Saturday, March 24, 2012

Management of Low Birth


1         MANAGEMENT


l  Preventive of prematurity

l  Management of preterm labour

l  Care of preterm baby after birth

1.1       Preventive of prematurity


l  To prevent preterm onset of labour if possible

  1. Primary care is aimed to reduce the incidence of preterm labour by reducing the high risk factors.
  2. Secondary care include screening test for early detection and prophylactic treatment
  3. Tertiary care is aimed to reduce the perinatal morbidity and mortality after the diagnosis
  4. Investigation full blood count, urine for routine analysis and sensitivity, ultrasonoghaphy for fetal wellbeing, serum electrolytes and glucose levels 

1.2       Management of preterm labour


1.2.1       First stage:-


l  to patient input to the bed to prevent early repture of the membrane

l  To ensure adequate fetal oxygenation

l  Strange sedation  should be avoided

l  Labour should be watched by intensive clinical monitoring

1.2.2       Second stage :-


l  the birth should be gentle and slow to avoid rapid compression of the head

l  Episiotomy

l  Cord is to be clamped

l  Shift the baby to the intensive neonatal care unit

1.3       Care of preterm neonate


l  The cord is to clamped quickly to prevent hypervolemia and development of hyperbilirubinaemia.

l  The cord length is kept long about 10 to 12 cm) in case exchange transfusion is required

l  The air passage should be cleared of mucous.

l  Adequate oxygenation through mask or nasal catheter in concentration  not exceeding 35%.

l  The baby should be wrapped including head in a sterile worm towel

l  Aqueous solution of vitamin K 1gm is to be injected I/M to prevent haemorrhagic

2         INTENSIVE CARE PROTOCOL


   Preterm babies are functionally mature and special care is needed for their survival

l  Inability to suck the breast and to swallow.

l  Incapacity to regulate the temperature within limit range from 96 to 99.

l  Inability to control the cardio pulmonary function without cyanosis attack. 

2.1.1       Principles requiring special care


·         To maintain a stable thermoneurtal condition :- keep delivery room worm, dry and the baby with towel, keep the baby with mother-skin to skin contact.

·         -The smaller babies are best place in the incubator.

-          The alternatively the baby could managed under  

·         the radiant warmer with protective plastic cover.

-          The baby’s cot should be kept worm        

  • Adequate humidification to counter balance increasable water loss

l  Oxygen therapy and adequate ventilation

l  To prevent infection the main sites of infection are resp. tract, G.I.T, skin and umbilicus every precaution should be taken to prevent or minimise the infection.

l  To maintain nutrition and adequate nursing care human milk is the first choice of nutrition for all low birth weight babies. colostrum help faster growth of the baby.200ml per kg body weight per day. If cow’s (1:1milk water) during 2nd month 2:1

l  Position :-the baby when feed in a cot, should be placed on one side with the head raised a little to prevent regurgitation.

l  Fluid requirement:- 60 to 80ml /kg/day of 10% dextrose water on first day and increase by 15 ml/kg/day amount should more if phototherapy is used.

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