care of newborn nfp

8/6/2019 Care of Newborn Nfp

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CARE OF THE NEWBORNNFP


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LEARNING OBJECTIVESDefine key terms relating to newbornsDescribe the ongoing assessment and care of newborn

Describe methods to protect newborns byproper identificationDescribe prevention of infection in newbornsDiscuss important considerations in parentteachingDescribe thermo-regulation in the newbornDescribe neonatal jaundice and its treatment


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RECAP

Immediate Care of Newborn- Prevention of heat loss

- Clearing the airway- Cutting the cord- Skin to skin initiation- Breastfeeding- Identification- Assessment of baby s condition


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M easurements

- Crown heel length (average 50cm)

- Head circumference ( average 35cm)- Chest ( average 35cm)- Weight ( average 2.5kg 4.5kg)

- Hepatitis B Immunoglobulin given to infants of HBV+ve mothers in LW


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Proper identification

Name band applied securely to the infantbefore he leaves the mother s side.ID band indicates:

- mother s name- Sex of infant- Date of birth- Time of birth* Removed only upon discharge


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O ngoing care

- Vitamin K administration

- Initial toilet- Maintenance of body temperature- Breastfeeding

- Taking vital signs- Identify deviations and refer accordingly


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Thermoregulation is critical to neonatalsurvival

Neutral thermal environment is defined as theambient air temperature at which oxygenconsumption or heat production is minimalwith the body temperature in the normalrange of 36.7 to 37.3 C


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Thermoregulatory crisis @ birth

Immediately after birth, body temperature of a neonate falls rapidly

Rate of fall is greatest in the first few minutesMaintaining temperature @ time of birth isone of the primary goals of NB care


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Heat Loss

Ev aporation- from skin, each ml thatevaporates removes 560 calories of heat

Conduction - in contact with cold surfacese.g.linen, surfacesCon v ection cool air currents passing overbabyR adiation transfer of heat to cold objects inthe vicinity eg. Trolleys, cannisters


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Thermoregulation

Non-shivering thermogenesisBrown fat assists with heat generation

Adopt flexed body position to minimise heatlossAbility to constrict subcutaneous and skin

vessels


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Prevention of infections

Meticulous hand washingMothers should be allowed to give necessary

care to their infantCare of the umbilicusNappies & excreta carefully disposed

Nappy area cleaned and dried appropriatelyCare givers with minor infections not tohandle babies


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Encouraging & assisting mothers withbreastfeeding immune systemAvoiding trauma/irritation to baby s skinEarly diagnosis & treatment of infectionAdequate spacing of cotsIndividual equipment for each babyIsolating infected babiesOngoing education on infection control


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Parent teaching

Teaching parents necessary skills to enablethem to :

- Prevent avoidable illness- Provide proper nutrition- Provide appropriate development stimulations

- Provide love that evolves and grows


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Identifying illnesses in neonates- Poor feeding or unable to feed- Hypo/hyperthermia- Cord sepsis- Fits/convulsions- Breathing fast/difficulty in breathing- Change in skin color- Skin pustules


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Newborn screening tests

Blood tests cord blood for Group O+ve mothers

Unbooked mothersReflexesHead scan/eye check for premature infants


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Basic care for Baby

Skin careBath time & groomingKeeping warm

BreastfeedingBurpingCare of crying babyGaseous babyColicShaken baby syndrome


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CRYING BABIES!!!!!!!!!!!!!!


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Why babies cry?

Need foodComfort

Too hot/too coldNeed to be heldNeeds rest

Something to make me feel better


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Taking vital signs

TPR

- Count respiration first- periodic breathing,immature respiratory system

- Take temperature and count heart rate- Check color of baby- Check cord- Check for PU and BO- Check for lactation & breastfeeding


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Ballard Score

The New Ballard Score is a set of proceduresdeveloped by Dr. Jeanne L Ballard, MD todetermine G estational Age throughneuromuscular and physical assessment of anewborn baby.Neurological criteria muscle tonePhysical criteria anatomical changes


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Physical maturity


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Neurological maturity


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Maturity RatingTotal score (neuromuscular + physical) weeks

-10 20

- 5 22

0 24

5 26

10 28

15 30

20 32

25 3430 36

35 38

40 40

45 42

50 44


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Conjugation of bilirubin

W hat is bilirubin?

- waste product of red blood cells

- haemoglobin broken down into haem, globinand iron- haem converted to biliverdin unconjugatedbilirubin- globin amino acids protein- iron stored/used for new RBC


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NORMAL CONJUGATION OF BILIRUBIN

S tep 1 :Red blood cells are broken down by the

reticuloendothelial system and unconjugatedbilirubin in the bloodstream is carried byalbumin to the liver. This is known as "pre-hepatic," "free," "unconjugated," or"indirectbilirubin"


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S tep 2:

The liver converts or conjugates bilirubin and

makes it water-soluble. This is known as"posthepatic", "conjugated" or "direct"bilirubin (normal value = 0.0 - 0.4 mg/dl)


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S tep 3:

Conjugated bilirubin is excreted via bile salts

to intestine. Bacteria in the intestine breakdown bilirubin to urobilinogen for excretion inthe feces


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Forms of Bilirubin

U nconjugated fat soluble cannot beexcreted easily in bile or urineConjugated water soluble excreted infaeces or urine3 stages of bilirubin conjugation process are:- transport- conjugation- excretion


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Types of Jaundice

1. P hysiological Jaundice

- appears after 24 hrs and fades by 1 wk of

age- a normal transitional state, affects about50% of term babies

- progressive rise in unconjugated bilirubin


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2. P athological jaundice

- appears within 24 hrs of birth

- rapid increase in total serum bilirubin(5mg/dl per day)


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Causes of jaundice

Blood type/group incompatibilityEnzyme deficiencies

SpherocytosisExtravasated bloodPolycythemia

SepsisHypothermia, hypoxia, acidosis


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TreatmentP hototherapyuse of fluorescent lights which photo- chemically

converts

fat-soluble unconjugated bilirubin

water-soluble conjugated bilirubin

excreted in bile and urine.


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Preparation for Phototherapy

Baby fully undressedCot/incubator

Phototherapy lightEye padsExpressed breast milk (EBM)

Feeding cupsExplain and reassure mom


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Monitoring during phototherapy

TemperatureEyesSkinHydrationNeurobehavioural statusCalcium levelsBilirubin levelsParent support


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Side effects of phototherapy

HyperthermiaRetinal damage

Lethargy/ irritability, loose stools, eagernessto feedSkin rashes/skin burns

Isolation & lack of usual sensory experienceincluding visual deprivationBronze baby syndrome


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care of newborn nfp

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