Basic Newborn Careat Postnatal ward/SCBU

Sri Lanka College of Paediatricians

Perinatal Society of Sri Lanka

2015

14-Dec-15 1Sri Lanka College of Paediatricians

Basic Newborn Interventions – Postnatal ward /

neonatal unit

Prevention of hypothermia

Prevention of hypoglycaemia

Promoting exclusive breast feeding

Kangaroo mother care (KMC)

Newborn screening

Inpatient care for sick /small newborns

Developmental care

Advice on discharge

Follow-up in the community14-Dec-15 2Sri Lanka College of Paediatricians

3

Four ways a newborn may lose heat to the environment

Mechanisms of heat loss

Conduction

Radiation

ConvectionEvaporation

14-Dec-15Sri Lanka College of Paediatricians

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Normal range

Cold stress

Moderate hypothermia

Severe hypothermia Outlook grave, skilled

care urgently needed

Danger, warm baby

Cause for concern

37.5o

36.5o

36.0o

32.0o

Definition & degrees of hypothermia

14-Dec-15Sri Lanka College of Paediatricians

Prevention of hypothermia

Room temperature (260C - 280C)

Check baby’s axillary temperature on admission

Rooming-in

Assess warmth every 4 hours

Bathing: delay

Breastfeeding – position and attachment

Keep radiant warmer ready, if necessary Prevent

hypothermia

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Prevention of hypothermiababies with mother

Prevent

hypothermia

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Prevention of hypothermia

14-Dec-15

Appropriate clothing – after drying,

hat, socks (mittens), towels, blanket

Prevent

hypothermia

Sri Lanka College of Paediatricians

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Bathing the baby – when appropriate only

Warm room – warm water Dry quickly & thoroughly

Dress warmly and wrap Give to mother to breast feed

14-Dec-15

Should be delayed in sick and small babies

When bathing – minimise risk of hypothermia

Sri Lanka College of Paediatricians

Prevention of hypoglycaemia

• Hypoglycaemia is preventable

• Symptomatic hypoglycaemia for long periods: dangerous

• Prevention

• Prevent hypothermia

• Correct breastfeeding technique - position and attachment

- resolving problems

• Monitor blood sugar of high risk infants – SGA,LGA,

infants of diabetic mothers, preterm, sick 14-Dec-15 9Sri Lanka College of Paediatricians

Kangaroo mother care (KMC)

Mother will be the incubatorReduces workload of nurses

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Kangaroo mother care (KMC)

What is it?

Skin-to-skin contact.

Dressed only in nappy

Baby next to carer’s chest

Advantages:

Temperature more stable

Babies mature faster

Breastfeeding easily established

Infection less in baby

Babies sleep & breathe better

Bonding increases14-Dec-15 11Sri Lanka College of Paediatricians

KMC eligibility criteria: baby

Birth weight >1800 gm:Start at birth

Birth weight 1200-1799 gm:takes a few days

Birth weight <1200 gm:may take weeks to initiate

12Hemodynamic stability is a MUST14-Dec-15Sri Lanka College of Paediatricians

KMC - monitoring

Check

Neck position - neutral

Airway - clear

Breathing - regular

Colour - pink

Temperature - stable

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Head position in KMC

Sri Lanka College of Paediatricians

Effect on temperature

Swings in temperatureConstant temperature in KMC

Ludington-Hoe etal, Whitlaw A

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KMC - Enhances mother’s milk production

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KMC - examples of binders :

Use locally available garments

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KMC - duration

Start KMC in the PBU

Practice at least one hour sessions initially

Transit from conventional care to longer KMC

Transfer baby to post-natal ward and continue KMC

Increase duration up to 24 hours a day14-Dec-15 17

Sri Lanka College of Paediatricians

KMC - discontinuation

Term gestation

Weight ~ 2500 gm

Baby uncomfortable

Wriggling out

Pulls limbs out

Cries and fusses

Mother can continue KMC

after giving the baby a bath

and during cold nights14-Dec-15 18

Sri Lanka College of Paediatricians

Newborn examination

Complete head to toe check

By medical officer

All babies before discharge

Clear follow-up plans

Birth defects – notify for Birth Defect surveillance

• Discharge weight 14-Dec-15 19Sri Lanka College of Paediatricians

Newborn screening

• Neonatal examination (birth defects)

• Pulse oximetry screening for critical congenital heart disease

• Hypothyroidism screening – TSH

• Hearing screening

• Preterm babies – retinopathy of prematurity screening

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Pulse oximetry screening

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Hypothyroidism screening

• Heel prick TSH– to Karapitiya (MRI also in the

future)

Hearing screening

Done in postnatal ward

In a quiet room

Oto-acoustic emission

Done in a few hospitals currently

Hypothyroid and hearing screening

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Danger signs

Bleeding

Jaundice – early extensive, prolonged

Failure to pass meconium or urine within 24 -48

hours

Bile-stained vomiting

Persistent vomiting

Poor feeding

Undue lethargy

Excessive crying14-Dec-15 23Sri Lanka College of Paediatricians

Danger signs (continued)

Drooling of saliva /choking

Respiratory difficulty/apnoea/ cyanosis

Body temperature changes

Seizures

Evidence of infections

conjunctivitis,

pustules,

umbilical sepsis

oral thrush

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Advice on discharge

Keep warm

Wash hands

Minimise handling

Restrict visitors

Know danger signs - seek help

Exclusive breastfeeding

- check technique

– LMC for follow-up

Home visits by PHM

Immunisation

Ensure baby check done & CHDR given 14-Dec-15 25Sri Lanka College of Paediatricians

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Questions

Sri Lanka College of Paediatricians

Basic Newborn Interventions – Postnatal ward /

neonatal unit

Prevention of hypothermia

Prevention of hypoglycaemia

Promoting exclusive breast feeding

Kangaroo mother care (KMC)

Newborn screening

Inpatient care for sick /small newborns

Developmental care

Advice on discharge

Follow-up in the community14-Dec-15 27Sri Lanka College of Paediatricians