Care of Sick Newborn
Weight <1.5 kg or any danger signs; not feeding, chest in drawing, fast breathing, convulsion or temperature <35.5 degree Celsius or >37.5 degree Celsius.
Care of Sick Neonates
Sick neonates is one who has any of the following features;
1. Weight <1500 gram
2. Temperature <36 degree Celsius despite of warming for one hours.
3. Cried after 5 minutes of birth.
4. Absent sucking
5. Not arousable
6. Respiratory rate more than 60 breaths/minutes with chest retraction.
7. Apnea or gasping respiration
8. Central cyanosis
9. Jaundice staining palms/ soles
10. Convulsion
11. Bleeding
12. Major malformation
13. Presence of two of the following-
1. Diarrhea or vomiting or abdominal distension
2. Umbilicus draining pus
3. Multiple skin pustules
4. Fever
If at risk neonates doesn't improve while being observed under care, also consider is sick neonates.
Care of the Sick Neonates
Immediate care Provided, the principles of care are;
1. Warmth
Thermal protection
2. Stabilization
Emergency triage
Sick Neonates need physical stimulation, bag and mask ventilation or oxygen.
If necessary intravenous access medication administrated.
Injection Dextrose (10%) 2ml per kg IV start.
Injection normal saline 10ml per kg IV, slowly over 10 minutes if pulses are poor or capillary refill time is over 3 seconds.
Injection Vitamin K 1 mg IM (if not given at birth)
3. Feeds
Feeding of normal and low birth weight baby.
Started on IV fluids; depending level of sickness.
Once baby stable, put mother's breast and allowed to breastfeed.
If baby unable to suck.
Given expressed breast milk by Gavage or spoon or paladai.
4. Specific therapy
First dose of antibiotics;
Injection Ampicillin 50 mg/kg IV start.
Injection Gentamicin 2.5 mg/kg IV start.
Vitamin K and anti convulsants, if indicated.
Oxygen started in baby with respiratory distress or central cyanosis.
5. Monitoring
All signs should monitored every one hours (hourly). Sign to be monitor;
Temperature
Sucking
Sensorium
Respiration
Apnea
Cyanosis
Convulsion
Bleeding
Diarrhea
Vomiting
Abdominal distension
Capillary refill time.
6. Communication
Explain condition of baby.
Explain need for referral, if baby can't managed.
Explain care during transport.
7. Organize transport (transportation of neonates)
Ensure warmth on the baby.
Keep baby's trunk and palms/sole warm to touch, keep airway open, physical stimulation if apneic.
Fastest mode of transport by shortest route (Incubator).
Prevention of Infection
Prevention of infection is more cost effective than treating infection in neonates.
Transmit of organism during routine procedure, colonization of organisms on surrounding skin of abdomen, perineum, groin and respiratory tract.
Asepsis Basics
Asepsis in baby care area;
1. Running water supply
2. Soap
3. Elobw and foot oriented tops
4. Strict hand washing
5. Avoid overcrowding
6. Recruit optimal number of nurses for care for more babies.
7. Plenty of disposables
8. Rational antibiotic policy asepsis routine and house keeping.
9. Strict adherence to housekeeping and asepsis routines.
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WHO Classification of Respiratory Distress
Classification Respiratory Grunting Requirement of oxygen Nasal Nasal
rate(bpm) or chest indrawing by hood catheter prongs
1. Severe more than 90, present. >5 liter/min. >1 liter/minutes. 3-5 liter/min
Less than 30
2. Moderate more than 90. Absent 3-5litre/min. 0.5-1.0 litre/minutes. 0.5- 1.0 litre/minutes
3. Moderate 60-90. Present. 3-5 liter/minutes. 0.5- 1.0 liter/minutes.0.5- 1.0 litre/minutes
4. Mild 60-90. Absent. <3 liter/minutes. <0.5 litre/minutes <0.5 litre/minutes
Note-
Avoid using nasopharyngeal catheter, partial- rebreathing mask and non rebreathing masks in neonates.
To reduce incidence of retinopathy of prematurity and other complication titre (concentration of solution) of oxygen flow to maintain saturation between 90-95% with continuous pulse oximeter.
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