Presentation on theme: "CARE AFTER DELIVERY: OBSERVATION OF NEWBORNS IN THE FIRST FEW HOURS OF LIFE Alexandra Wallace On behalf of the Neonatal Encephalopathy Working Group June."— Presentation transcript:
CARE AFTER DELIVERY: OBSERVATION OF NEWBORNS IN THE FIRST FEW HOURS OF LIFE Alexandra Wallace On behalf of the Neonatal Encephalopathy Working Group June 2012
Background – Normal Newborns Most term newborns adapt rapidly to life ex utero and require no resuscitation Early skin to skin contact and initiation of breastfeeding are integral to obstetric and neonatal best practice 1 Step 4 in the 10 steps of the BFHI policy 2,3 1. Moore, E. R. et al. Cochrane database of systematic reviews(2): CD003519. (2009) 2. World Health Organization/UNICEF: Ten Steps to Promote Successful Breastfeeding (1989). 3. Saadeh, R. and J. Akre (1996). Birth (1996).
Background – when things go wrong…. Some newborns require assistance to initiate or maintain normal cardiorespiratory function following delivery Problems may be apparent immediately after delivery or develop in the first few hours of life May be expected or unexpected Therefore….. Normal cardiorespiratory function cannot be assumed All newborns require assessment: at birth intermittently over the first few hours of life
Potential Newborn Problems Failure to adapt to ex utero environment Birth asphyxia Meconium aspiration Birth trauma Sepsis Congenital heart disease Other congenital anomalies Newborn vulnerability Thermoregulation Glucose homeostasis Immature respiratory control
Potential Maternal Factors Fatigue Pain +/- immobility Ongoing interventions or management of obstetric problems Effects of medication Body habitus
Example: Compounding Maternal and Newborn Factors 1 Primigravida, increased BMI Long labour, normal delivery Big baby but well, no resuscitation required Skin to skin soon after delivery with attempts to latch At 2 hours of age – Mum sleeping Baby prone on Mum’s chest, apnoeic, blue, cold Required resuscitation, ventilation, inotropic support Developed severe hypoxic-ischaemic encephalopathy and died at 15 days of age 1. Andres et al. Pediatrics, 2011.
SUDI vs SUPC vs SUEND SUDI: Sudden Unexpected Death in Infancy Clinically unexpected deaths in infants less than 12 months of age SUPC: Sudden Unexpected Postnatal Collapse Clinically unexpected collapse in apparently healthy term infants in the first hours of life SUEND: Sudden Unexpected Early Neonatal Death Does not include babies who collapse but do not die
SUPC Statistics 1,2 Incidence varies from 2.6 to 5 per 100,000 live births Death results in up to 50% of cases Over half of the events occur in 1 st 2 hours of life Identifiable cause found in up to 30% of cases Remainder due to accidental airway obstruction 3 commonly identified risk factors: Primiparous mother Skin-to-skin in prone position with mouth and nose occluded Mother and baby unattended by clinical staff 1. Becher, J-C et al Archives of Diseases in Childhood Fetal Neonatal Ed, 2012. 2. Fleming, PJ. Archives of Diseases in Childhood Fetal Neonatal Ed, 2012.
What is Required? Awareness of the issues What can go wrong? Newborn and maternal factors that increase risk Development of recommendations for observation of the WELL newborn that: Do NOT impinge on initiation of skin to skin contact and breastfeeding DO keep babies safe by identifying unexpected problems
DHB Survey 18 responses from 21 DHBs Of the 18 that responded: 2 have specific policy on observation of the newborn Variety of other policies submitted including: Examination of the newborn Early discharge Breastfeeding Hypoglycaemia guidelines Care of low birth weight babies Treatment of narcotic depression Safe sleeping/SUDI prevention
Mother and Baby Observations in the Immediate Postnatal Period: Consensus Statements Guiding Practice 1.Active assessment for ALL babies in the early postnatal period, regardless of birth context 2.Minimum assessment time of 1 hour Longer if increased risk 3.Early skin-to-skin contact and breast feeding is facilitated and supervised Monitoring of colour, tone, respiration ongoing Ensure nose and mouth are not occluded 4.Family/Whanau may be involved in process Must know what to check for and who to call for help
Newborn Observations Colour Heart rate Respiratory rate Temperature Airway patency Tone and activity Ability to feed Overall condition Any concerns require referral for Paediatric review
Summary Well newborns usually remain well A few newborns develop problems soon after birth All apparently well newborns require observation in the 1 st few hours of life This can be done without compromising early initiation of skin to skin contact and breast feeding Health care providers must: Be aware of the problems a newborn may encounter Understand the observations required Know what to do if a newborn becomes unwell