1. MATERNAL AND CHILD HEALTH (NSC 422) GROUP 16 ASSIGNMENT PHYSIOLOGY AND THE CARE OF NEW BORN GROUP MEMBER Ahmed Ayodeji Arogundade Toliah Olofinbiyi Oluwafunke Falana Racheal Ogunya Ronke

2. INTRODUCTION A new born baby’s survival is dependent on his ability to adapt to an extrauterine environment. This involves adaptation in cardio pulmonary circulation and other physiological adjustments to replace placental function and maintain homoeostasis.

3. INTRODUCTION (Continues) The transition from intrauterine to extrauterine life is a dramatic one and demands considerable and effective physiological alterations by the baby in order to ensure survival. The fetus leaves the uterine environment, which has been completely life sustaining for oxygenation, nutrition, excretion and thermoregulation. The baby emerges from the mother to encounter light noises cool air gravity end tactile stimuli for the first time. The baby has to make adjustments in the respiratory and circulatory systems as well as controlling body temperature.

4. ADAPTATION TO EXTRAUTERINE LIFE At birth, a baby is transposed from the warm contentment of the uterine environment to the outside world, where the role of independent existence is assumed. The baby must be able to make this sharp transition swiftly, and in order to achieve this, a series of adaptive functions have been developed to accommodate the dramatic change from the intrauterine to extrauterine environment; Pulmonary Adaptation Cardiovascular Adaptation Thermal Adaptation

5. Failure to Establish Respiration The majority of the babies gasp and establish respiration within 60 seconds of birth, however, failure to initiate and sustain respiration at birth necessitate prompt and effective intervention by the midwife. Causes of Respiratory Depression Maternal Cause: Such as; Disease condition of the mother; diabetes mellitus, hypertension, Renal diseases and pre-eclampsia. Maternal Infection- TORCH; toxoplasma rubella cytomegalovirus and herpesSimplex. Evidence of previous abnormal infant or perinatal death as well as APH and Placenta Abroptio in pregnancy. Maternal Blood Group; ABO and Rh Incompatibility. Fetal Cause: Congenital anomaly as in upper GIT obstruction presenting with polyhydraminios ( Oesophageal Atresia with or without Tracheoesophageal fistula), Chromosomal Aberration, Potter’s syndrome. Placenta Factor – Small or Abnormal. Cord accident – length and tendency to knotting, number of umbilical vessels in relation to other defects. Drug Administration e.g. opioids ( Pentazocine and variants ) and sedatives

6. Resuscitation of the Newborn Though the need for resuscitation can be anticipated in some situations, in many instances a baby is born in poor condition without forewarning. It is essential that resuscitation equipment is always available and in working order, and that, personnel in attendance at the birth of a baby is familiar with the equipment.

7. Aims and Methods of Resuscitation Aims are: -  Establish and maintain a clear airway, by ventilation and oxygenation  Ensure effective circulation  Correct acidosis  Prevent hypothermia, hypoglycaemia and haemorrhage. Methods are: Airway Management Ventilation and Oxygenation Intubation (Endotracheal) Mouth – to – face/nose resuscitation External cardiac massage Use of drug.

8. METHODS OF RESUSCITATION External Cardiac Massage.Bagging Demonstration

9. METHODS OF RESUSCITATION Small Towel Under The Neck (Sniffing Position) Endotracheal Intubation.

10. IMMEDIATE CARE OF THE BABY AT BIRTH Observation During And After Resuscitation: Monitor and record baby’s response through out resuscitation. Distressed baby may improve with good resuscitation. Observe for a few hours before transfer. Assessment Of The Baby’s Condition Dry the skin to minimize heat loss Do assessment at 1mintue and 5minutes after birth, using Apgar Score The higher the Apgar Score, the better for the baby. Apgar Score less than 7 require medical attention.

11. IMMEDIATE CARE OF THE BABY AT BIRTH APGAR SCORE CHAT MNEMONICSIGN012 A – AppearanceColorBlue, PaleBody Pink, Extremities Blue Completely Pink P - PulseHeat RateAbsentLess than 100 b/m Greater than 100 b/m G – GrimaceReflex response to stimulus NoneMinimal grimace Cough or Sneeze A – ActiveMuscle toneLimpSome flexion of limbs Active R- RespirationRespiratory effort AbsentSlow, IrregularGood or Crying

12. PREVENTION OF HEAT LOSS Switch off fan(s) prior to birth Keep labour room warm, close curtains Dry wet skin (body and head) Remove wet towel Do everything possible to prevent heat loss Provide ambient temperature of 21 – 25 0 c Maintain skin to skin contact HEAT LOSS CAN BE BY: Convection: To air current. Radiation: To cold structure in the vicinity Evaporation: From wet skin Conduction: To cold surface.

13. CLEARING THE AIRWAY Wipe gently the mouth, but avoid touching the nares. Most babies achieve clear airways unaided Use soft suction catheter attached to mechanical suction Aspirate oropharynx before nasophraynx Cutting of the Cord: Divide the umbilical cord between the two clamps (8 – 10cm) Apply a guaze swab over the cord while cutting Optimal time for umbilical cord clamping remains unknown.

14. IDENTIFICATION OF THE BABY Note the time of birth and sex, and record. Name-hand or tag should indicate: - Family name, sex of baby, Date of birth, Time of Birth. Father or Mother should verify information on the band Fasten band securely (not too tight or too lose) FIRST EXAMINATION BY THE MIDWIFE Detailed examination to discover obvious abnormalities. Replace initial cord clamp with disposable clamp (2 – 3cm). Record baby’s temperature and maintain warm environment (21- 25 0 ) Early transfer minimizes heat. Administration of Drug: - Vitamin – K: Depending on local policy, Vitamin K injection, IM or Orally may be given prophylatically.

15. Early Parent Baby Relationship The safe delivery of a healthy baby engenders considerable emotion in most parents and indeed in attendants at birth. The efforts of the preceding hours are temporarily forgotten as the mother sees her baby for the first time. Characteristically, her first query relates to sex of the baby speedily followed by an anxious enquiring about baby state of health is he all right? Bonding: This term is used to describe the establishment of parent-baby relationships in the early neonatal period. - Care of the baby, warmth, feeding, cord care and general cleanliness. - Care of the home, father – mother – relatives – e.t.c. - Care of the immediate family. - Follow up care, keep hospital appointments, baby’s immunisation, family planning.

16. Thanks for Listening