for paramedics

1. ALL INDIA INSTITUTE OF LOCAL SELF
GOVERNMENT
DELHI
“ NEW BORN CARE & UNDER FIVE CLINIC for
paramedics“
DR.P.P.SINGH
By
Dr. P.P.SINGH
Faculty AIILSGD
Ex Medical Superintendent Cum Consultant pathologist HRH
Delhi
Ex. Director India Population Project 8 Delhi..

2. NEW BORN CARE
 28 days of life ½ death in this period
Death is due to ;- Asphyxia, Hypothermia , Infection
Low birth weight < 2500 gm areat high risk.
Care of women has vital role in newborn.
Delivery should be in clean ventilated good lighted room
 Ensure Five Cleans.
Baby should be recived in dry clean cloths.
After drying baby the wet cloth be discarded.
Head of baby should be wiped first.
Cord Care
Cut & tied at 2.5 inches from umbilicus
Cut with new blade or autoclave scissors.
Inspect the stamp for any bleeding
Do not apply any medication or dressing to cord.
EYE CARE
Clean the eyes from medial to lateral with soft clean cloth or
cotton swab one for each eye .
Do not put any kajal or eye drops.

3. Bath to baby
do not bathe newborn at birth it may cause
hypothermia.
Wipe with clean cloth.
Ensure the room is worm.
Bathing is not recommended at least for one week.
Assessment of birth weight.
Spring balance with green, yellow and red color
mark
 green == 2500-4000gm
Yellow == 2000 – 2500gm
Red== less than 2000gm
New born who are sucking well and do not show any
sign of illness can be managed at home.

4. PREVENTION OF HYPOTHERMIA
 it is due to the poor thermal control mechanism in new
born.
Keep the baby in close physical contact with mother.
Baby should be wrapped in proper cloths as per the
environment.
PREVENTION OF INFECTION
It begin with Immunization of TT to mother.
Ensure Five Clean during delivery.
Person with skin, respiratory , diarrhea infection must not
be allowed.
Baby should not be taken to any OPD/ hospital
 ensure institutional delivery.
Zero dose of OPV , BCG & hepatitis vaccination be given
before discharge from hospital.
Mother be advised for full immunization and spacing
methods.

5. NORMAL PHENOMENA AT BIRTH
Most babies pass Mucconium with in 12 hrs. any delay
indicate prematurity.
Pass urine with in 24- 48hrs.
From 3rd -4rth day baby pass 10-15 stool /day.( watery &
yellowish green – No TT)
Regurgitation is common 1st few days , persistent vomiting or
bilious with abdominal distension indicate GIT anomaly.
White discharge from vegina on 2nd or 3rd day of life is normal.
It disappear by second week on 5th and 7th day. This due to the
withdrawal of maternal estrogen.
Breast engorgement is uncommon, it is self limiting in few
days.
Sub- conjunctiva hemorrhage in some babies does not require
treatment it will resolve spontaneously.

6. RESUSCITATION OF NEW BORN WHO DOES NOT CRY SOON.
Most cry soon after birth.
Start crying 15-20 seconds till the time taken to wipe dry and wrap in
clean linen .
Take steps immodestly , Extend Neck by placing folded towel under
shoulder
ABC , Clean mouth with mucus extractor
Flicking the sole with 2-3 times, donor slap or hold it upside down.
If still not cry assisted ventilation – mouth to mouth respiration.
Fill your cheek with air and blow gently into baby’s mouth after
covering with gauze.
Keep the nostril of baby pinched or closed.
Blow 40times per minute.

7. EXTERNAL CARDIAC MASSAGE
If after assisted ventilation heart fails to rise above
80/min. start ECM
Two persons are required.
First person stand at the foot side and place both thumb
at junction of middle & lower third of Sternum with
fingers wrapped around chest and supporting the back of
baby.
Depress the sternum about 2cmm. Each time.
Second person continue as sited ventilation .
For every assisted breath two chest compressions
should be given.

8. The APGAR SCORE – score to assess the
condition of new born.
S.N
o.
Sign 0 1 2
1 Heart Rate Absent Less
>100/min
More <
100/min
2 Respiratory
Rate
Absent Weak Cry Good
strong cry
3 Muscle Tone Limp Some flexion Well
flexed
4 Reflex
irritability
No
response
Some
movement
Cry
5 Colour Blue/pale Pink body ,
blue limbs
Pink
A Perfect score is 9 or 10., A score below 5 indicate
prompt action . Low APGAR are subjected as High
Risk baby.

9. POST NATAL CARE ( PNC)
Sufficient Rest
Plenty of fluids
Nourishing Diet.
Careful watch on uterine involution
Type of color or smell of discharge.
Two visits for first three days , bi-weely for thee
weeks and one more by the end of six weeks.
Diet 500 Extra calories, 25 gram protein , Calcium
1 gm and extra Vitamin A. & iodine.
Personal Hygiene

10. IMPORTANCE OF HOME VISITS BY HEALTH WORKER in
MCH
Priority to Houses with;-
•Pregnant but not registered .
•Pregnant with ANC registration.
•ANC with complications.
•ANC not attending ANC or irregular.
•PNC not seen after delivery.
•To introduce – FP methods & Breast feeding.

11. CARE OF INFANT
What is an Infant?
0-1years ( 0-28 days Neonate 0-7 days early
neonate.)
Indicators of Health in infancy?
Infant mortality.
Premature ( LBW)
 Small for gestational age ( SAG)
Health of Mother
-ANC
- Nutrition
-Immunisation
-Environmental sanitation.
-Quality & quantity of Health care.
- sets of Communicable diseases
-Social practices.
Infant Mortality – Ratio of infant death to live birth during
defined period and geographical area as per 1000 live birth.
Number of deaths of children less than 1 year of
age in year
IMR = -----------------------------------------------------------------------
--------- Number of live birth in same year.-

12. IMR in India.
1991- 80/1000. now 2015 it is 35/1000
Twice in rural area to urban area.
Highest in Uttar Pradesh up to 140.
Lowest in Kerala .30/1000
There is decreasing trend of IMR
20%in infancy 50% in neonatal period & half in early
Neonate further half in 48 hrs .
CAUSES OF IMR
A. During Neonatal period
 Birth injury
 Difficult labor
 Congenital abnormality
 Hemolytic diseases.
 Abnormal Placenta / Cord.
 ARI, Diarrhea, Asphyxia, Hypothermia & Infection .
B. Causes Post natal Period.
 ARI, Diarrhea
 Environmental factors
 Malnutrition, Infections

13. C. Biological causes
LBW ( Low Birth Weight)
SAG ( Small for Age of Gestation )
Birth order
Spacing multiple pregnancies.
Maternal age ( less than 20 or More than 30
yrs)
Nuclear family
Large size family leading to poverty.
Multiple births ( Twins or triplets)

14. Economic / Social causes
Poverty – Ignorance
 myths –Breast feeding, Bottle feeding.
Working Mothers
Religion - lowest in Christian High in Hindu – Sc/St.
Sex of child
Child rearing customs- skin branding, Holy ash , cow
dung.
Delivery by un trained Dai.
Poor Personal hygiene.
Poor utilization of health services.

15. PERI NATAL MORTALITY
a. Maternal Causes
 Cephalic pelvic disproportion
 Toxemia
 Incomplete OS
 Under nutrition , Sever anemia.
 APH /PPH
b. Fetal Causes
 Prematurity
 SAG
 IUGR
 Infection
 Congenital abnormalities.
c. Intra natal causes – BITWA
 Birth Injury
 Infections
 Tetanus
 Low weight
 Asphyxia.

16. LOW BIRTH WEIGHT
Normal 2500- 4000 gm Green
LBW 2000 – 2500 gm Yellow
V. Low > 2000 gm RED
SAG ( Small for gestation )
Term Baby = 37 – 40weeks complete baby. (253-293
days)
Post Term Baby = after 42 weeks ( 294 days)
Preterm = less than 37 weeks
At present 39% babies are LBW Aim is 105 by 2000 now
2020.

17. Causes of LBW
 Nutrition to mother
Manual labour in ANC
Tobacco
Weight of mother < 40 Kg.
Mid Arm ,< 27.5 cm
Sever Anemia
 Malaria
Multi gravid..
CARE OF LBW babies
 Prevention of hypothermia.
Breast feeding
Gentle handling.
Health Education
Early Diagnosis and Treatment
Immunization
Growth monitoring

18. PREVENTION METHOD TO REDUCE IMR
A. General
 Right age of marriage
 Regulate use , advertise and marketing commercial foods,
weaning.
 Environmental sanitation improvement.
 Family Planning
 Implementation of GOBIFFF.
 Attitude to growth monitoring .oral hydration, Breast feeding
 Raise the status of Women
B. Pre conception care
 Improve Education
 Educate abut child rearing, growth, development
 Maternal Nutrition
 Reproductive Health services
C. Community Education
D. ANC
E. Intra partum care.
f. Care of New Born

19. Care Of NEW Born
 Five Clean
Cord cutting 2 & ½ Inch
 Respirator petancy
Clean eye
Clean Mucconium
Bath after 5-7 days
Breast feeding
CARE IN First six Months
ROOM IN
Breast feeding Exclusive
Immunisation
Weaning after 5 months
Watch for infection.
CARE AFTER SIX MOTHS
In addition to above
Measles vaccination
Vitamin A
Personal hygiene
ICDS
Prevention of Diarrhea ARI

20. BREAST FEEDING
Available required quantity & quality.
At required temperature.
Free from infections
Fresh
Easily digestible
Immunity
Helps Physical development of Jaw muscles
Social binding
Prevent malnourishment
Economical
Reduces allergy, Ca of GI/RI , dental
carries.
Helps to reduce cancer in mother.

21. HIGH RISK INFANTS - A
 LWB
Twins/ Triplets
Lack of breast feeding
Working women
History of Prolong labour
Less spacing
HIGH RISK INFANTS- B
Poor Suckling Reflex.
Too cold / Too worm
Blue or pale
appearance
Red umbilicus –
discharge
Distention of Abdomen
 Jaundice.
Convulsions.

22. MEASUREMENT OF BABY
Weight by Spring Balance = 2.5 to 3 Kg.
10% Reduction in Five days.
½ Kg increase per month for 3 months.
 Could be Double in 5 months.
Triples in 1 years.
Length is measured by INFANTOMETRE.
 Head circumference take Occipital frontal
Diagonal

23. UNDER FIVE CLINIC
Due to the high mortality amongst Children in developing
countries , special care is required. So emphasis of Under
five clinic is envisaged.
Aims
To supervises the health of all children upto Five years.
To prevent occurrence of Vaccine preventable diseases
To provide simple treatment for diarrhoea, pnemonia and
common skin conditions.
Role of doctors & Nurses
Children are seen by Nurse and refers to the doctor
if required . Great importance is given for physical,
Psychological conditions and advice to the parents.

24. Under five Care
It has Five Major components.
1. Care of Illness.
2. Preventive Care.
3. Growth Monitoring.
4. Family Planning.
5. Health Education.
Care In
Illness
FP
Preventive
CareGrowth
Monitoring

25. CARE OF ILLNESS
A. Diagnosis and Treatment of:-
Acute Illness
Chronic illness including Physical, Mental , Congenital
and Acquired.
Disorders of Growth and development.
B.X-rays and Laboratory services.
C. Referral services
PREVENTIVE CARE
1. Immunization.
2. Nutritional Surveillance ( PEM – ICDS to below 6 years.)
3. Health Check up. ( every 3-6 months
4. Oral Hydration .
5. Family Planning.
6. Health Education.
GROWTH MONITORING.
Road to health developed by David Morley modified by WHO.

26. USES OF GROWTH CHART.
1. Growth monitoring is a great value in child health
care.
2. Diagnostic Tools for Identification of High Risk
children
3. Planning and policy making by grading
malnutrition.
4. Educational tools ( Audio visual )
5. Tools for actions
6. Evaluation methods
7. Tools for Teaching ( Charts Modules etc)