Enc lecture2
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Basic care to support survival and wellbeing of newborns is called essential newborn care (ENC). ENC includes immediate care at birth, care during the first day, and up to 28 days. It is important to help initiate breastfeeding within the first hour of birth, identify and refer neonates requiring special care, take all precautions to prevent infection, hypothermia, and counsel mothers on danger signs and follow-up.
Enc lecture2
- 1. EssEntial nEwborn CarE PRESENTED BY ANJALI SHUKLA M.SC NURSING( Obs & Gynae)
- 2. HEALTHY NEWBORN A healthy infant born at term b/w 38-42wks should have average birth weight , cries immediately following birth, establishes independent rhythmic respiration & quickly adapts to the changed environment ESSENTIAL NEWBORN CARE Basic care to support survival and wellbeing is called ENC • It includes immediate care at birth, care during the first day and up to 28 days
- 3. IndiaWorld Neonatal deaths37% 55% Under five deaths Neonatal Deaths Neonatal deaths are a major contributing factor to U5 mortality in India Source: 2007 UNICEF
- 4. Major causes of U5 mortality Pneumonia 19% Neonatal 45% Others 8% injuries 2% Malaria 1% Measles 4% HIV/AIDS 1% Diarrhoea 20% Asphyxia, 23 Neonatal Tetanus, 4 Congenital anomaly, 4 Diarrhoea, 2 Others, 6 Sepsis, 36 Small/Very Small at birth, 21 Causes of Neonatal Deaths WHO 2016,
- 5. PrEParinG For birtH WASH YOUR HANDS ESSENTIAL • A draught free, warm room - temperature 250 C + • A clean, dry and warm delivery surface • A radiant heater • Two clean, warm towels/cloths: to dry, wrap or cover the newborn baby. • A folded piece of cloth • A suction device • A newborn size self inflating bag, masks • Laryngoscope • Oxygen • Medications • A CLOCK
- 6. Essential Newborn Care Interventions (Soon after the delivery of the baby) Initial care • It should be placed on a clean dry or warm linen with the head slightly downwards (150 ). It facilitate the drainage of the mucus accumulated in the trachea bronchial tree by gravity. • The time of baby’s birth and the sex are noted and recorded soon. Clearing the airway : • Wiping of the baby’s face and fluid from the nose and mouth. • Suctioning the oral and nasal passage with a soft rubber bulb syringe or mucus sucker.(if needed) • The airway should be cleared with the aid of a mucus extractor or soft suction catheter • Clear oropharynx prior to nasopharynx
- 7. Importance of suctioning: • Several natural mechanisms help with this: • As the fetal chest passes through the birth canal it is compressed, squeezing excess fluid out of the lungs prior to the baby taking its first breath. • After several seconds in this "partly delivered" position, fluid can be seen streaming out of the babys nose and mouth.
- 8. Clamping and cutting the cord: • The cord is clamped by two kocher’s forceps , the near one is placed 5cm away from the umbilicus and is cut in between . • Two separate cord ligatures are applied with sterile cotton thread 1 cm apart. 2.5 cm away from the navel squeezing the cord with fingers prior to applying ligeratures or plastic cord clamp. Delay cord clamping: for 2-3 minutes or till cessation of the cord pulsation facilitates transfer of 80-100ml blood from the compressed placenta to a baby when placed below the level of uterus. Early cord clamping : Should be done in cases of Rh – incompatibility or babies born asphyxiated one of a diabetic mother.
- 9. Identification : Quick check is to any gross abnormality and dry or wraped in warm towel When the babies are born in the hospital , it is essential to identifiable. The identification tape is tied both on the wrist of the baby and the mother
- 10. . APGAR SCORE MONITORING: After the baby is seen making respiratory effort , the midwife can proceed to dry the infant in order to avoid evaporative heat loss . • At 1 min , after the baby’s birth the midwife will assess the baby’s general condition and will repeat this for 5 min. It Involves 5 indicators : • Activity • Pulse • Grimace • Appearance • Respirations TOTAL SCORE = 10 NO DEPRESSION: 7-10 MILD DEPRESSION: 4-6 SEVERE DEPRESSION : 0-3
- 12. PREVENTION OF HEAT LOSS: • It is important to keep the baby warm. This is initated by wiping off and drying the baby. • Bodily contact with the mother • Radiant warmer or 200 watt bulb • Warmed blanket • The wet towel removed before wrapping the baby in warm blankets , skin to skin contact with mother to conserve heat . • Prior to transferring the baby to the ward must carry out a gross examination of the baby for any congenital defect. • Vitamin K 1mg IM given as a prophylaxis against bleeding . erythromycin or Gentamicin eye ointment is applied as prophylaxis with in 1 hour of birth.
- 13. Newborn can lose heat in four ways
- 14. Keeping a newborn baby warm after delivery Method of heat loss Prevention Evaporation: Wet baby Immediately after birth dry baby with a clean, warm, dry cloth Conduction: Cold surface e.g weighing scale etc. Put the baby on the mother’s abdomen or on a warm surface Convection: Cold draught Provide a warm, draught free room for delivery at ≥25o C Radiation: Cold metallic surroundings Keep the room warm
- 15. Universal Precautions & cleanliness • Wash hands. • Wear gloves. • Protect yourself from blood and other body fluids during deliveries. • Practice safe sharps disposal. • Practice safe waste disposal. • Deal with contaminated laundry. • Sterilize and clean contaminated equipment.
- 16. ‘‘Five cleans’ to prevent infectionFive cleans’ to prevent infection
- 18. CARE IN NURSERY: ADMISSION IN NURSERY • Common indications of the new born in the nursery are : prematurity , respiratory distress, poor perfusion or presence of cyanosis , malformation and need for O2therapy. Components of Routine Nursing Care • A nthropometric Measurements • B athing – Oil bath/ warm water bath • C ord Care • D ressing/ Wrapping - mummified • E ye prophylaxis • F oot printing / Identification & Feeding • G et APGAR score – 1 & 5 mins • H R, RR, Temp • I njection of Vitamin K & Imuunization • R outine medication • V ital sign • W eight
- 19. Bathing – • complete warm water bath • From cleanest to dirties part • Do not remove vernix caseosa vigorously Cord care It is kept exposed to air and allowed to dry to promote early detachment. • Topical antiseptic like triple dye and Neosporin powder may be applied to reduce bacteria colonization . CORD BLOOD COLLECTION Make sure cord blood is collected for analysis and sent to laboratory for checking of Rh Blood type, Hematocrit & possible cord blood gases.
- 20. • Eye prophylaxis – eyes are kept clean wool soaked with sterile normal saline as a prophylaxis against opthalmia neonatrum. • Immunization and vaccines at birth time Screening of the new born – screening test like glucose screening and detect hypoglycaemia specially for infants of diabetic mothers, bilirubin screening . • Feeding – the frequency, duration and volume of each feed is important for newborn’s growth and development usually it is 8-12 times per day. • Weight – The weight is loss of 7-10% in the first week of life . weight gain generally begins by the second week. Average daily weight gain is 20-30 g/day . the infant weighted should be daily. • Vital sign- RR , HR, axillary temp. Are recorded every 6-8 hours in baby’s chart .each urine and stool output is recorded . most of the newborn pass urine by 24 hour and meconium by 48 hours of life.
- 21. Anthropometric Measurement- LENGTH: • (from top of head to the heel with the leg fully extended) • Average range: 18-22 inches (46-56 cm) Head circumference: Head circumference (repeat after molding and caput succedaneum are resolved). Average range: 33 to 35 cm (13-14 inches) Normally, 2 cm larger than chest circumference Place tape measure above eyebrows and stretch around fullest part of occipital at posterior fontanel. Chest circumference (at the nipple line): • Average range: 30-33 cm (12-13 inches) Normally, 2 cm smaller than head circumference Stretch tape measure around scapulae and over nipple line.
- 22. Warm Chain • Warm delivery room • Immediate drying • Skin to skin contact at birth • Breastfeeding • Bathing and weighing postponed • Appropriate clothing • Mother and baby together • Warm transportation
- 23. Prevention of infections: ‘cleanPrevention of infections: ‘clean chain’chain’ At delivery: WHO five 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
- 24. Prevention of infections: ‘cleanPrevention of infections: ‘clean chain’chain’ After delivery Hand washing before handling the baby Exclusive breastfeeding Keep the cord clean and dry; do not apply anything Use a clean cloth as a diaper/napkin Hand wash after changing diaper/napkin
- 25. DanGer siGn in neW Born
- 26. Ask the mother • Do you or baby have any problems? • Has infant passed stool with in 24 hours ( lubricated per rectal thermometer and suspect obstruction ) • Failure to pass urine? ( 48hrs) – delayed passage or obstrctive uropathy etc • Causes of vomiting ( ingestion of meconium , systemic illness) • Causes of Diarrhea ( mother ingestion of drugs, infection by non breast feed baby, metabolic disorder • Have you started breast feeding infant? • Do you have any pain while breast feeding?
- 27. Examine the Baby • Count breaths in one minute (grunt, central cynosis) Central cynosis- ( cardiac and pulmonary disease) Peripheral cynosis- ( cold) • Look for severe chest indrawing • Look at umbilicus. Is it red or draining pus? • Look for skin pustules. Are there 10 or more pustules or a big boil? • TEF( tracheo- esophageal fistula) – excessive drooling , choking )
- 29. Examine the baby • Measure axillary Temperature (if not possible, feel for fever or low body temperature) • See if young infant is lethargic and poor sucking • Look for jaundice. Are the face, abdomen or soles yellow? • Look for malformations • Capillary refill time (CRT) ( indicates tissue perfusion) • Abnormal weight loss pattern
- 30. Follow-up • Schedule postnatal visit within first week on day 3 and day 7 of delivery. Also visit on day 14, 21 and 28 if baby is LBW. • Assess for growth and development and signs of illnesses • Health education of parents done • Assessed at least once every month for 3 months and subsequently 3 monthly till 1 year.
- 31. Special situationsSpecial situations Mother has HIV/AIDS 1. Follow universal precautions as with any other delivery 2. Baby can have immediate skin-to-skin contact as any other mother and baby 3. Breastfeeding can begin when the baby is ready 4. If mother chooses replacement feeding, prepare formula for the first few feeds 5. All other care (including cord care and eye care) remain the same
- 32. SUMMARY • Basic care to support survival & wellbeing is ENC • Ventilation must be initiated within 1st min of life • Help to initiate breast feeding within 1st hr of birth • Identify and refer neonates requiring special care • Take all precautions to prevent infection, hypothermia and counsel mother for the same • Counsel mother for Danger signs, immunization & follow-up
- 33. QUeStionS Q. 1-Which of the following is the most common cause of neonatal death in India: • (A) Birth asphyxia • (B) Sepsis • (C) Low birth weight • (D) Congenital anomaly
- 34. Q2. After birth, how long it can take to achieve an oxygen saturation of 90% in normal term newborn • (A) 1 minute • (B) 2 minutes • (C) 5 minutes • (D) 10 minutes
- 35. Q3. As per neonatal resuscitation program India, need for resuscitation at birth is decided by assessing following risk factor/s at birth- • (A) Gestational maturity • (B) Breathing • (C) Muscle tone • (D) All of the above
- 36. Q4. All of the following statements are true about kangaroo mother care except • (A)Especially useful for low birth weight babies • (B) Risk of apnea is increased • (C) Decreased risk of infection • (D) Can be practiced by other family members