Resuscitation of new bornSBA - Presentation 5 (b) Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India

Resuscitation of new born

Resuscitation of new born*Session objectivesTo learn aboutCare of newborn immediately after deliveryNew born resuscitation

Resuscitation of new born

Resuscitation of new born*Immediate care to newbornPlace baby on mothers abdomenDry the baby with clean cloth (Do not clean the uernix)Ensure baby is crying and breathingPut clean thread ties tightly around the cord at 2 cm and 5 cm from the babys abdomen once cord stops pulsating in 2-3 minutesCut between the ties with a sterile/clean blade after 1-3 minutes

Resuscitation of new born

Resuscitation of new born*Immediate care to newbornWipe mouth and noseAvoid routine suction of babyWeigh the babyLeave the baby between the mothers breasts to start skin to skin contactCover the babys head with a clothInitiate Breastfeeding Cover the mother and the baby with a warm cloth

Resuscitation of new born

Resuscitation of new born*Immediate care to newbornWhat should you do if baby not breathing or crying? Call for help Proceed to resuscitationAnticipate the need for resuscitation, especially if the woman has history of EclampsiaVaginal bleedingProlonged/obstructed labourPreterm birth Fetal distressMultiple pregnancies

Resuscitation of new born

Resuscitation of new born*Preparation for resuscitationEquipment should always be ready and in working conditionAmbu bag self inflating with the neonatal size maskClean dry napkins to put under the babys shoulderRadiant warmer ensure that the electricity supply and connections are proper and there is no current leakage.Radiant warmer should be warmed 20 minutes prior to receiving babySuction apparatus new disposable nasogastric tube should be used each timeOxygen cylinder is available in the labour room with flow meter and the key on it.Oxygen mask or tube should be clean and disinfected

Labour room staff should be trained to use the equipments

Resuscitation of new born

Resuscitation of new born*Steps of artificial ventilationSelf-inflating Ambu bagCorrect position of the head for ventilationCorrect position of mask on the faceVentilation with bag and mask

Resuscitation of new born

Resuscitation of new born*Steps of resuscitationProvide warmth: dry and shift the baby in newborn corner and place him/her under radiant warmerPosition the baby: put 2-3 cm thick towel under babys shoulders to keep the neck in right positionClear airway: clean the mouth first and then noseDry, stimulate to breath and reposition: Drying will provide stimulus to breath. Also flick the soles or gently rub back, trunk or extremities Ventilation: use self-inflating Ambu bag with right size of maskAssess breathing: after 30 sec assess if further artificial ventilation is needed

Resuscitation of new born

Resuscitation of new born*Harmful resuscitation practicesRoutine suction of the babys stomach at birthPostural drainageSqueezing the chest to remove secretions from the airwayRoutinely giving Sodium-Bicarbonate to newborn

Resuscitation of new born

Resuscitation of new born*no meconium dry the babymeconium present suction mouth, nose & dry the babyNot breathing wellBreathing well

Initial stepsCut cord,Place on firm, flat surfaceProvide warmth, Position baby with neckslightly extended,Suction mouth and noseStimulate, repositionRoutine carePlace on mothers abdomen,Wipe mouthand nose, Cut cord after 13 minutes,Keep baby with motherInitiate breastfeeding Watch colour and breathObservation/care : Provide warmth, Observe colour, breathing and Temp. Initiate breastfeeding, Watch for complications; if present - ReferProvide bag and mask ventilation for 30 seconds; ensure chest riseContinue bag and mask,add oxygenAssess heart rate (umbilical pulsation -check for 6 secondsHeart rate 100 or continue ventilation Assess breathing. If breathing well, Slowly discontinue ventilation & provide observational careHeart rate 100 / baby not breathing well continue ventilation with oxygen. ReferNEW BORN RESUSCITATIONAssess BreathingAssess BreathingBreathing well Not breathing wellAssess BreathingNot breathing wellAssess heart rate

Resuscitation of new born

Resuscitation of new born*Postnatal adviceAdvise the mother toInitiate breastfeeding including colostrum within an hour of the birth of babyDrink warm fluids Eat full and nutritious meal Take adequate rest and sleep Maintain hygiene : perineal hygiene, use of sanitary napkins, daily bath and hand washing before handling the baby, cutting nailsCare of breasts

Resuscitation of new born

Resuscitation of new born*Role of birth companionShould stay with the mother and not leave the mother and the newborn alone. Should call for help if the mother has :Excessive vaginal bleedingDizziness/ severe headache/ visual disturbances/ epigastric painConvulsionsIncreased pain in the perineumUrinary incontinence or inability to pass urineDifficulty in breast feeding

Resuscitation of new born

Resuscitation of new born*Care of the NewbornPlace an identity label with mothers name and other identification data on babys wrist or ankle.Give Inj Vit K one mg I/M to the baby Put the baby to breast immediately after birthEnsure that the baby is passing urine/stoolsKeep the baby warm either by proper wrapping or by KMCExamine the baby quickly for malformations/ birth injuryIf present - refer the baby to the FRU Ensure warmth during examination and transportation

Resuscitation of new born

Resuscitation of new born*Care of the NewbornCheck the babys colour and breathing every five minutesRefer to MO at the PHC after initial resuscitation if -The baby becomes cyanotic (bluish) Has difficulty in breathing (60 breaths / minute)

Resuscitation of new born

Resuscitation of new born*Care of the NewbornCheck warmth by feeling the babys feet every fifteen minutesIf the babys feet feel cold, check the axillary temperatureIf the babys temperature < 36.5 0C :Provide warmth to the baby by placing baby under radiant warmer. If not available, ensure warmth by placing the baby under a 200 watt bulb placed at a height of 50-60 cms. Teach the mother to provide skin to skin contact, kangaroo mother care (KMC)

Resuscitation of new born

Resuscitation of new born*Kangaroo careProvide privacy to the motherRequest the mother to sit or recline comfortablyMothers chest should be bareUndress the baby gently, except for cap, nappy and socksPlace the baby prone on mothers chest, between her breasts, in an upright and extended posture,Maintain skin to skin contact

Resuscitation of new born

Resuscitation of new born*Kangaroo careTurn babys head to one side to keep airway clearCover the baby with mothers blouse, pallu or gownWrap the baby-mother duo with an added blanket or shawl or warm the room with a heating deviceBreastfeed the baby frequentlyIf mother is not available, skin to skin contact may be provided by the father or any other adultKangaroo care should not be given by a person who has any infection

Resuscitation of new born

Resuscitation of new born*Kangaroo careWhat should you do when skin to skin contact is not possible? Keep the room warm with a home heating device Clothe the baby in 1-2 layers (summer), 3-4 layers (winter) Cover the head, hands and feet of the baby with cap, gloves and socks respectively.Let the baby and mother lie together on soft, thick bedding.Cover the baby and the mother with additional quilt, blanket or shawl in cold weather

Resuscitation of new born

Resuscitation of new born*Kangaroo care

Resuscitation of new born

Resuscitation of new born*Care of the NewbornCheck the cord for any bleeding every 15 minutesIf the cord is bleeding, re-tie the cord more tightly Do not apply any substance to the stumpLeave the stump uncovered and dryWipe off any meconium or blood from babys skinDelay the babys first bath to beyond 24 hours of birth Weigh all babies before they leave the delivery roomEnsure baby is dressed warmly

Resuscitation of new born

Resuscitation of new born*Care of the NewbornEncourage breastfeeding within an hour of birthEmphasize importance of colostrum (helps to protect baby against infections)Check if position and attachment of the baby to the breast are correct at the first feedMother can feed her baby while she is lying down or sitting both mother and baby should be comfortableDo not give artificial teats or pre lacteal feeds such as sugar water or local foods or even water to the newborn

Resuscitation of new born

Resuscitation of new born*Key MessagesNewbornMaintain the body temperature and prevent hypothermiaMaintain the airway and breathingInitiate breast feeding within an hour of birthRecognize danger signsTimely and appropriate referrals

Resuscitation of new born

Resuscitation of new born*Preparing for discharge - MotherEnsure uterus is hard and bleeding per vaginum is within normal limits

Counsel the mother about:Diet and restExclusive breast feedingMaintenance of hygiene Avoiding sexual intercourse till perineal wound healsNeed to take iron tabletsContraceptionWhen to return for follow upComplete immunization of babyCare of breast and periniumRemain happy and focused on care of the baby

Resuscitation of new born

Resuscitation of new born*Preparing for discharge - BabyEnsure baby is warmBreathing is normalAccepting and retaining breast milk Cord is cleanPassing urine and stool

The baby should receive:BCG and OPV Hepatitis B preferably before discharge

Resuscitation of new born

Resuscitation of new born*Advice on discharge - MotherDanger signs: Return immediatelyIncrease in vaginal bleedingFast / difficult breathingFever Feels too weak to get out of bedSevere abdominal painBreasts swollen, red or tenderDribbling of urine or inability to pass urine.Pain in the perineum or draining pusFoul smelling lochiaConvulsions

Resuscitation of new born

Resuscitation of new born*Advice on discharge - BabyDanger signs:(If any of the following signs are there return immediately) Breastfeeding poorlyDevelops fever or feels cold to touchFast / difficult breathingBlood in stoolCord stump red, swollen or discharge presentSkin infection (pustules)ConvulsionsDull and lethargic

Resuscitation of new born

Resuscitation of new born*Thank you

Resuscitation of new born