Essential newborn care


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Essential newborn care

  1. 1. Essential Newborn CareImmediate and thorough dryingEarly skin-to-skin contactProperly timed cord clampingNon-separation of the newborn andmother for early initiation ofbreastfeedingTime Band: Within 1st 30 secsImmediate Thorough Drying• Call out the time of birth
  2. 2. • Dry the newborn thoroughly for at least 30seconds– Wipe the eyes, face, head, front and back, armsand legs• Remove the wet clothTime Band: Within 1st 30 secsImmediate and Thorough Drying• Do a quick check of breathing while drying• Notes:– During the 1st secs:• Do not ventilate unless the baby isfloppy/limp and not breathing• Do not suction unless the mouth/nose areblocked with secretions or other materialTime Band 0 - 3 mins:Immediate, Thorough Drying• Notes:– Do not wipe off vernix– Do not bathe the newborn– Do not do footprinting
  3. 3. – No slapping– No hanging upside - down– No squeezing of chestTime Band: After 30 secs of dryingEarly Skin-to-Skin Contact• If newborn is breathing or crying:– Position the newborn prone on the mother’sabdomen or chest– Cover the newborn’s back with a dry blanket– Cover the newborn’s head with a bonnetTime Band: After 30 secs of dryingEarly Skin-to-Skin Contact• Notes:– Avoid any manipulation, e.g. routinesuctioning that may cause trauma or infection– Place identification band on ankle (not wrist)– Skin to skin contact is doable even forcesarean section newborns
  4. 4. Time Band: 1 - 3 minsProperly - timed cord clamping• Remove the first set of gloves• After the umbilical pulsations havestopped, clamp the cord using a sterileplastic clamp or tie at 2 cm from theumbilical base• Clamp again at 5 cm from the base• Cut the cord close to the plastic clampTime Band: 1 - 3 minsProperly - timed cord clamping• Notes:– Do not milk the cord towards the baby– After the 1st clamp, you may “strip” the cordof blood before applying the 2nd clamp– Cut the cord close to the plastic clamp so thatthere is no need for a 2nd “trim”– Do not apply any substance onto the cordTime Band: Within 90 minsNon-separation of Newborn
  5. 5. from Mother forEarly Breastfeeding• Leave the newborn in skin-to-skin contact• Observe for feeding cues, including tonguing,licking, rooting• Point these out to the mother and encourageher to nudge the newborn towards the breastTime Band: Within 90 minsNon-separation of Newbornfrom Mother forEarly Breastfeeding• Counsel on positioning––––Newborn’s neck is not flexed nor twistedNewborn is facing the breastNewborn’s body is close to mother’s bodyNewborn’s whole body is supported
  6. 6. Time Band: Within 90 minsNon-separation of Newbornfrom Mother forEarly Breastfeeding• Counsel on attachment and suckling––––Mouth wide openLower lip turned outwardsBaby’s chin touching breastSuckling is slow, deep with some pausesTime Band: Within 90 minsNon-separation of Newbornfrom Mother forEarly Breastfeeding• Notes:
  7. 7. – Minimize handling by health workers– Do not give sugar water, formula or otherprelacteals– Do not give bottles or pacifiers– Do not throw away colostrumTime Band: Within 90 minutesNon-separation of Newbornfrom Mother forEarly Breastfeeding• Weighing, bathing, eye care, examinations,injections (hepatitis B, BCG) should be doneafter the first full breastfeed is completed• Postpone washing until at least 6 hours To establish, maintain and support respirations. To provide warmth and prevent hypothermia. To ensure safety, prevent injury and infection. To identify actual or potential problems that may require immediate attention.Establish respiration and maintain clear airwayThe most important need for the newborn immediately after birth is a clear airway to enable thenewborn to breathe effectively since the placenta has ceased to function as an organ of gasexchange. It is in the maintenance of adequate oxygen supply through effective respiration thatthe survival of the newborn greatly depends.Newborns are obligatory nose breathers. The reflex response to nasal obstruction, opening themouth to maintain airway, is not present in most newborns until 3 weeks after birth.To establish and maintain respirations:1. Wipe mouth and nose of secretions after delivery of thehead.2. Suction secretions from mouth and nose. Compress bulb syringe before inserting
  8. 8.  Suction mouth first, then, the nose Insert bulb syringe in one side of the mouth 3. A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously, or if the cry is weak. Do not slap the buttocks rather rub the soles of the feet. Stimulate to cry after secretions are removed. The normal infant cry is loud and husky. Observe for the following abnormal cry:  High, pitched cry – indicates hypoglycemia, increased intracranial pressure.  Weak cry – prematurity  Hoarse cry – laryngeal stridor 4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote drainage of secretions. Trendelenburg position – head lower than the body Side lying position – If trendelenburg position is contraindicated, place infant in side lyingposition to permit drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine position.5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction.Newborns are obligatory nose breathers until they are about 3 weeks old.Care of the EyesIt is part of the routine care of the newborn to give prophylactic eye treatment against gonorrheaconjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passedon the fetus from the vaginal canal during delivery. This practice was introduced by Crede, aGerman gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic ointmentsare the drugs used for this purpose.Erythromycin or tetracycline Opthalmic Ointment:1. These ointments are the ones commonly used now a days for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis.2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes.Vitamin K or AquamephytonThe newborn has a sterile intestine at birth, hence, the newborn does not possess the intestinalbacteria that manufactures vitamin K which is necessary for the formation of clotting factors.This makes the newborn prone to bleeding. As a preventive measure, .5 (preterm) and 1 mg (fullterm) Vitamin K or aquamephyton is injected IM in the newborn’s vastus lateralis (lateralanterior thigh) muscle.Care of the cordThe cord is clamped and cut approximately within 30seconds after birth. In the delivery room, the cord isclamped twice about 8 inches from the abdomen and cut inbetween. When the newborn is brought to the nursery,another clamp is applied ½ to 1 inch from the abdomen andthe cord is cut at second time. The cord and the area aroundit are cleansed with antiseptic solution. The manner of cordcare depends on hospital protocol. What is important is thatthe principles are followed. Cord clamp maybe removedafter 48 hours when the cord has dried. The cord stump usually dries and fall within 7 to 10 daysleaving a granulating area that heals on the next 7 to 10 days.Instruction to the mother on cord care:
  9. 9. 1. No tub bathing until cord falls off. Do not sponge bath to clean the baby. See to it that cord does not get wet by water or urine.2. Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution which is 70% alcohol.3. Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine.4. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air.5. If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten.6. Report any unusual signs and symptoms which indicates infection.  Foul odor in the cord  Presence of discharge  Redness around the cord  The cord remains wet and does not fall off within 7 to 10 days  Newborn feverTHE APGAR SCORING SYSTEMThe APGAR Scoring System was developed by Dr.Virginia Apgar as a method of assessing the newborn’sadjustment to extrauterine life. It is taken at one minute andfive minutes after birth. With depressed infants, repeat thescoring every five minutes as needed. The oneminute score indicates the necessity for resuscitation. Thefive minute scoreis more reliable in predicting mortalityand neurologic deficits. The most important is the heartrate, then the respiratory rate, the muscle tone, reflexirritability and color follows in decreasing order. A heartrate below 100 signifies an asphyxiated baby and a heartrate above 160 signifies distress.ASSESS 0 1 2HEART RATE Absent Below 100 Above 100RESPIRATION Absent Slow Good cryingMUCLE TONE Flaccid Some flexion Active motion
  10. 10. REFLEX IRRITABILITY No response Grimace Vigorous cryCOLOR Blue all over Body pink, Pink all over Extremities blueScore: 7 – 10 Good adjustment, vigorous Moderately depressed infant, needs airway clearance Severely depressed infant, in need of resuscitation.ASSESSING THE AVERAGE NEWBORNHead Circumference 34 – 35 cmTemperature 97.6 – 98.6 F axillaryChest Circumference 32 – 33 cmHeart Rate 120 – 140 bpmRespirations 30 – 60 bpmWeight 2.5 to 3.4 kgLength 46 to 54 cm