ESSENTIAL NEW BORN CARE

Essential new born care is the care provided to the baby immediate after the birth of the baby which is very important to reduce the neonatal mortality rate includes
supporting breastfeeding.
providing adequate warmth.
ensuring good hygiene and cord care,
recognizing early signs of danger and providing prompt treatment and.
referral, giving extra care to small babies, and.
having skilled health workers attend mothers and babies at delivery.

1. “ESSENTIAL NEW BORN CARE” PRESENTED BY- MADHU BALA NURSING TUTOR OBSTEtRICS AND GYNAECOLOGICAL NURSING m. M. college of nursing , mullana , ambala

2. INTRODUCTION Essential care of the normal healthy neonates can be best provided by mothers under supervision of nursing staff or primary health care providers. The normal term baby should be kept with their mother rather than in separate nursery. Rooming in promotes better emotional bondage, prevents cross infection and establishes breast feeding easily .

3. Cont. A HEALTHY NEWBORN - A healthy infant born at term (between 38–42 weeks) should have adequate birth weight (2500 to 3500 g), cries immediately following birth, establishes independent rhythmic respiration and quickly adapts to the changed environment. Early neonate - Early neonate is the one having age of 0-6 days Late neonate - Late neonate is the one who is having age of 7-27 days.

4. ASSESSMENT OF WELLBEING   Assessment of the new-born immediately starts the moment he or she is delivered, and there are a lot of standard assessments used to evaluate them rapidly. Apgar scoring - The Apgar scoring is done during the first 1 minute and 5 minutes of life. The heart rate, respiratory rate, muscle tone, reflex irritability, and the color are evaluated in an infant. Apgar score is the baseline for all future observations.

5. APGAR SCORING

6. CONT. Apgar scoring 0-3 points :  the baby is serious danger and need immediate resuscitation. 4-6 points :  the baby’s condition is guarded and may need more extensive clearing of the airway and supplementary oxygen. 7-10 points :  are considered good and in the best possible health.

7. IMMEDIATE NEWBORN CARE 1. Call out the time of birth 2. Receive the baby on a warm, clean and dry towel or cloth-

8. CONT. 3. Maintenance of airway and circulation. 4. Clamp and cut the umbilical cord 5. Assess the baby’s breathing while drying

9. CONT. 6. Wipe both eyes with sterile gauze. 7. Leave the baby between the mother’s breasts to start skin to skin care. 8. Place an identity label on the baby.

10. CONT. 9. Cover the baby properly 10. Encourage mother to initiate breast feed 11.Weigh the baby

11. DAILY ROUTINE NEWBORN CARE The majority of complication of the normal newborn may occur during first 24 hours or within 7 days, so close observation and daily essential routine care is important for health and survival of the newborn baby. The major goals - Establish and maintain homeostasis stability of normal physiological status

12. Daily routine newborn care includes

13. 1.OBSERVATION The baby should be kept in continuous observation twice daily for detection of any abnormalities

14. 2. ANTHROPOMETRIC MEASUREMENT Average weight of the normal full term new born infant is about 2.9kg with the variation of 2.5-3.9kg Average daily weight gain for healthy term babies is about 30g per day in the 0first month of life It is about 20g per day in the second month 10g per day afterwards during the first year of life

15. Length - At birth the average crown heel length of the term infant is 50 cm Average range is 46 to 56 cm Head circumference- The occipito frontal head circumference should be measured. Average range is 33 to 35 cm Normally 2 cm larger than chest circumference   Chest circumference The chest circumference is measured at the level of nipple. At birth Average range 30 to 33 cm Normally 2 cm smaller than head circumference  

16. “WARM CHAIN”- At delivery- ensure the temperature of delivery room, it should be warm (25^C). dry the baby immediately, Keep the baby in skin to skin contact with mother and postpone bathing for at least 6 hours or next day. After delivery- Keep the baby clothed and wrapped with head covered, avoid bathing especially in cold weather, keep the baby close to the mother and use KMC.

17. BREAST FEEDING - The baby should be put to the mother breast within half an hour of birth of baby or as soon as possible the mother has recovered from the exertion of labor . Before providing breast feeding, nipples should be cleaned properly. Use proper techniques of breast feeding by mother

18. CONT. Preparing the infant and the mother: Ensure that the infant is clinically star. Ensure that the infant is alert. Make sure that the mother is comfortable and relaxed. Make her sit down in a comfortable and convenient position. Baby’s head and body should be straight. Baby’s face should face mothers’ breast. Baby’s body should be close to her body. Mother should support the baby’s whole body.

19. CONT. Show the mother how to breastfeed Explain the mother that she should: Put her fingers below her breast. Use her first finger to support the breast. Put her thumb above the areola helping to shape the breast. Not keep her fingers near the nipple.

20. CONT. Ask the mother to : Express a little milk on to her nipple. Touch the baby’s lip with her nipple. Wait until the baby’s mouth opening wide and the tongue is downward forward. Move the aby quickly onto her breast, aiming the nipple toward the baby’s palate and his lower lip well below the nipple.

21. Look for signs of good attachment: More areola is visible above the baby’s mouth than below it. Baby’s mouth is wide open. Baby’s lower lip is turned outwards. Baby’s chin is touching the breast. Correct positioning will ensure effective sucking and prevent sore nipple and breast engorgement. Observe the baby carefully during breast feeding After breast feeding, burping should be done in view of regurgitation.

22. Duration of breastfeeding : A healthy new born baby can be breast feed “ ON DEMAND ” i.e whenever the baby cries for feed. The usual time interval between each feed is about 2-3 hours. Mother should be advised that they should feed their babies at least 8-10 times in 24 hours and importantly they should not skip any night feeds.

23. SKIN CARE AND BABY BATH Skin should be cleaned off blood, mucus and meconium by gentle wiping before he or she is presented to the mother Baby bath can be given at the hospital or home by using warm water in a warm room gently and quickly. First bath- Once baby’s temperature has stabilized, first bath can be given Do not bath the baby before 24 hours of age. Wash the face ,neck and underarms of the baby daily. In case of the low birth weight babies , bathe only after the aby reaches a weight of 2000g.

24. CONT. Ensure that the room is warm and there is no draught while changing the clothes, washing and bathing. Use warm water for bathing. Thoroughly dry the baby ,dress and cover after bath. First bath- Once baby’s temperature has stabilized, first bath can be given

25. CLOTHING OF THE BABY Baby should be dressed with loose, soft and cotton clothes Large button, synthetic frock and plastic or nylon napkin should be avoided Woollen Fibre clothes should be avoided as the fibres of clothes can enter into the respiratory tract of the baby, dress the baby in one or more layer of clothing

26. GENERAL CARE

27. CARE OF THE EYES Eye care is given to protect a baby’s eyes from infection i.e ophthalmia neontarum . In areas where sexually transmitted diseases are common, eye care needed soon after delivery because infection such as gonorrhoea can passed to the baby’s during the birthing process which can result in blindness. A baby’s eyes should be wiped as soon as possible after birth and once in every day. Both eyes should be gently wiped with separate sterile swabs soaked in warm sterile water. Eye drops i.e anti-microbial/antibiotic e.g. Erythromycin (whenever indicated) or ointment should be given with in one hour of the delivery.

28. CARE OF THE UMBLICAL CORD Keep the cord clean and dry Topical application of antiseptics is usually not necessary unless the baby is living in a highly contaminated area

29. IMMUNIZATION

30. FOLLOW UP AND ADVICE

31. SPECIAL CASES Caesarean section, instrumental delivery and breech delivery Before delivery, keep the newborn resuscitation tray ready. Delay between the time of birth and skin to skin contact and the first breastfeed may happen in each case mentioned above If a long delay between delivery and breastfeeding is expected, encourage the mother to express colostrum.

32. HIV and newborn care at birth Standard safety precautions should be followed Baby can have immediate skin to skin contact as any other mother and baby. Exclusive breast feeding is recommended and infant is provided with prophylaxis for 6 weeks. Mother’s choice and condition need to be assessed before putting baby on latch Avoid mixing feeding (breast and replacement feeding) All other care is same Give oral nevirapine for six weeks to the neonate as per national policy

33. HARMFUL TRADITIONAL PRACTICES FOR NEWBORN Use of unclean substance such as cow dung, mud on umbilical cord. Immediate bathing- It will disturb haemostasis of the baby. Application of kajal in new born eyes. Instillation of oil drops into ears and nostrils. Giving brandy and opium to neonates.

34. Use of readymade expensive formula feeds. Giving cow’s milk to baby below 6 months- Cow’s milk is heavily loaded with protein and minerals which is hard to digest by newborn. Dabbing a lot of powder- It can lead to cancer as talcum powder contain some carcinogens such as magnesium, silicon, asbestos etc. Giving vigorous massage to the baby.

35. ROLE OF NURSE IN NEWBORN CARE Nursing infants is very different from nursing adults. Infants cannot communicate verbally when in pain, their bodies respond differently to medications and treatments and they must be protected from potential dangers neonatal nurse must educate and support the infant’s parents, who may be stressed or frightened A neonatal nurse should have excellent interpersonal skills, with the ability to establish rapport and provide compassion and empathy to parents. She must also understand and be vigilant to prevent harm from risks that specifically affect newborn, such as temperature changes or excess oxygen.

36. Basic skills should be there such as management of intravenous lines, cardiopulmonary resuscitation and the use of specialized equipment such as ventilators and incubators. Counsel and educate the mother and family - Ensure that the family understands importance of administering prescribed medicines Build confidence of the family in taking care of baby at home Educate mother for follow up after discharge and for immunization of baby. Educate mother when to report early if there is worsening of conditions at any time after discharge

37. CONCLUSION