PN Info- Baby

Question 1

Baby Weigh Schedule and “Normal” gain

Answer 1

• • Day 5 – up to 7%
  • Day 10-14 - Regain birth weight
  • Weekly. expect 25-30g / day
  • 72hrs (ONLY if risk factors)

Question 2

Normal output for baby

Answer 2

is baby output normal?
day 1- 1 Mec, 1 wet nappy
day 2- 1 mec, 2 wet nappy
day 3- 3 transitional, 3 wet nappy (transitioning poo + increased wet nappies indicates lactogenesis II)
day 5- 3 soft/yellow, 5 wet
day 6- 3 soft/yellow, 6 wet

Question 3

BF plan 1- ( weight loss 7-10%)

Answer 3

-Breastfeeding assessment
- Identify + address attachment / position issues
- Confirm milk transfer
- ≥ 8 feeds / 24 hours
- Skin to skin
- Explain normal output
- Reweigh in 24hrs
If no gain / further loss, use plan 2

Question 4

Feeding plan 2- (10-12.5% loss)

Answer 4

Plan
- Increase feed vol
- BF 2-3 hourly
- Top Ups (ideally expressed milk)
§ Half of daily feed required (~10-20ml top up/ feed?)
- **Promote Skin to Skin
- Review / assess issues
**- Take comprehensive hx
**- LC referral **
- Reweigh after 24hours
- If gain- continue close monitoring and wean down top ups
- If no gain- Plan 3

**REFER /CONSULT- NICU

Question 5

Metabolic Screening (capillary sampling)

Answer 5

1) select site-
Choose sides of foot- ideally little toe side.
( imagine line from middle of big and small toe

2) encourage BF/ SKIN TO SKIN
3) clean site and let alcohol ry
4) position lancet- perpendicular?
5) wipe away first drop
6) allow 2nd large drop to form
7) fill all circles

Question 6

Jaundice-
causes/ signs of “physiological” vs “pathological”

Answer 6

“physiological jaundice”
* baby makes fHb which breaks down into bilirubin
* bilirubin broken down slowly after birth due to immature liver- helped by BF
* Normal for babies (60%) have some excess bilirubin- believed to have protective benefits for baby
* assessing bilirubin- location of jaundice + sclera of eyes / baby’s gums
* indication
—> visible ~72 hrs postpartum, peaks day 4, declines over next week
—-> baby alert, normal muscle tone, feeding well, normal PU

**pathological jaundice
**excess bilirubin due to issues clearing bilirubin (e.g. preterm, BF issues, haemolysis (ABO incompatibility, Rh immunisation, sepsis)
indication
—> present <24hrs post partum
—-> late onset (7-0 days), prolonged after 7-10 days

Question 8

Cause of baby regurgitation

Answer 8

immature control of stomach / muscle tone.

Question 9

Normal umbilicus separation physiology

Answer 9

• Cord drys out, hardens, turns black.
• Separation should occur 5-15 days (lthugh can take longer)
• Note- moist and sticky appearance is not necessarily sign of infection - assess baby alert / feeding well, afebrile?

Care
- skin to skin (helps colonise baby)
- care giver Hand washing
- avoid bathing baby with cord in situ- top n’ tail
- keep cord area clean and dry- can use wet cotton wool if area is soiled with urine/faeces
- expose cord to light- fold nappy down
– DON’T USE ANTISEPTICSs - this prolongs healing process + hinders separation

Signs of infection
-redness, oedema, tenderness
-bleeding from cord
-smelly discharge
signs of systemic infection (pyrexia, lethargy, poor feeding)