Training module for doctors, students, trainees , nurses, paramedics involved in Neonatal Care

1. Dr Isha Deshmukh
Assistant Professor
Pediatrics
BJGMC & Sassoon General Hospital, Pune

2.  Temp < 35.5- hypothermia
 Use of radiant warmer
 Skin to skin contact with mother or any adult
Steps to prevent hypothermia :
 Maintain room temperature = 26 C
 Baby dry and covered
 Continue BF
 Sponging , no bathing till 24 hours after birth
in normal weight baby and 7 days in low birth
weight baby.

3.  Keep room warm
 Layer clothing 2 layers for normal weight
baby and 3 to 4 layers for LBW infant
 Rooming in
 KMC = for babies <2 kg
 Give Vitamin K

6. Birth weight (gms) 1200 to 1800 >1800
Initial Orogastric Breast feeds
After 1 to 3 days Cup feeding Breast feeds
1 to 3 weeks and
beyond
Breastfeeding Breast feeds

8.  Daily fluid requirement of newborns (ml/kg
body weight )
Day of Life Fluids in ml/kg /day
Birth weight >1.5 kg Birth weight <1.5 kg
1 60 80
2 75 95
3 90 110
4 105 125
5 120 140
6 135 150
7 150 150

9. Type of fluid :
 First 2 days = IV D10%
 After 2 days = Isolyte P
Administration of IV Fluids:
 Use of syringe infusion pumps
 The number of drops per minute is equal to ml of
fluid per hour.
 Record of iv fluids
 Daily weight
 Urine output
 Check IV Site
 Introduce BF or milk feeds as soon possible.

10.  As newborn is stable
 Initial volume 12 to 24 mL/kg/day
 Increase daily 20 to 30 ml/kg/day
 Volume of iv fluids to be substracted from
TFR
 Omit fluids at 2/3 of TFR
 Non nutritive sucking
 Excessive weight loss (greater than 3 to 5 % in
24 hours ) Manage underlying conditions

12.  Frequent in babies less than 1.5 kg at birth or
born before 32 weeks gestation.
 Respiratory pause >20 seconds with or
without central cyanosis or bradycardia.
 Stimulate newborn if apnoea
 Resuscitate SOS
 Maintain temperature, oxygen saturation and
glucose levels
 Refer to SNCU .

13.  FPC – supervised delivery of care to
haemodynamically stable, sick & preterm
newborns by the parents/attendants.
 Building capacity of caregiver
 Supervising and supporting the caregiver
 Rooming in of Babies weighing 1800 to 2500
grams.
 Temperature maintainance
 Breastfeeding

14.  Assess and stabilize
 Record current weight
 Record the diagnosis and treatment received
in SNCU
 Plan completion of iv antibiotics
 Encourage BF and support assisted feeding
 Communicate with family
 Inform regarding home visits to ASHA / ANM

15.  Normal baby temperature
 No iv fluids, no medications
 3 days of weight gain
 BF or assisted feeds
 Completed treatment for phototherapy
 Danger signs explained, KMC and follow up
plan to family .

16.  Prepare summary
 Inform ASHA / ANM
 Vaccines
 ROP for all babies <2 kg at 4 weeks
 BERA at 40 weeks corrected age
 Advice mother to give home care .
 Exclusive breast feeds
 Hand washing and danger signs

17. Supplement Indicated in
which babies
When to
start
Dose Till when to
administer
Vitamin D All LBW
babies <2.5
kg who are
exclusively
breastfed
When baby
starts
accepting
full feeds
<2.5 kg ;
400 IU
Till one year
of age
MV Drops
with Zinc
All LBW
babies <2.5
kg
From 2
weeks of age
1 ml/day Till 40 weeks
post
menstrual
age
Calcium &
Phosphorous
VLBW babies
<1.5 kg
When baby
starts
accepting
full feeds
120 to 160
mg/kg/day
elemental
calcium;
60 to 80
elemental
phosphorus
Till 40 weeks
post
menstrual
age
Iron VLBW babies
<1.5 kg
From 2
weeks of age
2
mg/kg/day
Till one year
of age ;
followed by
routine IFA
supplementa

18.  Refusal to feed
 Fast or difficult breathing
 Cold or hot to touch
 Jaundice involving palms and soles/ Pallor /
Cyanosis
 Abnormal movements
 Abdominal distension
 Bleeding from any site
 Diarrhoea with blood in stool

19. Sr no Equipment Disinfection/ Sterilisation
process
Frequency
1 Radiant warmer Clean canopy and mattress with
detergent solution
Daily : Every time
after shifting a
baby
2 Cot Suction jar to be cleaned with
detergent
Daily
3 Suction
Apparatus
Clean with detergent Suction tube
should be
changed daily
Suction jar to be
cleaned daily
4 Oxygen hood Disinfect – clean with detergent
and wash
Sterilize – Immerse in 2%
gluteraldehyde for 4 hours
followed by rinsing in water
Daily and after
every use
5 Bag & Mask Maintain asepsis during
connecting/ disconnecting Avoid
Disinfect daily and
after every use.

20. A. Disinfection of surroundings
 Clean with 3% phenol or 5% Lysol once a day
 Wet mopping should be done at least 3 times
a day
 Dry dusting should be avoided
 Surface cleaning of the unit may be done
using 2 percent gluteraldehyde
 Concentration of the available Bacilloid may
vary from place to place . Refer to
instructions before preparing.

21. A. Segregation of waste
B. Disposal of waste
C. Cleaning of spillage
D. Additional practices : Early enteral feeding.
Exclusive breast-milk feeding, rooming in
with mother, maintainance of maternal
hygeine