73 Care for the newborn baby

Helen Brotherton 07/11/18

2.6m newborns die every year in the world

Sierra Leone has highest maternal and neonatal mortality rates in world

Preterm births most common reasons for newborns to die, followed by sepsis and intrapartum related deaths

What is essential newborn care? Thermal/Skin to Skin, Hygeinic, Breast Feeding, Skilled birth attendant

73.1 Preterm/low birth weight babies

“babies born alive before thirty seven weeks”

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73.2 Low Birth Weight

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Defns of low birth weight. Different weights have different outcomes

Growth charts published by intergrowth 21, are evidence based from a large cohort of 8 countries.

73.3 Preterm VS SGA

How do you tell the difference?

Differences in history (preterm get sick first three days then get better, whereas SGA will be stable first few days), complication risk (NEC is only seen in preterm less than 32-34 weeks, so a SGA would get sick from sepsis rather than NEC), management (Preterm get put on caffeine to prevent apnoea, you don’t need it for SGA), follow up (preterms get hernias and eye problems that SGA wont)

73.4 Estimating gestational age

1st trimester USS is gold standard for estimating gestational age, not easily accessible for a lot of people, and lots of women would present late

LMP is very inaccurate (+/- 2 weeks), also dependent on mother

Pubic symphisis height, very inaccurate

Post natal gestational age assessment: One called dubowitz (will give +/- 2.6 weeks)

So we need better methods!

73.5 Challenges for preterm care

Overcrowding (risk of infection spread)
Infection control (consistent running water)
Maintenance of equipment (who will fix this stuff?)
High patient to nursing ratio/attrition rate
Lack of monitoring (preterm babies are fragile and deteriorate quickly, especially over first 24 hours, so you need effective monitoring in place)

73.6 Example Neonatal Units

You need infrastructure and human resources

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73.7 Care of the newborn

Most newborn babies don’t need resuscitation, they need stabilisation

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73.8 CRITICAL ILLNESS

GLOBAL HEALTH MEDIA PROJECT

What signs of critical illness?

Respiratory distress
Unconscious (clap, rub foot, lift arm, pull up)
Convulsions
Unable to feed/Not wake up to feed
Apnoea
Central cyanosis
Bulging fontanelle (increased ICP from infection/obstruction)
Persistant vomiting (3x in 30 mins, after every attempt to feed)

Also refer congenital malformation/bleeding/surgical conditions

ADD DETAILS ABOUT: - Antibiotics (ampicillin and gentamicin) - Warm - Feeding

73.9 Management

73.9.1 Resp Distress

Theres a resp distress scoring system called the “silverman andersons system”

Oxygen can be piped, cylinders, or concentrators (theres increasing work on solar powered oxygen concentrators)

You can connect multiple babies to same concentrator if needed

73.9.1.1 Nasal Cannula

Max nasal cannula for babies = 2L/min

Too much can cause problems in babies: retinopathy of prematurity, scarring in lungs

Preterm babies should get blended O2 with FiO2 0.3

Preterm babies need SpO2 88-92%

73.9.1.2 Bubble CPAP

This has revolutionised care in low and middle income settings

66% reduction in in hospital mortality in preterms (when studying Fiji, SA, Malawi)

Needs electriciy
and constant O2
and which do you treat?

73.9.1.2.1 TRY Algortihm

Babies tone needs to be good,
Respiratory distress,
Heart rate > 100 bpm

73.9.2 Antenatal Steroids

Standard of care in high income settings,

to stimulate babies to produce surfactant,

but this doesn’t mean it necessarily works in other settings.

The ACT trial looked at 40,000 live births in LMIC. These babies were more likely to die at 28 days. Mothers were more likely to get infections. These babies that died were more likely to be term or close to term (so maybe more effective in preterm babies). There’s a different infection burden in these settings.

At the moment steroids are still recommended by WHO, but it’s still very controversial.

Usually given to 34 weeks.

Needs given 12 hours before to labour

73.9.3 Hypoglycaemia

ADD DETAILS FROM SLIDE Give sick babies 10% glucose

73.9.4 Feeding

As soon as clinically allowed

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73.9.4.1 How to feed/monitor weight

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The smaller the babie the more they lose over the first five days

73.9.5 IV Fluids

They are a necessary evil, very easy to overload a baby

73.10 Jaundice

BLAH

Need to add a lot from the slides, lecture sped up and lost me here.