10.Immediate care for the newborn. Flashcards
what are the steps for immediate care of the newborn ?
1) clear airway
2) dry the newborn
3) ensure onset of respiration
4) APGAR SCORE - at 1 min and 5min
5) clamping of the cord
6) correct surfactant defficiency
7) further measurements
when do we clear the airway ?and with what ?
when the head emerges from vagina with towel
bulb suction to aspirate secretion from oropharynx
why should we clear the airway
delivery causes compression of the chest wall resulting discharge of fluid from mouth and nose
suction should not be used on nose initially why?
initiate the gasp , cause bradycardia from vagal reflex
when clearing the airway if there is moderate meconium present ?
Tracheal tube intubation to suction the meconium
Continuous positive air way pressure mask
Inhaled nitric oxide - reduce the pulmonary hypertension
Glucocorticoid for anti inflammatory
Surfactants are given
If serious
Mechanical ventilation
Extracorporeal membrane oxygenation
why is it important to dry the new born
important part of neonatal adaption
initiation of non shivering thermogenesis.- heat production due to metabolic energy and not due to the contracting of the skeletal muscles
thermoregulation of the fetus is also inadequate
why is the thermoregulation of new born inadequate ?
fetal T4 is converted to reverse rT3 metabolically inactive - several days after the onset of labour cortisol levels increase in fetes - induce thyroid hormone changes , allowing conversion of t4 -t3 necessary for neonatal thermogenesis
at 30 minutes after birth and in no time after that ever in life there is a surge of TSH - followed by hyperthyroid neonatal state necessary for newborn to maintain its temp
for which type of babies is drying of skin vey important
if preterm infants - excessive cooling of skin is detrimental
why should newborn be dried in a preheated environment
preheated environment - also serves to stimulate the onset of respiration
how long does it take for the umbilical arteries usually close spontaneously
45-60 second of birth whereas the umbilical vein remains 3-5 minutes longer.
what can happen if there is a delay in clamping the cord ?
neonatal jaundice and tachypnea can occur if there is a delay in clamping
what is the ideal time in clamping the cord ? and describe the process
Delay in clamping for 1–3 minutes or till cessation of the cord pulsation
till then placed below the level of uterus.
This is beneficial to a mature baby but may be harmful to a preterm or a low birthweight baby due to hypervolemia and hyperbilirubinemia.
other areas with early clamping should be done in : Rh-incompatibility, asphyxiated babies or diabetic mothers
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process
cord has stopped pulsing
cord is clamped by two Kocher’s forceps
sterile scissors, cut between the two clamp
when should the onset of respiration take place ?
normally within few seconds of birth
what if the onset of respiration not commenced after 30 seconds or HR is less than 100
less than 100 percent positive pressure ventilation with oxygen should be started
if no improvement after 90 seconds - oxygen should b increased
surfactant deffieicncy is common in what types of babies ?
premature infant
