care of a newborn

Care of a Newborn

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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

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