Newborns management

1. Resuscitation
of new born
SBA - Presentation 5 (b)
Maternal Health Division
Ministry of Health & Family Welfare
Government of India

2. Resuscitation of new born 2
Session objectives
To learn about
• Care of newborn immediately after delivery
• New born resuscitation

3. Resuscitation of new born 3
Immediate care to newborn
• Place baby on mother’s abdomen
• Dry the baby with clean cloth (Do not clean the uernix)
• Ensure baby is crying and breathing
• Put clean thread ties tightly around the cord at 2 cm
and 5 cm from the baby’s abdomen once cord stops
pulsating in 2-3 minutes
• Cut between the ties with a sterile/clean blade after
1-3 minutes

4. Resuscitation of new born 4
Immediate care to newborn
• Wipe mouth and nose
• Avoid routine suction of baby
• Weigh the baby
• Leave the baby between the mother’s breasts to
start skin to skin contact
• Cover the baby’s head with a cloth
• Initiate Breastfeeding
• Cover the mother and the baby with a warm cloth

5. Resuscitation of new born 5
Immediate care to newborn
What should you do if baby not breathing or crying?
• Call for help
• Proceed to resuscitation
• Anticipate the need for resuscitation, especially if the woman has history of
– Eclampsia
– Vaginal bleeding
– Prolonged/obstructed labour
– Preterm birth
– Fetal distress
– Multiple pregnancies

6. Resuscitation of new born 6
Preparation for resuscitation
Equipment should always be ready and in working condition
• Ambu bag – self –inflating with the neonatal size mask
• Clean dry napkins to put under the baby’s shoulder
• Radiant warmer – ensure that the electricity supply and connections
are proper and there is no current leakage.
• Radiant warmer should be warmed 20 minutes prior to receiving baby
• Suction apparatus – new disposable nasogastric tube should be used
each time
• Oxygen cylinder is available in the labour room with flow meter and
the key on it.
• Oxygen mask or tube should be clean and disinfected
Labour room staff should be trained to use the equipments

7. Resuscitation of new born 7
Steps of artificial ventilation
Self-inflating Ambu bag
Correct position of the head for ventilation
Correct position of mask on the face Ventilation with bag and mask

8. Resuscitation of new born 8
Steps of resuscitation
• Provide warmth: dry and shift the baby in newborn corner
and place him/her under radiant warmer
• Position the baby: put 2-3 cm thick towel under baby’s
shoulders to keep the neck in right position
• Clear airway: clean the mouth first and then nose
• Dry, stimulate to breath and reposition: Drying will
provide stimulus to breath. Also flick the soles or gently
rub back, trunk or extremities
• Ventilation: use self-inflating Ambu bag with right size of
mask
• Assess breathing: after 30 sec assess if further artificial
ventilation is needed

9. Resuscitation of new born 9
Harmful resuscitation practices
• Routine suction of the baby’s stomach at birth
• Postural drainage
• Squeezing the chest to remove secretions
from the airway
• Routinely giving Sodium-Bicarbonate to newborn

10. Resuscitation of new born 10
no meconium — dry the baby
meconium present — suction mouth, nose & dry the baby
Not breathing well Breathing well
Initial steps
Cut cord,Place on firm, flat surface
Provide warmth, Position baby with neck
slightly extended,Suction mouth and nose
Stimulate, reposition
Routine care
Place on mother’s abdomen,Wipe mouth
and nose, Cut cord after 1–3 minutes,
Keep baby with mother
Initiate breastfeeding
Watch colour and breath
Observation/care : Provide warmth,
Observe colour, breathing and Temp.
Initiate breastfeeding,
Watch for complications; if present - Refer
Provide bag and mask ventilation
for 30 seconds; ensure chest rise
Continue bag and mask,add oxygen
Assess heart rate (umbilical pulsation -
check for 6 seconds
Heart rate 100 or  continue ventilation
Assess breathing. If breathing well,
Slowly discontinue ventilation & provide observational care
Heart rate 100 / baby not breathing well
continue ventilation with oxygen. Refer
NEW BORN RESUSCITATION
Assess Breathing
Assess Breathing
Breathing well
Not breathing well
Assess Breathing
Not breathing well
Assess heart rate

11. Resuscitation of new born 11
Postnatal advice
Advise the mother to
• Initiate breastfeeding including colostrum within an hour
of the birth of baby
• Drink warm fluids
• Eat full and nutritious meal
• Take adequate rest and sleep
• Maintain hygiene : perineal hygiene, use of sanitary
napkins, daily bath and hand washing before handling the
baby, cutting nails
• Care of breasts

12. Resuscitation of new born 12
Role of birth companion
• Should stay with the mother and not leave the mother and
the newborn alone.
• Should call for help if the mother has :
– Excessive vaginal bleeding
– Dizziness/ severe headache/ visual disturbances/
epigastric pain
– Convulsions
– Increased pain in the perineum
– Urinary incontinence or inability to pass urine
– Difficulty in breast feeding

13. Resuscitation of new born 13
Care of the Newborn
• Place an identity label with mother’s name and other
identification data on baby’s wrist or ankle.
• Give Inj Vit K one mg I/M to the baby
• Put the baby to breast immediately after birth
• Ensure that the baby is passing urine/stools
• Keep the baby warm either by proper wrapping or by KMC
• Examine the baby quickly for malformations/ birth injury
• If present - refer the baby to the FRU
• Ensure warmth during examination and transportation

14. Resuscitation of new born 14
Care of the Newborn
• Check the baby’s colour and breathing every five minutes
• Refer to MO at the PHC after initial resuscitation if -
– The baby becomes cyanotic (bluish)
– Has difficulty in breathing (<30 or >60 breaths / minute)

15. Resuscitation of new born 15
Care of the Newborn
• Check warmth by feeling the baby’s feet every
fifteen minutes
• If the baby’s feet feel cold, check the axillary temperature
• If the baby’s temperature < 36.5 0C :
– Provide warmth to the baby by placing baby under
radiant warmer.
– If not available, ensure warmth by placing the baby
under a 200 watt bulb placed at a height of 50-60 cms.
– Teach the mother to provide skin to skin contact,
kangaroo mother care (KMC)

16. Resuscitation of new born 16
Kangaroo care
• Provide privacy to the mother
• Request the mother to sit or recline comfortably
• Mother’s chest should be bare
• Undress the baby gently, except for cap, nappy and socks
• Place the baby prone on mother’s chest, between her
breasts, in an upright and extended posture,
• Maintain skin to skin contact

17. Resuscitation of new born 17
Kangaroo care
• Turn baby’s head to one side to keep airway clear
• Cover the baby with mother’s blouse, ‘pallu’ or gown
• Wrap the baby-mother duo with an added blanket or
shawl or warm the room with a heating device
• Breastfeed the baby frequently
• If mother is not available, skin to skin contact may be
provided by the father or any other adult
• Kangaroo care should not be given by a person who has
any infection

18. Resuscitation of new born 18
Kangaroo care
What should you do when skin to skin contact
is not possible?
• Keep the room warm with a home heating device
• Clothe the baby in 1-2 layers (summer), 3-4 layers (winter)
• Cover the head, hands and feet of the baby with cap,
gloves and socks respectively.
• Let the baby and mother lie together on soft, thick
bedding.
• Cover the baby and the mother with additional quilt,
blanket or shawl in cold weather

19. Resuscitation of new born 19
Kangaroo care

20. Resuscitation of new born 20
Care of the Newborn
• Check the cord for any bleeding every 15 minutes
– If the cord is bleeding, re-tie the cord more tightly
– Do not apply any substance to the stump
– Leave the stump uncovered and dry
• Wipe off any meconium or blood from baby’s skin
• Delay the baby’s first bath to beyond 24 hours of birth
• Weigh all babies before they leave the delivery room
• Ensure baby is dressed warmly

21. Resuscitation of new born 21
Care of the Newborn
Encourage breastfeeding within an hour of birth
• Emphasize importance of colostrum (helps to protect
baby against infections)
• Check if position and attachment of the baby to the
breast are correct at the first feed
• Mother can feed her baby while she is lying down or
sitting – both mother and baby should be comfortable
• Do not give artificial teats or pre lacteal feeds such as
sugar water or local foods or even water to the
newborn

22. Resuscitation of new born 22
Key Messages
Newborn
• Maintain the body temperature and prevent hypothermia
• Maintain the airway and breathing
• Initiate breast feeding within an hour of birth
• Recognize danger signs
• Timely and appropriate referrals

23. Resuscitation of new born 23
Preparing for discharge - Mother
Ensure uterus is hard and bleeding per vaginum is within
normal limits
Counsel the mother about:
• Diet and rest
• Exclusive breast feeding
• Maintenance of hygiene
• Avoiding sexual intercourse till perineal wound heals
• Need to take iron tablets
• Contraception
• When to return for follow up
• Complete immunization of baby
• Care of breast and perinium
• Remain happy and focused on care of the baby

24. Resuscitation of new born 24
Preparing for discharge - Baby
• Ensure baby is warm
• Breathing is normal
• Accepting and retaining breast milk
• Cord is clean
• Passing urine and stool
The baby should receive:
• BCG and OPV
• Hepatitis B preferably before discharge

25. Resuscitation of new born 25
Advice on discharge - Mother
Danger signs: Return immediately
• Increase in vaginal bleeding
• Fast / difficult breathing
• Fever
• Feels too weak to get out of bed
• Severe abdominal pain
• Breasts swollen, red or tender
• Dribbling of urine or inability to pass urine.
• Pain in the perineum or draining pus
• Foul smelling lochia
• Convulsions

26. Resuscitation of new born 26
Advice on discharge - Baby
Danger signs:
(If any of the following signs are there – return immediately)
• Breastfeeding poorly
• Develops fever or feels cold to touch
• Fast / difficult breathing
• Blood in stool
• Cord stump red, swollen or discharge present
• Skin infection (pustules)
• Convulsions
• Dull and lethargic

27. Resuscitation of new born 27
Thank you