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CARE OF THE NEWBORN

Thermal control and Infant


feeding
Newborn period vulnerable due to
physiologic adjustments required for
extrauterine life.
Reflected by high neonatal mortality
rate.
Accounting for two third of IMR.
Basic needs of the newborn

Resuscitation.
Assessment and examination.
Thermal management.
Feeding.
Prevention of infections.
Neonatal resuscitation
About 10% newborns need
resuscitation at birth.
Described as stepwise time bound
activities to aid newborn establish
and sustain respiration.
Need for skilled attendant at delivery
can not be over-emphasized.
Successful resuscitation averts
perinatal asphyxia and its attendant
sequelae.
Need for planned resuscitation for high
risk pregnancies prior to delivery.
Active management of labour as some
pregnancies become risky in labour.
Basic resuscitation materials made
available with skilled staff attendant
at delivery.
Assessment and
examination
Asessment : APGAR scoring checking for
colour,tone,breathing,heart rate,activity.
Establishes need for resuscitation.
Gestational asessment: using certain
Meet nutritional requirements.
physical and neurological characteristics
Tools for assessment:Dubowitz
&Dubowitz,Lubchenko charts.
Subclassified into SGA,AGA,LGA babies for
anticipation and mgt of class specific
problems.
A Normal Full-term newborn baby
Physical examination
Initial assessment focusing on
1:cardiorespiratory problems.
2: congenital malformations.
3: Birth trauma
NB:All findings should be documented.
A full examination performed later
before discharge.
Thermal management
First and vital component of
newborn care and neonatal
resuscitation.
Protects against excessive heat loss
leading to cold stress.
Decreases their bodies needs to
perform heat producing metabolic
work.
Eliminates problem associated with
rewarming.
Mechanisms of heat loss
Evaporation: from babys wet skin to the
environment.
Radiation: from the skin to the surrounding
walls.
Convection: from the skin to the ambient air.
Conduction: from the skin to the delivery
surface/beddings.
Respiratory tract via evaporation and
convection but to lesser degree.
Methods of thermal
management
Dry and wrap baby in dry
towels/linen immediately baby is
born.
Do not clean vernix caseosa or bath
baby immediately after delivery.
Early skin to skin contact with
mother after drying baby.
If baby needs resuscitation, dry ,wrap
and resuscitate under a radiant
warmer
Avoid cold surfaces, and keep
delivery area draught free.
For anticipated preterm babies, a
prewarmed incubator should be
ready before delivery.
Kangaroo mother care for low birth
weight/preterms with stable
cardiorespiratory system.
Use of cellophane bags and hot
water bottles.
Infant feeding
Dramatic growth in infancy imposes
unique nutritional needs on the
infant.
Lack of sufficient nutrients likely to
have adverse effects on growth and
development..
Breastfeeding should commence as
soon as possible after birth(within
30mins).
Fall in infants blood glucose occurs
Breastfeeding
Component of child survival strategies.
Exclusive for 1st 6months of life.
Most appropriate, uniquely adapted to
infants nutritional needs for optimal
growth and development.
Recommended for 2years with
introduction of appropriate
complementary feeds from 6months
onward.
Advantages of
breastfeeding
MOTHER
It aids placental separation, uterine involution
and prevention of postpartum hemorrhage.
Sense of psychological satisfaction.
Fosters bonding and love with infant.
Natural birth spacing(lactational amenorrhea).
Decrease risk of certain malignancies(breast)
Conserve family resources(cost of BMS,waste).
Advantages contd
INFANT
Optimal nutrition: readily available,
right temp,free of contaminants.
Fewer feeding diff:allergy
,intolerance,atopy .
Anti-infective Properties
a:Secretory IgA which reduces
incidence of
diarrhoea,pneumonia,otitis
media,bacteremia and meningitis in
b:Macrophages which synthesize
complement,lysozyme,lactoferrin.
c:Bifidus factor(confers acidic gut PH)
d:Bile salt stimulated lipase(kills
Giardia lamblia,Entamoeba
histolytica).
e:Passive immunity(immunoglobullins).
Breast milk substitutes
Commonly used are artificial infant formulas.
Indicated for certain categories of newborns(HIV
exposed infants, mothers with breast
cancer,chemotherapy,lactose intolerance etc).
Meet nutritional requirements.
Lack anti-infective,other immunologic
components of human milk.
Increased risk of diarrheal and respiratory
illnesses, atopic dermatitis.
Cost & other logistics(AFASS criteria).
Prevention of infection
Seek for maternal risk
factors(PROM,maternal peripartum
pyrexia,fetal tachycardia).
Hygienic delivery practices.
Handwashing.
Universal safety precautions.
Avoiding harmful traditional
practices.
Infection surveillance.

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