immediate new born care

nursing

1. MITTAL COLLEGE OF NURSING PRESENTATION ON IMMEDIATE AND ESSENTIAL CARE OF NEW BORN BABY SUBJECT :- OBSTETRIC $ GYNECOLOGY SUBMITTED TO, SUBMITTED BY MRS SNEHLATA PARASHAR Miss KHUSHBU RAWAT M.SC   LECTURER B.Sc Nursing (OBG $ GYN) IVth Year SUBMITTETED DATE :- 27/03/2019

2. SPECIFIC OBJECTIVE :- At end at the class presentation, students will able to :- To explain the introduction and definition of new born. To discuss the characteristic and reflexes of new born. To discuss the immediate care of new born. To discussion the immunization. Assessment of gestational age. To discuss the essential and daily routine care. Explain about the follow up care and general observation of new born. To explain the grade of neonatal care.

3. NEW BORN BABY Introduction ;- The healthy new born infant born at term , between 38-42 weeks ,cries immediately after birth , establishes independent rhythmic respiration , quickly adapts with extra uterine environment .

4. Definition ;- New born refers to an infant in the birth 28 days after birth , a new born is an infant with in hours , days or up to a few weeks from birth.

5. Characteristics of new born - 1.General measurement – weight= length= apgar score=

6. 2. Head measurement- Shape – round symmetrical , may have moulding and over riding suture. Head circumferance-33-35cm Fontanel in size ,shape- Anterior- Posterior-

7. 3.Eyes- Colour - blue white sclera Movement - random Reaction to light - pupils equal in size ,round and reaction to light. Tears - absent or occasionally Eyelids - Oedema present

8. 4.Ears- Reaction to noise – startle reflex to loud noise Position – symmetrical Patency – evidence of hearing

9. 5.NOSE= 1.Mucus - clear 2.patency - Infant are obligatory nose breathers. 6.MOUTH= Sucking and swallowing reflex present

10. 7.CHEST= 1.breast tissue – Nipple prominent 2.shape – almost circular and barrel shaped. 3. size – 30-35cm[12-13inches].

11. 8.Respiration - 1. Rate – 30-60 min 2. Rhythm – shallow ,irregular 3. muscular activity - diaphragmatic and abdominal 9.PULSE - 1. Rate - 120-160 min 2.Rhythm – irregular after crying

12. 10.ABDOMEN - Rounded ,protruded , bowel sound audible after 1-2 hours after birth. 11.UMBLICUS – 1.Apperance – clear ,gelatin,odorless 2.Number vessels at birth-

13. 12.ARMS - 1.movement – spontaneous. 2.Muscle tone – Flexed 3.fist – often clenched

14. 13.GENITO –URINARY - Female genitals – usually oedematous Male genitals – testes palpable each side Voiding – start by 24 hrs. after delivery ,3-4 times/day . 14.RECTUM – Number of stool – meconium by 24 hrs.

15. 15.HIPS - Symmetrical , glateal folds even . 16 . SKIN – Colour – generally pink Birth mark – may be present Lenguo – present over shoulder , pinnas ,forehead Vernix caseosa – white , cheesy odorless , present in creases and folds .

16. CONT..... Hair – amount varies 17. TEMPRATURE – Normal – Heat loss – by conduction ,radiation and evaporation

17. 18.REFLEXES - DOLL ‘S EYE – present Rooting - present Sucking /swallowing – present Gag reflex – present Grasp - present Babinski – present Moro – present Tonic neck reflex – present

18. 19.CRY - 1.Frequancy – variable 2.pitch – moderate , pitch may be strong . 20. BEHAVIOUR – Responding to handling

19. . Reacts to environment . Eating ,sleeping pattern varies in interest 21.EXTERMITIES – 1.polydactyly 2.syndactyly 3.talipes equinovarus

20. 22.BACK - Check abnormal spinal curvature Spina bifida occulta ,meningocele ,meningomyelocele. 23.BUTTUCKS - Observed for any mass . Perianal area examined – anal opening ,anal fissures or any other abnormalities.

21. 24.PATTERN OF ELIMINATION - The neonate passes urine and meconium within 24 hrs. Afterwards for first few days baby voids 10-15 times and average six stool per day .

22. ASSESSMENT OF REFLEXES = 1. Reflexes' of EYE – 1.blinking – infant blink at sudden appearance of bright light or any object towards eye . At birth .

23. 2.Pupillary reaction - Pupil constrict when bright light falls on it

24. 3.DOLL’S EYE - At head is moved to right or left ,slowly . Disappearance – 3-4 month .

25. REFLEXES OF NOSE - 1.Sneeze – spontaneous response of nasal passage to any irritant .

26. 2.Globellar - Repetitive tapping on the forehead , cause eye to close tightly . At birth

27. REFLEXE’S OF MOUTH - 1. Rooting – Disappearance - 3-4 month

28. 2.SUCKING 3.GAG

29. 4.EXTRUSION 5.COUGH

30. REFLEX OF EXTERMITIES - 1.GRASP – Disappearance – 3 month 2. BABINSKI – Disappearance - 1 yr.

31. BABINSKI -

32. MASS REFLEX’S - 1. MORO’S - Disappearance – 3-4 month 2. TONIC NECK – Disappearance - 3-4 month

33. MORO TONIC NECK

34. CONT... 3.CRAWL REFLEX Disappearance – 4 weeks 4.DANCE / STEPPING – Disappearance – 3-4 weeks .

35. CONT...

36. 5.GALANT [ TRUNK INCURVATION ]

37. IMMEDIATE CARE OF NEW BORN INTRODUCTION – Essential care of the normal healthy neonates can be provided by the mothers under supervision of nursing personnel or basic /primary health care providers . About 80percent of the newborn babies should be kept with their mothers rather than in separate nursery .

38. IMMEDIATE BASIC CARE Maintenance of temperature . Establishment of open airway and circulation . Identification of new born . Vitamin k injection . Initiation of breast feeding .

39. MAINTENANCE OF TEMPERATURE - Immediately dry the infant under a radiant warmer . Skin to skin contact with mother . Keep neonate head and extremities covered . Rooming in [the baby should not be separated from mother ]. Bathing is avoided to prevent hypothermia and infection . Temperature should be recorded and observation . Avoided to unnecessary exposure and undressing baby.

40. ESTABLISHMENT OF OPEN AIRWAY- [majority of babies cry at birth and take spontaneous respiration ] When the head is delivered birth attendant immediately suction the secretions ,wipe mucus from face and mouth and nose .

41. CONT.... Suction the mouth and nose by using bulb syringe . Keep head slightly lower than the body . Position the baby on their backs or tilted to the side ,but not on their stomachs .

42. Importance of suctioning ; As the foetal chest passes through the birth canal it is compressed ,squeezing excess fluid out of the baby taking its first breath. After several seconds in this ‘’partly delivered ‘’ position ,fluid can be seen streaming out of the baby’s nose and mouth .

43. NEONATAL RESUSCITATION - Series of action ,used to assist newborn babies who have difficulty with making the physiological ‘transition ‘ from the intrauterine to extra uterine life . Neonatal resuscitation is a set of intervention used to assist the airway, breathing ,and circulation of a following birth.

44. CONT... It means a to support a maintain breathing ,circulation ,for an neonate .who has stop breathing or whose heart stop .

45. Initial steps of resuscitation - Receiving the newborn baby in a prewarmed towel and placing the baby on the preheated radiant warmer . AIRWAY- Positioning the baby on the back with the neck slightly extended .[sniffing position]

46. SNIFFING POSITION

47. CONT... Providing tactile stimulation – [rubbing the infant back , slapping the sole of the foot , flicking the heel ]. BREATHING – 1.Bag mask ventilation 2.Mouth to mouth 3.Mouth to mask

48. CHEST COMPRESSION - Techniques – 1.two finger method. 2. two thumb encircling hand . RATIO – 15;2 =2 RESCUE 30;2 = 1 RESCUE

49. APGAR SCORING - A – Activity /muscle tone P- Pulse / heart rate G- Grimace /reflex response A- Appearance /skin colour R- Respiration

50. A- ACTIVITY 0 points – flaccid /floppy limp 1 points – some flexion of extremities 2 point – active body movement P - Pulse rate 0 points –absent 1 points – below [100 beats /min.] 2 points –more than [100 beats /min.]

51. G- GRIMACE 0 points –no response 1 points –facial movement /grimace with stimulation 2 points – cry A- APPEARANCE 0 points –blue ,pale ,bluish -gray 1 points –body pink ,but extremities blue 2 points – complete pink

52. R- RESPIRATION 0 points –absent 1 points –irregular ,slow cry 2 points –good , strong cry TOTAL SCORE = 10 no depression – 7-10 Mild depression – 4-6 Severe depression – 0-3

53. CONT..... Apgar score quick test performed on a baby at 1 -5 min. After birth . The 1 min . Score determine how well the baby tolerate the birthing process . The 5 min . Score tells the health care provider how well the baby is doing outside’s the mother womb . In rare case ,the test will be done 10 min . After birth

54. NEW BORN IDENTIFICATION - New born identification before a baby leaves the delivery area , identification bracelets with identical numbers are placed on the baby and mother . Babies often have two ,on the wrist and ankle.

55. VITAMIN – K Vit.k prevent neonatal haemorrhage during first few days of life before infant is able to produce vit.k administration . Term infant [ 1mg ] –IM Preterm infant [ 0.5 mg ] – IM

56. ALTERNATIVE ROUTE - ORAL DOSE - 2 mg orally at birth REPEAT DOSE – [ 2 mg ] at 3-5 days and at 4-6 weeks of age .

57. INITIATION OF BREAST FEEDING - Babies can be breast – feed as soon as the airway is cleared and they are breathing normally . Breast feeding is the most effective way to provide baby with a caring environment and complete nutrition . The first breast feeding should be with in 30 min. Of normal delivery and 4 hrs.in lscs .

58. CONT... Breast milk and colostrums prevent neonate from anaemia and many nutritional deficiency disease . Breast milk contains high lactose , low protein , enhance growth of lactobacillus which inhibit growth of E.Coli . Breast milk reducing the risk of breast and uterine cancer in mother .

59. ASSESSMENT OF GESTATIONAL AGE AT BIRTH INTRODUCTION – Assessment of gestational age is mandatory for all neonates for further management . Last menstrual period is important clue for calculation of gestational age . Using a new Ballard scale ,can be use with neonate born between 20-44 week gestational.

60. NEW BALLARD SCORE - The Ballard scale is a commonly used technique of gestational age assessment . These criteria are divided into two type physical and neuromuscular maturity . The new Ballard score is a set of procedures developed by Dr. JEANNE L BALLARD .

61. COMPARISON - OLD NEW Score ranged from 5 – 50 26 -44 wks. Score starts with Inaccurate in extremely preterm -10 to 50 20 -44 wks. Starts with - 1 More accurate

62. cont... Optimal age for maturational assessment ; between 30 and 42 hrs. Of age . Eyes ; not included Birth to 96 hrs. Included

63. NEURO MUSCULAR MATURITY - 1.POSTURE ; As maturation progresses – increasing passive flexor tone. Increasing passive flexor tone – centripetal direction . Lower extremities slightly ahead of upper extremities .

64. POSTURE -