4_immediate care of the nb

8/9/2019 4_immediate Care of the Nb

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Phil. ENCC 1

Care of the newborn at the time of

birth

Immediate Newborn Care


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Phil. ENCC 2

Care of the newborn at the time of birth

Immediate

Newborn

Care


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Phil. ENCC 3

Objectives

To describe and carry out the evidencebased routine care of a newborn baby atthe time of birth and prevent

complications.


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Phil. ENCC 4

The birth of JojoD11

To keep Jojo

alive and

healthy,what are his

immediate

needs?


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Phil. ENCC 5

Basic Needs of a Baby at Birth

To breathe normally

To be warm

To be protected

To be fed


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Phil. ENCC 6

PREPARATIONS PRIORTO DELIVERY

Equipment for Child Birth:

yPCPNC Manual D11, L3

yNewborn Care Protocol p.31-32

Wash hands

Wear Gloves

Line up materials for deliveryaccording to sequence of use


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Phil. ENCC 7

Broken equipment is dangerous!


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Phil. ENCC 8

Broken equipment is dangerous!

Equipment must be checked daily andwell before a delivery takes place.

Resuscitation equipment should alwaysbe close to the delivery area

Health workers must know how to use theequipment. Restock after every delivery.

D11


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Phil. ENCC 9

Care of the Normal Newborn at Birth

Role Play

y Two participantsy Scenario: mother delivers a normal baby


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Phil. ENCC

Immediate Newborn Care *

Deliver the baby prone on the mothersabdomen

Call out time of birth.

Dry the newborn thoroughly. Remove wet cloth.

Check breathing (while drying)

Position the newborn on the mothers abdomen

in skin-to-skin contact. Cover the back with a dry

blanket.

y If this is not possible, place newborn in a warm,

safe place close to the mother.

Examine page 5 of DOHNewborn Care Protocol


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Phil. ENCC


Remove first set of gloves. Clamp and cut the cord.

Place the newborn on the mothers chest in

skin-to-skin contact Cover the babys head with a hat. Cover the

mother and baby with a warm cloth.

Initiate breastfeeding while maintaining

skin-to-skin contact.

Place identification band on ankle.

Examine page 5 of DOHNewborn Care Protocol


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If baby is not breathing, dry andstimulate.

If after 30 secs, and patient fails tobreath:

y suction, change gloves and cut cordquickly

y transfer to a firm, warm surface and startnewborn resuscitation K11


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Phil. ENCC 13

Specific Care of the Baby in the Immediate

Period after Delivery

A. Drying the newborn- Stimulates the newborn to breathe normally- Minimizes heat loss

Duration: ~ 30 seconds

Do not rub off vernix!


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Drying the baby immediately after birth

Babys need to

breath

normally

-02 to brain

-RR=30-60

90% of newborns do

not have problems

with their breathing

after birth.

Phil. ENCC


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Phil. ENCC 15

Immediate Care of the Newborn

During the 1st 30 seconds of drying /

stimulation:

y Do not suction unless mouth/nose are

obstructed with secretions or othermaterial

y Do not ventilate unless apneic baby isfloppy


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Phil. ENCC 16


B. Skin-to-Skin Contact

-Provides warmth

-

Improves bonding-Provides protection from infection by

exposure of the baby to good bacteria ofthe mother

-Increases the blood sugar of the baby


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Keeping the baby warmImmediate skin-to-skin contact

use warm cover ifroom temp


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Phil. ENCC 18


C. Non-immediate clamping of the

umbilical cord

- Allows the newborn to get a free bloodtransfusion from the placenta

-Reduces the risk of anemia in both term and

preterm babies

-Reduces the risk of transfusions andintraventricular hemorrhage in preterms


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Phil. ENCC 19

Initial Cord Care (Non-immediate Cord Clamping)

Remove the first set of gloves. If not possible, wash

gloved hands.

Clamp and cut cord after cord pulsations stop (1-3

minutes)

y Put plastic clamp or tie tightly around cord at 2cm and the forceps5cm from babies abdomen.

y Cut between ties with a sterile instrument.

y Observe for oozing blood. If blood oozes, place a second tie

between the skin and first tie.

DO NOT apply any substance to stump.

DO NOT bind or bandage stump.

Leave stump uncovered.


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Phil. ENCC 20

After Cord Care

Exclude a second baby

Never leave the mother and baby

unattended


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Phil. ENCC 21

D. Assessing the babyDuring the first hour after complete

delivery of the placenta, the baby (andthe mother) should be monitored every

15 minutes.After the cord is cut, examine baby:

assess the baby for any signs of illness,

e.g. chest in-drawing J2

If the baby is doing well, continue skin-to-skin contact and provision of warmthK 9


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Phil. ENCC 22

E.Initiation ofBreastfeeding

Leave baby the newborn between themothers breasts in skin-to-skin contact.

To begin with the baby will want to rest.

Every baby is different and the rest

period may take from a few minutes to30 or 40 minutes before the babyshows signs of wanting to breastfeed.


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Phil. ENCC 23

Initiation ofBreastfeeding

Help the mother and baby into a comfortableposition

Observe the newborn. Only once the

newborn shows feeding cues (e.g. openingof mouth, tonguing, licking, rooting) K2,make verbal suggestions to the mother toencourage her newborn to move toward the

breast e.g. nudging.


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Phil. ENCC 24

Skin-To-Skin Contact and Breastfeeding


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Signs of Readiness to Breastfeed: Feeding Cues


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Phil. ENCC 27

Importance of first

breastfeedingofcolostrum


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Phil. ENCC 28

Initiation ofBreastfeeding

Health workers should not touch the newborn unlessthere is a medical indication.

Do not give sugar water, formula or otherprelacteals.

Do not give bottles or pacifiers.

Do not throw away colostrum.

If the mother is HIV-positive, see G7G8 ofPCPNC forspecial counseling


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Phil. ENCC 29

Standard precautions MUST be followed as with ANY otherdelivery and after care.

Her baby can have immediate skin-to-skin contact as any othermother and baby.

Breastfeeding can begin when the baby is ready after delivery.

DO NOT GIVE the baby any other food or drink.

Good attachment and positioning is vital to prevent breastproblems.

Ifreplacement feeding G8prepare formula for the mother forthe first few feeds to be given by cup NOT bottle. G8

If the Mother has HIV/AIDS


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Phil. ENCC 30

SPECIAL SITUATIONS

*What should be done if a baby does not feedin one hour after birth?

Help the mother to initiate breastfeeding

within 1 hour, when baby is ready K2 If the baby does not feed in 1 hour, examine

the baby (J2-J9).

If healthy, leave the baby with the mother to

try later. Assess in 3 hours, or earlier if the

baby is small (J4).


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SPECIAL SITUATIONS

*How can a baby be fed if the mother is ill ?

If the mother is ill and unable to breastfeed, helpher to express breast milk and feed the baby bycup (p.J6).

*What options are there for a mother who cannotbreastfeed at all?

If unable to initiate breastfeeding,

plan for alternative feeding method K5-K8

What difficulties do you encounter in the ff:

Breech delivery


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Phil. ENCC 32

The first breastfeed

To help a baby successfully breastfeed soon after

birth, we: position the newborn prone on the mothers

abdomen in skin-to-skin contact.

may transfer the newborn to a position between herbreasts so that the baby can feed when it is ready.

check the position and attachment when the baby isfeeding.

let the baby feed for as long as he/she wants onboth breasts.

keep the mother and baby together for as long aspossible after delivery,

delay tasks such as weighing, bathing injections etcuntil after breastfeeding has been started.


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Phil. ENCC 33

Monitoring of the Baby

The babys breathing and warmth should bemonitored by a health professional every 15minutes for the first hours after birth and deliveryof the placenta.

- Breathing: listen for grunting, look for chest in-drawing andfast breathing.

- Warmth: check to see if feet are cold to touch.

DO NOT leave the mother and baby alone duringthe first hour after delivery.


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Phil. ENCC 34


What is the immediate care of NB?

What practices interrupt the time the

mother and baby may spend togetherimmediately after birth?

What practices are necessary after birth

which can be postponed later?


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Bathing the Baby

Do not bath the baby before 6 hours

after birth


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Eye care

Wipe the eyes

Apply an eye antimicrobial within 1 hour of

birth

- 1% silver nitrate drops or

- 2.5% povidone iodine drops or

- 1% tetracycline ointment or

erythromycin eye drops

D19


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INJECTIONS

AdministerVitamin K IM upper outer

quadrant (vastus lateralis) of the thigh

y 0.5 mg preterm

y 1.0 mg term

AdministerBCG and Hepatitis B vaccine


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Phil. ENCC 39

Summary

P

repare the delivery areay Keep delivery room warm, close windows

y Have resuscitation equipment near deliverybed

y Have clean warm towels/covers/cloths readyfor newborn baby at delivery

Standard precautions

y Use soap and warm water to wash andclean hands

y Double glove


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Phil. ENCC 40

Summary

Immediate Newborn Carey Dry baby with a clean cloth immediately after

delivery

y

Position the newborn prone in skin-to-skin contacton the mothers abdomen

y Remove first set of gloves

y Clamp/tie and cut cord using a sterile kit

y Keeping mother and baby in skin-to-skin contactfrom birth encourages early breastfeeding


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Dry the baby

Remove wet cloth

Keep baby warm

Check breathing

Is the baby gasping or not breathing?Clamp the cord

Perform Newborn

Resuscitation

* Place baby in skin-to-skin contact on mothers abdomen or chest

* Clamp the umbilical cord after pulsations stop at around 1-3 mins

* Encourage breastfeeding

* Do not separate the baby from the mother for at least 90 minutes

unless in respiratory distress or maternal emergency

* Do eye care, cord care

* Postpone bathing until after NB is at least 6 hours of age

Does baby have signs of illness?

Is the baby visibly small?

*After 90 minutes of age (after baby has detached from breast)

- examine the baby

- weigh the baby

- inject Vit. K, Hep B, BCG

Does the baby weigh


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Phil. ENCC 42

Videos

Immediate Newborn Care

y UP-PGH

DOH UNICEF Breast Crawl

y Jose Fabella Memorial Hospital


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Phil ENCC

4_immediate care of the nb

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