3-Ed-2014-FBNC-Nursi..

184 Pages·2015·5.47 MB·English

3rdEdition,January2014-15
1stEdition,July2004
2ndEdition,2009
Compiled by Faculty, Residents and Nursing Staff of the WHO Collaborating Centre for Training and
Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, in collaboration with
Collegeof Nursing,AllIndiaInstituteof MedicalSciences,NewDelhi.
ThispublicationissupportedwithfundsprovidedbyWHO-SEAROasapartof APWwithDepartmentof
PediatricsWHO-CC,AIIMS,NewDelhi. Itscontentsaresolelytheresponsibilityof theauthorsanddo
notnecessarilyreflecttheviewsof WorldHealthOrganization.
The protocols and recommendations in the module are based on an extensive
review of available literature and the standard practices in leading neonatal
centres in the country. The publications of the World Health Organization,
Saving Newborn Lives, American Academy of Pediatrics, JHPIEGO,
KangarooFoundationandNationalNeonatologyForum,amongothers,served
as important sources of information. The evidence-based principles of
newborncarewerecarefullyadaptedforapplicationintheoperationalmilieuof
small facilities. Medical and nursing knowledge keeps changing rapidly.
Therefore,theusersof thisGuideareadvisedtorefertoliteratureandamend
thesepracticeswithpassageof timetosuitthesituationprevalentintheirunits.
Thepracticesandpoliciesmayvaryfromonefacilitytoanother,hencetherecan
benouniversalrecommendations.Thepracticesmentionedinthisguidearejust
guidelinesandarenottobetakentobefirmandfinalortheonlywaytoperform
such procedures in newborn. The authors or sponsors will in no way be
responsible for any harm or damage to patients, care givers or equipment
resultingfrommisinterpretationormisuseof thesepracticeguidelines.
Publishedby
Divisionof Neonatology,
Departmentof Pediatrics,AIIMS,NewDelhi
ThismaterialispublishedbyNeonatalDivision,Departmentof Pediatrics,AllIndiaInstituteof Medical
Sciencesforgeneraldistribution.Allrightsarereserved. Subjecttodueacknowledgment,thisdocument
may,however,bereviewed,abstracted,reproducedortranslated,inpartorinwhole,providedthatsuchis
notdoneforcommercialpurposes.
Design&Printed by
M/sPapyriPrints
NewDelhi.Tel:[phone]

C O N T E N T S
Module I : Care of the normal baby at birth
Module 2 : Thermal Protection
Module 3 : Kangaroo Mother Care
Module4: Feedingof NormalandLowBrithWeightBabies
Module5: Resuscitationof theNewbornBaby
Module6: CommonProcedures
Module7: Preventionof InfectionHouse-KeepingandWasteDisposal
Module8:Careof At-riskandSickNeonates
Module 9 : Common Equipments & Troubleshooting
Annexures
References
KAP Questionnaire
Key Operationalization Criteria of Essential Newborn Care

FOREWORD
Ensuringhealthysurvivalof allneonateshasclearlyemergedasakeyareaforimprovingchildhealth.The
globalcommunityhascommitteditself toattainanunder-fivechildmortalityrateof lessthan20per1000
live births in all counties by 2035. This would only be achieved if the neonatal mortality rate declines to
under10per1000births.ForIndia,thiswouldbeatwo-thirdsreductionfromtheprevailinglevelof 29.
Since 99% of neonatal death occur in middle and low income countries, the strategies and tools that are
appropriateforthesesettingsareurgentlyrequiredtobedeveloped,disseminatedandtranslatedintoaction.
Investments in newborn nursing is all the more important as staff nurses are identified as one of the
important service providers to deliver the recently launched Every Newborn Action Plan (ENAP). The
Newborn Nursing for Facility Based Care intends empowering nurses to provide skilled care to sick and
prematureneonatesforuseinIndiaandinotherdevelopingcountries.
Careof mothers,neonatesandchildreninsmallhospitalsislargelyshoulderedbyournursingcolleagues.It
isthenurseswhoprimarilyprovidethelife-savinginterventionstothebabies,enablethemothersfortheir
babiescare,andcounselthefamilies.Nurseshaveanimportantroleinallclinicaldisciplines,butforneonatal
caretheirroleasskilledprofessionalswithhumantouchiscentral.Forqualitycareitisessentialtohavewell
trainedhealthacreprofessionals.Thepresentpackageaimstostrengthentheircorecompetence.Thefocus
is on skills and the approach is participatory. We proudly believe that this resource material is of global
standardsandisrelevantnotonlyinIndia,butalsomanyothercountriesacrosstheworld.
Iwouldliketocongratulatethecontributors,reviewersandtheeditorialteamforaproductof outstanding
educational and technical quality. It is indeed remarkable that a majority of contributors are experienced
nurses themselves. Professor A K Deorari has set new standards in training methods and technology
throughthiseducationalendeavour.Iwarmlycomplimenthimforhisstellarleadership.
I am sure this training resource material will contribute toward saving many newborn infants in years to
come.
Prof.VinodPaul
Incharge,WHO-CCforTrainingand
ResearchinNewbornCare
Head,Departmentof Pediatrics
AllIndiaInstituteof MedicalSciences
14thNovember2014

PREFACE
Nursesplayapivotalandvariedroleinmanydevelopingcountrieshealthcarefacilities,includingproviding
prenatal education, labor and delivery, and ongoing newborn care. Most notably, it is nurses who are
providing skilled attendance during birth, performing newborn resuscitation, initial newborn care,
stabilizationof at-riskandsicknewborns,anddeterminetheneedfortransfertoregionalhospitalswhen
necessary.Inaddition,nursesprovidecounselingtomothersabouttheimportanceof institutingkangaroo
mothercareandbreastfeedingaswellasthespecialneedsof lowbirthweightbabies.Duetoashortageof
physicians, especially in rural areas in developing countries, the nurses role is especially critical at district,
sub-district areas, and villages. Often they perform critical care procedures and look after neonatal
equipment.
There is no well-structured or standardized in-service training program in newborn care for nurses
employedatabovehealthfacilities.Thenewborncarecurriculuminthepre-servicetrainingcourseof the
nursesisoftenscantyandtheoretical.ItisinthisbackgroundthatAIIMStookaleadindevelopingahigh
quality training module directed to clinical care practices on Newborn Nursing for facility based care
buildinguponearlierpackageofessentialnewbornnursingof 2009.Themoduleusesparticipatorylearning
methodologyusingself reading,self evaluation,demonstration,oraldrill,roleplay,casediscussion,group
work, video and clinical skill demonstration. The entire package is also available on smart phone as a
memorytool.
AIIMS team are indebted to the contributors for their outstanding efforts in providing technical inputs.
RotaryInternationalFocusGroupStudyExchangeprogrammebetweenRotaryDistrict3010(Delhi,India)
and Rotary District 5360 (Calgary, Canada); support for workshops from UNICEF in September 2000;
LaerdalFoundation,NorwayinJan2003;DFID,BritishCouncilMarch2004;WHO-SEARO2007-08and
fundssavedfromcontinuingmedicaleducationof DoctorsatAIIMShavesowntheseedforthisinitiative.
WewouldliketoexpressourappreciationtoteamatCentreof MedicalEducation&Technology,AIIMS
for developing video films. Special thanks to NIPI (Norway India Partnership Initiative) and UNICEF
UNICEFIndiaofficefortheongoingsupportfordisseminationandcapacitybuildingof newbornnursing
inIndia.
Prof.AshokDeorari
WHO-CCforTrainingand
ResearchinNewbornCare
Head,Divisionof Neonatology
AllIndiaInstituteof MedicalSciences
NewDelhi-110029
NewbornWeek2014
Module1-Careofthebabyatbirth
CARE OF THE NORMAL BABY AT BIRTH
The module is designed to complement in-service education and orientation of health personnel
involvedincareofnewborns.
LEARNING OBJECTIVES
At the end of this session, participants will be able to:
(cid:2)
Describe basic needs at birth and every day care of the newborn baby
(cid:2)
Describe evidence-based routine care of a newborn baby at birth
(cid:2)
Enumerate the components of 'Clean chain' and 'Warm chain'
(cid:2)
Educate mother how to look after her baby and what to do if her baby is sick
MODULE CONTENTS
M
The module includes following elements:
o
(cid:3) Textmaterial:Easytoreadformatforquickreproductionandessentialreferencematerial d
u
fortheparticipants.Keymessagesarehighlightedintheboxes. l
e
(cid:3) Role-play: Observing the steps of normal newborn care at birth. Participant will also be I
:
providedwithanopportunitytodoroleplay.
C
(cid:3) Demonstration:Demonstrationofimmediatecareofcordandeyeatthetimeofbirth. a
r
(cid:3) Self-evaluation: At the end of text, self evaluation based on what has been learnt is e
o
included.Feelfreetoconsultyourtextmaterial,ifyouneedassistanceinrecapitulating. f
t
h
I. CARE OF BABY AT BIRTH e
n
o
r
m
1. INTRODUCTION
a
l
Thefirsthourafterbirthhasamajorinfluenceonthesurvival,futurehealth,andwellbeingofa b
a
newlyborninfant.Thehealthworkershaveanimportantroleatthistime.Thecaretheyprovide b
during this period is critical in helping to prevent complications and ensuring survival. All y
a
mothers need help, support, and advice in the initial few days after delivery to ensure proper t
b
careoftheirnewlybornbaby.
i
r
t
2. THEBASICNEEDSOFANORMALBABYATBIRTH h
ThefourbasicneedsofALLbabiesatthetimeofbirth(andforthefirstfewweeksoflife)are:
i. Warmth
ii. Normalbreathing
iii. Mother'smilk
iv. Preventionofinfection
Thesebasicneedsindicatethatababy'ssurvivalistotallydependentuponhermotherandother
caregivers. Therefore it is important to provide proper care to all the neonates immediately
after birth. All newborns require essential newborn care to minimize the risk of illness and
maximize their growth and development. This care will also prevent many newborn
emergencies. For example, the umbilical cord may be the most common source of neonatal
sepsis and also of tetanus infection, and good cord care can dramatically reduce the risks of
these serious conditions. Exclusive breastfeeding has a significant protective effect against
infections. Early breastfeeding and keeping the baby close to the mother reduce the risk of
hypothermiaandhypoglycemia.
NeonatalDivision,AIIMS,NewDelhi
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