Facets of Neonatal Care

Facets of Neonatal Care
by Dr. M. Tauseef Omer

Apart from all that you are doing for the management of the baby, do not forget the following.


Thermoregulation:
..Maintain body temperature 98 to 99.5 degF
..Maintain a neutral thermal environment with environmental temperature between 25 to 28 degC and humidity around 60%

Maintain normoglycemia
Glucose infusion rate (GIR) 4 to 6 mg/Kg/min if feeds are not yet started. May need to increase GIR as required.

Monitoring of vital signs
.. Pulse rate, respiratory rate, capillary refill time, oxygen saturation, temperature, blood pressure

nCPAP Care Bundle
Mechanical Ventilation Care bundle

Apnea of prematurity Care Bundle

Maintenance fluids and electrolytes:
Calcium supplements on Day 0
Na and K on Day 3

Infection prevention
Maintain hand hygiene 
Advise hygiene of hands and chest to mother

Disinfection of equipment and devices used in case of baby as per protocols of the unit.

Minimal Handling and Clustering of care provided to the baby.

Partial or complete kangaroo mother care.

Prevent oxygen toxicity
Oxygen Saturation Targets:
91 to 95 % with alarms set at 89% to 96% to avoid both hypoxia and hyperoxia.
Calculate oxygenation index in mechanically ventilated babies.

Neurodevelopmental care: Make nest around baby, dim lights in the night for 8 to 12 hours for circadian rhythm to develop, and to promote physiologic stability. 

Pain management before procedures.

Nutrition:
..Apply buccal colostrum in oropharynx of babies who are on OG feeding or nill per oral (unless contraindicated).
..Orogastric tube feeding with expressed breast milk
..Peripheral parenteral nutrition
..Total Parenteral nutrition
..Oral breast feeding
.. Human milk fortification
..Micronutrient and multivitamin supplementation

-Screening for DDH
-Screening for ICH

Point of care ultrasound scan (POCUS)


Multidisciplinary care.

Written counselling of parents relating the ongoing management, prognosis, complications associated with the disease and treatment, and risks such as neurocognitive delays, etc, if any.

Discharge and follow-up
-Disease specific instructions at discharge
-General instructions (breast feeding advice, vaccinations advice, vitamin D3 drops (400 IU/drop) one drop daily)
-Retinopathy of prematurity screening at follow-up or during admission
-Screening cranial ultrasound scan at follow-up or during admission
-Hearing assessment, visual assessment and complete developmental assessement
--Advocacy of breast feeding, and counselling against formula feeding.
--Advise mother to take her own care, balance her diet, have adequate sleep, and maintain hand hygiene. So parents may need family planning advice also.

Critical baby Care bundle
It should be formulated as per case basis.

Preterm baby care bundle , review and include surfactant

Family centered care

Baby friendly hospital initiative