Care of the Newborn

PowerPoint Presentation: 

C a r e o f t h e Newborn - C.S.N.Vittal

Newborn Deaths: 

Newborn Deaths 8.1 million infant deaths (1993) 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)

Known Interventions to Prevent and Treat Maternal and Newborn Complications: 

Known Interventions to Prevent and Treat Maternal and Newborn Complications Birth preparedness Iron/folate Tetanus toxoid Intermittent preventive therapy (IPT) in malaria-endemic areas Treatment of prenatal infections (urinary tract infection; Gonorrhea/Chlamydia; Syphilis; Bacteriuria) Steroids for fetal prematurity Identification/referral high-risk pregnancies Antenatal

Known Interventions to Prevent and Treat Maternal and Newborn Complications: 

Known Interventions to Prevent and Treat Maternal and Newborn Complications Partograph Infection prevention Eclampsia management Sepsis management Hemorrhage management Intrapartum

Known Interventions to Prevent and Treat Maternal and Newborn Complications: 

Known Interventions to Prevent and Treat Maternal and Newborn Complications Active management of third stage labor Prompt treatment of maternal hemorrhage Treatment of maternal and newborn infections Essential newborn care: thermal protection, early/exclusive breastfeeding; clean cord care; vaccination; Vitamin K Newborn resuscitation Care of low birth weight (LBW) infant Immediate Post-Partum

Evidence-based Interventions to Reduce Newborn Deaths: 

Evidence-based Interventions to Reduce Newborn Deaths Infection 36% Sepsis/Pneumonia Tetanus Diarrhea Asphyxia 23% Other 7% Complications of Prematurity 27% Cong. Anom 7% Low birth weight is a significant contributor in 40–70% of neonatal deaths . Tetanus Toxoid Immunization of Mother Clean Delivery Cord Care Early & Exclusive Breastfeeding Antibiotics for mother and baby Warming Resuscitation Skilled Birth Attendants Syphilis Control Folate Supplementation Adapted from Lancet 2005 Malaria Control Antenatal Corticosteriod Treatment of Bacteriuria Kangaroo Mother Care Birth Spacing Maternal Nutrition

Care of the Newborn: 

Care of the Newborn Prenatal 1 Periatal 2 Postnatal 3

Preventive Neonatology: 

Preventive Neonatology Prenatal 1 “Health of the baby should be guarded from the day of conception.”

Preventive Neonatology: 

Preventive Neonatology 95% of adolescent girls are anemic Average weight and height of rural women in India are 42 kg and 152 cm respectively 1/3 of 18 yr old women have body weight of < 40 kg and height of < 145 cm NNMB Healthy woman produces healthy babies

Care of mother during pregnancy: 

Care of mother during pregnancy Adequate antenatal care Optimal nutritional advice Iron and folic acid supplementation Vaccinations Adequate physical rest and relaxation Motivation for breast feeding

High Risk Pregnancy: 

High Risk Pregnancy Poor socioeconomic Illiteracy Maternal under nutrition, short stature, anemia Inter pregnancy interval of < 24 months Primi / Grand multipara Maternal age < 20 or > 35 Presence of systemic illness Past bad obstetric history Rh – ve blood group PIH Rh isoimmunixation Maternal infection Anemia APH Slow growth of fetus Multiple pregnancy Poly or oligo hydramnios CPD Fetal distress PROM Early onset of labor PRIMARY SELECTION SECONDARY SELECTION

Foetal monitoring: 

Foetal monitoring Physical assessment Amniotic fluid Shake test Creatinine Cytology Ultrasonography Foetal sex BPD Femur length Foetal position Incompetent cervical os Placental position

Down Syndrome Screening: 

Down Syndrome Screening MSAFP hCG UE3 Prenatal cytogenetics Nuchal fold thickness increase

Perinatal Pharmacology: 

Perinatal Pharmacology Drugs which can cause Foetal Death Quinine Lead Aloes Large doses of anti-folic acid agents High doses of corticosteroids

Perinatal Pharmacology: 

Perinatal Pharmacology Teratogens High doses of cortisone Oral hypoglycemic agents Salicylates Vitamin D Penicillamine Tetracycline Streptomycin Meprobomate Penicillin Antihistamines Thyroxine

Maternally administered drugs & Adverse effects on newborn: 

Maternally administered drugs & Adverse effects on newborn Drug Effect on newborn Anaesthetics CNS Depression Aspirin Neonatal bleeding Dilantin Bleeding, hydantoin syndrome Nitrofurantoin Hemolytic anemia Phenobarbitone Hemolytic anemia Sulfa drugs Kernicterus Oxytocin Hyperbilirubinemia Smoking IUGR Progesterone Masculanization Propranalol Bradycardia, hypoglycemia, RDS Tetracycline Staining of teeth Vitamin D Supraventricular aortic stenosis

Some maternal problems & their impact on infant: 

Some maternal problems & their impact on infant Oligohydramnios Renal agenesis IUGR Obstructive uropathy Pulmonary hypoplasia Fetal facial defects Prune belly syndrome Club foot Cord compression during delivery

Some maternal problems & their impact on infant: 

Some maternal problems & their impact on infant Polyhydramnios Esophageal aresia Lung malformations IUGR Anencephaly Duodenal atresia Annular pancreas Diaphragmatic hernia Hydrocephalus Neuromuscular disease Encephalocele

Some maternal problems & their impact on infant: 

Some maternal problems & their impact on infant Diabetic mother Macrosomia CCF Polycythemia Hyperviscosity IUGR Electrolyte disturbances Transposition of great arteries Coractation of aorta Meningomyelocele Renal agenesis Caudal compression syndrome Vertebral anomalies

Care of the Newborn: 

Care of the Newborn Perinatal 2

Plea of a baby at birth: 

Plea of a baby at birth I have come from an extremely warm, clean, quiet and comfortable abode Protect me at birth from microbes and cold I am wet and naked, cover me and place me under a heater I don’t know how to smile, let me announce my arrival by a cry Don’t hurt me but gently clean my windpipe to let me cry Don’t give me injections but give me a breath to save my life I have been swimming all through in the womb, don’t be in a hurry to bathe me in the labor room. Dr. Meharban Singh

Fetal Lung Blood Flow: 

Fetal Lung Blood Flow

Successful Resuscitation: 

Successful Resuscitation Anticipation Adequate preparation of Equipment and personnel

Neonatal Evaluation Factors: 

Neonatal Evaluation Factors Respirations Heart Rate Colour APGAR

Respirations: 

Respirations Present Absent

Heart Rate: 

Heart Rate >100 60 – 100 < 60

Colour: 

Colour Pink Cyanosis Central Acral

Essence of Neonatal Resuscitation: 

Essence of Neonatal Resuscitation Airway Breathing Circulation

PowerPoint Presentation: 

is Resuscitation delayed Resuscitation Denied

PowerPoint Presentation: 

Everything ought to be done to ensure that an infant be born at term, well developed, and in a healthy condition. But in spite of every care, infants are born prematurely. Pierre Budin , The Nursling

Low Birth Weight: 

Low Birth Weight Preterm Small for Date (IUGR)

PowerPoint Presentation: 

Some 20 million low-birth-weight (LBW) babies are born each year, because of either preterm birth or impaired prenatal growth, mostly in less developed countries. They contribute substantially to a high rate of neonatal mortality whose frequency and distribution correspond to those of poverty. Of the estimated 4 million neonatal deaths, preterm and LBW babies represent more than a fifth.

Gestational Age Assessment: 

Gestational Age Assessment Physical Parameters Hair and Skin Ear cartilage Breast bud Genitalia Sole creases

Gestational Age Assessment: 

Gestational Age Assessment Neonatal reflexes Moro Grasp Rooting, sucking, swallowing Tonic neck reflex Walking, standing and stepping Glabellar tap New Ballard Score Muscle tone assessment Scarf sign Heel to ear Polpliteal angle Square window sign Arm recoil Neuromuscular Integrity

Care of the Newborn: 

Care of the Newborn Postnatal 3

Rooming in (Bedding in !): 

Rooming in (Bedding in !)

Kangaroo Mother Care: 

Kangaroo Mother Care A universally available and biologically sound method of care for all newborns, but in particular for premature babies, with 3 components - Skin-to-skin Contact Exclusive breastfeeding Support to the mother infant dyad.

Eye prophylaxis: 

Eye prophylaxis Single-use doses of sterile ophthalmic ointment containing 1% tetracycline or 0.5% erythromycin is usually done within the first hour after birth, but may be delayed until after the first breastfeeding. This medication is given to all neonates to prevent gonococcal opthalmia neonatorum.

Vitamin K: 

Vitamin K 1 mg IM to prevent Hemorrhagic Disease of Newborn

Newborn Physical Examination: 

Newborn Physical Examination First examination: Soon after birth, in the labor room Vital signs Anthropometry Birth trauma recognition Look of congenital anomalies

Newborn Physical Examination: 

Newborn Physical Examination Second examination- after feed (Detailed) Within 24 hrs To detect deviations from normal Gestational age assessment Head to foot exam.

Newborn Physical Examination: 

Newborn Physical Examination Third examination - Before discharge To assess adequacy of nutrition Systemic examination Guidelines for follow up

Neonatal Assessment - Skin: 

Neonatal Assessment - Skin Looking for Variations

Mongolian spots: 

Mongolian spots

Erythema toxicum: 

Erythema toxicum Small papules or pustules on an erythematous base. Typically appear on 1 st day – may last several weeks DD : Staphylococcal scalded skin syndrome – infant looks ill Pyoderma Candidial infection

PowerPoint Presentation: 

Neonatal acne: Possibly as a result of increased response to circulating androgenic hormones Rarely require therapy

Cutis marmorata: 

Cutis marmorata Cutis marmorata: Vasomotor response to stress. Skin assumes a lacy pattern similar to cobble stones. A persistent form seen in Trisomy 21, 18 and cutis marmarota telangiectasia congenita

Birth Marks: 

Birth Marks Capillary (strawberry) hemangiomas Macular lesions in the first months – quickly grow in 1 st year Occur anywhere Bright red in color Treatment not necessary as they regress spontaneously

Birth Marks: 

Birth Marks Nevus sebaceous (of Jadassohn) Yellow-orange hairless plaques resembling flat warts located on scalp Potential to become malignant – hence removed by adolescence

Neonatal Assessment: 

Neonatal Assessment Looking for birth Injuries

Birth Injuries: 

Birth Injuries Cephalhematoma Subperiosteal bleed Limited to bone Dose not cross suture line Can be associated with underlying skull fracture Not preset at birth – can increase in size over first few days A rim can be felt around edge Resolve spontaneously

Birth Injuries: 

Birth Injuries Brachial Palsy Sec, to traction on the head during delivery Erb-Duchenne Paralysis Involve C5 – C6 Klumpke Paralysis Involve C7 – T1

Birth Injuries: 

Birth Injuries Brachial Palsy Erb-Duchenne Paralysis Involve C5 – C6 Arm abducted, pronated with flexion and finger flexion Waiter’s tip If C4 is also involved, ipsilateral diaphragmatic paralysis

Birth Injuries: 

Birth Injuries Facial Palsy Peripheral type Sec. to difficult delivery Affected site does not move when the child cries

Birth Injuries: 

Birth Injuries Calviculuar fracture Most commonly fractured bone during delivery Associated with large babies & shoulder dystocia Fussy baby with asymmetric Moro reflex Crepitus over fracture Healing callus palpated within 1 week No treatment needed

Neonatal Assessment: 

Neonatal Assessment Looking congenital anomalies

What Next ?: 

What Next ?

PowerPoint Presentation: 

India can save the lives of 250,000 babies every year by just ONE action

Neonatal Immunization: 

Neonatal Immunization

PowerPoint Presentation: 

Special Situations Care of the Newborn

PowerPoint Presentation: 

Because of the greater probability of serious bacterial infection, a more aggressive approach to the evaluation and management of fever is warranted in young infants. Fever in Newborn

Jaundice in Newborn Blanching of skin: 

Jaundice in Newborn Blanching of skin

Jaundice in Neonate: 

Jaundice in Neonate Zone 1 2 3 4 5 SBR (umol/L) (mg/dL) 100 6 150 9 200 12 250 15 >250 >15 Kramer Rule

Pathological Jaundice: 

Pathological Jaundice When it appears on the first day Stains palms and soles Persists beyond 2 weeks Serum total bilirubin > 15 mg/dL Serum conjugated bilirubin > 2.5 mg/dL