essential newborn care dr hussain bux korejo assistant professor paediatrics lumhs
TRANSCRIPT
Essential newborn care
Dr Hussain Bux korejoAssistant Professor paediatrics
LUMHS
Learning objectives
• Define essential elements of early newborn care.
• Discuss best practices and techniques for promoting newborn health.
• Use relevant data and information to develop appropriate essential newborn intervention.
Essential newborn care
• Newborn care is important because major causes of newborn death are preventable eg birth asphyxia and infection.
• A skilled attendant at childbirth who can assess the newborn correctly, perform essential interventions and does not delay resuscitation if indicated, is crucial.
• The attendant should also be able to care for or transport a sick newborn if needed.
4Normal Newborn Care
Newborn Deaths
• 8 million infant deaths • 3.9 million (48%)
newborn deaths• 2.8 million (67%) early
newborn deaths• Major causes of
newborn deaths– Birth asphyxia: 21%– Infections: 42%
(tetanus, sepsis, meningitis, pneumonia, diarrhea)
Causes of neonatal deaths
• Birth process is the cause of 2/3 of deaths due to infections;– Lack of hygiene at the time of childbirth and during
newborn period.– Home deliveries without skilled birth attendants.
• Birth asphyxia in developing countries:– 3% of newborns suffer mild to moderate birth
asphyxia– Prompt resuscitation is often not initiated or
procedure is inadequate or incorrect
Causes of neonatal deaths
• Hypothermia and newborn deaths– Significant contribution to deaths in low birth
weight infants and preterm newborns– Social, cultural and health practices delaying care
to the newborn• Ophthalmia neonatorum is a common cause of
blindness
Risk factors for neonatal deaths
• Low birth weight– An extremely important factor in newborn mortality
• Place of childbirth– At least 2 out of 3 childbirths in developing countries
conducted at home.– Only half are attended by skilled birth attendants– Strategies for improving newborn health should
target• Birth attendant, families and communities• Healthcare providers within the formal health system
8 Normal Newborn Care
Essential Newborn Care Interventions
• Clean childbirth and cord care– Prevent newborn infection
• Thermal protection– Prevent and manage newborn hypo/hyperthermia
• Early and exclusive breastfeeding– Started within 1 hour after childbirth
• Initiation of breathing and resuscitation– Early asphyxia identification and management
9 Normal Newborn Care
Essential Newborn Care Interventions (continued)
• Eye care– Prevent and manage ophthalmia neonatorum
• Immunization– At birth: bacille Calmette-Guerin (BCG) vaccine, oral
poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine (WHO)
• Identification and management of sick newborn• Care of preterm and/or low birth weight
newborn
How to do these intervention
All these interventions can be carried out under the umbrella of two health programs
ENCC : Care at the time Of Delivery Examination Of Newborn Routine Newborn Care Basic Neonatal Resuscitation IMNCI : Identification and management of sick newborn
ENCC 3 11
Care of the baby at the time of birth
(Until around 1 hour after birth)
ENCC 3 12
Objectives
• To describe and carry out the evidence based routine care of a newborn baby at the time of birth and prevent complications.
ENCC 3 13
The birth of Jojo
ENCC 3 14
Second Stage of Labour: Immediate newborn care
• Call out time of birth
• Deliver baby onto mothers abdomen or into her arms
• Dry baby with a warm, clean towel or piece of cloth.
• Wipe eyes.
• Assess the baby’s breathing while drying.– Make sure there is not a second baby– Change gloves
• Clamp and cut the umbilical cord
• Put the baby between mother’s breasts for skin-to-skin care
• Place an identity label on baby
• Cover mother and baby with warm cloth.
• Put a hat on the baby’s head.
• Encourage breastfeeding
ENCC 3 15
Drying the baby immediately after birth
ENCC 3 16
Immediate skin contact
ENCC 3 17
Keeping a newborn baby warm after delivery
• Provide a clean, warm, draught free room for delivery at 25-280C.
• After birth immediately dry baby with a clean, dry, warm cloth.
• Put baby on mother’s abdomen or a warm, clean, dry surface.
• Give baby to its mother for skin-to-skin contact.
• Put naked baby between mother’s naked breasts, cover them both (as
• long as immediate medical care is not needed by either).
• Cover baby’s head.
• Encourage breastfeeding as soon as possible after birth
• If mother and baby are separated wrap baby in warm covers and
• place in a cot, in a warm room.
• Use a radiant heater if the room is not warm or baby is small.
ENCC 3 18
Immediate cord care
• Change gloves. If not possible, wash gloved hands.
• Clamp and cut cord.
• Put ties tightly around cord at 2cm and 5cm from babies
abdomen.
• Cut between ties with a sterile instrument.
• Observe for oozing blood. If blood oozes, place a second
tie between the skin and first tie.
• DO NOT apply any substance to stump.
• DO NOT bind or bandage stump.
• Leave stump uncovered
ENCC 3 19
Eye care at the time of birth
ENCC 3 20
ENCC 3 21
Summary• Universal precautions
– Use soap and warm water to wash and clean hands (protection)
– Wear gloves (Protection)
• Make sure delivery area is ready for mother and new baby:– Keep delivery room warm, close windows (warmth, protection)– Have resuscitation equipment near delivery bed (breathing)– Have clean warm towels/covers/cloths ready for newborn baby at delivery
(warmth)– Dry baby with a clean cloth immediately after delivery (warmth,
protection)– Have sterile kit to tie and cut cord (protection)– Help mother to wear clothes which make immediate skin contact easy
(warmth)– Keeping mother and baby in skin-to-skin contact from birth encourages
early breastfeeding (feeding)
22 Normal Newborn Care
Early and Exclusive Breastfeeding• Early contact between mother and newborn
– Enables breastfeeding– Rooming-in policies in health facilities prevents
nosocomial infection• Best practices
– No prelacteal feeds or other supplement– Giving first breastfeed within one hour of birth– Correct positioning to enable good attachment of the
newborn– Breastfeeding on demand– Psycho-social support to breastfeeding mother
WHO 1999.
23 Normal Newborn Care
Immunization
• BCG vaccinations .• Single dose of OPV at birth or in the two
weeks after birth• HBV vaccination as soon as possible where
perinatal infections are common.
24 Normal Newborn Care
Pearls
The essential components of normal newborn care include:
• Clean delivery and cord care• Thermal protection• Early and exclusive breastfeeding• Monitoring• Eye care• Immunization