NEONATAL CARE

Neonatal Care Program: It comprises normal neonatal reference values, a mortality prevalence chart, and various care programs (Early Intervention, NIDCAP, SPEEDI, MITP, COPCA, EI SMART, SENSE Program, Oro motor Rehabilitation).

1. NEONATAL CARE PROGRAM

2. INTRODUCTION Neonates- born under 28 th day of life i.e initial 4weeks of life irrespective of born prematurely or full term. Infants- aged >28days to 12months. Pre terms- born before a gestational age of 37 completed weeks (259 days) T erm-   born  at a gestational age of 37 to 42 completed weeks (259 to 293 completed days). Post terms- born any time after the beginning of the forty-two weeks (288 days) of gestation. High-risk infants- one who requires more than the standard monitoring and care offered to a healthy term newborn infant who has been exposed to any one of a number of medical factors that may contribute to later developmental delay.

3. Initial steps: Drying Stimulation and Clear airway Cord and Eye Care Warming Positioning Assess Vaccine Feeding

4. Positioning: A comfortable and soft nest, with secure and deep boundaries should be sufficiently high, secure, and in contact with the infant to provide support and secure containment (Sundance fluidized positioners is a are 3-dimensional, contour for best alignment, reduces damaging force on skin, and adapt to medical equipment).

5. NORMAL VALUES

6. Normal Neonatal Ranges HR Awake Sleeping Newborn to 3months 85-205 80-160 3months to 2yrs 100-190 75-160 2yrs to 10 yrs 60-140 60-90 > 10yrs 60-100 50-90

7. SPO2 (Targeted) Time 60 to 65% 1min 65 to 70% 2min 70 to 75% 3min 75 to 80% 4min 80 to 85% 5min 85 to 95% 10min Site Temperature Oral (skin temp 0.4 C lower than oral) 95.9 to 99.5 F Ear 96.4 to 100.4 F Axilla 97.8 to 99.5 F Rectum (oral is 0.4 C lower than rectal) 97.9 to 100 F

8. Description Weight Extremely low (ELBW) <1000gm Very low (VLBW) 1001 to 1500gm Moderately low (MLBW) 1501 to 2500gm Normal 2500 to 3900gm Overweight > 4500gm

9. Average Length – 44 to 55 cm Occipital-Frontal Circumference – 33 to 36cm Chest circumference should be 1–2 cm less than the head circumference Mid-arm circumference – 9 to 11cm Upper segment (vertex to pubis symphysis) / Lower segment (PS to heel) = 1.7 /1.0 (at birth) Once milk is feed is started – dark green to brownish meconium seen in initial 5days Urine output should be 100 to 120 ml/kg/day in first 7 days ( or > 1ml/ hr ) Age Weight gain (gm/day) Stature gain (cm/month) Head growth (cm/month) 0 to 3months 30 3 to 5 2.0

10. Age CSF Values Newborns 8 to 11cm H2O pH Pao 2 (mmHg) Paco 2 (mmHg) HCO 3- ( mEq /L) Cord blood 7.28 ± 0.05 18.0 ± 6.2 49.2 ± 8.4 14-22 Newborn (birth) 7.11 ± 7.36 8-24 27-40 13-22 5-10 min 7.09 ± 7.30 33-75 27-40 13-22 30 min 7.21 ± 7.38 31-85 27-40 13-22 60 min 7.26 ± 7.49 55-80 27-40 13-22 1 day 7.29 ± 7.45 54-95 27-40 13-22 Child/adult 7.35 ± 7.45 83-108 32-48 20-28

11. Neonatal Physical Maturity Lanugo – Fine downy hair on body. Vernix caseosa – white coating Telangiectatic nevi (stork bites), Port wine stains, White spots(milia), Ecchymoses & Petechiae Fontanelles – moulding and caput succedaneum should resolve quickly, fontanelles and sutures are palpable Limbs – positional talipes and planter creases Genitals – male/female and appearance (in males descending of testes) Peripheral cyanosis – due to reduced peripheral perfusion (should resolve within 24 to 48hrs)

12. Expanded Apgar Score Form

13. Neonatal Neuromuscular Maturity HAMMERSMITH NEONATAL NEUROLOGICAL EXAMINATION ( HNNE ) HAMMERSMITH NEONATAL NEUROLOGICAL EXAMINATION ( short version )

14. Neonatal Mortality Prevalence

15. NEONATAL CARE PROGRAMMES

16. EARLY INTERVENTION PROGRAMME Early intervention aims ‘to promote child health and well-being, enhance abilities, minimize developmental delays, remediate existing or emerging disabilities, prevent functional deterioration, and promote adaptive parenting and overall family function’. An early intervention program for high-risk infants typically begins within the first year of life. The se strategies are educational and neuroprotective which seek to take advantage of cerebral plasticity as 0-2 years of age is Sensory-motor period. Early intervention addresses children: 1. age of 0-3yrs, 2. who are at risk for developmental delays, 3. ones with established developmental delays, 4. disabilities at all degrees of severity and functional levels. PreEMPT (Preterm Infant Early Intervention for Movement and Participation Trial is adopted on Early Intervention.

17. Mother Infants Transaction Program (MITP) The aims of the intervention are as follows: l. To enable the mother to appreciate her infant's unique characteristics, temperament, and developmental potential. 2. To sensitize the mother to the infant's cues, particularly those that signal stimulus overload or exhaustion and those that indicate when the infant is in a state most conducive to interaction. 3. To teach the mother to respond appropriately, and in a timely fashion, to infant cues indicating overload, distress, exhaustion, or readiness for interaction. 4. To enable the mother to imbed her sensitivity and contingent responsiveness in the tasks of cleaning, bathing, feeding and soothing the infant. 5. To enhance the mother's of her baby.

18. Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Originated in 1984 by Heidelise Als. It is a comprehensive, family centered, evidence-based approach to newborn developmental care. The NIDCAP is a complex intervention that contains several interacting components. It requires health care team and parents for support, along with different organizational levels within the hospital. NIDCAP is an evidence-based, comprehensive, internationally recognized program that improves outcomes for premature infants. Film is to be made during the first week of life, at least one film between 8–30 days and at least one film between 31–60 days. Each film should last for 20 min and include three sequences each lasting 6–7 min, clearly identified by three inlays with words “before care,” “during care” and “after care. Observation is guided by a behavioral checklist to record on NIDCAP Observation Sheet .

19. COPING WITH AND CARING FOR INFANTS WITH SPECIAL NEEDS (COPCA) Developed by Tineke Dirks and Mijna Hadders-Algra (2011) Comprises of 2 components: family involvement and neurodevelopmental education. This component aims to increase the size of the motor repertoire (variation) and to enhance adaptability in an active learning process with trial and error experiences. The infant with atypical motor development needs ample opportunities for self produced motor behaviour, variation, and trial-and-error experiences to improve his/ her development. Delivered in the family’s home environment.

20. EI SMART (Early Intervention: Sensorimotor development, Attention and regulation, Relationships, and Therapist support ) APPROACH It is a clinical reasoning framework, derived from clinical expertise in along with parents and supported by current evidence. The core components of EI SMART are: Supporting a consistent and responsive parent-infant relationship Challenging the infant with a wide variety of self-produced motor activities in a variety of conditions Scaffolding the infant’s next developmental steps (is a practice where guidance is removed gradually to allow the child to learn to become competent) Minimizing infant stress Supporting the infant’s self-regulation Promoting parental well-being

21. Sensory Experiences (SENSE) Program The SENSE program included parent education materials along with the specific amounts of auditory, tactile, vestibular, /kinesthetic, olfactory, and visual exposures to be conducted daily through hospitalization. The sensory exposures are intended to be implemented by parents. The education materials stressed the important role for the parents at the center of care delivery. Types and doses of each positive sensory exposure change based on the infant's level of immaturity. Modified Sensory Experiences (SENSE) program is published in 2021.

22. Supporting Play, Exploration and Early Development Intervention (SPEEDI) E xperimental developmental intervention for infants born preterm combining early and intense intervention with family support to engage parents in their child's development from the neonatal unit to home to improve developmental outcomes. It includes both hospital and home-based parent support with a physical therapist, at a high dosage and focuses on early motor, cognitive and parent-child interaction

23. Premature Infant Oral Motor Intervention (PIOMI) Provides assisted movement to activate muscle contraction Focueses to increase functional response to pressure and movement. Cheeks, lips, tongue and palate are targeted.

24. Kangaroo Mother Care It is a method of care for preterm infants. Aims to improve bonding by skin-to-skin contact, Enhance breast milk production, early discharge, weight gain, induce hyperthermia, and induce relaxation in mothers. Newborn is secured to the chest by a binder or strapping.

25. Family Integrated Care ( FICare ) In the NICU, infants are physically separated from parents; this has an impact on physical, psychological and emotional health of both. This approach is to plan and deliver health care the encourages greater parent involvement. This approach is different than the Family Centered Care Approach(FCCA) as parents are educated and made an integral part of care team. While FCCA is delivered by the parents. The four main pillars of FICare is: 1. staff education and support 2. Parent education, 3. NICU Environment, 4. Psychological support

26. PremieStart It is an adaptation of the Mother Infant Transaction Programme , which focus on increasing maternal sensitivity to infant behavioural cues. It is a maternal–premature infant interaction program, within a neonatal unit which enhances maternal–infant synchrony and developing communication skills up to 6 months corrected age. Its is 9 session training program held with mother while newborn is still in the hospital.

27. Stockholm Preterm Interaction Based Intervention (SPIBI) It is an early interventions directed towards extremely preterm children (EPT) and their parents, based on home visits during the child’s first year. Aims to examine the effects of Stockholm Preterm Interaction-Based Intervention (SPIBI) in three domains: 1. Parent-child Interaction 2. Child Development 3. Parental Mental Health.

28. Bucket Aqua Therapy Baby-sized “ ofuro ” bucket (40.3 x 36.0 × 34.6 cm, 18 L, Sanremo ®). Before starting the intervention, bucket asepsis was performed with a neutral soap, 70% alcohol, and sterile gauze pads, according to hospital protocol. The researcher filled the bucket with warm water. Thermo-hygrometer maintaining range of 36.6 to 37.5°C

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