1. Dr. Sudhira Kumar Parida.

2. Introduction Care at birth When a newborn baby should be examined ? Danger signs Examining the newborn at birth High risk neonates Prevention of hypothermia Prevention of infection Immunisation Normal phenomena after birth Resuscitation of newborn not breathing soon after birth Care of LBW babies Care of sick newborn babies Special situation Training Health Programmes Key messages References. 3. INTRODUCTIONWORLD: NMR: 4 millions/yr 50% in 1st 24 hrs 2/3rd in South-East Asia , AfricaINDIA: 61.3% of infant deaths -in neonatal period. 50% of these deaths-in 1st wk of life. NFHS-3(05-06): 2/3rd of IMR & of U5MR Major causes: birth asphyxia hypothermia infections Essential Newborn Care(ENC). 4. CARE AT BIRTH Delivery room- 5 Cleans PROVISION OF WARMTH: *dry, pre-warmed & clean cloth *200W bulb *dry immediately *do not remove vernix *close contact with mother 5. CORD CARE: *4 Cs *left dry *no antiseptics/dressings EYE CARE: *clean cotton swabs *medial to lateral side *no prophylactic eye applications RECORDING BIRTH WEIGHT: *N: 2.5-3 kg 6. INITIATING BREASTFEEDING:*within 1 hr of birth(within 4hr-C.S.)*advantage formotherbaby*no pre-lacteal feeds. 7. WHEN A NEWBORN BABY SHOULDBE EXAMINED ? AFTER BIRTH:+ at around 1 hr+before discharge from hospital+if there is a maternal concern about the babys condition+if a danger sign is observed during monitoring AFTER LEAVING THE HOSPITAL:+during the 1st wk of life at a routine visit+ follow-up+ sick newborn visit 8. DANGER SIGNS Not suckling (after 6 hours of age) Fast breathing (> 60 breaths/min) Grunting Eyes swollen and draining pus Yellow skin on face and < 24 hours old > 10 skin pustules 9. EXAMINING THE NEWBORN ATBIRTH IDENTIFICATION OF MALFORMATIONS:hydrocephalusmeningomyelocelelarge omphaloceleabsent anal openings BREATHING PATTERN:N: 30-40/minirregularperiodicat least 1 min quiet,not feeding 10. Respiration is not normal if- RR >60/min intercostal/subcostal retractions assoociated apnoea(+ cyanosis/HR 20 mg% or requirement of exchange transfusionMajor malformations 15. PREVENTION OF HYPOTHERMIA< 36 C1st signs: less active, doesnot BF well, has a weak cry, has resp. distress STEPS OF WARM CHAIN:1. Warm delivery room2. Warm resuscitation3. Immediate drying4. Skin to skin contact5. BF6. Bathing postponed7. Appropriate clothing8. Mother & baby together9. Professional alertness10. Warm transportation 16. TEMPERATURE RECORDING: axilla/ per rectally at least 3 min N: 36.5- 37.5 C MANAGING HYPOTHERMIA: immediate Tt 200W bulb/45cm or KMC or radiant warmer refer if: 17. PREVENTION OF INFECTION Minimize Neonatal tetanus 5 Cs Cord: dry , clean Exclusive BF Persons with infective disease must not handlethe baby till infection is under control. 18. IMMUNISATION OPV-O BCG Hepatitis B(birth dose) 19. NORMAL PHENOMENA AFTER BIRTH MECONIUM PASSAGE:dark, greenish-black, stickyN: within 24 hrs URINE PASSAGE:N: soon after birth/ by next 24 48 hrsafter 2nd day, 6 7 times/day TRANSITIONAL STOOLS:greenish yellowed frequencyloose (& sometimes watery)N: highly variable; after first 2wk,upto 15-20 times/day oronce in 5-6days 20. VOMITTING:mucous gastritisswallow air during feedingpathological if: MONGOLIAN SPOT:bluish-black patches of pigmentationsacral & buttock; also trunk & extremitiesdisappear by 6 months of age ERYTHEMA TOXICUM:an erythematous rashon 2nd/3rd daybegins from face & spreads to trunk &extremitiesover next 24 hrsdisappears spontaneously in 2-3 days 21. VAGINAL DISCHARGE/BLEEDING:thin white mucoid secretionsTt: clean it with clean water &keep the place dryupto 25%: menstrual like withdrawl bleedingafter 3-5 days of life &for 2-4 days MASTITIS:breast engorgement on 3rd /4th daymay last for 2-4 daysavoid local massage, fomentation or manualexpression of discharging milk 22. PHYSIOLOGICAL JAUNDICE: clinical jaundice after 24 hrs of birth > 15 mg% ng by 7-10 days of lifeIf not, Pathological: immediate referral & Tt >20 mg% - risk of brain damage 23. CAPUT SUCCAEDANEUM:a boggy s/c swelling over scalpsoon after birthbenignCEPHALHEMATOMA: sub-periosteal hemorrhage does not cross sutural lines can be asso. With anaemia/jaundice 24. RESUSCITATION OF NEWBORN NOTBREATHING SOON AFTER BIRTH Equipment needed: self-inflating bag & mask 02 mucus sucker syringe/needle(no.24) adrenaline(1:1,000) SUCTION: most cry soon after birth but if not started to breathe by the time it is dried start IMMEDIATE RESUSCITATION: 25. 200W bulb/radint warmer extend the neck mucus sucker- 1st mouth , then nose do not use gauge/clothIf still does not cry: flick the soles with fingers 2 or 3 timesdo not slap the baby/hang upside downIf does not start breathing or is gasping:start ASSISTED VENTILATION with a bag & mask 26. USE OF DRUGS: Adrenaline- when HR 1800g home mt.1500-1800g : PHC 60/min severe chest-indrawing nasal canula ( no.8) inserted 2cm into nostril O2 must be humidified & water-warm in absence of O2 monitors, O2 level determined by the level at which cyanosis disappears. ANTIBIOTICS: Inj Amp(50mg/kg BD)+ Inj Gentamicin(2.5mg/kg BD)at least 5 days If no response after 48 hrs: Refer 32. FLUIDS & FEEDING:1st 2 days 10Dday 3 onwards 1/6 saline in 10DDAILY FLUID REQUIREMRNTS DURING 1ST WK OF LIFE (50 ML/KG/DAY) : BIRTH DAY 1DAY 2DAY 3 DAY 4DAY 5 DAY 6 DAY 7 WT.&ONWARDS < 1500g 80 95 110 120130 140 150 >1500g60 75 90105120 135 150 ORAL FEEDING: started as soon as baby can suck if difficulty in sucking- expressed milk using a NG tube 20ml/kg/feed, 6times /day 33. VERY SEVERE ILLNESS:Iinability to feedpersistent hypothermiaabdominal distentionREFER to healthfacility which hascyanosis specialist care availableapnoeaconvulsionsbleedingsevere jaundicegrunting/ stridor 1st dose antibiotic a referral slip a vehicle mother with newborn KMC & adequate clothing 34. SPECIAL SITUATIONS IF MOTHER HAS AIDS / TB : immediate skin-to-skin contact BF 35. TRAINING NAVJAAT SISHU SURAKSHYA KARYAKRAM: 1 day basic newborn care & resuscitation 2009(MOHFW, IAP,deptt. of padiatrics , AIIMS) 36. HEALTH PROGRAMMES RCH-II IMNCI JSY VHND MAMATA SCHEME UIP 37. KEY MESSAGES Hand should be washed each time before handling thebabyExclusive BFNo pre-lacteal feedsBaby should be kept warm check if body & feet are warmIf DANGER SIGNS are present, health care providersshould be immediately conacted:not able to take feeds ed drowsinessdifficulty breathing/ 60/min 38. yellow staining of palm & soles convulsions Mother is advised to bring the child at 6 wks forimmunisation Mother is instructed to keep the immunisation cardcarefully & encouraged to weigh the child at a near byhealth centre No pacifier . 39. REFERENCES RCH module for MO(PHC). GHAI essential paediatrics,7th edition PARKS textbook of preventive & social medicine. 21stedition www.who.int 40. THANK U