normal newborn care
TRANSCRIPT
Normal Newborn Care
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Introduction• 4 million neonatal deaths per year• 2/3 of neonatal deaths occur in 1st week of life• Must improve maternal education in basic newborn
care and recognition of danger signs• Improve training in neonatal resuscitation and
recognition and management of sick neonates
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Main Causes of Infant Mortality
7%15%
9%1%
29%
24%
10% 5%
Neonatal tetanus 7%
Pneumonia 15%
Sepsis/Meningitis 9%
Diarrhea 1%
Birth asphyxia and trauma 29%
Prematurity 24%
Congenital anomalies 10%
Others 5%
Main Causes of Mortality
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Essential Care for Newborn Health• Care of future mothers• Care during pregnancy• Care at time of birth• Care after birth
International Immediate Care of the Newborn
At birth, ask yourself the four following questions. If any answer is NO, THE BABY REQUIRES RESUSCITATION
•Breathing or crying?•Good muscle tone?•Color pink?•Term gestation?
Routine care
-Warmth
- Dry
IF YES
IF NO-Provide warmth
-Position; clear airway
-Dry, stimulate
Evaluate:
-Respirations
-Heart rate
-Color
RAPID INTERVENTION…for resuscitation
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Apgar Scores• A tool used to document the clinical
status of the newborn• NOT used to identify newborns that
require resuscitation• A score of 0 to 10 is assigned at 1, 5,
and 10 minutes
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Sign Score0 1 2
Heart rate Absent Slow (< 100 beats/minute)
=> 100 beats/min
Breathing Absent Slow, irregular Good, crying
Muscle Tone Limp Some flexion Active motion
Reflex irritability
No response Grimace Cough, sneeze
Color Blue or pale Pink body with blue extremities
Completely pink
Apgar ScoringApgar Scoring
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Cleanliness for the Newborn• Clean hands, perineum and delivery
surface• Immediate tying and clean cutting of
cord• Clean cloth to wrap baby in after delivery• Clean cord care
- nothing applied to cord stump- cord stump to be left uncovered to dry
International Thermal Protection of the Newborn
• Warm delivery room• Immediate drying• Skin to skin contact• Breastfeeding• Delay weighing and bathing• Appropriate clothing and bedding• Keep mother and newborn together• Warm transportation and resuscitation
Newborn ResuscitationNewborn Resuscitation
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• Be prepared for resuscitation – 10% of babies require resuscitation
• 30-40% of babies that require resuscitation are a surprise
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What is Necessary to Prepare for Resuscitation?
• Appropriate equipment • Skill to use equipment• Learn to recognize which baby needs
resuscitation
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At birth, ask yourself the four following questions. If any answer is NO, THE BABY REQUIRES RESUSCITATION
Breathing or crying?Good muscle tone?Color pink?Term gestation?
- Provide warmth- Position; clear airway- Dry, stimulate
Evaluate:- Respirations- Heart rate- Color
Supportive care
Provide breathing assistance
RAPID INTERVENTION…for resuscitation
HR > 100 & pink
Abnormal respirations or HR < 100
Routine care- Warmth- Dry
IF NONormal breathing
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Meconium Babies (10 – 12%) may be born through meconium stained
amniotic fluid
Meconium can plug the airway
A vigorous baby is: - breathing or crying - heart rate > 100 bpm - good tone If baby not vigorous then clearing the airway by intubating
and suctioning of the trachea may be life saving.
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How to Assess a Baby in a Health Care Facility
Breathing or Crying : -Watch babies chest rise -Normal rate 40-60/bpm - A vigorous indicates breathing Abnormal breathing may be: - absence of breathing - shallow respirations, poor chest movement - gasping respirations – extreme effort to inhale
associated with a slow respiratory rate
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Muscle tone - healthy term babies have a flexed position
Color – Normal is pink lips and mucous membranes. A dusky blue hue of lips and mucous membranes indicates central cyanosis.
Term gestation – by history Heart rate – normal heart rate 120 – 160 bpm
determined by auscultation of the heart.
How to Assess a Baby in a Health Care Facility
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Heart rate Hold the base of the umbilical cord with your thumb
and index finger. The cord pulsations felt are the heart
rate of the baby. The baby’s heart rate should be more than your own heart rate.
All other assessments are similar to health facility
How to Assess a Baby in the Community
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How to Provide Resuscitation in a Health Care Facility
Warmth - warmer - warm delivery room - temperature – 25oC to 28oC (77 – 82.4o F) - no fans or draughts - warm linen including 2 blankets/sheets, cap and clothing for baby -Dry baby immediately and remove wet linen - kangaroo care: even premature babies can maintain temperature
with skin to skin contact
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How to Provide Resuscitation in a Health Care Facility
Suction - suction mouth and nostrils before delivery of baby - suction mouth and nostrils after delivery of baby.
Remember mouth is to be suctioned before the nose Stimulate – If the baby is not breathing provide: - tactile stimulation by gently rubbing the back - stroking the feet - drying also provides tactile stimulation
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How to Provide Resuscitation in the Community
Warmth - deliver baby in a room that is warm and has no draughts - may
need heating. - dry baby immediately and remove wet linen - warm linen including 2 blankets/sheets, cap and clothing for baby - baby’s body can be wrapped in a towel and then covered by
plastic. Ensure baby’s head is not covered by plastic. - kangaroo care: even premature babies can maintain temperature
with skin to skin contact
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How to Provide Resuscitation in the Community
Suction if you do not have a suction catheter or bulb syringe then wipe the
mouth gently with a cloth - deep suctioning may cause bradycardia
Stimulate - If the baby is not breathing provide: - tactile stimulation by gently rubbing the back - stroking the feet - drying also provides tactile stimulation
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Breathing Assistance in a Health Care Facility
Bag and Mask Ventilation Indication: - not breathing - heart rate < 100 bpm
Equipment: - self inflating bag with oxygen reservoir - infant mask
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Breathing Assistance in a Health Care FacilityTechnique:
- connect O2 to reservoir - cover mouth and nostrils with mask - squeeze bag 40-60 times/minute
WATCH for chest movement. If no movement: - check for seal - reapply mask -reposition head - check for blocked airway and continue bag and mask ventilation
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Breathing Assistance in the Community
- If you have a self inflating bag and mask, follow instructions in health care facility section.
- You may use a tube and mask:• - get a good seal covering the mouth and nostrils• - breathe 40 times/minute into the tube by blowing into the
tube - make sure the chest rises
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When does the baby require continuing observation and additional attention?
Danger signs: - ineffective breathing/labored respiration – respiration rate >
60/min - heart rate < 100 bpm - cyanosis - pale, mottled or gray - abnormal tone - jitteriness - seizures - cool/warm baby - not feeding - at risk for infection
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Successful Resuscitation BABY SHOULD BE:• WARM• PINK• BREATHING COMFORTABLY
Preventative Care for the Newborn
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Breastfeeding• Within one hour of birth• Feed on demand to stimulate milk production• 8 to 12 feeds in 24 hours• Feeding is appropriate if: 6-8 wet diapers per day, frequent
bowel movements and weight gain• No supplements needed• Empty breast completely to use hind milk• Mother must increase caloric and fluid intake
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Proper LatchProper Latch
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Eye Care• Helps prevent infectious conjunctivitis in 85
to 90% of newborns• Clean eyes in all newborns within 1 hour of
birth• Prophylactic agents:
• Silver nitrate 1% solution (2 drops per eye)• Tetracycline ointment 1%• Erythromycin ointment 0.5%• Provilodone solution – iodized 2.5%
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Other Measures Vitamin K
• 1 mg IM to prevent haemorrhagic disease Cord Care
• Keep stump clean and uncovered• No traditional medicines, herbs, etc
Immunizations• BCG if at risk of TB• One dose of oral polio vaccine (OPV) <2 wks after
birth• Hepatitis B if available
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Recognition and Management Recognition and Management of Problems Following of Problems Following
Resuscitation or Presenting Resuscitation or Presenting During the First Week of LifeDuring the First Week of Life
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IMPORTANT PRINCIPLES• Training
• neonatal resuscitation• post resuscitation management• prompt recognition of danger signs• prompt management of danger signs
• Maternal education• Urgency of assessment and management of
a sick newborn
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DANGER SIGNS• A danger sign is a sign or a symptom identified from
history (mother, pregnancy, delivery, baby) as well as physical exam of the baby, which indicates that he/she is at risk for, or is in trouble and needs urgent evaluation.
• Signs and symptoms are non-specific in the neonatal period.
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HISTORICAL DANGER SIGNS maternal history
• maternal fever• incomplete maternal immunization status• maternal HIV, TB, syphilis, malaria
delivery history• prolonged rupture of membranes• prolonged labor• unclean delivery• bleeding, foul amniotic fluid• need for neonatal resuscitation
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DANGER SIGNS
Not feeding well
(<6 feeds/day) Respiratory
Cardiac
Other
Neurologic
Skin
Risk of infection
General
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NEONATAL DANGER SIGNS Not feeding well
• After first day of life, a healthy baby should be feeding 8-12 times a day. He/she should wake up for feeding and show interest in feeding.
General appearance• low birth weight <2500g• premature <34 weeks• twins or triplets• dysmorphism• temperature abnormalities
hypothermia <35.5 °C axillary hyperthermia >37.5 °C axillary
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DANGER SIGNS Respiratory
• tachypnea RR>60, irregular breathing, apnea• labored breathing, grunting, retractions• cyanosis• cough• requiring bag and mask ventilation
Cardiac• tachycardia HR>200, bradycardia HR<100• pale, mottled, capillary refill>3sec• cyanosis
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DANGER SIGNS Neurologic
• seizures• hypotonia• hypertonia• jitteriness, tremors• irritability• lethargy• poor suck• weak cry or high pitch cry• bulging fontanel, depressed fontanel
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DANGER SIGNS Skin
• jaundice• pustules• pus from the umbilicus• redness around the umbilicus• purulent eye discharge
Other• abdominal distension, diarrhea• vomiting• bleeding
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CLINICAL SIGNS Not feeding well (with risk of hypoglycemia)
• irritability•seizures• jitteriness•temperature instability•respiratory distress•poor colour• jaundice
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CLINICAL SIGNS Sepsis /meningitis
• all the danger signs Pneumonia
• RR>60• retractions, nasal flaring• grunting• cough
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CLINICAL SIGNS Asphyxia
• abnormality of muscle tone• lethargy, poor activity, irritability• seizures, jitteriness, tremors• poor sucking reflex• poor respiratory effort• poor colour
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CLINICAL SIGNS LBW/prematurity
•BW<2500g•physical immaturity•risk of respiratory problems, especially the
premature infant•difficult temperature control (risk of
hypothermia)•poor feeding•higher risk of infections•higher risk of jaundice
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MANAGEMENT Not feeding well with no other danger
signs• evaluate
milk production feeding technique sucking ability of the baby
• spoon feeding of extracted milk or formula• treat oral thrush with gentian violet
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MANAGEMENT Severe infection (pneumonia, sepsis,
meningitis)• antibiotics: Septra PO for 10 days, and
Gentamicin IM for 7 days• temperature control• nutrition• transfer (with mother) to a hospital, if feasible
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MANAGEMENT Local infection
•Eyes: IM Cefotaxime or Ceftriaxone, 1dose, or Penicillin for 7 days
•Umbilicus: if mild redness not extending: observation if redness extending or pus draining, or other danger signs: see severe infection
•Skin:hygiene and oral cloxacillin if not improving with oral treatment, or other danger signs present: see severe infection
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MANAGEMENT Asphyxia/seizures
• treat the seizures with phenobarbital• antibiotics (see severe infection)• nutrition/prevention of hypoglycemia• temperature control• transfer if possible
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MANAGEMENT LBW/Premature baby
•handle with care•temperature control•early and frequent feedings•spoon feeding of expressed colostrum/breast milk if unable to suck
•close observation for signs of infection•check skin for jaundice