Child health nursing

1. ESSENTIAL NEWBORN CARE

2. INTRODUCTION
• The satisfactory transition from fetus to newborn infant is the greatest task
the baby has to overcome.
• It necessitates a very rapid change from the warmth and shelter of the uterus
to the cold uncertain world outside. Survival depends on the baby to make this
transition.
• Major physiological adjustments are therefore necessary at birth and continue
within the next few days and weeks. These include the establishment of
respirations, changes in cardiovascular system and the blood, the regulation
of the body temperature, digestion and absorption of food and the
development of a resistance to infection.

3. DEFINITION
Essential Newborn Care (ENC) is care that
every newborn baby needs regardless of where it is
born or its size. ENC should be applied immediately
after the baby is born and continued for at least the
first 7 days after birth

4. HEALTHY NEWBORN
A healthy infant born at term between 38-
42wks should have average birth weight, cries
immediately following birth, establishes
independent rhythmic respiration & quickly
adapts to the changed environment

5. IMPORTANCEOFNEWBORNCARE
• Most of the neonatal deaths occurring during delivery or on
the day of death.
• Even for the deaths occurring in the rest of neonatal period,
care given at the time of birth is an important influencer
• A lot of deaths of newborns due to hyperthermia,
asphyxia and infection can be prevented by providing
essential newborn care to all infants immediately after
birth

6. 1. IMMEDIATE BASIC CARE
⚫Maintenance of temperature
⚫Establishment of open airway and circulation
⚫Identification of newborn
⚫Vitamin K injection
⚫Initiation of breastfeeding

7. MAINTENANCE OF TEMPERATURE
⚫Immediately dry the infant under a radiant warmer
⚫Skin to skin contact with the mother
⚫Keep neonatal head covered
⚫Rooming in ( The baby should not be separated from the
mother)

8. ESTABLISHMENT OF OPEN AIRWAY
⚫Majority of babies cry at birth and take spontaneous
respiration
⚫When the head is delivered birth attendant immediately
suction the secretions, wipe mucus from face ,mouth and
nose
⚫Suction the mouth and nose by using bulb syringe
⚫Keep head slightly lower than the body

9. MAINTENANCE OF TEMPERATURE
⚫Immediately dry the infant under a radiant warmer
⚫Skin to skin contact with the mother
⚫Keep neonatal head covered
⚫Rooming in ( The baby should not be separated from the
mother)

10. IMPORTANCE OF SUCTIONING
Several natural mechanisms helps with this:
As the fetal chest passes through the birth canal it is
compressed, squeezing excess fluid out of the lungs prior
to the baby taking its first breath
After several seconds in this “partly delivered” position,
fluid can be seen streaming out of the baby’s nose and
mouth

11. APGAR SCORING

12. NEWBORN IDENTIFICATION
Newborn identification before a baby leaves the delivery
area, identification bracelets with identical numbers are
placed on the baby and mother. Babies often have two, on
the wrist and ankle.

13. VITAMIN - K
Vitamin K prevent neonatal hemorrhage during first few
days of life before infant is able to produce vitamin-K
administration:
Term infant (1 mg) – IM
Preterm infant (0.5mg)-IM
ALTERNATIVE ROUTE :
Oral dose: 2mg orally at birth
Repeat dose (2mg) at 3-5 days & at 4-6 weeks of age

14. Initiation of breastfeeding
⚫Babies can be breastfeed as soon as the airway is cleared
and they are breathing normally

15. NEWBORN HYGIENE
⚫Newborn hygiene care, including bathing, skin care and
changing diapers is important for the baby’s health and
comfort

16. 2. DAILY ROUTINE CARE/HYGIENE OF
NEONATES
The majority of complications of the normal newborn may
occur during first 24 hours or within 7 days. So close
observation and daily essential routine care is important
for health and survival of the newborn baby

17. The daily routine care of the neonates
are-
⚫Warmth
⚫Breastfeeding
⚫Skin care and baby bath
⚫Care of umbilical cord
⚫Care of eyes
⚫Clothing of the baby
⚫General care
⚫Observation

18. ⚫Taking anthropometric measurement
⚫Immunization
⚫Follow up and advice

19. Harmful traditional practices
for the care of neonates
⚫Use of unclean substance such as cow dung, mud on
umbilical card
⚫Immediate bathing
⚫Use of prelacteal feeds
⚫Application of kajal in the newborn eyes
⚫Instillation of oil drops into ears & nostrils
⚫During bathing of baby, use of unhygenic herbal water
⚫Use of pacifiers

20. Articles needed for newborn care
Suction
machine
Mucous
sucker
Radiant
Warmer
Cord clamp
Sterile cotton
balls
Sterile cord
cutting scissor
Measuring tape
Rectal
thermameter

21. Articles needed for
newborn care
Emergency medication
Syringes
Baby sheets
Identification tags
Gloves
Clean tray
Sthethoscope
Sterile linen

22. 1
. The emergency
resuscitation is
neonatal area.
equipment
to be always
for neonatal
kept ready in
General Instruction
2. Do not stimulate baby (Rubbing the back on
suctioning nose) if the amniotic fluid is muconium
stained.
3. If any deviation from the normal is anticipated a
neonatologist is to be informed
Avoid
back rub

23. PROCEDURE (newborn care)
S. N. Procedure Rational
1 Place the baby soon after
delivery in a tray with sterile
linen with head slightly
downward
Facilitate drainage of the
mucous accumulated in the
tracheobroncheal tree by the
gravity
2 Place the tray between the legs
of the mother at a lower level
than uterus
Facilitate gravitational flow of
blood from placenta to the
fetus

24. PROCEDURE (newborn care)
S. N. Procedure Rational
3 Clean the air passage of the
newborn using the mucous
extractor or bulb syringe.
Maintain patent airway
4 Check “APGAR” rating at one
minute and five minute and
record
Assess the health status of the
newborn

25. PROCEDURE (newborn care)
S. N. Procedure Rational
5 Clamp and cut the cord. Cord is
to be clamped divided and
examined following birth of
baby
To identifies abnormality,
Separate the baby from
mother for extra uterine life
6 Dry the baby thoroughly.
Remove the linen and wrap the
baby in dry, warm
blanket/sheets
To prevent loss of heat by
evaporation and chilling
cut the cord
wrap the baby

26. PROCEDURE (newborn care)
S. N. Procedure Rational
7 Tie the identification tags which
has the mothers name and the
hospital number, wriest of both
the mother & baby & on leg of
baby
To avoid confusion between
staff and chances of wrong
identification.
8 Apply cord clamp and cut the
cord shorten to desired length.
To separate baby from mother
& avoid blood loss
Identification tags
Apply cord clamp

27. PROCEDURE (newborn care)
S.
N.
Procedure Rational
9 Place the baby under a
radiant warmer until
temperature is stable.
To maintain body
temperature of baby
10 Clean the eyes with
sterile cotton balls
soaked in sterile water.
To reduce eye
infection

28. PROCEDURE (newborn care)
S. N. Procedure Rational
11 Instill soframycin eye drop/
erythromycin eye ointment to each
eye.
Act as prophylaxis against
ophthalmic neonatorum &
Chlamydia trichimosis.
12 Cloth the baby using a dress that is
appropriate for the climate.
Extremities should be free for
movement
Moisture increases chances of
microorganism colonizing in the skin.

29. PROCEDURE
S. N. Procedure
13 Check potency of rectum by
introducing lubricated rectal
thermometer.
14 Check the weight & length of the baby.
15 Check vital signs
Rational
Identifies imperforated anus
To know the Normal measurement
To identifies Normal measurement

30. PROCEDURE (newborn care)
S. N. Procedure Rational
16 Administer vitamin K, 1mg
Intramuscularly.
To minimizes risk of
hemorrhage.
17 Administered prophylactic
antibiotic therapy if ordered in
case of – PROM, Instrumental
delivery
To prevent secondary
infection
Administer vitamin K

31. PROCEDURE (newborn care)
S. N. Procedure Rational
18 Observe the baby frequently
atleast for 4 to 8 hours.
Identify any abnormal sign
developing in newborn
19 Fill baby card (Crib card) &
antenatal folder & document it.
Acts as a communication
between the staff member.

32. Care provided to the newborn
includes
1. Maintenance of temperature.
2. Establishment of open airway and
circulation.
3. Identification of newborn
4. Vitamin k injections
5. Initiation of breastfeeding

33. What
to
do
For Maintenance of temperature
- Immediate dry the
infant under radiant
heat warmer
•keep neonate head
•covered
•ROOMING IN
•skin to skin contact
with mother

34. What
to
do? For establishment of open

35. What
to
do? For identification of baby
Identification tags
For vitamin k injection
Administer vitamin K
Intramuscularly

36. As early as possible
What
to
do? Initiation of breastfeeding

37. • Attending births
• Measuring and weighting infants
• Caring for and monitoring health of the infant after
birth.
• Educating new parents about the breastfeeding and
care of child
• Monitor the vital signs of both the baby and mother
Role of nurse

38. THANK
YOU