ESSENTIAL NEWBORN CARE (ENC) / UNANG YAKAP 1. Immediate drying 2. Uninterrupted skin-to-skin contact 3. Proper cord clamping and cutting 4. Non-separation of the newborn from the mother for early breastfeeding

initiation and rooming-in

IMMEDIATE NEWBORN CARE Call out time of birth. Deliver the baby prone on the mothers abdomen. Dry the newborn thoroughly for a full 30 seconds. Remove wet cloth. Check breathing while drying. Position newborn prone on the mothers abdomen in skin-to-skin contact.

Cover the back with a dry blanket. o If this is not possible, place newborn in a warm, safe place close to the

mother. Exclude second baby Remove first set of glove. Clamp and cut the cord after cord stops pulsating (1-3 minutes) for pre-

transfusion and lesser chance of anemia and intraventricular hemorrhage. Maintain skin-to-skin contact; do not separate baby from the mother until a

full breastfeed is achieved; watch for feeding cues. Place identification band on ankle.

CLASSIFICATION OF NEONATAL SEPSIS EARLY ONSET LATE ONSET LATE, LATE ONSET

Time of Onset Birth to 7 days usually 30 days

Intrapartum complication

Often present Usually absent Usually absent

Transmission Vertical: maternal genital

tract

Vertical: Postnatal

environment

Environment/ community

Clinical Manifestations

Fulminant course, multisystem involvement, pneumonia (common)

Insidious, focal infection, meningitis (common)

Multisystem or focal

Prematurity is the most important neonatal factor predisposing to infection

NEONATAL JAUNDICE

Indirect Hyperbilrubinemia: Yellowish Direct Hyperbilirubinemia: Greenish

PHYSIOLOGIC JAUNDICE PATHOLOGIC JAUNDICE Onset 24 HOL usually on the

3rd day of life TSB increasing less than 5

mg/kg/day Decline to adult levels by the

10th to 12th day of life

Early onset < 24 HOL TSB increasing more than 5

mg/kg/day TSB concentration exceeding

12.9 mg/dL (FT) and >15 mg/dL (PT)

DSB > 2 mg/dL or 20% of TSB (total serum bilirubin)

Persists > 1 wk (FT) or >2 wks (PT)

BREASTFEEDING JAUNDICE BREASTMILK JAUNDICE

Occurs in the first week of life Starvation jaundice Can be prevented by frequent

breastfeeding

Occurs beyond the first week of life until the 3rd week of life

Extension of physiologic jaundice Enhanced enterohepatic

absorption of UCB of unidentified factors in human milk which inhibits hepatic glucoronosyl transferase

-glucoronidase converts back conjugated bilirubin to unconjugated bilirubin

NEONATAL COLD INJURY SIGNS AND SYMPTOMS: Apathy Refusal to eat Oliguria Coldness to touch Edema Redness of the extremities Temperature between 29.5-35 C Bradycardia, apnea, hypoglycemia, acidosis and massive pulmonary

hemorrhage TREATMENT OF NEONATAL COLD INJURY Warming

o Warm, ironed blanket o For premature babies, you can put a cap on the head since the head

has the highest surface area (especially important for low birth weight and SGA babies)

o Thermoregulated bed sheet o Radiant warmer

Correction of metabolic disturbances

HYPOGLYCEMIA Definition: Blood sugar of

NEONATAL PNEUMONIA

Route of Transmission Ascending infection Aspiration of infected material during passage through the birth canal Predisposing factor: Prolonged rupture of membranes Causative Agents: Group B Streptococci (major pathogen producing pneumonia for developed country) E. Coli (major organism in the Philippines) Listeria spp.. Klebsiella spp. Enterococcus spp.

Clinical Course: Sign of respiratory distress: Tachypnea, Retractions, Cyanosis Non-specific signs: Apneic spells, Thermal instability, Jaundice

Xray: Streaky densities Confluent opacified areas Diffusely granular appearance with air bronchogram

Treatment: Penicillin/ ampicillin and aminoglycosides Late onset (occurs more than 3 days of life)

o Staphylococcus: Oxacillin / Vancomycin o Chlamydia: Erythromycin o Fungi: Amphotericin B

Duration of treatment: 10 days

TRANSIENT TACHYPNEA OF THE NEWBORN

Follow an uneventful delivery at or near term Major presenting symptom: persistently high RR Other symptoms:

o Mild cyanosis o Minimal respiratory distress

Due to delayed resorption of fetal lung fluid Increased risk in cesarean delivery X-ray:

o Central perihilar streaking o Hyperaeration o Fluid in the minor fissure

Self- limited course Resolves within 6- 8 hours mostly May last for 72 hours Minimal O2 support usually enough Antibiotics not needed

MECONIUM ASPIRATION SYNDROME

Meconium: The first intestinal discharge from newborns; a viscous, dark green substance composed of intestinal epithelial cells, lanugo, mucus, and intestinal secretions, such as bile

Meconium aspiration induces hypoxia via 3 major pulmonary effects:

o Airway obstruction o Surfactant dysfunction o Chemical pneumonitis

Risk Factors Post-Term delivery SGA neonates Ante-intrapartum distress and hypoxia Maternal complications causing impaired uteroplacental blood flow Eg. Hypertension Intrapartum conditions causing impaired uteroplacental blood flow Eg. cord compression

Management Vigorous infants at birth: No required treatment Depressed/non-vigorous infants: Direct endotracheal suctioning Pulmonary toilet (remove all meconium) Supplemental oxygen Antibiotic coverage Mechanical ventilation Surfactant Inhaled nitric oxide Extracorporeal membrane oxygenation (ECMO)