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Managing Low Birth Weight and Sick Newborns

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Managing Low Birth Weight and Sick Newborns. Advances in Maternal and Neonatal Health ... At least one person skilled in newborn resuscitation present at birth. 5 ... – PowerPoint PPT presentation

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Title: Managing Low Birth Weight and Sick Newborns


1
Managing Low Birth Weight and Sick Newborns
  • Advances in Maternal and Neonatal Health

2
Session Objectives
  • To define essential elements of the care of sick
    newborns, including neonatal resuscitation
  • To discuss best practices and technologies

3
Management of Newborn Illness
  • Education of mothers to recognize danger signals
  • Working with families to develop complication
    plan for newborns
  • Early recognition and appropriate management of
    newborn illness

4
Minimum Preparation for ANY Birth
  • The following should be available and in working
    order
  • Heat source
  • Mucus extractor
  • Self-inflating bag of newborn size
  • 2 masks (for normal and small newborns)
  • 1 clock
  • At least one person skilled in newborn
    resuscitation present at birth

5
Essential Care for All Newborns
  • Most newborns breathe as soon as they are born
    and only need
  • A clean and warm welcome
  • Vigilant observation
  • Warmth
  • To be observed for breathing
  • To be given to the mother for warmth and
    breastfeeding

6
Immediate Care of the Newborn Warmth
  • Lay newborn on mothers abdomen or other warm
    surface
  • Immediately dry newborn with clean (warm) cloth
    or towel
  • Remove wet towel and wrap/cover newborn, except
    for face and upper chest, with a second
    towel/cloth

7
Immediate Care of the Newborn Warmth (continued)
  • Blood on newborn is not a risk to newborn, but is
    a risk to caregiver
  • Bathe after 24 hours
  • In areas with high HIV prevalence, consider
    bathing earlier to reduce risk of maternal-fetal
    transmission, and to reduce risk to caregiver and
    to other newborns

8
Immediate Care of the Newborn
  • Assess breathing
  • Keep head in a neutral position
  • IMMEDIATELY assess respirations and need for
    resuscitation

9
Signs of Good Health at Birth
  • Objective measures
  • Breathing
  • Heart rate above 100 beats/minute
  • Subjective measures
  • Vigorous cry
  • Pink skin
  • Good muscular tone
  • Good reactions to stimulus
  • Most important measure is whether newborn is
    breathing
  • Assessing all of above delays resuscitation, if
    it is necessary.

10
Birth Asphyxia
  • Definition Failure to initiate and sustain
    breathing at birth
  • Magnitude
  • 3 of 120 million newborns each year in
    developing countries develop birth asphyxia and
    require resuscitation
  • An estimated 900,000 of these newborns die as a
    result of asphyxia

11
Steps in Resuscitation
  • Anticipate need for resuscitation at every birth,
    be prepared with equipment in good condition
  • Prevent of heat loss (dry newborn and remove wet
    clothes)
  • Assess breathing
  • Resuscitate
  • Open airway
  • Position newborn
  • Clear airway
  • Ventilate
  • Evaluate

WHO 1998.
12
Assess Breathing
13
Open Airway
  • Position newborn on its back
  • Place head in slightly extend position
  • Suction mouth then nostrils

WHO 1998.
14
Ventilate
  • Select appropriate mask size to cover chin, mouth
    and nose with a good seal
  • Squeeze bag with two fingers or whole hand, look
    for chest to rise
  • If chest not rising
  • Reposition head and mask
  • Increase ventilation
  • Repeat suctioning

WHO 1998.
15
Evaluate
After ventilating for about 1 minute, stop and
look for spontaneous breathing
If no breathing, breathing is slow (lt 30 breaths/
min.) or is weak with severe indrawing
If newborn starts crying/breathing spontaneously
  • Stop ventilating
  • Do not leave newborn
  • Observe breathing
  • Put newborn skin-to-skin with mother and cover
    them both

Continue ventilating until spontaneous cry/
breathing begins
16
Harmful and Ineffective Resuscitation Practices
  • Practices to be avoided include
  • Routine aspiration of the newborns mouth and
    nose as soon as the head is born
  • Routine aspiration of the newborns stomach at
    birth
  • Stimulation of the newborn by slapping or
    flicking the soles of her/his feet only enough
    stimulation for mildly depressed-delays
    resuscitation
  • Postural drainage and slapping the back dangerous

WHO 1998.
17
Harmful and Ineffective Resuscitation Practices
(continued)
  • Squeezing the chest to remove secretions from the
    airway
  • Routine giving of sodium bicarbonate to newborns
    who are not breathing
  • Intubation by an unskilled person
  • Some traditional practices
  • Putting alcohol in newborns nose
  • Sprinkling or soaking newborn with cold water
  • Stimulating anus
  • Slapping newborn

WHO 1998.
18
Infection Prevention for Resuscitation
  • Handwashing
  • Use of gloves
  • Careful suctioning if using a mucus extractor
    operated by mouth
  • Careful cleaning and disinfection of equipment
    and supplies
  • Do not reuse bulbdifficult to clean, poses risk
    of cross infection
  • Correct disposal of secretions

19
Documentation
  • Details of the resuscitation to be recorded
    include
  • Identification of newborn
  • Condition at birth
  • Procedures necessary to initiate breathing
  • Time from birth to initiation of spontaneous
    breathing
  • Clinical observations during and after
    resuscitation
  • Outcome of resuscitation
  • In case of failed resuscitation, possible reasons
    for failure
  • Names of healthcare providers involved

20
Post-Resuscitation Tasks Successful Resuscitation
  • Do not separate mother and newborn
  • Leave newborn skin-to-skin with mother (kangaroo
    care)
  • Measure temperature, count breaths, observe for
    indrawing and grunting
  • Encourage breastfeeding within 1 hour after birth

21
Post-Resuscitation Tasks Unsuccessful
Resuscitation
  • Inform patients fully
  • Provide counseling, as needed
  • If culturally appropriate, allow parents private
    time with dead newborn
  • Burial should be arranged according to
    regulations and parents wishes

22
Policy Decisions for Resuscitation
  • Guidelines on when to start
  • Apparently stillborn newborn
  • Malformations
  • Lethal
  • Less severe malformations
  • Extremely low gestational age
  • Guidelines on when to stop
  • 20 minutes

23
Principles of Success
  • Readily available personnel
  • Skilled providers
  • Coordinated team
  • Resuscitation tailored to newborn response
  • Available and functioning equipment
  • Avoidance of harmful and ineffective practices
  • Follow rules for infection prevention

24
Care of the Low Birth Weight Newborn
  • Birth weight Gestation duration intrauterine
    growth
  • Most low birth weight newborns in developing
    countries are term or near term (Small for
    gestation age)
  • Increased risk of hypothermia and poor growth

25
Care of the Preterm Newborn
  • Associated problems with prematurity
  • Feeding
  • Respiratory
  • Jaundice
  • Intracranial bleed

26
Principles of Management for Low Birth Weight and
Preterm Newborns
  • Warmth
  • Feeding
  • Detection and management of complications (e.g.,
    resuscitation, assisted respiration)

27
Warmth
  • As for all newborns
  • Lay newborn on mothers abdomen or other warm
    surface
  • Dry newborn with clean (warm) cloth or towel
  • Remove wet towel and wrap/cover with a second dry
    towel
  • Bathe after temperature is stable

28
Warmth Problem with Incubators
  • Potential source of infection
  • Often temperature controls malfunction
  • Often share incubator for more than one newborn
  • Need alternative method kangaroo care

29
Feeding
  • Early and exclusive breastfeeding
  • Breastmilk best nourishment
  • Already warm temperature
  • Facilitated by kangaroo care

30
Definition of Kangaroo Care
  • Early, prolonged and continuous skin-to-skin
    contact between a mother and her newborn
  • Could be in hospital or after early discharge

31
How to Use Kangaroo Care
  • Newborns position
  • Held upright (or diagonally) and prone against
    skin of mother, between her breasts
  • Head is on its side under mothers chin, and
    head, neck and trunk are well extended to avoid
    obstruction to airways
  • Newborns clothing
  • Usually naked except for nappy and cap
  • May be dressed in light clothing
  • Mother covers newborn with her own clothes and
    added blanket or shawl

32
How to Use Kangaroo Care (continued)
  • Newborn should be
  • Breastfed on demand
  • Supervised closely and temperature monitored
    regularly
  • Mother needs lots of support because kangaroo
    care
  • Is very tiring for her
  • Restricts her freedom
  • Requires commitment to continue

33
Effectiveness of Kangaroo Care
  • Randomized controlled trial
  • Conducted in three tertiary and teaching
    hospitals in Ethiopia, Indonesia and Mexico
  • Study effectiveness, feasibility, acceptability
    and cost of kangaroo mother care when compared to
    conventional methods of care

Cattaneo et al 1998.
34
Benefits of Kangaroo Care
  • Is efficient way of keeping newborn warm
  • Helps breathing of newborn to be more regular
    reduce frequency of apneic spells
  • Promotes breastfeeding, growth and extra-uterine
    adaptation
  • Increases the mothers confidence, ability and
    involvement in the care of her small newborn
  • Seems to be acceptable in different cultures and
    environments
  • Contributes to containment of cost salaries,
    running costs (electricity, etc.)

deLeeuw et al 1991 Karlsson 1996 Lamb 1983
Ludington-Hoe et al 1993 Ross 1980.
35
Summary
  • Skilled attendant
  • Equipment available and working
  • Begin resuscitation immediately
  • Ventilate
  • Reassess frequently
  • Kangaroo care once successful

36
References
  • Cattaneo et al. 1998. Kangaroo mother care for
    low birthweight infants a randomized controlled
    trial in different settings. Acta Paediatr 87
    976985.
  • de Leeuw R et al. 1991. Physiologic effects of
    kangaroo care in very small preterm infants.
    Biology of the Neonate 59 149155.
  • Karlsson H. 1996. Skin-to-skin care heat
    balance. Arch Dis Child 75F130F132.
  • Lamb ME. 1983. Early mother-neonate contact and
    mother-child relationship. J Child Psychol
    Psychiatry 24(3) 487494.
  • Ludington-Hoe SM et al. 1994. Kangaroo care
    Research results, and practice implications and
    guidelines. Neonatal Network 13(1) 1927.
  • Ross GS. 1980. Parental responses to infants in
    intensive care. The separation issue
    re-evaluated. Clin Perinatol 7 4760.
  • World Health Organization (WHO). 1998. Basic
    Newborn Resuscitation A Practical Guide. WHO
    Geneva.
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