Normal Newborn Care

Normal Newborn Care - Advances in Maternal and Neonatal Health

Normal Newborn Care
Session Objective
* Define essential elements of early newborn care
* Discuss best practices and technologies for promoting newborn health
* Use relevant data and information to develop appropriate essential newborn recommendations

Newborn Deaths
Essential Newborn Care Interventions
* Clean childbirth and cord care
o Prevent newborn infection
* Thermal protection
o Prevent and manage newborn hypo/hyperthermia
* Early and exclusive breastfeeding
o Started within 1 hour after childbirth
* Initiation of breathing and resuscitation
o Early asphyxia identification and management
* Eye care
o Prevent and manage ophthalmia neonatorum
* Immunization
o At birth: bacille Calmette-Guerin (BCG) vaccine, oral poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine (WHO)
* Identification and management of sick newborn
* Care of preterm and/or low birth weight newborn

Cleanliness to Prevent Infection
* Principles of cleanliness essential in both home and health facilities childbirths
* Principles of cleanliness at childbirth
o Clean hands
o Clean perineum
o Nothing unclean introduced vaginally
o Clean delivery surface
o Cleanliness in cord clamping and cutting
o Cleanliness for cord care
* Infection prevention/control measures at healthcare facilities

Thermal Protection
* Newborn physiology
o Normal temperature: 36.5–37.5°C
o Hypothermia: < 36.5°C
o Stabilization period: 1st 6–12 hours after birth
+ Large surface area
+ Poor thermal insulation
+ Small body mass to produce and conserve heat
+ Inability to change posture or adjust clothing to respond to thermal stress
* Increase hypothermia
o Newborn left wet while waiting for delivery of placenta
o Early bathing of newborn (within 24 hours)

Hypothermia Prevention
* Deliver in a warm room
* Dry newborn thoroughly and wrap in dry, warm cloth
* Keep out of draft and place on a warm surface
* Give to mother as soon as possible
o Skin-to-skin contact first few hours after childbirth
o Promotes bonding
o Enables early breastfeeding
* Check warmth by feeling newborn’s feet every 15 minutes
* Bathe when temperature is stable (after 24 hours)

Early and Exclusive Breastfeeding
* Early contact between mother and newborn
o Enables breastfeeding
o Rooming-in policies in health facilities prevents nosocomial infection
* Best practices
o No prelacteal feeds or other supplement
o Giving first breastfeed within one hour of birth
o Correct positioning to enable good attachment of the newborn
o Breastfeeding on demand
o Psycho-social support to breastfeeding mother

Breathing Initiation and Resuscitation
* Spontaneous breathing (> 30 breaths/min.) in most newborns
o Gentle stimulation, if at all
* Effectiveness of routine oro-nasal suctioning is unknown
o Biologically plausible advantages – clear airway
o Potentially real disadvantages – cardiac arrhythmia
o Bulb suctioning preferred
* Newborn resuscitation may be needed
o Fetal distress
o Thick meconium staining
o Vaginal breech deliveries
o Preterm

Eye Care To Prevent or Manage Ophthalmia Neonatorum
* Ophthalmia neonatorum
o Conjunctivitis with discharge during first 2 weeks of life
o Appears usually 2–5 days after birth
o Corneal damage if untreated
o Systemic progression if not managed
* Etiology
o N. gonorrhea
+ More severe and rapid development of complications
+ 30–50% mother-newborn transmission rate
o C. trachomatis

Eye Care To Prevent or Manage Ophthalmia Neonatorum (continued)
* Prophylaxis
o Clean eyes immediately
o 1% Silver nitrate solution
+ Not effective for chlamydia
o 2.5% Povidone-iodine solution
o 1% Tetracycline ointment
+ Not effective vs. some N. gonorrhea strains
* Common causes of prophylaxis failure
o Giving prophylaxis after first hour
o Flushing of eyes after silver nitrate application
o Using old prophylactic solutions

Efficacy of Prophylaxis for Conjunctivitis in China
* Objective: To assess etiology of newborn conjunctivitis and evaluate the efficacy of regimens in China
* Design: November 1989 to October 1991 rotated regimens monthly: tetracycline, erythromycin, silver nitrate
* 302 (6.7%) infants developed conjunctivitis, most S. aureus (26.2%) and chlamydia (22.5%)
* Silver nitrate, tetracycline: fewer cases than no prophylaxis (p < 0.05), erythromycin: not significant

Prophylaxis for Conjunctivitis: Objective and Design
* Objective: To compare efficacy in prevention of nongonococcal conjunctivitis
* Design: Randomized control trial to compare erythromycin, silver nitrate, no prophylaxis
o Examined with test for leukocyte esterase and chlamydia trachomatis antibody probe 30–48 hours postpartum, 13–15 days later, and telephone contact up to 60 days of life
* Main outcome measured: conjunctivitis within 60 days of life and nasolacrimal duct patency

Prophylaxis for Conjunctivitis: Results and Conclusion

* Results: 630 infants
* 109 with conjunctivitis
o Silver nitrate vs. no prophylaxis: Hazard ratio 0.61 (0.39-0.97)
+ Chemical conjunctivitis with silver nitrate resolves within 48 hours
o Erythromycin vs. no prophylaxis: Hazard ratio 0.69 (not significant)
* Conclusion: Parental choice of prophylaxis, including no prophylaxis, is reasonable IF antenatal care and STD screening

Povidone-Iodine for Conjunctivitis: Objective and Design

* Objective: To determine incidence and type of conjunctivitis after povidone-iodine in Kenya
* Design: Rotate regimen weekly: erythromycin, silver nitrate, povidone iodine
* Results:
o Conjunctivitis:
+ Chlamydia in 50.5%
+ S. aureus in 39.7%
o More infections in silver nitrate than povidone-iodine, OR 1.76, p < 0.001
o More infections in erythromycin OR 1.38, p=0.001

Povidone-Iodine for Conjunctivitis: Conclusion
Povidone-iodine:
o Is good prophylaxis
o Has wider antibacterial spectrum
o Causes greater reduction in colony-forming units and number of bacterial species
o Is active against viruses
o Is inexpensive

Immunization
* BCG vaccinations in all population at high risk of tuberculosis infection
* Single dose of OPV at birth or in the two weeks after birth
* HBV vaccination as soon as possible where perinatal infections are common

Summary
The essential components of normal newborn care include:

* Clean delivery and cord care
* Thermal protection
* Early and exclusive breastfeeding
* Monitoring
* Eye care
* Immunization
References

Normal Newborn Care.ppt