Lectures on taking care of babies

2021-03-21 12:00 AM

Staff involved in neonatal resuscitation must be present in the delivery room before pregnancy, check equipment and tools.

Outline

Neonatal period: from day 1 to day 28 after birth.

Early neonatal period: 1st to 7th day after birth.

Late neonatal period: from day 8 to day 28 after birth

After birth, babies have changes in the function of organs in the body to adapt to life outside the uterus In order for this transition period to be regulated, it is necessary to have:

Effective respiration.

The circulatory system must adapt.

The kidneys are responsible for good homeostasis.

The body regulates its own body temperature.

The body regulates blood sugar levels within its normal range.

Therefore, infant care plays a very important role for the development of children in the future.

Newborn examination in the delivery room

The newborn baby is examined in the delivery room right after birth to:

Assess whether the child needs resuscitation intervention

The following steps need to be done systematically:

Put the child on the heating table, dry him.

Suction of mouth, pharynx, nose quickly but effectively, if long-term suction can cause laryngospasm reflex and slow heart rate. If amniotic fluid is inhaled, the trachea should be aspirated directly with the laryngoscope or immediately after intubation, before applying the balloon.

Breathing count, heart rate, crying nature, skin color and ability to respond to stimuli.

APGAR index assessment: calculated at 1, 5 and 10 minutes. Term infants with Apgar:

If ≥ 8 points in the 1st minute is normal.

From 3 to 7 points in the 1 st minute is moderate fetal failure, must have appropriate treatment attitude.

If <3 points at 1 minute is clinical death, emergency resuscitation is required.

Making the umbilical cord, taking care of the umbilical cord.

Get body temperature.

Comprehensive examination and detection of birth defects if any

General condition: observing whether the baby has ruddy, good limb movement, loud crying, good reflexes or not.

Average breathing rate 40-60 times / minute.

Average heart rate 140 times / minute.

Maximum blood pressure 60-65mmHg.

Head bone examination: observing the anterior rhombus, triangular posterior fontan. The overlapping phenomenon can be seen in severely malnourished and old-aged children. Determine the magnitude and location of serum tumors, blood tumors. Detecting hydrocephalus, brain anemia, brain herniation.

Face examination: look for unusual signs such as:

Hemorrhage under the conjunctiva, congenital cataracts, squinting ...

Cleft lip, cleft palate, cleft palate.

Abnormal position of the ear.

In the mouth there are tooth buds, tongue receding, short. . .

Neck examination: finding defects in the neck such as a crooked neck, short neck ... A hematoma in the sternum muscle causing a child to turn his head to the side can be encountered when giving birth to a large child with a shoulder or a difficult buttock.

Chest examination: Count breathing rate, observing the balance and mobility of the chest when breathing, listening to bilateral alveolar murmur, whether there is pathological sound when listening to the lungs. Hear the heart to locate the heart and detect pathological sounds.

Abdominal examination:

Check the condition, morphology (toad belly).

Evaluate abnormal conditions such as umbilical hernia, abdominal wall hernia, length, umbilical cord blood vessels.

Examination of the extremities:

Upper limbs: evaluate movement, count, count fingers to detect excess or missing finger.

Lower extremities: check for movement of the lower limbs, or crooked feet.

Examination of the hip joint: see if the hip joint is dislocated, or loose.

Skin examination: normally the child is pinkish, possibly slightly edema of the eyelids, feet, hands. Look for scratches in the face, blood tumors in the skin.

Genital examination:

Boys: Examination of the testicles in the scrotum. Testicular hydrocephalus can go away spontaneously within 6 months. If you have foreskin stenosis need to monitor the baby's urination in the first days after birth.

Girls: The vagina has white mucus, a few days after giving birth may have physiological menstrual phenomenon. The breasts may be slightly erect.

Examination of the primary reflexes: a healthy child must have the original reflexes, which will go away 4-5 months after birth.

4-point reflex: using the index finger to stimulate the top, bottom and sides of the child, the baby will turn his head, bring his tongue to the stimulated, if he touches the mother's breast he will suck.

Gripping reflex: stimulate the child's palms, give the baby little finger to hold, the child will hold tightly, we can lift the child's head off the examination table. By stimulating the soles of the feet, the child's toes will contract.

Moro reflex: holding the child's hands gently lifted from the examination table and slowly letting go of the hand, the child will react through 3 stages:

Stretch your arms out and stretch your forearms.

Open, open your hands.

Burst  into tears, folds and shrinkage forearms, arms as if holding something in long.Thu Moro reflex can evaluate paralysis arm plexus meet in shoulder dystocia due.

Cross-stretching reflex: let the child lie on his back comfortably, the examiner grabs one side of the baby's leg using the stretching force, holds the knee and stimulates the soles of the foot to observe that the foot on the opposite side shows 3 signs:

Children with legs curled up.

Children stretch their legs.

Free leg form and close to irritated leg.

Automatic step reflex: the child is held upright, picked up on either side of the child's armpit so that the foot touches the table. Observe that the child leans up, feet stomped down and curled up as if wanting to step forward.

Classification of babies

Depending on the level of maturity and nutritional status, gestational age, weight, height and head circumference corresponding to gestational age, newborns are classified into 3 categories.

Full term birth

Full term neonatal convalescence: weight ≥ 2500g, height ≥ 47cm, and head circumference ≥ 32cm, corresponding to 38-42 weeks of gestational age.

Full-term infants with retardation:

Weak births:

Gestational age 38-42 weeks.

Your weight and / or head circumference (and / or height) is smaller than that of full term pregnancy.

Fetal malnutrition:

Gestational age 38 -42 weeks.

Weight, height and head circumference are all smaller than full term gestational age.

Newborn babies are born prematurely

Gestational age <37 weeks, weight <2500g, height <47cm, head circumference <32cm.

A nutritious preterm baby: weight, height, head circumference and gestational age respectively.

Malnourished preterm labor: the weight, height and head circumference are smaller than gestational age, also known as weak preterm birth.

Month old newborn

Gestational age> 42 weeks. Manifested by the following nine signs:

Dry, wrinkled, and flaky skin.

Hands and feet long, spindly. Muscle masticity. Big head.

Children increased stimulation, always active.

The whole body is slender, the skull is hard or has signs of overlapping.

The umbilical cord is yellow or green due to the staining of su stool.

Long nails and nails tinged with yellow or green.

In case of severe old age, the whole body is skinny, the chest is protruding, the belly is flat.

The skin peels off in large, dry patches.

The whole body is tinged with gold, the navel is dry and stiff.

Clifford is divided into 3 levels:

Level 1: includes signs 1, 2, 3.

Level 2: includes signs 1, 2, 3, 4, 5, 6.

Level 3: all 9 signs.

Follow up and take care

Care immediately after birth registration

Staff involved in newborn care and resuscitation must be present in the delivery room before pregnancy, check the equipment and tools to receive the newborn and be able to resuscitate as soon as needed.

When taking the pregnancy, take the following steps:

Dry, warm.

APGAR Index Review.

Decide whether to resuscitate or not.

Newborn care.

Care process:

Ensure airway circulation.

Guaranteed body temperature. Put your child on a table with a heated lamp, keep the environment warm from 28-30 0 C.

Take care of your belly button

Cut the umbilical cord: Clamp the first umbilical cord about 20cm from the base of the navel. The second umbilical clamp is about 2 cm away from the first and the pair is toward the mother. Cut the umbilical cord between the two clips. Place the baby on the umbilical table.

Umbilical care: Disinfect the umbilical cord and umbilical cord with 5% iodine alcohol. Tie the umbilical cord with plastic clips or just 2.5 to 3 cm from the base of the umbilical cord, cut off the remaining umbilical cord on the tie; Disinfect the section with iodine alcohol 5% and allow to dry. Avoid falling iodine into the skin because it can cause burns to children. Check for enough 2 arteries and 1 umbilical vein. The umbilical cord and umbilical cord clamp plastic are wrapped with a sterile gauze pad and a sterile bandage, changing the bandage daily. The umbilical cord usually falls out after 1 week, if there is an umbilical bud, silver nitrate can be applied to speed up the scar formation process.

Other care

Prevent neonatal bleeding due to decreased prothrombin ratio: Vitamin K1 1mg intramuscularly.

Eye antiseptic: small solution of silver nitrate 1%, usually use Argyrol1% solution. Erythromycin 0.5% solution can be used against Chlamydia. If the child's eye is infected with small dilute penicillin small gonorrhea (500 units / ml distilled water).

Weigh, measure length, head circumference, bust.

Wear clothes, diapers for children. Clothes and diapers are soft, thin, absorbent and wash off quickly and warm enough.

Put the baby next to the mother and encourage early breastfeeding, about 30 minutes to 1 hour after birth, 4-6 hours after surgery to help quickly gain milk, help the uterus to contract well and let the baby suck colostrum ( is breast milk appearing in the first few days after birth), feeding on demand. Should breastfeed one breast at a time so that the baby can benefit from a feeding of both first and last milk, the next time to change to another breast to avoid erection if only one breast is fed. Before feeding, the areola should be wiped with a sterile gauze.

Contraindications to breast-feeding babies:

Mother is developing tuberculosis.

The mother has a serious infection or is taking medications such as: medicines for thyroid disease, drugs for treating mental illnesses, anticoagulants, anti-cancer drugs. In these cases, artificial milk must be used

Cases where artificial milk must be used:

There are many mixed milk products on the market, on the principle of mixing close to breast milk: very little sweetness, the components lipid, caséine, salt are almost like breast milk.

The number and number of breastfeeds must depend on the gestational age and weight of the infant. In the case of preterm infants, the suck and swallow reflexes are not good, can be passed through a drip through the stomach (sond). For premature babies, it is necessary to choose formula for premature babies.

Daily baths with cloth towels with boiled water to cool from 38 - 40 0 C, the principle is to take a quick bath, not to let the child get cold, only really wet the baby when the umbilical cord has fallen, completely scarred. It is possible to bathe with a soap solution suitable for the baby's skin pH. Do not use shower creams or lotions as this can cause skin irritation. After taking a bath, you can use talcum powder, infant powder to rub on the neck, armpits, buttocks, groin. Changing diapers every time your baby has wet pee is the best way to prevent diaper rash and ulcers for children ..

If it is necessary to administer the drug by intramuscular injection, it should never be injected into the buttocks even on the outer 1/4 because there is a risk of damage to the sciatica, most appropriate injected in the middle of the front of the thigh or face. In addition to the thigh, this position is equivalent to the femur body, pull the skin up by hand and inject.

Monitoring jaundice: Physiological jaundice: seen in 85 - 90% of infants, appearing on day 3 to 7 in term babies, lasting longer than in preterm infants.

Monitoring physiological weight loss: babies lose less than 10% of their weight, return to birth weight within 10 days.

Monitor urination: children urinate, have poop in the first day after birth.

Immunization to ensure prevention for babies who need to be vaccinated against tuberculosis and hepatitis B after birth within the first month. All children who are vaccinated, except in some cases of too premature or having a medical condition on antibiotics, will be vaccinated later. After that, the child continued to follow the national immunization program.