IMMEDIATE NEWBORN CARE Call out time of birth. Deliver the baby prone on the mother’s abdomen. Dry the newborn thoroughly for a full 30 seconds. Remove wet cloth. Check breathing while drying. Position newborn prone on the mother’s abdomen in skin-to-skin contact. Cover the back with a dry blanket. o If this is not possible, place newborn in a warm, safe place close to the mother. Exclude second baby Remove first set of glove. Clamp and cut the cord after cord stops pulsating (1-3 minutes) for pretransfusion and lesser chance of anemia and intraventricular hemorrhage. Maintain skin-to-skin contact; do not separate baby from the mother until a full breastfeed is achieved; watch for feeding cues. Place identification band on ankle.
• • CLASSIFICATION OF NEONATAL SEPSIS LATE, LATE EARLY ONSET LATE ONSET ONSET Time of Onset Birth to 7 days 7 – 30 days > 30 days usually <72 hours • • •
NEONATAL JAUNDICE
Immediate drying Uninterrupted skin-to-skin contact Proper cord clamping and cutting Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in
Intrapartum complication Transmission
Often present
Usually absent
Pediatrics Pediatrics
Indirect Hyperbilrubinemia: Yellowish Direct Hyperbilirubinemia: Greenish PHYSIOLOGIC JAUNDICE • Onset ≥ 24 HOL usually on the 3rd day of life • TSB increasing less than 5 mg/kg/day • Decline to adult levels by the 10th to 12th day of life
PATHOLOGIC JAUNDICE • Early onset < 24 HOL • TSB increasing more than 5 mg/kg/day • TSB concentration exceeding 12.9 mg/dL (FT) and >15 mg/dL (PT) • DSB > 2 mg/dL or 20% of TSB (total serum bilirubin) • Persists > 1 wk (FT) or >2 wks (PT)
Usually absent
Vertical: Vertical: Environment/ maternal genital Postnatal community tract environment Clinical Fulminant Insidious, focal Multisystem or Manifestations course, infection, focal multisystem meningitis involvement, (common) pneumonia (common) Prematurity is the most important neonatal factor predisposing to infection
NEONATAL COLD INJURY
BREASTFEEDING JAUNDICE • Occurs in the first week of life • Starvation jaundice • Can be prevented by frequent breastfeeding
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BREASTMILK JAUNDICE Occurs beyond the first week of rd life until the 3 week of life Extension of physiologic jaundice Enhanced enterohepatic absorption of UCB of unidentified factors in human milk which inhibits hepatic glucoronosyl transferase β-glucoronidase converts back conjugated bilirubin to unconjugated bilirubin
RESPIRATORY DISTRESS SYNDROME
SIGNS AND SYMPTOMS: • Apathy • Refusal to eat • Oliguria • Coldness to touch • Edema • Redness of the extremities • Temperature between 29.5-35 °C • Bradycardia, apnea, hypoglycemia, acidosis and massive pulmonary hemorrhage TREATMENT OF NEONATAL COLD INJURY • Warming o Warm, ironed blanket o For premature babies, you can put a cap on the head since the head has the highest surface area (especially important for low birth weight and SGA babies) o Thermoregulated bed sheet o Radiant warmer • Correction of metabolic disturbances
HYPOGLYCEMIA Definition: Blood sugar of <40mg/dL Management: • Blood glucose determination and early feeding • INFANTS WHO CANNOT TOLERATE ORAL FEEDING, ARE SYMPTOMATIC, OR IN WHOM ORAL FEEDINGS DO NOT MAINTAIN NORMAL GLUCOSE LEVELS o Administer D10W at 2mL/kg over 1 min o Maintain a Glucose Infusion Rate (GIR) at 6-8 mg/kg o Increase dextrosity to 12.5 to 15 o Hydrocortisone/Glucagon if patient is still not responding
CAPUT SUCCENDANEUM Soft tissue swelling May cross the midline Edema disappear in the first few days of life Molding of the head and overriding of the parietal bones No treatment Hyperbilirubinemia can develop (hemorrhagic caput)
CEPHALHEMATOMA Subperiosteal hemorrhage Does not cross the midline Resorbs within 2 weeks to 3 months Absent No treatment Hyperbilirubinemia may need phototherapy
GENERAL PREVENTIVE MEASURES • Prevention of prematurity • In utero acceleration of pulmonary maturity • Betamethasone 48 hr before delivery of fetuses between 24 and 34 wks gestation SPECIFIC THERAPY • Exogenous surfactant (from bovine lungs) o Instilled intratracheally (4 mg/kg) • Assisted/ mechanical ventilation INDICATIONS FOR MECHANICAL VENTILATION • Arterial blood pH <7.20 • Arterial blood pCO2 >60mmHg • Arterial blood pO2 <50mmHg on CPAP and Fio2 >60% • Persistent apnea GOALS OF ASSISTED VENTILATION • Improve oxygenation and eliminate CO2 without causing barotrauma and O2 toxicity • Target: o PaO2 50- 70 mmHg o PaCO2 45- 55 mmHg o pH 7.25- 7.35
NEONATAL PNEUMONIA Route of Transmission • Ascending infection • Aspiration of infected material during passage through the birth canal
MECONIUM ASPIRATION SYNDROME Meconium: The first intestinal discharge from newborns; a viscous, dark green substance composed of intestinal epithelial cells, lanugo, mucus, and intestinal secretions, such as bile
Predisposing factor: Prolonged rupture of membranes Causative Agents: • Group B Streptococci (major pathogen producing pneumonia for developed country) • E. Coli (major organism in the Philippines) • Listeria spp.. • Klebsiella spp. • Enterococcus spp. Clinical Course: • Sign of respiratory distress: Tachypnea, Retractions, Cyanosis • Non-specific signs: Apneic spells, Thermal instability, Jaundice Xray: • Streaky densities • Confluent opacified areas • Diffusely granular appearance with air bronchogram Treatment: • Penicillin/ ampicillin and aminoglycosides • Late onset (occurs more than 3 days of life) o Staphylococcus: Oxacillin / Vancomycin o Chlamydia: Erythromycin o Fungi: Amphotericin B • Duration of treatment: 10 days
TRANSIENT TACHYPNEA OF THE NEWBORN • • •
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Follow an uneventful delivery at or near term Major presenting symptom: persistently high RR Other symptoms: o Mild cyanosis o Minimal respiratory distress Due to delayed resorption of fetal lung fluid Increased risk in cesarean delivery X-ray: o Central perihilar streaking o Hyperaeration o Fluid in the minor fissure Self- limited course Resolves within 6- 8 hours mostly May last for 72 hours Minimal O2 support usually enough Antibiotics not needed
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Meconium aspiration induces hypoxia via 3 major pulmonary effects: o Airway obstruction o Surfactant dysfunction o Chemical pneumonitis
