Antenatal Steroids: The Evidence

• Overall reduction in neonatal death

RR 0.69 (95% CI 0.58-0.81)

• Reduction in RDS RR 0.66 (95% CI 0.59 to 0.73)

• Reduction in cerebroventricular hemorrhage RR 0.54 (95% CI 0.43 to 0.69)

• Reduction in sepsis in the first 48 hours of life

RR 0.56 (95% CI 0.38 to 0.85) Does not increase risk of death, chorioamnionitis ar puerperal sepsis in the
mother

Antenatal Steroids

Betamethasone 12 mg IM q 24 hrs x 2 doses

⚫ May be the preferred drug-less PVL

Dexamethasone 6 mg IM q 12 hrs x 4 doses

• Have dexamethasone available in the E-cart

No additional benefit to using higher or more frequent doses

• Prednisone, methylprednisolone, cortisol are

Unreliable

Every Newborn Has Needs

To breathe normally

• To be warm

• To be protected

• To be fed
Providing Warmth: Check the Environment

• Check temperature of the

delivery room

• Ideal temp: 25-28°C

• Check for air drafts

Turn air conditioner off at time of delivery

Immediate Thorough Drying- to prevent hypothermia and to prevent the heat loss through the process
of evaporation as well as to stimulate breathing

Dry the newborn thoroughly for at least 30 ssecond

Do a quick check of breathing while drying

>95% of newborns breathe normally after birth

Follow an organized sequence (from the face, back of head and back, the chest and the extremities)

Wipe gently, do not wipe off the vernix- because it has insulator, moisturizer and it prevents the growth
of bacteria such as e. coli and group b streptococci

Remove the wet cloth, replace with a dry one.

Immediate Thorough Drying

Immediate drying:

Stimulates Breathing

Prevents hypothermia

Hypothermia can lead to

•Infection

Coagulation defects

Acidosis

Delayed fetal to newborn circulatory adjustment

• Hvaline membrane disease

Immediate Thorough Drying

If baby not breathing. STIMULATE by DRYING!

Do not slap, shake or rub the baby

Do not ventilate unless the baby is floppy/limp and not breathing

Do not suction unless the mouth or nose are blocked by secretion- Rationale: Vigorous suction can lead
to injury of mucosa

Early Skin-to-Skin Contact- to prevent heatloss thru the process of conduction

If breathing or crying: Position prone on the

mother's abdomen or

chest

Cover the newborn Dry linen for back- to prevent heat loss through the process of radiation
Bonnet for head.

Temperature Check Room: 25-28 °C

Baby: 36.5-37.5°C

When should the cord be clamped after birth?

When the cord pulsations stop

Between 1 and 3 minutes

Not less than 1 minute in terms and preterms needing PPV

All of the above are appropriate

Properly-Timed Cord Clamping

When preparing for delivery, don 2 pairs

of gloves after thorough handwashing

Remove the first set of gloves Palpate the umbilical cord

Wait 1-3 minutes or until cord pulsations have stopped.

⚫Clamp cord using a sterile

plastic clamp or tie at 2 cm from the umbilical base

Clamp again at 5 cm from the base

Cut the cord close to the plastic clamp

Note: Check for oozing of the blood from the cord.

All nb are prone to bleeding because they have hypoprothrombinemia (low prothrombin) (a
prothrombin is a factor in the clotting mechanism) Why NB has low prothrombin? It is because they do
not have vitamin K because it is not transferred thru fetoplacental circulation and NB can not produce
their own vit k due to their GIT is sterile. The production of vit k is produced with the help of intestinal
flora.

Care of the Cord

• DRY cord care is recommended.

• Do not apply any substance onto the cord
• Do not use a binder or "bigkis"- because cord needs to be exposed for airdrying
• Observe for the oozing of blood. If blood oozes, place a second tie between the skin and the
clamp

Washing the Baby in the First 6 Hours is Protective?

-No because the washing will remove vernix caseosa

Washing

Vernix

• protective barrier to Ecol and Group Strep

Early washing

Hinders crawling reflex-

Can lead to hypothermia

infection, coagulation defects, acidosis, delayed fetal to newborn circulatory adjustment, hyaline
membrane disease and brain hemorrhage

BQ: What is the approximate capacity of a newborn's stomach?

- Approximately 5cc

How long after birth is a newborn ready to breastfeed?

It should be between 20-60mins and wait for the NB to show feeding cues.

Mother for Early Breastfeeding

Weighing, bathing, eye care, examinations, injections

should be done after the first full breastfeed is

completed

Postpone bathing until at least 6 hours

Non-separation of

Newborn from Mother Never leave the mother and baby unattended

• Monitor mother and baby q15 minutes in the first 1-2 hrs. Assess breathing and warmth.

Breathing: listen for grunting (may indicate upper airway obstruction)

look for chest in Drawing and fast breathing (rr of more than 60bpm)

Warmth: check to see if feet are cold to touch if no thermometer

Early and Appropriate Breastfeeding Initiation

Leave the newborn between the mother's breasts in continuous skin-to-skin contact

• The baby may want to rest for 20-30 mins and even up to 120 minutes before showing signs of
readiness to feed (Opening of eyes, mouth opens and tongue's out,

Note: The NB vision has limitation. Clearest visual distance is only 9 to 12 inches.

NB can see but limited only to 9-12 inches. NB is colorblind and can only see black like black nipple.

Early and Appropriate Breastfeeding Initiation

• Health workers should not touch the newborn unless there is a medical indication

• Do not give sugar water, formula or other prelacteals • Do not give bottles or pacifiers

Do not throw away colostrum (usually it is color yellow and thick) (Colustrum is important on the part of
the baby, because it contains living Wbc, antibodies, certain factors that is very benefitial to the
gastrointestinal tract of the baby orbits growth factor.

• Let the baby feed for as long as he/she wants on both breasts

Help the mother and baby into a comfortable position

• Observe the newborn

Once the newborn shows feeding cues, ask the mother to encourage her newborn to move toward the
breast
Ensure that the mother and baby are both in a comfortable position.

Breastfeeding cues:

eye movement under closed lids

increased alertness

of arms and legs

⚫tossing, turning or wiggling

mouthing, licking, tounging movements

⚫rooting

changes in facial expression

⚫squeaking noises or light fussing

Crying is a late sign of hunger.

Support Continued and Exclusive Breastfeeding

• After delivery, mother is moved onto a stretcher with her baby and transported to Recovery Room,
mother-baby ward or private room

• Breastfeeding support is continued

Counsel on positioning

• Newborn's neck is not

flexed or twisted

Newborn is facing the breast

Newborn is close to

mother's body

Newborn's whole body is supported

Counsel on attachment and suckling (REMEMBER THIS)

Mouth wide open

Lower lip turned outwards

• Baby's chin touching breast

• Suckling is slow, deep with some pauses (it has pause because the baby is swallowing)

BQ: Why the areola needs to be inside the nb mouth?

-because beneath the areola is the lactopherosinuses (milk reservoir)

Proper Breastfeeding Hold

Look for a quiet place

• Find a most relaxed position for mother

• Provide adequate back support

Support feet

Do not hunch shoulders

Cradle vs. Cross Cradle Hold

If mother has 2 babies

Football hold

Baby is held like a clutch bag

Nose further away.

from the breast.

• Baby's trunk is secure beside mother's trunk

NOTE: The more baby sucks the nipple the more milk is produced.

Sucking stimulates production of milk for prolactin and oxytoxin to work.

Breastfeeding after Caesarian

Side-Lying Position-

Note: The breast should not be scissored it should be cupped.

The following Newborn Care Practices will save lives:

Immediate and Thorough Drying

Early Skin-toxin Contact

Properly-Timed Cord Clamping

Non-separation of Newborn from Mother for Early Breastfeeding

Immediate Care to the NB

• Crede’s prophylaxis Prevention of Gonococcal conjunctivitis/ ophthalmia neonatorum

Signs: red, swelling, purulent discharges prevent

Passes the birth canal of the infection mother (Gonorrhea))

Ophthalmic antibiotic/ antiseptic

Chemical conjunctivitis side effect of Sever Nitrate Serous discharge red, swollen

• Hypoprothrombinemia prophylaxis
Prevention of bleeding Vitamin K injection
1mg
IM
Thigh, vastus lateralis, anterior-lateral middle third of the thigh

3. Immunization

Hepa B injection at birth

-IM
-0.5ml
-thigh, vastus lateralis
BCG anytime after birth
-ID
-0.05ml
-right deltoid

Measurements

Weight

The birth weight of newborn infants differ depending on the

-racial,
-nutritional
-intrauterine, --- any condition in the mama that may actually decrease the oxygenation in the
uterus will lead to small baby
If mother has diabetes- large baby
Has heart, thyroid problem---- small baby

-genetic factors that were present during conception and pregnancy

Range: 2700-4100 grams or 6-9 pounds or 2.7-4.1 kilograms

2.5kg---- lower limit
If below 2.5kg----- low birth weight

Average: 3000 grams or 7 pounds or 3 kilograms

Sex=the average female is born lighter than a male

Ordinal position= second born children generally weigh more Than first borns;
Weight Continues to increase with each succeeding child in the family.

Caucasians generally weigh approximately a half pound more than

First week of life-----

-the newborn loses 5 to 10 percent of birth weight (6 to 10 ounces) during the first few days
after birth. This weight loss is called physiologic weight loss

and which occurs because of

withdrawal of hormones originally obtained from mother (estro and proge is high during
pregnancy)
fluid intake is limited----- because of NB small tummy
loss of urine and feces---- nb needs to urinate and defecate during 24hrs after birth
The original birth weight of the newborn is regained by the 7 to the 10 day – following the initial
weight loss of weight, the newborn has one day of stable weight and then will begin to gain
about.

20 grams per day for the first 5 months.

15 grams per day up to 1 year. So that the weight of the infant

Is DOUBLED at 5-6 months and TRIPLED at the end of 1 year:

If doubled in 4th moth----- overfeeding