Essential newborn care

1. Day 2 recall summery

2. Topic covered
1. Essential newborn care
It is a care that offered to every newborn baby at birth.
It should be done to all baby
It involves
--Preparation of the room for delivery
--Identification of the delivery team
--Routine care at birth
--Emergency plan and execute them

3. Immediately care at birth
Thoroughly drying
Delayed cord clamping (1-3min)
Assessment of breathing
Skin to skin contact
At between birth to 60min
Early breastfeeding

4. Baby that fail to sustain breathing at
birth
Risk factors could be
1.Prolonged sec stage of LB
2.Severe PIH
3.Meconium stain liquor
4.Precipitate labor
Essential medicine in the golden hour
1. Vit K 1mg >1500gms
Vit K 0.5mg <1500gms
Use insuline syringe

5. Cont....
2. Tetracycline eye ointment
Apply from medial to lateral
Single tube per single baby, then discard to minimize
cross infections.
Measurements at 60 to 90 min
General examination
Body weight
Gestation age

6. 2. Neonatal resuscitation
Is a set of interventions after a newborn is born to assist
breathing and circulation.
It is always follows ABC principle, not CAB as for adults
Steps of resuscitation
Keep warm, dry thoroughly
Check and clear airway if needed
Stimulation
Ventilation

7. Equipments for resuscitation

8. Perform ventilation
Position newborn on the table, head slight extended to open
airway
Check mask size and positioning, use C-grip to hold the mask
Give 40-60 ventilation breath per min.. See chest movements?
Breathing?
No chest movement, improve ventilation. Mask leak? Head
position? Or Suction needed?
Check pulse using stethoscope
If above 60/mn, cont ventilation until baby start breathing
If below 60/mn, persistently after effective ventilation, start CPR

9. Cont..
3 compression, 1ventilation
Medications used
Iv adrenaline 0.01-0.03mg/kg, can repeat every 3 to 5 minutes max of
3 doses
Adrenaline dilution
1ml +9mls of NS or WHO for injection
Mechanism of action
Increase coronary artery perfusion
Improve blood flow to myocardium

10. Volume Expander
Indicated when bradycardia not improving with adrenaline
Preferable NS 10mls/kg slow over 20min
When to stop resuscitation
10min after effective ventilation, no HR, no breathing
20min of effective ventilation still HR <60b/m and no breathing
30min

11. 3.BIRTH ASPHYXIA
Responsible for 1 in every 4 neonatal death
Number 1 cause of neonatal death in Tanzania
Def. Inability of newborn to initiate and sustain adequate respiration
after delivery.
Apgar score <7 in 5th min
HIE/neonatal encephalopathy
Shortage of oxygen (hypoxia) shortage of blood flow to the brain
(ischemia) resulting in brain damage (encephalopathy).

12. Clinical features
All organ are affected
1. Tone (hypertonia, hypotonia or abnormal movement)
2.Seizure -loss of consciousness
3. Poor feeding
4. Signs of respiratory distress
5.Failure to pass urine
Classification
1.Mild HIE/birth asphyxia
Apgar score <7
HIE <10
2.Moderate HIE

13. Cont..
Moderate HIE
Apgar score 4-6
HIE 10-14
Severe HIE
Apgar score<4
HIE >15
HIE scoring should be done daily up to 7days
Management
No curative treatment for brain damage

14. Fluids management
Moderate to severe HIE
Do not feed orally on day 1
Swab the infant's mouth with breast milk (colostrum)
Start iv D10% 40mls/kg/day up to 60mls/kg/day.
Mild HIE
Initiate oral feeling if sucking reflexes are present
Breastfeed or feed expressed breast milk via cup or NGT
Adjust oral feed based on what the infant can tolerate.

15. Management of convulsions
If convulsions, always rule out hypoglycemia first. Check
RBG <2.6mmol/l give D10% 2mls/kg
1st line Iv phenobarbitone 20mg/kg. Repeat after 30min by
10mg/kg if still convulsions, and then 3rd dose 10mg/kg
after 30min if still convulsions occur.
Start maintenance 5mg/kg/d OD 24hrs after loading dose.
2nd line. Levetiracetam 15-20mg/kg Iv over 15-20min
If still convulsions, go to 3rd line
Phenytoin iv 20mg/kg slowly

16. Tertiary preventions
Management of complications
Oxygen target 90-95%,-for term baby, 88-95%-Preterm
2. Infections
Iv ampicillin + Gentamycin+ Cloxacyllin

17. 4.CARE OF SMALL AND SICK
NEWBORN
Danger signs for sick baby
1.Not feeding (after 6hrs of age)
2.Vomiting everything
3.Body weight <1500g
4.Fever >37.5°C/hypothermia <36°C
5.Jaundice before 24hrs
6.Diffcult in breathing ( chest in drawing,grunting,
RR>60/mn, <30/mn

18. Cont..
7.convulsions
8.Reduced or no movement
9.Bleeding
10.Cyanosis
Newborn at Risk

19. Problems of Prematurity
Problemes in respiration
Central (Apnea)
RDS (lung surfactant deficiency)
Hypoglycemia
Hypothermia
Emergency signs
Severe respiration distress
Bleeding
Shock

20. Cont..
Estimated amount of blood in newborn is about 80mls/kg
Management of bleeding
Identify source of bleeding
If umbilical cord, clam cord propery or tie
Give iv vit k 2mg stat, then cont OD for 3days if bleeding
continues.
Take blood grouping and x-match, other may need
transfusion depending on amount of blood loss.

21. Management of shock
Iv NS or RL 10mls/kg over 10min, repeat once after
20min if signs of shock are persist.
Management of hypoglycemia
RBG <2.6mmol/L
Give Iv D10% 2mls/kg bolus, then maintenance until
cause of hypoglycemia established and managed.

22. 5. KANGAROO MOTHER CARE
It is natural incubator
Is a care of small newborn who is continuously carried in
skin to skin with the mother, father or any other member
of the family and exclusively fed by breast milk.
Advantage of KMC
1.Promote nutrition growth
2. Monitoring of their breathing

23. 4. Warmth baby
5.Provide protection from infections
6.Connection to their mother
7.Support brain development
Recommended room temperature is at least 25-28°C
Positioning
Baby should be in upright, arm flexed, frog-like position, head and
chest are on mother's chest, while the head in a slight extended
position.

24. Monitoring
1. Body temp every 6hrs
<36.5°C
2. Breathing, 30-60/mn
3. Growth, measure weight daily until gaining.
Every KMC room should have its own weigh scale.

25. 6. Respiratory distress syndrome RDS
Disease of immature lungs, x-rised by
1. Luck of pulmonary surfactant with alveolar collapse
2.Decrease lung compliance
3.Failure of Oxygenation and progressive lung injury
It's most occurs in baby born before 34W GA

26. Risk factors
Premature baby (especially <34w)
Caesarean section without labour
Cold stress/Hypothermia
Maternal DM
Birth asphyxia
Multiple pregnancy

27. Clinical features
Onset within 1mn to hrs after birth
Mild to moderate cases
Tachycardia (>60/mn)
Nasal flaring, chest wall in drawing, inter costal retraction.
Expiratory grunting,
Cyanosis
Severe cases
Decrease RR <30/mn

28. SILVERMAN ANDERSON SCORE
Score 0-3
Score 4-7, stat CPAP
Score >8 , CPAP
Indication to stat CPAP
1.RDS
2.TTN
3.Meconium aspirations
4. Post extubation

29. Types of CPAP
1.
2.
3.
Management of RDS
Resuscitate first (if required) using bag and mask
Monitor with pulse Oxymeter
Oxygen or CPAP ( use Silverman Anderson score) to determine if
CPAP is indicated.

30. Cont..
Avoid over ventilation, due to risk of retinopathy of prematurity.
Prevention of RDS
1.Antenatal steroid therapy
2.Control maternal DM
3. Avoid unnecessary CS
4.Early recruitment of CPAP

31. Supportive treatment
1. Support nutrition to maintain glucose
2.IPC
Monitoring
Oxygen saturation
RR and HR
Nasal or Oral secretions
Nasal septum integrity

32. Complications of CPAP
1.Nasal irritation
2.Demage to nasal septal
7. APNEA OF PREMATURITY
is a cessation of breathing for more than 20 sec
Treatment- Iv caffeine citrate 20mg stat, then 2.5mg/kg 12hrly
for 24hrs
NB. baby should not discharged until 7days after given caffeine
citrate. . Aminophylline not recommend currently

33. Points rises
1. Wakati wa ku-initiate early breastfeeding, usimfute mtoto
hadi mikononi, unazuia natural movement ya mtoto kufuata
nyonyo ya mama.
Qn. Kama mtoto amejaa meconium hadi mikononi,tusimfute?
Qn. How long should cord clamping delay.
Response; 1-3minutes

34. Qn. Mtoto anatakiwa kuogeshwa muda gani baada ya mama
kujifungua?
Response: Do not birth the baby soon after delivery until 24hrs
Qn. Inashauriwa mtoto abaki skin to skin na mama yake, Je
ikitokea mama amepata shida wakati wa kujifungua (eg.perineal
tear)