ETATA 15. Neonatal Care 2020.pdfkhhfdxvh

ETAT SIERRA LEONE

1. Neonatal Care
ETAT+ Sierra Leone 2020

2. Learning Objectives
At the end of the session you will be able to:
Apply the principles of neonatal care
Assess and treat neonates with presumed severe
bacterial infection in neonates (PSBI)
Assess and treat neonates with Hypoxic
Ischaemic Encephalopathy (HIE)
Care for the premature and low birth-weight
neonates

3. Principles of Neonatal Care

4. Essential care for all newborn babies after birth
Hygiene
Warmth
Inclusion of mother as partner in care
Provision of appropriate nutrition – promotion of
exclusive breast feeding
Vitamin K, eye care and cord care

5. Maintaining hygiene and warmth at delivery
Hygiene
1.Hand hygiene – health
workers and carers
2.Clean environment and
instruments
3.Clean cloth to wrap baby and
mother
4.Exclusive breastfeeding
5.Cord care
6.Eye care


Warmth
1.Warm environment
2.Immediate drying at birth
3.Skin-to-skin contact
4.Breastfeeding
5.Appropriate clothing and
bedding
6.Mother and baby roomed in
together
7.Training and awareness on
unnecessary exposure

6. Vitamin K
All newborns are vitamin K
deficient
Haemorrhagic disease of the
newborn can result in severe
morbidity and mortality
Vitamin K IM given at birth is
preventative in neonates
1mg IM if term
0.4mg/kg (max 1mg) IM if preterm

7. Eye and cord care
Eye care
Clean eyes immediately after birth from medial to lateral
side with swab soaked in sterile water (separate swabs for
each eye)
Give tetracycline eye ointment (TEO) within 1 hour of birth
to both eyes
Cord care
Clamp & cut cord after at least 1 minute (unless
emergency)
Keep the cord clean and dry
Apply 4% chlorhexidine to the cord daily

8. Feeding and fluids

9. Breastfeeding
Should be initiated early, within 1 hour of birth
Should be on demand
Positioning and attachment are important and
the mother may need support with this

Infants should be exclusively breastfed for the
first 6 months of life
The best nutrition
Protection from illness

10. Neonatal Feeding Recommendations
When to use NG feeds
•Unable to suck/swallow
•Mild-moderate respiratory
distress
When to use IV fluids
•Preterm
•Low birth weight (<1.5kg)
•Not feeding
•Convulsions/coma
•Severe respiratory
distress
•Abdominal problems
•Infection
•Distension
•Green vomiting

11. Presumed Severe Bacterial
Infection in Neonates

12. Presumed Severe Bacterial Infection in
Neonates (PSBI)
Severe bacterial infection in a baby up to 28 days
of life
Infection can be acquired before, during and after
delivery
Can include meningitis, pneumonia, urinary tract
infection, umbilical infection or skin infection
We need to:
recognise the signs early
start antibiotics promptly

13. PSBI signs
Systemic signs
Temperature < 35.5 or > 38
Respiratory rate >60 bpm
Respiratory distress
Grunting
Apnoeas
Low SpO2
High or low pulse/shock
Central cyanosis
Lethargy (AVPU = P or U)
Poor feeding
Convulsions
Mottled skin


Localised signs
Pus from the umbilical cord
Periumbilical flare (redness)
Bulging fontanelle
Distended abdomen

14. Antibiotic treatment
Ampicillin and gentamicin are first line therapy
for neonatal sepsis and neonatal meningitis
If there is no improvement at 48 hours you can
change to ceftriaxone
Sepsis needs 7 days of IV treatment – babies will
often look better after 2-3 days but the course
must be completed

15. AMPICILLIN
< 7 days 50 mg/kg BD
7-28 days 50 mg/kg TDS
>28 days 50 mg/kg QID

16. GENTAMICIN
Babies <2kg <7 days 3 mg/kg OD
Babies ≥2kg <7 days 5 mg/kg OD
Age > 7 days 7.5 mg/kg OD
CEFTRIAXONE
1-28 days 100 mg/kg OD

17. Hypoxic Ischaemic Encephalopathy

18. Hypoxic Ischaemic Encephalopathy (HIE)
HIE is lack of oxygen to organs before/during/
immediately after birth
Consider if there is a history of:
Prolonged/difficult labour
Antepartum haemorrhage
Required resuscitation at birth
Low APGAR score (<6)
Lethargic/floppy/restless/convulsing/unable to feed
Affects all organs of the body
Effects on the brain are often the most obvious

19. APGAR Scoring System

20. HIE
Requires good supportive care
Treat respiratory distress with oxygen
Treat hypoglycaemia
Treat convulsions
Give antibiotics as there is often risk of infection
Withhold feeds for first 24h and give IV fluids
Support feeding with NG tube when necessary

21. Convulsions
Main causes:
Hypoglycaemia
Hypoxic ischaemic encephalopathy
Meningitis/encephalitis

Convulsions can be subtle in the neonate
Look for repetitive, mechanical movements of
limbs/mouth/eyes
Be vigilant and start treatment early

22. Treatment
ABC
Check for hypoglycaemia
Treat with 2ml/kg D10%
Anticonvulsants
Phenobarbitone 20 mg/kg IM/IV/NG loading
Give maintenance 5 mg/kg daily (stop 3 days after last
convulsion)

23. Care of Premature and Low Birth-
Weight Neonates

24. Prematurity & low birth weight neonate
Warmth and hygiene are key
Treat respiratory distress promptly
Avoid hypoglycaemia
Early feeding/prompt starting of IV fluids
Feed frequently (every 2-3 hours)
NG or IV fluids if unable to feed
Treat for sepsis if suspected (a common
cause of preterm labour)

25. Kangaroo mother care
Skin-to-skin contact - the more the better, aim
for 20 h/day
Indications
Stable preterm
Low birth weight (<2kg)
Benefits
Prevents hypothermia
Improves milk production & breastfeeding
Reduces infection
Reduces stress and encourages bonding
Reduces apnoea in preterm babies
Increases confidence of mother
Better prognosis

26. Questions?

27. Summary
Essential care for all newborn babies after birth:
Hygiene, warmth, nutrition, vitamin K
Breast feed <1 hour
Low threshold to suspect & treat neonatal sepsis
HIE requires good supportive care
Convulsions can be difficult to detect
Check for & treat hypoglycaemia
Treat with phenobarbitone
Kangaroo mother care if stable preterm or low
birth weight

28. Thank you so much for
your attention!