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Basic Newborn Careat Postnatal ward/SCBU
Sri Lanka College of Paediatricians
Perinatal Society of Sri Lanka
2015
14-Dec-15 1Sri Lanka College of Paediatricians
Basic Newborn Interventions – Postnatal ward /
neonatal unit
Prevention of hypothermia
Prevention of hypoglycaemia
Promoting exclusive breast feeding
Kangaroo mother care (KMC)
Newborn screening
Inpatient care for sick /small newborns
Developmental care
Advice on discharge
Follow-up in the community14-Dec-15 2Sri Lanka College of Paediatricians
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Four ways a newborn may lose heat to the environment
Mechanisms of heat loss
Conduction
Radiation
ConvectionEvaporation
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Normal range
Cold stress
Moderate hypothermia
Severe hypothermia Outlook grave, skilled
care urgently needed
Danger, warm baby
Cause for concern
37.5o
36.5o
36.0o
32.0o
Definition & degrees of hypothermia
14-Dec-15Sri Lanka College of Paediatricians
Prevention of hypothermia
Room temperature (260C - 280C)
Check baby’s axillary temperature on admission
Rooming-in
Assess warmth every 4 hours
Bathing: delay
Breastfeeding – position and attachment
Keep radiant warmer ready, if necessary Prevent
hypothermia
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Prevention of hypothermiababies with mother
Prevent
hypothermia
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Prevention of hypothermia
14-Dec-15
Appropriate clothing – after drying,
hat, socks (mittens), towels, blanket
Prevent
hypothermia
Sri Lanka College of Paediatricians
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Bathing the baby – when appropriate only
Warm room – warm water Dry quickly & thoroughly
Dress warmly and wrap Give to mother to breast feed
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Should be delayed in sick and small babies
When bathing – minimise risk of hypothermia
Sri Lanka College of Paediatricians
Prevention of hypoglycaemia
• Hypoglycaemia is preventable
• Symptomatic hypoglycaemia for long periods: dangerous
• Prevention
• Prevent hypothermia
• Correct breastfeeding technique - position and attachment
- resolving problems
• Monitor blood sugar of high risk infants – SGA,LGA,
infants of diabetic mothers, preterm, sick 14-Dec-15 9Sri Lanka College of Paediatricians
Kangaroo mother care (KMC)
Mother will be the incubatorReduces workload of nurses
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Kangaroo mother care (KMC)
What is it?
Skin-to-skin contact.
Dressed only in nappy
Baby next to carer’s chest
Advantages:
Temperature more stable
Babies mature faster
Breastfeeding easily established
Infection less in baby
Babies sleep & breathe better
Bonding increases14-Dec-15 11Sri Lanka College of Paediatricians
KMC eligibility criteria: baby
Birth weight >1800 gm:Start at birth
Birth weight 1200-1799 gm:takes a few days
Birth weight <1200 gm:may take weeks to initiate
12Hemodynamic stability is a MUST14-Dec-15Sri Lanka College of Paediatricians
KMC - monitoring
Check
Neck position - neutral
Airway - clear
Breathing - regular
Colour - pink
Temperature - stable
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Head position in KMC
Sri Lanka College of Paediatricians
Effect on temperature
Swings in temperatureConstant temperature in KMC
Ludington-Hoe etal, Whitlaw A
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KMC - Enhances mother’s milk production
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KMC - examples of binders :
Use locally available garments
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KMC - duration
Start KMC in the PBU
Practice at least one hour sessions initially
Transit from conventional care to longer KMC
Transfer baby to post-natal ward and continue KMC
Increase duration up to 24 hours a day14-Dec-15 17
Sri Lanka College of Paediatricians
KMC - discontinuation
Term gestation
Weight ~ 2500 gm
Baby uncomfortable
Wriggling out
Pulls limbs out
Cries and fusses
Mother can continue KMC
after giving the baby a bath
and during cold nights14-Dec-15 18
Sri Lanka College of Paediatricians
Newborn examination
Complete head to toe check
By medical officer
All babies before discharge
Clear follow-up plans
Birth defects – notify for Birth Defect surveillance
• Discharge weight 14-Dec-15 19Sri Lanka College of Paediatricians
Newborn screening
• Neonatal examination (birth defects)
• Pulse oximetry screening for critical congenital heart disease
• Hypothyroidism screening – TSH
• Hearing screening
• Preterm babies – retinopathy of prematurity screening
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Pulse oximetry screening
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Hypothyroidism screening
• Heel prick TSH– to Karapitiya (MRI also in the
future)
Hearing screening
Done in postnatal ward
In a quiet room
Oto-acoustic emission
Done in a few hospitals currently
Hypothyroid and hearing screening
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Danger signs
Bleeding
Jaundice – early extensive, prolonged
Failure to pass meconium or urine within 24 -48
hours
Bile-stained vomiting
Persistent vomiting
Poor feeding
Undue lethargy
Excessive crying14-Dec-15 23Sri Lanka College of Paediatricians
Danger signs (continued)
Drooling of saliva /choking
Respiratory difficulty/apnoea/ cyanosis
Body temperature changes
Seizures
Evidence of infections
conjunctivitis,
pustules,
umbilical sepsis
oral thrush
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Advice on discharge
Keep warm
Wash hands
Minimise handling
Restrict visitors
Know danger signs - seek help
Exclusive breastfeeding
- check technique
– LMC for follow-up
Home visits by PHM
Immunisation
Ensure baby check done & CHDR given 14-Dec-15 25Sri Lanka College of Paediatricians
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Questions
Sri Lanka College of Paediatricians
Basic Newborn Interventions – Postnatal ward /
neonatal unit
Prevention of hypothermia
Prevention of hypoglycaemia
Promoting exclusive breast feeding
Kangaroo mother care (KMC)
Newborn screening
Inpatient care for sick /small newborns
Developmental care
Advice on discharge
Follow-up in the community14-Dec-15 27Sri Lanka College of Paediatricians