Resuscitation of new born

1. SBA - Presentation 5 (b) Resuscitation of new born Maternal Health Division Ministry of Health & Family Welfare Government of India

2. Session objectives To learn about • Care of newborn immediately after delivery • New born resuscitation Resuscitation of new born

3. Immediate care to newborn • Place baby on mother’s abdomen • Dry the baby with clean cloth (Do not clean the uernix) • Ensure baby is crying and breathing • Put clean thread ties tightly around the cord at 2 cm and 5 cm from the baby’s abdomen once cord stops pulsating in 2-3 minutes • Cut between the ties with a sterile/clean blade after1-3 minutes Resuscitation of new born

4. Immediate care to newborn • Wipe mouth and nose • Avoid routine suction of baby • Weigh the baby • Leave the baby between the mother’s breasts to start skin to skin contact • Cover the baby’s head with a cloth • Initiate Breastfeeding • Cover the mother and the baby with a warm cloth Resuscitation of new born

5. Immediate care to newborn What should you do if baby not breathing or crying? • Call for help • Proceed to resuscitation • Anticipate the need for resuscitation, especially if the woman has history of • Eclampsia • Vaginal bleeding • Prolonged/obstructed labour • Preterm birth • Fetal distress • Multiple pregnancies Resuscitation of new born

6. Preparation for resuscitation Equipment should always be ready and in working condition • Ambu bag – self –inflating with the neonatal size mask • Clean dry napkins to put under the baby’s shoulder • Radiant warmer – ensure that the electricity supply and connections are proper and there is no current leakage. • Radiant warmer should be warmed 20 minutes prior to receiving baby • Suction apparatus – new disposable nasogastric tube should be used each time • Oxygen cylinder is available in the labour room with flow meter and the key on it. • Oxygen mask or tube should be clean and disinfected Labour room staff should be trained to use the equipments Resuscitation of new born

7. Steps of artificial ventilation Self-inflating Ambu bag Correct position of the head for ventilation Correct position of mask on the face Ventilation with bag and mask Resuscitation of new born

8. Steps of resuscitation • Provide warmth: dry and shift the baby in newborn corner and place him/her under radiant warmer • Position the baby: put 2-3 cm thick towel under baby’s shoulders to keep the neck in right position • Clear airway: clean the mouth first and then nose • Dry, stimulate to breath and reposition: Drying will provide stimulus to breath. Also flick the soles or gently rub back, trunk or extremities • Ventilation: use self-inflating Ambu bag with right size of mask • Assess breathing: after 30 sec assess if further artificial ventilation is needed Resuscitation of new born

9. Harmful resuscitation practices • Routine suction of the baby’s stomach at birth • Postural drainage • Squeezing the chest to remove secretions from the airway • Routinely giving Sodium-Bicarbonate to newborn Resuscitation of new born

10. no meconium — dry the babymeconium present — suction mouth, nose & dry the baby NEW BORN RESUSCITATION Assess Breathing Not breathing well Breathing well Routine care Place on mother’s abdomen,Wipe mouth and nose, Cut cord after 1–3 minutes, Keep baby with mother Initiate breastfeedingWatch colour and breath Initial steps Cut cord,Place on firm, flat surface Provide warmth, Position baby with neck slightly extended,Suction mouth and nose Stimulate, reposition Assess Breathing Observation/care : Provide warmth, Observe colour, breathing and Temp. Initiate breastfeeding, Watch for complications; if present - Refer Not breathing well Provide bag and mask ventilation for 30 seconds; ensure chest rise Breathing well Assess Breathing Not breathing well Continue bag and mask,add oxygen Assess heart rate (umbilical pulsation - check for 6 seconds Assess heart rate Heart rate 100 / baby not breathing well continue ventilation with oxygen. Refer Heart rate 100 or  continue ventilation Assess breathing. If breathing well, Slowly discontinue ventilation & provide observational care Resuscitation of new born

11. Postnatal advice Advise the mother to • Initiate breastfeeding including colostrum within an hour of the birth of baby • Drink warm fluids • Eat full and nutritious meal • Take adequate rest and sleep • Maintain hygiene : perineal hygiene, use of sanitary napkins, daily bath and hand washing before handling the baby, cutting nails • Care of breasts Resuscitation of new born

12. Role of birth companion • Should stay with the mother and not leave the mother and the newborn alone. • Should call for help if the mother has : • Excessive vaginal bleeding • Dizziness/ severe headache/ visual disturbances/ epigastric pain • Convulsions • Increased pain in the perineum • Urinary incontinence or inability to pass urine • Difficulty in breast feeding Resuscitation of new born

13. Care of the Newborn • Place an identity label with mother’s name and other identification data on baby’s wrist or ankle. • Give Inj Vit K one mg I/M to the baby • Put the baby to breast immediately after birth • Ensure that the baby is passing urine/stools • Keep the baby warm either by proper wrapping or by KMC • Examine the baby quickly for malformations/ birth injury • If present - refer the baby to the FRU • Ensure warmth during examination and transportation Resuscitation of new born

14. Care of the Newborn • Check the baby’s colour and breathing every five minutes • Refer to MO at the PHC after initial resuscitation if - • The baby becomes cyanotic (bluish) • Has difficulty in breathing (<30 or >60 breaths / minute) Resuscitation of new born

15. Care of the Newborn • Check warmth by feeling the baby’s feet every fifteen minutes • If the baby’s feet feel cold, check the axillary temperature • If the baby’s temperature < 36.5 0C : • Provide warmth to the baby by placing baby under radiant warmer. • If not available, ensure warmth by placing the baby under a 200 watt bulb placed at a height of 50-60 cms. • Teach the mother to provide skin to skin contact, kangaroo mother care (KMC) Resuscitation of new born

16. Kangaroo care • Provide privacy to the mother • Request the mother to sit or recline comfortably • Mother’s chest should be bare • Undress the baby gently, except for cap, nappy and socks • Place the baby prone on mother’s chest, between her breasts, in an upright and extended posture, • Maintain skin to skin contact Resuscitation of new born

17. Kangaroo care • Turn baby’s head to one side to keep airway clear • Cover the baby with mother’s blouse, ‘pallu’ or gown • Wrap the baby-mother duo with an added blanket or shawl or warm the room with a heating device • Breastfeed the baby frequently • If mother is not available, skin to skin contact may be provided by the father or any other adult • Kangaroo care should not be given by a person who has any infection Resuscitation of new born

18. Kangaroo care What should you do when skin to skin contact is not possible? • Keep the room warm with a home heating device • Clothe the baby in 1-2 layers (summer), 3-4 layers (winter) • Cover the head, hands and feet of the baby with cap, gloves and socks respectively. • Let the baby and mother lie together on soft, thick bedding. • Cover the baby and the mother with additional quilt, blanket or shawl in cold weather Resuscitation of new born

19. Kangaroo care Resuscitation of new born

20. Care of the Newborn • Check the cord for any bleeding every 15 minutes • If the cord is bleeding, re-tie the cord more tightly • Do not apply any substance to the stump • Leave the stump uncovered and dry • Wipe off any meconium or blood from baby’s skin • Delay the baby’s first bath to beyond 24 hours of birth • Weigh all babies before they leave the delivery room • Ensure baby is dressed warmly Resuscitation of new born

21. Care of the Newborn Encourage breastfeeding within an hour of birth • Emphasize importance of colostrum (helps to protect baby against infections) • Check if position and attachment of the baby to the breast are correct at the first feed • Mother can feed her baby while she is lying down or sitting – both mother and baby should be comfortable • Do not give artificial teats or pre lacteal feeds such as sugar water or local foods or even water to the newborn Resuscitation of new born

22. Key Messages Newborn • Maintain the body temperature and prevent hypothermia • Maintain the airway and breathing • Initiate breast feeding within an hour of birth • Recognize danger signs • Timely and appropriate referrals Resuscitation of new born

23. Preparing for discharge - Mother Ensure uterus is hard and bleeding per vaginum is within normal limits Counsel the mother about: • Diet and rest • Exclusive breast feeding • Maintenance of hygiene • Avoiding sexual intercourse till perineal wound heals • Need to take iron tablets • Contraception • When to return for follow up • Complete immunization of baby • Care of breast and perinium • Remain happy and focused on care of the baby Resuscitation of new born

24. Preparing for discharge - Baby • Ensure baby is warm • Breathing is normal • Accepting and retaining breast milk • Cord is clean • Passing urine and stool The baby should receive: • BCG and OPV • Hepatitis B preferably before discharge Resuscitation of new born

25. Advice on discharge - Mother Danger signs: Return immediately • Increase in vaginal bleeding • Fast / difficult breathing • Fever • Feels too weak to get out of bed • Severe abdominal pain • Breasts swollen, red or tender • Dribbling of urine or inability to pass urine. • Pain in the perineum or draining pus • Foul smelling lochia • Convulsions Resuscitation of new born

26. Advice on discharge - Baby Danger signs: (If any of the following signs are there – return immediately) • Breastfeeding poorly • Develops fever or feels cold to touch • Fast / difficult breathing • Blood in stool • Cord stump red, swollen or discharge present • Skin infection (pustules) • Convulsions • Dull and lethargic Resuscitation of new born

27. Thank you Resuscitation of new born