MANAGEMENT OF NEWBORN
Immediate Care of Newborn:
Immediate newborn care involves properly assessing and stabilizing the newborn.
Immediate newborn care is crucial for stabilizing the fetus from intrauterine life to extrauterine life.
Goal of immediate newborn care
1) Respiration of newborn is done to establish, maintain and provide support.
2) To prevent the newborn from vomiting and hypothermia.
3) To prevent infection in the newborn.
4) To provide safety to the newborn and prevent him from injury.
5) To provide immediate treatment by early identification of any actual or potential problem in the newborn.
Immediate newborn care is provided.
Immediate Newborn Care
1) Establishment of Respiration
Immediately patent the newborn’s airway and clear the airway properly when the newborn is received. Due to which the newborn can effectively breathe.
As soon as the newborn’s head is born, wipe the mouth and nose and suction the mouth and nose so that the newborn can breathe properly. Saxon should be done through the mouth first and then through the nose to prevent aspiration of secretions.
2) Initiation of cry
Normally up to 99% of newborns cry immediately and spontaneously after delivery, this cry is recognized as a good sign for newborn breathing.
If the newborn does not cry properly, follow the steps below:
a) If the baby does not cry spontaneously or if the cry is weak then slightly simulating the baby to cry.
b) Lightly rub the soles of the baby’s feet instead of slapping them on the bum to stimulate the baby’s cry. Stimulate the baby to start crying after removing the newborn’s secretions.
C) Newborn’s cry is usually loud and husky and proper monitoring of newborn if there is any abnormal cry like,
Hypitch cry: = due to hypoglycemia and increased intracranial pressure,
Week cry:= prematurity,
Hosacry:= laryngeal stridor
3) Care of Code
Cord care is important immediate care of the newborn.
A newborn’s cord should be clamped within 30 seconds of birth and then properly cut.
After the newborn is delivered, keep the newborn on the mother’s abdomen.
Then properly clamp the cord from two opposite sites by cord clamp.
The first clamp should be placed 5 cm from the umbilicus and the second clamp should be placed 2.5 cm from the first camp.
Then cut the cord properly between the two clamps.
Do not apply anything to the cord, let it dry and fall naturally.
The code folds down naturally within seven to ten days after birth.
Prevent the cord from getting wet by water and urine.
If any kind of discharge and bleeding is present in the cord, immediately assess the cord clamp and then loosen it properly.
Immediately if the following signs and symptoms are observed in the coda
To report such as,
Foul smell coming from the cord,
Seeing any discharge,
Redness around the cord,
The cord is wet,
If the cord does not fall down in 7-10 days,
inflammation,
Fever etc.
4) Maintain position of the newborn
During the first 12-18 hours after birth, a newborn is prone to choking, phlegm and gagging of mucus. So providing proper position to the newborn.
In which proper side lining position should be provided to the fitters due to which the mucus can be removed and drainage.
5) Identification and banding
After the baby is born, proper identification band should be applied to the baby so that the baby can be properly identified.
6) Eyecare
Clean the newborn’s ice from inner canthers to outer canthers with properly sterile gauze.
Apply erythromycin or tetracycline ointment from the lower lead in ice if needed.
7) Attachment and attachment (bonding)
After the birth of the baby, placing the baby on the mother’s abdomen, due to which bonding with the mother and proper skin-to-skin contact can take place, due to which the attachment of the mother and the baby can occur and the baby can be prevented from hypothermia.
8) APGAR score
APGAR score is the most important parameter of immediate newborn care.
APGAR score should be assessed at 1 minute and 5 minutes after birth.
In APGAR score,
A:= Appearance (Skin Color),
P:=Pulse (hotrate),
G:= grimace (reflux irritability),
A:=Activity (muscle tone),
R:= Respiration (Respiratory Efforts)
is assessed.
APGAR score has a total score of 0-10.
APGAR score at 1 minute after birth:
If the Apgar score is 7-10 then it is called normal i.e. no depression in which the baby is provided with normal post delivery routine care.
If the APGAR score is between 4-6, it indicates mild depression in which the child requires assistance for breathing.
If the APGAR score is between 0-3, it indicates severe depression requiring resuscitation of the child.
APGAR score at 5 minutes after birth:
An APGAR score between 7-10 is considered normal, but if the Apgar score is below 7, the baby needs to be monitored for another half hour.
9) Vitamin K:
A newborn’s intestine is sterile for some time after birth i.e. the bacteria responsible for manufacturing vitamin K is not present in the intestine which is why the newborn cannot manufacture vitamin K i.e. vitamin k a clotting factor. The factor responsible for this is that if this vitamin K is not present in the body of the newborn, then there are chances of building in the newborn, so as a preventive measure, artificial injection of vitamin K is provided to the newborn baby.
Dose:=
In pre term:=0.5 ml,
Full term:= 1 mg.
Intra muscularly (IM) is provided on the vastus lateralis (lateral anterior thigh).
APGAR Score:
Apgar scoring was developed by obstetric anesthesiologist Virginia Apgar in 1952 and has become the standard method for evaluating newborns.
Apgar is an instant, quick and complete assessment of neonatal or newborn health or it is a practical method of evaluating neonate or newborn.
APGAR score is the most important parameter of immediate newborn care.
APGAR score A,
1) Immediately after birth,
2) 1 minute after birth
3) Assess at 5 minutes after birth.
A one-minute Apgar scoring provides information about the child’s physical health and helps the physician make an assessment and determine whether immediate or future medical treatment is needed.
Whereas, the 5-minute Apgar score, if performed, provides information about the child’s response to previous measures of resuscitation.
In APGAR score,
A:= appearance (skin color),
P:=Pulse (hotrate),
G:= grimace (reflux irritability),
A:=Activity (muscle tone),
R:= Respiration (Respiratory Efforts)
is assessed.
Five Criteria of the Apgar Score:
1) (A : Appearance) Skin Color:
Score 0: Whole body blue or pale.
Score 01: Body Pink and Extremities Blue.
Score 02: Body and extremities pink with no cyanosis.
2) P: Pulse Rate:
Score 0 : Sebcent.
Score 01 : Less than 100 pulses per minute.
Score 02 : More than 100 pulses per minute.
3) G : Grimace (Reflex Irritability)
Score 0: No response to stimulation.
Score 01 : Grimaces on suction or aggressive stimulation.
Score 01 : Crying on stimulation.
4) A : Activity:
Score 0 : None.
Score 01 : Some flexion.
Score 02 : Flexed arms and legs that resist extension.
5) R : Respiratory effects
Score 0 : Absent,
Score 01: Weak Irregular and Gasping,
Score 02: Strong and lusty.
APGAR score has a total score of 0-10.
APGAR score at 1 minute after birth:
If the Apgar score is 7-10 then it is called normal i.e. no depression in which the baby is provided with normal post delivery routine care.
If the APGAR score is between 4-6, it indicates mild depression in which the child requires assistance for breathing.
If the APGAR score is between 0-3, it indicates severe depression requiring resuscitation of the child.
APGAR score at 5 minutes after birth:
An APGAR score between 7-10 is considered normal.
But if the Apgar score is below 7, the baby needs to be monitored for another half hour.
After Birth Observation of Newborn Baby:
Observation of newborns immediately after birth is crucial to assess their overall health, well-being and development.
Here, some aspects for newborn observations are given:
1) General Appearance:
Color:
Assessing the color of the child’s skin, most children are pink or red in color. If there is cyanosis (bluish discoloration), it indicates breathing difficulties.
Posture:
Note the baby’s muscle tone. A healthy newborn baby has their hands slightly flexed and their feet slightly curved along the spine.
Activity:
Observation of spontaneous movement involving sucking reflex and grasping reflex.
2) Vital Sign:
Heart Rate:
The normal range is 120-160/minute.
Respiratory Rate:
Normal respiratory rate is 30-60 breaths.
Temperature:
A normal temperature is 36.5-37.5°C (97.7-99.5°F).
3) Head and Face:
Fontanelles:
Palpate the anterior fontanel (soft spot) and posterior fontanel of the newborn. To perform proper closure and tension of the fontanelles.
Ice:
Checking the ice for its cementation. Assessing red reflex (indicative of normal eye structure) and response to light.
Nose:
Assess the patency of the nose so that breathing can be appropriate.
4) Mouth and Neck:
Oral mucosa:
Assessing the presence of cleft palate, oral thrush and any lesions in the oral mucosa.
Neck:
Assess for any mass-like structures or abnormalities in the neck.
5) Chest and Lungs:
Breathing Sound:
Properly listening to the child’s breathing sound.
Chest Movement:
Properly assess whether the child’s chest rises symmetrically and falls down with breathing.
6) Heart and Abdomen:
Heart Sound:
Proper auscultation of heart sound to assess for any murmur type abnormal voice and abnormalities.
Abdomen:
Palpate the abdomen and auscultate bowel sounds to assess whether there is any mass-like structure in the child’s abdomen.
7) Genital Area and Anus:
Genital Area:
To assess whether the anatomical structure of the genital area of the child i.e. male (presence of testes in male child) and female (labial structure in female child) is proper or not.
Anus:
Assess the patency of the anus and assess whether there are any abnormalities.
Urine and Stool:
Urine is passed within 24 hours of birth and the first stool called miconium is greenish black in color which occurs in the first 48 hours three to four times a day for three to four days and then three to four times a day. Four days of transitional stools that are greenish brown.
8) Extremities:
Hand & Fits:
Counting the child’s fingers and toes. and to assess symmetry or to assess whether there are any abnormalities.
Movement:
Assess whether the child has spontaneous movement and the range of motion of the hands and legs.
9) Skin and Umbilicus:
Skin:
Assessing the child whether there are any birthmarks, lesions and rashes on their skin.
Umbelicus:
Provide proper cord care to the child and assess for any signs and symptoms of infection and bleeding.
10) Behavioral Assessment:
State of Alertness:
Properly assess the baby’s level of awareness and the amount of stimulus to provide a response.
Crying:
Properly assessing whether the child is crying properly or not due to which the respiration status of the child can be properly assessed.
Additional Considerations:
Documentation:
To accurately record all findings in the newborn assessment chart.
Parenteral Education:
Educate parents about newborn care including proper breast feeding technique, maintain hygiene, and seek immediate health care if any signs and symptoms of infection are observed in the child.
To provide education to parents for going to the center.
By properly observing the child after birth, if there is any congenital abnormality or potential risk factor of any disease in the child, it can be identified early and adequate measures can be taken and the child’s condition can be prevented from getting complicated.
Physiological Adaptation of Neonate/Newborn:
Newborn
A healthy newborn is one born at term i.e. 38 to 42 weeks and cries immediately after birth and individually, rhythmically, starts breathing and accepts extrauterine life and whose weight is the same as normal weight and A neonate that does not have any congenital anomalies is called a normal neonate.
Physiological Adoption of Newborn:
Physiological adaptation in the newborn is important for survival of the fetus from intrauterine life to extrauterine life.
Physiological adaptations occurring in the newborn:
1) Respiratory System:
Fits to Neonate Transitions:
Before birth, the fetus receives oxygen from the placenta.
After birth, the lungs of the fetus expand and the lungs mature to oxygenate the blood.
Clearance of Lungs Fluid:
After the birth of the newborn, when the newborn takes its first breath, the fluid in the lungs is cleared and the lungs are transferred from the fetal circulation to the neonatal circulation.
Surfactant Production:
A surfactant is a substance that works to reduce the surface tension of the lungs. And prevents alveoli from collapsing due to which gas exchange can take place properly.
Closure of fetal sunt:
After birth, shunts in newborns such as Doctor’s arteriosus (a shunt between the aorta and pulmonary artery) and foramen ovale (a shunt in the septum between the right atrium and left atrium) close and redirect blood to the lungs.
2) Cardiovascular System:
Circulatory Changes:
After birth, after clamping and cutting the umbilical cord, the umbilical vessels are constricted and the umbilical arteries and umbilical veins are closed.
Increases pulmonary blood flow:
After birth, the newborn lungs expand to be able to oxygenate the blood, thereby increasing the pulmonary circulation.
Closure of ductus arteriosus:
These blood vessels connect the pulmonary artery and the aorta, which close shortly after birth.
Closure of foramen ovale:
The foramen ovale is a hole in the septum between the right atrium and the left atrium that closes a few months after birth.
3) Thermoregulation:
Maintenance of Body Temperature:
Newborns have limited ability to regulate their body temperature and brown fat metabolism, vasomotor response (shivering), and being kept in a warm environment (incubator or skin-to-skin contact).
4) Gastrointestinal System:
Production of digestive enzymes:
After birth, the digestive enzymes of the fetus increase due to which the newborn can digest breast milk and formula milk.
Meconium Pass:
A few days after birth, the baby passes meconium (baby’s first stool) which indicates a normal digestive track.
5) Metabolism:
Glucose metabolism
Insulin secretion increases after the birth of the baby, which can decrease the maternal blood glucose and due to which the fetal blood glucose level can be properly maintained.
Adjustment infeeding:
The gastrointestinal tract and metabolism of the fetus adjust to the transition from placental nutrients to feeding.
6) Renal System:
Urine Production:
After the birth of the baby, the kidneys work to filter the fetal blood and produce urine.
Fluid Balance:
Fits’ urinary system adjusts to maintain fit’s fluid and electrolyte levels.
7) Immune System:
Passive Immunity:
A newborn receives antibodies through the placenta and through breast milk and works to increase immunity and fight against infection.
8) Neurological Adaptation:
Sensorimotor Integration:
New bone adjusts after birth to maintain coordination of sensory and motor responses to sensory stimuli.
Cephalocaudal Development:
A newborn develops head to toe after birth like lifting the head, grasping objects etc.
This adaptation takes place through hormonal, neural and metabolic processes through which the newborn can properly survive from intrauterine life to extrauterine life.
And this physiological adaptation is important for the proper growth and development of the newborn.
First Day Examination of Newborn Baby:
After the birth of the newborn, check all the parameters properly like:
1) Vital sign
Vital sign temperature is mostly taken by axillary method. And to account for heart rate and respiratory rate for a full minute.
2) Physical Measurement:
a) Weight :
Checking the weight on the infant weighing machine If the baby’s weight is less than 2.5 kg, it is considered as a low birth weight baby. While weighing the baby, place a thin cloth or paper on the weighing scale properly.
b) Length:
Assessing crown hill length from a tape measure.
C) Head Circumference:
Take the measure tape from above the eyebrow and pinna of the ear backwards to the occipital protuberance and record it in centimeters (Cm).
D) Chest Circumference:
Chest circumference is measured around the chest, at the level of the nipple. Make sure that the tape is placed around the widest part of the chest, under the armpit and on the upper back. And the tape measure should not be too tight.
Chest circumference is usually 2-3 cm less than head circumference.
3) Color:
The color of the skin should usually be like a normal pink.
If the heart rate is high with pallor, it indicates the condition of anemia.
If there is a gray color along with the pale, it indicates a condition of acidosis. And if the baby is pale, it indicates the condition of hyperthermia or sepsis.
Acrocyanosis in which the hands and feet are blue is usually caused by exposure of the child to a cold environment.
If a condition of general cyanosis is seen in a newborn, it is usually seen in cardiac or lung conditions and usually brownish color of lips and tongue.
If the newborn’s body is excessively red, then it is usually seen when the red blood cells are high in polycythemia.
Harlequin Color: That is, in which the lower half of the baby’s body is pink and the upper half is pale.
Ecchymosis: In which color does not return when pressure is applied to the skin and indicates a condition of bleeding within the skin.
If yellow discoloration is seen in the baby’s skin, it usually indicates the condition of jaundice.
4) Cry:
A newborn’s cry immediately after birth gives an idea of whether the lung function has been established or not, loud and vigorous cries are normal, weak and fable cries are seen in low birth weight babies, while meningeal irritation has a high pitch or Shrill cry is seen, horse cry is seen in vocal cord paralysis, hypothyroidism and trauma.
5) Activity:
Checking for spontaneous and uniform movement. In which the child can lift and stretch the legs, open and close the fist, move the hands and fingers, it shows a good activity level.
In central nervous system (CNS) damage the child is flaccid and convulsed, whereas in birth trauma there is asymmetric movement. Thus, activity or crying in the abnormality is less.
6) Skin:
Normal skin is smooth, rose-petal-like and good skin turgor means that the skin returns to its original state after grasping it with the fingers and releasing it. Variations include small white papules on the cheeks, chin, and nose called milia.
Lenugo:
The thin hair on the baby’s body is called lanugo. Look for the distribution of vernix caseosa (a white cheesy substance on the baby’s skin) all over the baby’s body and skin folds.
7) Head to Toe Examination:
Head:
To check the fontanelles in the head usually the anterior fontanel of the newborn is diamond shaped which usually closes at 16 – 18 months while the posterior fontanel is triangular in shape and usually closes by 6 weeks. is Photonelles are usually smooth and palpable at the space between the two sutures.
Check for head size, sap, fontanelles, capute and any abnormalities such as hydrocephalus, meningitis, meningomyelocele encephaly and molding.
Ice:
The eye is usually slate gray or brown in color, does not produce tears and has a blinking reflex, can see only from the front when objects are held in front of the eye, and has clear eyebrows and corneas. It is bright and shiny alike and responds to light.
To properly check pupillary reaction to light, epicanthal fold and inner canthus of ice.
Watch for squint, nystagmus, trauma, lacrimal duct obstruction, corneal opacity, congenital cataract, conjunctivitis, blinking reflex, and doll’s eye reflex.
Ear:
Usually the pinna is easily palpable and cartilage is present, the top of the ear is parallel to the outer corner of the eye, and a startle reflex is present. Look for the shape and position of the ear and look for any additional lobes present. Low set ears indicate Down syndrome.
Neck:
The neck is usually short and thick and can rotate to both sides, the clavicle is complete and the tonic neck reflex is present with some control of the head.
Look for mass and shortness in the neck. Checking for the cervical spine on the back. Check for lateral sternomastoid muscles, trapezius muscles, and thyroid gland.
Palpate lymph nodes and check neck motion.
Watch for torticollis (contraction of the neck muscles on one side causes the arm on that side to bend).
Nose:
Assess for any blockage in the nose and see if the baby can breathe through the nose.Assess for any nasal discharge. Flaring off nurses
(Nascora fulva) indicates respiratory distress or depressed nasal bridge Down syndrome.
mouth
Usually in the mouth the uvula is in the midline and the palate is minimal or absent and in the cheek the fat is well developed and the mucosa is moist, the palate is high and there is shaking, rooting and gag reflex. are present. and to inspect the lips, tongue, palate and oropharynges. Properly identify whether the child has any cleft lip, cleft palate, small chin and small head.
Chest:
Examining the chest for its symmetry including properly assessing whether the nipple is symmetrical.
Heart:
Lower in the heart is between the fourth or fifth ribs of the left sternal border, S2 heart sounds are louder than S1 when the heart rate is 120-160 beats/min.
Assess whether severe respiratory distress is present by looking for retraction of the intercostal and subcostal muscles.
Breast:
Check the breast for size, cementum, color, turgor and discharge. Auscultate for air entry into the lungs. To check the heart sound properly.
Abdomen:
The abdomen is usually cylindrical in shape and palpable on palpation. The umbilical cord is well developed and palpable two to three centimeters below the right costal margin, while the kidney is palpated two to three centimeters above the umbilicus. Auscultate in hours.
Abdomen counter check. Premature neonates are distended due to poor muscle tone.
A flat, flabby abdomen remains in drug or neurological depression.
If the abdomen is concave, it indicates a diaphragmatic hernia.
On the outside of the omphalo sac lies the intestinal organ Look for an inguinal hernia when the baby relaxes or cries. Look for bilateral pulsation of the femoral artery Look for lymph node enlargement in the groin.
Genital Organs:
Female :
The labia and clitoris are swollen with the labia majora completely covering the labia minora and vernix lying between the labia. Urine is passed in an adequate amount within 24 hours after birth.
Check to see if the labia majora completely covers the labia minora. And checking for vaginal discharge and pseudomenstruation. Look for the size and shape of the clitoris.
Mail:
The urethral opening is usually located at the tip of the glans penis. The testes are palpable with a large, swollen, pendulous lump in the scrotum. Adequate amount of urine is passed in 24 hours after birth.
Checking the scrotum for swelling. Palpate the scrotum to see if the testes descend. Ashes for retraction in prepossess and urethral opening in penishes. Look for congenital hydrocele and inguinal hernia by flashing a light over the scrotum. Watch for ambiguous genitalia (ambiguous genitalia).
Rectum:
There is usually an open passage in the rectum. Meconium is passed 24 to 48 hours after birth.
Passage of patency meconium into the anus and check for meconium passage or not. Fistula, and rule out the legibility of anal muscle tone.
Assess the patency of the anal opening by passing a catheter or with a gloved finger.
Extremities:
Maintains a flexed position. The movement and tone are the same on both sites. Adequate amount of movement occurs in all joints. And there are ten fingers in hand and foot. The foot appears bow-shaped and the soles appear flat.Lines are visible in the palms.Lines are present in the anterior two-thirds of the soles and the Babinski reflex is present.
Look for range of motion (ROM) extra fingers (polydactyly) jointing of the toes (syndactyly) and the lines of the soles of the feet and dislocation conditions in the feet.
In case of congenital hip dislocation, flexion of the leg shows that the femur is short and the affected side appears short.
Bake:
Normally the spinal cord is straight, in midline and complete.
Checking for normal curvature of the back and abnormalities such as spina bifida and mongolian sports in the sacral area are common variations.
Reflexes of the Normal Neonate:
1) Rooting Reflex:
Stimulation
Touching or stroking the cheek near the corner of the mouth.
response
The head will turn towards stimulation mainly to find food.
Disappear
3 to 4 months while the baby is awake and 7 to 8 months during sleep.
2) Sucking reflex
Stimulation
Touching the lips to the newborn’s lips by the mother’s nipple or the examiner’s little finger.
response
Shaking moment for food.
Disappear
Does not disappear.
3) Swallowing reflex
Stimulation
Seen only with shaking reflex.
response
Swallowing occurs when food reaches the posterior part of the mouth.
Disappear
It does not disappear.
4)Gagging Reflex:
Stimulation
The baby gags as the posterior fairings are simulated by a food or section tube.
dispon
The child immediately coughs and the food returns.
Disappear
It does not disappear.
5) Sneezing and Coughing Reflex:
Stimulus
Foreign substances enter the upper and lower airways.
response
The upper air passage is cleared by sneezing and the lower air passage by cuffing.
Disappear
Does not disappear.
6) Blinking reflex
Stimulation
Eye exposure to bright light.
response
Closes the eye lead and protects the eye.
Disappear
Does not disappear.
7) Doll’s eye reflex
Stimulation
Gently turn the neonate’s head to the right or left side.
response
Ice moves in the opposite direction.
Disappear
Disappears when the child focuses.
8) Palmer Grasp:
Stimulation
Placing the object in the neonate’s palm.
response
The fingers will close and grasp the object.
Disappear
Disappears in 6 weeks to 3 months.
9)Stepping and Dancing Reflex:
Stimulation
Hold the neonate in a vertical position to rest its fit on a flat and firm surface.
response
Flexion and extension of the legs is done quickly like a step.
Disappear
Disappears in three to four weeks.
10) Tonic Neck Reflex:
Stimulation
Provide the neonate with supine position and turn the head to one side.
response
The arms and legs of the side to which the head is turned straighten and the arms and legs of the opposite direction bend.
Disappear
Disappears in 3 to 4 months.
11) Babinski
Stimulation
Starting from the heel in the outer sole of the foot, stroking upwards, from the lateral aspect to the finger to the ball of the foot.
response
Dorsifection of the thumb and fanning of the other digits.
Disappear
It disappears after a year.
12) Morrow Reflex:
stimulation
Place the neonate on a firm surface on the examination table, make loud noises through the hand or mouth, and hold the neonate in a supine position, supporting the upper back and head with one hand and providing lower back and support with the other hand, then tilt the head suddenly downwards. Leave about an inch.
response
A sudden change in balance causes extension and abduction of the arms and legs and fanning of the fingers with the index finger and thumb forming a “C” shape followed by flexion and adduction of the arms and legs and the infant cries.
Disappear
Disappears in 3 to 4 months and is strong in two months.
Infant Feeding:
During the first six months, the infant’s growth rate is fast. Its weight doubles in 1st 5 to 6 months and triples by the end of one year. So feeding them in adequate amount (both in quality and quantity) improves digestion and absorption.
Breast feeding:
Every baby should be given early and exclusive breast feeding for six months. Exclusive breastfeeding means giving the baby nothing but colostrum and breastmilk. Medicines and vitamins can be given in it.
The 10 steps of BFHI (Baby Friendly Hospital Initiatives) are given by WHO/UNICEF in 1991 to help protect, promote and support breastfeeding.
BFHI: (Baby Friendly Hospital Initiative)
The Baby Friendly Hospital Initiatives is a global program started in 1991 by the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF).
Its main goal is to promote, protect and provide support to breastfeeding and to strengthen maternal practices so that the life of the newborn can start in the best way.
Objectives of BFHI (Baby Friendly Hospital Initiative):
Component of BFHI (Baby Friendly Hospital Initiative):
The Baby Friendly Hospital Initiative has several components to promote, protect and support breastfeeding.
Here are the main 10 components of the Baby Friendly Hospital Initiative:
1) Have a written breastfeeding policy that is regularly communicated to all healthcare personnel.
2) Provide proper training to all healthcare staff in the necessary skills to effectively implement the breastfeeding policy.
3) To provide proper education to all pregnant women about the management of breast feeding and its benefits.
4) To properly help the mother to start breastfeeding the baby within one hour after the birth of the baby.
5) Show the mother how to breastfeed and how to maintain breastfeeding, even if the mother is separated from her child.
6) Do not give the newborn any food or drink other than breast milk unless medically indicated.
7) Practice rooming in- allowing mother and her baby to stay together for 24 hours a day.
8) Anchorage breast feeding on demand – Advising the mother to provide breast feeding whenever the baby shows signs of hunger.
9) Do not give artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10) To promote the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic.
This component forms the core of the BFHI and is designed to create an environment that supports breastfeeding as the best way to nurture the infant, promote mother-infant bonding, and improve health outcomes for both mother and infant. Supports and encourages.
Benefits of (Baby Friendly Hospital Initiative)
Health Benefits:
Best fitting provides many health benefits to both mother (reduced risk of breast and ovarian cancer) and child (reduced risk of infection, reduced risk of allergies and chronic diseases).
Psychological benefit
Breast feeding promotes bonding between mother and infant.
Due to this, there is an emotional attachment between the mother and the infant.
Economic benefit
Breast feeding helps reduce the healthcare costs of health problems related to artificial feeding.
The Baby Friendly Hospital Initiative (BFHI) is a comparative initiative that aims to provide a supportive environment for breastfeeding in health care settings that can lead to improvements in maternal and child health.
Advantages of Breast Feeding:
Benefits of Best Feeding are as follows:
Best feeding is the safest, cheapest and best protective food for infants. Human milk is a preferred food for the infant due to its superior nutritive and protective value and helps in fulfilling the infant’s total nutrient requirement in the first six months. Proper growth and development of the child can take place due to best feeding.
1) Nutritive Value:
Breast milk has the ideal composition and is easily digestible and contains all the essential nutrients that a baby needs.
Which is necessary for 4 to 6 months of growth and development of the child.
It contains high percentage of lactose and galactose which are essential for brain growth.
It facilitates absorption of calcium for body growth. Best feeding provides specific nutrients for preterm babies in preterm delivery.
Best feeding contains amino acids such as cysteine and taurine which are important during the neonatal period.
Breastfeeding contains polyunsaturated fatty acids that are essential for myelination of the nervous system.
Best feeding contains vitamins, minerals, electrolytes and water, which are essential for the maturation of the intestinal tract.
100 ml breast milk contains 66 calories, 1.2 gm protein, 3.8 gm fat, 7 gm lactose, 170 to 160 IU vitamin A, 2 to 6 mg vitamin C, 2.2 IU vitamin D, calcium. 35 mg, and phosphorus is 15 mg.
2) Digestibility :
Breast milk is easily digested due to lactoalbumin and lactoglobulin, its enzyme lipase facilitates digestion of fat and provides free fatty acids.
3) Protective value
IgA, IgM, macrophages, lymphocytes, unsaturated lactoferrin, lysozyme, etc. present in breast milk provide protection to the baby against infection and allergy.
Due to exclusive breast feeding, the chances of developing diseases like malnutrition, hypertension, diabetes mellitus, coronary artery disease in the child are reduced.
4) Psychological benefit
Due to the close physical and emotional bond of the mother with the child due to breast feeding, psychomotor and social development is also improved.
Intelligence and feelings of security increase in the child.
5) Maternal benefits
Breast feeding reduces the chances of post partum haemorrhage in the mother and leads to better uterine involution.
Lactational amenorrhea leads to recovery of iron.
Exclusive breastfeeding in the first 6 months provides protection against pregnancy.
The risk of breast and ovarian cancer in the mother is reduced.
Consuming excess fat makes the body thinner.
Metabolic efficiency increases. And mother can provide fresh, pure, prepared, clear and proper temperature milk to her child.
6) Other Benefits
Breast feeding is properly convenient due to which there is no need for preparation.
Bestfeeding works as a natural contraceptive. So chances of conception during lactation period are less. And best feeding has laxative action.
It reduces the chances of ulcers, gastrointestinal infections, and eczema, and also reduces the incidence of scurvy and rickets.
7) Family and Community Benefit
Breast feeding is the proper food for saving money, time and energy.
Reduced costs of milk, health care and illness for families Breast milk is economically beneficial for families, hospitals, communities and countries.
Different Composition of Breast Milk:
1) Colostrum
The milk secreted from the breast for the first three days after delivery is called colostrum. It is thick, yellow and in small quantity, it contains more antibodies, protein and fat soluble vitamins (A,D,E,K) in sufficient quantity, it is also called the first immunization of the baby as it is protective.
2) Transitional Milk:
In the postnatal period, breast milk for the first three days after colostrum is called transitional milk. It is high in fat and sugar and low in protein and immunological content.
3) Mature Milk:
After 10 to 15 days after delivery, the milk is called mature milk and it contains essential nutrients for optimal growth of the baby.
4) Pretma Milk:
Preterm milk secreted by mothers who deliver preterm contains adequate amounts of protein, sodium, iron, immunoglobulins, and calories for a preterm baby.
5) For milk:
The milk secreted initially in regular breast feeding is called fore milk as it is more watery and satisfies the baby’s thirst and contains more protein, sugar, vitamins and minerals.
6) Hind Milk :
In regular breast feeding, the last secreted milk is called hind milk, it is high in fat and energy, it satisfies the baby’s hunger, so the mother should breastfeed on the other breast only after one breast is completely empty, so the baby gets the necessary fluid and Nutrients can be found in both fore and hind milk.
Preparation for Breastfeeding:
Preparation for breastfeeding starts during the antenatal period. In this, education should be provided to the mother about the benefits of breast feeding and its technique during the antenatal period itself.
Breast examination should be done during the antenatal period and early identification of any breast problem like retracted nipple, cracked nipple, and depressed nipple should be treated properly. And necessary advice and intervention should be provided to the pregnant woman regarding its treatment. Adequate amounts of nutritionally rich food should be consumed for energy and nutrients during the prenatal period.
Provide advice to the mother to maintain adequate micronutrients, rest, regular exercise and maintain proper hygiene during the antenatal period. Counseling should be provided to the mother during the antenatal period for proper breast feeding techniques.
To provide adequate counseling to psychologically prepare the mother for breastfeeding immediately after birth. Advising pregnant women to express colostrum from breast by proper massage during last 4 weeks of pregnancy and maintain cleanliness of breast.
Management of breast feeding
Advising the mother to do breast wash and nipple cleansing at least once daily in modern practice.
Advising the mother that proper hand washing should be done before providing breast feeding, and providing a comfortable position to the baby and giving advice to the mother for frequent feeding i.e. 8 to 12 feeds in 24 hours.
Initiation of breast feeding:
Breast feeding as soon as possible after birth i.e. half to one hour (1/2-1hours/
Should be started within (30-60 minutes) If cesarean delivery is done then breast feeding should be started within the first four hours.
Frequency of Feeding:
Time Schedule:
In the first 24 hours after birth, advise the mother to provide feeding at an interval of two to three hours, then after the end of a week, advise the mother to start a pattern of three to four hours and provide feeding as per the demand of the baby. Giving advice.
Demand Feeding:
There is no restriction in the amount and sequence of feedings in which the baby is breastfed when he is hungry.
Duration of Feed:
Initially feeding should be given on both breasts for five to ten minutes (5-10 minutes). So slowly increasing the time after letdown reflux can help, placing the baby on the other breast only after one breast is completely empty, so the baby can get both fore and hind milk.
Night feeding:
Night feeding is provided to avoid intervals of more than five hours in the initial period so that the baby can get adequate sleep as the breast is completely empty.
Amount:
Average milk requirement: First day- 60 ml/ kg/ 24 hours for 10 days. And providing feeding to the baby on demand.
Technique/Position of Breastfeeding:
The first requirement should be the mother’s desire to provide proper breast feeding to the child which can lead to successful lactation.
Mother should be psychologically prepared to provide feeding to the child.
Mother should drink milk, juice and water in appropriate amount before providing feeding to the child.
Mother should wash her hands properly before providing feeding.
Mother should be physically and emotionally relaxed and comfortable.
Then the mother can sit comfortably with support behind the back. And it is advised to keep the baby in her lap.
If she cannot sit, she can provide feeding by lying on the child’s side with a pillow under the shoulder.
The baby’s head should be supported and raised slightly. Advise the baby to keep his head close to the breast in a semi-sitting position and then support him with one hand.
The baby’s cheek should touch the nipple so that the rooting reflex of the baby can reach the nipple and the let down reflex can be anchored.
If the breast is firm and full, first of all, to prevent the baby’s nose from being pressed, the breast should be pressed with the first finger.
At the time of breast feeding, advise the mother to breast feed alternately and completely on both breasts.
During the first few days, most babies fall asleep after a few shakes. They should be stimulated by gently tickling the back of the ear or the sole of the foot. If possible, one breast should be completely emptied during alternate feeding.
Burping:
Every baby swallows some air during feeding and the child should be held upright and gently patted on the back until the child burps. If excess air is swallowed and not expelled, the baby may experience vomiting, colic. After feeding, diaper should be changed if necessary.
Factors for Successful Lactation:
Positioning, attachment of breast.
Difficulties in Breast Feeding and its Treatment:
Due to Mother:
If the mother does not like to provide breast feeding, listen to the mother calmly and solve the problem by counseling her.
If the infant’s attachment to the breast is poor, teach him the correct best feeding technique.
Avoid prelacteal feed.
To provide reassurance and proper support to the mother in anxiety and stress.
If milk secretion is inadequate, provide proper position and emotional support.
If the mother has breast engorgement, cracked nipple, depressed nipple, mastitis, provide proper treatment.
Due to Infant:
If the baby is of low birth weight, there may be difficulties in breastfeeding due to temporary illness.
Burping properly due to air swallowing.
Surgical correction of congenital malformations (cleft lip, cleft palate).
Complementary Feeding or Weaning:
Breast feeding alone is sufficient for the growth and development of the infant from 4 to 6 months Weaning or complementary feeding is the gradual and progressive transfer of the baby from breast feeding to the family’s normal diet with additions when breast feeding is insufficient for the child. Winning food is provided in
Weaning food is usually provided first as liquid food, followed by semisolid, and then solid food.
in which,
Liquid food involves vegetable soup, tomato pulses and fruit juice.
Among semi-solid foods, potatoes, pulses and root vegetables should be thoroughly cooked and washed before feeding. Bananas can be fed to mesd (choondi). Soft cooked rice and soft cooked fish can be mashed before feeding.
Foods like ragi + jaggery + gram + ghee + sugar can be used to increase the nutritional value. This will supply protein, calories and iron.
And
Solid food ma
Cooked rice, chapati, idli, bread, biscuits, peanuts, roasted gram, banana. Solid food can be started when babies learn to chew properly
The period for winning food is usually from six months to a year.
Artificial feeding:
When the infant is fed with a preparation other than human milk, drugs or vitamins, it is called artificial feeding, when it is given with a bottle, it is called bottle feeding and it can be given without a bottle.
Indication:
When there is a temporary or permanent contraindication to best feeding.
When breastfeeding in inadequate amounts.
When women’s life style changes or socioeconomic conditions change.
Food Used:
There is no perfect formula as a substitute for breast milk but the following foods can be used, such as boiled cow’s milk,
Dry Milk Formula,
cow milk,
Buffalo milk.
Principles of Artificial Feeding:
Deciding on artificial feeding when all efforts to breastfeed the baby have failed or human milk is not available.
Provide a properly comfortable position to the baby while feeding.
The purpose of artificial feeding is similar to that of breast feeding. As it provides Adequate Nutrients, it is sterile and economical and according to the needs of the child.
Artificial feeding should be given from spoon, bowl, cup. It should be given by nasogastric tube in sick and pre-term infants and in hospitalized babies.
Bottle feeding should be avoided and the mother should be explained about the risk of diarrhoea.
Streak cleanliness should be maintained in the preparation and feeding procedure and the milk that has been added should not be reused.
According to the baby’s weight, fluid and calories should be counted and fed in adequate amount.
Correct way of feeding should be maintained and milk should be free.
Time should be kept for 15 to 20 minutes as per total content in which the frequency of feeding should be 6 to 8 times in infant and 3 to 5 times in older baby.
If there is cow milk, provide it by diluting it in cow milk for the first two months and then provide it with undiluted milk, cool wet milk with sugar added.
If dry milk (milk or powder) is to be used, it should be prepared as per the prescription and as per the instructions of the manufacturer.
If the infant has any illness, then during illness the need of calories is more, so feeding should be done frequently and in small quantity. If air is swallowed, burp to prevent vomiting and discomfort.
If the baby is deficient in any vitamins and minerals, supplement it.
After providing feeding to the baby, clean all the utensils properly and sterilize them by boiling.
Successful feeding
The most satisfactory guideline for successful feeding is regular weight gain of the baby after 10 days which should be at the rate of 25-30 g/day for 3 months.
Care of Skin, Ice, Buttocks, Cord of Newborn:
Care of Skin:
Blood, mucus and meconium on the baby’s body should be gently cleaned with a sterile moist swab and should not be given a deep bath until it falls off on its own. As vernix cassia provides protection to the baby’s smooth skin, it should not be rubbed off. The baby’s clothes and equipment should be kept separate so as to prevent cross infection from another infected person.
Baby bath
While giving a baby bath in hospital or home, proper instructions should be followed such as the baby should be bathed slowly and quickly in the left room and dried from head to toe and covered with a warm towel or cloth. Sponge bath should be provided instead of dip bath in winter.
Massaging the baby using olive oil or coconut oil three to four weeks after birth improves circulation and muscle tone. Oil massage should be done before providing bath to the baby. Do not use mustard oil (rainu oil) in massage as it causes skin irritation.
By keeping the baby in sunlight, his body gets warm and vitamin D is available in adequate amount.
While providing bathing, the baby should be observed for behavioral abnormalities, infection, Mongolian sports, milia and toxic erythema.
Clothing of the Baby/ Care of Buttocks:
Baby should wear loose, soft and cotton clothes.
A thick, soft and absorbent cloth of cotton should be used as a napkin. But synthetic clothes should not be used.
Baby’s cloth should be cleaned with a small amount of detergent and allowed to dry properly in sunlight to prevent skin irritation.
Wet napkins should be changed immediately.
Care of Ice:
Clean the ice properly from inner canthus to outer canthus by dipping a sterile cotton swab in normal saline or sterile water.
Clean both ices with separate swabs.
Erythromycin (0.5%) and silver nitrate drops (1%) can also be used.
Ophthalmia neonatrum can be prevented by not applying soot in the eye.
Observing the eye for redness, sticky ice and excessive tearing.
According to cultural practice, human colostrum can be used to prevent sticky ice.
Care of Umbilical Cord:
After delivery, the umbilical cord should be cut 2-3 inches away from the navel.
The cord should be ligated using sterile cotton thread or a plastic cord clamp to maintain aseptic precautions.
Then inspect the ligature for loosening or bleeding.
Usually the cord falls down in 5 to 10 days, if not, observe for infection.
Do not apply dressing on the cord. It should be kept open and dry.
Bonding:
Definition:
Bonding is the emotional connection that develops between a parent/parents and their newborn. It is a crucial aspect of a child’s early development, affecting a child’s emotional, social and psychological well-being.
Bonding is a critical component of early childhood development and involves a dynamic interplay of emotional, physical, and behavioral elements. It lays the foundation for a secure and supportive parent-child relationship, which is essential for a child’s overall well-being and future development.
Importance:
1) Emotional security
Early bonding after a baby’s birth provides the baby with a sense of security and comfort, which is important for the baby’s growth and emotional development.
2) Attachment
Bonding is the foundation for a strong parent-child relationship, and contributes to better social and emotional development for the child.
3) Parental satisfaction
Bonding helps in developing a strong connection, understanding and relationship between both parent and child. And helps in developing parental satisfaction and confidence.
How Bonding Happens:
Skin to Skin Contact:
Holding the child close, often skin-to-skin contact immediately after birth, helps control the baby’s body temperature and heart rate and helps promote bonding.
Breastfeeding:
Best feeding not only provides nutrients but also promotes bonding between mother and child through physical closeness and eye contact.
Gentle touch and voice:
Cuddling, soothing and talking to the baby strengthens the parent-child bonding.
Challenges:
Postpartum Depression:
This condition can affect the bonding process, making it difficult for parents to bond with their child.
Premature birth:
Due to medical interventions and time spent in the neonatal unit, premature babies and their parents may have different bonding experiences.
Rooming-in:
Rooming-in means that after the birth of the newborn, the mother and her child are kept together in the same room instead of keeping them in separate nurseries for care. Due to rooming-in, the body temperature of the newborn is maintained and they can get adequate amount of breast feeding and the bonding relationship between the mother and her child is also improved.
Rooming-in is the concept of keeping the mother and her baby in the same room in the hospital for the care of the baby after the birth or hospitalization of the baby.
Objectives:
1) Promote bonding
Due to the rooming-in concept, a continuous physical connection is maintained between the mother and her child due to which proper bonding can be established between them. And a strong emotional connection can be established.
2) Support Breastfeeding:
Due to the rooming-in concept, the mother can immediately recognize the food cues made by her child, thereby ensuring that the child is properly breastfed.
3) Enhance Parental Involvement:
Rooming-in allows parents to be more involved in their child’s care from the start, thereby promoting a sense of competence and confidence in parenting.
4) Integrated Care:
When a mother and her child are together, health care providers can properly monitor the health of both. and provides facilities for coordinated care.
Implementation:
Hospital Arrangement:
In a rooming-in setup, the baby is placed in the bassinet next to the mother’s bed. Hospitals that implement rooming-in usually have appropriate facilities such as private or semi-private rooms.
Care Procedure:
Health care personnel make daily room visits to assess, provide care, and breast-feeding and newborn care, and to provide support to the mother. This includes assisting with any necessary medical procedures and the well-being of both mother and baby. It involves making sure.
3) Parenting Guidance:
Parents receive guidance on newborn care, safe sleep practices, and breastfeeding techniques. This support helps them manage their baby’s immediate needs.
Benefits:
1) Improve Bonding:
Continuous contact strengthens the emotional bonding between mother and baby. Which is crucial for the emotional development and well-being of the baby.
2) Better Breast Feeding Outcome:
Due to the rooming-in concept, the child can get breast feeding in adequate amount and frequently, which improves the milk supply and supports the nutritional needs of the baby.
3) Reduce Stress:
Keeping the parent and child close can reduce the anxiety and stress of both mother and child. And the mother and her child get a more comfortable and stable environment.
4) Enhancing Monitoring:
If the mother and child are together, the health care provider can properly assess both of them and provide proper health care facilities as per their needs and early identification of any complications.
Challenges:
1) Sleep disturbance:
A mother’s sleep can be interrupted by the baby’s needs, which can be challenging, especially for those recovering from childbirth.
2) Resource Limitation:
Facilities for the concept of rooming-in are not available in all hospitals and health care personnel in adequate amount who can provide care for rooming-in are not available which can also be a challenge.
3) Parental Overwhelm:
New parents can be overwhelmed by constant attendance for their newborn’s care and may occasionally need comfort or extra support.
Minor Disorders of Newborn:
Minor disorders are mostly seen in newborns and can lead to complications if not treated properly. Minor alignment is a physical condition that can cause disturbances in normal function.
Minor disorders like,
1) Stuffy nose,
2) Sticky Ice,
3)Skin Races:
Types:
a) blotchy erythematous,
b) Napkin race (ammonia dermatitis),
c) perianal dermatitis,
d) Intertrigo,
E) Oral thrush.
4) Congenital phimosis,
5) Genital crisis,
6) Birth marks,
7) Physiological Jaundice,
8) Constipation.
1) Stuffy Nose:
If there is a stuffy nose, due to this, the newborn has breathed through the mouth due to which the newborn swallows excessive air and due to this, conditions like abdominal distension and vomiting are seen in the newborn.
Treatment:
Nostril can be cleaned with a clean cotton soaked in normal saline.
2) Sticky Ice:
Sticky ice can be caused by a chemical irritant or bacterial conjunctivitis caused by streptococcus bacteria.
Treatment:
To treat sticky ice, use erythromycin eye ointment every six hours for seven to ten days.
3)Skin Races:
Types:
a) blotchy erythematous,
b) Napkin race (ammonia dermatitis),
c) perianal dermatitis,
d) Intertrigo,
E) Oral thrush,
a) Blotchy erythematous:
Blotchy erythematous is localized on trunk, limbs and face and blotchy erythematous disappears within a day or two.
Treatment:
Blotchy erythematous can be treated by simply applying the powder after bathing the baby.
b) Napkin Race :
Napkin race is more common in artificially fed babies.
It is also called ammonia dermatitis.
Napkin Race a
diarrhea,
Frequent loose stools,
Strong ammoniacal urine,
Due to lack of cleanliness,
A wet nappy due to longer stay,
Due to fungal infection,
By using nylon or water tight plastic napkins.
A napkin race can happen.
Prevention:
Napkin race can be prevented by providing frequent care and attention to the napkin area and properly changing napkins when they become soiled.
This condition can be prevented by changing the wetted napkin immediately and keeping the skin dry.
Wash napkins properly with antiseptic solution.
c) Perianal dermatitis:
Perianal dermatitis is situated around the anal opening.
The skin around the anus is red, indurated, excoriated. It is usually due to the alkalinity of the stool and is more common in artificially fed babies.
Treatment:
It can be prevented by changing weighted napkins promptly and keeping the skin dry.
Wash the napkin properly with an antiseptic solution.
Keep the napkin in air or sunlight and apply coconut oil or anti-fungal cream on the perianal region.
d) Intertrigo:
This is a variant of the napkin race with soreness at the groin area and flexors.
It also occurs where the neck folds.
In its cause, due to the two surfaces of the wet skin coming into contact and the air being cut off in this skin, it gradually gets infected.
Treatment:
Treatment involves exposing the infant’s buttocks to warm air to promote healing.
Advise the mother to avoid plastic pants as they prevent evaporation and increase skin damage from breakdown of urine.
E) Oral thrush:
Oral thrush is an infection of the buccal mucus membrane and tongue caused by Candida albicans.
Treatment:
of oral thrush
Treatment is 1% gentian violet solution or nystatin suspension (100,000 units/ml) applied to each side of the mouth 3-4 times a day with a cotton tipped swab.
4) Congenital Phimosis:
In these newborns prepuce is the pin point due to which the newborn feels discomfort during micturition due to which the baby cries.
Treatment:
Congenital phimosis is treated by dilatation using mosquito forceps.
5) Genital Crisis:
Genital crisis does not require any treatment. Only reasons are provided and the mother is assured and explained that the genital crisis resolves in a short period of time in which,
Mastitis Neonatal,
Hydrosil of Newborn,
Vaginal bleeding during first week.
etc. is involved.
Introduction:
The main cause of birthmarks is unknown but they are less common in Asian people but more common in Spain, Italy and some Arab countries.
They believe that these birth marks are seen due to unsatisfied and unfulfilled desires of the pregnant mother.
Ex: If the antenatal mother has any twenties and her twenties are not fulfilled, birth marks are seen in the skin of her child.
Birth Marks A benign regularity seen on the skin of a newborn at the time of birth or shortly after birth is called birth marks.
Birth marks are divided into two types.
a) Pigmented birth marks:
Pigmented birth marks are caused by excessive skin cells becoming pigmented which include,
mall,
Cafe U Latte Spots,
Mongolian spot.
b) Vascular Birth Marks:
Vascular birthmarks are called red birthmarks which are usually seen due to increased blood vessels.
such as,
Muscular stain
(salmon patches),
hemangiomas,
A pot of wine stain.
There is involvement of etc
Types of Birth Marks:
1) Cafe U Latte Spots:
This is a type of pigmented birthmark. This is one of the most common birth marks that are usually oval in shape and light brown to milky coffee in color.
These birthmarks are present at birth and sometimes present shortly after birth.
These birth marks do not fade with age.
b) Silver Mark:
This is seen as a silver streak on the right or left side, where the forefade and hairline meet. It is hereditary.
C) Port Wine Stain:
It is a vascular birthmark that presents as red and purple marks on the face and can be elsewhere on the body.
A port wine stain is caused by abnormal bleeding from blood vessels in the affected area. It is different in size. It is a few millimeters and it can also become dark if not treated.
d) Salmon patches/stroke beats/telangiectatic nevus:
This is a vascular birthmark that usually presents as patches of slightly reddened skin on the face.
It is also found in nape of neck, upper eyelid, forehead, and nose. It gets relieved on its own within a few months.
e) Hemangiomas:
This is a vascular birthmark and Strawberrymax. This is a red and raised mark.
Initially it is small and flat but it grows rapidly during four to five months of life and then fades.
f) Mongolian Spot:
This is a pigmented birthmark.
These Mongolian spots are harmless marks. Its color is bluish gray.
Mongolian spot A Down syndrome, irregular blue patches of skin pigmentation seen on the sacral area of a newborn baby, and sometimes on the back and extremities, resolves on its own between the ages of six months to one year.
G) Congenital melanocyte nevus:
It is a pigmented birthmark that can be found anywhere on the body but usually more on the head and neck parts. It is light brown to black in color, irregular in shape, flat raised and lumpy.
It is often dark and hairy during puberty.
Treatment:
Most birthmarks are harmless and do not require treatment.
Pigmented marks tend to resolve on their own while vascular birthmarks have to be removed for cosmetic reasons.
H) Milia:
Many fine raised white or yellowish white sports called milia due to the retention of sebum on the nose, nasolabial folds, cheeks and fore head of the neonate.
Initially, it resolves on its own within a few weeks.
I) Epstein Pearl:
Epithelial cysts found in the lateral to midline of the hard plate called Epstein’s pearls require no treatment.
7) Physiological Jaundice:
Physiological jaundice is commonly seen in newborns also called neonatal jaundice.
In this condition, the skin of the new bone and its sclera turn yellow due to the increase in the amount of bilirubin in the body.
This jaundice appears during two to three days after birth and its peak level is seen at six to seven days.
Treatment:
Physiological jaundice is relieved within a week.
Provide adequate extra fluid to the child.
Provide proper phototherapy to reduce the child’s bilirubin.
8) Constipation:
Constipation is more common in artificially fed babies.
Treatment:
Properly correcting dietary errors.
Provide some fluid to the neonate.
Do not provide laxatives to neonates.
If the above measures fail, provide milk of magnesia in small quantities.
Avoid insertion of suppositories and catheters in neonates.
Caput Sucadenium:
Accumulation of serosangenous fluid in the layers of the scalp causing edematous swelling is called caput sukkadenium. It is caused by the pressure of girdle of contact. It is either a bony pelvis, a dilating cervix or a vulval ring. Swelling and lymphatic drainage are seen due to low venous return.
Caput sucadenium is also seen at birth. And by pressing it, a hole falls in it. Swelling is a bogie. And it crosses the suture line which disappears in 24-36 hours, mostly after membrane rupture.
Cephalohematoma:
A cephalohematoma is a condition in which a collection of blood occurs beneath the pericranium and flat bones of the head that cover the skull bones, usually unilaterally and above the parietal bones.
It is caused by rupture of a small emissary vein from the skull and may be associated with a fracture of the skull bone. This can occur due to forceps delivery but can also be seen after normal labor. Ventous application does not increase the incidence of cephalohematoma. It is never present at birth but develops slowly after 12-24 hours.
This swelling is limited by lines of sutures in the pericranium of the skull which are fixed to the margin of the bone, soft, fluctuant and incompressible.
It grows and disappears on its own after a few weeks i.e. approximately 6 weeks.
Differentiate between caput sucadenium and cephalohematoma
Cephalohematoma:
It develops within a few hours after birth.
It increases in size for 2-3 days.
In this the swelling is limited to the bone i.e. does not cross the suture line.
It is confined.
Pressing it does not make a dent.
Double cephalohematoma usually appears bilaterally.
The border of the cephalohematoma may be marked and well defined.
The cause of cephalohematoma is subperiosteal hemorrhage.
It disappears about 6 weeks after birth.
Its complications may include jaundice, skull fracture, intracranial bleeding and shock.
Caput Sucadenium:
A caput sukkadenium is present at birth.
There is no increase in its size.
Swelling in it is unlimited and can cross suture lines.
It spreads.
Pressing it makes a hole in it.
A double cap is always unilateral.
In Caput seucadenium the border is indistinct and poorly defined.
Caput is caused by diffuse edematous swelling and soft tissue involvement.
Disappeared a few days after birth.
Complications are rare. And if present, anemia may occur.
Birth asphyxia or asphyxia neonatorum:
Definition:
Asphyxia neonatorum is failure to establish satisfactory pulmonary respiration at birth, meaning absence of pulse. Clinically
Also defined as failure to initiate and maintain spontaneous respiration within one minute of birth, leading to varying degrees of hypoxic and ischemic injury to body tissues and organs. It is accompanied by hypo ventilation, anaerobic glycolysis and lactic acidosis.
It is characterized by progressive hypoxia, hypercapnia, hypoperfusion and metabolic acidosis. It results in hypoxic ischemic encephalopathy with multi-organ dysfunction and neuromotor sequelae (neuromotor sequelae are long-term neurological and motor impairments due to brain injury or dysfunction).
Etiology:
Due to airway obstruction due to inhaled mucus or amniotic fluid.
Low alveolar surfactant causes lung expansion failure.
Administering morphine, pethidine and anesthetic agents to the mother in the prenatal and intra-natal period can cause asphyxia due to depression of the respiratory center of the baby.
Disturbance in the placental circulation leading to intrauterine hypoxia is the main cause of neonatal hypoxia. Like anatomical changes in the placenta, placenta prematurity
Separation, post dated pregnancy, retro placental haemorrhage, pregnancy induced hypertension, and cord compression etc.
Due to birth trauma. Difficult forceps delivery, prolonged labour, contracted pelvis, breech delivery, oblique lie, occipito posterior position etc.
Due to weak respiratory muscles, immature respiratory center, and poor lung expansion in premature babies.
Congenital heart disease, blood loss, and circulatory collapse in shock.
Classification:
It is divided into two parts according to the intensity of clinical features viz:
1) Asphyxia Livida / Stage of Cyanosis/Blue Asphyxia
This is the primary condition of respiratory failure in which APGAR SCORE may be 4-6.
2) Asphyxia pallida/stage of shock/white asphyxia
This is a condition of respiratory and vasomotor failure with an APGAR SCORE of 0-3.
Clinical Features:
Clinical features of neonatal asphyxia vary according to degree of depression, duration of hypoxemia, plasma CO2 level and cause.
Muscle tone decreases in it.
Respiratory distress is observed.
Breathing difficulties are seen.
Irregular breathing is seen.
Cyanosis (Bluish discoloration of skin is seen especially around the lips and face.)
Abnormal heart rate (eg, bradycardia and tachycardia).
Reduced alertness and responsiveness.
Seizures.
Feeding difficulties.
Management:
The management of asphyxia neonatorum is divided into two parts viz.
1) Prophylactic management,
2) Definitive Management
1) Prophylactic Management:
To identify high risk during antenatal period itself.
Early fetal detection in high risk pregnancies. Because of this, if there is a condition of fetal distress, early identification can be done.
Use of electronic fetal monitoring during intrapartum period and scalp blood PH assessment as needed.
Proper use of anesthetic agents and anti-depressant medication during labour.
Definitive Nursing Management
It involves assessing the baby’s APGAR score and providing proper treatment accordingly.
If APGAR score is between 7 – 10 then it is called normal.
If there is mucus in the baby’s oropharynges and laryngopharynges, clean them properly by suctioning.
Provide supplemental oxygen if needed.
Then reassess the condition of the neonate after five minutes, if normal, send the infant to the nursery.
If the baby’s APGAR score is between 4-6
Suction the baby’s mucus immediately from the oropharynx and nasopharynx by mucus suckers or suction operators.
After that, by providing the baby on a flat surface and head down position and turning his face to one side, due to which his mucus can be drained by gravitational force.
Simultaneously administer oxygen to the baby at a pressure range of 25-30 cm H2O through bag and mask.
Provide intermittent positive pressure ventilation to the infant if required.
Provide stimulus to infant on back and sole.
In majority of the cases, the baby can take independent respiration by using these simple measures.
After that, assess the APGAR score of the baby at five minutes, if it is satisfactory, then the infant should be given to the mother.
If the above measures fail,
Perform oral suction and start endotracheal intubation.
Connect an endotracheal tube to a resuscitation bag, through which O2 can be administered at a rate of 6-8 L/min.
Maintain Intermittent Positive Pressure Airway (IPPV) ventilation for 30 – 40/min.
Perform central external cardiac massage if heart rate is less than 60/min.
If the mother has a history of using a central depressant drug such as pethidine or morphine within 3 hours of delivery. A suitable antidote, e.g. Naloxone hydrochloride 60 mg/kg IM (single dose) or 10 µg/kg IV is given and may have to be repeated.
To combat acidosis, 8.4% NaHCO3 (sodium bicarbonate) 1 mEq/kg in 5% dextrose (diluted 1:1) is given very slowly (at a rate of 1 ml/min) in minimal doses through the umbilical or peripheral vein.
If the baby’s APGAR score is below 4,
Immediately perform tracheal intubation and start intermittent positive pressure ventilation.
If the mother has a history of using a central depressant drug such as pethidine or morphine within 3 hours of delivery. A suitable antidote, e.g. Naloxone hydrochloride 10 µg/kg IV is given to the neonate.
It is repeated every 2 – 3 minutes.
Complications:
respiratory distress syndrome,
cardiac failure,
respiratory infection,
septicemia,
Disseminated Intravascular Coagulation (DIC),
hyperbilirubinemia,
cerebral depression,
Failure to Thrive,
mental retardation,
cerebral palsy,
Convulsive disorder.
Introduction:
To prevent asphyxia by detecting risk factors and providing intensive intrauterine care.
Management of risk factors through necessary facilities or referrals.
Intranatal of fetal condition to detect fetal hypoxia
Assessment and management of fetal distress.
Preventing birth injuries through efficient management of malpresentation, contracted pelvis, instrumental delivery.
Careful use of anesthetic and depressant agents during the labor period.
Prognosis:
The prognosis of neonatal hypoxia depends on the maturity of the baby, duration and intensity of hypoxia, acidosis, and competent management.
Respiratory distress syndrome (RDS)
Definition:
Respiratory distress syndrome is a lung disease seen in newborns/neonates. It is mainly seen in premature babies, in neonates whose mothers are diabetic, in babies born by caesarean section or in breech deliveries.
Respiratory Distress Syndrome (RDS) is usually seen in the neonate’s body due to the deficiency of SURFACTANT (an enzyme that works to reduce the surface tension of the alveoli).
The main reason is that when the body of a newborn child cannot produce adequate amount of surfactant and due to lack of adequate amount of surfactant, the lungs of the child cannot function properly due to which gaseous exchange also does not take place properly. The amount of oxygen in the child’s body is reduced due to which conditions of hypoxia and acidosis arise.
Surfactant:
Introduction
Surfactant is a type of lipoprotein substance that is produced by combining phospholipids, mainly lecithin and sphingomyelin. And its ratio is usually (lecithin(L)):sphygomyelin(S)) of 2:1. Thus phospholipids called lecithin and sphingomyelin meet and produce surfactant.
function
Surfactant works to reduce the surface tension inside the alveoli, its functional unit inside the lungs in the body, due to which the lungs and alveoli do not collapse and gaseous exchange takes place within them properly.
production
Surfactant starts production at 20 weeks gestation period and its maximum production takes place during 37 weeks gestation period. A hormone called cortisol helps in the production of surfactant.
Surfactant is produced by alveolar type 2 epithelial cells of the lungs in the newborn. And its storage takes place in the laminar bodies (LBS) of the alveolar cells. Maximum activity of surfactant to mature lungs occurs at 34 weeks’ gestation.
A child born before 37 weeks of gestation is called a preterm baby and is more likely to develop the condition of Respiratory Distress Syndrome (RDS) due to insufficient production of surfactant. Therefore, the condition of respiratory distress syndrome is seen in 50-80% of premature children.
Etiology:
pre maturity,
low birth weight baby,
asphyxia,
Maternal diabetes.
Symptoms and signs:
Rapid and slow breathing,
Respiratory rate to be 60/min,
Expiratory audible grating sound,
rib retraction,
Inter costal or sub costal retraction,
cyanosis,
in AD,
respiratory acidosis,
Electrolyte disturbance,
Dyspnoea.
Diagnostic Evaluation:
History Collection,
Physical Examination,
Chest X ray.
Management:
Aim of Treatment:
Provide surfactant replacement therapy.
Provide breathing support through a nasal continuous positive airway pressure (NCPAP) machine or a ventilator so that the infant can breathe properly.
Provide oxygen therapy.
Nursing Management:
If infants and neonates are suffering from Respiratory Distress Syndrome (RDS), provide them with artificial surfactant by inserting an artificial airway or breathing tube into the trachea/wind pipe so that the surfactant can enter the lungs directly.
Generally, the surfactant in the lungs of Fitus starts to form from 24 weeks of gestation and is completely formed at 37 weeks of gestation. If adequate amount is not formed, there is a need to provide artificial surfactant.
Provide proper ventilatory support to the infant.
Infants with respiratory distress syndrome require the provision of ventilatory support through a mechanical ventilator connected to a breathing tube that passes through the infant’s mouth or nose into the wind pipe. to provide
Provide breathing support to the neonate by nasal continuous positive airway pressure (NCPAP).
To condition and treat hypoxia and acidosis in the neonate, warmed and humidified oxygen therapy is provided through positive pressure at 35% to 40% of endotracheal intubation.
Provide continuous positive airway pressure (CPAP) to the neonate if the arterial oxygen tension PO2 is not greater than 50 mm of Hg.
PO2, PCO2, and PH levels should be checked for early identification of any metabolic and respiratory acidosis conditions.
If condition of acidosis then administer sodium bicarbonate 4.2% (0.5 meq/ml Ex : 0.5 meq/ml amount to 1 meq/kg weight 1:1 with 5% glucose to provide minimum dose.)
Excessive use of alkaline can cause intra ventricular hemorrhage or even death in preterm babies.
Infants suffering from Respiratory Distress Syndrome (RDS) are treated with N. I. C. U. (NICU) and kept in a radiant warmer or incubator to keep them warm and reduce the risk of infection.
In this, the air passage of the infant is periodically cleaned by endotracheal suctioning.
Continuous monitoring of heart rate, breathing and temperature through sensors taped on the infant’s body, apart from this, using sensors on fingers or toes to check the amount of oxygen in the infant’s blood.
Administer albumin or colloid solutions to treat hypovolemic conditions as prescribed by pediatrician.
Treat anemia or electrolyte imbalance conditions properly.
Properly maintaining the nutritional level of the child including intragastric feeding or intravenous administration of 10% glucose i.e. 70ml/kg body weight daily followed by breast milk and infant formula through feeding tube to prevent malnutrition.
Regularly monitor fluid intake to ensure fluid does not build up in the child’s lungs.
Complications:
Intra ventricular hemorrhage,
pulmonary hemorrhage,
Retrolental fibroplasia,
Neurological Abnormalities.
Prevention:
Administration of betamethasone to patients who are likely to deliver before 34 weeks.
Assessment of lung maturity before induction of pre-mature labor and delaying induction to minimize the risk to the fetus as much as possible.
If there is a diabetic mother, then to prevent the condition of hypoxia of the fetus.
Neonatal Jaundice:
Definition:
When yellow discoloration of skin, sclera, and mucus membranes and body secretions due to accumulation of excessive bilirubin in body tissues is called “neonatal jaundice”.
Normal bilirubin is 0.1 to 0.8 mg/dl in blood. Now, when the level of bilirubin is more than 5 mg/dl in the body, it is called neonatal jaundice, it is also called icterus neonatrum or neonatal hyperbilirubinemia.
Incidence:
About 60% of full term babies and 80% of preterm babies are seen in the first week of life.
Approximately 6% of term babies develop severe jaundice with bilirubin levels of 15 mg/dl or greater.
Type of Jaundice:
There are generally two types of jaundice namely,
1) Physiological Jaundice,
2) Pathological jaundice.
1) Physiological Jaundice:
Physiological jaundice is non hemolytic jaundice caused by immaturity.
In which the life span of neonatal RBC (red blood cells) is short and the conversion of urobilinogen is reduced. Defective uptake in liver cells from plasma, poor conjugation of bilirubin, increase in enterohepatic circulation increases load in liver and causes defects.
Characteristic:
Jaundice usually appears 24-72 hours after birth.
Maximum yellow discoloration is observed on 4th – 5th day in full term baby and 6th – 7th day in preterm baby.
It usually disappears by 7 days in full term babies and by 14 days in preterm babies.
Bilirubin level does not exceed 12 – 15 mg/dl.
It mostly does not require treatment and gets relieved on its own.
Cozies:
It is mostly seen due to excessive breakdown of RBC (red blood cells) due to short life span of red blood cells.
Inadequate enzymatic action of liver to convert bilirubin to soluble bilirubin due to hepatic immaturity.
Decreased conversion of bilirubin by the intestinal flora increases the amount of bilirubin in the circulation.
Treatment and Nursingcare:
There is no need to provide any specific treatment.
Provide adequate amount of fluid to the baby.
Careful observation of premature babies.
Advising the mother to provide adequate amount of breast feeding to her child.
If there is evidence of increased bilirubin levels to excessive amounts, treat by exchange transfusion.
Use phenobarbitone and phototherapy to treat this jaundice.
Providing proper daily routine or care to the child.
Careful observation of the child if there is any sign of complications.
Pathological Jaundice:
Definition:
Pathological jaundice occurs within 24 hours of birth. And if it is a mature baby it is usually seen for more than 1 week when
A pre-mature baby has mainly pathological jaundice for 2 weeks. Up to 5% of pathological jaundice occurs in the first 24 hours due to hemolytic disease and intrauterine infection.
Bilirubin in it increases at the rate of 5mg/100 ml in 24 hours.
Absolute bilirubin is greater than 15 mg/100 ml (250 μmol/L).
Reason:
Due to excessive hemolysis of red cells.
Due to defective conjugation of bilirubin.
Due to failure of excretion of conjugated bilirubin.
Due to Rh incompatibility.
Due to cephalohematoma.
ABO incompatibility.
Vitamin k therapy.
Congenital spherocytosis.
Due to glucose 6 phosphate dehydrogenase deficiency.
Prematurity is due to reduced production of enzymes such as glucuronyl transferase by immature liver cells.
Types:
Prolong unconjugated hyperbilirubinemia
Jaundice is mainly caused by hemolytic diseases of the breast mill.
Prolonged conjugated hyperbilirubinemia: It is mainly due to infection.
Clinical Features:
Yellow staining is seen on the face, trunk, palms and soles.
Urine staining is seen on the cloth.
The color of stool is clay, white or dark.
Bilirubin levels rise by 5 mg/dl/day.
Then Bija features symptoms like lethargy, drowsiness, poor sucking reflex, fever, infection etc.
Kernicterus (a pathological condition of the brain due to unconjugated bilirubin) develops when bilirubin develops above 15 mg/dl.
Its features include vomiting, high pitch cry, convulsions, opisthotonous position, nystagmus, hyperpyrexia, and spasticity.
Treatment:
The following methods are used to treat jaundice such as:
1) Phototherapy
2) Pharmacologic therapy
3) Exchange transfusion
Phototherapy:
Phototherapy is best when used in moderate cases where bilirubin levels rise above (12 mg%).
Phototherapy is stopped when the serum bilirubin level is about 10 mg%. A rebound increase in serum bilirubin may occur once phototherapy is stopped. It is important to maintain adequate hydration of the newborn. Spacial blue lamps with an output of 420 to 470 mm wavelength are most effective in treatment.
Phototherapy should be started as early as possible when maximum surface area can be exposed and ice shielding can be performed.
Phototherapy causes insensible fluid loss in newborns. Hydration is promoted by breastfeeding. Administering intravenous fluid therapy during phototherapy.
A phototherapy blanket protects the infant.
Phenobarbital therapy:
Phenobarbital therapy induces hepatic microsomal enzymes and increases bilirubin conjugation and excretion. A dose of 5.8 mg/kg every 24 hours. is used. It takes 3-7 days to become effective. However, as a prophylaxis, it can be used in In which the mother is provided at a rate of 90 mg/dl two weeks before delivery.
Exchange transfusion:
Exchange transfusion is commonly used to prevent kernicterus.
In which double volume exchange replaces up to 80% of red blood cells and helps reduce bilirubin levels by up to 50%.
Indication of exchange transfusion
The level of bilirubin in the body increases progressively (more than 1mg/dl/hour) despite taking phototherapy.
If the neonate has anemia and in cases of congestive cardiac failure.
If the newborn’s serum bilirubin level is greater than 20 mg/dl.
If cord blood hemoglobin is less than 12 g/dl and bilirubin level is more than 5 mg/dl.
Phototherapy:
Phototherapy is a non-invasive, effective and simple and less expensive method to lower unconjugated bilirubin. Its light waves convert unconjugated bilirubin to a water-soluble non-toxic form by photooxidation that is readily excreted from the blood.
Start phototherapy when bilirubin level reaches 15 mg/dl and 5mg/dl or higher in preterm babies.
Blue wave length is 450-460 nm. The tubelight and plexiglass are covered with a shield. A photo therapy unit is fixed above the crib or incubator. Fluorosonic or halogen lights can also be used.
Nursing Responsibilities in Phototherapy:
The baby should be completely exposed to the light source.
And the light should be kept at a distance of 45 cm.
Child’s head and genital area should be properly covered.
Advise the mother to provide frequent breast feeding to the child during photo therapy.
Provide feeding by intravenous infusion or nasogastric tube if extra fluid is required.
The position of the child should be changed every two hours and the position should be changed in such a way that it can get maximum light.
Keep checking the child’s temperature, pulse, and respiration (TPR) every two hours.
Continuously monitor the child for any side effects of phototherapy and have the serum bilirubin level tested every 12 hours.
Discontinue phototherapy when serum bilirubin level reaches 10 mg/dl.
Often phototherapy should be continued for 2-3 days. Or
6 hourly/day and,
Giving 2 hourly 3 times / day.
Involve the mother in the care of the baby.
It is important to give proper explanation, instruction and emotional support to the parents.
Complications and Side Effects of Phototherapy:
Immediate Problems:
Dehydration, hypothermia, hyperthermia,
loose stool/green stool,
Bronze baby syndrome (Bronze baby syndrome is a condition in which dark green-brown pigmentation of the child’s skin, mucus membranes and urine is observed after phototherapy is provided.)
skin lesions,
Hypocalcemia etc. are seen.
Long Term Problem:
Disturbance occurs in endocrine and sexual maturation.
Ratai damage.
Skin cancer (rare condition).
Exchange Blood Transfusion (EBT):
This is an effective method to remove circulating bilirubin and antibodies in patients with Rh incompatibility. Direct comb test is positive in Rh+ Ve baby with rapidly developing jaundice and anemia due to low Hb%, exchange blood transfusion is indicated.
Nature and Amount of Blood for Exchange Blood Transfusion:
Rh isoimmunization – using Rh negative, ABO compatible blood.
ABO incompatibility: Use “o” group Rh compatible blood.
Prefer fresh blood of less than 72 hours. And its content is 160-180ml/kg for an exchange transfusion. It replaces 80-90% of fetal blood.
Procedure:
Exchange Blood Transfusion (EBT) is performed by an expert team maintaining aseptic technique in a well-equipped setup.
This process is slow and continuous for one hour.
Keep the baby upright and well restrained. Stomach contents should be aspirated. Vital signs should be properly monitored.
10 ml of blood should be withdrawn and 10 ml of blood should be transfused at the same time.
Precautions should be taken to prevent toxic effects, shock, embolism, thrombosis, acidosis and cardiac failure.
The recording of the procedure includes the time of initiation, how much blood was withdrawn in each cycle and in what amount, how much was given in the cycle and the total exchange amount in blood.
Blood bilirubin level and Hb% done after the procedure. Administration of post-transfusion antibiotics and observation for signs of complications are important.
Complications after exchange blood transfusion:
Immediate Complications:
cardiac failure,
air embolism,
acidosis,
tetanus,
sepsis,
hyperkalemia,
Umbilical or portal vein perforation,
hypoglycemia,
Thrombocytopenia.
Delayed complications:
Extrahepatic portal hypertension,
Portal vein thrombosis,
HIV,
Hepatitis B & C infection,
Unserative colitis etc.
Hemorrhagic Diseases of the Newborn
Definition
Hemorrhagic disease is a syndrome characterized by spontaneous internal and external bleeding usually due to hypothrombinemia and low levels of vitamin K-dependent coagulation factors (5, 7, 9, 10) called hemorrhagic disease of the newborn.
It usually occurs between the 2nd and 5th day but if treated early, blood values can return within a week.
Prevalence:
It is most commonly found in preterm babies and higher in breastfed babies (breast milk contains very little vitamin K).
Symptoms and signs:
Haematemesis and Melina conditions may occur due to hemorrhage in the alimentary tract.
Bleeding may occur from the umbilical cord stump.
A condition of haematuria can occur due to urinary tract haemorrhage.
Sometimes cutaneous ecchymosis is also seen.
It may also increase the risk of bleeding after any operative procedure or from the injured site.
In it, the baby becomes anemic and sometimes the condition of shock can also occur.
In some cases, bleeding can also occur from the nose and genitals.
Investigation:
Prolonged prothrombin time and partial thromboplastin time are seen in it.
Low platelet count is seen.
Introduction:
Vitamin K 1 mg to the baby immediately after birth
Intramuscular administration of I/M or 2:5-5 mg administration to mother at least 2 hours before delivery.
Treatment and Nursingcare:
Vitamin K: Intramuscular administration of 1-2 Mg and repeat after 24 hours if necessary.
If the condition of shock has arisen due to blood loss, compatible wall blood transfusion at 15-20 ml/kg/body weight should be administered over 4-6 hours.
Fresh frozen plasma can also be used in alternative treatments.
In chronic anaemia, a suitable liquid iron preparation may be prescribed along with medication containing 20-30 mg of elemental iron content.
Local application of pressure dressings with coagulants such as thrombin and fibrin is valuable to accessible sites.
It is given in 2 divided doses daily.
Avoiding unnecessary handling of fits.
If there is a condition of hematemesis, the child is placed in a side-turned and head-down position.