Transcript Care of the well newborn - Ibaden

Care of the newborn infant
Partners in Global Health Education
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
Variations exist from place to
place in the care of the newborn
infant. However, although often
neglected, their basic needs are
the same.
Infants who are unwell or have
congenital abnormalities fall short
of the mother’s expectation of a
beautiful bundle of joy. All
mothers require urgent and
sensitive counselling.
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
For more information about the authors and reviewers of this module,
click here
How should I study this module?
Partners in Global Health Education
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
• This self-directed learning (SDL) module has been
designed primarily for medical students but may also
be of use to healthcare providers especially at the
primary care level.
• We suggest that you first read the learning outcomes
and try to keep these in mind as you go through the
module slide by slide and at your own pace.
• Answer the MCQ at the end to assess your learning.
• You should research any issues that you are unsure
about. Look in your textbooks, access the on-line
resources indicated at the end of the module and
discuss with your peers and teachers.
• Finally, enjoy your learning! We hope that this module
will be easy to study and complement your learning
about newborn care from other sources.
Learning outcomes
Partners in Global Health Education
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
After studying this module, you should be able
to
• Describe the routine clinical assessment of
newborn infants
• Describe some common congenital
abnormalities
• Describe the essential elements of the
routine management of newborn infants
including hygiene, cord care, feeding and
rooming-in
• Describe what routine immunisations are
required during infancy
• Discuss what information is required by
mothers prior to discharge
Clinical assessment
Partners in Global Health Education
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
After delivery of the baby and in
the absence of any immediate
problems, essential newborn
care begins with a thorough
general clinical assessment.
This should be done on all
infants soon after birth to detect
signs of illness and congenital
abnormalities.
The following slides describe the
assessment that should be
performed routinely in all infants.
This initial assessment should
indicate where more detailed
clinical assessment is required.
A resident doctor washing her hands up to
the elbows prior to examination
11. Feeding
12. Immunization
13. Quiz
Hand washing with soap and water before and after a baby
is handled goes a long way in reducing the risk of infection
Clinical assessment
First steps and appearance
Partners in Global Health Education
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
• Start by congratulating the
mother on the arrival of her new
baby and ask if she has any
concerns. The mother is usually
the first person to notice any
problems.
• Ask about feeding and the
passage of urine and stools.
The infant should pass
meconium (the first black, tarry
stools) within 24 hours of birth.
• General observation: inspect
colour, breathing, alertness and
spontaneous activity.
• Well infants have a flexed,
posture. Partially flexed posture
is found in hypotonia or
prematurity
Well term infant showing typical well flexed
posture
Note the abduction of the hips in this
partially flexed preterm infant (“froglike”
posture)
Clinical assessment
Examine skin for prematurity or dismaturity
Partners in Global Health Education
1.
Introduction
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How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
Thin,
transparent
skin in preterm
infants
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Wrinkled peeling skin of
dysmaturity in an IUGR infant
Pale pink skin of a term infant (hair
shaved to site IV line)
Clinical assessment
Skin: some common normal findings
Partners in Global Health Education
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Introduction
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module
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Learning
outcome
4.
Clinical
assessment
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Appearance
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Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
• Vernix caseosa: a cream/white cheesy material on the
skin at birth which cleans off easily with oil.
• Lanugo; fine downy hairs seen on the back and shoulders
especially in preterm infants.
• Milia: pinpoint whitish papules on nose and cheeks due to
blocked sebaceous glands.
• Mongolian blue spots: grey/bluish pigment patches seen in
the lumbar area, buttocks and extremities in dark skinned
babies.They usually disappear by one year.
• Capillary heamangiomas (“stork bite” naevi): red flat
patches which blanch with gentle pressure. Commonly
occur on upper eyelids, forehead and nape of the neck.
• Erythema toxicum: small white/yellow papules or pustules
on a red base seen on face, trunk and limbs. Develop 1 –
3 days after birth and usually disappear by one week.
Clinical assessment
Colour
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outcome
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Clinical
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Appearance
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Skin
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Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
• Note palor or plethora
• Cyanosis: the baby should
be uniformly pink
– Blueness of the hands and
feet (peripheral cyanosis)
may be due to cold
extremeties.
– Blueness of the mucous
membranes and tongue is
central cyanosis and is
usually due to lung or heart
problems
• Bruising (ecchymosis) is
common after birth trauma.
Unlike cyanosis, bruising
does not blanch on gentle
pressure.
A Caucasian infant with marked
central cyanosis
Clinical assessment
Jaundice
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Clinical
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Appearance
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Skin
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Routine care
8.
Cord care
9.
Thermal
control
Jaundice is common in the first week
of life and may be missed in dark
skinned babies
•
Blanch the tip of the nose or hold
baby up and gently tip forward
and backward to get the eyes to
open.
•
Teach mother to do the same at
home in the first week and report
to hospital if significant jaundice is
observed.
Blanching the tip of the nose
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Two infants with jaundice; note yellow sclerae
Clinical assessment
Head
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Introduction
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module
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Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
After these general observations,
examine the infant starting with
the head and moving down the
body.
• Observe the size and shape of
the head (micro- or
macrocephaly;
cephalhaematoma)
• Check the anterior and posterior
fontanelles and that the skull
sutures feel normal
• Form and position of ears (low
set ears occur in chromosomal
abnormalities, e.g. Down
syndrome)
Cephalhaematoma limited to the
right parietal region
Huge encephalocoele. Head
is disproportionately small
Clinical assessment
Eyes and face
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Introduction
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module
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Learning
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4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
• Examine eyes for ocular anomalies and check for
red reflex using the ophthalmoscope (to exclude
cataract)
• Examine the face for dysmorphic features and
normal movements
• Examine lips and palate for clefts
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Bilateral cleft lip and palate. Also
note purulent left eye discharge
Facial asymmetry due to
left facial palsy
Clinical assessment
Cardiovascular and respiratory
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module
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Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
• Feel femoral and radial pulses for volume, rate and
rhythm.
• In aortic coarctation, femoral pulse is reduced, absent
or not synchronous with radial pulse.
• If child is sick, measure blood pressure.
• Locate the apex beat and listen to the heart sounds
for murmurs.
• Count the respiratory rate
– normal 30 – 40 breaths/min in term infants
– faster in preterms.
– > 60 / minute abnormal
• Observe for respiratory distress: nasal flaring,
intercostal and subcostal recession.
Clinical assessment
Abdomen
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module
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Learning
outcome
4.
Clinical
assessment
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Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
•
Inspect the umbilical cord for
presence of 2 arteries and a
vein. Abnormal components
may be a pointer to the
presence of intra-abdominal
anomalies e.g. renal.
•
Look for umbilical
abnormalities, e.g. hernia,
omphalocoele, exompholos
•
Gently palpate the abdomen
– the liver may be palpable
upto 2cm below the costal
margin
– the lower pole of the right
kidney may also be
palpable
Large omphalocoele. Surounding
erythema indicates cellulitis.
Clinical assessment
Spine and genitalia
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module
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outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Examine:
• The spine for dimples, tuft of
hair (spina bifida occulta) or
cystic swellings (spina bifida
cystica)
• Remove the diaper to examine
the genitalia. In boys, confirm
that both testicles have
descended into the scrotum.
• Designate the infant’s sex
• Inspect the perineum and check
anus for position and patency
(can be done by gently checking
rectal temperature)
Spina bifida cystica
Clinical assessment
Dysmorphic features
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Clinical
assessment
5.
Appearance
• Inspect the feet. Note effects of
foetal posture should be noted.
6.
Skin
• Check hips for dislocation
7.
Routine care
8.
Cord care
9.
Thermal
control
• Examine hands. Note single
palmar crease in chromosome
abnormalities.
Short stuby fingers and single
palmar crease of Down syndrome
• Limitation of limb movements
occurs in fractures and nerve
injury
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Talipes affecting the left leg
Clinical assessment
Routine measurements
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1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
Measure:
• Weight
– normal 2.5 – 3.99kg
• Length
– normal 48 – 52cm
• Occipitofrontal
circumference (OFC)
– normal 33 – 37cm
Measurement of OFC using a
non-stretchable tape measure
Routine care of the well newborn
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module
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outcome
Any problems identified during the initial assessment will
need specific management. However, newborn infants
are a highly susceptible group and high-quality routine
care prevents a multitude of problems. The major
elements of routine care include:
4.
Clinical
assessment
• Cord care
5.
Appearance
• Thermal control
6.
Skin
• 24 hour rooming in
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
• Feeding
Click on the links for more
information on these
important elements of routine
care
• Immunization
• Maternal education on hygiene and every other aspect
of routine care
11. Feeding
12. Immunization
13. Quiz
Hand washing with soap and water every time a baby is
handled goes a long way in reducing the risk of infection!
Quiz: Concerning care of the newborn
Write “T” or “F” on the answer sheet. When you have completed
all 5 questions, click on each box and mark your answers.
Partners in Global Health Education
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
a.
b.
Nursing a newborn with the mother
rather than in the nursery predisposes
the child to infections
Hand washing with soap and water
before handling a newborn
significantly reduces the risk of
infection in the baby
Click to reveal
correct answers
a
b
c.
Fortified infant formula is superior to
mother’s breast milk in a sick term
newborn
c
d.
Newborn babies cannot be kept warm
without the use of incubators
d
e.
Jaundice cannot be detected early in
dark skinned babies
e
Sources of information
Partners in Global Health Education
1.
Introduction
2.
How to use
module
3.
Learning
outcome
4.
Clinical
assessment
5.
Appearance
6.
Skin
7.
Routine care
8.
Cord care
9.
Thermal
control
10. Rooming in
11. Feeding
12. Immunization
13. Quiz
• Pocket book of Hospital care for children;
guidelines for the management of common
illnesses with limited resources. WHO
http://www.who.int/child-adolescenthealth/publications/CHILD_HEALTH/PB.htm
• Essential newborn care
http://www.who.int/reproductive health/publications/
• Nelson Textbook of Pediatrics: 16th Edition.
Richard E. Behrman Robert Kliegman, Hal B.
Jenson (Editors),