Nursing Care of Healthy Neonates

NURSING CARE OF HEALTHY NEONATES

The first week of life is the most critical period in the life of an infant. The expert obstetric care is scarce and the home environment conditions in which baby is born are usually unsatisfactory.

Objectives

·           To establish and maintain cardiopulmonary functions.

·           To maintain body temperature.

·           To avoid infections.

·           For satisfactory feeding regime.

·           For early detection and treatment of congenital and acquired disorders.

Nursing care of healthy new born baby includes

I     Immediate care

II    Routine care

I.  Immediate Care

Immediate basic care of neonates at birth includes maintenance of temperature, establishment of airway, initiation of breathing and maintenance of circulation.

1. Clearing the Airway

As majority babies cry at birth and take spontaneous respiration. No resuscitation is required at birth for about 95 to 98% neonates. Establishment and maintenance of cardio respiratory function (ex. breathing) is the most important thing. The chest movement of the baby is primary and everything else is secondary.

Airways should be cleaned of mucus and other secretions by gentle suction

Resuscitation may require more active measures such as suction, application of oxygen mask, integration and assisted respiration.

2. Apgar Score

It is an useful quantitative assessment of neonates condition at birth, especially for the respiratory, circulatory and neurological status.

II.  Daily routine Care of Neonates

•            Warmth

•            Care of umbilical cord

•            Care of the eyes

•            Care of the skin

•            Breast feeding

•            Baby bath

•            Clothing

•            General care

•            Weight Recording

•            Immunization

The major goal of nursing care of the new born, infant is to establish and maintain homeostasis.

Warmth

Warmth is provided by keeping the body dry and wrapping with adequate clothing. It can be placed in skin to skin contact with mother to maintain temperature. (Auxillary temp 36.50 C – 37.60C)

Care of Umbilical Cord

The umbilical cord is cut about 2-3 inches from the naval with aseptic precautions during delivery and tied with sterile cotton thread or disposable plastic clip. The cord must be inspected for infection.

Care of the Eyes

Eyes should be cleaned with sterile cotton swabs soaked is sterile water or normal saline.

Observe the eyes for redness, sticky discharge or excessive tearing for early detection of problems and for prompt management.

Care of the Skin

The baby must be cleaned off blood, mucous and meconium by gently wiping before he or she is presented to the mother.

During hospital stay ‘no bath’ reduces the incidence of neonatal infections. No vigorous attempt should be made to remove the vernix caseosa.

Breast Feeding

·           The baby should be put to the mother’s breast within half an hour of birth or as soon as possible.

·           No prelactal feeds to be given and colostrums feedings must be offered.

·           Educate the mother about breast feeding techniques.

·           Initially the feeding should be given in short interval of 1-2 hours and then every 2-3 hours. Most babies regularize their feeding pattern by the end of first week.

Baby Bath

·           During hospital “No bath”

·           Baby bath should be given with warm water in warm room

·           Baby should be dried immediately from head to toe and wrapped in a dry warm towel.

·           Use of olive oil or coconut oil can be allowed after 3-4 weeks of age.

·           Exposure to sunlight is an important source of vitamin D and warmth.

Clothing

·           The baby should be dressed with loose soft and cotton clothes.

·           The clothes should not be too tight around the neck or abdomen.

·           Clothes should be cleaned with light detergent and washed properly and sun dried.

General Care

·           Baby should be handled with gentle approach after proper hand washing.

·           No infected person should handle.

·           Baby should be allowed to sleep in supine position.

Weight Recording

·           Average daily weight gain in healthy, new born baby increases about 30g/day in the first month of life.

·           It is about 20g/ day in second month and 10g/day afterwards during the first year of life.

·           Most infants double their birth weight by 4-5 months.

Immunization

·           All neonates should be immunized with BCG, ‘O’ dose OPV and ‘hepatitis B’ vaccine at birth.

·            Mother should be informed about the recommended National Immunization Scheme.

Harmful Traditional Practices

Harmful traditional practices are forms of actions in certain communities. A large number of customs and cultural practices are found for mother and child. Harmful practices should be avoided. The examples are

·           Use of cow dung or mud on umbilical cord

·           Discarding colostrums and delayed breast feeding. Prelactal feeds like gold rubbed in water, honey, sugar water, distilled water and donkey’s milk

·           Neglecting female new born emotionally and nutritionally

·           Instillation of oil into eye and ears before bath

·           Using grape water or bonnison

·           Giving opium and brandy

·           Using feeding bottles

·           Application of kajal in the new born eyes

Identification of Risk Infants

It means that a new born has great chances of complication because of the mother during labour or birth.

The basic criteria for identifying these babies include

·           Birth weight less than 2.5 kg – preterm or small for date. Weight below 70% expected weight

·           failure to gain weight during 3 successive months

·           Twins, Birth order 5 and more

·           Artificial feeding , Children with diarrhoea

·           Congenital disorders like down’s syndrome

·           Apnoea or asphyxia

·           Dimorphism