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Immediate Care of normal newborn:
The events during first few minutes and hours of life have an immense bearing on the immediate and long term outcome of the infant. The aims of neonatal care at birth include the following.
Establishment of respiration
Prevention of hypothermia
Establishment of breast-feeding.
Prevention of infection
Care of the newborn can be divided into four sections.
1. Preparation before delivery
2. Immediate care at birth
3. Care after birth
4. Essential postnatal care.
Preparation before delivery:
Each delivery room must have a well-lighted, well-ventilated and warm environment without droughts to receive the newly born baby. The baby care area in the delivery room should have
1. A radiant warmer or simple 100 or 200-watt electric bulb kept about 20 inches (50 cm) above the baby.
2. Clean sterile linen, like towels, bed sheets and baby blankets should be available. At least two blankets should be provided for each baby, one for drying and one for wrapping.
3. Disposable cord clamps, sterile cord-cutting scissors, cotton swabs, gauze pieces and bulb sucker.
4. Oxygen supply, suction device, resuscitation equipments, adhesive tape, scissors etc must be checked well in advance.
5. Weighing scales, measuring tapes, identification tags, clinical thermometer.
6. Medication tray containing spirit, distilled water, normal saline for cleaning eyes. Vitamin K ampoules, medications needed during resuscitation ie epinephrine injection, disposable syringes 2 cc, 5cc and 10 cc should be kept.
Immediate care at birth:
The radiant warmer should be put on 15 minutes before the birth of the baby. The baby should be received in pre-warmed linen and dried from top to bottom immediately after birth. The wet linen should be removed and baby should be covered with a dry and warm towel. The baby should be placed in a head low position to facilitate drainage of oropharyngeal secretions.
The mouth should be suctioned first followed by suctioning of the nose using a bulb sucker. Suction should be done gently and intermittently. Suctioning should not be more than 5 seconds at a time. The heart rate should be monitored for possible bradycardia.
These steps take around 20 to 30 seconds. By this time most babies are vigorously crying, actively moving and pink.
Care after birth:
A sterile disposable delivery kit should be used for each baby to prevent cross infection. The eyes should be cleaned with sterile normal saline using one swab for each eye from inner canthus toward outer canthus.
The umbilical cord should be tied using umbilical cord
clamp, 2 or 3 cm beyond the base of the cord.
Do not apply anything on the cord.
The patency of the anus should be checked by passing a stiff rubber catheter into the anal orifice.
Essential postnatal care:
1. The bay should be warm to touch and soles should be pink.
2. The umbilical stump should be clean and dry.
3. The tie should be tight. There should be no bleeding.
4. Check that the baby has good suckling. If suckling is poor, assure correct positioning and attachment to breast. Initiate breast-feeding within half an hour in normal delivery.
5. Check that the baby is crying well and has no breathing difficulty. If found the difficulty refer to pediatrician.
Advice on discharge:
Advise the mother
1. to keep the umbilical stump clean and dry and not to apply anything on the cord stump.
2. to protect the baby from cold or heat by wrapping according to climate.
3. to exclusively breastfeed the baby till 6 months frequently day and night. Do not give to baby any other food including water.
4. Feed the baby on demand, day and night.
5. Do not apply anything in the eyes.
1. Obstructed labour
2. Fetal distress
3. cord prolapse
Puerperium is the period immediately following labour during which,
1. The reproductive organs return to their pre pregnant stage.
2. Lactation is initiated, and
3. The mother recovers from the physical and emotional experiences of parturition.
4. Puerperium begins as soon as the placenta is expelled and lasts for 6 weeks (42 days)
5. The process whereby the genital organs revert back to their original state is called 'Involution'
Involution of the uterus:
Immediately following delivery, the uterus becomes firm and weighs about 1000gm. At the end of 6 weeks, its measurement is almost similar to that of the non-pregnant state and weighs about 60gm.
By the end of second week after delivery, the uterus becomes a pelvic organ.
Lochia are the discharges from the uterus, cervix and vagina for the first fortnight during puerperium. They are alkaline in reaction and contain bloods, debris of deciduas, and liquor amnii, lanugo, vernix caseosa and meconium.
Colour of lochia:
1. Lochia rubra (red) lasts for 1-4 days.
2. Lochia serosa - lasts for 5-9 days. Colour is yellowish or pink or pale browne.
3. Lochia alba- (pale white) lasts for 10-15 days.
4. The character of the lochia gives useful information about the abnormal puerperal state.
1. postpartum hemorrhage
2. thrombo embolic manifestations
3. puerperal infections
4. postpartum psychosis
5. lactation failure
Initiation of breast feeding is more important during the immediate postnatal period. For the first two days, colostrum will be secreted from the breasts, which is a yellow serous fluid rich in protein and immunoglobulins. It provides resistance against infection to the newborn.
The first feeding is an important experience to the mother and baby. The success of breast-feeding depends on mother' s learning of a good breast-feeding technique in a happy and positive way.
Breast-feeding should be given on demands of the baby and normally a healthy baby takes breast feeds 6 to eight times in 24 hours, for not less than 10 minutes each.
Advantages of breast-feeding:
1. Ideal composition. Helps in easy digestion for the baby.
2. Breast milk contains a number of protective factors. Breast fed babies are less likely to develop infections like diarrhea and respiratory infections.
3. Breast milk is readily available, usually sterile.
4. It is convenient, requiring no preparation and costs nothing.
5. It protects against allergies like asthma.
6. It has a laxative action for the baby.
7. It enhances emotional bonding between the mother and the baby.
8. Breast-feeding acts as a natural contraceptive. Chance of conception is less during lactation period.
9. Helps in involution of uterus.
10. Breast fed babies have a higher IQ and have less chance of developing hypertension, diabetes mellitus, coronary heart disease, liver disease and cancer in later life.
11. For mother, breast-feeding reduces the risk of breast and ovarian cancer.
12. Breast-feeding saves money and time and conserves energy. The family and society spend less on milk, health care and illness.
Management of puerperium:
The basic principles of post-natal care include.
1. Promotion of physical well-being by good nutrition, adequate fluid intake, comfort, cleanliness, and sufficient exercises to ensure good muscle tone.
2. Early ampulation is insisted to prevent deep vein thrombosis.
3. Establishment of emotional well-being.
4. Promotion of breast-feeding.
5. Prevention of complications.
The important considerations of postnatal care include.
1. Adequate rest and sleep:
2. Watch for the signs and symptoms of infection and excess bleeding.
3. Diet: A balanced diet containing sufficient protein (90 gm) minerals and vitamins should be given. Additional fluid
4. intake is encouraged. Fresh fruits and vegetables should be included in the main meals.
5. Antibiotics and analgesics are given to combat infection and to relieve pain and discomfort.
6. Perinial care with aseptic precautions to prevent puerperal infections
7. Micturition: Difficulty with urination is quite common during the first few days due to trauma. It must be ensured that the bladder emptied completely.
8. Constipation: It is common during puerperium as there is a tendency of the bowels to be sluggish. A diet rich in fibre will overcome the problem.
9. Postnatal exercise: The importances of post-natal exercises are stressed to the mother and are also taught to her to regain the muscle tone, which are stretched during pregnancy and labour.
10. Continuance of supplementary iron therapy.
11. Advise for a gradual return to day-day activities.
12. Advise on breast-feeding and care of newborn including immunisation.
13. Family planning advice and guidance.
14. To have a postnatal check up after 6 weeks.
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