Care after delivery Observation of newborns in the First Few Hours of Life.pptx

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Care after delivery  Observation of newborns in the First Few Hours of Life.pptx Powered By Docstoc

Alexandra Wallace

On behalf of the
Neonatal Encephalopathy Working Group
June 2012
 Background – Normal Newborns

Most term newborns adapt rapidly to life ex utero and
 require no resuscitation
Early skin to skin contact and initiation of breastfeeding are
 integral to obstetric and neonatal best practice1
   Step 4 in the 10 steps of the BFHI policy2,3

1. Moore, E. R. et al. Cochrane database of systematic reviews(2): CD003519. (2009)
2. World Health Organization/UNICEF: Ten Steps to Promote Successful Breastfeeding
3. Saadeh, R. and J. Akre (1996). Birth (1996).
Background – when things go wrong….

Some newborns require assistance to initiate or
 maintain normal cardiorespiratory function
 following delivery
  Problems may be apparent immediately after delivery
   or develop in the first few hours of life
  May be expected or unexpected
  Normal cardiorespiratory function cannot be assumed
  All newborns require assessment:
    at birth
    intermittently over the first few hours of life
Potential Newborn Problems
Failure to adapt to ex utero environment
Birth asphyxia
Meconium aspiration
Birth trauma
Congenital heart disease
Other congenital anomalies
Newborn vulnerability
 Glucose homeostasis
 Immature respiratory control
Potential Maternal Factors
Pain +/- immobility
Ongoing interventions or management of obstetric
Effects of medication
Body habitus
Example: Compounding Maternal and
Newborn Factors1
Primigravida, increased BMI
Long labour, normal delivery
Big baby but well, no resuscitation required
Skin to skin soon after delivery with attempts to latch
At 2 hours of age – Mum sleeping
     Baby prone on Mum’s chest, apnoeic, blue, cold
     Required resuscitation, ventilation, inotropic support
Developed severe hypoxic-ischaemic encephalopathy and
 died at 15 days of age

1.   Andres et al. Pediatrics, 2011.
SUDI: Sudden Unexpected Death in Infancy
 Clinically unexpected deaths in infants less than 12
   months of age
SUPC: Sudden Unexpected Postnatal Collapse
 Clinically unexpected collapse in apparently healthy
   term infants in the first hours of life
SUEND: Sudden Unexpected Early Neonatal Death
 Does not include babies who collapse but do not die
  SUPC           Statistics 1,2

Incidence varies from 2.6 to 5 per 100,000 live births
   Death results in up to 50% of cases
Over half of the events occur in 1st 2 hours of life
Identifiable cause found in up to 30% of cases
Remainder due to accidental airway obstruction
3 commonly identified risk factors:
   Primiparous mother
   Skin-to-skin in prone position with mouth and nose occluded
   Mother and baby unattended by clinical staff

1. Becher, J-C et al Archives of Diseases in Childhood Fetal Neonatal Ed, 2012.
2. Fleming, PJ. Archives of Diseases in Childhood Fetal Neonatal Ed, 2012.
What is Required?
Awareness of the issues
  What can go wrong?
  Newborn and maternal factors that increase risk
Development of recommendations for observation
 of the WELL newborn that:
  Do NOT impinge on initiation of skin to skin contact and
  DO keep babies safe by identifying unexpected
DHB Survey
18 responses from 21 DHBs
Of the 18 that responded:
  2 have specific policy on observation of the newborn
  Variety of other policies submitted including:
   Examination of the newborn
   Early discharge
   Hypoglycaemia guidelines
   Care of low birth weight babies
   Treatment of narcotic depression
   Safe sleeping/SUDI prevention
Mother and Baby Observations in the Immediate
Postnatal Period: Consensus Statements Guiding Practice

  1. Active assessment for ALL babies in the early
     postnatal period, regardless of birth context
  2. Minimum assessment time of 1 hour
     Longer if increased risk
  3. Early skin-to-skin contact and breast feeding is
     facilitated and supervised
     Monitoring of colour, tone, respiration ongoing
     Ensure nose and mouth are not occluded
  4. Family/Whanau may be involved in process
    Must know what to check for and who to call for help
Newborn Observations
Heart rate
Respiratory rate
Airway patency
Tone and activity
Ability to feed
Overall condition
Any concerns require referral for Paediatric review
Well newborns usually remain well
A few newborns develop problems soon after birth
All apparently well newborns require observation in the
 1st few hours of life
  This can be done without compromising early initiation of
   skin to skin contact and breast feeding
Health care providers must:
    Be aware of the problems a newborn may encounter
    Understand the observations required
    Know what to do if a newborn becomes unwell

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