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What shall I do when I am called to an Obstetric Unit to
attend a normal newborn?
Dr Mukul Tiwari, MD, DCH, FIAP
Consultant Pediatrician & Neonatologist,
President Adolescent Chapter MP, Indian Academy of Pediatrics
Member Web Committee Adolescent Chapter, IAP
Exec Member: Disaster Management Group & Medico-legal
Group IAP
Director website-www.babycareindia.org
Author “A to Z Baby care" (English & Hindi Editions)
Central working Council Member, IMA
Email: dr_mtiwari@rediffmail.com
Address: Apex Hospital, University Road, Gwalior, PC 474011
Phone: 0751-2340924, 2340910. M-09827383008
Introduction: Neonatal Birth
asphyxia accounts for about 19% of the 5 million neonatal deaths
which occur each year world wide. It also accounts for a large
no of mentally and physically subnormal children. For most of
these newborns resuscitation was not available. Therefore
outcome of thousands of newborns per year may be improved if
neonatal care can be improved. About 90% babies require no help
to establish normal breathing .Approximately 10% of newborns
require some kind of assistance to begin breathing at birth;
about 1 % need vigorous resuscitation to survive.
As soon as I arrive in Obstetrician’s set up I
will first check that the delivery room has all the necessary
equipments to successfully resuscitate a newborn of any
gestational age. The equipment should include a radiant warmer,
warmed blankets, a source of oxygen, Neonatal Ambu Bag, Neonatal
Laryngoscope, Endotracheal tubes ,a source of regulated suction,
instruments and supplies for establishing intravenous access,
trays equipped for emergency procedures, and drugs that may be
useful in resuscitation like epinephrine and Soda Bicarb.
While the baby is coming out of delivery room or
operation theatre I can do a quick assessment. A term infant
with clear amniotic fluid, a lusty cry, adequate respiratory
effort and good muscle tone is enough to put me at ease without
attempting any frantic efforts. I will proceed in the
following manner then take the following steps-
·
Put baby supine
under a radiant warmer. If baby reception area is not having a
Radiant Warmer then a heater may be used judiciously.
·
Position the
baby’s head in slight hyperextension (sniffing position) to
create a good air passage.
·
Clear the
airway of secretions with a gentle suction of first mouth then
nostrils. It is important to first suction mouth. Suction is not
necessary if there are minimal or no secretions.
·
Dry the infant
with a pre-warmed sterilized cloth. Some babies come out full of
secretions and you need extra supply of cloth for them. Some
babies have a lot of vernix. Don’t try to peel off all the
vernix violently. Pre-sterilized cotton dipped in pre-sterilized
oil will clean the vernix smoothly.
·
Clamp and cut
the umbilical cord .Check the stump afterwards for bleeding
because clamps may be defective and thread tie may come loose.
·
Drying and
suctioning of baby will produce enough stimulation for baby to
cry spontaneously. If there is meconium baby’s throat and nose
should be suctioned thoroughly followed by suctioning of trachea
with an infant feeding tube with the help of a laryngoscope.
This should be followed by a gastric wash with normal saline.
·
Baby may be
then clothed and kept for a brief period of observation after
which the baby may be sent to the mother’s room. If it is a
normal delivery baby may be kept on the mother’s chest or side
to keep her warm. If it is a Cesarean operation delivery and
mother will take time to come out of the OT the baby may be kept
a little longer in the baby reception unit under strict
supervision of a competent attendant or sent to the mother’s
room where relative ladies, probably her Grandma, will hold the
baby and take care of it.
Newborn infants who need extensive resuscitation
should be rapidly identified. After initial stabilization
(provide warmth, position, clear the airway, dry, stimulate, and
reposition) they need positive pressure ventilation, chest
compressions, and medications. Below is the algorithm for the
steps of immediate post partum newborn care
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