IMMEDIATE CARE OF NEWBORN

DEFINE A HEALTHY NEWBORN The healthy newborn infant is born at term, cries almost immediately after delivery and establishes satisfactory rhythmic pulmonary respiration

IMPORTANCE OF IMMEDIATE CARE Period of transition from intrauterine to extrauterine condition Changes in the CVS and respiratory system Immaturity of the body in thermoregulation Loss of heat through conduction, convection, radiation and evaporation Check for bleeding

CLEARING THE AIR PASSAGES It is an urgent duty that must be performed without delay Mucus should be suctioned from the mouth as soon as the head is born. As soon as the body is born the body should be held for a few seconds with the head slightly dependent for the drainage. Some hold the baby upside down. Mucus must be removed before the first breath to prevent aspiration. If the body cries immediately there should be no need to use suctioning. If the infant continues to have an accumulation of mucus in the mouth or nose do suction again.

SUCTIONING Use a bulb syringe or a soft, small catheter for suctioning Do suction first in the mouth followed by nose. Avoid vigourous suctioning If the bulb syringe is used for suctioning it should be decompressed before being inserted the infant’s mouth or nose. In case of asphyxiated baby endotracheal suctioning has to be done. Keep ready resuscitation equipments and medications

Baby laryngoscope Endotracheal tube Suction tubes Mucus extractors Paediatric I.V administration set

MEDICATIONS Inj. Sodium bicarbonate Inj. Calcium gluconate Sodium chloride Glucose 10% Neonatal nalaxon (Narcan)

Slow, irregular weak cry Response to flicking foot APGAR SCORING Signs Score 1 2 Colour Blue pale Body pink limbs blue Completely pink Respiratory effort Absent Slow, irregular weak cry Strong cry Heart beat Slow, less than 100 Over 100 Muscle tone Limp Some flexion of limbs Active movement Response to flicking foot Fascial grimace Crying Severe 0 -2 Moderate 3-4 Mild 5-7 No asphyxia 8-10

THERMOREGULATION Maintain the room temperature 21C (70 F) Loss of heat through conduction, convection, radiation and evaporation. Dry the body and wrap the baby with a warm sterile blanket. Cover the head Keep the baby under radiant warmer Immediate bath is not permitted Re-assess the temperature after one hour. If the temperature is 98.6 F and stable, bath can be given Keep the baby warm Hot water bottles are potentially dangerous in providing warmth.

ATTENTION TO THE UMBILICAL CORD Time of clamping and cutting the cord. Where do you clamp the cord? Type of scissors used for cutting the cord How did you cut the cord? Examination of the cord for arteries and veins Types of clamps Plastic cord clamps (disposible) Rubber bands Pieces of compression tubing Assess cord haemorrhage

OTHER NURSING MEASURES Case of the eyes Rest after the trauma of birth Bonding of mother and baby - Initiation of breast feeding within half an hour - By administering sedatives during labor - By encouraging fathers to be present By ascertaining and complying with the mother’s wishes regarding the bonding process. By allowing the mother to cuddle here whapped baby By practising rooming in

NURSING DIAGNOSIS Risk for ineffective airway clearance related to presence of mucus in mouth and nose at birth. Risk for ineffective thermo regulation related to newborn’s transition to extra uterine environment. Risk for infection related to newly clamped umbilical cord and exposure of eyes to vaginal secrtens.