WELCOME

1. WELCOME PRESENTED BY MRS.BENAZEERA LECTURER,YNCDEPT.CHILD HEALTH NURSING

2. HIGH-RISK NEWBORN

3. Learning objective 1. Define High risk newborn 2. Explain the classification of the High risk newborn 3.Discuss the nursing management of Low-birth weight baby 4. Explain the KMC[kangaroo mother care] 5.Explain the nursing management of High risk newborn

4. HIGH-RISK NEWBORN A newborn, regardless of gestational age or birth weight, who has a greater than average chance of morbidity or mortality because of conditions or circumstances superimposed on the normal course of events associated with birth and the adjustment to extra uterine existence.

6. CLASSIFICATION OF HIGH-RISK NEWBORNS

7. ACCORDING TO SIZE LBW – Less than 2500 gm regardless of gestational age MLBW – 1500 – 2500 gm VLBW - <1500 gm ELBW (Extremely-low-birth-weight ) - <1000 gm

8. INTRAUTERINE GROWTH CHART • AGA (Appropriate-for-gestational-age ) 10th – 90th percentiles on intrauterine growth curves • Small-for-date (SFD) or small-for-gestational age (SGA) - <10th percentile on intrauterine growth curves (= IUGR) • LGA (Large-for-gestational-age  ) > 90th percentile on intrauterine growth curves

9. ACCORDING TO GESTATIONAL AGE Premature/ preterm infant – Born before 37 completed weeks of gestation, regardless of birth weight Full tem infant – Born at 38 weeks and completion of the 42 weeks of gestation, regardless of birth weight Post term/ post mature infant – Born after 42 weeks of gestation, regardless of birth weight

10. According to mortality Live birth – Birth in which the neonate manifests any heart beat, breathes or displays voluntary movement, regardless of birth weight Fetal death - Death of fetus after 20 weeks of gestation and before delivery, with absence of any signs of life after birth

11. According to mortality • Neonatal death – Death in the first 27 days of life (Early – first 7 days) • Post natal death – Deaths that occur at 28 days to 1 year • Perinatal mortality – Total no of fetal and early neonatal deaths per 1000 live births

12. CAUSES

13. FETAL CAUSES • Premature birth. • Fetal growth restriction.

14. Conditions In The Mother • Preterm labor  • Chronic health conditions  • Infections  • Problems with the placenta  • Not gaining enough weight during pregnancy  • Smoking, drinking alcohol and using drugs 

15. Other conditions • Have low income • Education • Are younger than 17 or older than 35

16. NURSING MANAGEMENT OF LOW BIRTH WEIGHT BABY

17. PROBLEMS OF LBW • Hypothermia • Respiratory distress syndrome (RDS) • Bleeding in the brain (called intraventricularhemorrhage or IVH). • Patent ductusarteriosus (PDA). • Necrotizing enterocolitis (NEC) • Retinopathy of prematurity (ROP). • Hyperbilirubinemia • Feeding difficulties • infections

18. CHARACTERISTICS • Born before 37 weeks of gestation • Usually small in size • Head is large and sutures are separated • Face appears small • Skin –shiny and edematous covered with vernix and lanugo

19. Reduced subcutaneous fat • Small breast nodules • Poor activity • Diminished reflexes

20. CARE OF LOW BIRTHWEIGHT BABIE

21. 1. Appropriate Resuscitation /Respiratory Care

22. A. Prevention and Management of Hypothermia • 36 to 37o Celsius (or about 96.8 to 98.6oFahrenheit). • Warming of the rooms - Immediate drying and wrapping after birth - Frequent feeding • Delayed bathing • - Skin to skin contact with the mother (Kangaroo Mother Care) – KMC

23. B. Thermal protection A series of measures taken at birth and during the first few days of life to ensure that the baby maintains a normal body temperature (36.5-37.5°C) • Does not become too cold (<36.5°C = • hypothermia) • Does not become too hot (>37.5°C = • hyperthermia).

25. 2.Appropriate feeding and prevention of Hypoglycaemia

26. 3.Infection Control • Avoiding overcrowding • - Strict policy of clean hands • - Promoting breast feeding • - Skin to skin care • - Limiting use of antibodies

27. Therapeutic - Clean equipment , feeds preparation - Monitoring bacterial cultures and sensitivity - Visiting policy and parent education - Well trained staff

30. KangarooMotherCare

31. COMPONENTS OF KMC • Skin-to-skin contact Early, continuous and prolonged skin-to- skin contact • Exclusive breast feeding Promotes lactation and facilitates feeding KMC-

32. Pre-requisites of KMC • Support to the mother • In hospital & • At home • Post-discharge follow-up

33. Benefits of KMC to the baby • Breast feeding • Increased breast feeding rates • Increased duration of breast feeding • Thermal control • Effective thermal control • Equivalent to conventional incubator care in stable babies

34. Benefits of KMC to the baby • Early discharge • Better weight gain leads to early discharge • Lesser morbidity • Regular breathing • Less apnea • Protection from nosocomial infections

35. Benefits of KMC to the mother • Stronger bonding with the baby • Deep satisfaction • More confident parents

36. Requirements for KMC implementation • Skills Nurses, physicians and other staff • Educational material Information sheets, posters and video films on KMC • Furniture (optional) Semi-reclining easy chairs Beds with adjustable backrest

37. Eligibility criteria: Baby • Birth weight >1800 gm: Start at birth • Birth weight 1200-1799 gm: Hemodynamically stable – takes a few days • Birth weight <1200 gm: need specialized care due to sickness – may take weeks to initiate

38. Eligibility criteria: Mother • Willingness • Lack of significant illness • Hygiene • Supportive family • Supportive community

39. Preparing for KMC • Counseling • Demonstrate procedure • Ensure family support • KMC support group • Mother’s clothing • Front-open, light dress as per the local culture • Baby’s clothing • Cap, socks, nappy and front-open sleeveless shirt or ‘jhabala’

40. What should the baby wear? • Cap • Socks • Nappy and • front-open sleeveless shirt or 'jhabala'

41. What should the mother wear? Any front-open, light dress as per local culture (blouse and sari, gown or shawl)

42. KMC procedure: Kangaroo positioning • Place baby between the mother’s breasts in an upright position • Head turned to one side and slightly extended • Hips flexed and abducted in a “frog” position; arms flexed • Baby’s abdomen at mother’s epigastrium • Support baby’s bottom

43. KMC procedure: Kangaroo positioning (cont..) Maintain privacy for the mother

44. Monitoring during KMC Check • Neck position is neutral • Airway is clear • Breathing is regular • Color is pink • Temperature is being maintained Head position in KMC

45. Initiation of KMC • Baby should be stable • Short KMC sessions alright even if the baby is receiving • IV fluids • Oxygen therapy • Orogastric tube feeding

46. Duration of KMC • Start KMC sessions in the nursery • Practice at least one hour sessions initially • Transit from conventional care to longer KMC • Transfer baby to post-natal ward and continue KMC • Increase duration up to 24 hours a day

47. KMC during sleep

48. KMC during resting

49. Position for sleeping

50. Any family member can do it ! Father Grandmother Father & other family members can also provide skin-to-skin care