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ESSENTIAL NEWBORN CARE (ENC) / UNANG YAKAP

Pediatrics
Pediatrics

IMMEDIATE NEWBORN CARE

Call out time of birth.
Deliver the baby prone on the mothers abdomen.
Dry the newborn thoroughly for a full 30 seconds. Remove wet cloth.
Check breathing while drying.
Position newborn prone on the mothers abdomen in skin-to-skin contact.
Cover the back with a dry blanket.
o If this is not possible, place newborn in a warm, safe place close to the
mother.
Exclude second baby
Remove first set of glove.
Clamp and cut the cord after cord stops pulsating (1-3 minutes) for pretransfusion and lesser chance of anemia and intraventricular hemorrhage.
Maintain skin-to-skin contact; do not separate baby from the mother until a
full breastfeed is achieved; watch for feeding cues.
Place identification band on ankle.

CLASSIFICATION OF NEONATAL SEPSIS

LATE, LATE
EARLY ONSET
LATE ONSET
ONSET
Time of Onset Birth to 7 days 7 30 days
> 30 days
usually <72

hours

NEONATAL JAUNDICE

Immediate drying
Uninterrupted skin-to-skin contact
Proper cord clamping and cutting
Non-separation of the newborn from the mother for early breastfeeding
initiation and rooming-in

Intrapartum
complication
Transmission

Often present

Usually absent

Pediatrics
Pediatrics

Indirect Hyperbilrubinemia: Yellowish

Direct Hyperbilirubinemia: Greenish
PHYSIOLOGIC JAUNDICE
Onset 24 HOL usually on the
3rd day of life
TSB increasing less than 5
mg/kg/day
Decline to adult levels by the
10th to 12th day of life

PATHOLOGIC JAUNDICE
Early onset < 24 HOL
TSB increasing more than 5
mg/kg/day
TSB concentration exceeding
12.9 mg/dL (FT) and >15 mg/dL
(PT)
DSB > 2 mg/dL or 20% of TSB
(total serum bilirubin)
Persists > 1 wk (FT) or >2 wks
(PT)

Usually absent

Vertical:
Vertical:
Environment/
maternal genital
Postnatal
community
tract
environment
Clinical
Fulminant
Insidious, focal
Multisystem or
Manifestations
course,
infection,
focal
multisystem
meningitis
involvement,
(common)
pneumonia
(common)
Prematurity is the most important neonatal factor predisposing to infection

NEONATAL COLD INJURY

BREASTFEEDING JAUNDICE
Occurs in the first week of life
Starvation jaundice
Can be prevented by frequent
breastfeeding

BREASTMILK JAUNDICE
Occurs beyond the first week of
rd
life until the 3 week of life
Extension of physiologic jaundice
Enhanced enterohepatic
absorption of UCB of unidentified
factors in human milk which
inhibits hepatic glucoronosyl
transferase
-glucoronidase converts back
conjugated bilirubin to
unconjugated bilirubin

RESPIRATORY DISTRESS SYNDROME

SIGNS AND SYMPTOMS:

Apathy
Refusal to eat
Oliguria
Coldness to touch
Edema
Redness of the extremities
Temperature between 29.5-35 C
Bradycardia, apnea, hypoglycemia, acidosis and massive pulmonary
hemorrhage
TREATMENT OF NEONATAL COLD INJURY
Warming
o Warm, ironed blanket
o For premature babies, you can put a cap on the head since the head
has the highest surface area (especially important for low birth weight
and SGA babies)
o Thermoregulated bed sheet
o Radiant warmer
Correction of metabolic disturbances

HYPOGLYCEMIA
Definition: Blood sugar of <40mg/dL
Management:
Blood glucose determination and early feeding
INFANTS WHO CANNOT TOLERATE ORAL FEEDING, ARE
SYMPTOMATIC, OR IN WHOM ORAL FEEDINGS DO NOT MAINTAIN
NORMAL GLUCOSE LEVELS
o Administer D10W at 2mL/kg over 1 min
o Maintain a Glucose Infusion Rate (GIR) at 6-8 mg/kg
o Increase dextrosity to 12.5 to 15
o Hydrocortisone/Glucagon if patient is still not responding

CAPUT SUCCENDANEUM
Soft tissue swelling
May cross the midline
Edema disappear in the first few
days of life
Molding of the head and overriding
of the parietal bones
No treatment
Hyperbilirubinemia can develop
(hemorrhagic caput)

CEPHALHEMATOMA
Subperiosteal hemorrhage
Does not cross the midline
Resorbs within 2 weeks to 3
months
Absent
No treatment
Hyperbilirubinemia may need
phototherapy

GENERAL PREVENTIVE MEASURES

Prevention of prematurity
In utero acceleration of pulmonary maturity
Betamethasone 48 hr before delivery of fetuses between 24 and 34 wks
gestation
SPECIFIC THERAPY
Exogenous surfactant (from bovine lungs)
o Instilled intratracheally (4 mg/kg)
Assisted/ mechanical ventilation
INDICATIONS FOR MECHANICAL VENTILATION
Arterial blood pH <7.20
Arterial blood pCO2 >60mmHg
Arterial blood pO2 <50mmHg on CPAP and Fio2 >60%
Persistent apnea
GOALS OF ASSISTED VENTILATION
Improve oxygenation and eliminate CO2 without causing barotrauma and
O2 toxicity
Target:
o PaO2 50- 70 mmHg
o PaCO2 45- 55 mmHg
o pH 7.25- 7.35

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NEONATAL PNEUMONIA
Route of Transmission
Ascending infection
Aspiration of infected material during passage through the birth canal

MECONIUM ASPIRATION SYNDROME

Meconium: The first intestinal discharge from newborns; a viscous, dark
green substance composed of intestinal epithelial cells, lanugo, mucus, and
intestinal secretions, such as bile

Predisposing factor: Prolonged rupture of membranes

Causative Agents:
Group B Streptococci (major pathogen producing pneumonia for developed country)
E. Coli (major organism in the Philippines)
Listeria spp..
Klebsiella spp.
Enterococcus spp.
Clinical Course:
Sign of respiratory distress: Tachypnea, Retractions, Cyanosis
Non-specific signs: Apneic spells, Thermal instability, Jaundice
Xray:
Streaky densities
Confluent opacified areas
Diffusely granular appearance with air bronchogram
Treatment:
Penicillin/ ampicillin and aminoglycosides
Late onset (occurs more than 3 days of life)
o Staphylococcus: Oxacillin / Vancomycin
o Chlamydia: Erythromycin
o Fungi: Amphotericin B
Duration of treatment: 10 days

TRANSIENT TACHYPNEA OF THE NEWBORN

Follow an uneventful delivery at or near term

Major presenting symptom: persistently high RR
Other symptoms:
o Mild cyanosis
o Minimal respiratory distress
Due to delayed resorption of fetal lung fluid
Increased risk in cesarean delivery
X-ray:
o Central perihilar streaking
o Hyperaeration
o Fluid in the minor fissure
Self- limited course
Resolves within 6- 8 hours mostly
May last for 72 hours
Minimal O2 support usually enough
Antibiotics not needed

Meconium aspiration induces hypoxia via 3 major pulmonary effects:

o Airway obstruction
o Surfactant dysfunction
o Chemical pneumonitis

Risk Factors
Post-Term delivery
SGA neonates
Ante-intrapartum distress and hypoxia
Maternal complications causing impaired uteroplacental blood flow Eg. Hypertension
Intrapartum conditions causing impaired uteroplacental blood flow Eg. cord compression
Management
Vigorous infants at birth: No required treatment
Depressed/non-vigorous infants: Direct endotracheal suctioning
Pulmonary toilet (remove all meconium)
Supplemental oxygen
Antibiotic coverage
Mechanical ventilation
Surfactant
Inhaled nitric oxide
Extracorporeal membrane oxygenation (ECMO)