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Managing Low Birth Weight and Sick Newborns


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

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

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

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

Minimum Preparation for ANY Birth
  • The following should be available and in working
  • 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

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

Immediate Care of the Newborn Warmth
  • Lay newborn on mothers abdomen or other warm
  • 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

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

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

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
  • Assessing all of above delays resuscitation, if
    it is necessary.

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

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
  • Assess breathing
  • Resuscitate
  • Open airway
  • Position newborn
  • Clear airway
  • Ventilate
  • Evaluate

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

WHO 1998.
  • 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.
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
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
  • Stimulation of the newborn by slapping or
    flicking the soles of her/his feet only enough
    stimulation for mildly depressed-delays
  • Postural drainage and slapping the back dangerous

WHO 1998.
Harmful and Ineffective Resuscitation Practices
  • Squeezing the chest to remove secretions from the
  • 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.
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

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

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

Post-Resuscitation Tasks Unsuccessful
  • 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

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

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

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

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

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

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

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

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

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

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

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

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.
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
  • Increases the mothers confidence, ability and
    involvement in the care of her small newborn
  • Seems to be acceptable in different cultures and
  • 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.
  • Skilled attendant
  • Equipment available and working
  • Begin resuscitation immediately
  • Ventilate
  • Reassess frequently
  • Kangaroo care once successful

  • Cattaneo et al. 1998. Kangaroo mother care for
    low birthweight infants a randomized controlled
    trial in different settings. Acta Paediatr 87
  • 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