CARE OF THE NEWBORN - PowerPoint PPT Presentation

Loading...

PPT – CARE OF THE NEWBORN PowerPoint presentation | free to download - id: 4e80e1-OGFjM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

CARE OF THE NEWBORN

Description:

CARE OF THE NEWBORN ALELI PAGULAYAN-SUDIACAL, MD, MPH National Center for Disease Prevention and Control DEPARTMENT OF HEALTH * * Read the * * Read the ... – PowerPoint PPT presentation

Number of Views:9807
Avg rating:3.0/5.0
Slides: 63
Provided by: plgpmiOrg
Category:
Tags: care | newborn | the | baby | birth | feeding | weight

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: CARE OF THE NEWBORN


1
CARE OF THE NEWBORN
  • ALELI PAGULAYAN-SUDIACAL, MD, MPH
  • National Center for Disease Prevention and
    Control
  • DEPARTMENT OF HEALTH

2
Outline
  • Newborn Mortality in the Philippines
  • Evidence Based Interventions
  • Newborn Care Practices Our Report Card
  • DOH-WHO Newborn Care Protocol
  • DOH Administrative Order

3
Definitions
  • Newborn Period
  • - birth up to the 27th completed day (total
    of 28 days)
  • Essential Newborn Care Course
  • - Covers essential interventions in the 1st hours
    after birth until the first week of life
  • - Emphasizes the need for a package /bundle of
    interventions

4
lt5 year old and Neonatal Mortality, 1988 to 2008
  • lt5 Yr Old mortality decreased 40 (1988-1998)
  • Past 10 years, declined by 20
  • Slow decline since neonatal mortality hasnt
    improved

Under Five Mortality Rate
Neonatal MR
DHS 88, 93, 98, 03, 08
5
Causes of death in children
Under- nutrition 53
Source CHERG estimates of under-five deaths,
2000-03
The Philippines is one of the 42 countries that
account for 90 of global under five mortalities
6
Majority of newborns die due to stressful events
or conditions during labor, delivery and the
immediate postpartum period.
3 out of 4 newborn deaths occur in the 1st week
of life
Number of deaths
Day of Life
NDHS 2003, special tabulations
7
Deaths of Neonates by day of life, Philippines
1998-2003
50 of neonatal deaths occur in the first two
days of life
Number of deaths
Day of Life
8
Children are Dying
Mortality Rates Mortality Rates Mortality Rates
Under Five Under One Newborn (lt 28 days)
National 42 29 16 (NDHS 2008) 17 (NDHS 2003)
NDHS 2008
9
What Immediate Newborn Care Practices will save
lives?
10
After a baby is born, what should be the first
action performed?
  • A. Clamp and cut the cord
  • B. Dry the baby
  • C. Suction the babys mouth and nose
  • D. Do foot printing

11
After a baby is born, what should be the first
action performed?
  • A. Clamp and cut the cord
  • B. Dry the baby
  • C. Suction the babys mouth and nose
  • D. Do foot printing

12
Immediate Thorough Drying
Tunell R., in Improving Newborn Health in
Developing Countries, A. Costello and D.
Manandhar, Editors. 2000, Imperial College Press
London, UK. p. 207-220 Tollin M, et al.. Cell
Mol Life Sci 2005
  • Immediate drying
  • Stimulates breathing
  • Prevents hypothermia
  • Hypothermia which can lead to
  • Infection
  • Coagulation defects
  • Acidosis
  • Delayed fetal to newborn circulatory adjustment
  • Hyaline membrane disease
  • Brain hemorrhage

13
During drying and stimulation of the baby, your
rapid assessment shows that the baby is crying.
What is your next action?
  • A. Suction the babys mouth and nose
  • B. Clamp and cut the cord
  • C. Do skin-to-skin contact
  • D. Do early latching on

14
During drying and stimulation of the baby, your
rapid assessment shows that the baby is crying.
What is your next action?
  • A. Suction the babys mouth and nose
  • B. Clamp and cut the cord
  • C. Do skin-to-skin contact
  • D. Do early latching on

15
What are the benefits of immediate
skin-to-skin contact?
  • A. Provides warmth
  • B. Increases overall duration of exclusive
    breastfeeding
  • C. Allows colonization with good bacteria
  • D. All of the above

16
What are the benefits of immediate
skin-to-skin contact (SSC)?
  • A. Provides warmth
  • B. Increases overall duration of exclusive
    breastfeeding
  • C. Allows colonization with good bacteria
  • D. All of the above

17
Skin-to-Skin Contact
  • Generally perceived to be an intervention for
    provision of warmth and bonding
  • Less well appreciated are its contributions to
  • Overall success of breastfeeding/colostrum
    feeding
  • Stimulation of the mucosa-associated lymphoid
    tissue system
  • Protection from hypoglycemia
  • Colonization with maternal skin flora

Moore E, et al. Cochrane Rev. 2007 Jul 18(3).
Anderson GC, et al. Cochrane Rev
2003(2). Brandtzaeg P. Ann N Y Acad Sci
20029641345
18
When should the cord be clamped after birth?
  • A. When the cord pulsations stop
  • B. Between 1 and 3 minutes
  • C. Between 30 secs - 1 minute in preterms
  • D. All of the above are appropriate

19
When should the cord be clamped after birth?
  • A. When the cord pulsations stop
  • B. Between 1 and 3 minutes
  • C. Between 30 secs - 1 minute in preterms
  • D. All of the above are appropriate

20
Properly-Timed cord clamping
  • Term babies less anemia in the newborn
  • 24-48 hrs after birth
  • RR 0.2 (95 CI 0.06, 0.6)
  • NNT 7, (4.5- 20.8)
  • Preterms less infant anemia
  • RR 0.49 (95 CI 0.3, 0.81)
  • NNT 3 (1.6 - 29.6)
  • Preterms less intraventricular hemorrhage
  • RR 0.59 (95 CI 0.35, 0.92)
  • NNT 2 (1.4 - 9.8)
  • No significant impact on incidence of Post-Partum
    Hemorrhage
  • Ceriani Cernadas ,et al. 2006
  • Rabe H, et al. 2004
  • McDonald SJ, et al. 2008
  • Hutton EK, et al. 2007
  • Kugelman A, et al. 2007
  • Van Rheenen PF, et al. 2006
  • Van Rheenen PF Brabin BJ. 2006

21
Washing the Baby in the First 6 Hours is
Protective
  • True
  • False

22
Washing the Baby in the First 6 Hours is
Protective
  • True
  • False

23
Early Washing Can Lead to
  • Hypothermia which can lead to
  • infection, coagulation defects, acidosis, delayed
    fetal to newborn circulatory adjustment, hyaline
    membrane disease, brain hemorrhage
  • Infection
  • The vernix is a protective barrier to bacteria
    such as E. coli and Group B Strep so is maternal
    bacterial colonization
  • No crawling reflex.
  • Tunell R., Cell Mol Life Sci 2005 622390-99
  • Righard L, Alade M. Lancet 1990 336 1105-07.

24
Non-separation of Newborn from Mother for Early
Breastfeeding
  • Weighing, bathing, eye care, examinations,
    injections should be done AFTER the first full
    breastfeed is completed
  • Postpone washing until at least 6 hours

25
Delaying Initiation of breastfeeding increases
risk of infection-related death, Nepal 2008,
22,838 breastfed babies
RR
Mullany LC, et al. J Nutr, 2008 138(3)599-603.
Hours after Birth
26
The evidence is solid The following Newborn
Care Practices will save lives Immediate and
Thorough Drying Early Skin-to-Skin
Contact Properly Timed Cord Clamping Non-separat
ion of Newborn from Mother for Early Breastfeeding
27
Current State of Newborn Care Practices in
Philippine Hospitals
28
A Minute-by-Minute Assessment of Newborn Care
within the First Hour of Life in Philippines
Hospitals (2009)
Intervention Percentage and Median Time WHO Standard
Cord Clamp 12 sec 99 in lt 1 min Until pulsations stop (1-3 mins)
Drying 97 at 1 min 100 Immediately
Immediate Skin-to-skin contact 9.6 at 5 min gt90 (except those needing resuscitation)
Put on cold surface 12 None
Not dried 2.5 None
Head not dried 6.2 None
Wash 84 at 8 min gt6 hours
Temp taken before 17 All
Sobel, Silvestre, Mantaring, Oliveros, 2009
29
A Minute-by-Minute Assessment of Newborn Care
within the First Hour of Life in Philippines
Hospitals (2009)
Intervention Median Time or Percentage WHO Standard
Breast feed 69.3 at 10 min Within 1 hour (but when baby shows signs)
Separated from mother 92.9 at 12 min gt1 hour
Weigh 100 at 13 min gt 1 hour
Exam 75.7 at 17 min gt 1 hour
Hepatitis B Vaccine 69.4 at 20 min gt1 hour
Nursery 52 at 19 min Never
Rooming in 83 (155 min) Immediately with mother
Sobel, Silvestre, Mantaring, Oliveros, 2009
30
Resuscitation action of 26 infants with apnea
Action N ()
Suctioning 24 (92.3)
Bag and Mask 12 (46.1) at 120 seconds
Slapping back 7 (26.9)
Intubation 2 (7.7) at 3 and 6 min
Chest compressions/ Epi 2 (7.7) at 4 min
Drying 1 (3.8)
Should be first action, immediately, for full
30 seconds, unless both floppy/limp and apneic
Sobel, Silvestre, Mantaring, Oliveros, 2009
31
Unnecessary Resuscitation
  • Of the 455 who were already breathing
  • 94.9 suctioned once
  • 84.0 suctioned more than once

Sobel, Silvestre, Mantaring, Oliveros, 2009
32
Newborn Care Practices in 51 Philippine
Hospitals, 2009
  • Performance and timing of evidence-based
    interventions in immediate newborn care are below
    essential newborn care standards recommended by
    the WHO.
  • Hospital practices prevented Philippine newborns
    from benefiting from their mothers natural
    protection in the first hour of life.

Sobel HL, Silvestre MA, Mantaring JB III. DOH/WHO
Commissioned Study on Newborn Care Practices,
2009
33
Differences in Practices
  • There was minimal difference in
  • timing or performance of immediate newborn
    interventions regardless of whether the attendant
    at delivery was a pediatrician, nurse or midwife

Sobel, Silvestre, Mantaring, Oliveros, 2009
34
Indications that a guideline is needed
  • Wide variation in practices
  • Reports of inappropriate care
  • High health care costs
  • All of these indicate the Essential Newborn Care
    Protocol is needed in the Philippines.

35
Essential Newborn Care Protocol was developed to
address these issues
36
Newborn Care Protocol
  • - Simple, to-the-point, user-friendly,
    evidence-based protocol for essential newborn
    care focusing on the 1st week of life
  • - Emphasizes a core sequence of actions
  • or steps
  • - Need for a package/bundle of interventions
  • - Some time-bound but doable even by a single
    health worker caring for both mother and newborn

37
Estimations of NMR impact
38
  • Next Steps
  • Dissemination
  • Implementation
  • Monitoring

39
Time Band Prepare for the Delivery
  • Check temperature of the delivery room
  • 25 - 28 o C
  • Free of air drafts
  • Notify appropriate staff
  • Arrange needed supplies in linear fashion
  • Check resuscitation equipment
  • Wash hands with clean water and soap
  • Double glove just before delivery

40
Four Core Steps of Essential Newborn Care
  • Immediate and thorough drying
  • Early skin-to-skin contact
  • Properly timed cord clamping
  • Non-separation of the newborn and mother for
    early initiation of breastfeeding

41
Time Band Within 1st 30 secs Immediate Thorough
Drying
  • Call out the time of birth
  • Dry the newborn thoroughly for at least 30
    seconds
  • Wipe the eyes, face, head, front and back, arms
    and legs
  • Remove the wet cloth

42
Time Band Within 1st 30 secs Immediate and
Thorough Drying
  • Do a quick check of breathing while drying
  • Notes
  • During the 1st secs
  • Do not ventilate unless the baby is floppy/limp
    and not breathing
  • Do not suction unless the mouth/nose are blocked
    with secretions or other material

43
Time Band 0 3 mins After 30 secs of
drying Early Skin-to-Skin Contact
  • If newborn is breathing or crying
  • Position the newborn prone on the mothers
    abdomen or chest
  • Cover the newborns back with a dry blanket
  • Cover the newborns head with a bonnet
  • Place identification band on ankle (not wrist)

44
Time Band 1 - 3 mins Properly - timed cord
clamping
  • Remove the first set of gloves
  • After the umbilical pulsations have stopped,
    clamp the cord using a sterile plastic clamp or
    tie at 2 cm from the umbilical base
  • Clamp again at 5 cm from the base
  • Cut the cord close to the plastic clamp

45
Time Band 1 - 3 mins Properly - timed cord
clamping
  • Notes
  • Do not milk the cord towards the baby
  • After the 1st clamp, you may strip the cord of
    blood before applying the 2nd clamp
  • Cut the cord close to the plastic clamp so that
    there is no need for a 2nd trim
  • Do not apply any substance onto the cord

46
Time Band Within 90 mins Non-separation of
Newborn from Mother for Early Breastfeeding
  • Leave the newborn in skin-to-skin contact
  • Observe for feeding cues, including tonguing,
    licking, rooting
  • Point these out to the mother and encourage her
    to nudge the newborn towards the breast

47
Time Band Within 90 mins Non-separation of
Newborn from Mother for Early Breastfeeding
  • Counsel on positioning
  • Newborns neck is not flexed nor twisted
  • Newborn is facing the breast
  • Newborns body is close to mothers body
  • Newborns whole body is supported

48
Time Band Within 90 mins Non-separation of
Newborn from Mother for Early Breastfeeding
  • Counsel on attachment and suckling
  • Mouth wide open
  • Lower lip turned outwards
  • Babys chin touching breast
  • Suckling is slow, deep with some pauses

49
Time Band Within 90 mins Non-separation of
Newborn from Mother for Early Breastfeeding
  • Notes
  • Minimize handling by health workers
  • Do not give sugar water, formula or other
    prelacteals
  • Do not give bottles or pacifiers
  • Do not throw away colostrum

50
Time Band Within 90 minutes Non-separation of
Newborn from Mother for Early Breastfeeding
  • Weighing, eye care, examinations, injections
    (hepatitis B, BCG) should be done after the first
    full breastfeed is completed
  • Postpone washing until at least 6 hours

51
Adopting New Policies and Protocol on Essential
Newborn Care (Administrative Order 2009 - 0025)
52
Scope of Application
  • Whole hierarchy of the DOH and its attached
    agencies
  • Public and private providers
  • Development partners involved in the MNCHN
    strategy
  • All health practitioners involved in maternal and
    newborn care

53
Time-Bound Interventions
  • Within 30
  • Seconds
  • Objective
  • To provide
  • warmth, prevent
  • hypothermia
  • After thorough
  • drying
  • Objective
  • To facilitate bonding
  • through STS
  • (infection,
  • hypoglycemia)
  • Up to 3 minutes
  • Post-delivery
  • Objective
  • To reduce incidence
  • anemia in term
  • and IVH in pre-
  • term
  • Within 90 minutes
  • Of age
  • Objective
  • To facilitate initiation
  • of breastfeeding
  • through sustained
  • contact
  • Put on double
  • Gloves
  • Dry thoroughly
  • Remove wet cloth
  • Quick check of
  • NBsbreathing
  • Put prone on chest/
  • abdomen in STS
  • Cover w/ blanket,
  • bonnet
  • Place identification
  • on ankle
  • Do not separate
  • Do not remove vernix
  • Remove 1st set of
  • gloves
  • Clamp and cut cord
  • after cord pulsations
  • (1-3 mins)
  • Do not milk cord
  • Active management
  • of labor
  • Leave the NB on
  • STS contact
  • Observe NB for
  • feeding cues
  • Counsel on
  • positioning and
  • attachment
  • Do eye care

54
Non-Immediate Interventions
  • Vit. K
  • Hepatitis B
  • BCG
  • Re-Examination of the NB
  • Weigh
  • Look for malformations, etc.
  • Feeding difficulties

55
NB Resuscitation
  • Not breathing or gasping after 30 secs of drying
    and stimulation or before 30 secs if floppy and
    not breathing
  • Clamp and cut
  • Call for help
  • Transfer, provide warmth
  • Inform the mother

Silvestre MA April 2009
56
Care for a small baby or twin - preterm or 1-2
months early or weighing 1,500 2,499 g
  • Kangaroo Mother Care
  • More warmth
  • More support for breastfeeding
  • Weigh daily
  • Discharge planning
  • Breastfeeding well and gaining weight for past 3
    days
  • Normal temperature for past 3 days
  • Able and confident to care for NB

57
Unnecessary Procedures
  • Routine suctioning
  • Early bathing/washing
  • Footprinting
  • Giving sugar water, prelacteals, formula and
    using bottles and pacifiers
  • Application of alcohol, other subs on the cord
    stump and bandaging the stump/
  • abdomen

58
Discharge Instructions
  • When to return jaundice of the soles or any of
    the following are present difficulty of feeding,
    convulsions, movement only when stimulated fast
    or slow or difficult breathing, temp gt37.5 or
    lt35.5 C
  • Post natal Visits 48 72 hrs, 7 days,
    immunization at 6 weeks
  • Additional Visits 2 days, 7 days
  • NBS

59
The evidence is solid The following Newborn
Care Practices will save lives Immediate and
Thorough Drying Early Skin-to-Skin
Contact Properly Timed Cord Clamping Non-separat
ion of Newborn from Mother for Early Breastfeeding
60
How can I contribute to implementing ENC?
  • Enable the environment for ENC
  • Disable the environment that hinders ENC
  • Join us to bring Unang Yakap to your membership
    and every mother, father that they can
    influence.

61
CLOSING THOUGHTS
  • The current state of newborn care needs urgent
    action
  • Evidence-based interventions are not practiced
    sufficiently.
  • ENC Protocol provides an evidence-based, low
    cost, low technology package of interventions
    that will save tens of thousands of lives.
  • Each of us, as individuals and as organizations,
    have to look inward to find ways to implement ENC
  • Join us to bring Unang Yakap to your membership
    and every person they can influence.

62
THANK YOU FOR LISTENING!
About PowerShow.com