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Postnatal care of the baby
Dr Utpal Sharma
Assistant Professor
Dept Of Community Medicine
Sikkim Manipal Institute of Medical
Sciences
Introduction
 Infants (0-1year) constitutes about 2.92% of total population of
India
 Of 136 million births every year 90% are in third world.
 About 20-30% of the thee babies are underweight
 About 40% of total infant mortality occurs in the 1st
month of the life
 During weaning period about 25% children doesn’t receive quality
nutrition…
….making them susceptible to impaired health conditions
later in life
 Many low cost measures like immunization, breast feeding etc.
are available to save these precious lives
Objectives of early
neonatal care
Establish and maintenance of cardio-respiratory
functions
Maintenance of body temperature
Avoidance of infection
Establishment of suitable feeding regimen
Early detection and treatment of congenital and
acquired disorders
Immediate care
Clearing the airway
The airway should be cleared of mucus and
other secretions
For newborns already subjected to hypoxia
resuscitation requires more active measures
If the heart is not beating for 5 min, probably
the baby dead
Apgar score
Taken at 1min and again at 5min after birth
Requires immediate and careful observation of
Heart rate
Respiration
Muscle tone
Reflex response
Colour of the infant
Each sign is given a score of 0,1or 2
Perfect score is 9-10, of a total score of 10
A score of 0-3 indicates baby is severly
depressed, 4-6 indicate moderate depression
Cont…
Score below demands prompt action
Low Apgar score at the end of 5 min is
associated with….
….high risk of complication and
…..death during neonatal period
Appearance
Pulse
Activity
Grimace
Respiration
Apgar score chart
Cont…
Care of cord
Cord should be cut only after cessation of pulsation
Stump should be kept dry with no application
Care of eyes
Should be cleaned before opening with sterile swabs
from inner to outer side
Any discharge from eyes is pathological
and demands immediate treatment
As a preventive measure maternal genital tract
infections should be treated beforehand
Cont….
Care of skin
 First bath/sponging may be delayed for 24 hrs after birth
 Thereafter no need of bathing till discharged
Maintenance of body temperature
 Normal body temperature of a newborn is 36.5º to 37.5º C
 Most of the heat loss occurs trough evaporation of amniotic
fluid from the body of the wet child
 About 75% of heat loss occurs from the head
 It is important to dry the baby quickly with a
clean cloth and wrapped in warm clothing
A naked newborn exposed to an
environmental temperature of 230
C
suffers the same heat loss as a naked
adult in 0 0
C
Do you know…..?????
Cont….
Breast feeding
 Initiated within 1/2 hour in case of a vaginal delivery
and within 4-6 hours in case of a C/S. (IYCF)
 First milk called “colostrum” should be given to the
baby
 Exclusive breast feeding should be practiced for six
months
 Baby should be breastfed ON DEMAND i.e. whenever
the baby cries for feeds.
 Time interval between each feed is about 2 to 3 hours.
 Frequency of feeds should be at least 8-10 times in 24
hours and compulsory night feeds
Warm chain
At delivery:
 Ensure the delivery room is warm (25° C), with no draughts.
 Dry the baby immediately; remove the wet cloth.
 Wrap the baby with clean dry cloth.
 Keep the baby close to the mother to stimulate early
breastfeeding.
 Postpone bathing/sponging for 24 hours.
After delivery:
 Keep the baby clothed and wrapped with the head covered.
 Minimize bathing especially in cool weather or for small
babies.
 Keep the baby close to the mother.
 Use kangaroo care for stable LBW babies and for re-warming
stable bigger babies
Low birth weight babies
Introduction
Birth weight is the single most important determinant
of chances of child survival, healthy growth and
development.
Low Birth Weight (LBW)babies are grouped as
Preterm (short gestation) and…
Small for Age/Date (SFA/D) term infants.
Countries with fewer incidence of LBW, preterm is
the cause
In countries like India, where the proportion of LBW
is high, majority of LBW is due to SFA.
Cont…
 By international agreement LBW is considered as
Low Birth Weight (LBW) :
 Any neonate weighing less than 2500 gm at birth
irrespective of gestational age.
Very Low Birth Weight baby (VLBW) :
 Any neonate weighing less than 1500 gm at birth
irrespective of gestational age.
Extremely Low Birth Weight baby (ELBW) :
 Any neonate weighing less than 1000 gm at birth
irrespective of gestational age.
…when measured preferably within one hour of life
Cont…
 Besides this babies are also classified according to the
gestational age
Pre-term Baby :
 Babies born before 37 completed weeks (<259 days) of
gestation irrespective of the birth weight.
Term baby :
 Babies born between 37 to 42 weeks of pregnancies
(259-294 days) irrespective of the birth weight.
Post-term baby
 Babies born at 42 completed week or thereafter (> 294
days of gestation)
Cont…
A LBW is any infant with birth weight <2.5 kg
irrespective of gestation and includes….
Extremely preterm (<28 weeks of gestation)
Very preterm (28-32 weeks of gestation)
Moderate to low preterm (32-37 weeks of gestation)
Even though born early their intrauterine growth
may be normal according to the gestation
Given good care, these babies catch up good
growth and by 2-3 years of age will be of normal
size and performance.
Scenario
 In 2010, an estimated 15 million babies were born
prematurely and about more than 1 million of these died
globally.
 Prematurity is now the leading cause of deaths amongst
under-5 year children…..
..…and single most important cause of death in the
first month of life.
 The survivors may face a lifetime with significant
disability
Causes of preterm birth
Preterm births are classified into two groups
Spontaneous preterm birth
Provider initiated preterm birth
Prematurity is an important risk factor for developing
NCDs (HTN, DM) in later life for these babies
This creates a intergenerational cycle of risk
So the link between prematurity and NCDs adds a
very important dimension in public health aspect…
…..when increasing trend of both are
observed worldwide
Types of preterm births and risk
factors involved
Spontaneous preterm births Provider initiated preterm
births
Age at pregnancy and
spacing
Multiple pregnancy
Infection
Underlying chronic medical
condition
Lifecycle/ work related
Psychological health
Genetic and other
Medical induction /
Cesarean section for maternal
or foetal indication
Other- Not medically
indicated
Small for date babies
May be born at term or preterm
Weighs less than 10th
percentile
for the gestational age
Results due to intrauterine growth retardation
These babies have high mortality rate not only in
neonatal period but during infancy as well
Hence inflate the perinatal and infant mortality rates
They are frequent victims of PEM and infections
Cont…
In developing nations 3 determining factors
are associated with adverse prenatal and
postnatal development of the child
Malnutrition
Infections
Unregulated pregnancy
LB
W
Factors associated with IUGR
Maternal factors Placental cause Foetal causes
Malnutrition
Severe anemia
Heavy physical work
during pregnancy
Hypertension
Malaria
Toxemia
Smoking
Low socio-economic
status
Short maternal stature
Very young age
High parity and close
spacing
Low educational
status
Placental insufficiency
Placental
abnormalities
Foetal abnormalities
Intrauterine infections
Chromosomal
abnormalities
Multiple gestation
Importance
 High incidence
 Association with mental retardation
 High risk of perinatal and infant mortality
 Human wastage and suffering
 Very high cost of special care
 Association with socioeconomic underdevelopment
 Infant mortality is 20 times higher in LBW babies
 Serves as an important guide for level of care to the children
 Indicates the malnutrition and ill health of the mother
 High percentage of LBW warrants need of improved care of
newborn
What Problems Do Low Birth
Weight Babies Have?
 Breathing problems at birth and later.
 Low body temperature because there is little fat on the body
and the newborn’s temperature regulating system is immature.
 Low blood sugar because there is very little stored energy.
 Feeding problems because of their small size, lack of energy,
small stomach and inability to suck.
 Infections because the infection fighting system is not mature.
 Jaundice (high bilirubin) because the liver is not mature.
 Bleeding problems due to immature clotting ability at birth.
Other clinical Problems
related to prematurity
Apnea
IVH
RDS/HMD
NEC
Oxygen toxicity
Prevention
Despite of all efforts rate of LBW can’t be
lowered more than 10% around the world.
This is due to multiplicity of causes
Intervention have to be cause specific
Attention must be given to good prenatal care
and intervention programme…….
…..rather than “treatment” of
the LBW babies born later
Direct Interventions
 Identifying “at risk” pregnant ladies by using mother health
card….
…..primarily by the grass root level health care
workers
 A small increase in food intake, even in the last trimester
results in considerable improvement in weight of the infant
 Other interventions consists of supplementary nutrition, IFA
tablets, food fortification etc.
 Infections affecting foetal growth should be detected and
treated early
 Other medical disorders like HTN, toxemias and diabetes
should be detected and treated early
Indirect interventions
 Family planning
 Avoidance of excessive smoking
 Improved sanitation measures
 Measures to improve health and nutrition of young girls
 In addition improved socioeconomic and environmental
conditions with distribution of health and social
services…..
….. guarantees long lasting effect
 Government support in form of maternity leave and child
benefits.
Treatment
For treating LBW babies, the are classified
into 2 groups
Those under 2 kgs
Requires first class modern neonatal care in
intensive care unit until gains weight >2.5 kg
Those between 2-2.5 kgs
Needs intensive care unit for a day or two
Cont….
Intensive care includes
 Incubatory care comprising adjustment of
temperature, humidity and oxygen supply
 Feeding of baby with breast milk if possible by
nasal catheter.
 Prevention of infections
Leading causes of death in LBW babies
Atelectesis
Malformation
Pulmonary haemorrhage
Intracranial haemorrhage, secondary to trauma or
anoxia
Pneumonia and other infections
Kangaroo mother
care(KMC)
Introduced first in Colombia in 1979
by Dr. Hector Martinez and Dr Edzar Rey
Intervention to combat high infection and
mortality rate owing to overcrowding in
hospitals.
Now adopted across the developing world and
considered as essential element in continuum in
neonatal care
Cont…
 Four components of KMC are
 Skin to skin positioning of baby on mother’s
chest
 Adequate nutrition through breast-feeding
 Ambulatory care as a result of earlier discharge from
hospital
 Support for the mother and her family in caring for the
baby
 For improved management of newborn in facilities,
newer initiatives has been designed
 Newborn care corner
 Newborn stabilizing unit
 Special newborn care unit
Thank you
for listening
to my story

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Low birth weight

  • 1. Postnatal care of the baby Dr Utpal Sharma Assistant Professor Dept Of Community Medicine Sikkim Manipal Institute of Medical Sciences
  • 2. Introduction  Infants (0-1year) constitutes about 2.92% of total population of India  Of 136 million births every year 90% are in third world.  About 20-30% of the thee babies are underweight  About 40% of total infant mortality occurs in the 1st month of the life  During weaning period about 25% children doesn’t receive quality nutrition… ….making them susceptible to impaired health conditions later in life  Many low cost measures like immunization, breast feeding etc. are available to save these precious lives
  • 3. Objectives of early neonatal care Establish and maintenance of cardio-respiratory functions Maintenance of body temperature Avoidance of infection Establishment of suitable feeding regimen Early detection and treatment of congenital and acquired disorders
  • 4. Immediate care Clearing the airway The airway should be cleared of mucus and other secretions For newborns already subjected to hypoxia resuscitation requires more active measures If the heart is not beating for 5 min, probably the baby dead
  • 5. Apgar score Taken at 1min and again at 5min after birth Requires immediate and careful observation of Heart rate Respiration Muscle tone Reflex response Colour of the infant Each sign is given a score of 0,1or 2 Perfect score is 9-10, of a total score of 10 A score of 0-3 indicates baby is severly depressed, 4-6 indicate moderate depression
  • 6. Cont… Score below demands prompt action Low Apgar score at the end of 5 min is associated with…. ….high risk of complication and …..death during neonatal period Appearance Pulse Activity Grimace Respiration
  • 8. Cont… Care of cord Cord should be cut only after cessation of pulsation Stump should be kept dry with no application Care of eyes Should be cleaned before opening with sterile swabs from inner to outer side Any discharge from eyes is pathological and demands immediate treatment As a preventive measure maternal genital tract infections should be treated beforehand
  • 9. Cont…. Care of skin  First bath/sponging may be delayed for 24 hrs after birth  Thereafter no need of bathing till discharged Maintenance of body temperature  Normal body temperature of a newborn is 36.5º to 37.5º C  Most of the heat loss occurs trough evaporation of amniotic fluid from the body of the wet child  About 75% of heat loss occurs from the head  It is important to dry the baby quickly with a clean cloth and wrapped in warm clothing
  • 10. A naked newborn exposed to an environmental temperature of 230 C suffers the same heat loss as a naked adult in 0 0 C Do you know…..?????
  • 11. Cont…. Breast feeding  Initiated within 1/2 hour in case of a vaginal delivery and within 4-6 hours in case of a C/S. (IYCF)  First milk called “colostrum” should be given to the baby  Exclusive breast feeding should be practiced for six months  Baby should be breastfed ON DEMAND i.e. whenever the baby cries for feeds.  Time interval between each feed is about 2 to 3 hours.  Frequency of feeds should be at least 8-10 times in 24 hours and compulsory night feeds
  • 12. Warm chain At delivery:  Ensure the delivery room is warm (25° C), with no draughts.  Dry the baby immediately; remove the wet cloth.  Wrap the baby with clean dry cloth.  Keep the baby close to the mother to stimulate early breastfeeding.  Postpone bathing/sponging for 24 hours. After delivery:  Keep the baby clothed and wrapped with the head covered.  Minimize bathing especially in cool weather or for small babies.  Keep the baby close to the mother.  Use kangaroo care for stable LBW babies and for re-warming stable bigger babies
  • 14. Introduction Birth weight is the single most important determinant of chances of child survival, healthy growth and development. Low Birth Weight (LBW)babies are grouped as Preterm (short gestation) and… Small for Age/Date (SFA/D) term infants. Countries with fewer incidence of LBW, preterm is the cause In countries like India, where the proportion of LBW is high, majority of LBW is due to SFA.
  • 15. Cont…  By international agreement LBW is considered as Low Birth Weight (LBW) :  Any neonate weighing less than 2500 gm at birth irrespective of gestational age. Very Low Birth Weight baby (VLBW) :  Any neonate weighing less than 1500 gm at birth irrespective of gestational age. Extremely Low Birth Weight baby (ELBW) :  Any neonate weighing less than 1000 gm at birth irrespective of gestational age. …when measured preferably within one hour of life
  • 16. Cont…  Besides this babies are also classified according to the gestational age Pre-term Baby :  Babies born before 37 completed weeks (<259 days) of gestation irrespective of the birth weight. Term baby :  Babies born between 37 to 42 weeks of pregnancies (259-294 days) irrespective of the birth weight. Post-term baby  Babies born at 42 completed week or thereafter (> 294 days of gestation)
  • 17. Cont… A LBW is any infant with birth weight <2.5 kg irrespective of gestation and includes…. Extremely preterm (<28 weeks of gestation) Very preterm (28-32 weeks of gestation) Moderate to low preterm (32-37 weeks of gestation) Even though born early their intrauterine growth may be normal according to the gestation Given good care, these babies catch up good growth and by 2-3 years of age will be of normal size and performance.
  • 18. Scenario  In 2010, an estimated 15 million babies were born prematurely and about more than 1 million of these died globally.  Prematurity is now the leading cause of deaths amongst under-5 year children….. ..…and single most important cause of death in the first month of life.  The survivors may face a lifetime with significant disability
  • 19. Causes of preterm birth Preterm births are classified into two groups Spontaneous preterm birth Provider initiated preterm birth Prematurity is an important risk factor for developing NCDs (HTN, DM) in later life for these babies This creates a intergenerational cycle of risk So the link between prematurity and NCDs adds a very important dimension in public health aspect… …..when increasing trend of both are observed worldwide
  • 20. Types of preterm births and risk factors involved Spontaneous preterm births Provider initiated preterm births Age at pregnancy and spacing Multiple pregnancy Infection Underlying chronic medical condition Lifecycle/ work related Psychological health Genetic and other Medical induction / Cesarean section for maternal or foetal indication Other- Not medically indicated
  • 21. Small for date babies May be born at term or preterm Weighs less than 10th percentile for the gestational age Results due to intrauterine growth retardation These babies have high mortality rate not only in neonatal period but during infancy as well Hence inflate the perinatal and infant mortality rates They are frequent victims of PEM and infections
  • 22. Cont… In developing nations 3 determining factors are associated with adverse prenatal and postnatal development of the child Malnutrition Infections Unregulated pregnancy LB W
  • 23. Factors associated with IUGR Maternal factors Placental cause Foetal causes Malnutrition Severe anemia Heavy physical work during pregnancy Hypertension Malaria Toxemia Smoking Low socio-economic status Short maternal stature Very young age High parity and close spacing Low educational status Placental insufficiency Placental abnormalities Foetal abnormalities Intrauterine infections Chromosomal abnormalities Multiple gestation
  • 24. Importance  High incidence  Association with mental retardation  High risk of perinatal and infant mortality  Human wastage and suffering  Very high cost of special care  Association with socioeconomic underdevelopment  Infant mortality is 20 times higher in LBW babies  Serves as an important guide for level of care to the children  Indicates the malnutrition and ill health of the mother  High percentage of LBW warrants need of improved care of newborn
  • 25. What Problems Do Low Birth Weight Babies Have?  Breathing problems at birth and later.  Low body temperature because there is little fat on the body and the newborn’s temperature regulating system is immature.  Low blood sugar because there is very little stored energy.  Feeding problems because of their small size, lack of energy, small stomach and inability to suck.  Infections because the infection fighting system is not mature.  Jaundice (high bilirubin) because the liver is not mature.  Bleeding problems due to immature clotting ability at birth.
  • 26. Other clinical Problems related to prematurity Apnea IVH RDS/HMD NEC Oxygen toxicity
  • 27. Prevention Despite of all efforts rate of LBW can’t be lowered more than 10% around the world. This is due to multiplicity of causes Intervention have to be cause specific Attention must be given to good prenatal care and intervention programme……. …..rather than “treatment” of the LBW babies born later
  • 28. Direct Interventions  Identifying “at risk” pregnant ladies by using mother health card…. …..primarily by the grass root level health care workers  A small increase in food intake, even in the last trimester results in considerable improvement in weight of the infant  Other interventions consists of supplementary nutrition, IFA tablets, food fortification etc.  Infections affecting foetal growth should be detected and treated early  Other medical disorders like HTN, toxemias and diabetes should be detected and treated early
  • 29. Indirect interventions  Family planning  Avoidance of excessive smoking  Improved sanitation measures  Measures to improve health and nutrition of young girls  In addition improved socioeconomic and environmental conditions with distribution of health and social services….. ….. guarantees long lasting effect  Government support in form of maternity leave and child benefits.
  • 30. Treatment For treating LBW babies, the are classified into 2 groups Those under 2 kgs Requires first class modern neonatal care in intensive care unit until gains weight >2.5 kg Those between 2-2.5 kgs Needs intensive care unit for a day or two
  • 31. Cont…. Intensive care includes  Incubatory care comprising adjustment of temperature, humidity and oxygen supply  Feeding of baby with breast milk if possible by nasal catheter.  Prevention of infections Leading causes of death in LBW babies Atelectesis Malformation Pulmonary haemorrhage Intracranial haemorrhage, secondary to trauma or anoxia Pneumonia and other infections
  • 32. Kangaroo mother care(KMC) Introduced first in Colombia in 1979 by Dr. Hector Martinez and Dr Edzar Rey Intervention to combat high infection and mortality rate owing to overcrowding in hospitals. Now adopted across the developing world and considered as essential element in continuum in neonatal care
  • 33. Cont…  Four components of KMC are  Skin to skin positioning of baby on mother’s chest  Adequate nutrition through breast-feeding  Ambulatory care as a result of earlier discharge from hospital  Support for the mother and her family in caring for the baby  For improved management of newborn in facilities, newer initiatives has been designed  Newborn care corner  Newborn stabilizing unit  Special newborn care unit

Editor's Notes

  1. ( spontaneous onset of labour following PROM) (induced labour or cesarean section before 37weeks)