All necessary equipments and supplies should be assembled before the birth and one should know how to use it. Anticipation of baby’s need is a critical tool.
Essential new born care
ESSENTIAL NEW BORN CARE (ENBC)Dr Prabir Ranjan MoharanaMD(Community Medicine),PGDHHM.
Definitions Preterm Baby: A baby who is born before 37 weeks(259days). Low Birth Weight(LBW): A baby weighing <2.5 kg. Neonate: A baby who is ≤ 4 weeks or 28 days. Early Neonatal Period(< 7 days). Late Neonatal Period(7-28 days). Infant: A child who is less than 1 year or 365 days.
Trend in Child Mortality in India 2 out of 3 under five deaths(66%) happen in 1styear of life. 2 out of 3 infant deaths(66%) happen in 1stmonth/ neonatalperiod. 3 out 4 neonatal deaths(75%) happen in 1stday of life. Out of 4 babies dying in 1stmonth, 1 death occurs due toprematurity/low birth weight(Hypothermia,Feedingdifficulty, Sepsis).
Trend in Child Mortality in India 1 death occurs due to birth asphyxia. 1 death occurs due to infection/sepsis/pneumonia. 1 death occurs due to other causes like congenital defect,tetanus, jaundice, diarrhea etc.
Trend in Neonatal Mortality in Bihar Around 4 babies out of 100 newly born die in the firstmonth of life in Bihar(NMR in Bihar: 35 per 1000 livebirths:Census-2011). 3 out of these 4, die in the 1stweek of life. 1 out of 3 dying in 1stweek, dies in the 1stday of life.
Major Causes of Under 5 Child MortalityBryce et al. WHO estimates of the causes of death in children. Lancet 2005
What care/protection does a baby needjust after birth? A newborn needs care of breathing (Protection fromHypoxemia). Care of temperature (Protection from Hypothermia). Care of feeding (Protection from Hypoglycemia). Care of skin, cord and eye (Protection from Infection andsepsis).
How to identify a baby with Birth Asphyxia/ hypoxemia//inadequate breathing/respiratory distress? If a new born is not crying. If a new born is having a breathing rate of < 30 per minute Noisy Breathing like Grunting. Chest Retraction, nasal flaring and Cyanosis, the baby issaid to be in respiratory distress. All neonates can show a periodic breathing patterndefined as apnoea of less than 5 seconds. Apnoea of morethan 15 seconds may be seen in preterm babies.
How to care for breathing? Crying is the first sign of breathing. If baby is crying, Receive the baby in a dry, clean, warm towel. Put the baby over mother’s abdomen. DRY the baby but don’t wipe off VERNIX. Replace the wet towel and wrap the baby with second clean, dryand warm towel. Cut the cord within 1-3 minutes.
Golden 1 Minute of Resuscitation:(Navjaat Shishu Suraksha Karyakram:NSSK) Establishing of breathing is the most prior action to take afterdelivery of baby.If a baby is not crying or not breathing well:Step-1(a):Look for Meconium, if meconium is absent, dry thebaby.Drying up by clean cloth stimulates and helps in initiation ofbreathing.During drying baby gets stimulated to start crying/breathing.
Golden 1 Minute(NSSK)Step-1(b):If meconium is present, Gentle suction is done toremove mucus and amniotic fluid from mouth and nose withthe help of manual mucus sucker.If baby is not crying now:Step-2:i. Cut the cord,ii. Place on flat, firm, warm surface,iii. Provide warmth,iv. Position the baby with neck slightly extended (helps indrainage of secretion),v. Suction of mouth and then nose,vi. Stimulate and reposition.Step 1 to 2 should happen in 30 seconds.
Golden 1 Minute(NSSK)If baby doesn’t cry after step-2, go to step-3.Step-3: It should happen in next 30 seconds and resuscitationbecomes necessary to prevent hypoxemia, brain damageand death if natural breathing fails to establish. Resuscitation requires more active measures:i. Repeat suction,ii. Reposition the baby,iii. Apply bag and mask ventilation for 30 seconds, If breathing doesn’t start,i. Call for help.ii. Continue bag & mask ventilation.iii. Add Oxygen
How to care for temperature? The baby is projected out of mother’s warm womb where thetemperature is around 38 degree C. New Born loses heat by mode of Radiation, Convection,Evaporation and Conduction. Preterm and LBW babies developHypothermia easily. The room where the delivery is conducted should have atemperature not less than 25 degree C. 75% total heat loss occurs from head. As soon as the baby isdelivered the head and body of the baby should be dried upwith clean and dry cloth.
How to care for temperature? The body and head should be completely wrapped up. The baby should be kept away from wet cloth, cold room, coldwalls, cold surface, open windows, draught, revolving fan andair conditioner. Don’t wipe off VERNIX by massage. The baby should be kept in close skin-to-skin contact with themother with breast feeding.
How to care for temperature? The temperature of newborn should be maintained at 36.5-37.5 degree C. Postpone bathing/sponging for 24 hours. Keeping warm helps in regular breathing and circulation.
How to identify a baby with hypothermia? If a newborn is felt cold to touch over its abdomen andfeet. If a new born becomes lethargic and stops breast feeding. If the axillary temperature recorded is less than 36.5degree C.
How can we prevent infection/sepsis in anewborn? Clean and dry cloth should be used to wipe out fluid presentover body and head. The cord should be cut with a new blade/sterilized scissor. The cord should be tied with a sterilized thread or clampedwith cord-clamp. Cord is left as dry as possible for next 5-8days. Both eye lids should be swabbed with sterile and wet swab,one for each eye from inner canthus to outer canthus.
Care of skin, cord, eye. Instill a drop of freshly prepared 1% Silver Nitrate Solution orapply 1% Tetracycline ointment into each eye. After cleaning and drying-up, the baby’s body and headshould be covered with another dry and clean cloth toprevent heat loss from body and head. Vernix caseosa should not be wiped out. The baby should notbe massaged with oil. Baby should not be given bathe until 24 hours.
1. A draught free, warm room with temperature>25°C.2. A clean, dry and warm delivery surface.3. A radiant warmer / overhead lamp.4. Two clean, warm towels/clothes.5. A folded piece/roller of cloth (1/2 to1”thick).6. A newborn size self inflating bag.7. Infant masks in two sizes: size ‘1’ for normalweight baby and ‘0’ for small baby.8. A suction device.9. Oxygen (if available).10. A clock (with seconds hand). Preparation in delivery room (Preparation in delivery room (ESSENTIAL):