This document provides an overview of neonatal care programs and interventions. It begins with definitions of neonates, infants, preterm, term, and post-term babies. It then describes various neonatal positioning techniques and provides normal vital sign ranges for neonates. The document summarizes several early intervention programs that aim to support high-risk infants and their families, including the MITP, NIDCAP, COPCA, EI SMART, SENSE, and SPEEDI programs. It also outlines specific therapeutic interventions like PIOMI, kangaroo mother care, FICare, PremieStart, and SPIBI. The document concludes with a brief description of bucket aqua therapy.

1. NEONATAL CARE PROGRAM

2. INTRODUCTION
• Neonates- born under 28th 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)
• Term- 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 Pao2 (mmHg) Paco2 (mmHg) HCO3- (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)

13. Expanded Apgar Score Form

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

16. Neonatal Mortality Prevalence

17. NEONATAL CARE PROGRAMMES

18. 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.
• These 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.

19. 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.

20. 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.

21. 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.

22. 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:
1. Supporting a consistent and responsive parent-infant relationship
2. Challenging the infant with a wide variety of self-produced motor activities in a variety of
conditions
3. Scaffolding the infant’s next developmental steps (is a practice where guidance is
removed gradually to allow the child to learn to become competent)
4. Minimizing infant stress
5. Supporting the infant’s self-regulation
6. Promoting parental well-being

23. 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.

25. Supporting Play, Exploration and Early Development Intervention (SPEEDI)
• Experimental 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

26. 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.

28. 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.

29. 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

30. 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.

31. 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.

32. 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

33. THANKYOU !