PEDIATRIC 1: EINC Flashcards
ENC (NEW); EINC (OLD)
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
GOAL OF THE WHO WITH ENC/EIN?
↓ NMR (28 days)
↓ MMR
Before ENC/EINC: increase number of neonatal death in the first 7 hours.
2009: Adopted by the DOH:
EINC/Unang Yakap
ENC/ EINC:
4 INTERVENTIONS
D-S-P/D-N
1.DRY THE BABY
2. SKIN-TO-SKIN CONTACT
3. DELAYED/PROPERLY TIMED CORD CLAMPING & CUTTING
4.NON-SEPARATION & BREASTFEEDING
Dry the baby
Dry the baby:
Immediate: 30 seconds
Thorough: Face, Head, Body, Extremity
Purpose:
-Stimulation: crying
-Prevents hypothermia: Evaporation
SKIN-TO-SKIN CONTACT
Time: Next 30 secs; within 1 minute
Prone with head turned to side to the mother’s chest/abdomen
Purpose:
-promotes bonding, B.F., Baby’s sucking reflex.
-Prevents hypothermia, hypoglycemia, infection
Nudging: Crawling of the baby to breast.
-Montgomery’s: produces oil :pheromones.
Vision (10 in)
-delays crede’s prophylaxis until baby finds breast >1hr.
What do u call when the manner of crawling of the baby to breast.
Nudging
BEST TIME FOR DELAYED/PROPERLY TIMED CORD CLAMPING & CUTTING
When the pulsation stops
Rationale: Prevents ANEMIA
DELAYED/PROPERLY TIMED CORD CLAMPING & CUTTING
Time: 1-3 minutes
Best time: when the pulsation stops
-Prevents ANEMIA
*Observe aseptic technique.
-Breech: Tetanus Neonatorum
*No milking of the cord
-Can cause intracerebral
hemorrhage
Umbilicus –2cm—C1–3cm–C2
-5cm from umbilicus to c2
-cut near clamp 1
Observe: A-V-A
-Lacking: complication
-Heart defects
-Renal agenesis: Dysfunctional kidneys
-Down syndrome: Trisomy 21 (translocation)
After cord clamping & cutting
-give 10 u of oxytocin (IM)
-To stimulate uterine contraction
No milking of cord, otherwise:
Can cause intracerebral hemorrhage
CLAMPING DISTANCE!!!
1st clamp: 2cm; From umbilicus
2nd clamp: 3cm; from: near 1st clamp
overall= 5cm
Umbilicus –2cm–C1—3cm—C2
*CUT NEAR THE 1ST CLAMP!!!!
After clamping/cutting of cord, Observe for:
Observe: A-V-A
-Lacking: complication
Heart defects
-Renal agenesis: Dysfunctional kidneys
-Down syndrome: Trisomy 21
(translocation)
After cord clamping & cutting
-give 10 u of oxytocin (IM)
-To stimulate uterine contraction
NONSEPARATION & BREASTFEEDING
Nonseparation: 90 mins (1 1/2 hrs)
Breastfeeding: start within 60 minutes
Duration: 20 minutes;
10 mins & 10 mins
1st 10 minutes: Nourishment
2nd 10 minutes: Sucking pleasure
***5 mins per breast
Interval: B.F. per demand/ 2-4 hrs
late sign of hunger:
CRYING
*dont wait until bby cry
Feeding cues:
-Opening mouth
-Licking
-Rooting
-tonguing
-Crying: late sign of hunger
EYE OINTMENT
DELAYED IN 1 HOUR
CREDE’S PROPHYLAXIS
DRUG: Antibiotic (erythromycin)
APPLICATION: 1-2 cm; inner to outer canthus
Prevent: Opthalmia Neonatorum
Chlamydial conjunctivitis,
Gonorrheal conjuctivitis,
Newborn Blindness.
Manner of Applying Crede’s Prophylaxis:
1-2 cm; inner to outer canthus
Causes of opthalmia Neonatorum:
-Gonorrhea: Neisseira Gonorrhea
-Chlamydia: Treponema Pallidum
***Syphilis: baby will have IUFD
90 MINUTES- 6 HOURS
2 vaccines are given:
1 vitamin
BCG
HEPA B
Vitamin K
BCG
-ID
-Right deltoid
-0.05 ml
-Prevents: TB
HEP B
-IM
-Right Vasus Lateralis (outer middle aspect of thigh)
-0.5ml
Vitamin K AKA?
Phytomenadione/ Aquamephyton
Vitamin K
Phytomenadione/ Aquamephyton
-IM
-Left Vastus Lateralis
-0.5 mg (preterm); 1.0 mg (term)
-Prevents: bleeding
ANTHROPOMETRICS:
Height
Normal: 18-22 inches; 45-55cm
Average: 20 inches; 50cm
Height gain:
1 mon-6 mon: 1inch/month
6mon-12mon: 1.5 inch/month
ANTHROPOMETRICS:
Weight
Normal: 2,500-4,000 grams
2.5-4 kg
5.5-8.8 lbs
*1st 10 days/ within 10 days
Weight loss (10% max wt loss)
Physiologic weight loss: Extrauterine life.
After 10 days: Progressive weight gain
Doubles (2x) 6 months
Triples (3x) 12 months
Quadruople (4x) 24 months
ANTHROPOMETRICS:
CIRCUMFERENCE
Head Circumference
13-14 inches; 33-35 cm
Chest circumference
12-13 inches; 31-33 cm
Abdominal Circumference
12-13 inches/ 31-33 cm
***if HC is < CC: Abnormal microcephaly (Low IQ, M.R.)
Cause:
-Hereditry
-Viral infection: Zika, Rubella (forchheimer’s spot: discrete rose-colored spot soft palate; rubella)
6 HOURS AFTER
Bathe the baby
-Bathe 1 part at a time
-test & feel temperature of water
(using elbow)
-never remove vernix caseosa
-For insulation & Infection
Prevention
-Craddle cap/Seborrhea
-Remove by bathing
WOF: hypothermia
PREVENT HEAT LOSS:
-Contact with Cold object/Surface.
-Touching wall, Weigh scale w/o cloth
Conduction
PREVENT HEAT LOSS
-proximity/near cold object;
-Near wall
Radiation
PREVENT HEAT LOSS
-Wet body parts
Evaporation
PREVENT HEAT LOSS
-Room air drafts (Window doors)
-Thermostat
-Ideal room tempt: 25-28 C
Convection
-Ideal room tempt: 25-28 C
WITHIN 24-72 HOURS (1-3 DAYS)
NEWBORN SCREENING
-Heel prick blood
-Med tech: Collect specimen
Trained RN
-Diagnose metabolic congenital diseases
Basic Newborn screening
-6 diseases
Expanded/ Advance N.S.
-28 diseases
-results are available in 1 week
Things to avoid/ Obsolete practices:
-Bathing within 6 hours
-no foot printing
-slapping, spanking, turning upside down
-application of anything in cord stump
APGAR SCORE
-Conduct twice: 1 & 5 minutes
1st: within 1 minute
-Determine the need for resuscitation
2nd: 5 minutes
-check for the adaptation to extrauterine life
-Basis for FDAR
Apgar score: 0-3
SEVERELY DEPRESSED
Management:
-Cpr
-Intubation
-Mechanical Ventilator
-Manual ventilation (ambubag)
-Treat the cause
Apgar score: 4-6
FAIR/GUARDED
Management:
-Suction: withdrawal; 10 secs max
-Hyperoxygenation before & after intermittent
-Gentle and rotating motion
-O2: high flow
WOF: Retrolental Fibroplasia
-Blindness caused by ↑ o2
-Drop light
EXTENDED SKIN-TO-SKIN CONTACT:
KMC (Kangaroo-mother-care)
-can be done by father, grandmother, relatives.
↑ o2 exposure to neonates will lead to:
Retrolental Fibroplasia
-Blindness caused by ↑ o2
-Drop light
Apgar score: 7-10
Routine Newborn care
ASSESSMENT: Head to Toe
VITAL SIGNS
HR: 120-160 bpm
RR: 30-60 cpm
BP: Sytole: 60-80 mmhg
Diastole: 40-50 mmhg
Temperature: 36-5- 37.2
-1st rectal: imperforated anus
-2nd axillary
SaO2: >95%
