early neonatal care

1. Dr. BINU JOE

2. NEWBORN CARE

3. INTRODUCTION
The transition from intrauterine to extra
uterine life is a complex one and
demands considerable and effective
nursing care for ensuring survival. The
main goal of the nurse in the care of
newborn is to establish and maintain
homeostasis.

4. The
1st 24 hours
of Life
The first 24 hours of life is a very
significant and a highly vulnerable time
due to critical transition from
intrauterine to extrauterine life

5. Immediate
Care of the
Newborn
•Airway
•Breathing
•Circulation
TEMPERATURE

6. IMMEDIATE CARE OF NEWBORN
• Clearing the airway/ maintenance of respiration
• Apgar score
• Maintenance of body temperature
• Care against infection
•Care of cord
•Care of eyes
•Care of skin
• Breast feeding
•Vitamin K injection
• Screening

7. ESSENTIAL NEWBORN CARE
• Care at birth
• Care during immediate and early neonatal period
• Care in the late neonatal period and beyond

8. NEONATAL CARE
Warmth/ Thermal protection
Initiation and maintenance of
respiration.
Prevention of infection.
Referral for appropriate care.

9. Warmth/Thermal Protection
• Newborn physiology
– Normal temperature: 36.5–37.5°C
– Hypothermia: < 36.5°C
– Stabilization period: 1st 6–12 hours after birth
• Large surface area
• Poor thermal insulation
• Small body mass to produce and conserve heat
• Inability to change posture or adjust clothing to
respond to thermal stress
• Reasons of hypothermia
– Newborn left wet while waiting for delivery of
placenta
– Early bathing of newborn (within 24 hours)

10. Heat Loss Mechanisms
• Convection – the flow of
heat from the body
surface to cooler
surrounding air
– Eliminating drafts such as
windows or air con,
reduces convection
• Conduction – the
transfer of body heat to
a cooler solid object in
contact with the baby
– Covering surfaces with a
warmed blanket or towel
helps minimize
conduction heat loss

11. • Radiation – the transfer
of heat to a cooler
object not in contact
with the baby
– Cold window surface or
air con; moving as far
from the cold surface,
reduces heat loss
• Evaporation – loss of
heat through conversion
of a liquid to a vapor
– From amniotic fluid; NB
should be dried
immediately

12. Hypothermia Prevention
• Deliver in a warm room
• Dry newborn thoroughly and wrap in dry, warm cloth
• Keep the baby on a warm surface
• Give to mother as soon as possible which helps
– Skin-to-skin contact first few hours after childbirth
– Promotes bonding
– Enables early breastfeeding
• Check warmth by feeling newborn’s feet every 15
minutes
• Bath only when temperature is stable (after 24
hours)

13. Dry the baby
immediately
after birth…..
Care at birth…
Teaching Aids: ENC

14. Ensuring warmth at the time of
delivery: ‘Warm chain’
NC- 14
Teaching Aids: ENC

15. ‘Warm chain’: At delivery
At delivery:
1. Ensure the delivery room is warm (25° C), with no
draughts.
2. Dry the baby immediately; remove wet cloth
3. Wrap the baby with clean dry cloth
4. Keep the baby skin-to-skin with mother
NC- 15
Teaching Aids: ENC

16. 1. Keep the baby clothed and
wrapped; cover the head
2. Postpone bathing particularly for
small babies
3. Keep baby close to the mother
4. Use kangaroo care for stable LBW
babies
5. Show mother how to avoid
hypothermia and to recognize
6. Initiate breastfeeding
NC- 16
Teaching Aids: ENC
‘Warm chain’: After delivery

17. Temperature
• Dry immediately
• Place in infant warmer or use droplight
• Wrap warmly

18. ESTABLISHMENT AND MEINTENANCE
OF RESPIRATION
 When babies are born they need to clear the mucous and
amniotic fluid from their lungs
 As the head is born, excess mucous is wiped off gently from
mouth
 Suctioning
bulb syringes are commonly used.
Aspirate the oropharynx prior to the
nasopharynx
 Stimulate the baby to cry
 Position the infant that would promote drainage
Trendelenburg position
Side lying position

19. Airway & Breathing
• Suction gently &
quickly using bulb
syringe or suction
catheter
• Starts in the mouth
then, the nose to
prevent aspiration

20. Airway & Breathing
• Stimulate crying by rubbing
• Position properly- side lying /
modified t-berg
• Provide oxygen when
necessary

21. Initiation and maintenance of
respiration.
Respiratory rate (> 30 breaths/min.) in most newborns
– Gentle stimulation, if at all
– clear airway: Routine oro-nasal suction
– if the baby is not breathing or gasping, then skilled care
in the form of positive pressure ventilation etc. (i.e.
RESUSCITATION) would be required
Newborn resuscitation may be needed in conditions
– Fetal distress
– Thick meconium staining
– Vaginal breech deliveries
– Preterm

22. Clearing the airway
• Positioning : head low
• Gentle suction
• If natural breathing fails :
– Resuscitation and
active intervention

23. PREVENTION OF INFECTION
Principles of cleanliness essential in both home and
health facilities childbirths
Principles of cleanliness at childbirth
– Clean hands
– Clean perineum
– Nothing unclean introduced vaginally
– Clean delivery surface
– Cleanliness in cord clamping and cutting
– Cleanliness for cord care
Infection prevention/control measures at healthcare
facilities

24. Avoidance of infection
• Care of the cord
– Prevent tetanus
– Prevent anemia
• Care of eyes
– Wipe with sterile swab
– Silver nitrate/
tetracycline

25. Prevention of infections: ‘Clean
chain’
At delivery: WHO five POINTS/CLEANS
Clean
1. Hands of attendants (washed with soap)
2. Surface for delivery
3. Cutting instrument for cord(i.e. razor, blade)
4. String to tie cord
5. Cloth to wrap baby and mother
NC- 25
Teaching Aids: ENC

26. ‘Five cleans’ to prevent infection

27. Prevention of infections: ‘Clean
chain’
After delivery
1. Hand washing before handling the baby
2. Exclusive breastfeeding
3. Keep the cord clean and dry; do not apply anything
4. Use a clean cloth as a diaper/napkin
5. Hand wash after changing diaper/napkin
NC- 27
Teaching Aids: ENC

28. Cord Care

29. • Apply a sterile tie tightly around cord or cord clamp at 2
cm and 5 cm from the abdomen
• Cut between the ties/clamp with a sterile instrument
• Observe for oozing blood every 15 minutes; if blood
oozes, place a second tie
• Do not apply any substance to the stump
• DO NOT bind or bandage stump
• Leave stump uncovered
Cord care
NC- 29
Teaching Aids: ENC

30. Daily Cord Care
• Keep cord dry and clean & clamp secured
• Apply 70% isopropyl alcohol to the cord
with each diaper change and at least 2-3x
a day.
• DO NOT cover with diaper
• Note for any signs of bleeding or drainage
from the cord and other abnormalities

31. CORD CARE
• Umbilical Cord
– 2 arteries; 1 vein
– White & gelatinous immediately after birth
– Begins to DRY between 1-2 hrs following
birth
– Blackened or shriveled between 2-3 days
– Dried & gradually falls off by 7 days

32. CUTTING THE CORD
Early Clamping
Prevent overloading
of placental blood
Prevent
Polycythemia
Prevent Jaundice
Delayed Clamping
Prevent Anaemia
Enabling better
storage of iron
Receive complete
clotting factor
Better O2 level so
preventing RDS

33. 33
EYE CARE

34. EYE CARE
• Administer eye medication within 1 hr
after birth to prevent Ophthalmia
neonatorum
– Erythromycin 0.5%
– Tetracycline 1%
– Silver Nitrate 1%
• From inner to outer canthus of the eye
(conjunctival sac)

35. • Clean eyes immediately after birth with
swab soaked in sterile water
• Use separate swabs for each eye; clean
from medial to lateral side
• Give prophylactic eye drops within 1 hour
of birth (as per hospital policy)
• Do not put anything else in baby’s
eyes
Eye care

36. SKIN CARE
• Care of skin
– First bath with soap
and water( previous
practice)
– By nursing staff
– ? Delay by 12-24 hrs

37.  BATHING THE BABY
 The room should be warm with windows closed and AC off
 Always test the water first
 Fill cold water first and then hot water
 Hold the baby firmly by supporting the neck
 Avoid getting water in to the ears
 Give special attention for skin folds [ groin, armpit, back of
knees, neck]
 Take baby away from bathing area and dry the baby

38. REFERRAL FOR APPROPRIATE CARE
Proper assessment of the child.
Check the deviation as early as possible.
Follow prompt interventions as per the the
deviations.
Refer appropriate agents.
Through system wise assessment needs to be
done

39. Early and Exclusive Breastfeeding
• Early contact between mother and newborn
– Enables breastfeeding
– Rooming-in policies in health facilities prevents noso-
comial 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

40. Breast feeding
• Within an hour
• Avoid supplementary
feeds and bottle
feeding
• Breast milk
– Creates bonding
– Highly nutritive
– Anti infective

41. IMMUNIZATION
At birth: bacillus Calmette-Guerin (BCG)
vaccine, oral poliovirus vaccine (OPV) and
hepatitis B virus (HBV) vaccine (WHO)
BCG vaccinations in all population at high risk
of tuberculosis infection
Single dose of OPV at birth or in the two
weeks after birth
HBV vaccination as soon as possible where
perinatal infections are common

42. POINTS TO BE REMEMBERED
• Identification band
• Birth Registration
• Birth record and
documentation

43. Proper Identification
• After delivery, gender
should be determined
• Pertinent records should
be completed including
the ID bracelet
• Before transferring to
nursery, ID tag should
be applied.

45. GRADES OF NEWBORN CARE

46. LEVEL I CARE
• NEONATES WEIGHING ABOVE 2000gm
OR HAVING A GESTATIONAL
MATURITY OF 37 WEEKS OR MORE
BELONG TO THIS CATEGORY.THE
CARE CAN BE PROVIDED AT
HOME,PRIMARY HEALTH CENTRE
LEVEL.

47. LEVEL II CARE
• INFANT WEIGHING BETWEEN 1500-
2000gm OR HAVING A GESTATIONAL
MATURITY OF 32-36 WEEKS NEEDS
SPECIALIZED NEONATAL CARE
SUPERVISED BY TRAINED NURSES &
PAEDIATRICIANS.

48. LEVEL III CARE
• LESS THAN 1500gm OR THOSE BORN
BEFORE 32WEEKS OF GESTATION
REQUIRE INVASIVE NEONATAL
CARE.ONLY 3-5% OF ALL NEW BORN
BABIES NEED THIS CARE BY SKILLD
NURSES & NEONATOLOGISTS
ESPECIALLY TRAINED IN NEONATAL
INVASIVE CARE.

50. Thank you