Neonatal care
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Transcript of Neonatal care
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NEONATAL CARE
Dr. Bhuwan Sharma
Asst. Professor
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Phases of Infancy
• Perinatal Period – 28 wk- 7 days• Early Neonatal Period- Birth- 7
days• Late Neonatal Period- 7 days – 28
days• Post Neonatal Period- 28 days – 1
year
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Terms
• Pre- Term - < 37 weeks• Term – 37 – 42 weeks• Post- Term - > 42 weeks
• LBW - < 2500gm• VLBW - < 1500gm• ELBW - < 1000gm
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Indicators
1. Perinatal Mortality Rate (PMR) – • Deaths between 28 wks upto 7 days of
life per 1000 live births.• Wt > 1000 gm, CRL > 35 cm• Ideally should include all births > 1000
gm • Sensitive indicator of essential
Maternal and New born care.• Factors responsible for Stillbirths and
early neonatal deaths are often similar.
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Infant Mortality Rate
• No of Infant deaths in a given year to total no. of live births, expressed in per 1000.
• It measures health status and level of living of community.
• One of the parameter for calculating PQLI.
• Deaths are due to specific causes different from those in adults.
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Trends in India
Indicator 1994 2000 2006
IMR 74 68 57/ 44 (2012)
NMR 48 44 37/32 (2010)
PMR 26 23 22
SBR 9 8 9
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• Deaths in 1st year of life accounts for 18.7 % of total deaths
• Of these > 60% occurs in 1st month of life.
• Of this 40% of neonatal deaths occur in 1st week of life.
• 50% of these in first 48 hours.• The above fact underlies the
importance of early neonatal care in child survival.
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Causes of Infant Mortality
Neonatal Post Neonatal
LBW & prematurity ADD
Birth Injury ARI
Sepsis Other Infectious diseases (eg.- Measels, Malaria)
Congenital Anomalies Malnutrition
Hemolytic diseases Congenital Anomalies
Conditions of Placenta and cord Accidents
ADDs
ARI
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Prevention
Direct Indirect
Safe & clean delivery Family Planning
Essential New born care Nutritional status of mother
Infection control measures Education of mother (women empowerment)
EBF ANC
Early diagnosis & management Growth monitoring of child
Special care for LBW babies Prevention of Malnutrition
ORT for ADDs Vit. A prophylaxis
Antibiotics for ARIs Improved Sanitation/ Safe water
Immunization Access to primary health care
Socio-economic development
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Essential Newborn Care
• Cardiopulmonary maintenance
• Body temperature maintenance
• Avoidance of Infections
• Establishment of a satisfactory feeding regimen
• Early detection and Rx of any abnormalities or infections
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• Immediate care
• Neonatal examination
• Screening
• Measurements
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IMMEDIATE CARE
• Clearing the airway
• APGAR score
• Maintenance of body temperature
• Care against infection
•Care of cord
•Care of eyes
•Care of skin
• Breast feeding
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Clearing the airway
• Positioning : head low
• Gentle suction
• If natural breathing fails :
– Resuscitation and active intervention
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APGAR SCORE
Activity
Pulse
Grimace
Appearance
Respiration
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Apgar score
Sign 0 1 2
Muscle tone (A)
Flaccid Some flexion of extremities
Active movements
Heart rate (P) Absent <100 >100
Reflexes (G) No response Grimace Cry
Colour (A) Blue, pale Body pink, extremities blue
Completely pink
Respiratory effort (R)
Absent Slow irregular Good crying
Total Severe depression(0-3)
Mild depression (4-6)
No depression (7-10)
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Avoidance of infection
• Care of the cord– Prevent tetanus
– Prevent Anemia
• Care of eyes– Wipe with sterile swab
– Silver nitrate/ tetracycline
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Care of Skin
– First bath with soap and water
– By nursing staff
– ? Delay by 12-24 hrs
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Maintenance of body temperature
• Little thermal control
lesser in preterm and LBW babies
• Dry and wrap in a clean dry cloth
• Skin to skin contact with mother
“Kangaroo care method” (strategy for LBW babies in IMNCI)
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Breast feeding
• Within an hour• Whenever the baby
wants• Avoid supplementary
feeds and bottle feeding
• Breast milk– Creates bonding– Highly nutritive– Anti infective
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NEONATAL EXAMINATIONS
• First examination– Rule out injury
– Detect malformations
• Second examination– Within 24 hours
– Systematic head to foot examination
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• Infections– Neonatal tetanus
– Cong. Syphilis
– Newborn with HBV+ mother
– Newborn with HIV+ mother PPTCT ART (Zidovudine) to mother during pregnancy, child
birth and to child No Breast feeding..?? Elective LSCS Reassess baby after 6 months
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MEASUREMENTS
• Birth weight– Within 1 hr
– Wt. > 2.5 kg
• Length– Within 3 days
– Using Infantometer
– CRL- 50 cm
• Head circumference - HC - 34 cm
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LBW BABIESCAUSES
Maternal – Medical, Infections, Short stature, Under-Nutrition, Smoking
Placental- Previa, APH, Infraction, anamolies
Foetal- Congenital anamolies, twins, IUGR, TORCH infections
Medical Complications- HT, DM, Cardiac conditions, Toxemia, Anaemia, Foetal distress, Rh-Isoimmunisation, IUGR
HAZARDS
Birth Asphyxia Hyperbilirubinemia
Hypothermia Hypoglycemia
Infections Apnoea
MAS Resp. distress
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Management of LBW Babies
• Care at birth – delivery at well equipped facilities
• Maintaining Warm Chain • Appropriate place of care – acc. to
weight • Feeding regimen• Early detection and management
of complications• Kangaroo mother care (KMC)
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Delivery
Normal infant
High risk infant
Without complications
With complications
Temporary observation unit
Regular nursery
Home
Special care nursery with neonatal ICU
Special procedures
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Schemes in India
• UIP (1985)• CSSM (1992)• RCH I (1997)• JSSK/ NSSK (2005)• RCH II (2005) – New Born Care
Corners, NBSU, SNBCU• Verbal autopsy for every death• IMNCI plus (Includes care between
0-7 days)
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Thank you