Essential Intrapartum and Newborn Care Flashcards
Simple, cos-effective newborn care intervention
Improve neonatal and maternal care
Unang Yakap
Essential Newborn Care
4 core steps of Unang Yakap
- Immediate and Thorough Drying
- Early Skin-to-Skin Contact
- Properly-Timed Cord Clamping
- Non-separation of Newborn from Mother for Early Breastfeeding
= rubbing 30 secs or until the NB responds by Crying
= stimulates lung expansion
= Assess Breathing
= Suction if Necessary (mouth before nose x 5 to 10 secs.)
= Position NB prone on top of Mom
- Immediate and Thorough Drying of the Skin
LUNG EXPANSION=
* INCREASE PRESSURE IN THE LEFT SIDE HEART
* CLOSURE OF FETAL STRUCTURES (FORAMEN OVALE AND DUCTUS
ARTERIOSUS)
= Place a Bonnet over head
= Initial bath at 6 to 8 hours after birth
= Benefits from Skin to Skin contact
a. Transfer heat
b. Transfer of normal bacterial flora c. Transfer love to the NB (Bonding)
- Early Skin to Skin contact
= done after 1 to 3 minutes or after placental pulsation has stopped
= Benefits:
= additional 50 to 100 ml of blood (more Fe, more antibodies, hormones, enzymes)
= decrease pressure in the R side of the heart promotes closure of fetal accessory structures
= apply cord clamp 2 cm from base
= apply forcep 5 cm from base
= cut after cord clamp ( no milking)
- Properly Timed Cord Clamping
Cutting of the umbilical cord
* DECREASE PRESSURE IN THE RIGHT SIDE OF THE HEART
* CLOSURE OF THE DUCTUS VENOSUS AND UMBILICAL
BLOOD VESSSELS
* PROMOTE ADEQUATE
CIRCULATION
* FACTORS THAT INFLUENCE CIRCULATORY CHANGES AFTER
BIRTH
* LUNG EXPANSION
* CUTTING OF THE UMBILICAL CORD
Purposes:
= promote special mutual relationship between
mother and baby ( Bonding)
= stimulates the release of Colostrum and
Breastmilk
= stimulates the release of Prolactin by the APG
(milk production) and Oxytocin by the Posterior Pituitary
gland ( happy hormone and let down reflex)
= stimulates uterine contraction post partum to
prevent bleeding
= promotes uterine involution
= stimulates the baby to passed out
meconium early and more frequently which
may promote excretion of bilirubin
= promotes infants brain development
and intellect ( Taurine)
= boost baby’s immune system
( WBC, Macrophages,IgA, Lactoferrin)
= economical and readily available
Note: if exclusive for 1st 6 mos, a natural
contraceptive by inhibiting ovulation ( LAM)
= Advise to eat Galactogogues and
drink a lot of water
- Non separation of the Newborn from the Mother for early breastfeeding (90 minutes)
Birth Weight 5.5 to 7.8 lbs 2,500 to 3,400 grams
Birth Length 18 to 22 in 48 to 54 cm
Head Circumference 13 to 14 in 33 to 35 cm
Chest Circumference 12 to 13 in 31 to 33 cm
Abdominal Circumference 11 to 12 in 29 to 31 cm
- IDENTIFICATION
- CREDE’S PROPHYLAXIS
- VITAMIN K INJECTION
- IMMUNIZATION
- NEWBORN SCREENING TEST
- ANTHROPOMETRIC MEASUREMENT
A Heelstick method is used to collect 4 drops of blood. The blood is analyzed within two to three weeks.
Six diseases are screened for: Phenylketonuria, Galactosemia, G6PDD, Cretinism, Congenital Adrenal Hyperplasia (CAH), Maple Syrup Urine Disease (MSUD)
Hearing is also screened. Sounds are played into the ears, and its response is measured. It can be done within 10 minutes and results are immediate.
Newborn Screening Test: based on R.A. 9288, the Newborn Screening Act of 2004. It is done within 48 to 72 hours. The diseases screened within this act is checked to prevent mental retardation, physical abnormalities, and death.
Created by Dr. Virginia Apgar, this is a screening test done one minute and five minutes after birth. The first test is to determine the newborn’s ability to cope with the birthing process, and the second test is done to determine the newborn’s ability to adjust to extrauterine life. This test determines the degree of acidosis and aids in determining the need for CPR.
APGAR Scoring
0 to 3: poor, serious, severely depressed. CPR may be required.
4 to 6: fair, guarded, moderately depressed. Suctioning may be required. Monitoring is required.
7 to 10: good, healthy.
Appearance
Pink Acrocyanosis (extremities are blue) Central cyanosis or pallor
Pulse
> 100 BPM <100 BPM No pulse
Grimace
Cries, sneezes, pulls away Grimaces or weak cry No response
Activity
Active movement; well flexed Some flexion of extremities Flaccid/limp; no movement
Respiration
Good, strong cry Weak cry; slow/irregular No breathing
Respiratory Rate: normally 80 breaths/min soon after birth, stabilizing to 30-60 breaths/min. The breathing of a newborn is normally rapid, irregular, with normal physiologic apnea of <15 seconds in a minute. They are shallow but quiet, and abdominal/diaphragmatic.
Pulse Rate: normally 180 BPM, stabilizing to 120-160 BPM. It is also rapid and irregular, increasing with crying and decreasing during sleep. The sites for pulse rate observation in a newborn may be at the apical pulse, brachial pulse, femoral pulse, (if weak, this suggests CoA), and pedal pulse.
Temperature: the thermoregulating center of a newborn is immature. Reasons for difficulty in maintaining temperature include an underdeveloped shivering mechanism, inadequate adipose tissues, and large surface area, making newborns more prone to heat loss. The normal temperature of a newborn is 36.4°C to 37.2°C (Prof. says 36.5°C to 37.5°C). It takes 6 to 8 hours after birth for temperature to stabilize.
Complications of hypothermia:
Hypoglycemia: normally 30 to 65 MG%
Metabolic acidosis
Respiratory Distress
Blood Pressure: normally 80/46 mm Hg at birth, increasing to 100/50 in 10 days. When measured, it is normally higher in the lower extremities than in the upper extremities. Otherwise, this also suggests a congenital heart defect (CoA). Measurement may be via doppler or flush methods.
Blood pressure monitoring is optional in a newborn, but is required at 3 years old.
