Common daily care of baby in NICU Takvani

Common daily care of baby : 

Common daily care of baby Dr.H.K.Takvani MD(Ped), FIAP President NNF GSC 2009-10 National Eb Mb. IAP 2002-08 President IAP GSB, 2001 President IMA Jamnagar 2008-09 drtakvani@gmail.com www.takvanidr.multiply.com

Learning objectives:: 

8/30/2011 Dr.Takvani 2 Learning objectives: To learn common methods to hold and handle the baby safely. Sponge bath of baby in NICU. Massage of baby in NICU.

Introduction: 

8/30/2011 Dr.Takvani 3 Introduction Common daily care measures Cleaning, clothing, bathing, massage etc. Careful and methodical behavior by the nurse. It has been believed that all these acts are easy to perform and need no protocol In real life scene these acts are performed unscientifically at times and often endanger the safety of newborn.

Lifting the baby: 

8/30/2011 Dr.Takvani 4 Lifting the baby A newborn baby do not have control over holding the head. Hence the head needs the support while lifting the baby otherwise over flexion or extension of neck leads to apnea and difficulty in respiration. The baby also needs support at back also & that makes him steady while lifting up safely. There are two common techniques used for this :

Lifting with one thigh used maneuvering: 

8/30/2011 Dr.Takvani 5 Lifting with one thigh used maneuvering In this method the baby is gently provided support at head with the palm of hand and fingers while the forearm of nurse provides support at back. The other hand holds the thigh of the baby from outside this produces a firm grip ensuring the baby’s safety even if the other hand looses control. This is very useful in emergency situations and especially when a moving baby is handled.

Lifting with two hands at armpit: 

8/30/2011 Dr.Takvani 6 Lifting with two hands at armpit In this method the baby is lifted with two hands of examiner entering from armpit and fingers extending behind neck to support the neck of baby. This is especially helpful in lifting babies with heavier weights. It also helps when baby is wet and limb holding might be difficult and unsafe.

Holding the baby: 

8/30/2011 Dr.Takvani 7 Holding the baby There are three basic positions used: Cradle Football Over the-shoulder

The cradle hold: 

8/30/2011 Dr.Takvani 8 The cradle hold It is the most common way to hold your baby. Place the baby in your forearm nestling the baby's head in the bend of your elbow. Use your wrist and hand to support the baby's bottom and lower spine while the hand of the same hand holds the thigh of baby ensuring the safety incase of movement of baby. This method is useful to nurse while caring the baby out of NICU for investigations where she can use the other hand for holding documents or file or equipments bag.

The football hold: 

8/30/2011 Dr.Takvani 9 The football hold This method has been derived from the game of ‘American football’. In this method the nurse has to place one hand under the baby's head and neck while Sliding the baby's bottom between elbow and hip in a tucked position. This method allows nurse to hold the baby with one arm while the other arm can move freely. This is at times used when twin babies are supposed to be transported by single nurse.

Over the-shoulder hold: 

8/30/2011 Dr.Takvani 10 Over the-shoulder hold In this method the nurse has to place the baby high enough so the baby’s chest rests on your shoulder. She has to use one hand to support the baby's head and neck and place the other under the baby's bottom to support the body. The over-the-shoulder hold is commonly used for burping the baby following a feed so also known as “the burping position”.

Bathing a New born: 

8/30/2011 Dr.Takvani 11 Bathing a New born Principles : New born baby should not be bathed immediately within first 24 hrs. Until the umbilical cord dries out –falls off and mature umbilicus is made up no tub bath should be done to avoid umbilical sepsis. Sponge baths can be done till first 10 to 14 days.

Bathing a New born: 

8/30/2011 Dr.Takvani 12 Bathing a New born Critical NICU babies do not require any bath till they are stabilized except mild cleaning for removal of maternal blood or meconium. Even haemodynamically stable newborns do not require daily bath it can be done twice or thrice weekly.

Bathing a New born: 

8/30/2011 Dr.Takvani 13 Bathing a New born Temperature of water used should be 97-100 degree Fahrenheit. Soaps are generally not needed; alkaline soap destroys the skin’s acid mantle by neutralizing the pH, which disturbs the balance of protective skin flora. While bathing a baby the room should be warm and draught free.

Sponge bath: 

8/30/2011 Dr.Takvani 14 Sponge bath Preparation: Things to keep ready: 2-3 clean /sterile washcloths, Sterile cotton balls (for cleaning around the eyes), Towel, warm water bowl, Emollient cream (not in all babies). No soap is needed.

Sponge Bath Procedure: 

8/30/2011 Dr.Takvani 15 Sponge Bath Procedure Temperature of the room is set. If the baby is under warmer shift to air mode for a while. The nurse should do her hand washing prior to bathing baby. If baby is wrapped remove clothes one by one as bathing progress. Remove cap only at last if head is to be washed.

Sponge Bath Procedure: 

8/30/2011 Dr.Takvani 16 Sponge Bath Procedure The bathing should be from head to toe keeping the anal region last.

Sponge Bath Procedure: 

8/30/2011 Dr.Takvani 17 Sponge Bath Procedure Face: Use a sterile cotton ball moistened in warm water, clean your baby’s eyes, wiping gently from the medial (nose) to lateral (cheek). Use a separate fresh cotton ball for each eye. Wipe around your baby’s mouth , nose, forehead, cheeks, and chin . Wipe around the outer ears, but not inside. Dry all parts of the face.

Sponge Bath Procedure: 

8/30/2011 Dr.Takvani 18 Sponge Bath Procedure Neck and chest. . clean the neck creases where spit up is likely to collect & after wash dry them. Arms. Open the arms to get into the elbow creases, and press the palms to open the fist. Bath & Dry Back. Turn baby over on the abdomen with head to one side, and wash the back, being sure not to miss the neck folds. Dry, and dress the upper body before continuing .

Sponge Bath Procedure: 

8/30/2011 Dr.Takvani 19 Sponge Bath Procedure Legs. Next , nurse has to extend the baby’s legs to get the back of the knees. Then clean the baby’s toes & dry. Head. Wash it once a week (only if doctor permits), after that, dry your baby’s hair, then place the infant cap on his or her head avoid hypothermia.

Sponge Bath Procedure: 

8/30/2011 Dr.Takvani 20 Sponge Bath Procedure Diaper area : at last take a new washcloth to clean the genitals. Please not that in girls wash from front to back, spreading the labia and cleaning gently with a washcloth and warm water. A white vaginal discharge or blood at times is normal; don’t try to scrub it away. Rinse gently with warm water. In boys wash carefully, getting into all the creases with soap and warm water. Do not try to retract the foreskin . Dry the diaper area well and apply ointment if needed. Diaper your baby.

Sponge Bath Procedure: 

8/30/2011 Dr.Takvani 21 Sponge Bath Procedure If indicated it’s the ideal time to apply emollient just after a bath. Remove the wet or dirty linen below and replace with new autoclaved dry linen. Apply clothes and sensor probes on baby back again.

COMFORT TOUCH OR MASSAGE: 

8/30/2011 Dr.Takvani 22 COMFORT TOUCH OR MASSAGE Touch is one of the basic sense of human being & newborns are no exception to it. Massaging babies in NICU who have stable hemodynamics helps in many ways as below : The friction of massage warms the baby’s skin. The oil applied during massage helps in reducing heat and water loss from the skin.

COMFORT TOUCH OR MASSAGE: 

8/30/2011 Dr.Takvani 23 COMFORT TOUCH OR MASSAGE It helps in better neurodelvelopment and acts as early stimulation within NICU. Regular massage is associated with growth and weight gain in newborns. Continuous stroking can calm a fussy newborn.

How to give comfort touch ?: 

8/30/2011 Dr.Takvani 24 How to give comfort touch ? A nurse may do certain maneuver or help mother to do so… Laying a gentle hand on baby’s head and a second hand over the bottom and back for several minutes.

How to give comfort touch ?: 

8/30/2011 Dr.Takvani 25 How to give comfort touch ? Gently placing your baby into a “nest” of blankets to feel secure and then touching your baby’s arms and legs, back, bottom or head. Holding the baby skin to skin on a bare chest in an upright position and covered by a blanket or person’s clothing as done with kangaroo mother care.

Procedure - MASSAGE: 

8/30/2011 Dr.Takvani 26 Procedure - MASSAGE Set room temperature as per baby’s need based upon gestational age. Make the room draught free by closing window or switching off the fan & air conditioner. Wash hands properly in six steps. One can massage simply with bare hands or use oil for this. If oil is to be used take few drops of the vegetable oil preferably coconut oil. Be slow – gentle and methodical. The steps of the massage can be as following :

Slide 27: 

8/30/2011 Dr.Takvani 27 Image courtesy : The Ohio State University Medical Center, Women and Infant Nursing

Slide 28: 

8/30/2011 Dr.Takvani 28 Image courtesy : The Ohio State University Medical Center, Women and Infant Nursing

Slide 29: 

8/30/2011 Dr.Takvani 29 Image courtesy : The Ohio State University Medical Center, Women and Infant Nursing

Massaging Premature : 

8/30/2011 Dr.Takvani 30 Massaging Premature All other principles remain same however the steps can be curtailed and massage only after advice of doctor. Close observation of vitals and the behavior of the baby is must while doing this.

Slide 31: 

8/30/2011 Dr.Takvani 31 Thanks Do communicate drtakvani@gmail.com