Care of the newborn infant
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Partners in Global Health Education 1. Introduct ion 2. How to use module 3. Learning outcome 4. Clinical assessmen t 5. Appearanc e 6. Skin 7. Routine care 8. Cord care 9. Thermal control 10. Rooming in 11. Feeding Care of the newborn infant For more information about the authors and reviewers of this module, click here Variations exist from place to place in the care of the newborn infant. However, although often neglected, their basic needs are the same. Infants who are unwell or have congenital abnormalities fall short of the mother’s expectation of a beautiful bundle of joy. All mothers require urgent and sensitive counselling.
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Variations exist from place to place in the care of the newborn infant. However, although often neglected, their basic needs are the same. - PowerPoint PPT Presentation
Transcript of Care of the newborn infant
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Care of the newborn infant
For more information about the authors and reviewers of this module, click here
Variations exist from place to place in the care of the newborn infant. However, although often neglected, their basic needs are the same.
Infants who are unwell or have congenital abnormalities fall short of the mother’s expectation of a beautiful bundle of joy. All mothers require urgent and sensitive counselling.
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessment
After delivery of the baby and in the absence of any immediate problems, essential newborn care begins with a thorough general clinical assessment.
This should be done on all infants soon after birth to detect signs of illness and congenital abnormalities.
The following slides describe the assessment that should be performed routinely in all infants. This initial assessment should indicate where more detailed clinical assessment is required.
Hand washing with soap and water before and after a baby is handled goes a long way in reducing the risk of infection
A resident doctor washing her hands up to the elbows prior to examination
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessmentFirst steps and appearance
• Start by congratulating the mother on the arrival of her new baby and ask if she has any concerns. The mother is usually the first person to notice any problems.
• Ask about feeding and the passage of urine and stools. The infant should pass meconium (the first black, tarry stools) within 24 hours of birth.
• General observation: inspect colour, breathing, alertness and spontaneous activity.
• Well infants have a flexed, posture. Partially flexed posture is found in hypotonia or prematurity
Well term infant showing typical well flexed posture
Note the abduction of the hips in this partially flexed preterm infant (“froglike”
posture)
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessmentExamine skin for prematurity or dismaturity
Wrinkled peeling skin of dysmaturity in an IUGR infant
Thin, transparent
skin in preterm infants
Pale pink skin of a term infant (hair shaved to site IV line)
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessmentSkin: some common normal findings
• Vernix caseosa: a cream/white cheesy material on the skin at birth which cleans off easily with oil.
• Lanugo; fine downy hairs seen on the back and shoulders especially in preterm infants.
• Milia: pinpoint whitish papules on nose and cheeks due to blocked sebaceous glands.
• Mongolian blue spots: grey/bluish pigment patches seen in the lumbar area, buttocks and extremities in dark skinned babies.They usually disappear by one year.
• Capillary heamangiomas (“stork bite” naevi): red flat patches which blanch with gentle pressure. Commonly occur on upper eyelids, forehead and nape of the neck.
• Erythema toxicum: small white/yellow papules or pustules on a red base seen on face, trunk and limbs. Develop 1 – 3 days after birth and usually disappear by one week.
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
• Note palor or plethora
• Cyanosis: the baby should be uniformly pink
– Blueness of the hands and feet (peripheral cyanosis) may be due to cold extremeties.
– Blueness of the mucous membranes and tongue is central cyanosis and is usually due to lung or heart problems
• Bruising (ecchymosis) is common after birth trauma. Unlike cyanosis, bruising does not blanch on gentle pressure.
Clinical assessmentColour
A Caucasian infant with marked central cyanosis
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Jaundice is common in the first week of life and may be missed in dark skinned babies
• Blanch the tip of the nose or hold baby up and gently tip forward and backward to get the eyes to open.
• Teach mother to do the same at home in the first week and report to hospital if significant jaundice is observed.
Clinical assessmentJaundice
Blanching the tip of the nose
Two infants with jaundice; note yellow sclerae
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessmentHead
After these general observations, examine the infant starting with the head and moving down the body.
• Observe the size and shape of the head (micro- or macrocephaly; cephalhaematoma)
• Check the anterior and posterior fontanelles and that the skull sutures feel normal
• Form and position of ears (low set ears occur in chromosomal abnormalities, e.g. Down syndrome)
Huge encephalocoele. Head is disproportionately small
Cephalhaematoma limited to the right parietal region
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessmentEyes and face
• Examine eyes for ocular anomalies and check for red reflex using the ophthalmoscope (to exclude cataract)
• Examine the face for dysmorphic features and normal movements
• Examine lips and palate for clefts
Bilateral cleft lip and palate. Also note purulent left eye discharge
Facial asymmetry due to left facial palsy
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessmentCardiovascular and respiratory• Feel femoral and radial pulses for volume, rate and
rhythm. • In aortic coarctation, femoral pulse is reduced, absent
or not synchronous with radial pulse.• If child is sick, measure blood pressure. • Locate the apex beat and listen to the heart sounds
for murmurs.• Count the respiratory rate
– normal 30 – 40 breaths/min in term infants– faster in preterms. – > 60 / minute abnormal
• Observe for respiratory distress: nasal flaring, intercostal and subcostal recession.
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessmentAbdomen
• Inspect the umbilical cord for presence of 2 arteries and a vein. Abnormal components may be a pointer to the presence of intra-abdominal anomalies e.g. renal.
• Look for umbilical abnormalities, e.g. hernias
• Gently palpate the abdomen
– the liver may be palpable up to 2cm below the costal margin
– the lower pole of the right kidney may also be palpable
Large omphalocoele. Surounding erythema indicates cellulitis.
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessmentSpine and genitalia
Examine:• The spine for dimples, tuft of
hair (spina bifida occulta) or cystic swellings (spina bifida cystica)
• Remove the diaper to examine the genitalia. In boys, confirm that both testicles have descended into the scrotum.
• Designate the infant’s sex• Inspect the perineum and check
anus for position and patency (can be done by gently checking rectal temperature)
Spina bifida cystica
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessment
Dysmorphic features
• Examine hands. Note single palmar crease in chromosome abnormalities.
• Inspect the feet. Note effects of foetal posture should be noted.
• Check hips for dislocation
• Limitation of limb movements occurs in fractures and nerve injury
Talipes affecting the left leg
Short stuby fingers and single palmar crease of Down syndrome
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Clinical assessmentRoutine measurements
Measure:
•Weight – normal 2.5 – 3.99kg
•Length– normal 48 – 52cm
•Occipitofrontal circumference (OFC)
– normal 33 – 37cm
Measurement of OFC using a non-stretchable tape measure
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Any problems identified during the initial assessment will need specific management. However, newborn infants are a highly susceptible group and high-quality routine care prevents a multitude of problems. The major elements of routine care include:
• Cord care
• Thermal control
• 24 hour rooming in
• Feeding
• Immunization
• Maternal education on hygiene and every other aspect of routine care
Routine care of the well newborn
Hand washing with soap and water every time a baby is handled goes a long way in reducing the risk of infection!
Click on the links for more information on these
important elements of routine care
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Quiz: Concerning care of the newbornWrite “T” or “F” on the answer sheet. When you have completed all 5 questions, click on each box and mark your answers.
a. Nursing a newborn with the mother rather than in the nursery predisposes the child to infections
b. Hand washing with soap and water before handling a newborn significantly reduces the risk of infection in the baby
c. Fortified infant formula is superior to mother’s breast milk in a sick term newborn
d. Newborn babies cannot be kept warm without the use of incubators
e. Jaundice cannot be detected early in dark skinned babies
a
d
e
c
b
Click to reveal correct answers
Partners in Global Health Education
1. Introduction
2. How to use module
3. Learning outcome
4. Clinical assessment
5. Appearance
6. Skin
7. Routine care
8. Cord care
9. Thermal control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Sources of information• Pocket book of Hospital care for children;
guidelines for the management of common illnesses with limited resources. WHO http://www.who.int/child-adolescent-health/publications/CHILD_HEALTH/PB.htm
• Essential newborn care http://www.who.int/reproductive - health/publications/
• Nelson Textbook of Pediatrics: 16th Edition. Richard E. Behrman Robert Kliegman, Hal B. Jenson (Editors),
