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NEWBORN CARE

VIEWS: 18 PAGES: 38

									NEWBORN CARE
    Dr.BENNETXYLEM.P
   MBBS,DCH,PGDHRM
      PAEDIATRICIAN
   District Model Hospital
        Peroorkada.
    Phone - 09447230557




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Hand washing




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  EXAMINATION OF THE NEW
           BORN
• CONGENITAL MALFORMATIONS
• GESTATION
    Neuromuscular maturity
    Physical Maturity




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•   CARDIORESPIRATORY SYSTEM
•   ABDOMEN
•   SKIN
•   SKELETON
•   HEAD




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FEEDING AND NUTRITION




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Technique of spoon feeding




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TUBE FEEDING


  • SICK CHILD




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                  How to feed
Birth weight               Infant sucking response
     (g)         Good suck           Slow suck        No suck


   <1600       NGF. Try BF as     NGF. Try BF as   NGF. Try BF as
                 soon as            soon as          soon as
                 possible           possible         possible
 1600-2000       Breast feed        Breast Feed    NGF. Try BF as
                                    + cup/spoon      soon as
                                                     possible
      Ad lib feeding is recommended in older well babies




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             How much to feed
  Birth        Starting       Volume           Maximum      Frequency
Weight (g)   volume (ml/    Increment         volume (ml/    of feeds
                kg/d)        each day            kg/d)
                             (ml/kg/d)
 >1600          60              30               150         3 hrly


1200-1599       60              30               180         2 hrly


 <1200         10-20       20 ml/kg/d            180         2 hrly
                            after day
                            2-3 days
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             What to feed
• Breast milk is the preferred choice

• If breast milk insufficient or non-available
  (first few days of life/mother not available
  or sick) consider using appropriate
  preterm formula till adequate breast milk is
  available.


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      Maintaining Lactation
Technique of breast milk expression:
 Mothers should be as comfortable and relaxed
  as possible.
 She must wash her hands thoroughly before
  commencing manual expression. All containers
  must be washed with soap and hot water.
 Must be taught not to squeeze the nipples and
  should not slide the fingers or thumb along the
  skin of the breast

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   Technique of spoon feeding
• Spoon lightly pressing lower lip
• Don’t pour milk into the mouth
• In LBW babies give 5-15 ml/kg per feed
  every 2 hrs
• Hold the baby slightly upright
• Turn the baby to one side if vomits and
  clear airway with clean cloth
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 She must place her thumb on top of the breast
  and behind the areola and the fingers below.
 To express the milk she must compress and
  release the breast tissue behind the areola with
  thumb and fingers repeatedly and collect the
  expressed milk in the container held in the other
  hand.
 She should express milk from each breast for
  about 3-5 minutes. If the procedure causes pain,
  it indicates that the technique is incorrect.

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      Maintaining Lactation
• Mothers must be encouraged to provide NNS to
  their stable LBW babies.
• Expressed breast milk that remains unutilized
  during a feed can be stored in covered stainless
  steel containers at 4-8oC till the next feed.
  Expressed breast milk can be stored at 4-8oC for
  upto 24 hrs.
• Proving Kangaroo Mother Care (KMC), where,
  feasible can also help promote lactation
  maintenance

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MAINTAINING TEMPERATURE




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How does the newborn lose
           body heat?




Four ways a newborn may lose heat to the environment



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How can heat loss be prevented?

Ten commandant of warm chain

   Warm delivery room
   Immediate drying
   Skin-to-skin contact
   Breast-feeding
   Bathing and weighing postponed
   Appropriate clothing and bedding
   Mother and baby together
   Warm transportation
   Warm resuscitation
   Training/awareness raising
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    How can you Prevent heat loss in
           Delivery Room?
•    Ensure that there is a separate area for neonatal
     resuscitation
•    Maintain the delivery room temperature at least at
     250 C
•    Ensure that the radiant warmer is switched on at
     least ½ hour before delivery
•    Keep the delivery room warm by using heating
     devices such as 200 watts bulb or room heater
     if radiant warmer is not available
•    Receive the baby in a prewarmed sheet after
     delivery and clean and dry the baby
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     What should be the clothing of
              Neonates
 •   Full sleeves shirt
 •   Paijamas
 •   Cap
 •   Gloves
 •   Stockings
 •   Swaddle in dry sheet

A neonate without cap. Socks and gloves in half naked



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 How can you Prevent Heat Loss in
           Post-natal Ward?

   Ensure that the baby is kept warm with
    appropriate clothing and skin to skin contact with
    mother
   Change wet clothing promptly and keep the baby
    dry
   Cover the baby adequately
   Keep windows closed and fans off
   Continue breast feeding day and night
   Do not bath the baby

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How would you teach a mother to keep a low
    birth weight baby warm at home?




             Warm home                           Kangaroo-mother care




        Baby warmly wrapped                          Breast-feeding

 Keeping preterm, low birth weight and sick babies warm at home
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                                                                        Source WHO
What is kangaroo-mother care
      A non-conventional method of caring for low birth
 weight and preterm newborns after initial stabilization




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What are the benefit of kangaroo
           Mother Care
   Assists in maintaining the temperature of infant
   Facilitates breastfeeding
   Helps to increase the duration of breastfeeding
   Improves mother infant bonding
   Promotes physical growth and extra-uterine
    adaptation, and increases the mother's
    confidence, ability and involvement in the care
    of her small newborn



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  What is the procedure of Kangaroo
             mother care
Dress the baby with a cap, socks, kurta and napkin
Place the newborn in a prone and upright (diagonal)
position between the mother's breasts, covered with the
mother's clothes and shawl/blanket (A loose blouse,
sweater or wrap tied at the waist holds the baby)
Let baby suckle at breasts as often as he wants, at
least every 2 hourly.
Advise the mother to sleep in propped up position so
that the baby stays upright
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Make sure the baby stays warm at all times
Dress the baby with extra clothing if environmental
temperature is low, and cover his head
Ask the father or another family member to
‘kangaroo’ the baby when mother wants to bathe or
rest, or wrap infant in several layers of warm clothing,
covered with blankets and keep in a warm place
Take baby for regular check ups for vaccination and
weight record



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•   Place the baby on the mothers abdomen/chest for
    skin to skin contact (while cleaning and drying the
    baby) to prevent heat loss from evaporation,
•   Remove the wet sheet and wrap in another warm
    and dry sheet/cloth, covering the head of the
    newborn
•   Keep the baby on the mothers abdomen/chest for
    skin to skin contact with the mother or use
    appropriate clothing full sleeves shirt with pajamas,
    cap, gloves and stockings
•   Start breast feeding as soon as possible
•   Do not bath the baby
•   Post pone bathing for first few days after birth

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What is hypothermia?




  Hypothermia in the newborn infant



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   Prevention Of sepsis :Infection
           Control Policies

Written policies for:
• Admission into the unit

• Antibiotic Policies

• Disinfection Policies: Equipment, house-
  keeping.

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• Waste Disposal

• Nosocomial Infection Surveillance.

• Control Of An Outbreak




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         Prevention Of sepsis

 Strict Infection Control measures:

• Hand washing

• Asepsis during procedures

• Minimize invasive interventions

• Promote breastfeeding & use of breastmilk1
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FLUID THERAPY




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Umbilical Venous Cannula




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    Physiology of fluid composition
              of neonate
• Body Fluid Composition
 Total body water ( TBW) at term = 75%
 Total body water pre- term = >75%-80%
 There are 3 fluid compartments:
      1. Intracellular space ( ICF)
      2. Extracellular space( ECF)
      3. Interstitial space ( IS)
       TBW=ICF+ECF+IS

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         Physiology contd.
• Perinatal Changes In TBW :
• During 1st 7-10 days of life     in
  Weight
• Term babies lose up to 7-10%
• Preterms up to 10-20% of Birth weight




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IV Fluid rates according to birth
             weight
  • Suggested fluid rates as per BW on Day 1 of
    life
   Wt (gms) <750 750-1000 1000-2500 >2500
   Fluid     120    100        80       60

    Fluid rates as per BW from day 2
  • Increase total fluid intake 20 cc/kg/d each day
    until goal of 140-160 cc/kg/d is reached
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     Principles of fluid therapy
• 1.Start on 10% dextrose( In ELBW use 5%
  dextrose). Monitor blood glucose.
• 2.If under a radiant warmer, add 20 (mature) to
  40 (immature) ml/kg/day.
• 3.If under phototherapy, add 20 ml/kg/day to 40
  ml/kg/day.
• Very preterm infants should be placed in
  humidified incubators in a neutral thermal
  environment as soon as practical after birth


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THANK YOU




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