Chapter 5-1 -1PROVIDING CARE FOR A NEONATE WITH NEONATAL.pptx

providing care for Neonatal problems

1. PROVIDING CARE FOR A NEONATE WITH NEONATAL PROBLEMS Eyayalem Melese Jan 2021

2. 1. LOW BIRTH WEIGHT BABY

3. Definition: Low birth weight has been defined by the WHO as weight at birth of less than 2,500 grams (5.5 pounds). This is based on epidemiological observations that infants weighing less than 2,500 g are approximately 20 times more likely to die than heavier babies.

4. Definitions: LBW is less than 2500g . Very LBW is less than 1,500 g . Extremely LBW is less than 1,000 g .

5. The incidence of LBW: is defined as the percentage of live births that weigh less than 2,500 g out of the total of live births during the same time period. incidence rate therefore is=

6. Classifications of LBW Low birth weight babies are divided into two groups Per term : borne before 37 weeks of gestational periode . Light for dates (SGA): Born during gestational period (between 37-42 weeks of GA),but BW is < 2.5 kgs.

7. Weight for Gestational age Graph

8. Causes of LBW 1. Maternal - Poor socioeconomic condition . Malnutrition . Unmarried - Height less than 150 cm - Chronic ill health 2. Obstetric - Complication of pregnancy - Poor placental function - Smoking - Poor A/N care 3. Fetal - Multiple pregnancies - Congenital abnormalities - Slow intrauterine growth - Chromosomal abnormality

9. 1. Preterm A baby born before 37 completed weeks of gestation. All his organs are immature or not well developed at birth.

10. FEATURES OF THE PRE-TERM INFANT The preterm infant is small, under weight, with diminished subcutaneous fat. The head is relatively large with soft bones and separated sutures. The abdomen is also relatively prominent. The others are also:- Poor respiratory control Inadequate regulation of body temperature Impaired resistance to infection Tendency to hemorrhage Skin soft texture, pink

11. FEATURES OF THE PRE-TERM INFANT Lounge present Few plantar creases Flat nipples Very little cartilage in the pinna of the ear Prominent clitoris and labia minora in the female Scrotum empty with nor or few reggae in the male Inactive Feeds poorly

12. 2. Light - for – dates(Small - for gestational age) A baby whose weight is below the tenth percentile for gestational age Features of the small - for gestational age (small - for - dates) baby Wasted or thin appearance Skin cracked, dry and peeling, pale Mature new born genitalia and nipple with bud and areola Usually alert and active Feeds well A number low birth weight infant will, of course, be both pre-term and small-for dates and liable to the problems of both groups.

13. 2. Light - for – dates(Small - for gestational age) Meconium aspiration is not un common in the small for dates infant:- This complication may give rise to problems with respiratory infection when the infant is preterm and small for dates. However, the complication of RDS in these babies seems less common than in the true pre-term infant

14. The infant’s abilities to suckle, swallow, and control respiration and temperature are of course the most important features from a management point of view. In practice most babies below 2000 gm. are in need of special care. Incidence :- 2 / 3 of LBW babies are preterm 75% of all early neonatal death are seen in the LBW babies.

15. PREVENTION OF LOW NEONATES 1. General good health of the mother 2. Good antenatal supervision of the mother includes a. Health education in the value of good nutrition b. Extra rest and less work for mothers in multiple pregnancies c. Treat early signs of pre- eclampsia d. Admit the mother with APH on the 1 st bleeding e. VDRL for all pregnant women and complete treatment if possible

16. MANAGEMENT A. CARE IN LABOUR Deliver the mother in a consultant unit with special care baby unit. Avoid giving the mother drugs, which will depress the fetal respiratory center at birth. Do episiotomy to shorten 2 nd stage some obstetrician recommend elective forceps to reduce the risk of cranial injury C/S may be performed in obstetrics. Complications (breech press)

17. MANAGEMENT B. CARE AT BIRTH Establishment ofair way & respiration Warms Mother and baby relationship

18. MANAGEMENT C. The care given to the preterm baby is of vital importance as his survival depends on the quality of care he receive. 1 - CONTROL OF BABY TEMPERATURE Put the baby = in an incubator on an apnea warn, the baby has at about 30 c. But the incubator temperature should be adjusted according to the weight of the child, 3kg-32.2 c , 2kg-34 o c 1 kg -35 o c

19. MANAGEMENT 2. MATNTENANCE OF RESPIRATION Nurse the baby on an apnea mattress which sets off an alarm when the baby has not breathed. Resuscitative measures can be carried out prompt. Humidified O 2, if the baby is cyanosed while the caring of very small premature babies in high oxygen tensions is known to result in the development of detrimental fibroplasias (retinopathy or prematurity)

20. MANAGEMENT 3. HYGIEN AND PREVENTION OF INFECTION Daily toilet should be carried prior to a feed Washing the face and hands with sterile swabs Cleansing the skin folds with antiseptic lotion on cotton wool swabs Napkin area needs special attention Observe for sign of infection Clean the nurseries, damp dusting for the surfaces All staff should be free from contamination and infection. Hand washing carried out before and after handling each baby Clean the incubator with antiseptic daily

21. MANAGEMENT 4. OBSERVATION AND RECORDING Body temperature :- checked hourly, then after is reached 36.8 C can be done less frequently Respiration :- Rate. Apex beat :- should range 120 and 160 beats/nine. Color pallor, cyanosis or jaundice Activity and muscle tone Passage or urine and me conium Umbilical cord inspected for bleeding Baby should be carefully examined daily for sign of infection weight -weighed soon after birth

22. MANAGEMENT THE PRINCIPLES OF MANAGEMENT AREA AS FOLLOWS 1. A separate unit where this is possible with adequate facilities and trained staff 2. The mother should be nearby so that she can participate in the care of their babies and provide the necessary breast milk. 3. Provision of optimal environmental temperature. 4. Skilled nursing. The skilled manpower must be avilable to the best advantage organizing, supervising, and constantly training the less skilled in procedure like resuscitation, prevention of infection and feeding.

23. MANAGEMENT 5. Control of infection. There should be strict adherence to aseptic techniques both in the handling of the infant and the preparation of food. Breast feeding, besides all its their advantages. Diminished the chance of infection.

24. MANAGEMENT FEEDING Breast feeding is of the atmost importance, not only for the proper nourishment but also for the protection against infection which provides for the low birth weight baby. Those unable to suck and swallow efficiently are tube fed. Mothers should be helped to express milk for their babies. Early feeding is advocated to prevent hypoglycemia and hydration. Feed with in 2 hours of birth, there after frequent regular intervals. Only when breast milk is not available should a powdered low solute cow’s milk to use. Method of feeding depends on the size, maturity, and condition of the baby. Weight 2000 - 2500 g. may be ready to suck may breast or bottle feed Weight under 2000 g. has poor sucking reflex and thus tube feeding is necessary

25. MANAGEMENT The daily volumes required are approximately as follows. 1. Under 2000 gm. 60 ml/ kg. 1 st day 90 ml/kg. 2 nd day 120 ml/kg. 3 rd day 150 ml/kg. 4 th day 180 ml/kg. 5 th day If necessary the quantity is increased to 200ml/kg. per day by the 10 th day 2. Under 1500g . 60ml/kg. per day increasing daily by 30 - 60ml/kg. depending on the baby's tolerance to 200 - 250 ml/kg per day 3. Small - for dates babies 100ml/kg. 1 st and 2 nd day 120ml/kg. 3 rd day 150ml/kg. 4 th day increasing until 180 - 200 ml./kg. is reached . FEEDING