Immediate Care of the Newborn Baby PDF

Clinical Procedures Immediate Care of the Newborn Baby Outlines  Introduction  Immediate care of new born baby 1. clearing the air way 2. Assessment of baby's condition using Apgar score 3. Clamping and cutting the cord 4. Thermal adaptation 5. Identification 6...

Clinical Procedures Immediate Care of the Newborn Baby Outlines  Introduction  Immediate care of new born baby 1. clearing the air way 2. Assessment of baby's condition using Apgar score 3. Clamping and cutting the cord 4. Thermal adaptation 5. Identification 6. Care of the eyes 7. Vitamin K 36  Clinical Procedures Introduction Definition of neonatal period: The time from birth though the twenty eight day of life. During this time the neonate must make many adjustments to extra - uterine life. The following measures are designed to assist the infant in accomplishing the adaptations to extra uterine life. 1- Clearing the air way As soon as the head is born, and before the baby takes its first breath, the pharynx (mouth) and Nasopharynx (nose) must be suctioned to prevent aspiration of mucous, blood and meconium and debris into the trachea when breathing begins. This should be done using mechanical suction to minimize the risk of virus transmission. Once the baby is born it should be held down for a few moments to promote drainage of mucous and to facilitate the drainage of liquid material from pharynx by gravity. Then, the infant is transferred to a warmed bassinet. 37  Clinical Procedures 2-Assessment of baby's condition using Apgar score Apgar score is scoring system used to assess cardiopulmonary function of newborn baby Assessment by Apgar scoring is carried out at 1 minute and at 5 minute after birth for rapid evaluation of early cardiopulmonary adaptation. A score of 7 to10 is normal, 3 to 6 indicates mild to moderate distress, 0 to 2 sever distress and the infant needs resuscitation and I.C.U The infant is assigned a score of 0 to 2 in each of the five items and the scores are totaled. A Appearance (color) P Pulse (Heart rate) G Grimes (Reflexes) A Activity (muscle tone) R Respiration 38  Clinical Procedures Sign 0 1 2 Heart rate Absent < 100 b.p.m ≥ 100 b.p.m Weak cry, Respiratory effort Absent Good, crying hypoventilation Cry or active Reflex irritability No response Grimace withdrawal Some flexion of Muscle tone Limp Active motion extremities Body pink, Color Blue, pale Completely pink extremities blue NOTE:- Bradypnea: less than 15 breath /min Tachypnea: more than 60 breath /min 3-Clamping and cutting the cord The cord consists of 2 arteries and one vein, covered by substance called Wharton’s jell. The length of cord is about 50 cm. Separation of the infant from the placenta is achieved by dividing the umbilical cord between two clamps which should be applied approximately 8-10 cm from the umbilicus of the fetus. The cord is clamped and divided, as soon as pulsations have ceased. If ligation is done carelessly the baby may loss a great deal of blood very quickly. The cord ligation is applied 2-2.5 cm from the umbilicus. The cord is ligated with a special clamp or rubber bands or tapes. The blood volume of a term newborn infant is 80-100ml per kg body weight. 39  Clinical Procedures 4-Thermal adaptation Characteristics of newborns that predispose them to loss heat. The skin is thin. The blood vessels are close to the surface. Heat is readily transferred from the warmer internal areas of the surrounding air. To conserve heat, the healthy full- term infant remains in apposition of flexion. This reduces the amount of skin surface exposed to the surrounding temperatures and decreases heat loss. Methods of heat loss in the neonate:- A-Evaporation Occurs when wet surfaces are exposed to air At birth the infant loses heat when amniotic fluid on the skin evaporates. 40  Clinical Procedures Evaporation also occurs during bathing. Thus drying the infant as quickly as possible at birth and after bathing helps prevent excessive heat loss. B-Conduction Occurs when new born come in direct contact with objects that are cooler than their skin. Placing infants on cold surfaces such as (scales or touching them with cold hands or a cold stethoscope causes this type of heat loss). The reverse is also true, that is wrapping newborns in warm blankets or placing them against the mother's skin can protect them against heat loss. C-Conviction Occurs when heat is transferred to air surrounding the infant by currents of cool air passing over the surface of this body. Maintaining warm environmental temperatures help to prevent this type of heat loss. Oxygen should be warmed before administration. Newborns are often placed in incubators for a short time after birth so that the surrounding temperature can be controlled to prevent convective heat loss. D-Radiation Is the transfer of heat to cooler objects that are not in direct contact with the infant. For examples:- Infants placed near cold windows loss heat by radiation. 41  Clinical Procedures Infants should be kept away from windows and outside walls to minimize radiant heat loss. Small amounts of heat are lost through respiration and in urine and faces. It is important for the midwives to ensure that they employ measures to minimize heat loss at delivery by ensuring that the delivery room temperature is 21-24 C and encouraging skin to skin contact with the mother to promote heat gain. Covering the baby head is of particular importance 5-Identification When babies are in hospital, it is necessary that they are readily identifiable one from another. Various methods of indicating identity can be employed. e.g.:- Name bands are applied usually one on the infant's wrist and one on the ankle. Each contain the family name, sex of the infant, 42  Clinical Procedures and date and time of birth.name bands should remain on the baby until his discharge from hospital. 6-Care of the eyes Before the baby is transferred to the nursery the eyes must be receive prophylactic treatment to prevent ophthalmic neonatorum. The most common medication for eye prophylaxis is: tetracycline and erthromycin ointment. 7-Vitamin K Hemorrhagic disease of the new born is acumination which results from a deficiency of vit-K one dose of vit-K prevents bleeding problems until the infant is able to produce it on his her own. Vitamin K is given to the neonate within the first hour after birth intramuscularly injection of 0.5 mg to 1 mg of water soluble vit.K. This can be prevent hemorrhagic disease. Note: Post natal bleeding tendency occurs as a result of: In ability of synthesize vit. K Immaturity of liver in terms of production of prothrombin and other clotting factors 43