More Related Content
Similar to NRP and care of Newborn.pptx- APPT presentation about neonatal resuscitation and newborn care (20)
More from GururajaRamaiah1 (20)
NRP and care of Newborn.pptx- APPT presentation about neonatal resuscitation and newborn care
- 1. NRP & Care Of Newborn at Birth PRESENTER : DR GURURAJA R
- 2. NEONATAL RESUSCITATION PROGRAM ALGORITHM:
- 5. QUESTION TO BE ASKED BEFORE BIRTH What is the expected gestational age?. Is the amniotic fluid clear? Are there any additional risk factors? What is our umbilical cord management plan? ANTENATAL COUNSELLING :
- 6. TEAM BRIEFING : Team members : - i. No risk : 1 qualified person skilled in PPV & initial steps of newborn care ii. High risk : >= 2 skilled people iii. Multiple pregnancy : 2 resuscitation teams
- 7. Team work : i. Know environment ii. Anticipate and plan iii. Assume leadership iv. Communicate effectively v. Delegate workload optimally vi. Allocate wisely vii. Use all available information and resources viii. Call for help when needed ix. Professional behaviour
- 8. EQUIPMENT CHECK : Warmth : 1. Radiant warmer with firm padded resuscitation surface : switch on 20 mins before delivery (100%) 2. 2 clean dry cloth pre-warmed 3. Switch off fan/ AC and close windows 4. Re-closable, food grade plastic bag (size : 1 gallon) or plastic wrap 5. Transport incubator Bassinet Quartz rod Skin probe Control panel Heater output display Heater output control knobs Temperature selection panel Temperature display Mode selector
- 9. Airway : 1. Bulb syringe 2. Mechanical suction and tubing(80-100 mmHg) 3. Suction catheters 5F 6F 8F 10F 12F 14F 8F feeding tube , 20ml syringe 4. Meconium aspirator FEEDING TUBES
- 10. Breathing : 1. AMBU bag 2. Face masks with cushioned rims (term and preterm sizes) 3. Oxygen source, Compressed air source, Oxygen blender with flowmeter (10L/min) + tubing 4. Pulse oximeter and oximeter probe 5. Laryngoscope with straight blades no. 00, 0, 1 6. Extra bulbs and batteries 7. ETT 2.5, 3.0, 3.5, 4.0 mm internal diameter (uncuffed) 8. Stylet 9. Scissors, tape 10. Alcohol sponges 11. Capnograph 12. Laryngeal mask airway
- 11. WEIGHT (GMS) GESTATIONAL AGE (WEEKS) ETT SIZE (MM ID) SUCTION CATHETER SIZE < 1000 < 28 2.5 5 F or 6 F 1000 – 2000 28 – 34 3 6 F or 8 F
- 13. SELF INFLATING BAG – free flow O2 can be given by it’s open tail reservoir FLOW INFLATING BAG – free flow T PIECE RESUSCITATO R – free flow O2 can be
- 16. Circulation : 1. Epinephrine 1 : 10,000 dilution (0.1mg/ml) 2. Isotonic crystalloids (NS or RL) for dilution and volume expansion – 100ml / 250 ml 3. Dextrose 10% 250ml 4. NS for flushes 5. UVC supplies (Umbilical catheters 3.5 F, 5 F) 6. IV cannula, tape 7. 1 ml, 2 ml, 3 ml, 5 ml, 10 ml, 20 ml, 50 ml syringes 8. 3 way stopcock 9. Sterile gloves 10. Needles 25 G, 21 G, 18 G
- 17. Others : 1. Vitamin K 2. Cord clamp and sterile blade/ scissors 3. Sterile gauze pieces, gloves, personal protections
- 19. ROUTINE CARE : T : Term T : Good tone R : Vigorous cry or good respiration 1. Delayed cord clamping 2. Warmth : skin to skin contact associated with breast-crawl/ radiant warmer 3. Clear airway if necessary 4. Dry : head, chest + abdomen, limbs (flexures) 5. Observe baby mother side
- 20. T : Preterm / Term T : Poor tone R : Poor cry / no cry INITIAL STEPS 1. Warmth : radiant warmer 2. Dry : head, chest + abdomen, limbs (flexures) 3. Stimulate : 2 flicks at sole (tactile stimulus) 4. Position : Rose position/ sniffing the morning air position 5. Airway 6. Suction : clear airway by wiping mouth and nose ; suction mouth (sweeping) followed by nose (twisting) 7. Check heart rate (6sec x 10), gasping, apnoea Normal with no laboured breathing or persisting cyanosis : Routine care Normal with laboured breathing or persisting cyanosis : WPS with SpO2 monitoring and supplemental O2 (O2 tubing/ masking, BMV, T piece resuscitator) ; consider CPAP ; post resuscitation care Abnormal : further resuscitation
- 21. POSITIVE PRESSURE VENTILATION : Apnoea Gasping HR < 100bpm SpO2 < target despite free flow O2 or CPAP Start BMV at room air (>= 35 weeks) or 21-30% O2 (<35 weeks) at 10L/min flow for 30 sec at the rate SQUEEZE, 2, 3 Check for chest raise(first 15 sec), HR, SpO2 Chest raise absent or minimal : ventilation corrective steps HR between 60-100 bpm : PPV HR >100 bpm : Post resuscitation care SpO2 < target but HR good : adjust O2 flow/min PIP : 20 – 25 cm H2O PEEP : 5 cm H2O
- 22. CO2 DETECTOR BY FACE MASK : CALORIMETRIC METHOD
- 25. ALTERNATIVE AIRWAYS : ENDOTRACHEAL INTUBATION LARYNGEAL MASK AIRWAY Laryngoscope lift in rocking motion Attempt intubation for 30 sec only Measure for length of insertion NTL (nasal septum to ear tragus + 1 cm) Proper tip placement : • CO2 detector by calorimetric and capnographs • Audible equal breath sounds near axillae during PPV • Symmetrical chest movements • Little or no air leak from mouth during PPV • Decreased or absent air entry over stomach • Chest X-ray : tip seen mid-trachea between 1st and 2nd vertebrae, above carina
- 27. CO2 DETECTOR BY INTUBATION (within 8-10 breaths) : CALORIMETRIC METHOD
- 28. DOPE MNEUMONIC D Displaced ETT O Obstructed ETT (murphy’s eye can serve as second tip temporarily) P Pneumothorax E Equipment failure SUDDEN DETERIORATION AFTER INTUBATION: ENDOTRACHEAL INTUBATION LARYNGEAL MASK AIRWAY Subglottic airway device Supraglottic airway device Difficult to insert Easy to insert Used for intubation, stabilization of diaphragmatic hernia, suction of tracheal secretions, surfactant therapy (INSURE) Keeps airway open but can’t ventilate can’t intubate; placed after 2 attempts of ETT insertion or suspecting congenital airway anomaly
- 29. CHEST COMPRESSIONS : Persisting HR < 60 bpm after 30 sec of PPV with effective ventilation (ideally effective PPV via ETT or LMA to be given for 30 sec) (s/o very low blood oxygen levels, significant acidosis, poor coronary perfusion) Chest compressions started only after securing good ventilation evidenced by chest movements with ventilation
- 30. Stand : side till ETT placed (100% O2) and then head end Position : 2 thumbs over lower 1/3rd of sternum ; other 4 fingers encircling chest and supports vertebrae NEVER ON XIPHOID STERNUM : LIVER INJURY Depth : 1/3rd of chest AP diameter Never lift thumb away from surface Rhythm : 1 and 2 and 3 and breathe and 1 and 2 and 3 and breathe and … 3 compressions 1 ventilation every 2 seconds = 90 compressions and 30 ventilations per minute Don’t squeeze ; only push thumbs downwards Assess after 60 seconds ; HR and CO2 detector changing colour Complications : injury to heart, lung(s), liver, ribs Stop after HR > 60 bpm with good ventilation
- 31. MEDICATIONS : 30 seconds PPV with good ventilation 60 seconds chest compressions + good PPV (100% O2) Epinephrine also given only after securing good ventilation evidenced by chest movements with ventilation Vascular & cardiac stimulant Constriction of blood vessels outside heart Increases coronary blood flow and perfusion Increases cardiac contractility
- 32. EPINEPHRINE SUMMARY CONCENTRATION 1 : 10,000 = 0.1 mg/ml (1 ml of 1 : 1000 in 9 ml NS) ROUTE Intravenous Intraosseous Endotracheal PREPARATION IV / IO : 1 ml syringe labelled epinephrine – IV ET : 3 – 5ml syringe labelled epinephrine – ET only DOSE IV / IO : 0.2 ml/kg (0.o2 mg/kg) ET : 1 ml/kg (0.1 mg/kg) ADMINISTRATION IV/ IO : rapid with 3 ml NS flush ET : rapid with PPV
- 33. H T HYPOVOLEMIA TOXINS HYPOXIA TAMPONADE (CARDIAC) HYDROGEN IONS (ACIDOSIS) TENSION PNEUMOTHORAX HYPO/HYPERKALEMIA THROMBOSIS (CORONARY) HYPOTHERMIA THROMBOSIS (PULMONARY) HYPOGLYCEMIA TRAUMA Stop resuscitation : Absence of detectable HR (APGAR 0) after 20 minutes of resuscitation
- 34. VOLUME EXPANDERS : INDICATED WHEN BABY NOT RESPONDING TO RESUSCITATION STEPS AND SHOWS SIGNS OF SHOCK OR HISTORY ACUTE BLOOD LOSS VOLUME EXPANDER Volume expander of choice Crystalloid fluid (0.9% NaCl) Volume replacement in severe foetal anaemia Packed RBC (cross matched to mother) Emergency : non cross matched O –ve blood Dose 10 ml/kg bolus over 5-10 mins +/- 10 ml/kg (slower infusion pre-terms <30 weeks GA d/t ICH) Route Umbilical venous catheter ; intraosseous Preparation 30-60 ml syringe labeled
- 35. UMBILICAL VEIN CATHETERISATION : 1. Sterile technique 2. Appropriate size UVC filled with 3-10 ml sterile water and 3 way stop cock used to lock it 3. Cord cleaned with antiseptic solution 4. Loose tie tied at base of cord or adjacent skin 5. Cut straight 1-2 cm above skin line 6. Identify vein and insert catheter 2-4 cm until free flow of blood obtained 7. Open stopcock and gently aspirate 8. Secure 1 cm away from aseptic site
- 36. INTRAOSSEOUS NEEDLE INSERTION : 1. Sterile technique 2. Flat surface of leg (2 cm below and 2 cm medial to tibial tuberosity) 3. Needle held perpendicular and advanced till change in resistance or ‘pop’ sound heard 4. Needle should be firm and not wiggly after insertion 5. Monitor the site
- 37. POST RESUSCITATION CARE :
- 39. PROLONGED RESPIRATORY DISTRESS OR NEED FOR SUPPLEMENTAL O2 : evaluate pneumonia / perinatal infection ACUTE RESPIRATORY DISTRESS WHILE DOING OR AFTER RESUSCITATION : consider pneumothorax PERISITENT PULMONARY HYPERTENSION OF NEWBORN : >= 34 weeks of gestation ; supplement O2 / inhaled NO / ECMO UNINTENTIONAL HYPOTHERMIA , SpO2 DROP : d/t labile pulmonary vascular tone ; avoid suction, immediate bathing, excessive stimulation UNINTENTIONAL HIGH BLOOD LEVELS OF O2 : adjust SpO2 with pulse oximeter METABOLIC ACIDOSIS : insufficient O2 and blood flow, worsen heart function, pulm. HTN; treat underlying cause, sodium bicarbonate not given ; worsens CO2 excretion from lungs and worsens other acid buffer systems
- 40. HYPOTENSION : hypoxia, hypovolemia, sepsis (dilation of blood vessels) ; volume expansion / dopamine/ dobutamine HYPOGLYCEMIA : anaerobic metabolism, IDM ; IV dextrose FEEDING PROBLEMS : perforation of intestines, feeding intolerance, poor motility, inflammation, bleeding ; parenteral nutrition given RENAL FAILURE (ATN) : hypotension, hypoxia, acidosis ; adjust fluid and electrolytes SEIZURES / APNEA : hypotension, hypoxia, acidosis (HYPOXIC ISCHAEMIC ENCEPHALOPATHY) ; h/o maternal narcotic / anaesthetic, infection, electrolyte disturbance, metabolic abnormality ; therapeutic cooling (33.3 0 C 6hrs – 3 days) HYPOTHERMIA / HYPERTHERMIA : maternal fever /chorioamnionitis
- 41. PREMATURITY : 1. Thin skin, low s.c. fat, large surface area relative to body mass 2. Immature brain development, immature blood vessels to brain 3. Immature lungs lacking surfactant, weak chest muscles, flexible ribs 4. Weak muscles 5. Rapid heat loss : minimal metabolic response to cold 6. Infection, chorioamnionitis (preterm labour), immature immune system (pneumonia, sepsis, meningitis) 7. Fragile blood vessels in brain 8. Small blood volume 9. Immature tissues : damaged by excess oxygen 10. Limited metabolic reserves and immature compensatory mechanisms : increases risk of hypoglycemia
- 42. PREMATURITY : ADDITIONAL RESOURCES NEEDED if < 32 WEEKS GA 1. Polythene wrap / food grade re-closable 1 gallon plastic bag , hat 2. Thermal mattress 3. Servo controlled radiant warmer 4. Oxygen blender , oximeter with appropriate sized sensor 5. ECG monitor and 3 leads 6. PEEP and CPAP ; T piece resuscitator or flow inflating bag 7. Preterm sized resuscitation mask, size 0 / 00 laryngoscope , ETT (2.5 / 3 mm) 8. Surfactant if <30 weeks GA 9. Pre warmed transport incubator with blended oxygen and pulse oximeter
- 43. PREMATURITY : RESUSCITATION 1. Warmth : maintain axillary temperature between 36.50 – 37.50 Celsius 2. Spontaneous breathing : CPAP 3. If PPV required : 20 – 25 cm H2O pressure inspiratory pressure given 4. If face mask used : 30 – 40 cm H2O inspiratory pressure given 5. If PPV required use devise that provides PEEP : 5 cm H2O 6. Consider surfactant in respiratory distress or extreme preterm (alternative is CPAP) 7. O2 supply according to saturation reading in monitor 8. <35 weeks GA : initiate resuscitation with 21 – 30 % O2
- 44. PREMATURITY : PRECAUTIONS 1. Handle gently 2. Do not position legs higher than head (Trendelenburg position) 3. Avoid excess pressure delivery by CPAP or PPV : pneumothorax , ICH 4. Use pulse oximeter and blood gas levels to monitor and adjust ventilation and O2 concentration 5. Do not rapidly infuse IV fluids 6. Monitor temperature 7. Monitor blood glucose 8. Monitor apnoea, bradycardia
- 45. DIMINISHED BREATH SOUNDS Inadequate ventilation Malpositioned endotracheal tube Pneumothorax Pleural effusion Tracheal obstruction Congenital diaphragmatic hernia Pulmonary hypoplasia or agenesis Enlarged heart PPV leak or equipment failure
- 46. PNEUMOTHORAX : Contraindication for PPV, especially preterm , babies with lung abnormalities and meconium aspiration syndrome Severe respiratory distress, bradycardia, desaturation : TENSION PNEUMOTHORAX Signs : no improvement in spite of resuscitation and sudden distress Rapid screening test : Transillumination Diagnosis : Chest x-ray Treatment : Thoracostomy tube placement
- 47. PLEURAL EFFUSION : Oedema, infection, leakage from lymphatic system Diagnosis made before birth by ultrasound H/o foetal anaemia, twin to twin transfusion, cardiac arrhythmias, congenital heart disease, congenital infection, genetic syndromes RESPIRATORY DISTRESS + GENERALISED OEDEMA : Hydrops Foetalis (suspect pleural effusion) Diagnosis : Chest X-ray Treatment : Intercostal Drainage
- 48. THORACOCENTESIS : Confirm side of aspiration Position : shoulder roll placed to displace air superiorly Site of puncture pneumothorax : 4th ICS anterior intercostal line or 2nd ICS midclavicular line Site of puncture pleural effusion : 5th or 6th ICS along posterior axillary line Sterile procedure Needle : 18-20 G percutaneous catheter over needle 900 to chest wall and top of rib / butterfly needle Direction : direct upwards (pneumothorax) , direct downwards (pleural effusion) Attach syringe and 3 way stopcock Repeat X-ray to see the residual pneumothorax or pleural effusion
- 49. AIRWAY OBSTRUCTION : Thick secretions : meconium, blood, mucus, vernix ; do ventilation corrective steps ; increase suction to 80-100 mm Hg Robin sequence : micrognathia + glossoptosis Put baby in prone position – tongue moves forward and open airway (OR) Insert small ETT 2.5 mm through nose with tip placed deep in posterior pharynx, past base of tongue, above vocal cords NOT INSERTED INTO TRACHEA (relieves airway obstruction) Face mask ventilation with ETT in place LMA maybe helpful in failed ventilation
- 50. Choanal atresia : obstruction of nasal airway by bone or tissue
- 53. What is a normal newborn….? Birth weight 2.5 kg or more Gestational age 37 weeks or more Birth weight appropriate for age 1min APGAR >7 Infant doesn’t need any resuscitation Infant did not suffer from any postnatal significant illness Mother did not suffer from any serious complications
- 54. PREPARATION BEFORE BIRTH OF BABY Review maternal records for o maternal age o Previous pregnancy outcomes o weight gain in pregnancy, o consanguinity, o History of any medical disease,
- 55. o Obstetric complications o Medications taken (native medicines, drugs, abortifacients), o Sociodemographic background including alcohol and drug use, o Pregnancy screening tests, o Ultrasound reports
- 56. Prenatal screening test results should be reviewed and documented on the infant’s chart at the time of delivery. Maternal prenatal screening tests • Blood type, Rh, and antibody screen • Hepatitis B surface antigen (HBsAg) • Serologic test for syphilis • Human immunodeficiency virus (HIV) • Glucose tolerance test • Antenatal testing results, including serum markers for aneuploidy, and ultrasonography results
- 57. CARE AT BIRTH The transition from fetal life to extrauterine life involves dramatic changes in physiology. During this period, the infant’s pulmonary vascular resistance decreases Blood flow to the lungs is greatly increased, Oxygenation improves rapidly, Ductus arteriosus begins to constrict or close
- 58. COMMON SIGNS OF DISORDERED TRANSITIONING • Poor cry at birth/poor respiratory efforts . • Poor tone and movements . • Poor color/perfusion/heart rate . • Respiratory distress ± cyanosis. If the neonate requires only initial steps of resuscitation (tactile stimulation or short positive- pressure ventilation)- observation near the mother may be considered.
- 59. AVOID SEPARATION OF NORMAL WELL BABY FROM MOTHER. Avoid separation of the mother and the infant especially during the first hour of life To promote immediate initiation of breastfeeding and early bonding through skin- to-skin contact. Healthy newborns must room-in with their mothers. Delay detailed examination (including taking birth weight), to allow the opportunity to breastfeed, immediately after birth
- 60. Security systems to protect newborns • Identification (ID) bands with matching numbers are placed on the newborn and the mother, as soon after birth as possible. • Transport of infants between areas should not occur until ID banding has been confirmed. • All staff are required to wear a picture ID badge, and parents should be instructed to allow the infant to be taken only by someone wearing an appropriate ID badge.
- 61. ROUTINE CARE Physical assessments, administration of medications, and routine laboratory tests should occur in the mother’s room or close to her room Infant’s weight, head circumference, and length are recorded. On the basis of these measurements, the infant is classified as appropriate for gestational age (AGA), small for gestational age (SGA), or large for gestational age If the gestational age of the infant is uncertain, an assessment of the gestational age can be performed using the expanded New Ballard Score The infant’s temperature is stabilized with skin-to-skin contact with the mother at birth. The baby should be wrapped in cotton wraps, caps, socks, and mittens.
- 62. FEEDING Breastfeeding should be started at the earliest given opportunity, preferably during the first golden hour Exclusive breastfeeding for the first 6 months of a new born’s life Mothers should initiate breastfeeding as soon as possible after delivery, preferably in the delivery room The infant should be fed on demand, 8 to 12 times per day during the birth hospitalization
- 63. SKIN CARE The first bath is given with warm tap water and nonmedicated soap Avoid the routine dip baths till the baby is in hospital due to the risk of infections. Daily sponging should be done at least once a day with clean water. Each eye should be cleaned from the inner to the outer canthus using separate sterile swabs (one for each eye) dipped in sterile or distilled water. Routine daily cleaning is not recommended.
- 64. UMBILICAL CORD CARE Dry cord care is generally sufficient. Routine application of antibiotics and antiseptics should be avoided. Evidence suggests that the use of 7.1% chlorhexidine is justified in community settings with high neonatal mortality rate and unclean cord practices. Keeping the cord dry also promotes earlier detachment of the umbilical stump. The diaper should be folded below the umbilical cord to avoid the risk of infection.
- 65. MEDICATIONS A single, intramuscular dose of vitamin K1 (phytonadione; 1 mg IM) should be given to all newborns before 24 hours of age to prevent vitamin K deficiency bleeding VACCINATIONS Hepatitis B: Administration of the first dose of hepatitis B vaccine is recommended for all infants during the newborn hospitalization, even if the mother’s HBsAg test is negative Hepatitis B vaccine is administered by 12 hours of age when the maternal HBsAg is positive or unknown. Infants of HBsAg-positive mothers require hepatitis B immune globulin in addition to vaccine
- 66. BCG vaccine is administered in most Asian countries. It is known to protect against serious forms of tuberculosis. The vaccine is given intradermal on the leftarm. Oral polio vaccine (OPV) zero dose is mandatory in India. The risk of vaccine-associated polio due to live strains is not noted.
- 67. ROUTINE ASSESSMENTS The physician should perform a complete physical examination within 24 hours of birth. The physical examination includes observation of the newborn’s general appearance, posture, and movements followed by head-to-toe examination. We have to palpate the femorals and examine the genitalia, hips, and spine for any deformity or malformation. Always check for vital signs, including respiratory rate, heart rate, and temperature, every 8 to 12 hours and record them.
- 68. Each urine and stool output is recorded in the infant’s chart. The first urination should occur by 48 hours of age. The first passage of meconium is expected by 24 hours of age. Delayed urination or stooling is a cause for concern and must be investigated. Weights are recorded in the infant’s chart. Weight loss in excess of 7% to 10% of birth weight should be investigated. Look for attachment and positioning of the neonate. Lactation support is important to help determine further management.
- 69. SCREENING 1. Screening for neonatal sepsis risk All newborns should be screened for the risk of infections from the mother gestational age <37 weeks, Maternal intrapartum temperature ≥100.4°F (38°C) Rupture of membranes >18 hours, Signs of chorioamnionitis.
- 70. Glucose screening Infants should be breastfed early and frequently to prevent hypoglycemia Healthy normal newborns require no glucose screening Infants of diabetic mothers, infants who are SGA or LGA, and preterm infants should be screened for hypoglycemia in the immediate neonatal period
- 71. Newborn metabolic screening Indian Academy of Pediatrics (IAP) recommends routine screening for congenital hypothyroidism. In populations in whom glucose-6-phosphate dehydrogenase (G6PD) is common, screening is advised by IAP. Many state governments and private sector hospitals screen for various metabolic disorders. There is no national recommendation. Routine collection of the specimen is between 48 and 72 hours of life.
- 72. Bilirubin screening Before discharge, all newborns should be screened for the risk of subsequent development of significant hyperbilirubinemia. Risk factors for developing significant hyperbilirubinemia include hemolytic disease, prematurity, G6PD deficiency, ,presence of cephalohematoma or significant bruising, exclusive breastfeeding with weight loss, and a sibling history of phototherapy treatment. Jaundice during the first 24 hours of life is considered pathologic and warrants a total serum bilirubin level. The bilirubin result should be plotted and interpreted on an hour-specific nomogram to determine the need for phototherapy Parents should be given verbal and written information about newborn jaundice.
- 73. Hearing screening 1. Routine screening for hearing loss in newborns is mandated in most states . The IAP also recommends universal screening for hearing impairment. 2. Verbal and written documentation of the hearing screen results should be provided to the parents with referral information when needed. 3. Parents must be explained that a ‘retest’ hearing screen does not mean that the baby is hearing impaired. The need to follow up should be clearly explained and documented.
- 74. Critical congenital heart disease screening Screening for critical congenital heart disease (CCHD) using pulse oximetry The pulse oximetry screening should be performed in all neonates after 24 hours of age or prior to discharge, whichever is earlier. CCHDs are congenital heart defects requiring surgery or catheter intervention within the first year of life.
- 75. In Pulse oximetry screening (of preductal and postductal oxygen saturations) is most likely to help diagnose the following seven CCHDs: a. Hypoplastic left heart syndrome b. Pulmonary atresia c. Tetralogy of Fallot d. Total anomalous pulmonary venous return e Transposition of the great arteries f. Tricuspid atresia g. Truncus arteriosus
- 76. Predischarge checklist • Adequacy of oral intake: • This includes a minimum of eight feeds per day, Change of meconium to transitional green/yellow stool by the second to third day • one to two urine voids on the first 2 days and six to eight per day thereafter. No significant jaundice; follow-up for jaundice should be scheduled and parents educated on its importance. • The infant’s vital signs are documented to be within the normal ranges (with appropriate physiologic variations) and stable
- 77. • Clinical course and physical examination reveal no abnormalities that require continued hospitalization. • Maternal and infant laboratory tests have been reviewed. • Vitamin K, BCG, OPV, and hepatitis B have been given. • Screening protocol (metabolic, hearing, CCHD) as per institution has been completed.
- 78. • Parents should be explained regarding immunization schedule with the date of next immunization visit mentioned on the discharge card. • Parental competency to care for the newborn has been demonstrated. • Family, environmental, and social risk factors have been assessed. • A primary care physician has been identified. • Danger signs and signs of illness including fever, irritability, lethargy, poor feeding pattern, difficulty in breathing, rapid breathing, or presence of abnor- mal movements have been explained to the parents.
- 79. FOLLOW-UP For infants discharged before 48 hours of life, an appointment with a health care provider should be arranged within 48 hours of discharge. If early follow-up cannot be ensured, early discharge should be deferred. For newborns discharged between 48 and 72 hours of age, outpatient follow-up should be within 2 to 3 days of discharge. Timing should be based on the risk for subsequent hyperbilirubinemia, feeding issues, or other concerns.
- 80. The follow-up visit is designed to perform the following functions: Assess the infant’s general state of health including weight, hydration, Degree of jaundice and identify any new problems. Look for danger signs. Review feeding patterns; encourage and support breastfeeding. Review the adequacy of stool and urine patterns. Provide referral for lactation support if feeding and elimination patterns are not reassuring.
- 81. Assess the quality of mother–infant bonding Reinforce maternal or family education. Review results of any outstanding laboratory tests. Perform screening tests in accordance with state regulations. Assess parental well-being and screen for maternal postpartum depression.
- 82. THANK YOU