PEDIAPrelims - 2. Care of the Newborn 1 (First 24 Hours to Vital Signs)

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AUFMED

Dr. Rodolfo Ng | June 18, 2015 | Pediatrics

CARE OF THE NEWBORN

CARE OF THE NEWBORN 

Transition from intrauterine to extrauterine – what is going to happen to the baby and how the baby will adapt to the environment. How we care for patients after delivery To be able to know if baby is normal or abnormal

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ST

THE 1 

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

PATTERN OF SUCCESSFUL TRANSITION FROM INTRAUTERINE TO EXTRAUTERINE LIFE 

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Expansion of lungs following initiation of first several breaths which clear the fetal lung field and termination of R-L shunting o Water – content of lungs before delivery (non-compliant) Elevation of P02 in both the alveoli and the arterial circulation (50-60 mm Hg)

PATTERN OF SUCCESSFUL TRANSITION FROM INTRAUTERINE TO EXTRAUTERINE LIFE 

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Decrease in pulmonary vascular resistance o Increased expansion and compliance of the lungs Conversion from fetal to neonatal circulation o Failure of transition – baby becomes cyanotic

IMMEDIATE CARE OF THE NEWBORN   

Airway – check the patency Breathing Temperature

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Position properly – side lying trendelenberg Provide oxygen when necessary

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modified

TRANSITIONAL PERIOD DURING THE FIRST 15-90 MIN  

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Immediate tachycardia up to 160-180/min, gradual drop to 100-120/min Irregular respirations, tachypnea up to 60-80/min, brief apnea o Abdominal breathers up to 6-7 years Moist-sounding lung fields, transient grunting and retraction Awake, moving, alert, easily startled, transient tremors o Differentiate tremors from seizure and hypoglycemia

ESSENTIAL NEWBORN CARE PROTOCOL: UNANG YAKAP - tremors: when you hold the neonate's extremity, these will STOP UNANG YAKAP - seizures: holding the shaking extremity will NOT STOP the shaking  The campaign to spread the use of the Essential Newborn Care protocol  Prevent at least half of newborn deaths without additional cost to both families and hospitals  Timely to rapidly reduce neonatal mortality ESSENTIAL NEWBORN CARE PROTOCOL   

A simple, concise, and straightforward guideline that is backed by solid research evidence Emphasizes a core sequence of four actions that are performed step by step Time-bound interventions

AIRWAY AND BREATHING   

Suction gently & quickly using bulb syringe or suction catheter Starts in the mouth then, the nose to prevent aspiration - neonates are NASAL and ABDOMINAL breathers Stimulate crying by rubbing

PI | ARELLANO π GAGUI π GALVAN π PAMINTUAN π TIMBANG PROPERTY OF AUFSOM BATCH 2017 v3.1 s2015-2016

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Major Causes of Death in Newborns and Children, WORLD, 2008

CHILDREN UNDER 5 YEARS Injuries (postneonatal) 3%

Noncommunica ble diseases (postneonatal) 4%

Other 13%

Newborn deaths 41%

Measles 1%

Essential Newborn Care Protocol – A simple, concise, and straightforward guideline that is backed by solid research evidence – Emphasizes a core of sequence of four actions that are performed step by step – Time-bound interventions 1. Drying 2. Skin to Skin Contact 3. Cord Clamping and Cutting Includes: 4. Breastfeeding 1. Immediate and thorough drying for 30 secs to one minute warms the baby and stimulates breathing.

HIV/AIDS 2%

Malaria 8%

Diarrhea (postneonatal) 14%

Pneumonia (postneonatal)1 4%

1. Neonatal Deaths 2. Postneonatal Pneumonia and Postneonatal Diarrhea

*35% of under-five deaths are due to the presence of undernutrition*

NEWBORNS UNDER 1 MONTH Prematurity & low birth weight 29%

2. Early skin-to-skin contact between mother & newborn & delayed washing for at least 6 hours prevents hypothermia, infection and hypoglycemia.

Other 11% Congenital anomalies 8% Neonatal tetanus 2% Diarrheal diseases 2%

Neonatal infections 25% Birth asphyxia & birth trauma 23%

*Sources: Cause of death: World Health Statistics 2010, WHO. Undernutrition: Black et al. Lancet, 2008.

3. Properly-timed cord clamping & cutting prevents anemia & protects against brain hemorrhage in prematures. Wait for cord pulsation to stop (1-3 minutes). *Milking the cord would push excessive RBC to the baby’s circulation causing polycythemia and later on, jaundice.

1. Prematuriy and Low Borth Weight 2. Neonatal Infections 3. Birth Asphyxia and Birth Trauma

PI | ARELLANO π GAGUI π GALVAN π PAMINTUAN π TIMBANG PROPERTY OF AUFSOM BATCH 2017 v3.1 s2015-2016

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2. 3. 4. 5. 4. Continuous non-separation of newborn & mother for early breastfeeding protects baby from dying from infection. First feed provides colostrum (babies' first immunization with protective properties). 6.

If parents decline IM or (+) family history of hemophilia in boy, offer oral vitamin K (2 mg) within 6 hours after birth. Hepatitis B & BCG vaccination at birth Examine the baby Check for birth injuries, malformations or defects Cord care  Alcohol or betadine can be used. o Do not apply too much betadine, because it contains iodine. It may cause thyroid problems once it is excessively absorbed. Provide additional care for a small baby (