Navjath shishu suraksha karyakram (nssk)

An overview of the components of NSSK

1. Dr Manu M Jr consultant Paediatrics General Hospital Muvattupuzha Navjath shishu Suraksha karyakram (nssk)

2. Resuscitation of the newborn baby Assess a newborn baby at birth Perform resuscitation of a newborn baby using standard equipment if needed Provide aftercare if a baby requires help with its breathing at the time of birth

3. One million deaths worldwide due to asphyxia 1/3 in India. Need of resuscitation should be anticipated Adequate ventilation is more important than additional Oxygen

4. Failed resuscitation: Did not recognize the problem promptly Did not react quickly enough Ineffective ventilation

5. Need for resuscitation

6. KEYS TO SUCCESSFUL RESUSCITATION

7. PREPARATION FOR BIRTH Prepare personnel Identifies helper, explains roles Describes an emergency plan

8. Preparation of Delivery room

9. Test the function of equipments Radiant warmer Bag and mask

10. Assessment at birth Deliver the baby on mother’s abdomen Note the time of birth Dry the baby

11. If meconium present: IMMEDIATELY start suction First the MOUTH , then the NOSE Depth: <5cm in mouth <2cm in nose

12. Assess Breathing While drying

13. Steps of resuscitation Provide warmth Position: Open the airway

14. Steps of resuscitation contd.. Suction (Mouth, then Nose) Stimulate Reposition Reassess

15. STILL NOT BREATHING: VENTILLATE!! Selection of appropriate size mask

16. Clear airway Position the baby’s head Position the bag and mask on face

17. Initiate Ventillation First few breaths may require higher pressures and longer inflation times Just enough to produce a gentle chest rise How often? 40-60 per minute

18. Ensure chest rise Steps to improve ventilation Reapply the mask for a better seal Check position, extend neck a bit more Check for secretions, clear if needed Try ventilating with mouth slightly open Increase the pressure on the bag

19. STILL NOT BREATHING WELL.. Call for help Continue Ventilation Provide oxygen, if available Assess Heart rate >100/min: normal <100/min: slow

20. veni , vidi , vici

21. veni , vidi , vici ( i came, i saw, i conquered)

22. veni , venti , vici

23. veni , venti , vici ( i came, i ventilated , i conquered)

24. CARE OF THE BABY AT BIRTH

25. Basic needs of a baby Warmth Normal Breathing Mother’s milk Protection from infection

26. Ensuring warmth: “WARM CHAIN”

27. Initiate breastfeeding

28. Prevention of Infections: “Clean Chain”

29. Immediate cord and eye care

30. Monitoring the baby

31. PREVENTION OF INFECTION In neonates, Prevention of infection is more cost effective than treating infection

32. Basic requirements for asepsis Running water supply Soap Elbow or foot operated taps Strict hand washing Avoid overcrowding, optimal number of health providers for care of more babies Plenty of disposals Strict adherence to good housekeeping and asepsis routines

33. Before entry into baby care area Remove shoes, socks, woolens , watch, bangles, and rings. Roll up the full sleeves up to elbow. Put on new slippers. Wash hands with soap and water for 2 minutes (follow six steps of hand washing). Put on sterile half sleeve gown. Personnel with active infection should not be allowed entry into the baby care area.

34. HAND WASHING MOST IMPORTANT means of preventing nosocomial infections VERY SIMPLE CHEAP

35. Steps of hand washing 1. Palms and fingers and web spaces 2. Back of hands 3. Fingers and knuckles 4. Thumbs 5. Finger tips 6. Wrists and forearm upto elbow 2 MINUTES hand washing (6 steps) to be done before entering the unit. 20 seconds hand washing to be done before and after touching babies. Rinsing hands with alcohol is NOT A SUBSTITUTE for proper hand washing

36. Thermal protection Why newborns? Larger surface area Decreased thermal insulation due to lack of subcutaneous fat Reduced amount of brown fat

37. Consequences of hypothermia Energy spent to maintain temperature Less activity Poor feeding Respiratory distress Poor weight gain Hypoglycaemia (especially in preterm)

38. Mechanisms of heat loss

39. Normal temperature of a newborn 36.5 o C to 37.4 o C Use a low reading thermometer (30-40 o C) Temperature is taken in the axilla Do NOT add anything to the reading

40. 5

41. WARM CHAIN A set of interlinked procedures carried out at birth and later which will minimize the likelihood of hypothermia in all newborns.

42. Common situations where cold stress can occur At birth After giving bath During changing of nappy/clothes Malfunctioning heat source or removing the baby from heat source While transporting a sick baby

43. Steps to prevent heat loss in labour room Warm delivery room (25°C) Newborn care corner temperature to be maintained at 30°C Drying immediately. Dry with one towel. Remove the wet towel and cover with another pre-warmed towel Skin-to-skin contact between mother and baby

44. Steps to prevent heat loss in postnatal ward Breastfeeding Appropriate clothing, cover head and extremities Keep mother and baby together Keep room warm Postpone bathing and weighing

45. Wrapping a baby

46. KANGAROO MOTHER CARE

47. Promotes Effective thermal control Breastfeeding Infection prevention Mother-baby bonding

48. Components: Skin-to-skin contact Exclusive breastfeeding Prerequisites: Support to mother in hospital and home Post discharge follow up

49. Benefits Temperature maintenance; reduced risk of hypothermia Increased breastfeeding rates Early discharge from the health facility Less morbidities such as apnea and infections Less stress (for both baby and mother) Better infant bonding

50. KMC positioning Baby should be placed between the mother's breasts in an upright position. Head should be turned to one side and in a slightly extended position. Hips should be flexed and abducted in a "frog" position; the arms should also be flexed. Baby's abdomen should be at the level of the mother's epigastrium. Support the baby’s bottom with a sling/binder.

51. Duration of KMC Minimum One hour KANGAROO FATHER CARE!!

52. FEEDING OF NEWBORNS Exclusive breastfeeding for 6 months Decreased risk of Diarrhoea Pneumonia Ear infections Death

53. Four key points on POSITION the baby’s head and body should be straight; the baby’s face should face mother’s breast; the baby’s body should be close to her body; she should support the baby’s whole body

54. Signs of GOOD ATTACHMENT More areola visible above the baby’s lips than below it Baby’s mouth is wide open Baby’s lower lip is turned outwards Baby’s chin is touching the breast

55. HOW FREQUENTLY? ON DEMAND Usual interval: 2-3 hours 8-10 feeds per day

56. Breastfeeding is adequate if: Passes urine 6-8 times in 24 hours Sleeps for 2-3 hours after each feeds Weight gain @10-15 gms /day Crosses birth weight by 2 weeks of age.

57. THANK YOU Dr MANU M 9605033674 www.amrithkiranam.in www.facebook.com/infoclinicindia