Post on 06-May-2015
transcript
Care of a Newborn
Download more documents and slide shows on The Medical Post [ www.themedicalpost.net ]
Dr. Kalpana MallaMD Pediatrics
Manipal Teaching Hospital
Care of Normal Newborn
Definition
• Neonatal period/neonate/ newborn – first 28 days of life
• Perinatal period – 22 weeks of gestation to 7 days after birth
Definition
• Early Neonate –birth to first 7 days of life• Late Neonate –after 7 days – 28 days of lif
Definitions
Term – baby born after 37 completed weeks upto 42 completed weeks of gestationPreterm – baby born before 37 completed weeks of gestationPost-term – baby born after 42 completed weeks of gestation
Definitions
• SFD / SGA : birth weight is <10TH CENTILE
FOR GESTATIONAL AGE
• AFD/ AGA :Birth weight is 10TH - 90TH CENTILES FOR GESTATIONAL
AGE • LFD/ LGA :Birth weight is >90TH
CENTILE FOR GESTATIONAL AGE
Classification of NewbornA) Depending upon gestational age: Term Preterm Post-term
B) Depending upon Birth weight :
• Normal birth weight (NBW) :2500-3999 g
• Low birth weight (LBW) : <2500 g• Very low birth weight (VLBW) : <1500 g• Extremely low birth weight (ELBW) : <1000
g• Preemie : <750 g• Micropreemie : <500 g
Very Low Birth weight: 1000-1500g
Very Low Birth weight: 1000-1500g
Extremely low birth weight: 500-1000g
C) Depending upon Gestational Age & B.WT
Preterm - SFD / SGA AFD/ AGA LFD/ LGATerm -SFD / SGA AFD/ AGA LFD/ LGAPost –Term - SFD / SGA AFD/ AGA LFD/ LGA
Plotting Weight, Length, HC
Component of Newborn care
1. Clean delivery & clean cord care2. Maintanance of body temperature –
room warm/cloths-cap, socks,oil massage
3. Skin care- sponge, not to scrub vernix4. Care of umbilical stump – keep dry (fall
after 5-10days)5. Care of eyes
Component of Newborn care
6. Breast feeding7. Weight record8. Early detection of serious Ds9. Immunization10. Supplements and follow up
Follow up
• Well baby clinic – evaluation• Exclusive breast feeding• Growth and development• Immunization• Nutrition advice
Care at birth-DELIVERY ROOM CARE
• Ensure clean and safe delivery• Delivery room - Clean, well ventilated,
adequately lighted, warm room• Temperature stabilisation• Suction - mouth and nostril• Cut the umbilical cord -2.5 inch from skin• Weigh and classify• Assess under warmth
Basic care of the normal newborn
1.Rooming in
2. Receive the baby in sterile sheet
Cover adequately and dress
3. Check color, respiration, temperature, and umbilical cord
4. Record skin temperature
Basic care of the normal newborn Mother’s role - Has instinct, concern, interest, love and affection - Can involve in nursing care - Recognition of early evidence of disease
Basic care of the normal newborn
Mother’s roleBreast feeding
- First feed within 1-2 hours
- No prelacteal feeds
- Colostrum to feed
- No need of water
- Demand feeding 2-3 hours -15-20min, Burp
- Adequacy of breast feeding
Care of normal newborn
• Maintenance of body temperature • - Avoid bath on first day• - Cover adequately and dress• Bath• - At birth - clean blood, mucus and meconium• - Bath can be given on next day, use unmedicated • soap and lukewarm water• - Sponging is sufficient• - Avoid dip bath• Skin care• - No need to clean all vernix, but clean blood and
meconium• - Skin abrasions - use topical antibiotics
Care of normal newborn
• Cord care Clamp, inspect 2- 4 hourly for bleeding, no dressing, spirit cleaning of tip and around the base• Eye care Sterile cotton swab cleaning, each eye separately, no kajal application• Vitamin K - 1mg IM within 2 hours of life• Dresses Loose, soft, preferably cotton, woolen, nappies
Care of normal newborn
Routine care(Term, vigorous, crying, pink
good tone , no meconium)
– Put on mother’s chest
– Dry– Cover with dry linen– Skin to skin contact– Clear airway
Supportive care• Warmth• Position • Suction• Dry• Stimulate• Give O2
Care during subsequent period
1.Weight recording - daily - Weight loss during first 2-3 days, 5-8% of body weight - Stationary for next 1-2days - Regain birth weight - at the end of first week - Average weight gain thereafter- 30g / day2. Immunisation - BCG3. Discharge plan and future visits
Grades of care of newborn
Level I care:• >89% require minimal care• Wt >2000gm• Gest maturity ≥ 37 weeks• Care provided at – home/subcenter/primary
health care
Level II care :
• 10-15% require this care• Wt- >1500gm• Gest maturity 32-36 weeks• Needs specialized neonatal care supervised by
trained nurses /pediatrician• Equipments – Et tube/Laryngoscope - IV infusion, NG tube, - Phototherapy - Facility for exchange transfusion ect
Level III care• 3-5% require this care• Intensive neonatal care• < 1500 gm• Gest < 32 weeks• Skilled neonatologists/trained nurses• Equipments – incubator, oxygen - Suction apparatus - Ventilator - Infusion pump, trancutaneous
monitors
Early detection of serious disease
1. Bleeding from any site
2. Jaundice appearing <24 hours / Deep
jaundice / Physiological jaundice
3. Not passed meconium within 24 hours / urine within 48 hours
4. Regurgitation, vomiting / loose stools
5. Poor feeding / lethargy/ Excessive sleepiness
Early detection of serious disease
6. Excessive frothiness / drooling of saliva
7.Cold to touch / fever / Dehydration fever
8.Abdominal distension
9.Difficult / rapid breathing
10.Convulsions
Common neonatal problems
11. Excessive cry- hunger, discomfort, full bladder, colic, insect bite, soiling
12.Superficial infections - skin pustules,
umbilical, sepsis, conjunctivitis, oral
thrush
13.Blocked nasolacrimal duct
Minor developmental pecularities
1. Erythema toxicum /urticaria neonatorum-erythematous rash with central pallor ,appears on 2-3rd day in term baby, starts on face & spreads to trunk & extremities in 24 hrs, disappears in 2-3 days
2. Peeling skin3. Milia- retention sebum4. Mongolian blue spot
Minor developmental pecularities
5. Subconjunctival hge6. Epstein pearl – epithelial inclusion cysts7. sucking callosities8. Tongue tie9. Hymenal tags/ non retractable prepuce10.Prominent xiphisternum11umbilical hernia
Minor developmental pecularities
13. disorders due to transplacental passage of hormones – Mastitis neonatorum
- vaginal bleeing - mucoid vaginal secretions
Criteria of normal newborn
1. Gestation – 37-42 completed weeks2. Birth wt – 2500 – 3999gm3. Breathing – spontaneous,regular,RR – 30-
60/min4. Color – pink but slight peripheral cyanosis
soon after birth5. Heart rate – 100 -160/min6. Temp ( axillary) – 97.5-990 F
Criteria of normal newborn
7. HC – 33-35cm8. Length – 50 cm9. Chest circumference – 3 cm< HC10.Upper segment : lower segment – 1.7-1.9:111. Sucks soon after birth12. Sleeps – 18 hr/day13.Physiological photophobia, sclera bluish
Criteria of normal newborn
14. Ear cartilage – firm with good elastic recoil15. Breast nodule > 5 mm16.Liver palpable – 2 cm17. Genitalia –Male -Testes in scrotum,deeply pigmented
scrotum/adequate rugaeFemale -Labia minora covered by labia majora18. Sloes – >anterior 2/3rd show deep crease
Criteria of normal newborn
19. Muscle tone – increased by adult standard/attitude of flexion
20. 95% term & preterm void within 24 hrs but some pass in 48hrs
21. 99% term & 95% preterm pass meconium within 24- 48 hrs of birth
22. No apparent cong anomalies
Examination of newborn
Examined region by region • Soon after birth• At 24 hrs of life• Before dischargePre-requisites • Wash and dry hands• Good light• Warm environment • Concent
Examination of newborn
1.Overall impression – face,trunk,limbs,activity2.Measurements – wt/length/HC3. Color – pink,jaundice4. Skin – pallor /jaundice/erythema toxicum5. Head –fontanelles/ sutures/ cephalhematoma/
superficial injuries6. Face – dysmorphic features
Examination of newborn
7.Ears – low set/demormity8. Eyes – discharge/inflammation/cataract9. Nose – choanal atresia10. Mouth – cleft palate
/macroglossia/micrognathia/excessive frothing
11. Neck – sternomastoid tumour /branchial & thyroglossal cysts/webbing neck/short neck/neonatal goiter/ cystic hygroma
Examination of newborn
12. Upper limbs – erb’s palsy/Klumky’s palsy/extra digits
13. Chest – accessory nipples/wide apart nipple/breast hypertrophy/lung field
14. CVS – mumurs15. abdomen – organomegaly/distension
/bowel sound16. umbilical cord – single U. artery/signs of
sepsis
Examination of newborn
17. Hip – congenital dislocation of hip18. Genitalia 19.Anus – imperforated anus20. Feet – club feet/sole creases21. Spine – midline defect ( spina bifida)/
meningomyelocele22. Primitive reflexes
Thank youDownload more documents and slide shows on The
Medical Post [ www.themedicalpost.net ]