Care of a Newborn

1. Care of a Newborn Download more documents and slide shows on The Medical Post [ www.themedicalpost.net ] Dr. Kalpana Malla MD Pediatrics Manipal Teaching Hospital

2. Care of Normal Newborn

3. Definition Neonatal period/neonate/ newborn – first 28 days of life Perinatal period – 22 weeks of gestation to 7 days after birth

4. Definition Early Neonate –birth to first 7 days of life Late Neonate –after 7 days – 28 days of lif

5. Definitions Term – baby born after 37 completed weeks upto 42 completed weeks of gestation Preterm – baby born before 37 completed weeks of gestation Post-term – baby born after 42 completed weeks of gestation

6. Definitions SFD / SGA : birth weight is <10 TH CENTILE FOR GESTATIONAL AGE AFD/ AGA :Birth weight is 10 TH - 90 TH CENTILES FOR GESTATIONAL AGE LFD/ LGA :Birth weight is >90 TH CENTILE FOR GESTATIONAL AGE

7. Classification of Newborn A) Depending upon gestational age: Term Preterm Post-term

8. B) Depending upon Birth weight : Normal birth weight (NBW) :2500-3999 g Low birth weight (LBW) : <2500 g Very low birth weight (VLBW) : <1500 g Extremely low birth weight (ELBW) : <1000 g Preemie : <750 g Micropreemie : <500 g

9. Very Low Birth weight: 1000-1500g

10. Very Low Birth weight: 1000-1500g

11. Extremely low birth weight: 500-1000g

12. C) Depending upon Gestational Age & B.WT Preterm - SFD / SGA AFD/ AGA LFD/ LGA Term -SFD / SGA AFD/ AGA LFD/ LGA Post –Term - SFD / SGA AFD/ AGA LFD/ LGA

13. Plotting Weight, Length, HC

14. Component of Newborn care Clean delivery & clean cord care Maintanance of body temperature – room warm/cloths-cap, socks,oil massage Skin care- sponge, not to scrub vernix Care of umbilical stump – keep dry (fall after 5-10days) Care of eyes

15. Component of Newborn care 6. Breast feeding 7. Weight record 8. Early detection of serious Ds 9. Immunization 10. Supplements and follow up

16. Follow up Well baby clinic – evaluation Exclusive breast feeding Growth and development Immunization Nutrition advice

17. Care at birth- DELIVERY ROOM CARE Ensure clean and safe delivery Delivery room - Clean, well ventilated, adequately lighted, warm room Temperature stabilisation Suction - mouth and nostril Cut the umbilical cord -2.5 inch from skin Weigh and classify Assess under warmth

18. Basic care of the normal newborn 1.Rooming in 2. Receive the baby in sterile sheet Cover adequately and dress 3. Check color, respiration, temperature, and umbilical cord 4. Record skin temperature

19. Basic care of the normal newborn Mother’s role - Has instinct, concern, interest, love and affection - Can involve in nursing care - Recognition of early evidence of disease

20. Basic care of the normal newborn Mother’s role Breast feeding - F irst feed within 1-2 hours - No prelacteal feeds - Colostrum to feed - No need of water - Demand feeding 2-3 hours -15-20min, Burp - Adequacy of breast feeding

21. Care of normal newborn Maintenance of body temperature - Avoid bath on first day - Cover adequately and dress Bath - At birth - clean blood, mucus and meconium - Bath can be given on next day, use unmedicated soap and lukewarm water - Sponging is sufficient - Avoid dip bath Skin care - No need to clean all vernix, but clean blood and meconium - Skin abrasions - use topical antibiotics

22. Care of normal newborn Cord care Clamp, inspect 2- 4 hourly for bleeding, no dressing, spirit cleaning of tip and around the base Eye care Sterile cotton swab cleaning, each eye separately, no kajal application Vitamin K - 1mg IM within 2 hours of life Dresses L oose, soft, preferably cotton, woolen, nappies

23. Care of normal newborn Routine care ( Term, vigorous, crying, pink good tone , no meconium ) Put on mother’s chest Dry Cover with dry linen Skin to skin contact Clear airway Supportive care Warmth Position Suction Dry Stimulate Give O2

24. Care during subsequent period 1.Weight recording - daily - Weight loss during first 2-3 days, 5-8% of body weight - Stationary for next 1-2days - Regain birth weight - at the end of first week - Average weight gain thereafter- 30g / day 2. Immunisation - BCG 3. Discharge plan and future visits

25. Grades of care of newborn Level I care: >89% require minimal care Wt >2000gm Gest maturity ≥ 37 weeks Care provided at – home/subcenter/primary health care

26. Level II care : 10-15% require this care Wt- >1500gm Gest maturity 32-36 weeks Needs specialized neonatal care supervised by trained nurses /pediatrician Equipments – Et tube/Laryngoscope - IV infusion, NG tube, - Phototherapy - Facility for exchange transfusion ect

27. Level III care 3-5% require this care Intensive neonatal care < 1500 gm Gest < 32 weeks Skilled neonatologists/trained nurses Equipments – incubator, oxygen - Suction apparatus - Ventilator - Infusion pump, trancutaneous monitors

28. Early detection of serious disease 1. Bleeding from any site Jaundice appearing <24 hours / Deep jaundice / Physiological jaundice 3. Not passed meconium within 24 hours / urine within 48 hours 4. Regurgitation, vomiting / loose stools 5. Poor feeding / lethargy/ Excessive sleepiness

29. Early detection of serious disease 6. Excessive frothiness / drooling of saliva 7.Cold to touch / fever / Dehydration fever 8.Abdominal distension 9.Difficult / rapid breathing 10.Convulsions

30. Common neonatal problems 11. Excessive cry- hunger, discomfort, full bladder, colic, insect bite, soiling 12.Superficial infections - skin pustules, umbilical, sepsis, conjunctivitis, oral thrush 13.Blocked nasolacrimal duct

31. Minor developmental pecularities Erythema toxicum /urticaria neonatorum-erythematous rash with central pallor ,appears on 2-3 rd day in term baby, starts on face & spreads to trunk & extremities in 24 hrs, disappears in 2-3 days 2. Peeling skin 3. Milia- retention sebum 4. Mongolian blue spot

32. Minor developmental pecularities 5. Subconjunctival hge 6. Epstein pearl – epithelial inclusion cysts 7. sucking callosities 8. Tongue tie 9. Hymenal tags/ non retractable prepuce 10.Prominent xiphisternum 11umbilical hernia

33. Minor developmental pecularities 13. disorders due to transplacental passage of hormones – Mastitis neonatorum - vaginal bleeing - mucoid vaginal secretions

34. Criteria of normal newborn Gestation – 37-42 completed weeks Birth wt – 2500 – 3999gm Breathing – spontaneous,regular,RR – 30-60/min Color – pink but slight peripheral cyanosis soon after birth Heart rate – 100 -160/min Temp ( axillary) – 97.5-99 F

35. Criteria of normal newborn 7. HC – 33-35cm 8. Length – 50 cm 9. Chest circumference – 3 cm< HC 10.Upper segment : lower segment – 1.7-1.9:1 11. Sucks soon after birth 12. Sleeps – 18 hr/day 13.Physiological photophobia, sclera bluish

36. Criteria of normal newborn 14. Ear cartilage – firm with good elastic recoil 15. Breast nodule > 5 mm 16.Liver palpable – 2 cm 17. Genitalia – Male -Testes in scrotum,deeply pigmented scrotum/adequate rugae Female -Labia minora covered by labia majora 18. Sloes – >anterior 2/3 rd show deep crease

37. Criteria of normal newborn 19. Muscle tone – increased by adult standard/attitude of flexion 20. 95% term & preterm void within 24 hrs but some pass in 48hrs 21. 99% term & 95% preterm pass meconium within 24- 48 hrs of birth 22. No apparent cong anomalies

38. Examination of newborn Examined region by region Soon after birth At 24 hrs of life Before discharge Pre-requisites Wash and dry hands Good light Warm environment Concent

39. Examination of newborn 1.Overall impression – face,trunk,limbs,activity 2.Measurements – wt/length/HC 3. Color – pink,jaundice 4. Skin – pallor /jaundice/erythema toxicum 5. Head –fontanelles/ sutures/ cephalhematoma/ superficial injuries 6. Face – dysmorphic features

40. Examination of newborn 7.Ears – low set/demormity 8. Eyes – discharge/inflammation/cataract 9. Nose – choanal atresia 10. Mouth – cleft palate /macroglossia/micrognathia/excessive frothing 11. Neck – sternomastoid tumour /branchial & thyroglossal cysts/webbing neck/short neck/neonatal goiter/ cystic hygroma

41. Examination of newborn 12. Upper limbs – erb’s palsy/Klumky’s palsy/extra digits 13. Chest – accessory nipples/wide apart nipple/breast hypertrophy/lung field 14. CVS – mumurs 15. abdomen – organomegaly/distension /bowel sound 16. umbilical cord – single U. artery/signs of sepsis

42. Examination of newborn 17 . Hip – congenital dislocation of hip 18. Genitalia 19.Anus – imperforated anus 20. Feet – club feet/sole creases 21. Spine – midline defect ( spina bifida)/ meningomyelocele 22. Primitive reflexes

43. Thank you Download more documents and slide shows on The Medical Post [ www.themedicalpost.net ]