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>1500ml 6. Nutrition status of the mother Pediatric Nursing and child health care 45 A) Management of low birth weight: Clean air way Initiate breathing Establish circulation Keep Warm Administer Vit. K Administer Silver nitrate or TTC ointment to the eyes Apply gentian Violet to the cord Feeding- Breast feeding NGT feeding Parental feeding Treat anticipated problems (infection) Hypothermia (cold injury). If Rectal temperature is < 350C Hyperthermia temperature >38.50C Normal temperature: Rectal 36.5 - 37.20C Axillary 36.5 - 370C Hyperthermia caused by Excessive environmental temperature Infection Dehydration (loss of ECF, Evaporation) Pediatric Nursing and child health care 46 B) Potential Deaths Averted: Cause percentage Number Diarrhea 40-60 24,000-36,000 Tetanus 80 450,000 Pneumonia 40 300,000 Sepsis/ meningitis 40-60 110,000-250,000 Where should the focus be for Perinatal/neonatal programs? • Globally most births occur at home • Most prenatal / neonatal deaths at home within the first week • Sick babies are rarely identified by families or health workers referred to facilities in time to prevent death Few health facilities are available to provide sophisticated neonatal care Focus for prenatal and neonatal programs: • In relation to neonatal mortality reduction, preventive approaches will be more effective and more feasible than curative care • Many of the known proven interventions could be provided by skilled attendants and by informed family members. Pediatric Nursing and child health care 47 Immediate Newborn care: • Drying, wrapping, close contact with mother • Immediate breast feeding • Prophylactic eye care, where appropriate Routine Newborn Care: • Exclusive breast feeding, counseling for problems • Maintenance of body temperature • Clean cord care • Early postpartum visit for mother and baby (within 3 days) • Recognition of danger signs; treatment and referral as needed • Immunization Special Newborn Care: • Special care for the sick children • Recognition and management of birth asphyxia • Recognition and management of infection • Special care for the LBW infant • Skin – to- skin / kangaroo mother care • Close surveillance for signs of infections and feeding difficulties Pediatric Nursing and child health care 48 Common causes of infants and childhood morbidity: Perinatal period: From 28 wks of gestation - one week of life after birth Cause of morbidity: • Perinatal asphyxia - Respiratory distress • LBW • Birth trauma • Perinatal infection 1. Common Neonatal Problems A. Due to maternal origin • Amniotic fluid infection • Obstructed labor • Congenital syphilis Placenta previa • Causeless • Toxemia of pregnancy • Recurrent and the bleeding is painless Gestational Hepatitis B. Due to fetal and maternal origin Premature separation of placenta Trauma Abruption placenta Pediatric Nursing and child health care 49 Causeless Accidental Painful(rigid) C. Due to fetal origin • Compression of umbilical cord • Congenital abnormality • Obstructed labor /mal presentation Clinical manifestation: Apnea - the cessation of respiratory movement for 15 second Pale or cyanotic Less than normal tactile movement / stop movement 5 - 7 mild asphyxia Management High-risk mother should be identified at ANC to institute resuscitation measure immediately after delivery. 2. Respiratory distress (RD) Cause: • Me conium aspiration • Congenital pneumonia (By aspiration of Amniotic fluid) • Metabolic problems (Acidosis, Hypoglycemia, Hypertension) • Congenital heart disease Pediatric Nursing and child health care 50 • Anemia • Drug (narcotic) Clinical Manifestations: • Tachypnoea • Intercostals muscles retraction • Flaring of Alai nasi • Cyanosis Management: • Resuscitation • Oxygen administration • Fluid administration • Warm - heat 3. Congenital pneumonia It is caused by aspiration of amniotic fluid or ascending infection. • Predisposing factors: • Prolonged labor • Prolonged rupture of membrane • Difficult labor Pediatric Nursing and child health care 51 4.3 Perinatal and infant infections: 1. Neonatal sepsis Causes: • Streptococcus • E. coli • Premature rupture of membrane (PROM) Four routes of
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