Immediate New born care in labour room

1. Immediate new born care LabourRoom Management MUNEESWARI JEYACHANDRAN, MSC NURSING

2. W.H.O Extract on New born Care • Of the 3.1 million new born deaths that occurred in 2010, a quarter to half of them occurred within the first 24 hours after birth. • The majority of mothers and newborns in low and middle income countries do not receive optimal care during these periods. • Studies have shown that many newborn lives van be saved by the use of interventions that require simple technology. The majority of these interventions can be effectively provided by a single skilled birth attendant caring for the mother and the newborn.

3. Apgar Scale • The Apgar scale is a simple, painless and effective test used by midwives and doctors to assess New born’s health condition. • Once carried out, the test will give an Apgar score. This score will help to decide if your baby needs any immediate treatment during the first moments of her life. • At one minute, and again at five minutes after birth, your midwife will evaluate your baby's wellbeing. Each factor is given a score between zero and two, then the scores are added up.

4. Apgar Scale

5. Interpreting Apgar scores • If your baby scores between 8-10, he/she is in good to excellent condition and will usually need only routine care. • If your baby scores between 5-7, he/she is in fair condition but may require help with breathing. Midwife may vigorously rub baby's skin or give oxygen. • If your baby scores below 5, he/she may be placed on a sloping pad to give her the heat, light and oxygen she needs. A paediatrician to be called to offer extra help.

6. Things to remember while interpreting Apgar scores • If your baby achieves a low score, the Apgar test will be used again later and until your baby is in a good and stable condition. • There is some evidence that low scores at the five-minute mark may be associated with a greater risk of problems, such as cerebral palsy. • There is no clear evidence that Apgar scores can predict future health problems of the baby. • The Apgar score is only one measure of newborn's health. There will be further tests and examinations over the coming weeks which will ensure that your baby is healthy.

7. Newborn Care Kit • Disposal cord clamp • Neonatal History Sheet • Clamp & Scissors • Warm towel and baby blankets • Neonatal I.D bands • Newborn Care kit • O2 sats monitor • Stethoscope • Thermometer

8. Objectives of Immediate Neonate Care • To observe and assist the neonate in adaption to “Extra Uterine Life”. • To provide a thermo-neural environment and support thermoregulation. • To promote parent-infant bonding and initiate chosen method of feeding. • To identify any abnormalities. • To recognize clinical deterioration and respond accordingly.

9. Immediate Newborn care procedures • At birth, make an immediate assessment, of the infant. If stable then immediately place the neonate skin-to-skin on the mother’s chest. If the infant is not stable or you are unsure then transfer the infant to the resuscitation cot and reassess or initiate resuscitation as appropriate. • Signs of clinical and physiological instability often precede a cardio-respiratory arrest. In many cases these events may be prevented if the cause of deterioration is recognised early and acted upon before the neonate deteriorates beyond the point of reversibility.

10. Resuscitation positions

11. Immediate Newborn care procedures • Dry the neonate with a warm towel, then cover the neonate with warm, dry blankets. • To promote initial attachment between parents and neonate. Skin-to-skin contact prevents heat loss by conduction.2 This reduces the potential for heat loss through evaporation and conduction and thus cold stress

12. Immediate Newborn care procedures • Clamp and cut the umbilical cord within 2-3 minutes of normal birth. • Earlier cord clamping may be required for prompt treatment of the infant or for harvesting of stem cells. • Delaying cutting of the umbilical cord within 2- 3 minutes of birth of term infants does not appear to increase the risk of PPH. It may be advantageous to the infant by improving their iron status for up to 6 months after birth, but has a possible additional risk for jaundice requiring phototherapy. • Delayed cord clamping may be less optimal in areas where treatment for jaundice is less accessible.The increase in polycythaemia in term infants from delayed cord clamping appears benign. • Delayed cord clamping may decrease the likelihood of feto-maternal transfusion.

13. Immediate Newborn care procedures • Apply a disposable umbilical cord clamp 1-2 centimetres from the umbilicus. Check the security of the clamp and then cut the cord on the distal side of the clamp with the cord scissors. • Ensure there is no bleeding from the site. • Note: For babies who require umbilical vein catheterisation, leave at least 4cm of cord between the umbilicus and the cord clamp.

14. Immediate Newborn care procedures • Assess the Apgar score at one minute and five minutes post birth. • Document the Apgar scores on the Neonatal History sheet. • The Apgar score is used to assess adaptation to extra uterine life. It measures heart rate, respiratory effort, colour, muscle tone and reflex response. • The APGAR scores provide information on the neonate’s early transition.

15. Immediate Newborn care procedures • Promote breastfeeding of the neonate within the first hour of life by supporting skin-to-skin contact and encouraging the mother to put the baby to the breast. • Feeding within the first hour of life helps to prevent hypoglycaemia and hyper-bilirubinemia.

16. Immediate Newborn care procedures • Apply two white identification (ID) bands to the neonate’s ankle with the mother’s UMRN number on it. • When the neonate’s own UMRN number has been issued, replace the original (mother’s UMRN) identification band5 for two neonatal ID bands (listing the neonate’s details), preferably one on each ankle. • Confirm that the mother’s details on the neonate’s identification bands match. • Be aware of Hospital guidelines to prevent Abduction of babies.

17. Immediate Newborn care procedures • After the first hour (if within normal limits), repeat assessment of respirations, HR, colour, tone/level of consciousness hourly for the next two hours. • Inform the mother to notify midwifery staff immediately of any changes in: • Colour • Tone • Respirations • Behaviour. • For the first hour after birth: Perform an assessment of the following every 15 minutes6 and document: • Respirations (Normal rate 30-60) • Listen for grunting, look for chest/rib recession, tachypnoea,6 and patent airway/position. • Heart rate (Normal 110-160) • Colour (Normal – Pink) • Check Sa02 on right hand/wrist if unsure) • Tone/level of consciousness. • Temperature (Normal 36.5 to 37.4)

18. Immediate Newborn care procedures • Perform and record in front of the mother / partner: • The cephalocaudal examination. • neonate’s weight,6 length and head circumference. • Check for malformations and any issues with the presenting part.

19. Do’s and Don’ts of a Newborn Care

20. SOURCE OF CONTENT • Integrated Management of Pregnancy and Childbirth - WHO 2nd Edition ( Somali context ) • Intrapartum care, Clinical guidelines - UK’s National Collaborating Center for Women’s and Children’s Health • Maternal and Newborn Health Toolkit - Maternal Health Division, Ministry of Health & Family Welfare

21. thank you..!!!