Care of the newborn infant.ppt
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1、Care of the newborn infant,For more information about the authors and reviewers of this module, click here,Variations exist from place to place in the care of the newborn infant. However, although often neglected, their basic needs are the same. Infants who are unwell or have congenital abnormalitie
2、s fall short of the mothers expectation of a beautiful bundle of joy. All mothers require urgent and sensitive counselling.,How should I study this module?,This self-directed learning (SDL) module has been designed primarily for medical students but may also be of use to healthcare providers especia
3、lly at the primary care level. We suggest that you first read the learning outcomes and try to keep these in mind as you go through the module slide by slide and at your own pace. Answer the MCQ at the end to assess your learning. You should research any issues that you are unsure about. Look in you
4、r textbooks, access the on-line resources indicated at the end of the module and discuss with your peers and teachers. Finally, enjoy your learning! We hope that this module will be easy to study and complement your learning about newborn care from other sources.,Learning outcomes,After studying thi
5、s module, you should be able to Describe the routine clinical assessment of newborn infants Describe some common congenital abnormalities Describe the essential elements of the routine management of newborn infants including hygiene, cord care, feeding and rooming-in Describe what routine immunisati
6、ons are required during infancy Discuss what information is required by mothers prior to discharge,Clinical assessment,After delivery of the baby and in the absence of any immediate problems, essential newborn care begins with a thorough general clinical assessment. This should be done on all infant
7、s soon after birth to detect signs of illness and congenital abnormalities. The following slides describe the assessment that should be performed routinely in all infants. This initial assessment should indicate where more detailed clinical assessment is required.,Hand washing with soap and water be
8、fore and after a baby is handled goes a long way in reducing the risk of infection,A resident doctor washing her hands up to the elbows prior to examination,Clinical assessment First steps and appearance,Start by congratulating the mother on the arrival of her new baby and ask if she has any concern
9、s. The mother is usually the first person to notice any problems. Ask about feeding and the passage of urine and stools. The infant should pass meconium (the first black, tarry stools) within 24 hours of birth. General observation: inspect colour, breathing, alertness and spontaneous activity. Well
10、infants have a flexed, posture. Partially flexed posture is found in hypotonia or prematurity,Well term infant showing typical well flexed posture,Note the abduction of the hips in this partially flexed preterm infant (“froglike” posture),Clinical assessment Examine skin for prematurity or dismaturi
11、ty,Wrinkled peeling skin of dysmaturity in an IUGR infant,Thin, transparent skin in preterm infants,Pale pink skin of a term infant (hair shaved to site IV line),Clinical assessment Skin: some common normal findings,Vernix caseosa: a cream/white cheesy material on the skin at birth which cleans off
12、easily with oil. Lanugo; fine downy hairs seen on the back and shoulders especially in preterm infants. Milia: pinpoint whitish papules on nose and cheeks due to blocked sebaceous glands. Mongolian blue spots: grey/bluish pigment patches seen in the lumbar area, buttocks and extremities in dark skin
13、ned babies.They usually disappear by one year. Capillary heamangiomas (“stork bite” naevi): red flat patches which blanch with gentle pressure. Commonly occur on upper eyelids, forehead and nape of the neck. Erythema toxicum: small white/yellow papules or pustules on a red base seen on face, trunk a
14、nd limbs. Develop 1 3 days after birth and usually disappear by one week.,Note palor or plethora Cyanosis: the baby should be uniformly pink Blueness of the hands and feet (peripheral cyanosis) may be due to cold extremeties. Blueness of the mucous membranes and tongue is central cyanosis and is usu
15、ally due to lung or heart problems Bruising (ecchymosis) is common after birth trauma. Unlike cyanosis, bruising does not blanch on gentle pressure.,Clinical assessment Colour,A Caucasian infant with marked central cyanosis,Jaundice is common in the first week of life and may be missed in dark skinn
16、ed babies Blanch the tip of the nose or hold baby up and gently tip forward and backward to get the eyes to open. Teach mother to do the same at home in the first week and report to hospital if significant jaundice is observed.,Clinical assessment Jaundice,Blanching the tip of the nose,Two infants w
17、ith jaundice; note yellow sclerae,Clinical assessment Head,After these general observations, examine the infant starting with the head and moving down the body. Observe the size and shape of the head (micro- or macrocephaly; cephalhaematoma) Check the anterior and posterior fontanelles and that the
18、skull sutures feel normal Form and position of ears (low set ears occur in chromosomal abnormalities, e.g. Down syndrome),Huge encephalocoele. Head is disproportionately small,Cephalhaematoma limited to the right parietal region,Clinical assessment Eyes and face,Examine eyes for ocular anomalies and
19、 check for red reflex using the ophthalmoscope (to exclude cataract) Examine the face for dysmorphic features and normal movements Examine lips and palate for clefts,Bilateral cleft lip and palate. Also note purulent left eye discharge,Facial asymmetry due to left facial palsy,Clinical assessment Ca
20、rdiovascular and respiratory,Feel femoral and radial pulses for volume, rate and rhythm. In aortic coarctation, femoral pulse is reduced, absent or not synchronous with radial pulse. If child is sick, measure blood pressure. Locate the apex beat and listen to the heart sounds for murmurs. Count the
21、respiratory rate normal 30 40 breaths/min in term infants faster in preterms. 60 / minute abnormal Observe for respiratory distress: nasal flaring, intercostal and subcostal recession.,Clinical assessment Abdomen,Inspect the umbilical cord for presence of 2 arteries and a vein. Abnormal components m
22、ay be a pointer to the presence of intra-abdominal anomalies e.g. renal. Look for umbilical abnormalities, e.g. hernia, omphalocoele, exompholos Gently palpate the abdomen the liver may be palpable upto 2cm below the costal margin the lower pole of the right kidney may also be palpable,Large omphalo
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