Neonatal Care

Tujuan Instruksional Khusus :

Mampu mengetahui dan memahami kegawatan perinatal dan tata cara merujuk ke unit
perawatan neonatal yang lebih tinggi

Perinatology

Obstetri Pediatri
c c

Perinatal Period
 Statistic Usage : 28 weeks  1 week after birth
 Science and service usage : conception  1 month after birth

Neonatal Period
 Birth  1 month after birth

FETUS NEONATES
Fetal circulation Neonatal circulation
Oxygen depend to uteroplacental Oxygen – own produce by breathing
circulation Feed – breast feeding
Nutrition depend on maternal status

Birth

fetu neonate
s

resuscitation adaptation

Normal Newborn  Temperature stability

 Gestational age > 37 weeks  Inisiate spontaneous
respiration
 Birth weight : 2500 – 4000 gr
 Early breast feeding
 Crying at birth ( Apgar Score
>7)  Infection prevention &
immunization
 No severe Congenital
Malformation
Regardless to the type of delivery Principles of Care at Birth
 Establishment of respiration
Care of Normal Newborn  Prevention of hypothermia
 Preparation before delivery  Establishment of breastfeeding
 Immediate care at and after  Prevention of infection
birth  Identification of at risk
 Essential post natal care neonates

Neonatal Essential Care Five cleans to prevent

 Clean & safe delivery infections
KKA-172 Mira Yulianti (01-107)
 • Clean hands  Plenty of disposables
• Clean cord tie
• Clean cord
• Clean surface
• Clean Blade

Content of Clean Delivery

Kit ( at home =
 Soap for washing hands
 2 to 3 sterilized cord ties
 A new clean blade/boiled home
instrument to cut cord
 Clean sun dried cloth sheet,
small gauze pads
 A clean plastic envelope/cloth
to keep the kit in Assessing/Evaluate Baby
At birth : respiratory effort, heart
Physical Facilities for rate, skin color

Resuscitation ( at hospital Asphyxia  resuscitate
= Not asphyxia  APGAR score

 Endotracheal tubes Newborn Care
(2.5,3.0,4.0 mm)
 Medications : epinephrine,
naloxone, normal saline, sodium
bicarbonate

apgar score
SYMPTOM/SIGN 0 1 2
Pulse 0 < 100/mnt >100/mnt
Respiratory effort none grunting Crying
Muscle tone Floppy Partial Full flexion
flexion Active
Sensitive to stimulation No Grimace Crying
response
Color Pale Blue Pink

APGAR SCORE
 Just for Assesment
 Not for starting resuscitation
 For determine prognosis
 5 variables comprehensively
 Observed consecutively : 1-5–
10 mins
 Divided : Mild, Moderate,
Severe Asphyxia
Immediate Care after Birth
 Prevent hypothermia
 Eye, skin, cord care
 Breastfeed within ½ hour
birth
 Search for malformation
increased Risk of
Malformation
 Single umbilical artery
 Simian crease
 Dysmorphic features
 Asymmetric cry due to DAOM
(Depressor Angular Oris Muscle)
 Excessive drooling of saliva
Quick Screening For
Malformation
of  Screen from top to bottom and
in midline
 Orifice examination
• anal opening

KKA-172 Mira Yulianti (01-107)

 • oesophagus patency (SFD baby, •Nasolacrimal duct blockage –
polyhidramnios, excessive massaging helps
drooling,single umbilical artery) •Erythromycine 0,5 %, Tetracycline 1%
• choanal atresia ointment  for prophylaxis

essential Post Natal Care

 Nurse in thermal comforts
(warm to taouch, pink soles)
 Check umbilicus, skin, eyes
 Good suckling at breast
 Screen for danger signals
 Advice on immunizations

CARE OF UMBILICAL STUMP Prefer to Refer : IDAI Guideline for

Immunization
• Inspect 2 to 4 hours
after ligation for bleeding
• Don’t apply anything, Danger Signs
keep cord clean and dry
 Lethargy
• Inspect for discharge  Hypothermia
and infection till healing occurs
 Respiratory Distress
• Another option :
 Cyanosis
▫ alcohol 70 %
▫ povidone  Convulsion
iodine  Abdominal distension
▫ breast milk  Bleeding
(colostrum)
 Yellow palm/soles
 Excessive weight loss
CARE OF THE SKIN  Vomiting
• Bathing  Diarrhea
soon after birth is not recommended
 Pallor
• Don’t make  Perinatal Distress after birth
vigorous attempts to remove vernix
caseosa
• Bring Follow up visit – Objectives
superficial infections to the notice  Assess growth and development
of the doctor  Early diagnosis and management
of illness
CARE OF THE EYES  Health education
•Clean at birth and subsequently daily  Exclusive breastfeeding for 4
months
•No Kajal application
 Adequate weaning after 4
•For sticky eyes, use normal saline or months
10% sulfacetamide
 Spacing of family

KKA-172 Mira Yulianti (01-107)