An overview of the components of NSSK

1. Dr Manu M
Jr consultant Paediatrics
General Hospital
Muvattupuzha

2. Resuscitation of the newborn
baby
 Assess a newborn baby at birth
 Perform resuscitation of a newborn
baby using standard equipment if
needed
 Provide aftercare if a baby requires
help with its breathing at the time of
birth

3.  One million deaths worldwide due to
asphyxia
 1/3 in India.
 Need of resuscitation should be
anticipated
 Adequate ventilation is more important
than additional Oxygen

4. Failed resuscitation:
•Did not recognize the problem promptly
•Did not react quickly enough
•Ineffective ventilation

5. Need for resuscitation
No intervention
Some assistance
Extensive
resuscitation
90%
<10%
~1%

6. KEYS TO SUCCESSFUL
RESUSCITATION

7. PREPARATION FOR BIRTH
 Prepare personnel
◦ Identifies helper, explains roles
◦ Describes an emergency plan

8. Preparation of Delivery room

9. Test the function of
equipments
 Radiant warmer
 Bag and mask

18. Assessment at birth
 Deliver the baby on mother’s
abdomen
 Note the time of birth
 Dry the baby

19. If meconium present:
 IMMEDIATELY start suction
 First the MOUTH, then the NOSE
Depth:
<5cm in mouth
<2cm in nose

20. Assess Breathing
 While drying

21. Steps of resuscitation
 Provide warmth
 Position: Open the airway

22. Steps of resuscitation contd..
 Suction (Mouth, then Nose)
 Stimulate
 Reposition
 Reassess

23. STILL NOT BREATHING:
VENTILLATE!!
 Selection of appropriate size mask

24.  Clear airway
 Position the baby’s head
 Position the bag and mask on face

25. Initiate Ventillation
 First few breaths may require higher
pressures and longer inflation times
 Just enough to produce a gentle chest
rise
 How often? 40-60 per minute

26.  Ensure chest rise
 Steps to improve ventilation
◦ Reapply the mask for a better seal
◦ Check position, extend neck a bit more
◦ Check for secretions, clear if needed
◦ Try ventilating with mouth slightly open
◦ Increase the pressure on the bag

27. STILL NOT BREATHING WELL..
 Call for help
 Continue Ventilation
 Provide oxygen, if available
 Assess Heart rate
>100/min: normal
<100/min: slow

28. veni, vidi, vici

29. veni, vidi, vici
(i came, i saw, i conquered)

30. veni, venti, vici

31. veni, venti, vici
(i came, i ventilated,
i conquered)

32. CARE OF THE BABY AT
BIRTH

33. Basic needs of a baby
 Warmth
 Normal Breathing
 Mother’s milk
 Protection from infection

35. Ensuring warmth: “WARM
CHAIN”

36. Initiate breastfeeding

37. Prevention of Infections: “Clean
Chain”

38. Immediate cord and eye care

40. Monitoring the baby

41. PREVENTION OF
INFECTION
 In neonates,
Prevention of infection is
more cost effective than treating
infection

42. Basic requirements for
asepsis
 Running water supply
 Soap
 Elbow or foot operated taps
 Strict hand washing
 Avoid overcrowding, optimal number of
health providers for care of more babies
 Plenty of disposals
 Strict adherence to good housekeeping
and asepsis routines

43. Before entry into baby care area
 Remove shoes, socks, woolens, watch,
bangles, and rings.
 Roll up the full sleeves up to elbow.
 Put on new slippers.
 Wash hands with soap and water for 2
minutes (follow six steps of hand washing).
 Put on sterile half sleeve gown.
 Personnel with active infection should not
be allowed entry into the baby care area.

44. HAND WASHING
 MOST IMPORTANT means of
preventing nosocomial infections
 VERY SIMPLE
 CHEAP

45. Steps of hand washing
1. Palms and fingers and web spaces
2. Back of hands
3. Fingers and knuckles
4. Thumbs
5. Finger tips
6. Wrists and forearm upto elbow
 2 MINUTES hand washing (6 steps) to be done before
entering the unit.
 20 seconds hand washing to be done before and after
touching babies.
Rinsing hands with alcohol is
NOT A SUBSTITUTE for proper hand washing

46. Thermal protection
 Why newborns?
 Larger surface area
 Decreased thermal insulation due to lack of
subcutaneous fat
 Reduced amount of brown fat

47. Consequences of hypothermia
 Energy spent to maintain temperature
 Less activity
 Poor feeding
 Respiratory distress
 Poor weight gain
 Hypoglycaemia (especially in preterm)

48. Mechanisms of heat loss

49.  Normal temperature of a newborn
◦ 36.5oC to 37.4oC
Use a low reading thermometer
(30-40oC)
Temperature is taken in the axilla
Do NOT add anything to the reading

50. 5

52. WARM CHAIN
 A set of interlinked procedures carried
out at birth and later which will
minimize the likelihood of hypothermia
in all newborns.

53. Common situations where
cold stress can occur
i. At birth
ii. After giving bath
iii. During changing of nappy/clothes
iv. Malfunctioning heat source or
removing the baby from heat source
v. While transporting a sick baby

54. Steps to prevent heat loss in
labour room
 Warm delivery room (25°C)
 Newborn care corner temperature to
be maintained at 30°C
 Drying immediately. Dry with one
towel. Remove the wet towel and
cover with another pre-warmed towel
 Skin-to-skin contact between mother
and baby

55. Steps to prevent heat loss in
postnatal ward
i. Breastfeeding
ii. Appropriate clothing, cover head and
extremities
iii. Keep mother and baby together
iv. Keep room warm
v. Postpone bathing and weighing

56. Wrapping a baby

57. KANGAROO MOTHER
CARE

58. Promotes
 Effective thermal control
 Breastfeeding
 Infection prevention
 Mother-baby bonding

59. Components:
 Skin-to-skin contact
 Exclusive breastfeeding
Prerequisites:
 Support to mother in hospital and
home
 Post discharge follow up

60. Benefits
 Temperature maintenance; reduced
risk of hypothermia
 Increased breastfeeding rates
 Early discharge from the health facility
 Less morbidities such as apnea and
infections
 Less stress (for both baby and
mother)
 Better infant bonding

61. KMC positioning
 Baby should be placed between the
mother's breasts in an upright position.
 Head should be turned to one side and
in a slightly extended position.
 Hips should be flexed and abducted in a
"frog" position; the arms should also be
flexed.
 Baby's abdomen should be at the level of
the mother's epigastrium.
 Support the baby’s bottom with a
sling/binder.

63.  Duration of KMC
 Minimum One hour
 KANGAROO FATHER CARE!!

64. FEEDING OF NEWBORNS
 Exclusive breastfeeding for 6 months
 Decreased risk of
◦ Diarrhoea
◦ Pneumonia
◦ Ear infections
◦ Death

66. Four key points on POSITION
 the baby’s head and body should be
straight;
 the baby’s face should face mother’s
breast;
 the baby’s body should be close to her
body;
 she should support the baby’s whole

67. Signs of GOOD
ATTACHMENT
 More areola visible above the baby’s
lips than below it
 Baby’s mouth is wide open
 Baby’s lower lip is turned outwards
 Baby’s chin is touching the breast

68. HOW FREQUENTLY?
 ON DEMAND
 Usual interval: 2-3 hours
 8-10 feeds per day

69. Breastfeeding is adequate if:
 Passes urine 6-8 times in 24 hours
 Sleeps for 2-3 hours after each feeds
 Weight gain @10-15 gms/day
 Crosses birth weight by 2 weeks of
age.

70. Dr MANU M
9605033674
www.amrithkiranam.in
www.facebook.com/infoclinicindi