Immediate Newborn Care..@..nursesoutlook

IMMEDIATE NEW BORN CARE

IMMEDIATE NEWBORN CARE

CARE AT BIRTH:

1. Soon after the delivery of the baby, it should be placed on a tray covered with clean dry linen with the head slightly downwards (15 ⁰). It facilitates drainage of the mucus accumulated in the tracheo-bronchial tree by gravity. The tray is placed between the legs of the mother and should be at a lower level than the uterus to facilitate gravitation of blood from the placenta to the infant.

2. Air passage should be cleared of mucus and liquor by gentle suction.

3. Apgar rating at 1 minute and at 5 minutes is to be recorded.

4. Clamping and ligature of the cord-The cord is clamped by two Kocher’s forceps, the near one is placed 5 cm away from the umbilicus and is cut in between. Two separate cord ligatures are applied with sterile cotton threads 1 cm apart using reef- knot, the proximal one being placed 2.5 cm away from the naval. Squeezing the cord with fingers prior to applying ligatures prevents accidental inclusion of embryonic remnants. Leaving behind a length of the cord attached to the navel not only prevents inclusion of the embryonic structure, if present, but also facilitates control of primary haemmorrhage due to a slipped ligature. The cord is divided with scissors about 1 cm beyond the ligatures taking aseptic precautions so as to prevent cord sepsis.

5. Delay in clamping for 2-3 minutes or till cessation of the cord pulsation facilities transfer of 80-100 ml blood from the compressed placenta to a baby when placed below the level of uterus. This is beneficial to a mature baby but may be deleterious to a pre term or a low birth weight baby due to hypervolaemia. But early clamping should be done in cases of Rh- incompatibility or babies born asphyxiated or one of a diabetic mother.

6. Quick check is made to detect any gross abnormality and the baby is wrapped with a dry warm towel. The identification tape is tied both on the wrist of the baby and the mother. Once the management of third stage is over(usually 10-20 minutes), baby is given to the mother or to the nurse.

CARE IN NURSERY:

Observation- The infant should be examined systematically beginning from the head followed by inspecting the whole body to detect any congenital abnormality.

To estimate the gestational age- This may be made soon after delivery. A baby is delivered at 39 weeks or more presents with the following features: (1) Sole covered with creases. (2) breast nodule diameter of 7 mm. (3)Scalp hair- coarse and silky. (4) Ear lobule- stiffened by thick cartilage. (5) In male, scrotum is full with testes with extensive rugae.

General care- The baby is placed in a cot where neutral thermal condition is maintained. Hypothermia must be avoided. The baby should be flat on the cot with the head slightly lowered. Handling should be gentle and be kept to a minimum. Temperature should be frequently recorded until it is stabilized.

Hypothermia(cold stress): -peripheral vaso constriction –increased O2 consumption –shivering –hypoxia –hypoglycemia –anaerobic metabolism –metabolic acidosis.

Baby bath- Routine bath is delayed until the baby is able to maintain the body temperature and has started breast feeding. The excess vernix, blood or meconium are wiped off from the skin by using sterile moist swabs and then make the skin dry by using towel. The water for baby bath should be at body temperature and a separate bath tub should be earmarked for each baby.

Weight- Immediately following bath or cleaning, the baby should be weighed naked.

Care of the umbilical cord- The cord is to be inspected once more for evidence of slipping of ligature. The cord is left exposed to the air, without any applicable of dusting powder, it dries up and falls off. Daily cleaning with spirit and use of antibiotic powder is usually done.

Clothing- The dress should be appropriate for the climate. The extremities should be free from movements. A napkin is applied which should be changed periodically.

Care of eyes: Eyes are kept clean with cotton wool soaked with sterile isotonic saline. As a prophylaxis against ophthalmic neonatorum and Chlamydia trachomatis, application of gentamicin ophthalmic ointment or erythromycin (0.5%) ophthalmic ointment every 6 hours may be used.

Medications- (a) Intramuscular administration of vitamin K 1 mg is given as a routine to minimize haemorrhagic disease. (b) Prophylactic antibiotic therapy is considered in: (i) Delivery following premature rupture of the membranes. (ii) Instrumentation

Close observation for at least 4-8 hours- to note: (i) Any excessive mucus secretion from the mouth. (ii) Any bleeding from the umbilical cord stump. (iii) Hourly temperature until it stabilizes and remains above 36 ⁰ c.

DAILY OBSERVATION AND CARE OF NEWBORN:

            As the majority of complications occur during the first 24 hours, close observation is mandatory during this period, noting specially the cardio- respiratory function. The infants are observed and cared for as follows:

·        Respiration is regular, smooth and quiet,, the rate being 40/ minute.

·        Temperature is to be taken twice daily.

·        Weight is to be taken every 3 rd day.

·        Feeding schedules as describes later are to be followed and difficulties if any, are to be noted.

·        Eyes are to be inspected for evidenced of early infection suggested by discharge.

·        The mouth should be inspected daily for detection of early evidence of thrush.

·        The umbilical cord is to be inspected daily and cared as outlined earlier.

·        Bath- cleaning the skin may be repeated daily as required, specially the buttocks, to remove the meconium. A daily bath is prescribed when the women is at home.

·        Rooming in- Soon after birth if the mother is otherwise fit, the baby is kept in a cot by the bed side of the mother. This not only establishes the mother child relationship but the mother is conversant with the art of baby care so that she can assume full care of the baby when at home.

·        Number and character of stools and rough estimation of the amount of urine passed daily are to be noted. Napkins should be changed immediately following soiling and the local parts should be cleaned dry.

·        Any abnormal behaviours and features should be promptly detected and corrected.

  Reflex behaviors

 The following reflexes are normal for a new born infant:

1)     Rooting reflex: A normal infant when touched on the cheeks, turns eagerly towards the stimuli and opens the mouth for a feed.

2)      Glabellar reflex: tap gently over the forehead and the eyes will blink.

3)     Grasp reflex: Place a finger in the palm of the infant and the infant will grasp the fingers.

4)     Moro’s reflex: Support the infant behind the upper back with one hand then drop the infant back 1 cm or more to- but not on the mattress. Then there is a sudden abduction of both the arms and extension of the fingers followed by slow abduction and flexion.

5)     Sucking and swallowing reflexes: A normal infant starts sucking when something touches the palate. Baby swallows when the mouth is filled with milk.