Resuscitation and immediate care of newborn

newborn baby care

1. RESUSCITATION AND IMMEDIATE CARE OF NEWBORN BABY Submitted by NEETHU P 1 ST YEAR MSc NURSING

2. DEFINITION A healthy newborn infant born at term (between 38 to 42 weeks) should have average birth weight for the country(usually exceeds 2500gm), cries immediately following birth, establishes independent rhythmic respiration and quickly adapts to the changed environment. “The period from birth to 28 days of life is called neonatal period and infant in this period is termed as neonate or newborn baby.” The first week of life is known as early neonatal period and the late neonatal period extends from 7th day to 28 days of age. Care given to new orn during neonatal period is known as newborn care.

3. OBJECTIVES OF IMMEDIATE CARE OF NEWBORN Gentleness and prevention of infection Establishment and maintenance of respiration Care of the umbilical cord Care of the eyes Stabilization of the baby’s temperature Identification of the infant Maintaining a record of observations on baby’s temperature

4. IMMEDIATE CARE OF THE NEWBORN CARE AT BIRTH Care of the baby that needs to be given at birth in the labor room. CARE IN NURSERY Care of the baby that needs to be given in nursery.

5. IMMEDIATE CARE OF THE NEWBORN (contd..) Should be placed on a tray, covered with clean dry linen, with head slightly downward(15 degree) Wipe mouth and nose of secretion after delivery of the head with clean sterile gauze pad. Position- Trendelenburg- Head lower than the body. Side Lying position- to permit drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine position. Gently suctioning with bulb syringe and short catheter from mouth first then nose to prevent aspiration of fluid into the lungs. Deliver the baby onto a warm, clean and dry towel or cloth and keep on mother's abdomen or chest (between the breasts).

6. IMMEDIATE CARE OF THE NEWBORN (contd..) Wipe both the eyes separately with sterile swab. Clamp and cut the umbilical cord after 1 minute, if baby breathing well. Immediately dry the baby with a warm clean towel or piece of cloth. Assess the baby's breathing while drying. Leave the baby between the mother's breasts to start skin-to-skin care for at least an hour. Cover the baby's head with a cap. Cover the mother and baby with a warm cloth. Place an identity label/band on the baby. Encourage mother to initiate breastfeeding (within half an hour of birth in normal delivery) & (after 2 hrs. in LSCS)

7. CLAMPING AND LIGATURE OF THE CORD The cord is clamped by two K ocher’s forceps. The near one is placed 5cms away from the umbilicus and is cut in between. Proximal one is being placed 2.5cms away from the navel. Squeezing the cord with fingers prior to applying ligature or plastic cord clamps. Cord is divided with scissors about 1cm beyond ligature. Taking aseptic precautions. Presence of any cord abnormalities to be noted. The cut end will be covered with sterile gauze piece. Delay in clamping for 2-3 minutes or till cessation of the cord pulsation . Facilitate transfer of 80 to 100ml blood to the baby. Early clamping should be done in case of Rh-incompatibility or babies born asphyxiated or one of a diabetic mother.

8. CARE IN NURSERY Admission in Nursery All healthy newborns are kept in the delivery room with their mother to promote immediate breast feeding and early bonding. Common indications for admission of the newborn in the nursery are: Prematurity Respiratory distress Poor perfusion or presence of pallor or cyanosis Malformation and need for O2 therapy.

9. CARE IN NURSERY Routine Nursery Care The newborn is examined systematically, and assessment of the gestational age will be done. Infant’s weight, Fronto -Occipital Circumference(FOC) and length are recorded. According to this, the newborn will be classified as: Average for Gestational Age - AGA Small for Gestational Age – SGA Large for Gestational Age – LGA The newborn must be kept under a Neutral Thermal Condition .

10. Mechanisms of heat loss : Radiation Conduction from the infant to the surface in direct contact Convection from the infant to the surrounding area Evaporation of water from skin Consequences of Hypothermia : DIC Pulmonary hemorrhage Shock IVH Increased Mortality

11. Measures to prevent heat loss Place the baby under a preheated (36.5 degree Celsius) radient warmer (servo control) immediately following delivery Dry baby immediately after birth. Cover baby (including head) with a prewarm towel. Put baby close to the mother's breast. (Kangaroo method) Wrap the mother and baby together. Commence early breast feeding.

12. Daily observation and care Rooming in Baby bath Umbilical cord care Routine medications Eye care Immunization Screening of the newborn Asessment of vital sign Feeding Discharge and followup

13. Infant growth assessment WEIGHT Weight varies between 2.7 kg and 3.1kg mean of 2.9kg Wt loss of 7-10% in the first wk of life.wt gain begin by second wk. average daily wt gain 20-30g/day. LENGTH 50-52 CM Normally weekly length gain .8-1.0 cm for first 8-12 wks. HEAD CIRCUMFERENCE 32-37CM

14. RESUCITATION OF THE NEWBORN

15. APGAR SCORE Apgar scoring is described by Dr. Virginia Apgar. It is useful to quantitative assessment of newborn’s condition at birth especially for the respiratory, circulatory and neurological status. Five objective criteria are evaluated at 1 minute and 5 minute, after the newborn body is completely born.

16. APGAR SCORE

17. TOTAL SCORE = 10 SEVERE DEPRESSION = 0 – 2 MODERATE DEPRESSION = 3 – 4 MILD DEPRESSION = 5 – 7 NO DEPRESSION = 8 – 10

18. BABIES WITH APGAR 5 – 7 Baby may follow primary apnea Place under a radiant heater, dry the baby A pulse oximeter placed on the right hand The baby is put flat, head in midline with slight extension position Suction Stimulus to back and sole Oxygen 100% at a rate of 5L per minute by bag and mask at a pressure range of 30 – 40cm H2O CPAP if needed

19. BABY IS APENIC DESPITE TACTILE STIMULATION CENTRAL CYANOSIS OR HEART RATE < 100 BPM (APGAR 3 – 4) Baby may develop secondary apnea : call for assistance Bag and mask ventilation O2 at a rate of 5 – 8L per minute Positive pressure of 25 to 30 cm H2O may be needed for appropriate chest rise If not effective, Intratracheal intubation and IPPV is started. A rate of 40 – 60 breaths per minute should be used. Baby reassessed in next 50 – 30 second

20. BABY IS APENIC Heart Rate < 100 bpm, despite 30 sec assisted ventilation (APGAR score 0 – 2) HR > 60bpm, continue positive pressure ventilation. Increase oxygen concentration upto 100% Cardiac massage is given to maintain circulation if HR < 60bpm

21. GENERAL MEASURES WARMTH POSITIONING CLEAR AIRWAY By gentle suction SOS First the mouth then the nose Only for 2-3 sec Suction pressure < 100 mmHg Avoid deep suction

22. DELIVERY ROOM RESUSCITATION PROTOCOL

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