Lala

 A neonatal intensive care unit (NICU) NICU) is an intensive care unit specializing in the care of ill or premature or  premature newborn infants infants.. The first official ICU for neonates was established in 1961 at at Vanderbilt University by Professor Mildred Professor  Mildred Stahlman, Stahlman, officially termed a NICU whenStahlman whenStahlman was the first to use a ventilator off-label to assist a baby with breathing difficulties. [1]

 A NICU is typically directed by one or more neonatologists and staffed by nurses nurses,,

nurse practitioners, practitioners, pharmacists pharmacists,, physician

assistants,, resident physicians, and respiratory therapists. assistants therapists. Many other ancillary disciplines and specialists are available at larger  units. The term neonatal comes neonatal comes from neo, neo, "new", and natal , "pertaining to birth or origin". origin".

[2]

Healthcare institutions have varying entry-level requirements for neonatal nurses. Neonatal nurses are Registered Nurses (RNs), and therefore must have an Associate an Associate of Science in Nursing (ASN) or Bachelor or Bachelor of Science in Nursing (BSN) degree. Some countries or institutions may also require a midwifery qualification. qualification.

[3]

Some institutions may accept newly-

graduated RNs who have passed the NCLEX exam; others may require additional experience working in adult-health or  medical/surgical nursing. nursing.

[4]

Some countries offer postgraduate degrees in neonatal nursing, such as the Master of Science in Nursing (MSN) and various doctorates doctorates.. A nurse practitioner may practitioner may be required to hold a postgraduate degree. degree .

[3]

The National Association of Neonatal

Nurses recommends two years' experience working in a NICU before taking graduate classes .

[4]

 As with any registered nurse, local lice nsing or certifying bodies as well as em ployers may set requirements for continuing education. education.

[4]

There are no mandated requirements to becoming an RN in a NICU, although neonatal nurses must have certification as a Neonatal Resuscitation Provider. Some units prefer new graduates who do not have experience in other units, so they may be trained in the specialty exclusively, while others prefer nurses with more experience already under their belt. Intensive care nurses endure intensive didactic and clinical orientation, in addition to their general nursing knowledge, to provide highly specialized care for critical patients. Their competencies include the administration of high-risk medications, management of high-acuity patients requiring ventilator support, surgical care, resuscitation, advanced interventions such as extracorporeal membrane oxygenation or hypothermia or hypothermia therapy for neonatal encephalopathy procedures, as well as chronic-care management or lower acuity cares associated with premature infants such as feeding intolerance, phototherapy phototherapy,, or administering antibiotics. NICU RNs undergo annual skills tests and are subject to additional training to maintain contemporary practice.

Equipment Incubator 

 An incubator (or  incubator (or isolette isolette

[14]

) is an apparatus used to maintain

environmental conditions suitable for a for a neonate (newborn baby). It is used in preterm births or for some ill full-term babies. Possible functions of a neonatal incubator are: 

Oxygenation, through oxygen supplementation by head hood or nasal cannula, or even continuous positive airway pressure (CPAP) or mechanical or mechanical ventilation. ventilation. Infant respiratory distress syndrome is the leading cause of death in preterm infants, infants,

[15]

and the main treatments are CPAP, in addition to administering surfactant and stabilizing the blood sugar , blood

salts,, andblood salts andblood pressure. pressure. 

Observation: Modern neonatal intensive care involves sophisticated measurement of temperature, respiration, cardiac function, oxygenation oxygenation,, and brain activity. activity.



Protection from cold temperature, infection, noise, drafts and excess handling: handling :

[16]

Incubators may be described

as bassinets enclosed in plastic, with climate control equipment designed to keep them warm and limit their exposure to germs. 

Provision of nutrition, through intravenous catheter or NG or NG tube. tube.



Administration of medications.



Maintaining fluid balance by providing fluid and keeping a high air humidity to prevent too great a loss from skin and respiratory evaporation. evaporation.

[17]

 A transport incubator is incubator is an incubator in a transportable form, and is used when a sick or premature baby is moved, e.g., from one hospital to another, as from a community hospitalt hospitalto a larger medical facility with a proper neonatal intensive care unit. It usually has a miniature ventilator , cardio-respiratory monitor , IV pump, pump, pulse oximeter , and oxygen supply built into its frame.

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The Ballard Maturational Assessment, Assessment , Ballard Score, Score, or Ballard or Ballard Scale is a commonly used technique of gestational age assessment. It assigns a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the baby baby.. These criteria are divided into Physical and Neurological criteria. This scoring allows for the estimation of age in the range of  26 weeks-44 weeks. The New Ballard Score is an extension of the above to include extremely pre-term babies i.e. up to 20 weeks. The scoring relies on the intra-uterine changes that the fetus undergoes during its maturation. Whereas the neurological criteria depend mainly upon muscle tone, the physical ones rely on anatomical changes. The neonate (less than 37 weeks of age) is in a state of physiological hypertonia hypertonia.. This tone increases throughout the fetal growth period, meaning a more premature baby would have lesser muscle tone.

The Physical criteria [edit source | editbeta] These are: 1. Skin 2. Ear/Eye 3. Lanugo Hair  4. Plantar Surface 5. Breast bud 6. Genitals Physical Maturity of the Ballard Maturational Assessment of Gestational Age

[2]

Record -1

0

1

2

3

4

5

Score Below:

Skin

Lanugo

Plantar  surface

Breast

Eye and Ear 

sticky, friable, transparent None Heel-toe 40-50 mm: -1 <40 mm: -2

Imperceptable

Genitals

red, translucent Sparse

Abundant

no crease

marks

superficial

cracking,

parchment,

peeling &/or 

pale areas, deep cracking, cracked, no vessels

wrinkled

Thinning

Mostly bald

Sparse

 Anterior  transverse crease only

Bald areas Creases over 

Creases over 

anterior 2/3 entire sole of sole Raised

Flat areola

Stippled areola

perceptable

no bud

1-2 mm bud

Sl. curved

Well-curved

Formed &

pinna

pinna

firm

Thick cartilage

soft; slow

soft but ready

instant

ear stiff 

recoil

recoil

recoil

Scrotum

Testes in

Testes

Testes

Testes

empty,

upper canal,

descending,

down,

pendulous,

faint rugae

rare rugae

few rugae

good rugae deep rugae

pinna flat

Tightly: -2

stays folded

Prominent

Prominent clitoris &

leathery,

rash, few veins rare veins

Barely

Loosely: -1

Clitoris

visible veins

Faint red

Lids open

smooth

smooth pink,

>50 mm

Lids fused

Genitals Scrotum flat, (Male)

gelatinous,

Majora &

areola 3-4 mm bud

Majora large,

Full areola 5-10 mm bud

Majora cover 

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then range from -10 to 50, the gestational range extending up to 20 weeks. (A simple formula to come directly to the age from the Ballard Score is Age=(2*score+120) /5) Jump up^ Ballard JL, Novak KK, Driver M (November 1979). "A simplified score for assessment of fetal maturation of newly born infants". J. Pediatr. 95 (5 Pt 1): 769 –74.  –74. doi doi::10.1016/S0022-3476(79)80734-9 10.1016/S0022-3476(79)80734-9.. PMID 490248 490248.. 1.

Jump up^ Ballard, JL; Khoury, JC; Wedig, K; Wang, L; Eilers-Walsman, BL; Lipp, R (September 1991). "New Ballard Score, expanded to include extremely premature infants.". infants.". The Journal of Pediatrics 119 (3): 417 –23.  –23. PMID 1880657 1880657.. Retrieved 13 August 2012. [hide hide]] V

T

E

Medical records and physical exam

OPQRST)) · ROS · Allergies Allergies//Medications · PMH PMH//PSH PSH//FH FH//SH History CC · HPI (OPQRST (SAMPLE SAMPLE)) Psychiatric history

General/ General/IPPA Inspection · Auscultation · Palpation · Percussion

Vital signs T · HR · BP · RR 

HEENT Oral mucosa · TM · Eyes (Ophthalmoscopy , Swinging-flashlight test) test ) · Hearing (Weber , Rinne Rinne))

Lungs: Respiratory sounds Respiratory

Other: Cyanosis · Clubbing Heart: Precordium (Heart sounds, sounds , Apex beat) beat) Cardiovascular Other: Jugular venous pressure · Abdominojugular test · Carotid bruit · Peripheral vascular (Ankle brachial Admission

PE

 pressure index index))

(incl. intimate)) intimate

Digestive Liver span · Rectal · Murphy's sign · Bowel sounds Abdominal Urinary Murphy's punch sign

Pelvis Cervical motion tenderness

Back ((Straight leg raise) Back  raise ) Knee (McMurray test) test) Hip Wrist (Tinel sign Phalen

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L/I Labs (Electrolytes Electrolytes,, ABG ABG,, LFT LFT)) · Medical imaging (EKG EKG,, CXR , CT CT,, MRI MRI))

A/P Medical diagnosis · Differential diagnosis

Progress

SOAP note

Common diagnosis and pathologies in the NICU include: 

 Anemia



 Apnea



Bradycardia



Bronchopulmonary dysplasia (BPD)



Hydrocephalus



Intraventricular hemorrhage (IVH)



Jaundice



Necrotizing enterocolitis (NEC)



Patent ductus arteriosus (PDA)



Periventricular leukomalacia (PVL)



Infant respiratory distress syndrome (RDS)



Retinopathy of prematurity (ROP)



Sepsis



Transient tachypnea of the newborn (TTN)

Levels of care [edit source | editbeta] The concept of designations for hospital facilities that care for newborn infants according to the level of complexity of care provided was first proposed in the United States in 1976 . published by the American the  American Academy of Pediatrics

[19]

[18]

Levels in the United States are designated by the guidelines

In Britain the guidelines are issued by The British Association of Perinatal

Medicine (BAPM), and in Canada they are maintained by The Canadian Paediatric Society.

Canada[edit source | editbeta] beta ]  Level 1: Basic neonatal care  [ edit [  edit source | edit beta



Level 1a: Evaluation and postnatal care of healthy newborn infants; and Phototherapy



Level 1b: 

Care for infants with corrected gestational age greater than 34 weeks or weight greater than 1800 g who have mild illness expected to resolve quickly or who are convalescing after intensive care;



Ability to initiate and maintain intravenous access and medications;



Nasal oxygen with oxygen saturation monitoring (e.g., for infants with chronic lung disease needing long-term oxygen and monitoring).

Level 2: special care care newborn nursery [ edit edit source | edit beta beta ]  

Level 2a:

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

Level 2b: Mechanical ventilation for brief durations (less than 24 h) or continuous positive airway pressure. Intravenous infusion, total parenteral nutrition, and possibly the use of umbilical central lines and percutaneous intravenous central lines.

Level 3: Intensive neonatal care [ edit edit source | edit beta beta ] 

US Navy 100204-N-6326B-008 Chief of Naval Operations Adm. Gary Roughead speaks with Capt. Douglas N. Carbine and Rear. Adm. Christine M. Bruzek-Kohler during a tour of the neonatal intensive care unit 

Level 3a: Care of infants of all gestational ages and weights; Mechanical ventilation support, and possibly inhaled nitric oxide, for as long as required Immediate access to the full range of subspecialty consultants.



Level 3b: Comprehensive on-site access to subspecialty consultants; Performance and interpretation of advanced imaging tests, including computed tomography, magnetic resonance imaging and cardiac echocardiography on an urgent basis Performance of major surgery on site but not extracorporeal membrane oxygenation, hemofiltration and hemodialysis, or  surgical repair of serious congenital cardiac malformations that require cardiopulmonary bypass.



Level 3c: Extracorporeal membrane oxygenation, oxygenation , hemofiltration and hemodialysis, or surgical repair of serious congenital cardiac malformations that require a cardiopulmonary bypass.

The Neonatal Intensive Care Unit (NICU) The birth of a baby is a wonderful yet very complex process. Many physical and emotional changes occur for mother and baby.  A baby must make many physical physical adjustments adjustments to life outside outside the mother's body. Leaving the the uterus means that a baby can can no longer depend on the mother's circulation and placenta for important ph ysiologic functions. functions. Before birth, breathing, eating, elimination of waste, and immunologic protection all came from the mother. When a baby enters the world, many body systems change dramatically from the way they functioned during fetal life:    



The lungs must breathe air. The cardiac and pulmonary circulation changes. The digestive system must begin to process food and excrete waste. The kidneys must begin working to balance fluids and chemicals in the body and excrete waste. The liver and immunologic systems must begin functioning independently. Illustration demonstrating fetal circulation

Click Image to Enlarge Your baby's body systems must work together in a new way. Sometimes, a baby has difficulty making the transition to the world. Being born prematurely, having a difficult delivery, or birth defects can make these changes more challenging. Fortunately for these babies, special newborn care is available.

What is the neonatal intensive care unit? Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained healthcare professionals to provide specialized care for the t iniest patients. NICUs may also have intermediate intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care.

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The following are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. However, each baby must be evaluated individually to determine the need for admission. High-risk factors include the following:







maternal factors: age younger than 16 or older than 40 years o drug or alcohol exposure o diabetes o hypertension (high blood pressure) o bleeding o sexually transmitted diseases o multiple pregnancy (twins, triplets, or more) o too little or too much amniotic fluid o premature rupture of membranes (also called the amniotic sac or bag of waters) o delivery factors: fetal distress/birth asphyxia asphyxia (changes in organ systems due to lack of oxygen) o breech delivery presentation (buttocks delivered first) or other abnormal presentation o meconium (the baby's first stool passed during pregnancy into the amniotic fluid) o nuchal cord (cord around the baby's neck) o forceps or cesarean delivery o baby factors: birth at gestational age less than 37 weeks or more than 42 weeks o birthweight less than 2,500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds, 13 ounces) o small for gestational age o medication or resuscitation in the delivery room o birth defects o respiratory distress including rapid breathing, grunting, or apnea (stopping breathing) o infection such as herpes, g roup B streptococcus, chlamydia o seizures o hypoglycemia (low blood sugar) o need for extra oxygen or monitoring, intravenous (IV) therapy, or medications o need for special treatment or procedures such as a blood transfusion o

Who will care for your baby in the NICU? The following are some of the specially trained healthcare professionals professionals who will be involved in the care of your bab y:



    

neonatologist - a pediatrician with additional training in the care of sick and premature babies. The neonatologist supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU. respiratory therapists occupational therapists dietitians lactation consultants pharmacists

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A/B –  A/B  – apnea/brady apnea/bradycardia cardia spell (episode of apnea and/or bradycardia) A/B/D –  A/B/D  – apnea/brady apnea/bradycardia/oxygen cardia/oxygen desaturation spell (episode of apnea and/or bradycardia and/or decreased oxygen saturation) AGA –  AGA  – appropriate appropriate for gestational age ARNP –  ARNP  – advanced advanced registered nurse practitioner (PNP or NNP) ASD –  ASD  – atrial atrial septal defect BBT –  BBT  – baby's baby's blood type BM – bowel BM –  bowel movement BPD –  BPD  – bronchopulmona bronchopulmonary ry dysplasia CBG –  CBG  – capillary capillary blood gas CHD –  CHD  – congenital congenital heart defect or congenital heart disease CHF –  CHF  – congestive congestive heart failure CMV –  CMV  – cytomegalovirus cytomegalovirus CNM –  CNM  – certified certified nurse midwife CNS –  CNS  – central central nervous system CPAP –  CPAP  – continuous continuous positive airway pressure C/S –  C/S  – cesarean cesarean section CPT - chest physiotherapy CSF –  CSF  – cerebrospinal cerebrospinal fluid CVN –  CVN  – central central venous nutrition CXR  – chest  – chest x-ray DIC –  DIC  – disseminated disseminated intravascular coagulation DR  – delivery  – delivery room ECMO –  ECMO  – extracorporeal extracorporeal membrane oxygenation ELBW –  ELBW  – extremely extremely low birth weight ETC –  ETC emergency treatment center   – emergency ETT –  ETT  – endotracheal endotracheal tube FOC –  FOC  – fronto-occipi fronto-occipital tal circumferenc circumferencee FTP –  FTP  – failure failure to progress

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IDM –  IDM  – infant infant of diabetic mother  IMV –  IMV  – intermittent intermittent mandatory ventilation iNO –  iNO  – inhaled inhaled nitric oxide IUFD –  IUFD  – intrauterine intrauterine fetal demise IUGR  – intrauterine  – intrauterine growth restriction IVF –  IVF  – in-vitro in-vitro fertilizati fertilization on IVH – intraventr IVH –  intraventricular icular hemorrhage L+D –  L+D  – Labor Labor and Delivery LGA –  LGA  – large large for gestational age LLSB –  LLSB  – lower lower left sternal border  LMD –  LMD  – local local medical doctor (usage of primary care provider - PCP preferred) LSB –  LSB  – left left sternal border  MAP –  MAP  – mean mean airway pressure MAS –  MAS  – meconium meconium aspiration syndrome MBT –  MBT  – mother's mother's blood type MCL –  MCL  – midclavicular midclavicular line MGF –  MGF  – maternal maternal grandfather  MGM –  MGM  – maternal maternal grandmother   NAD - no apparent distress  NAVA –   NAVA  – neurally neurally adjusted ventilatory assistance  NC –   NC  – nasal nasal cannula  NEC –   NEC  – necrotizing necrotizing enterocolit enterocolitis is  NICU –   NICU  – Neonatal Neonatal Intensive Care Unit  NNP –   NNP  – neonatal neonatal nurse practitioner   NNS – neonatal  NNS –  neonatal screen (newborn metabolic screen)  NO –   NO  – nitric nitric oxide  NPCPAP –   NPCPAP  – nasopharyngeal nasopharyngeal continuous positive airway pressure  NPO –   NPO  – nothing nothing by mouth

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PGM –  PGM  – paternal paternal grandmother  PICC –  PICC  – percutaneously percutaneously inserted central catheter  PIE –  PIE  – pulmonary pulmonary interstitial emphysema PIH –  PIH  – pregnancy pregnancy induced hypertension PIP –  PIP  – peak peak inspiratory pressure PIV –  PIV  – peripheral peripheral intravenous line PKU –  PKU phenylketonuria, a, a disease detected on the NNS  – phenylketonuri PMI –  PMI  – point point of maximum impulse PNP –  PNP  – pediatric pediatric nurse practitioner  PO2 –  PO2  – partial partial pressure of oxygen PPH –  PPH  – persistent persistent pulmonary hypertension PPHN –  PPHN  – persistent persistent pulmonary hypertension hypertension of the newborn PPROM –  PPROM  – preterm preterm premature rupture of membranes PPS –  PPS  – peripheral peripheral pulmonic stenosis PRBCs –  PRBCs  – packed packed red blood cells (concentrated erythrocyte suspension for transfusion) PROM –  PROM  – premature premature rupture of membranes (before the onset of labor) or prolonged rupture of membranes PS –  PS  – pressure pressure support PTL –  PTL  – preterm preterm labor  PVL –  PVL  – periventricular periventricular leukomalacia PVN –  PVN  – parenteral parenteral venous nutrition or peripheral venous nutrition RA –  RA  – room room air (21% oxygen) RCM –  RCM  – right right costal margin RDS –  RDS  – respiratory respiratory distress syndrome ROM –  ROM  – rupture rupture of membranes OR range of motion ROP – retinopathy ROP –  retinopathy of prematurity RSV –  RSV  – respiratory respiratory syncytial virus SAB or SAb –  SAb – spontaneous spontaneous abortion SF –  SF  – stock stock formula or standard formula (iron-fortified term infant formula)

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premature baby: terminology in the  NICU or SCN

 premature baby. Apart from It is very overwhelming for parents who find themselves in the Neonatal Intensive Care Unit ( NICU) with their  premature

learning to deal with the emotional aspect to having given  birth to a premmie baby, they also have to learn very quickly all the terms used by the nursing staff in the  NICU. Here is an overview of some of the terms that you may encounter.

Anemia  Too few red blood cells. Anemic babies may need blood transfusions

Apnoea   A short period of time when the baby does not take take a breath.

Aspiration  The drawing in of foreign matter or other material in the upper respiratory tract into the lungs. Aspiration also refers to a medical procedure in

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Chest tube   A tube inserted through the chest wall; wall; used to suction suction air and/or fluids fluids from the chest. chest.

Continu ous Positiv e Airway Pressure (   )  C PAP  CPAP   A continuous amount amount of air, sometimes sometimes with added oxygen, is is delivered through tubes tubes in the baby‟s baby‟s nose to keep the airways of the of  the lungs open as baby breathes.

Culture  Taking a sample of blood or body fluids to test for germs which may cause an infection.

Cyanosis   A bluish colouring colouring of the skin and lips caused by a low level level of oxygen in the blood.

Edema  The collection of extra fluid in body tissues, causing swelling or puffiness of skin.

Electrode   A sensor which sends heartbeat and breathing information information to the monitor. monitor. They can be placed on the chest, chest, arms, or legs. Also called leads.

Electrolytes  Sodium, potassium, and chloride levels in the blood. Correct levels of these chemicals must be present so that the body organs can function properly.

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Hyaline memb rane disease (   )  H M D   A breathing problem that causes the the tiny air sacs sacs in the lungs to collapse; usually due to lung lung immaturity and and lack of a natural natural lung chemical (surfactant). Also called respiratory distress syndrome ( RDS).

Hydrocephalus  Excess spinal fluid causing enlargement of the ventricles in the brain.

Hypoxia   A low level of oxygen in the body tissue. If If very low, tissue damage can occur.

Incubator / isolette / hum idicrib   A small, heated heated bed enclosed in clear plastic. Keeps the baby warm, while allowing caregivers caregivers see the baby. baby.

Intraventricu Intrave ntricu lar haemorrhage ( I VH   )  Bleeding within the brain‟s ventricles (spaces in the brain which contain spinal fluid). Also called intracranial haemorrhage (bleeding in or  around the brain).

Intravenou Intrave nou s line (IV)  (IV)   A hollow needle or plastic plastic tube inserted inserted into a vein; vein; used to give give fluids, blood, and and or medications. medications.

Intubation  Placing a tube through the nose or mouth into the trachea (windpipe).

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Neonate   A newborn infant, less than 30 days days old.

Neonatologist   A physician who specializes in the care of critically critically ill newborn infants.

Oscillator   A type of high frequency ventilator. ventilator.

Oxygen saturation  The level of oxygen in a baby‟s blood. Oxygen level is measured by a small probe on the baby‟s hand or foot, also by blood samples. This level tells at-a-glance how well oxygen is being carried through the b ody.

Patent Pate nt Ductu s Arteriosus (   )  PD A PD  A small vessel vessel (ductus) between between the major arteries arteries of the heart and the lungs. Before birth, birth, this vessel vessel is open and allows blood to bypass bypass the lungs (not yet in use). When this opening fails to close after birth, it can cause problems with oxygen rich blood getting to the body.

Peripherally Ins erted Central Catheter (   )  P ICC  PICC   A flexible, thin thin IV tube put into a vein in the arm, foot, or leg and then routed up into, or near, the heart.

Persistent Pulm Pulm onary Hypertension of Newborns ( PP  )  PPH H N   A serious condition condition that causes causes the baby to return to its prebirth prebirth route of blood circulation. The baby‟s blood is only partially oxygenated through the lungs. This results in very low oxygen levels, plus a higher blood pressure in the arteries of the lungs. Treatment includes, oxygen,

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Sepsis   An infection caused caused by bacteria. bacteria.

Spin al tap  tap  The removal of a small amount of fluid from the spinal canal. The fluid is then analyzed for infection, bleeding, and other disorders.

Surfactant   A substance in the lungs that helps keep the tiny tiny air sacs from collapsing and sticking sticking together. together. A lack of this substance substance contributes to to Respiratory Distress Syndrome ( RDS).

Transient Tra nsient Tachypn ea of the Newborn ( TT  )  TT N   A condition when a baby breathes with with quick, shallow shallow breathes (usually over 80 breaths per per minute). It is often caused by fluid fluid in the lungs and will improve as this fluid is absorbed. Some babies need oxygen as this resolves. TTN is often associated with cesarean delivery.

Umbilic al Catheter, Catheter, Arterial Arterial or Venous ( UA C ,

 )  UV C 

 A tube inserted through through the belly button button (umbilical cord) into the arterial or venous venous blood vessels. vessels. Either tube is used to to give the baby fluids and to draw blood samples. The UAC is used to monitor the baby‟s blood pressure. If the baby re quires oxygen therapy, the UAC will be used to draw blood gases and blood samples.

Ventilator   A machine which which fills the baby‟s baby‟s lungs with with air and helps the baby breathe. Also Also called a respirator. respirator.

Ventricles of the b rain  Spaces in the brain that contain spinal fluid to bathe and cushion the brain.

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25-28o C using a room thermometer. Wash hands with clean water and soap. (See page 33) Double glove just before delivery. TIME BAND: Within the 1st 30 secs Call out the time of birth INTERVENTION: INTERVENTI ON: Dry and provide warmth.  ACTION: Use a clean, dry cloth to thoroughly dry the baby by wiping the eyes, face, head, front and back, arms and legs. Remove the wet cloth. Do a quick check of newborn‟s breathing while drying. (See fold-out on Immediate Care of the Newborn.) Note: During the fi rst 30 seconds:  – Do not ventilate unless the ba by is fl oppy/limp and not breathing.  – Do not suction unless the mouth/nose are blocked with secretions or other material. D10 D11 IMMEDIATE NEWBORN CARE2 Clinical Practice Pocket Guide

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 – Do not wipe off vernix if present.  – Do not bathe the newborn earlier than 6 hours of life.  – Do not do footprinting.  – If the newborn must be separated from his/her  mother, put him/her on a warm surface, in a safe place close to the mother. INTERVENTION: INTERVENTI ON: Palpate the mother‟s abdomen. Exclude a second baby. If there is a 2nd baby, get help. Deliver the second newborn. Manage as in Multi-fetal pregnancy  ACTION: If a baby is crying and breathing normally, avoid any manipulation, such as routine suctioning, that may cause trauma or introduce infection. TIME BAND: 1 - 3 minutes INTERVENTION: INTERVENTI ON: Do delayed or non-immediate cord clamping  ACTION: Remove the fi rst set of gloves immediately prior to cord clamping. D11 D18 D18

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If the attachment or suckling is not good, try again and reassess. Notes:  – Health workers should not touch the newborn unless there is a medical indication.  – Do not give sugar water, formula or other prelacteals.  – Do not give bottles or pacifi ers.  – Do not throw a way colostrum.  – If the mother is HIV-positive, see of PCPNC for  special counseling. Diagrams of infants mouth showing good and poor  attachment to the breast. G7 Good Attachment Good Attachment Poor Attachment Poor Attachment (Outside appearance) Fr. WHO. Department of Child and Adolescent Health and Development. Relactation: A review of experience and recommendations for practice. Geneva, 1998 IMMEDIATE NEWBORN CARE6 Clinical Practice Pocket Guide INTERVENTION: INTERVENTI ON: Provide additional care for a small

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 – Bumps on one or both sides of the head, bruises, swelling on buttocks, abnormal position of legs (after breech presentation) or asymmetrical arm movement, or arm that does not move. K9 J2 J8 ESSENTIAL NEWBORN CARE 8 Clinical Practice Pocket Guide If present:  – Explain to parents that this does not hurt the newborn, is likely to disappear in a week or two and does not need special treatment.  – Gently handle the limb that is not moving.  – Do not force legs into a different position. Look for malformations:  – Cleft palate or lip  – Club foot  – Odd looking, unusual appearance  – Open tissue on head, abdomen or back If present:  – Cover any open tissue with sterile gauze before referral and keep warm. Refer for special treatment and/or evaluation if available.

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in a clean, dry, warm cloth and place in a cot. Cover with a blanket. Use a radiant warmer if the room is not warm or the baby small.  – Do not bathe the small baby. Keep the baby clean by wiping with a damp cloth but only after 6 hours. J6 J11 K9 ESSENTIAL NEWBORN CARE ESSENTIAL NEWBORN CARE Newborn Care until the First Week of Life 11 III. Care Prior to Discharge (but after the fi rst 90 minutes) TIME BAND: After the 90 minutes of age, but prior to discharge INTERVENTION: INTERVENTI ON: Support unrestricted, per demand breastfeeding, day and night  ACTION: Keep the newborn in the room with his/her mother, in her bed or within easy reach. Do not separate them (rooming-in). Support exclusive breastfeeding on demand day and night.  Assess breastfeeding breastfeeding in every baby before planning for  discharge. Ask the mother to alert you if with diffi culty

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 ACTION: Look for signs of serious illness :  – Fast breathing (>60 breaths per min)  – Slow breathing (<30 breaths per min)  – Severe chest in-drawing K10 K10 K10 J6 J7 CARE PRIOR TO DISCHARGENewborn Care until the First Week o f Life 13

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 – If the umbilicus is draining pus then consider  possible serious illness  – Give fi rst dose of two IM antibiotics  – Refer baby urgently Look at the skin, especially around the neck, armpits, inguinal area:  – Are there pustules?  – If less than 10 p ustules, consider local skin infection: Teach mother to treat skin infection.  – Follow-up in 2 days. If pustules worsen or do not improve in 2 days or more, refer urgently.  – If more than 10 pustules, refer for evaluation.

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or within easy reach  – Exclusively breastfeed breastfeed on demand day and night (≥8 times in 24 hours except in the fi rst day of life when newborn sleeps a lot). Observe a breastfeed, if possible.  Ask the mother mother to alert you if she has breastfeeding breastfeeding diffi culty, pain or fever. Observe, Treat and Advise:  – If nipple(s) is/are sore or fi ssured, s sured, and the baby is not well attached, in addition to the above;  – Reassess after 2 feeds (within the same day). IV. Care after Discharge to 7 days

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 – Yellow skin to the soles  – History or diffi culty feeding  – History of convulsions  – Movement only when stimulated  – Respiratory rate >60 per minute  – Severe chest in-drawing  – Temperature > 38.0o C (per local expert opinion)  – Temperature <35.5o C Refer baby urgently to hospital:  – After emergency treatment, explain the need for 

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 – Resuscitator working properly?  – Adequate pressure being used?  – Air distending the stomach?  – Air leak (pneumothorax)?  – If baby starts crying or breathing >30 per minute and has no chest-in-drawing, stop ventilating:  – Put the newborn in skin-to-skin contact on mother‟s chest and continue care while monitoring breathing and warmth. Explain the baby‟s condition to the mother. K11

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