ESSENTIAL NEWBORN CARE routine care,transport,equipments

INTRODUCTION All mothers need- help, support and advise in initial few days after delivery to ensure proper care of their newly born baby. This critical in maintaining the normality and preventing any complications in them. WHAT MOTHERS NEED IN INITIAL FEW DAYS? Ideally antenatal counselling- on baby care. This prepares them mentally. In initial few days mothers need to: Get to know their babies. Time to rest. What care to be given to the baby and how to carry out the care. Danger signs. ROUTINE CARE AFTER BIRTH The postnatal environment. Every day care of the baby. Looking for danger signs and giving treatment. Preparation for discharge. a) Post natal environment/ward Warm wit no draughts from open windows/doors. Room Temperature- at least 25C Or use radiant heater/warmer. Mother and baby should be kept together- helps bonding, maintain warmth. Bed net if mosquito or other insects.

b) Every day care of the baby Breast feeding On demand Help mother feed the baby. Assess breastfeeding technique and adequacy before planning discharge. If breastfeeding difficulty- help with position and attachment. Do not discharge if BF not established. Warmth Explain to mother importance of keeping the baby warm. Wrap baby in soft clean clothes. Cover babys head and limbs. Keep baby with mother. Do not separate. If separated ensure baby is covered well. Assess warmth every 4 hrs by touching babys feet. Keep room warm. Cord care Put nothing on the stump. Fold nappy below the level of the stump. Keep cord stump loosely covered with clean clothes. If stump is soiled wash it with soap and water and dry with clean clothes. Watch for signs of infection- redness around the cord, pus discharge, temp> 37.5 C. 1

 Explain to the mother- to seek care if any signs of cord infection. Ensuring hygiene Wash the neck, face & underarms of baby daily. Do not bathe the baby for 24 hrs or if baby is cold or small. Wash buttocks when soiled. Dry thoroughly. Do not apply Kajal in eyes. Use cloth diapers for buttocks. If bath is given ensure o The room is warm. o Use warm water for bathing. o Thoroughly dry baby, dress and cover. Take extra precautions if baby is small c) 1. 2. 3. 4. 5. 6. 7. 8. d) Danger signs Not feeding well. Less active than before/ lethargy. Fast breathing (more than 60 breaths/ min) Slow breathing (< 30/min) Moderate to severe chest in-drawing. Grunting/ moaning convulsions Floppy/stiff

9. Fever (temp>37.5C) 10. Temp< 35.5C or not rising after rewarming. 11. Umbilicus draining pus or redness extending to skin. 12. >10 skin pustules or bullae or swelling, redness. 13. Bleeding from umbilical stump. 14. Pallor

Criteria for discharge Feeding well.(at least 8 times in 24 hrs) No danger signs. No need for any medication except vitamins. For small baby- feeding well & gaining weight adequately.

DIFFERENTIATION OF AT RISK & SICK NEONATE

CARE OF AT RISK & SICK NEONATES

At risk neonate Warmth Stabilisation Feeds Specific therapy Monitoring Re evaluation Communication. Follow up Sick neonate Warmth Stabilisation Feeds Specific therapy Monitoring Re evaluation Communication. Organise transport

Advise to mother on discharge for at risk neonates Exclusive breast feeding Continue prescribed treatment. Observe progress of baby. Counsel & educate mother & family. Follow up- after 2 days and seven days

PREVENTION OF INFECTION (Asepsis basics)

Running water facility. Soap Elbow or foot operated taps. Strict hand washing. Avoid overcrowding. Plenty of disposables. Rational antibiotic policy. Strict adherence to house keeping and asepsis routines.

TRANSPORT OF NEONATES
Components Stabilisation prior to transport. Communication- with parents, referral unit. Preparation. Maintenance of warm chain. Prevention of hypoglycaemia. Maintain airway & oxygenation. 3

Instructions to accompanying family members STABLE Sugar Temperature Airway BP Lab work/ line Emotional support to parents.

EQUIPMENTS
Radiant warmer Ensure room temperature 22C for optimal functioning. Place warmer away from air currents. Keep warmer on beforehand to pre warm if anticipating delivery. Adjust heater output to high, medium or low. Turn baby frequently while under warmer. Keep baby wrapped with head and limbs covered. Modes- servo & manual. Disinfection damp cloth with mild detergent. Do not use spirit or other chemicals. ALARMS IN RADIANT WARMER Power alarm. System alarm. Skin probe failure. Skin temperature high/ low Heater failure. Phototherapy unit Keep baby naked with only nappy. Shield eyes with eye patch. Change position from supine to prone after each feed or 3 hrly. Place baby as close to light as manufactures instruction allows. Monitor temperature, urine output 4th hourly. Change tubes every 6 months or usage time > 1000hrs. Do not place anything on the PT unit. Disinfection- moist cloth, ensure reflector is dust free.

AMBU bag
Self inflating bag. Parts Valve assembly Patient outlet Air inlet Oxygen inlet Safety valve Body Disinfection Washing with mild detergent Autoclaved or gas sterilisation. 4

Weighing machine Parts Pans or baby tray. Weight scale display Machine proper Working Dos Keep on a flat firm surface Adjust Zero error every time before checking. Record weight prior to feeding. Remove excessive clothing. Record weight only when display is stationary. Don'ts Do not stack up linen or other objects on it. Do not pour water on electronic display. Cleaning & disinfection Lean with soap and water Wipe with spirit swab between patients. Troubleshooting Check if on firm surface Check power cord, fuse. Caliberation Record zero if it cannot be accounted for

Suction machine( electric)

Parts Motor Vacuum gauge with regulator. Suction bottles Suction tubing's Suction catheter Working Connect to mains Adjust pressure. Do not exceed 100 mm Hg. Use a d/s suction cath. Perform gentle suction. Flush with saline/ distilled water and discard Disinfection Soap & water Bottle solution (savlon) change every day Dos Gentle suction Maintain asepsis. Use D/S suction cath Check adequacy of pressure. Don'ts Vigourous & deep suction Troublshooting Check fuse, Cord, bottle, tubing. 5

INFUSION PUMP Definition An infusion pump infuses fluids, medication or nutrients into a patient's circulatory system. It is generally used intravenously, although subcutaneous, arterial and epidural infusions are occasionally used. Uses/indication Can administer fluids in ways that would be impractically expensive or unreliable if performed manually by nursing staff. They can administer as little as 0.1 ml per hour injections (too small for a drip), Injections every minute, Injections with repeated boluses requested by the patient, up to maximum number per hour (e.g. In patient-controlled analgesia), Fluids whose volumes vary by the time of day. Because they can also produce quite high but controlled pressures, they can inject controlled amounts of fluids subcutaneously or epidurally. Types of pump Large volume pumps-can pump nutrient solutions large enough to feed a patient. Small volume pumps- infuse hormones, such as insulin, or other medicines, such as opiates. Working mechanism Newer pumps Large-volume pumps Usually use some form of peristaltic pump. Classically, they use computer-controlled rollers compressing a silicone-rubber tube through which the medicine flows. Another common form is a set of fingers that press on the tube in sequence. Small-volume pumps Usually use a computer-controlled motor turning a screw that pushes the plunger on a syringe. Types of infusion given through infusion pumps

Continuous infusion usually consists of small pulses of infusion, usually between 500 nanoliters and 10000 microliters, depending on the pump's design, with the rate of these pulses depending on the programmed infusion speed. Intermittent infusion has a "high" infusion rate, alternating with a low programmable infusion rate to keep the cannula open. The timings are programmable. This mode is often used to administer antibiotics, or other drugs that can irritate a blood vessel. Patient-controlled is infusion on-demand, usually with a pre programmed ceiling to avoid intoxication. The rate is controlled by a pressure pad or button that can be activated by the patient. Total parenteral nutrition
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Safety features

Batteries- so the pump can operate if the power fails or is unplugged. Anti-free-flow devices- prevent blood from draining from the patient, or infusate from freely entering the patient, when the infusion pump is being set up. A "down pressure" sensor- will detect when the patient's vein is blocked, or the line to the patient is kinked. This may be configurable for high (subcutaneous and epidural) or low (venous) applications. An "air-in-line" detector- a typical detector will use an ultrasonic transmitter and receiver to detect when air is being pumped. Some pumps actually measure the volume, and may even have configurable volumes, from 0.1 to 2 ml of air. None of these amounts can cause harm, but sometimes the air can interfere with the infusion of a low-dose medicine. An "up pressure" sensor- can detect when the bag or syringe is empty, or even if the bag or syringe is being squeezed. A drug library-with customizable programmable limits for individual drugs that helps to avoid medication errors. Mechanisms to avoid uncontrolled flow of drugs in large volume pumps (often in combination with a giving st based free flow clamp) and increasingly also in syringe pumps (piston-brake) Internal electronic log- of the last several thousand therapy events. These are usually tagged with the time and date from the pump's clock. Usually, erasing the log is a feature protected by a security code, specifically to detect staff abuse of the pump or patient. Configuring-many makes of infusion pump can be configured to display only a small subset of features while they are operating, in order to prevent tampering by patients, untrained staff and visitors.

Safety issues Infusion pumps have been a source of multiple patient safety concerns, and problems with such pumps have been linked to more than 56,000 adverse event reports from 2005 to 2009, including at least 500 deaths. food and drug administration (fda) has launched a comprehensive initiative to improve their safety, called the infusion pump improvement initiative.
Emboli: to avoid this risk, make sure to purge infusion lines and syringes before use. Pulmonary oedema: an excessive or too rapid infusion may endanger the patient or cause death.

SYRINGE PUMP Definition

A syringe driver or syringe pump is a small infusion pump (some include infuse and withdraw capability), used to gradually administer small amounts of fluid (with or without medication) to a patient. Indication

Palliative care -to continuously administer analgesics, antiemetics and other drugs. This helps maintain constant serum drug levels over 24hrs.. For delivering iv medications over several minutes. This device saves staff time and reduces errors.
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Precautions
All components connected to the infusion equipment i.e. Additional infusion apparatus, extension sets,catheter, filters, 3-way valves, line connectors, etc., must comply with the technical requirements for pressure infusion equipment. The use of appropriate cannulae and kink-free layout of lines is of particular importance. Syringes should be changed when empty and the lines should be changed at least every 24 hours. The infusion must be carried out using an identical syringe to the one set during programming. The use of another type even identically looking and of the same volume does not guarantee obtaining the required infusion parameters with the accuracy stated in the specifications. It is recommended to use syringes topped with a luer-lock connection. This connection guarantees that the drain will net slip off, e.g. Due to a rise in pressure during occlusion. Before each use, the audible and visual alarms, as well as the remote nurse call facility (if fitted), should be checked for correct operation Use of inappropriate disposables and accessories may affect the functional safety of this pump During operation the pump should be placed either below or at the level of the patient. It should be remembered that the pump detects occlusion only when the too big pressure in the drain and the syringe stops the movement of the pressure arm. Gradually pressure builts and it takes a while to sense and alarm. Pump may or may not have air detection. The pump must not be connected with the patients vein before programming is fully completed and air bubbles removed.

CONCLUSION
Neonate who is adjusting to his new environment need utmost care and modification for successful adjustment. Therefore mothers need to be prepared to provide this care at home .

REFERENCES
http://en.wikipedia.org/wiki/Infusion_pump Deorari AK ( editorial).Essential newborn nursing for small hospitals. 2nd ed;WHO-SEARO: 2009. New Delhi.