unit vi ASSESSMENT AND ONGOING CARE OF NORMAL NEONATES .pptx

ASSESSMENT AND ONGOING CARE OF NORMAL NEONATES
Family centered care
Respectful new born care and communication
Normal Neonate – Physiological adaptation
New born assessment – Screening for congenital anomalies
Care of new born up to 6 weeks after the childbirth (Routine care of new born)
Skin to skin contact and thermoregulation
Infection prevention
Immunization
Minor disorders of new born and its management

1. SEMESTER VI

2. OBSTETRICS AND GYNAECOLOGY NURSING UNIT VI

3. ASSESSMENT AND ONGOING CARE OF NORMAL NEONATES

4. ASSESSMENT AND ONGOING CARE OF NORMAL NEONATES Family centered care Respectful new born care and communication Normal Neonate – Physiological adaptation New born assessment – Screening for congenital anomalies Care of new born up to 6 weeks after the childbirth (Routine care of new born ) Skin to skin contact and thermoregulation Infection prevention Immunization Minor disorders of new born and its management

5. FAMILY CENTERED CARE

6. INTRODUCTION Widely recognized model for its benefit in enhancing patient satisfaction, improving health outcome Providing more supportive environment for patient and family

7. Definition Family centered care (FCC) is a healthcare approach that respect and integrates the family as essential partners in the care and decision making process for patient

8. RATIONAL FOR FAMILY CENTERED CARE Human resource constraints and overburdening of staff in health facility is managed by family/ parent active participation in patient care involvement of parents leads to sharing of work and better delivery of care and staff satisfaction, although health care provider continue to be in charge

9. Involvement in the care of babies, helps the family/ parents are able to cope with stress, fear and altered parenting roles. especially in high risk conditions such as preterm, low birth weight and other complication

10. Empowerment with knowledge and skill about the babies during the period of stay in the health care facility that makes the parents are able to assume full responsibility for their babies care in the absence of health provider

11. The quality of long term care provided by parents/ family make difference not only to the survival but to the overall growth and development of the baby

12. PRINCIPLES OF FAMILY CENTERED CARE Respect and dignity Information sharing Participation collaboration

13. 1) RESPECT AND DIGNITY Nurses honor the perspectives and choices of the family Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into planning and delivery of care Care plan are developed with input from the family

14. 2) INFORMATION SHARING Health care providers communicate and share complete and unbiased information with families in ways that are affirming and useful Families to receive timely accurate and comprehensive information to make informed decision

15. 3) PARTICIPATION Families are encouraged and supported to participate in care and decision making to the extent they choose Family can be involved in daily care activities, attend rounds, and partake in discussion about treatment options

16. 4) COLLABORATION Families are included as partners in the planning, implementation and evaluation of programs and policies Collaboration extends beyond individual care to involve families in advisory roles and in the development of health care services and policies

17. Benefits of family centered care 1) Improved patient outcome; reduced hospital stay length, fewer the readmissions and better management of chronic conditions Enhanced emotional support and reduced stress for patients and family 2) Increased family satisfaction; Families feel more in control and satisfied with the care provided . Stronger relations between nurses and family

18. 3) Enhanced communication; Active family involvement, clear and consistent communication reduces misunderstandings and errors and leads to adherence to treatment plans 4) Efficiency in care delivery Efficient use of health care resources due to better care coordination

19. Benefits of family centered care particularly categorized as Benefits of FCC for staff Benefits of FCC for newborn Benefits of FCC for family

20. BENEFITS OF FCC FOR STAFF Work sharing Better quality of care Increased staff satisfaction Better job performance Positive impact on stress level Better allocation of resources

21. BENEFITS OF FCC FOR NEWBORN Decreased length of hospital stay Increase breast feeding Increase weight gain decrease nosocomial infection rates Better continuum of care Fewer rehabilitation Improved long term outcome

22. BENEFITS OF FCC FOR FAMILY Better response of health, comfort level and parenting confidence More informed parents Better coping with stress, fear and altered parenting roles Greater family satisfaction with the health care experiences Enhanced bounding Easy of transition from hospital to home

23. Implementation strategies for family centered care

24. EDUCATION AND TRAINING Staff training: Educate nurses about the principle of FCC and effective communication strategies Family education : inform families about their roles and rights in the care process

25. ENVIRONMENTAL ADJUSTMENT Facility design: create spaces that accommodate family presence, such as family rooms or overnight facilities Technology: utilize tools like video conferencing to include distant family members in care discussions

26. POLICY DEVELOPMENT Visitation policies: develop flexible visitation policies that support family presence and involvement Decision making policies: implement policies that formalize family roles in decision making processes

27. CARE COORDINATION Multidisciplinary team: encourage team based approaches that include families in care planning and review Continuity of care: ensure that families are part of the transition between different care settings

28. SUPPORT SERVICES Emotional support : provide counseling and support groups for families dealing with illness or injury Practical support: offer services such as financial counseling, logistic assistance

29. Challenges in family centered care

30. CULTURAL AND INDIVIDUAL DIFFERENCES Differences in cultural backgrounds, family structures, and expectations can complicate the implementation of FCC

31. RESOURCE LIMITATION Limitation in staffs, space, or funding can restrict the ability to provide comprehensive FCC Prioritize recourses allocation and seek innovative solutions reduces the complication in sacristy of resources

32. BALANCING FAMILY AND PATIENT NEEDS Conflicting needs or opinion between the patient and family members can arise Clear communication can help resolve conflicts and align goals

33. SYSTEMIC RESISTANCE Resistance to change within health care system and among professionals impede FCC Advocate for FCC through leadership support evidence based practices, and demonstrating its benefits

34. NURSES ROLL IN FAMILY CENTERED CARE Nurses play a central role in promoting and implementing practices that prioritize the needs and preferences of both the newborn and their family members

35. Building relationships and trust Facilitating communication Promoting parental involvement Advocating for family needs Supporting continuity of care Quality improvement and advocacy

36. 1) BUILDING RELATIONSHIPS AND TRUST Establish rapport: Nurses initiate and maintain trusting relationship with families by communicating effectively, listening attentively, and demonstrating empathy Understanding family dynamics: nurses acknowledge the diversity with in families including cultural , religious, and social backgrounds, to tailor care accordingly Supporting emotional needs: nurses provide emotional support and reassurance to families during times of uncertainty or stress, fostering a sense of partnership in care decisions

37. 2) FACILITATING COMMUNICATION Information sharing: nurses ensure families are well informed about their newborns condition, treatment options and care plans using clear understandable language Encourage participation: nurses encourage families to ask questions, express concerns, and actively participate in care discussions and decision making processes Collaboration with health care team: nurses serve as advocate for families with in the health care team, ensure their voices are heard and their preferences respected

38. 3) PROMOTING PARENTAL INVOLVEMENT Encouraging bonding: nurses facilitate opportunities for parents to bond with their newborn through skin to skin contact, breast feeding support, and involvement in daily care routine Educational support: nurses provide parents with education on newborn care practices, feeding techniques, safety measures and signs of infant wellbeing and illness Empowering parents: nurses empower parents to become confident caregivers by offering guidance and resources to promote health and development of new born

39. 4) ADVOCATING FOR FAMILY NEEDS Respecting preferences: nurses advocate for family preferences in care decisions including cultural practices, spiritual beliefs and individualized care approaches Navigating health care system: nurses assist families in navigating the complexities of the health care system, including access resources, understanding insurance coverage, and arranging follow up care Addressing barriers: nurses identify and address barriers to family involvement in care, such as language barriers, financial constraints, or logistical challenges

40. 5)SUPPORTING CONTINUITY OF CARE Coordination: nurses coordinate care transition and continuity of care between health care system, ensuring a seamless transition and ongoing support for families Follow up care: nurses provide guidance follow up appointments, medication management, and monitoring of newborn health status post discharge Monitoring progress: nurses monitor the progress of the new born and family adjustment to ensure ongoing support and intervention as needed

41. 6) QUALITY IMPROVEMENT AND ADVOCACY Feedback mechanisms: nurses participate in quality improvement initiatives by gathering feedback from families, identifying areas for improvement, and implementing changes to enhance family centered care practices Policy advocacy: nurses advocate for policies and practices that support family centered care with in their health care organization and community, promoting a culture of family engagement and partnership

42. RESPECTFUL NEWBORN CARE AND COMMUNICATION

43. Respectful newborn care prioritizes the dignity, comfort, and well-being of newborns and their families through gentle handling, skin-to-skin contact, and family-centered care.

44. Respectful communication in this context involves clear, honest, and empathetic interaction with families, active listening, and collaborative decision-making to support their needs and promote a positive care experience.

45. Respectful newborn care and communication in the context of family centered care are critical for establishing a positive foundation for the newborns health and family experience Nurses play a central role in ensuring that care is provided with respect, empathy, effective communication

46. CORE ELEMENTS IN RESPECTFUL NEWBORN CARE AND COMMUNICATION Gentle handling Minimizing stressors Pain management Supporting breastfeeding and bonding Respecting individual needs

47. GENTLE HANDLING: Handling the new born with care to minimize stress and discomfort Avoid rough movement and always support head and neck

48. MINIMIZING STRESSORS : creating an environment that reduces the stress for the newborn Control the environment to reduce noise , bright light and other stressors

49. PAIN MANAGEMENT: Addressing and managing pain effectively Use appropriate pain relief methods and monitor for signs of pain Implement pain management strategies Eg : breast feeding during stressful procedure

50. SUPPORTING BREASTFEEDING AND BONDING Encouraging practices that promote breast feeding and bonding Provide support and guidance on breast feeding, encourages skin to skin contact, and facilitate bonding time

51. RESPECTING INDIVIDUAL NEEDS Recognizing and responding to the unique needs of each newborn Observe and appropriate to respond as personalized c are based on the new born pattern of feeding, sleeping, and crying Respect and follow parents preferences for care practices when safe

52. CORE ELEMENTS IN NEWBORN COMMUNICATION Clear and compassionate communication Active listening Providing reassurance Cultural sensitivity Collaborative decision making

53. CLEAR AND COMPASSIONATE COMMUNICATION Providing information in a way that is clear, empathetic and supportive Use terms that are easy to understand Provide written materials or visual aids as needed

54. ACTIVE LISTENING Listening to and addressing the concerns and questions of the family listen without interrupting and validate their feelings

55. PROVIDING REASSURANCE Offering comfort and reassurance to the family about their newborns well being Reassure parents about normal newborn behavior and offer support and guidance for any challenges their face

56. CULTURAL SENSITIVITY Respecting and integrating cultural values and practices into care Ask about and incorporate cultural preference into care practices such as dietary restriction, rituals or traditional practices

57. COLLABORATIVE DECISION MAKING Engaging the family in decisions about newborn care Involve parents in discussion about care options and respect their preferences

58. NURSES ROLE IN RESPECTFUL CARE AND COMMUNICATION Educators Advocates Support providers Coordinators observers

59. EDUCATORS Teach parents about newborn care and developmental milestones

60. ADVOCATES Advocate for the needs and preferences of the newborn and family within the health care system

61. SUPPORT PROVIDERS Offer emotional and practical support to the family

62. COORDINATORS Coordinate care among health care team and ensure a seamless experience for the family

63. OBSERVERS Monitor the newborn health and development, and the family adaptation to the new dynamics

64. PHYSIOLOGICAL ADAPTATION OF NORMAL NEONATE

65. The transition from intrauterine to extra uterine life involves a series of complex physiological adaptation in a neonate The adaptation prepare independent life outside the womb and involve significant changes in multiple body system

66. Newborn is a term used for a baby from birth till the first 28 days of life or a baby born at term (between 38 and 42 weeks), has an average birth weight 3kg (in India), has breathed and cried immediately following birth, established rhythmic respiration and adopted quickly to the extra uterine environment

67. RESPIRATORY SYSTEM

68. The organ responsible for fetal respiration is placenta During delivery of baby fetal lungs changes from fluid filled state to a system well prepared for and capable for respiration The combination of biochemical and physiological changes due to other stimuli such as cold, gravity, pain, light, noise etc. which stimulate the neonate to take first breath

69. PHYSIOLOGY OF FIRST BREATH Respiratory center is stimulated by mild hypoxia and CO2 retention. During delivery baby takes first gasp due to elastic recoil of the chest, one third of the lungs liquid gets squeezed out through the nose during vaginal birth Lung alveoli get filled with air and lung liquid is pushed to periphery of alveoli and gets absorbed to pulmonary circulation. With crying lungs expand and infants breathes twice the rate of an adult

70. CIRCULATORY CHANGES Circulatory changes begin with the clamping of the umbilical cord and the first braeth taken by the newborn Fetal circulation is alters to mature circulation due to Closure of the ductus arteriosus Closure of the foramen ovale Closure of the ductus venosus Decreased pulmonary vascular resistance Increased aortic blood pressure

71. These changes eliminate the placental supply of oxygen and forces the neonate to obtain oxygen from lungs The onset of respiration increases the arterial oxygen pressure The increased oxygen causes vasodilation of pulmonary arterioles and an abrupt decrease in pulmonary resistance

72. GASTROINTESTINAL SYSTEM After around 1 hour of the birth, bowel sounds are present. The meconium containing bile, mucus, fatty acids and epithelial cells is passed for 2-3 days . During the first few days, cardiac sphincter is weak which may lead to regurgitation. Physiological jaundice generally appears in the newborn due to fails in red cell breakdown.

73. THERMOREGULATORY SYSTEM there is immaturity of hypothalamus at birth, the neonate is inefficient to maintain the optimum temperature and is at risk of hypothermia. The baby will try to maintain thermoregulation by adopting flexed posture and by peripheral vasoconstriction.

74. The neonate is capable of producing heat through both general and brown fat metabolism.

75. The neonate lose heat from the body through Evaporation : Whenever the skin becomes wet in a relatively dry room or incubator. Radiation : When heat is transferred from the body to cooler objects in the environment. Convection : With the movement of cool air passing over the surface of the body (skin). Conduction : When heat is lost from the surface of the body to other objects in direct contact with the skin.

76. MUSCULOSKELETAL SYSTEM The bones are not completely ossified, though the muscles are complete at birth. The skull bones are also not ossified completely which is mainly for the growth of brain and for helping in the molding during labor. Two fontanelles which can be palpated at birth; namely, anterior fontanelle (closes at around 18 months of age) and posterior fontanelle (closes at around 6-8 weeks of age).

77. RENAL SYSTEM Kidney of the neonate is not adequately mature. Glomerular filtration rate (GFR) is low along with restricted tubular resorption capillaries. The urine of the baby is straw-colored, dilute and odorless, and is passed for the first time at birth, or within 24 hours of birth

78. REPRODUCTIVE SYSTEM In females both the ovaries of female, primordial follicles are present. In males, there is no spermatogenesis till puberty. After the birth, there is withdrawal of the maternal hormones which can result in breast engorgement and secretion of milk in both males and females. Pseudo menstruation may occur in girls

79. NEUROLOGICAL SYSTEM nervous system is also not fully mature at birth. The brain grows rapidly after birth. Sometimes brain is not developed properly and remains immature because of which there is temperature instability and uncoordinated muscle movement.

80. NEWBORN ASSESSMENT

81. TYPES OF NEWBORN ASSESSMENT On the basis of time of performing, assessment is of three types : Immediate/ initial assessment of newborn Transitional assessment during period of reactivity Periodic assessment

82. IMMEDIATE / INITIAL ASSESSMENT OF NEWBORN Each newborn baby is carefully checked at birth for signs of problems or complications

83. PURPOSES OF IMMEDIATE EXAMINATION AT BIRTH To ensure the patency of orifices and spontaneous breathing. To identify life threatening congenital malformations and birth injuries. To classify the new born according to weight and gestational age.

84. IMMEDIATE NEWBORN ASSESSMENT INCLUDES: APGAR scoring Recording of birth weight Umbilical cord is examined for presence of 2 umbilical arteries and 1 vein. Orifice counting & checking their patency . Mouth is checked for cleft palate and lip . Ears and nose Anus is checked for imperforation or malformation . Urethra is checked for hypospadias or epispadias . Any visible lesions on back or front.

85. Physical exam General appearance . looks for physical activity, muscle tone, posture, and level of consciousness. Skin.   skin color, texture, nails, and any rashes. Head and neck. shape of head, the soft spots ( fontanelles ) Face .   eyes , ears, nose, and cheeks. Mouth.   roof of the mouth (palate), tongue, and throat. Lungs . breathing pattern Heart sounds and pulses in the groin (femoral) Abdomen.   any masses or hernias. Genitals and anus.   open passages for urine and stool. Arms and legs.   baby’s movement and development.

86. Measurements Head circumference.  Abdominal circumference.  Length .  vital signs: Temperature. (36.5-37.5 c) Pulse . (120 to 160 beats per minute). Breathing rate. (40 to 60 breaths per minute).

87. TRANSITIONAL ASSESSMENT Transitional assessment recommended for full and detailed examination of all babies is carried out at birth with in the 72 hours of birth

88. PERIODIC ASSESSMENT Refer to ongoing evaluations conducted at regular intervals after the initial assessment to monitor the newborn's growth, development, and any potential health changes. 

89. General Examination: observing the newborn's posture, activity level, cry, color , and vital signs (temperature, heart rate, respiratory rate )

90. Physical Examination involves a head-to-toe assessment, Skin: Color , texture, nails, and presence of rashes or lesions Head and Neck: Shape, fontanels (soft spots), and clavicles Face : Eyes, ears, nose, and cheeks Mouth : Palate, tongue, and throat Lungs : Breath sounds and breathing pattern Heart : Heart sounds and femoral pulses Abdomen : Presence of masses or hernias Genitals and Anus: Patency and any abnormalities Arms and Legs: Movement and development

91. Gestational Age Assessment: determine the newborn's maturity level Neurobehavioral Assessment Reflex Assessment: Newborn Screening: pulse oximetry screening, and hearing screening to detect potential health conditions Measurements: Head circumference, abdominal circumference, and length

92. NEWBORN REFLEXES

93. Reflexes are the indicator for the neurological development. It’s an essential component to be tested in newborn to detect the normality and abnormality earlier so that appropriate measures can be taken in case of any emergency. Some reflex are permanently present and some will disappear as per the growth and development of the child.

94. Reflexes are involuntary movements or actions. Some movements are unintentional and occur as part of the baby's normal routine. Others are responses to certain actions. Reflexes help identify normal brain and nerve activity. Some reflexes are only present at certain stages of development

95. DEFINITION A newborn reflex is a response of a newborn to a stimulus and that occurs without conscious thought

96. REFLEX: Blinking STIMULATION: The cornea is touched RESPONSE: Involuntary blinking of the eyelid AGE OF APPEARANCE: Birth AGE OF DISAPPEARANCE : Does not disappear PURPOSE/SIGNIFICANCE OF REFLEX: Protect the eyes from foreign bodies and bright lights SIGNIFICANCE FOR ABSENCE OF REFLEX: Dysfunctional blink reflex results due to damage at pathway of central or peripheral nervous system

97. REFLEX : Pupillary reaction STIMULATION: Bright light falls on eyes RESPONSE : Pupil constrict AGE OF APPEARANCE: Birth AGE OF DISAPPEARANCE: Does not disappear PURPOSE/SIGNIFICANCE OF REFLEX : Indicates balance between the sympathetic and parasympathetic nervous systems Its nature gives an indication of muscle tone. SIGNIFICANCE FOR ABSENCE OF REFLEX: Hypotonia is described as the inability of the arms or hands to move freely or completely open

98. REFLEX : Doll’s eye or Oculocephalic STIMULATION: Head is moved to right or left RESPONSE: Eye lag behind and do not immediately adjust to new position AGE OF APPEARANCE : Birth AGE OF DISAPPEARANCE: 3-4month PURPOSE/SIGNIFICANCE OF REFLEX: Indicating an intact brainstem function SIGNIFICANCE FOR ABSENCE OF REFLEX: Asymmetrical in hemiplagia and cerebral damage

99. REFLEX : Sneeze STIMULATION: Roll the cotton into a point, and place it in one nostril. Gently move the tissue back and forth , until feeling a tickling sensation RESPONSE : Spontaneous response of nasal passage by sneezing AGE OF APPEARANCE: Birth AGE OF DISAPPEARANCE : Does not disappear PURPOSE/SIGNIFICANCE OF REFLEX: Sneezing is a natural defense system to rid the baby’s nose of billions of irritants SIGNIFICANCE FOR ABSENCE OF REFLEX: Sneezing abnormalities are usually caused by irritation of the trigeminal nerve terminals in the nasal mucosa .

100. REFLEX : Glabellar or Myerson sign STIMULATION : Tapping briskly on bridge of nose RESPONSE: Eyes close tightly AGE OF APPEARANCE : Birth AGE OF DISAPPEARANCE : Does not disappear PURPOSE/SIGNIFICANCE OF REFLEX : Indicates the good condition of trigeminal nerve SIGNIFICANCE FOR ABSENCE OF REFLEX : Abnormal frontal elease . Absent when there is sensory loss

101. REFLEX: Rooting STIMULATION: The baby's mouth corner is stroked or touched. RESPONSE : The baby turns his head and open mouth to follow direction of stroking. AGE OF APPEARANCE : Birth AGE OF DISAPPEARANCE : 3-4month PURPOSE/SIGNIFICANCE OF REFLEX: It helps the baby to find the breast or bottle to start feeding SIGNIFICANCE FOR ABSENCE OF REFLEX : Absence seen in neurologically impaired infants.

102. REFLEX: Sucking STIMULATION : The roof of the baby's mouth is touched RESPONSE : : Baby begin to suck AGE OF APPEARANCE: Birth AGE OF DISAPPEARANCE : Persists during infancy PURPOSE/SIGNIFICANCE OF REFLEX : Helps in breast or bottle feeding SIGNIFICANCE FOR ABSENCE OF REFLEX : Persistence may inhibit voluntary sucking. Absence sucking at birth indicate sickness, Persistence beyond 7 months indicate developmental delay

103. REFLEX: Gag or Pharyngeal STIMULATION: Stimulation of posterior pharynx by food or suction RESPONSE: Infant gag AGE OF APPEARANCE: Birth AGE OF DISAPPEARANCE : Persists through-out life PURPOSE/SIGNIFICANCE OF REFLEX : It helps to prevent choking and protect from swallowing potentially harmful substances SIGNIFICANCE FOR ABSENCE OF REFLEX : Damage to the glossopharyngeal nerve, the vagus nerve and brain death

104. REFLEX: Moro or Startle STIMULATION : Baby is startled by a loud sound or movement . RESPONSE : In Birth 3-4 months, the baby throws back his or her head, stretches his or her arms and legs, cries, and then draws the arms and legs in back in AGE OF APPEARANCE : Birth AGE OF DISAPPEARANCE : 3-4months PURPOSE/SIGNIFICANCE OF REFLEX : It helps babies to develop the controlled skill of walking SIGNIFICANCE FOR ABSENCE OF REFLEX : Generalized depression of CNS, hemi paresis, Erb palsy, Fracture clavicle, Kernecterus

105. REFLEX: Tonic neck or Fencing STIMULATION : Assymetrical Passive rotation of head in supine position RESPONSE: Extension of the same side's upper limb and flexion of the opposite side's upper limb AGE OF APPEARANCE : At birth AGE OF DISAPPEARANCE : 3 months PURPOSE/SIGNIFICANCE OF REFLEX : It helps your newborn to discover their hands and develop hand- eye coordination SIGNIFICANCE FOR ABSENCE OF REFLEX : Spastic Cerebral palsy

106. REFLEX: Babinski STIMULATION: Stroking outer sole of foot upward from heel across ball of foot RESPONSE: The big toe bends back toward the top of the foot and the other toes fan out AGE OF APPEARANCE: Birth AGE OF DISAPPEARANCE: 1year PURPOSE/SIGNIFICANCE OF REFLEX : Indicates active neurological responses Indicates brain and nerve activities are normal SIGNIFICANCE FOR ABSENCE OF REFLEX : If no movement, then its a neutral response and has no clinical significance

107. REFLEX: STIMULATION: RESPONSE: AGE OF APPEARANCE: AGE OF DISAPPEARANCE: PURPOSE/SIGNIFICANCE OF REFLEX: SIGNIFICANCE FOR ABSENCE OF REFLEX: IMAGES:

108. SKIN TO SKIN CONTACT

109. Skin to skin contact also known as kangaroo mother care

110. The naked newborn is placed prone on the mother’s bare chest early skin-to-skin contact/ care ( SSC) begins immediately after the birth of the baby.

111. DEFINITION Skin-to-skin contact involves holding a newborn against a caregiver's bare chest, promoting physical and emotional closeness. This practice helps regulate the newborn's body temperature, heart rate, and breathing, while also fostering bonding and breastfeeding.

112. KANGAROO MOTHER CARE Kangaroo Mother Care is defined as early and continuous skin-to-skin contact, usually with the mother, to provide the habitat for optimal early adaptation to extra-uterine life . This practice is often used for premature newborns but can also be beneficial healthy full term infants.

113. INDICATION FOR SKIN TO SKIN CONTACT Preterm infants for regulation body temperature, heart rate and breathing Low birth weight infants for weight gain, reduces stress and promotes growth Stable newborns: enhance bonding, promote breast feeding and supports transition to extra uterine life Sick or vulnerable newborns: provides comfort, reduces stress and promotes physiological stability

114. PROCEDURE placing the naked newborn directly on the unclothed chest of the mother; for initial skin-to-skin care the baby should be dried while on the chest; both mother and baby covered with dry blankets; initial vital signs and procedures can be accomplished while skin-to-skin; if the mother is unable, the father or support person can do skin-to-skin care; infants can be transferred to other areas while skin-to-skin .

115. BENEFITS Thermoregulation: direct skin contact helps regulate the newborns body temperature through conductive and radiant heat transfer Physiological stability: stabilizes newborns heart rate, breathing patterns and oxygen saturation

116. Enhanced bonding; emotional connection promotes bonding and attachment between the newborn and parent through increased oxytocin release Facilitates the early initiation of breast feeding by enhancing the newborns natural rooting and sucking reflexes

117. Pain relief and comforting effect; provides natural analgesia for the newborn during painful procedure such as injections Facilitates self-attachment for breastfeeding higher blood glucose levels less initial weight loss; more restful natural sleep cycles and more quiet sleep; reduced stress reaction to painful procedures.

118. LONG TERM BENEFITS OF KANGAROO MOTHER CARE fewer infections at 6 & 12 months; smiles more often at 3 months; mothers more encouraging and instructing towards baby improved brain maturation; promotes self thermal regulation ; better emotional and cognitive regulatory abilities improved attachment shorter length of stay in the NICU.

119. THERMOREGULATION / THERMAL CONTROL IN NEWBORN

120. Temperature control or thermoregulation in the neonate is a critical physiological function that is strongly influenced by physical immaturity, extent of illness and environmental factors A newborn baby is homoeothermic, but his ability to maintain his body temperature can be easily overwhelmed by environmental temperature

121. CRITERIA FOR THERMAL CONTROL Thermal care in delivery room: maintain an optimum room temperature for delivery room( 25-28 o c), use room heaters for necessary. Preheat all the clothing use for baby. Keep ready and pre heat the radiant warmer at least 20-30 minutes in advance

122. Immediate drying :baby should be immediately dried with a dry towel, starting from the head then the whole body and body should be covered with dry towel Skin to skin contact: baby should be kept immediate on mothers chest for initial skin to skin contact

123. Breast feeding: initiate soon after birth to ensure adequate supply of calories for heat generation Bathing/weighing postponing: do not give bath to the newborn for first 24 hours. Cover the baby adequately before weighing and make zero correction for cloth

124. Clothing and bedding : cover the newborn with one or two layers of clothes and also use the cap, sock and hand gloves rooming in: babies and mother should be attached together for 24 hours in the same bed and breastfeed on demand

125. Warm transportation; make sure the warm chain (wrapping and skin to skin contact while transport the baby. Use incubator if necessary. Temperature should be monitor before and after transport Training and awareness raising: all the healthcare personnel involved in the newborn care should be adequately trained and informed about the principles of warm chain

126. MONITORING AND ASSESSMENT Regularly check the newborn body temperature (normal: 36.5 o c to 37.5 o c) Monitor for thermoregulation issues such as Signs of hypothermia; cold extremities, lethargy and poor feeding Signs of hyperthermia : sweating, flushed skin and irritability

127. INFECTION PREVENTION

128. Infection prevention and control are the measures that a healthcare facility undertakes to prevent harm caused by infection to newborn and health care workers

129. NEWBORN RISK FACTORS THAT INCREASE INFECTION Low birth weight baby Younger gestational age Immature immune system comorbidities

130. CARE RELATED RISK FACTORS THAT INCREASE THE RISK OF INFECTION Intensive care stay Presence of invasive medical devices Parenteral nutrition Antimicrobial therapy which may lead to multiple drug resistance organism Overcrowding and understaffing Congested Ward layout Contact with infected person increased length of stay

131. PREVENTIVE STRATEGIES Hand hygiene Bathing ; delay the first bath until the newborn temperature stabilize and umbilical cord tear off Umbilical cord care; keep the stump clean and dry Environmental hygiene

132. Use of personal protective equipment Safe use and disposal of sharps Limiting exposure from potentially infected individuals Use of exclusive breast milk and Maintain sterility in case of providing formula feed Vaccination Judicious antibiotic use and prevention of misuse

133. PREVENTIVE MANAGEMENT Screen the baby to detect and manage conditions that could compromise immunity Monitoring for infection signs such as fever, behavioral changes, skin changes and changes in breathing pattern

134. parental education for infection signs, hygiene practices and feeding practices Special care for premature and low birth weight babies Provide prophylactic treatment to prevent infection Prevent specific infection acquired during and due to hospital stay

135. IMMUNIZATION

136. RECOMMENDED IMMUNIZATION FOR NEWBORN IN INDIA At Birth BCG protect against tuberculosis, Hepatitis B vaccine OPV ( oral drops) 6 weeks OPV (oral drops) Pentavalent vaccine (diphtheria, tetanus, pertussis, hepatitis Ban haemophilus influvenza type B) Rotavirus vaccine (oral drops)

137. 10 weeks Pentavalent vaccine (diphtheria, tetanus, pertussis, hepatitis Ban haemophilus influvenza type B) Rotavirus vaccine (oral drops ) 14 weeks Pentavalent vaccine (diphtheria, tetanus, pertussis, hepatitis Ban haemophilus influvenza type B); 3 rd dose OPV (oral drops); 2 nd dose

138. 6 Months OPV (oral drops)3 rd dose Pentavalent vaccine (diphtheria, tetanus, pertussis, hepatitis Ban haemophilus influvenza type B); booster dose 9 Months 1) measles, mumps, and rubella (MMR)vaccine 1 st dose (subcutaneous injection)

139. 12 Months vitamin A supplementation 15-18 months measles, mumps, and rubella (MMR)vaccine 2 nd dose (subcutaneous injection ) 16-24 Months (booster Doses) DTP (booster doses) OPV (booster doses)

140. MINOR DISORDERS OF NEWBORN AND MANAGEMENT

141. The minor disorders are most common among newborns Most mothers observe their babies carefully and are often worried by minor physical peculiarities, which may be of no consequence

142. Minor disorders of newborns are refer to common, typically harmless conditions that may affect newborns in the first few weeks of life. These can include issues like physiological jaundice, newborn rash, milia , baby acne, or mild umbilical cord issues, which often resolve on their own or with minimal treatment.

143. DEFINITION OF MINOR DISORDERS OF NEWBORN Newborn or Neonate : From birth to till 28 days the baby is called newborn or neonates. Minor ailments/disorder are a physical condition in which there is a disturbances of normal functioning

144. 1) ORAL & PERIANAL THRUSH ORAL THRUSH is a fungal infection caused by candida albican . It is characterized by white patches in the mouth and tongue

145. PERIANAL THRUSH may cause soreness of the buttocks and is secondary to oral infection. The skin is extremely red and affected area may extend as far as the umbilicus.

146. MANAGEMENT Antifungal treatment : if necessary antifungal medication may be prescribed for the baby or breastfeeding mother Maintain good oral hygiene practices, including cleaning pacifiers and bottle nipples Consultation provide if thrush persist or worsens

147. OPHTHALMIANEONATRUM Any purulent discharge from the eyes of an newborn within 21 days of birth. The baby’s eyes are contaminated during the passage through the birth canal from a infected mother

148. MANAGEMENT Cleaning the eye by using sterile saline or clean water to gently wipe away the discharges, from the eyes Gentle massage of the tear duct area may help the open the duct Seek medical advice if discharge persists or accompanied by redness or swelling

149. OMPHALITIS Infection of umbilicus in the neonate, due to bacterial infection. Signs &symptoms include cellulitis around the umbilical stump (redness, warmth, pain, swelling), fever, poor feeding and offensive odor from the umbilicus.

150. MANAGEMENT A discharge from umbilical lesion should be sent for culture, to determine the organism and its sensitivity On the basis of the report, antibiotics are started, neomycin powder is applied locally

151. NEONATAL MASTITIS The enlargement of breast occurs in full term babies of both sex on 3rd or 4th day and may last for few days or even weeks. Lack of inactivation of progesterone and estrogen after birth due to immaturity of neonatal liver, leads to further rise in their levels thus resulting in hypertrophy of breast

152. MANAGEMENT If an abscess forms, it required management of incision and drainage. Antibiotics therapy- clinadamycin and vancomycin , oxacillin (100-200 mg/kg/day in 4 divided doses ) Antiseptic compresses and local massage

153. NASOPHARYNGITIS It is an acute infection of the respiratory tract which is usually caused by air borne organisms transmitted by parents or visitors or staff to the baby.

154. Symptoms running nose excessive cry Coughing sneezing.

155. MANAGEMENT Mother and baby should be nursed in a single room and the baby should be given extra fluid. Nostrils cleaned by cotton wool soaked with normal saline and nasal spray or drops can use

156. EXCESSIVE CRYING IN NEWBORN New-born cry very often due to a number of reasons: Due to hungry Discomfort due to soiled linen. May be due to full bladder before passing urine. Constipation. Insect bites

157. Excessive crying defined as Periods of inconsolable crying, often in the late afternoon or evening

158. MANAGEMENT Comfort measures; use soothing technique such as gentle rocking, swaddling, or holding Ensure proper feeding and burping technique Consultation: discuss with health care provide if crying persist

159. ABDOMINAL DISTENSION Baby with periodic distension should causes by complication of severe gastroenteritis, constipation with ineffective peristalsis, intestinal obstruction . Signs and symptoms Vomiting increased respiration refusal of feeds.

160. MANAGEMENT A flatus tube may be inserted to remove excessive gas, if present. Dehydration should be treated . In case of obstruction, nasogastric tube aspiration and continuous drainage may help to decompress the stomach.

161. CONSTIPATION Prolonged straining and forceful efforts at defecation with passage of hard stools is called constipation Due to insufficient fluid or milk intake symptoms lack of sleep Irritability abdominal pain

162. MANAGEMENT Best managed by giving frequent breastfeeding. Milk of magnesia one teaspoon twice a daily . Apply lubricant over anal region

163. DIARRHOEA Baby develop increases frequency of stools if the mother is taking ampicillin, tetracycline or certain laxatives Intake of large quantities of glucose water and honey by the baby. Due to over feeding

164. MANAGEMENT Avoid bottle feeding maintain hygiene, Wash nipple after each feed. Put on exclusive breastfeed. Mothers who are breastfeeding might need adjust their own diet to avoid any foods that could trigger diarrhea in their babies . Keep the diaper changing area clean

165. PAIN IN NEONATES The interpretation of pain is subjective . Observation of child’s behavior also helps to identify pain. The baby may be irritable , anxious, show limitation of movements, excessive crying and adoption specific position

166. MANAGEMENT Mother’s touch, soothing words and cuddling provides a sense of security and love to their baby. Local application of soothing lotions, application of heat & cold compress may be prescribed for superficial and peripheral pain.

167. VOMITING Vomiting is a forcible ejection of the gastric contents . There are several causes of vomiting like gastric irritation, reflex vomiting, emotional disturbances, due to faulty techniques of feeding.

168. MANAGEMENT Advice techniques of breast feeding in proper position keep the baby upright during and after feeding Feeding practices: avoid over feeding and ensure proper burping Typically resolves as the baby’s digestive system matures Avoid bottle feeding. Fluid & electrolyte balance should be maintained by monitoring the intake and output . Antiemetic medication should be administered in severe cases as prescribed

169. PHYSIOLOGICAL JAUNDICE Yellowing of the skin and whites of the eyes due to elevated bilirubin levels in the blood It appears on the second day of birth, reaches peak on the 4th or 5th day and disappears by 8 to 10 days. It is a yellow color of skin usually appearing on the face, chest, abdomen and legs, due to the excess bilirubin in blood

170. MANAGEMENT Regular assessment of bilirubin levels especially in the first few days after birth Exposure to blue or white light helps convert bilirubin into a form that can be excreted by the body Encouraging breastfeeding to promote bilirubin excretion In severe cases, exchange transfusion for necessary

171. SORE BUTTOCKS & NAPKIN RASHES Use of nylon or water tight plastic napkins and delay in changing the napkins causes redness. Due to frequent loose stool or poor hygiene

172. MANAGEMENT Frequent changing of diapers Apply barrier creams: use zinc oxide or petroleum based barrier creams to protect the skin Allow the baby to have diaper free time to let the skin air dry

173. CRADLE CAP OR SEBORRHEIC DERMATITIS Thick yellowish, greasy scales on the scalp

174. MANAGEMENT Gentle wash: use mild baby shampoo and gently brush the scalp with a soft brush or comb Apply baby oils or mineral oil to soften scales before washing Avoid scratching: avoid picking or scratching the scales to prevent infection

175. MILIA Small, white or yellow bumps on the face, particularly on the nose and cheeks

176. MANAGEMENT No treatment needed milia usually resolve on their own with in a few weeks with out any intervention Gentle skin care avoid scrubbing or using harsh products on the newborn skin