U.N.A. Atbp.

(The Keys to Essential Newborn Care)

JOSEPHINE T.R. HOLGADO, M.D., D.P.P.S OCTOBER 31, 2012 CALAMBA MEDICAL CENTER

INTRODUCTION
NEWBORN Greek word "neo" - NEW Latin word "natus - BORN
From birth to 28 days

INTRODUCTION
NORMAL NEWBORN
37-42 WEEKS APPROPRIATE FOR GESTATIONAL AGE (AGA) NO CONGENITAL ANOMALY/DISEASE NORMAL VITAL SIGNS (HR, RR, Temp) CEPHALIC PRESENTATION SPONTANEOUS VAGINAL DELIVERY NO MATERNAL INFECTION OR DISEASE

INTRODUCTION
HIGH RISK NEONATE Preterm or < 37 weeks Postterm or > 42 weeks SGA or LGA Abnormal Vital signs Not cephalic presentation Not spontaneous vaginal delivery With Maternal disease/infection With congenital anomaly/disease

INTRODUCTION
Philippine Health Statistics 82,000 Filipino children die annually 37 % due to Neonatal Deaths Neonatal mortality hasnt improved for the past 20 years. (1988-2008) Top 3 causes: Sepsis/Pneumonia, Asphyxia and Prematurity

OBJECTIVES
General Objective:
To acquire a general knowledge of essential newborn care (ENC)

OBJECTIVES
SPECIFIC OBJECTIVES 1. TO KNOW THE STEPS OF IMMEDIATE and SUBSEQUENT NEWBORN CARE 2. TO FIND OUT THE SCREENING METHODS IN THE NEWBORN 3. TO IDENTIFY THE DANGER SIGNS TO WATCH OUT FOR IN NEONATES 4. TO DETERMINE THE PROHYLAXIS GIVEN TO THE NEWBORN 5. TO KNOW THE VACCINES TO BE ADMINISTERED AT BIRTH

Four Core Steps of Immediate Newborn Care

1. Immediate and thorough drying 2. Early skin-to-skin contact 3. Properly timed cord clamping 4. Non-separation of the newborn and mother for early initiation of breastfeeding

Time Band: At perineal bulging Prepare for the Delivery

Check temperature of the delivery room 25 - 28 o C Free of air drafts Notify appropriate staff Arrange needed supplies in linear fashion Check resuscitation equipment Wash hands with clean water and soap Double glove just before delivery

Time Band: Within 1st 30 secs Immediate Thorough Drying

Call out the time of birth Dry the newborn thoroughly for at least 30 seconds by wiping the eyes, face, head, front and back, arms and legs Remove the wet cloth Do a quick check of breathing while drying

Time Band: Within 1st 30 secs Immediate and Thorough Drying

DONTS Do not ventilate unless the baby is floppy/limp and not breathing Do not suction unless the mouth/nose are blocked with secretions or other material Do not wipe off vernix. Do not bathe the newborn. Do not do footprinting. No slapping. No hanging upside down. No squeezing of chest.

Time Band: Within 1st 30 secs Immediate and Thorough Drying

Objectives: 1. warm the baby 2. stimulate breathing

Time Band: After 30 secs of drying Early Skin-to-Skin Contact

If newborn is breathing or crying: Position the newborn prone on the mothers abdomen or chest Cover the newborns back with a dry blanket Cover the newborns head with a bonnet

Time Band: After 30 secs of drying Early Skin-to-Skin Contact

Avoid any manipulation, e.g. routine suctioning that may cause trauma or infection Place identification band on ankle (not wrist) Skin to skin contact is doable even for cesarean section newborns

Time Band: After 30 secs of drying Early Skin-to-Skin Contact

Objectives: 1. To provide warmth and bonding 2. To prevent hypothermia, infection and hypoglycemia

Time Band: 1 - 3 mins Properly - timed cord clamping

Remove the first set of gloves After the umbilical pulsations have stopped, clamp the cord using a sterile plastic clamp or tie at 2 cm from the umbilical base Clamp again at 5 cm from the base Cut the cord close to the plastic clamp

Time Band: 1 - 3 mins Properly - timed cord clamping

Do not milk the cord towards the baby After the 1st clamp, you may strip the cord of blood before applying the 2nd clamp Cut the cord close to the plastic clamp so that there is no need for a 2nd trim Do not apply any substance onto the cord

Time Band: 1 - 3 mins Properly - timed cord clamping

Objectives: 1. To reduce anemia in term & preterm 2. To reduce IVH and transfusions in preterm

Time Band: Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding

Leave the newborn in skin-to-skin contact Observe for feeding cues, including tonguing, licking, rooting Point these out to the mother and encourage her to nudge the newborn towards the breast

Time Band: Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding

Counsel on positioning Newborns neck is not flexed nor twisted Newborn is facing the breast Newborns body is close to mothers body Newborns whole body is supported

Time Band: Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding

Counsel on attachment and suckling Mouth wide open Lower lip turned outwards Babys chin touching breast Suckling is slow, deep with some pauses

Time Band: Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding

DONTS No unnecessary/frequent handling by health workers Do not give sugar water, formula or other prelacteals Do not give bottles or pacifiers Do not throw away colostrum

Time Band: Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding

Weighing, bathing, eye care, examinations, injections (hepatitis B, BCG) should be done after the first full breastfeed is completed Postpone washing until at least 6 hours

Time Band: Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding

Objective: To facilitate initiation of breastfeeding through sustained contact

UNANG YAKAP
VIDEO
http://www.youtube.com/watch?v=5hCP7rYHrwA

SUBSEQUENT NEWBORN CARE

Care prior to discharge ( From 90 minutes of life until discharge)

Care after discharge to 7 days of life

Time band: after the 90 minutes of age, but prior to discharge

Ensure warmth of the baby
1. Ensure the room is warm (temp of 25C and draft free) 2. Explain to the mother that keeping the baby warm is important for the baby to remain healthy 3. Keep the baby in skin-to-skin contact with the mother as much as possible

Time band: after the 90 minutes of age, but prior to discharge

Support unrestricted, per demand breastfeeding, day and night

Keep the newborn with his/her mother (Rooming-In) Support exclusive breastfeeding (no other food or water) Explain that exclusive breastfeeding is the only feeding that protects her baby against serious illness.

Time band: after the 90 minutes of age, but prior to discharge

Washing and Bathing (Hygiene)
Wash or bathe a baby in a WARM, draught free room Wash your hands Wash the face, neck, underarms with a damp cloth DAILY Wash the buttocks when soiled. Dry thoroughly

Time band: after the 90 minutes of age, but prior to discharge

Cord Care Wash hands before and after cord care Put nothing on the stump Fold diaper below stump Keep stump loosely covered with clean clothes If the stump is wet, wash with clean water and soap, dry with clean cloth. If umbilicus is red or draining pus or blood, see the health worker.

Time band: after the 90 minutes of age, but prior to discharge

Sleeping

Let the baby sleep on his/her back or side Keep the baby away from smoke or from people who are smoking Ensure that the mother are sleeing under impregnated bed net if there is malaria in the area Keep the baby away from sick children or adults

NEWBORN SCREENING
Newborn screening (NBS) is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to brain damage, organ damage, and even death if left untreated. The heel of the baby is pricked and a few drops of blood are blotted on a filter paper and air-dried. It is normal for babies to cry hard during the procedure due to the pain of pricking.

NEWBORN SCREENING
A negative screen means that the result of the test indicates extremely low risk of having any of the disorders being screened. A positive screen means that the baby is at increased risk of having one of the disorders being screened so a referral is made to the nearest hospital or specialist for confirmatory testing and further management. Should there be no specialist in the area, the NBS secretariat office will assist its attending physician.

NEWBORN SCREENING
(1)
(2) (3)

(4)
(5)

(6)

Congenital Hypothyroidism (CH), Congenital Adrenal Hyperplasia (CAH), Galactosemia (GAL), Phenylketonuria (PKU); Glucose-6-Phosphate-Dehydrogenase Deficiency (G6PD Def.) and Maple Syrup Urine Disease (MSUD).

NEWBORN SCREENING
Expanded Newborn Screening (NBS) (video)
http://newbornscreening.multiply.com/video/item/6

HEARING SCREENING
A short test to tell if a person has a hearing loss Easy and not painful. Most babies are often asleep while being screened. All babies should be screened for hearing loss no later than 1 month of age. It is best if they are screened before leaving the hospital after birth.

HEARING SCREENING
Two different types of hearing screening tests: Otoacoustic emissions or OAE a miniature earphone and microphone is placed in the ear Auditory brainstem response or ABR band-aid like electrodes are placed on the baby's head to detect responses

DANGER SIGNS
Check for Very Severe disease: Not feeding well Convulsion Fast breathing (>60 breathes/min) Severe chest indrawing Fever of 37.5 C and above Low body temperature (< 35.5 C) Movement only when stimulated or no movement at all

DANGER SIGNS
Check for local bacterial infection: Umbilicus red or draining pus Skin pustules
Check for Jaundice: Severe Jaundice : < 24 hrs, soles & palms at any age Jaundice: > 24 hrs, palms and soles not yellow

PROPHYLAXIS
Vitamin K1 to prevent bleeding due to its deficiency Eye prophylaxis (0.5% erythromycin or 1% tetracycline ointment) to prevent ophthalmia neonatorum or neonatal conjunctivitis or eye infection in the newborn

IMMUNIZATION
BCG Route: Intradermal Site: Deltoid
Hepatitis B Route: Intramuscular Site: Anterolateral aspect of thigh

SUMMARY
Unang Yakap Newborn Screening Assessment of Danger Signs Prophylaxis Immunization

THANK YOU!