1. Dr. Sudhira Kumar Parida.

2.  Introduction
 Care at birth
 When a newborn baby should be examined ?
 Danger signs
 Examining the newborn at birth
 High risk neonates
 Prevention of hypothermia
 Prevention of infection
 Immunisation
 Normal phenomena after birth
 Resuscitation of newborn not breathing soon after birth
 Care of LBW babies
 Care of sick newborn babies
 Special situation
 Training
 Health Programmes
 Key messages
 References.

3. INTRODUCTION
WORLD:
 NMR: 4 millions/yr
 50% in 1st 24 hrs
 2/3rd in South-East Asia , Africa
INDIA:
 61.3% of infant deaths -in neonatal period.
 50% of these deaths-in 1st wk of life.
 NFHS-3(05-06): 2/3rd of IMR & ½ of U5MR
 Major causes:
birth asphyxia
hypothermia
infections
 Essential Newborn Care(ENC).

4. CARE AT BIRTH
 Delivery room-
 5 Cleans
 PROVISION OF WARMTH:
*dry, pre-warmed & clean cloth
*200W bulb
*dry immediately
*do not remove vernix
*close contact with mother

5.  CORD CARE:
*4 ‘C’s
*left dry
*no antiseptics/dressings
 EYE CARE:
*clean cotton swabs
*medial to lateral side
*no prophylactic eye applications
 RECORDING BIRTH WEIGHT:
*N: 2.5-3 kg

6.  INITIATING BREASTFEEDING:
*within 1 hr of birth(within 4hr-C.S.)
*advantage for mother
baby
*no pre-lacteal feeds.

7. WHEN A NEWBORN BABY SHOULD
BE EXAMINED ?
 AFTER BIRTH:
+ at around 1 hr
+before discharge from hospital
+if there is a maternal concern about the
baby’s condition
+if a danger sign is observed during
monitoring
 AFTER LEAVING THE HOSPITAL:
+during the 1st wk of life at a routine visit
+ follow-up
+ sick newborn visit

8. DANGER SIGNS
 Not suckling (after 6 hours of age)
 Fast breathing (> 60 breaths/min)
 Grunting
 Eyes swollen and draining pus
 Yellow skin on face and < 24 hours old
 > 10 skin pustules

9. EXAMINING THE NEWBORN AT
BIRTH
 IDENTIFICATION OF MALFORMATIONS:
hydrocephalus
meningomyelocele
large omphalocele
absent anal openings
 BREATHING PATTERN:
N: 30-40/min
irregular
periodic
at least 1 min
quiet,not feeding

10. Respiration is not normal if-
RR >60/min
intercostal/subcostal retractions
assoociated apnoea(+ cyanosis/HR <100 bpm)
 HR:
N: 100-160 bpm
 ASSESSING PERFUSION:
capillary refill time: N- 3s
 COLOUR:
N: pink
pale
yellow
blue

11. APGAR SCORING

12. TEST 0 Points 1 Points 2 Points
Appearance(skin Blue-grey,pale all Pink body & blue Normal over entire
color) over extremities body,completely
pink
Pulse(HR) Absent <100 bpm >100 bpm
Grimace(Reflex No response Facial grimace Sneeze,cough,pull
irritability) s away
Activity(m.tone) Absent Arms & legs Active movement
extended with flexed arms &
legs
Respiration(Breathi Absent Slow,irregular Good,crying
ng)
N: 7-10, 4-6: mod. Depressed, 0-3: severely depressed.
‘ONLY INDICATES IMMEDIATE HEALTH CONDITION OF BABY’

13.  Posture
1.Term newborn baby:
loosely clenched fists
flexed arms, hips, and knees
2.Small babies ( 2.5 kg at birth or born before 37 weeks
gestation)
limbs may be extended
3.Babies born in the breech position may have fully
flexed hips and knees, feet and mouth, and legs may
even reach near the mouth.

14. HIGH RISK NEONATES
 birth wt. < 1800 g and/or <35 wk GA
 SFD(<3rd centile) & LFD(>97th centile)
 Peri-natal asphyxia-APGAR score 3 at 5 min and/ or HIE
 Mechanical ventilation for >24 hrs
 Metabolic problems-symptomatic hypoglycemia & hypo-
calcemia
 Seizures
 Infections- meningitis and/or culture + sepsis
 Shock requiring inotropic / vasopressor agents
 Infants born to HIV + mothers
 Sr. B >20 mg% or requirement of exchange transfusion
 Major malformations

15. PREVENTION OF HYPOTHERMIA
< 36 C
1st signs: less active, doesnot BF well, has a weak cry, has
resp. distress
 STEPS OF WARM CHAIN:
1. Warm delivery room
2. Warm resuscitation
3. Immediate drying
4. Skin to skin contact
5. BF
6. Bathing postponed
7. Appropriate clothing
8. Mother & baby together
9. Professional alertness
10. Warm transportation

16.  TEMPERATURE RECORDING:
axilla/ per rectally
at least 3 min
N: 36.5- 37.5 C
 MANAGING HYPOTHERMIA:
immediate Tt
200W bulb/45cm or KMC or radiant warmer
refer if:

17. PREVENTION OF INFECTION
 Minimize Neonatal tetanus
 5 ‘C’s
 Cord: dry , clean
 Exclusive BF
 Persons with infective disease must not handle
the baby till infection is under control.

18. IMMUNISATION
 OPV-O
 BCG
 Hepatitis B(birth dose)

19. NORMAL PHENOMENA AFTER BIRTH
 MECONIUM PASSAGE:
dark, greenish-black, sticky
N: within 24 hrs
 URINE PASSAGE:
N: soon after birth/ by next 24 – 48 hrs
after 2nd day, 6 – 7 times/day
 TRANSITIONAL STOOLS:
greenish yellow
ed frequency
loose (& sometimes watery)
N: highly variable; after first 2wk,upto 15-20 times/day or
once in 5-6days

20.  VOMITTING:
mucous gastritis
swallow air during feeding
pathological if:
 MONGOLIAN SPOT:
bluish-black patches of pigmentation
sacral & buttock; also trunk & extremities
disappear by 6 months of age
 ERYTHEMA TOXICUM:
an erythematous rash
on 2nd/3rd day
begins from face & spreads to trunk &extremities
over next 24 hrs
disappears spontaneously in 2-3 days

21.  VAGINAL DISCHARGE/BLEEDING:
thin white mucoid secretions
Tt: clean it with clean water &
keep the place dry
upto 25%: menstrual like withdrawl bleeding
after 3-5 days of life &for 2-4 days
 MASTITIS:
breast engorgement on 3rd /4th day
may last for 2-4 days
avoid local massage, fomentation or manual
expression of discharging milk

22.  PHYSIOLOGICAL JAUNDICE:
clinical jaundice after 24 hrs of birth
> 15 mg%
ng by 7-10 days of life
If not, Pathological:
immediate referral & Tt
>20 mg% - risk of brain damage

23.  CAPUT SUCCAEDANEUM:
a boggy s/c swelling over scalp
soon after birth
benign
CEPHALHEMATOMA:
sub-periosteal hemorrhage
does not cross sutural lines
can be asso. With anaemia/jaundice

24. RESUSCITATION OF NEWBORN NOT
BREATHING SOON AFTER BIRTH
 Equipment needed:
self-inflating bag & mask
02
mucus sucker
syringe/needle(no.24)
adrenaline(1:1,000)
 SUCTION:
most cry soon after birth
but if not started to breathe by the time it is
dried start IMMEDIATE RESUSCITATION:

25. 200W bulb/radint warmer
extend the neck
mucus sucker- 1st mouth , then nose
do not use gauge/cloth
If still does not cry:
flick the soles with fingers 2 or 3 times
do not slap the baby/hang upside down
If does not start breathing or is gasping:
start ASSISTED VENTILATION with a bag &
mask

30.  USE OF DRUGS:
Adrenaline-
when HR <60/min in spite of CC &
assisted ventilation
0.1 mg/kg (1:10,000)
intracardiac /IV
HOW LONG SHOULD RESUSCITATIVE EFFORTS BE
CONTINUED ?
 discontinued if a baby did not establish
spontaneous breathing efforts after 30 min after
birth
 In fresh still born babies(1 min APGAR-O) IF NO
SIGNS OF LIFE at 10 min

31. CARE OF LBW BABIES
 India (2000-07): 28%
 Preterm
 SFD
 PREVENTION OF HYPOTHERMIA:
rooming-in
KMC
adequate cloth & dry
room free from cold air
100-200W bulb/18 inch from baby
temp. recorded at least 3-4 hrly

32.  EXCLUSIVE BF:
no pre-lacteal feeds
early BF
2hrly/more frequently
if suck poorly-manual expression/spoon
after 7 days of life, gain in BW:15-20 gms/day
 PREVENTION OF INFECTION:
ed risk
people with diarrhoea , skin infections &
skin infections must stay away
if the mother has diarrhoea/respiratory inf.-
only breast milk
must be wrapped in clean , dry linen & clothing
& not placed on dusty/dirty surfaces
immunisation-same schedule

33.  DISCHARGING A LBW BABY:
when it is- feeding well
gaining wt.
no sickness
 REFERRING A LBW BABY:
>1800g –home mt.
1500-1800g : PHC
<1500g : referred to a health facility where
specialist care is available

34. CARE OF SICK NEWBORN(IMNCI)
 MILD ILLNESS:
umbilical discharge
HOME management
conjunctivitis
pyoderma
 SEVERE ILLNESS:
Inpatient care at
diarrhoea PRIMARY
fast breathing/chest compression HEALTH CARE
FACILITY
feeding poorly
ed activity
fever

35.  PROVIDE WARMTH:
200W bulb/radiant warmer
 O2:
Indications- central cyanosis
RR > 60/min
severe chest-indrawing
nasal canula ( no.8) inserted 2cm into nostril
O2 must be humidified & water-warm
in absence of O2 monitors, O2 level determined
by the level at which cyanosis disappears.
 ANTIBIOTICS:
Inj Amp(50mg/kg BD)+ Inj Gentamicin(2.5mg/kg BD)
at least 5 days
If no response after 48 hrs: Refer

36.  FLUIDS & FEEDING:
1st 2 days – 10D
day 3 onwards – 1/6 saline in 10D
DAILY FLUID REQUIREMRNTS DURING 1ST WK OF LIFE (50 ML/KG/DAY) :
BIRTH DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7
WT. &
ONWA
RDS
< 1500g 80 95 110 120 130 140 150
>1500g 60 75 90 105 120 135 150
 ORAL FEEDING:
started as soon as baby can suck
if difficulty in sucking- expressed milk using a NG tube
20ml/kg/feed, 6times /day

37.  VERY SEVERE ILLNESS:
Iinability to feed
persistent hypothermia
abdominal distention REFER to health
facility which has
cyanosis specialist care available
apnoea
convulsions
bleeding
severe jaundice
grunting/ stridor
 1st dose antibiotic
 a referral slip
 a vehicle
 mother with newborn
 KMC & adequate clothing

38. SPECIAL SITUATIONS
 IF MOTHER HAS AIDS / TB :
 immediate skin-to-skin contact
 BF

39. TRAINING
 NAVJAAT SISHU SURAKSHYA KARYAKRAM:
 1 day
 basic newborn care & resuscitation
 2009(MOHFW, IAP,deptt. of padiatrics , AIIMS)

40. HEALTH PROGRAMMES
 RCH-II
 IMNCI
 JSY
 VHND
 MAMATA SCHEME
 UIP

41. KEY MESSAGES
 Hand should be washed each time before handling the
baby
 Exclusive BF
 No pre-lacteal feeds
 Baby should be kept warm
check if body & feet are warm
 If DANGER SIGNS are present, health care providers
should be immediately conacted:
not able to take feeds
ed drowsiness
difficulty breathing/ 60/min

42. yellow staining of palm & soles
convulsions
 Mother is advised to bring the child at 6 wks for
immunisation
 Mother is instructed to keep the immunisation card
carefully & encouraged to weigh the child at a near by
health centre
 No pacifier .

43. REFERENCES
 RCH module for MO(PHC).
 GHAI essential paediatrics,7th edition
 PARK’S textbook of preventive & social medicine. 21st
edition
 www.who.int

44. ‘‘THANK U’’