products covered by the Milk Code
DO NOT REQUEST or ACCEPT from Milk Companies or their representatives: