Care of a Newborn

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Care of a Newborn

  1. 1. Care of a Newborn Dr. Kalpana Malla MD Pediatrics Manipal Teaching HospitalDownload more documents and slide shows on The Medical Post [ www.themedicalpost.net ]
  2. 2. Care of Normal Newborn
  3. 3. Definition• Neonatal period/neonate/ newborn – first 28 days of life• Perinatal period – 22 weeks of gestation to 7 days after birth
  4. 4. Definition• Early Neonate –birth to first 7 days of life• Late Neonate –after 7 days – 28 days of lif
  5. 5. DefinitionsTerm – baby born after 37 completed weeks upto 42 completed weeks of gestationPreterm – baby born before 37 completed weeks of gestationPost-term – baby born after 42 completed weeks of gestation
  6. 6. Definitions• SFD / SGA : birth weight is <10TH CENTILE FOR GESTATIONAL AGE• AFD/ AGA :Birth weight is 10TH - 90TH CENTILES FOR GESTATIONAL AGE• LFD/ LGA :Birth weight is >90TH CENTILE FOR GESTATIONAL AGE
  7. 7. Classification of NewbornA) Depending upon gestational age: Term Preterm Post-term
  8. 8. B) Depending upon Birth weight :• Normal birth weight (NBW) :2500-3999 g• Low birth weight (LBW) : <2500 g• Very low birth weight (VLBW) : <1500 g• Extremely low birth weight (ELBW) : <1000 g• Preemie : <750 g• Micropreemie : <500 g
  9. 9. Very Low Birth weight: 1000-1500g
  10. 10. Very Low Birth weight: 1000-1500g
  11. 11. Extremely low birth weight: 500- 1000g
  12. 12. C) Depending upon Gestational Age & B.WTPreterm - SFD / SGA AFD/ AGA LFD/ LGATerm -SFD / SGA AFD/ AGA LFD/ LGAPost –Term - SFD / SGA AFD/ AGA LFD/ LGA
  13. 13. Plotting Weight, Length, HC
  14. 14. Component of Newborn care1. Clean delivery & clean cord care2. Maintanance of body temperature – room warm/cloths-cap, socks,oil massage3. Skin care- sponge, not to scrub vernix4. Care of umbilical stump – keep dry (fall after 5-10days)5. Care of eyes
  15. 15. Component of Newborn care6. Breast feeding7. Weight record8. Early detection of serious Ds9. Immunization10. Supplements and follow up
  16. 16. Follow up• Well baby clinic – evaluation• Exclusive breast feeding• Growth and development• Immunization• Nutrition advice
  17. 17. Care at birth-DELIVERY ROOM CARE• Ensure clean and safe delivery• Delivery room - Clean, well ventilated, adequately lighted, warm room• Temperature stabilisation• Suction - mouth and nostril• Cut the umbilical cord -2.5 inch from skin• Weigh and classify• Assess under warmth
  18. 18. Basic care of the normal newborn1.Rooming in2. Receive the baby in sterile sheet Cover adequately and dress3. Check color, respiration, temperature, and umbilical cord4. Record skin temperature
  19. 19. Basic care of the normal newbornMother’s role - Has instinct, concern, interest, love and affection - Can involve in nursing care - Recognition of early evidence of disease
  20. 20. Basic care of the normal newbornMother’s role Breast feeding - First feed within 1-2 hours - No prelacteal feeds - Colostrum to feed - No need of water - Demand feeding 2-3 hours -15-20min, Burp - Adequacy of breast feeding
  21. 21. Care of normal newborn• Maintenance of body temperature• - Avoid bath on first day• - Cover adequately and dress• Bath• - At birth - clean blood, mucus and meconium• - Bath can be given on next day, use unmedicated• soap and lukewarm water• - Sponging is sufficient• - Avoid dip bath• Skin care• - No need to clean all vernix, but clean blood and meconium• - Skin abrasions - use topical antibiotics
  22. 22. Care of normal newborn• Cord care Clamp, inspect 2- 4 hourly for bleeding, no dressing, spirit cleaning of tip and around the base• Eye care Sterile cotton swab cleaning, each eye separately, no kajal application• Vitamin K - 1mg IM within 2 hours of life• Dresses Loose, soft, preferably cotton, woolen, nappies
  23. 23. Care of normal newborn Routine care Supportive care(Term, vigorous, crying, pink • Warmth good tone , no meconium) • Position – Put on mother’s chest • Suction – Dry – Cover with dry linen • Dry – Skin to skin contact • Stimulate – Clear airway • Give O2
  24. 24. Care during subsequent period1.Weight recording - daily - Weight loss during first 2-3 days, 5-8% of body weight - Stationary for next 1-2days - Regain birth weight - at the end of first week - Average weight gain thereafter- 30g / day2. Immunisation - BCG3. Discharge plan and future visits
  25. 25. Grades of care of newbornLevel I care:• >89% require minimal care• Wt >2000gm• Gest maturity ≥ 37 weeks• Care provided at – home/subcenter/primary health care
  26. 26. Level II care :• 10-15% require this care• Wt- >1500gm• Gest maturity 32-36 weeks• Needs specialized neonatal care supervised by trained nurses /pediatrician• Equipments – Et tube/Laryngoscope - IV infusion, NG tube, - Phototherapy - Facility for exchange transfusion ect
  27. 27. Level III care• 3-5% require this care• Intensive neonatal care• < 1500 gm• Gest < 32 weeks• Skilled neonatologists/trained nurses• Equipments – incubator, oxygen - Suction apparatus - Ventilator - Infusion pump, trancutaneous monitors
  28. 28. Early detection of serious disease1. Bleeding from any site2. Jaundice appearing <24 hours / Deep jaundice / Physiological jaundice3. Not passed meconium within 24 hours / urine within 48 hours4. Regurgitation, vomiting / loose stools5. Poor feeding / lethargy/ Excessive sleepiness
  29. 29. Early detection of serious disease6. Excessive frothiness / drooling of saliva7.Cold to touch / fever / Dehydration fever8.Abdominal distension9.Difficult / rapid breathing10.Convulsions
  30. 30. Common neonatal problems11. Excessive cry- hunger, discomfort, full bladder, colic, insect bite, soiling12.Superficial infections - skin pustules, umbilical, sepsis, conjunctivitis, oral thrush13.Blocked nasolacrimal duct
  31. 31. Minor developmental pecularities1. Erythema toxicum /urticaria neonatorum- erythematous rash with central pallor ,appears on 2-3rd day in term baby, starts on face & spreads to trunk & extremities in 24 hrs, disappears in 2-3 days2. Peeling skin3. Milia- retention sebum4. Mongolian blue spot
  32. 32. Minor developmental pecularities5. Subconjunctival hge6. Epstein pearl – epithelial inclusion cysts7. sucking callosities8. Tongue tie9. Hymenal tags/ non retractable prepuce10.Prominent xiphisternum11umbilical hernia
  33. 33. Minor developmental pecularities13. disorders due to transplacental passage of hormones – Mastitis neonatorum - vaginal bleeing - mucoid vaginal secretions
  34. 34. Criteria of normal newborn1. Gestation – 37-42 completed weeks2. Birth wt – 2500 – 3999gm3. Breathing – spontaneous,regular,RR – 30- 60/min4. Color – pink but slight peripheral cyanosis soon after birth5. Heart rate – 100 -160/min6. Temp ( axillary) – 97.5-990 F
  35. 35. Criteria of normal newborn7. HC – 33-35cm8. Length – 50 cm9. Chest circumference – 3 cm< HC10.Upper segment : lower segment – 1.7-1.9:111. Sucks soon after birth12. Sleeps – 18 hr/day13.Physiological photophobia, sclera bluish
  36. 36. Criteria of normal newborn14. Ear cartilage – firm with good elastic recoil15. Breast nodule > 5 mm16.Liver palpable – 2 cm17. Genitalia –Male -Testes in scrotum,deeply pigmented scrotum/adequate rugaeFemale -Labia minora covered by labia majora18. Sloes – >anterior 2/3rd show deep crease
  37. 37. Criteria of normal newborn19. Muscle tone – increased by adult standard/attitude of flexion20. 95% term & preterm void within 24 hrs but some pass in 48hrs21. 99% term & 95% preterm pass meconium within 24- 48 hrs of birth22. No apparent cong anomalies
  38. 38. Examination of newbornExamined region by region• Soon after birth• At 24 hrs of life• Before dischargePre-requisites• Wash and dry hands• Good light• Warm environment• Concent
  39. 39. Examination of newborn1.Overall impression – face,trunk,limbs,activity2.Measurements – wt/length/HC3. Color – pink,jaundice4. Skin – pallor /jaundice/erythema toxicum5. Head –fontanelles/ sutures/ cephalhematoma/ superficial injuries6. Face – dysmorphic features
  40. 40. Examination of newborn7.Ears – low set/demormity8. Eyes – discharge/inflammation/cataract9. Nose – choanal atresia10. Mouth – cleft palate /macroglossia/micrognathia/excessive frothing11. Neck – sternomastoid tumour /branchial & thyroglossal cysts/webbing neck/short neck/neonatal goiter/ cystic hygroma
  41. 41. Examination of newborn12. Upper limbs – erb’s palsy/Klumky’s palsy/extra digits13. Chest – accessory nipples/wide apart nipple/breast hypertrophy/lung field14. CVS – mumurs15. abdomen – organomegaly/distension /bowel sound16. umbilical cord – single U. artery/signs of sepsis
  42. 42. Examination of newborn17. Hip – congenital dislocation of hip18. Genitalia19.Anus – imperforated anus20. Feet – club feet/sole creases21. Spine – midline defect ( spina bifida)/ meningomyelocele22. Primitive reflexes
  43. 43. Thank youDownload more documents and slide shows on The Medical Post [ www.themedicalpost.net ]

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