lecture slides

1. HNS 273 NEONATOLOGY
Dr. Ngotie

2. REVIEW
FERTILIZATION
AND
EMBRYOLOGY

3. 4–8 weeks
• Very rapid cell division
• More body systems laid down in primitive form and
continue to develop
• Spinal nerves begin to develop
• Blood is pumped around the vessels
• Lower respiratory system begins to develop
• Kidneys begin to develop
• Skeletal ossification begins developing
• Head and facial features develop
• Early movements
• Embryo visible on ultrasound from 6 weeks
Fetus
8–12 weeks
• Rapid weight gain
• Eyelids meet and fuse
• Urine passed
• Swallowing begins
• Distinguishing features of
external genitalia appear
• Fingernails develop
• Some primitive reflexes present
12–16 weeks
• Rapid skeletal development –
visible on X-ray
• Lanugo appears
• Meconium present in gut
• Nasal septum and palate fuse
• Eternal genitalia fully differentiate
into male or female
by week 12
• Fetus capable of sucking thumb
Embryo
0–4 weeks
• Blastocyst implants
• Primitive streak appears
• Conversion of bilaminar disc into trilaminar disc
• Some body systems laid down in primitive form
• Primitive central nervous system forms
(neurulation)
• Primitive heart develops and begins to beat
• Covered with a layer of skin
• Limb buds form
– Optic vessels develop
– Gender determined
16–20 weeks
• Constant weight gain
• ‘Quickening’ – mother feels fetal movements
• Fetal heart heard on auscultation
• Vernix caseosa appears
• Skin cells begin to be renewed
• Brown adipose tissue (BAT) forms
20–24 weeks
• Most organs functioning well
• Eyes complete
• Periods of sleep and activity
• Ear apparatus developing
• Responds to sound
• Skin red and wrinkled
• Surfactant secreted in the lungs from week 20
24–28 weeks
• Legally viable and survival may be
expected
if born
• Eyelids open
• Respiratory movements
28–32 weeks
• Begins to store fat and iron
• Testes descend into scrotum
• Lanugo disappears from face
• Skin becomes paler and less
wrinkled
32–36 weeks
• Weight gain 25 g/day
• Increased fat makes the body
more rounded
• Lanugo disappears from body
• Hair on fetal head lengthens
• Nails reach tips of fingers and
toes
• Ear cartilage soft
• Plantar creases visible.
36 weeks to birth
• Birth is expected
• Body round and plump
• Skull formed but soft and pliable

4. Foetal Circulation
Foetal circulation differs from adult circulation in order to facilitate oxygenation and nutrition
via the placenta. This is achieved by means of three temporary structures which are:
• The ductus venosus which shunts oxygenated blood from the placenta away from the liver.
• The foramen ovale which allows oxygenated blood entering the right atria from the placenta
via the inferior vena cava to shunt across to the left atria and therefore to enter the
systemic circulation and bypass the pulmonary circulation.
• The ductus arteriosus which shunts blood from the pulmonary artery into the aorta; this
also facilitates oxygenated blood exiting from the right side of the heart entering the systemic
circulation and therefore mostly bypassing the lungs.

5. Foetal
circulation

6. Physiology of
the neonate

7. Definition of newborn
• The healthy newborn infant is born at term, cries almost immediately
after delivery and
establishes satisfactory rhythmic breathing.
• Birth weight of a healthy term newborn is 2.5
kg or more.

8. Preventive measures during pregnancy to ensure a healthy
newborn
• knowledge and skills to provide high quality care for women
during pregnancy and labour to ensure the baby is able to start
life with the best possible chance of reaching adulthood.
1. To prevent newborn problems by providing antenatal care:
• Maternal tetanus immunisation
• Malaria prevention (intermittent preventive treatment and
treated bed nets)
• Screening and treatment for Sexually Transmitted Infections
• Screening for HIV and prevention of mother to child
transmission of HIV with antiretroviral therapy
• Screening and treatment for anaemia and hookworm
• Micronutrient supplements in pregnancy (e.g. iron, folate,
vitamin A)

9. 2. Teach women and families about danger signs in pregnancy, labour and delivery,
postpartum and the newborn.
3. Help women and families make birth plans
4. Promote access to and use of skilled attendants for delivery care
5. Use partographs to monitor labour
6. Monitor foetal condition during
7. Promote child spacing.

10. Ensure Infection Prevention measures are strictly
adhered to at all times:
- Scrub hands and put on sterile gloves during delivery
- Wash hands between touching different babies
- Use aseptic technique in all procedures to prevent cross infection
- Avoid massive handling of the baby
- Avoid overcrowding and cot sharing
- Instill eye ointment (tetracycline) at birth.

11. Neonatal adjustment to extra-uterine life
• EVIDENCE BASED CARE IN IMPORTANT
• It is a normal physiologicl process for majority of the NBs
• A few get dificulties due to congenital anomalies, or maternal conditions
• The transition from fetal circulation to extra-uterine circulation takes
approximately a week to 10 days following birth.
• Labour contractions and compression on the cord increase CO2 and
fall in O2
• worsened by cord clamping and cutting= respiratory centre is
stimulated plus compression and release of the chest wall during
birth stimulate the infant to take its first breath= Lung expansion= fall
in pulmonary vascular resistance= decrease in pressure in the right
atrium= constriction and then closure of the ductus venosus

12. • Cutting the cord= rise in systemic blood pressure
• increased flow of blood to the lungs and back to the left atria causes a
change of pressure within the heart which causes the foramen ovale to
close within 24–48 hours after birth.
• Changes in flow and pressure cause minimal flow in the ductus arteriosus.
• Oxygen saturations rise to normal limits as the extra-uterine circulation
takes over and this causes a fall in the production of prostaglandin E2
which results in closure of the ductus arteriosus during the first week or 10
days of life and obliterate by 3 weeks of age

13. Factors influencing the onset of first breath
• low blood oxygen levels
• increased blood carbon dioxide (CO2) levels
• low blood pH
• temperature change from the warm uterine environment to the
cooler extrauterine environment.

15. From ducts to ligaments
• The ductus arteriosus, located between the aorta and pulmonary
artery, eventually closes and becomes a ligament.
• The ductus venosus, between the left umbilical vein and the inferior
vena cava, closes because of vasoconstriction and lack of blood flow;
then it also becomes a ligament.
• The umbilical arteries and vein and the hepatic arteries also constrict
and become ligaments.

16. Basic care and resuscitation of the neonate

17. Goals:
• To establish, maintain and support respirations.
• To provide warmth and prevent hypothermia.
• To ensure safety, prevent injury and infection.
• To identify actual or potential problems that may require immediate
attention.

18. Quarter hourly observations of the baby should be
done on the following:
• Activity
• Colour
• Respirations
• Cord
• Temperature
• Breast feeding
• Documentation

19. • Establish respiration and maintain clear airway
• Clear airway to enable the newborn to breathe
• to maintain adequate oxygen supply- may use
bulb/penguin suction
(https://shop.laerdalglobalhealth.com/product/pengui
n/)
• Newborns are obligatory nose breathers.
• The reflex response to nasal obstruction, opening the
mouth to maintain airway, is not present in most
newborns until 3 weeks after birth.

20. • 3. A crying infant is a breathing infant. Stimulate the baby to
cry if baby does not cry spontaneously, or if the cry is weak.
• Do not slap the buttocks rather rub the soles of the feet.
• Stimulate to cry after secretions are removed.
• The normal infant cry is loud and husky. Observe for the
following abnormal cry:
–High, pitched cry – indicates hypoglycemia, increased
intracranial pressure
–Weak cry – prematurity
–Hoarse cry – laryngeal stridor

21. • Oral mucous may cause the newborn, to choke, cough
or gag during the first 12 to 18 hours of life.
• Place the infant in a position that would promote
drainage of secretions.
• Trendelenburg position – head lower than the body
• Side lying position – If trendelenburg position is
contraindicated, place infant in side lying position to
permit drainage of mucus from the mouth.

22. • Place a small pillow or rolled towel at the back to prevent newborn
from rolling back to supine position.
• Keep the nares patent. Remove mucus and other particles that may
be cause obstruction.
• Newborns are obligatory nose breathers until they are about 3 weeks
old.

23. Assessment of the neonate
Neonatal assessment includes initial and ongoing assessments, a head-
to-toe physical examination, and neurologic and behavioral assessments.

24. Essential newborn care
• At birth, the newborn must adapt quickly to life outside the uterus.
Most babies are born healthy at term.
• The care they receive during the first few hours, days and weeks of
life will determine whether they remain healthy.
• All babies require basic care to ensure survival.
• This basic care is called Essential Newborn Care (ENC) and includes:
– Immediate care at birth
– Care during the first day
– Care up to 28 days.

25. The main purpose of essential newborn care is to ensure that every
baby is kept healthy.
This includes:
• Helping the mother and close family meet the babies basic needs, i.e
• Warmth
• Normal breathing
• Feeding
• Infection prevention
• Ensuring the baby breastfeeds within the first hour
• Breastfeed exclusively
• Detecting signs of problems so that early action can be taken
• Advising mother and close family about baby care and danger signs
• Making plans for continuing care such as immunizations and growth
monitoring.

26. The warm chain
• Newborns lose heat rapidly after birth. They have difficulty maintaining a normal body
temperature due to their immature temperature regulating systems.
• They lose body heat very quickly if they are wet, uncovered and exposed to drafts or
placed on a cool surface.
• Health care providers must plan ahead of a birth and ensure that the newborn is not
unnecessarily exposed:
• Keep birthplace warm (at least 25 °C) and avoid drafts. Warm the room before the baby
• is born Immediately after birth dry the baby with a warm towel. Most cooling happens in
the
• first two minutes after birth. In the first 1-2 minutes the newborn may lose enough heat
• for his body temperature to fall 2°C, which is very dangerous.

27. Cont..
• Keep the baby lying on the mother’s abdomen or chest for all
care.
• If this is not possible, put the baby on a warm surface and keep
the baby covered.
• Put the baby in skin-to-skin contact with the mother for at
least 2 hours after birth.
• Cover both with a warm cloth.
• Help the mother breastfeed the baby as soon as possible, but
at least within one hour of birth
• Wait for at least 6 hours and preferably 24, to bathe the baby.
Wait longer if
(a) the baby feels cold or the auxiliary temperature is below 36°C;
(b) the environment is cold;
(c) the newborn is low birth weight; and
(d) the baby is unwell.

28. Cont..
• Dress the baby in light, loose, warm clothing.
• A baby needs at least 1-2 more layers than an adult in
the same climate.
• The number of layers depends on room warmth.
• About 25% of the baby’s heat loss can come from the
head, so cover the baby’s head with a hat or cloth.
• Cover the baby with a light, warm cover or blanket.
• Keep warm throughout the newborn period.

29. There are 4 ways in which a baby loses heat:
• Immediately after birth (or a bath) a baby loses heat by evaporation
• Through conduction if placed naked on an uncovered table
• Radiation to colder surfaces such as windows and walls
• Draught may cause a newborn to lose (or gain) heat through
convection.

30. Immediate care at birth
• Most babies breathe and cry at birth with no help.
• As soon as the head is born, wipe the mouth, nose and eyes with a
sterile swab.

31. 1.

32. Apgar
scoring
• Devised by the anaesthetist Virginia Apgar in 1952
• Newborn grading system of the five features
recorded at 1, 5, 10 minute interval
• Features: heart rate, respiratory effort, response to
stimulus, muscle tone and colour
• Each is given a score of 2 to give an overall of score
10
• provide a useful indicator of condition at birth and
those babies needing closer monitoring in the early
neonatal period.
• A score of under seven is considered low and under
four very low with the lower scores
• https://www.youtube.com/watch?v=cQKaTCMFjwc

33. APGAR Score
• The APGAR scoring or quantitative assessment of the newborn’s
condition at birth was described by Dr. Virginia Apgar.
• It remains a simple way to help you decide if a newborn baby needs
help. The healthcare provider looks, listens and feels for:
• A: Appearance or colour of the baby
• P: Pulse or heart beat of the baby
• G: Grimace face or response of the baby when you touch his feet
• A: Activity or muscle tone of arms and legs
• R: Respiration or breathing of the baby.
• The APGAR score should be done at birth (one minute), five minutes
and at 10 minutes then recorded on the partograph summary sheet

34. Fearures
scoring

35. Analyzing the scores
• For each category listed, assign a score of 0 to 2, as shown.
• A total score of 7 to 10 indicates that the neonate is in good condition
• 4 to 6, fair condition (the neonate may have moderate central nervous
system depression, muscle flaccidity, cyanosis, and poor respirations)
• 0 to 3, danger (the neonate needs immediate resuscitation, as ordered).
• Each component should be assessed at 1, 5, 10, 15, and 20 minutes after
delivery, as necessary.
• Resuscitation efforts such as oxygen, endotracheal intubation, chest
compressions, positive pressure ventilation or nasal continuous positive
airway pressure, and epinephrine administration should also be
documented.

36. resources
• Foundations of Maternal-Newborn and Women's Health Nursing,
8th Edition
Page 20

37. Initial assessment
Aim;
• Draining secretions
• Assessing abnormalities
• Keeping accuratte records
Achieved through these proceses

38. • For infection control all wash their hands and wear gloves
• Ensure a proper airway by suctioning, and administer oxygen as needed.
• Dry the neonate under the warmer while keeping his head lower than his
trunk (to promote the drainage of secretions)
• Apply a cord clamp and monitor the neonate for abnormal bleeding from
the cord; check the number of cord vessels.
• Observe the neonate for voiding and meconium; document the first void
and stools.
• Assess the neonate for gross abnormalities and clinical manifestations of
suspected abnormalities.
• Continue to assess the neonate by using the Apgar score criteria even after
the 5-minute score is received.
• Apply identification bands with matching numbers to the mother (one
band) and the neonate (two bands) before they leave the delivery room.
• Promote bonding between the mother and the neonate by putting the
neonate to the mother's breast or having the mother on skin to skin with
the neonate

39. Alert!
• Monitoring for effects of medication
• Closely observe a neonate whose mother has received heavy sedation
just before delivery or magnesium sulfate during labor. Even if he has
a high Apgar score at birth, he may exhibit
• Secondary effects of sedation later. Be alert for respiratory depression
or unresponsiveness. Monitor the neonate whose mother received
magnesium sulfate during labor for hypotonia.

40. Examination of the newborn
Read -Fundamentals of Midwifery - A Textbook for Students - 1st Edition (2015) Pg
204; Myles text book for midwives page 92.

41. 2. Gestational age and birth
weight
• Aim:
accurate method for assessing mortality risk
and offers guidelines for treatment.
Age classification:
 preterm (fewer than 37 weeks' gestation)
 term (37 to 42 weeks' gestation)
 postterm (42 weeks' gestation or longer)
Ballards gestational-age assessment tool can be
used to classify

42. Ballards gestational-age
assessment tool

43. Ongoing assessment
• Vital signs
• “Administer prescribed medications such as vitamin K
(AquaMEPHYTON), which is a prophylactic to the transient deficiency
of coagulation factors II, VII, IX, and X.
• Administer tetracycline ointment, the drug of choice for neonatal eye
prophylaxis, to prevent damage and blindness from conjunctivitis
caused by Neisseria gonorrhoeae and Chlamydia.
• Perform laboratory tests.
• Monitor glucose levels and hematocrit (test results aid in assessing for
hypoglycemia and anemia).

44. 3. Vital signs
• Vital signs include the respiratory
rate, heart rate (taken apically),
and the first neonatal temperature
(this is taken rectally to verify
rectal patency).
• Subsequent temperature readings
are axillary to avoid injuring the
rectal mucosa.
• Blood pressure readings may be
assessed by sphygmomanometer
or by palpation or auscultation.
• An electronic vital signs monitor
may be used
Respirations: 30-50breaths/min
Heart rate(apical):110-160b/m
Temperature:
rectal-35.6 to 37.5oC
Axillary-36.4o to 37.2o

45. Newborn care
during the first day

46. • Assess the baby every 30 minutes to one hour for the first six hours or
until
• the baby is stable and stays warm and pink.
• Check the baby by assessing the general appearance; normally the
baby is active and the skin colour pink.
• Check vital signs:
– Heart rate - 110–160 per minute.
– Breathing - newborns breathe with a shallow but regular rate varying
between 30–60
times a minute with no gasping, grunting or in-drawing of the chest.

47. • Warmth - normal temperature should be 36-37°C. Or feel the baby’s
abdomen or back with your hand and compare to that of a well
person.
• Colour - check that the tongue, lips and mucous membranes are pink.
• Bleeding - check the cord for bleeding. As the cord dries the tie may
become loose, put on gloves and tie the cord again tightly.

48. Implement normal newborn care
• Keep the baby warm:
- Continue to keep the baby in skin to skin contact with the mother
- Cover both mother and baby with a blanket
- Cover the baby’s head with cloth or hat.
• Support breast feeding
- Show the mother how to breast feed and provide continual support as
required.
• Teach the mother and the close family:
- How to check the baby’s breathing, warmth and colour
- How to check for any bleeding from the cord
- How to keep the baby warm.
• Give Vitamin K 1 mg intramuscularly
• Give first immunizations, BCG, Polio and Hepatitis B
• Complete baby’s and mother’s records including summary
section on partograph.

49. Newborn history and physical examination
• Collect information on the mother’s pregnancy and medical history to
know if the baby needs any special attention and to determine what
care to give the baby.
• The purpose of the physical examination is to find health status and
needs.
• The baby can be examined up to 6 hours after birth.
• Ensure warmth (auxiliary temperature of 36 -37°C) before doing the
exam.

50. History of pregnancy, birth and immediate newborn period
Ask the mother and read the mothers and baby’s records (if available)
to find the following information:
• Any maternal health problems during pregnancy that may affect the
baby Check for:
– Tuberculosis
– Fever during labour
– Waters broken for more than 18 hours
– Malaria
– Other infections such as Hepatitis B or C
– Syphilis
– HIV.

51. Record the method time and place of delivery
• Look for signs of infection (especially among babies born in unclean
conditions)
• Look for effects of birth trauma
• In case of caesarean section or vacuum delivery, look for effects of
procedure or anaesthetic medications.
What colour was the amniotic fluid?
• If the amniotic fluid was yellow, brown or green the baby may have
aspirated meconium stained fluid during birth and may have respiratory
difficulty.

52. Physical examination from head to toe
Head
• - Note size and shape
• - Trace suture lines and fontanelles with a finger
• - Note moulding, caput and haematoma
• - Head circumference to rule out hydrocephalus (Normal range of circumference of head
• is 33-37cm).
Face
• - Note Down’s syndrome level of ears and unusual appearance
• - Colour of sclera of eyes, sub-conjunctival haemorrhage, discharges, presence of eyes
• and eyeballs
• - Nose flaring, patency, low set ears.

53. Mouth
• - Note for cleft lip and palate; tongue-tie; false teeth; septic spots;
thrush; cysts.
Neck
• - Usually short, check for swelling, webbing.
Arms/hands
• - Extra digits, Erbs palsy.

54. Chest/breasts
• - Respiratory movements: the chest moves equally with breathing and abdomen pushes
• out with each breath. Listen to heart and lungs, breasts nodules maybe enlarged. Both
• boys and girls may have swollen breasts at birth.
Abdomen
• - Distension. . Should be rounded and soft
• - Cord is tied tightly and is not bleeding (shrivels within 24 hrs, falls off 6-1 0 days)
• - Infection e.g. discharge, foul smell, redness of the cord stump.
External genitalia
• - If a girl, check urethral vaginal opening, fusion of labia, discharges
• - If a boy, note position of urethral opening, palpate testes in scrotum.

55. Legs
• - Length, symmetry and movements, deformity such as talipes,
number of digits, hip
• joints for congenital dislocation etc should be noted.
• Back
• - Run a finger down the spine and note spina bifida/ other
deformities.
Anus
• - Examine for patency (Pass meconium within 12-24 hours).

56. Reflexes
- Sucking, rooting, moro, grasping, walking, tonic neck,
• Length
• - To determine length of baby.
• Weight
• - Normal range for birth weight is 2.5 up to 3.99kgs.
• Newborns usually lose 5% to 10%
• of their birth weight in a few days of life and then begin to gain weight. A
baby regains
• birth weight by about day 14.

57. Subsequent care of the newborn
Examination
wash hands before handling the child. critical areas:
• Temperature either too low or too high
• pulse rate,
• mouth for any thrush,
• the eyes for discharges,
• eye and skin colour for jaundice,
• breathing pattern,
• cord for haemorrhage and infection,
• elimination pattern,
• pattern of cry,
• Breastfeeding
• weight.

58. Maintain a clear airway
• - Observe pattern of breathing
- Ensure that the baby is breathing properly by proper positioning
- Advise mother to observe colour of skin -lips (should be pink
normally).

59. Stool
- Meconium is passed for the first three or four days and
usually 3-4 times a day.
- Failure to pass meconium within 24 hours may indicate
obstruction in the alimentary tract.
-Transitional stool occurs gradually from third day. It is
brown yellow in colour.
Urine
- The newborn often passes urine during or immediately
after delivery.
- During the first week of life, the output of urine is low in
first 24 hours.
- From the second week, urinary output increases to 8 -10
wet nappies in 24 hrs

60. Prevent infection by:
- Using aseptic technique at all times when handling baby
- Using aseptic technique when cleaning the cord
- Cleaning buttocks with damp swabs and dry if baby has
soiled himself
- Cleaning eyes with cotton wool and sterile water - isolate
if signs of inflammation
- Examining the mouth daily for thrush, the skin for septic
spots, and the cord stump for haemorrhage and infection
- Ensuring that cord ligatures are tight enough
- Giving BCG, Polio vaccination and Hepatitis B before
discharge

61. • Prevent hypothermia by:
- Maintaining warm room
- Skin to skin contact with mother (kangaroo method)
- Breastfeeding
- Appropriate clothing and bedding.

62. Management of the normal newborn
• Behaviour of the newborn
- Crying of the baby is usually due to discomfort, pain, hunger
- A healthy baby sleeps most part of the day and night
- Suckling, swallowing and vomiting reflexes are present at birth in term
babies
- Babies demand feed after birth
- Yawning, sneezing is normal in the neonatal period.

63. Promote mother and baby attachment and
appropriate breastfeeding practices. Advise mothers
to:
- Breastfeed frequently and on demand
- Maintain eye to eye and skin contact
- Breastfeed exclusively for 6 months.
- Assist with positioning and attachment of baby to
breast.
- Teach the mother the benefits of breast feeding and
exclusive breastfeeding.
- Infant is held close to the mother and she supports
the infant’s whole body.

64. Four signs of good attachment
- Chin touching the breast
- Mouth wide-open and lower lip turned outwards.
- More areola visible above than below the mouth of the baby.
- The tongue may be visible at angles of the mouth.
-If the baby is sucking effectively: slow deep sucks, sometimes pausing
to swallow. If the baby is satisfied s/he will release the breast
spontaneously and appear relaxed, sleepy and looses interest in the
breast.

65. Signs of good position
- Infant’s head and body are straight
- Head and body are facing breast.
Monitor growth and elimination pattern
- Weigh baby on alternate days (while in hospital)
- During the first three weeks normal weight loss is 5% of birth weight. The
baby should regain its birth weight within 7 -10 days.
- Observe type, colour and frequency of stools and urine to assess bowel and
urinary function.

66. Bonding Behaviors
• Face positioning
• Baby talking (high pitched, sing song)
• Fingertips  open palm  enfolding
• Eye gazing
• Entrainment (baby moves in rhythm with adult speech)
• Encouraging rooming in with support is essential

67. Parental education for care of baby at home
• Assess the mother’s knowledge of the newborn and infant care and
educate her according to gaps identified. Counsel mother on:
- Exclusive breastfeeding and maintenance of warmth
- Show the mother how to bath the baby.
- Detection of infection and other health problems that may occur to the baby
- Bowel and bladder function
- Subsequent immunization
- Hygiene/prevention of infection
- Cord care
- Importance of growth monitoring
- Advise mother on importance of health cards
- Advise her to bring the baby for assessment after 2 weeks or earlier if baby
appears unwell.

68. Plan for discharge
a) Make sure baby has received BCG, first Polio and
Hepatitis
b) Assess establishment of lactation and condition of
cord
c) Counsel mother to assess home environment and
advice on what needs to be done
to ensure safety of both mother and baby
d) Reinforce the knowledge given to mother on baby
care and recognition of danger signs

69. e) Inform mother on the birth weight of the baby and
the immunization given.
f) Encourage mother to return for a postpartum check
for herself and a postnatal check
for her baby at 2 to 3 days (if discharged before 48hrs),
7-14 days and 28 days after birth.
f) Document on the discharge form.
NB: DANGER SIGNS IN NEWBORN: not feeding well,
fast breathing, severe chest
retractions, grunting, fever, yellowness, blueness,
paleness, convulsions, fever, no urine output.

70. Assessment of the newborn for danger signs
• The following signs should be
assessed during each postnatal
care contact, and the newborn
should be
• referred for further evaluation if
any of the signs is present:
• not feeding well
• history of convulsions
• fast breathing (breathing rate >
60 per minute)
• severe chest in-drawing
• no spontaneous movement
• fever (temperature > 37.5 °C)
• low body temperature (temperature < 35.5
°C)
• any jaundice in first 24 hours after birth, or
yellow palms and soles at any age.
The parents and family should be encouraged
to seek health care early if they identify any
of the above
danger signs between postnatal care visits.

71. • Care of the Newborn 6 Weeks After Birth:
• History taking
• Complete physical examination
• Management according to findings and protocol
• Documentation

72. Minor complications of a newborn
• Vomiting-common in the first 24 hrs due to improper feeding
techniques eg feeding too fast, not removing wind, belching,
rough handling.
• If this persists, seek medical attention to prevent weight
loss and dehydration.
• Skin rashes: mostly seen on skin folds. Keep skin dry and
expose to air. Medical advice if not responding
• Sore buttocks: reddening of the buttocks due to excoriation by
urine or stool. Change frequently, expose to air, apply barrier
cream, avoid strong detergents on clothing, rinse clothes well.
• Engorged breast: due to maternal oestrogen; do not squeeze.

73. • Pseudomenstruation: maternal oestrogen. Disapears in 2 to 3 days.
Reasure the parents.
• Constipation: infrequent hard stool. Newbons can go for more than a
day without stool. Reasure, exclussive breastfeeding, avoid
suplementary feeds unless indicated
• Flatulence: common in artificially fed babies, distension may occur,
colick pain, crying. Bring up the wing and abdominal massage
• Diarrhoea: common in bottle fed babies. Use cup and spoon. Hygiene.
Seek medical attention if not resolving.
• Dehydration fever: if not feeding well or not warm: high temp,
concentrated little urine; advise proper feeding.

75. • Questions…………………..