Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
Integrated Maternal and Newborn Care Basic Skills Course ...
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Reference Manual<br />
The following three adaptations may be necessary during an examination of a newborn:<br />
• Count the respiratory rate whenever the baby is quiet.<br />
• If the baby cries, take advantage to examine the mouth to look for cleft palate or thrush.<br />
• If feeding is necessary to calm the baby, take advantage to observe attachment at the<br />
breast <strong>and</strong> quality <strong>and</strong> adequacy of the sucking.<br />
Check for danger signs<br />
Check for the following newborn danger signs:<br />
• Difficulty in sucking. The danger signs related to sucking/feeding can be assessed by<br />
asking the mother <strong>and</strong> verified by direct observation.<br />
• Lethargy, diminished activity, moving only when stimulated. Except in deep sleep,<br />
babies move frequently, both spontaneously <strong>and</strong> on stimulation. The arms <strong>and</strong> legs are<br />
flexed. If a limb is consistently kept straight, evaluate for paralysis. Note also if the limbs<br />
seem very limp or flaccid.<br />
• Fever or hypothermia. Assess the body temperature by at least touching the baby’s<br />
abdomen, h<strong>and</strong>s, <strong>and</strong> feet <strong>and</strong> ensuring that all are warm. Where possible, note the<br />
axillary temperature with a thermometer leaving it in place for four minutes or as<br />
recommended by the manufacturer for axillary temperature recording. The normal<br />
temperature is 36.5-37.5 °C. The thermometer should be clean, preferably washed with<br />
soap <strong>and</strong> clean water, <strong>and</strong> wiped with an alcohol swab to prevent cross infection. Storing<br />
in liquid antiseptics should be done only if they are changed frequently. Otherwise there<br />
is risk of infections with Pseudomonas sps which may be highly resistant organisms. It is<br />
not recommended to take a rectal temperature as it is associated with a higher risk of<br />
infection <strong>and</strong> trauma. In the newborn infant, both fever <strong>and</strong> low body temperature<br />
outside the normal range of 36.5-37.5 °C are danger signs, especially if they are not<br />
reversed rapidly with simple steps, such as warming through skin-to-skin contact, or<br />
through removal of excess clothes, or covering in the hot weather.<br />
• Rapid breathing/difficulty in breathing. Assess respiration: the normal respiratory rate<br />
is 30-60 breaths/minute. There should be no flaring of the nostrils, grunting, or subcostal<br />
retractions. Although breathing can be somewhat irregular with short pauses, there<br />
should be no apnea, which is defined as cessation of breathing lasting for more than 20<br />
seconds or of a shorter duration associated with cyanosis, pallor, or bradycardia with a<br />
heart rate less than 110/minute. The normal heart rate ranges between 110-160<br />
beats/minute, with the lower rates when the baby is asleep <strong>and</strong> the higher rates when<br />
the baby is active or crying.<br />
• Convulsions. Features of convulsions are often atypical in the newborn, such as a<br />
“staring” look, blinking of eyelids, “chapping” movements of the lips, <strong>and</strong> clonic/tonic<br />
movements of the limbs.<br />
• Persistent vomiting <strong>and</strong>/or abdominal fullness . Vomiting is determined from the<br />
history taken from the mother. Occasional vomiting is normal, but persistent vomiting or<br />
green-colored vomitus are abnormal.<br />
• Severe umbilical infection. Lift the cord to see the base; check for pus discharge,<br />
redness, swelling, <strong>and</strong> foul smell. In the first day or two also check the cord for bleeding<br />
or oozing of blood.<br />
The danger signs are summarized in Table 10 below.<br />
<strong>Integrated</strong> maternal <strong>and</strong> newborn care<br />
<strong>Basic</strong> skills course<br />
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