nursing care of newborn.nursing management of newborn

1. Nursing Care Of
Neonates
UNIT:3
By: Sakshi Srivastava
Associate professor
KINPMS

2. OBJECTIVES
• Basic care of newborn
• Hygiene measures
• Breast feeding
• immunization

3. Definition:-
 Essential new born care is
comprehensive stagey designed to
improve the health of newborns through
interventions before conception ,during
pregnancy at and soon after birth ,and in
the postnatal period .Treatment of key
problems such as sepsis and birth
asphyxia.

4. IMMEDIATE BASIC CARE OF
NEONATES:
1)Deliver the baby on a warm and
clean towel.
2)Establish and maintain a patent
airway. 3)Ensure warmth
4)Assessment and
documentation of
baby’s
condition.
5)care of
eyes
6)clamp and cut the
cord

5. 7)care of
skin
8)Administration of vitamin
K
9)Identification of baby.
10)Transfer of baby according
to
level of care
required.

6. 1)Deliver the baby on a warm
and clean towel.

7. 2)Establish and maintain a
patent airway

8. 3)Ensure
warmth

9. 4)Assessment and
documentation of baby’s
condition

10. 5)care of
eyes

11. 6)clamp and cut the
cord

12.  The umbilical cord is clamped when the cord
pulsation stops as this provides the infant extra
blood from the placenta.
 Delay in clamping for 2–3 minutes or till cessation
of the cord pulsation facilitates transfer of 80-100
mL blood from the compressed placenta to a baby
when placed below the level of uterus.This is
beneficial to amature baby but may be deleterious
to a pre-term or a low birth weight baby due to
hypervolemia.
 But early clamping should be done in cases of
Rh- incompatibility (to prevent antibody transfer
from the mother to the baby or babies born
asphyxiated or one of a diabetic mother.

13. 7)care of
skin

14. 8)Administration of vitamin
K

15. 9)Identification of
baby.

16. 10)Transfer of baby according
to level of care required.
 Level II Nursery:- Preterm babies with i)
Gestational age between 32-36 weeks ii)Low
birth weight (1500- 2000gm) iii)Major congenital
malformation or iv)Suspected of having
aspirated meconium ,should be transferred to
special care nursery.
 Level III Nursery :-The following categories of
neonates should be admitted to intensive Care
Nursery i)Birth weight less than 1.5kg
ii)Gestational period less than 32 weeks
iii)Neonates with respiratory distress iv)Infants with
convulsions,central cyanosis(Congintal heart
disease),severe Neonate jaundice
(erythroblastosis fetails) and those requiring
major surgery

17. HYGIENE
MEASURES
1)Rooming
in
2)Initiating breast feeding
3)Observation of early signs of
disease 4)Prevention of infection
5)Care of bladder and bowel
6)Maintenance of personal hygiene
7)Parental teaching and follow up

18. 1)Rooming
in

Promotes early initiation
of breast feeding

Provides opportunity for
mother baby interaction and
bonding.

Relieves mother ‘s
anxiety related to where
about of the baby.

20. 3)Observation of early signs
of disease
Failure to pass meconium within 24 hours of birth
Failure to pass urine within 48 hours of birth
Failure to take feed.
Excessive crying or undue lethargy.
Jaundice within 24 hours of birth(Pathological
Jaundice)
Hypothermia or Hyperthermia
Seizures
Persistent vomiting or diarrhea
Evidence of superficial infection like oral
thrush,conjunctivitis,umbilical cord pustules on
skin etc.

21. 4)Prevention of infection:
 All personnel coming in contact with
the baby should be free from infection
 Hand washing should be
practiced strictely
 Strict aseptic precautions should be
taken while handling the baby.
 The personal hygiene of mother and
baby should be maintained
 Restrict the number of visitors
attending the baby.

22. 5)Care of bladder
and
Bowel:
 If the neonate fails to pass
urine and stool within 24
hours of birth ,it should be
notified to the physician.

The urine output is about
200- 300ml by the end of
first week of life so neonate
voids about 15-20 times in a

23. 6)Maintenance of
personal
hygien
e

24. 7)ParentalTeaching and follow
up:
The period when mother is in post natal ward
can be utilized for teaching the mother about
all aspects of baby care.
Parents are taught to observe the child’s
daily behaviorrelated to
feeding,sleep,activity,cry,elimination etc.
Parents need to be told about- holding the
baby,baby bath,eye and cord care ,feeding
and nutritional
supplements,immunization,prevention from
infection and follow up.
The parents should be educated about the
danger signs in the baby, which if present

25. NEW BORN NUTRITION
NUTRITIONAL REQUIREMENTS IN
THE NEONATE
The infant should get sufficient fluid.
Fluid intake should be 150–175 mL/kg body
weight per day
The infant should get adequate calorie. A
term healthy infant needs 100–110 KCal/kg of
body weight per day.Low birth weight infant
needs about 105–130 KCal/kg/ day.Each 30
mL (1 oz) of breast milk gives 20 calories.
Calorie needs are primarily dependent on
oxygen consumption

26. The food should have a
balanced composition of
protein (2–4 g/kg/day), fat
(4–6 g/kg/day),
carbohydrate (10–15
g/kg/day), minerals and
vitamins and it should be
easily digestible.

27. If the baby does not
responding after
birth then what we
should do????

28. Newborn Resuscitation
20% death occur due to the
birth asphaxia developmental
delay,vision loss,cerebral palsy.
For most babies, the immediate
care give at the birth is enough
to stimulate the baby to start
breathing.

29. 

Approximately 10% of newborns require some
assistance to begin breathing at birth.Less
than 1% require extensive resuscitation
measures.
◦ Term Gestation?
◦ Crying or
breathing?
◦ Good muscles
tone?
 If answer to all these questions is “YES’’,
the baby does not need resuscitation.The
baby should be dried and placed in skin –
to-skin contact with the mother.Apgar
scoring should be done simultaneously.If
answer to above three questions is
“NO’’,the infant requires resuscitation.

30.  TABC of
Resuscitation


T-Maintenance of
Temperature
◦ Dry the baby
quickly
◦ Remove wet
linen
◦ Place the baby under radiant
warmer A-Establish an open
airway
◦ Position the
infant
◦ Suction mouth and nose {in few cases
also trachea}
◦ ET intubation ,if needed to ensure open
airway.

31. Position of Baby




Place the baby on his back on
a flat surface.
Position the head so that the
neck is slightly extended. We
may put a rolled cloth under
the shoulders to maintain the
position.
The resuscitation surface
should be well lit and warm.
Keep the baby’s head and
lower body covered to keep
him warm.

32.  B-Initiate
Breathing
◦Tactile stimulation to
initiate respiration
◦ PPV when necessary ,using
either Bag and mask or mask
or Bag and ET tube.
 C-
circulation
 Chest
compression
 Medication [if
needed]

33.  Step 3: Ventilate




Ventilate about 40 times in 1 minute.
After 1 minute, stop to see if the baby starts to
breathe independently.
Continue ventilation until the baby spontaneously
cries or breaths
If there is no breathing or gasping after 20 minutes,
stop ventilation.

34.  Step 4: Monitor
 Closely monitor a baby who had resuscitation or
who has poor color, even if he appears to be
breathing well.
 If the baby’s breathing and color are good, give him
to his mother






REFERRAL AFTER RESUSCITATION
Not sustaining adequate breathing (less than 30
breaths in 1 minute) or gasping: continue
resuscitation efforts during transport
More than 60 breaths in 1 minute
Indrawing of the chest
Grunting (sound made when breathing out) The
baby’s tongue and lips are blue or the whole
body is pale or bluish.