Parturition and Routine Care
|Watch Parturition Physiology|
Preterm: defined as babies born alive before 37 weeks of pregnancy are completed.
Term: defined as babies born alive after 37 weeks and before 42 weeks
Postterm (induced for labour): defined as babies born alive after 42 weeks
- Low birth weight: <2500g regardless of age
- Very low birth weight: <1500g regardless of age
- Extremely low birth weight: <1000g regardless of age
Complications of prematurity are the underlying reasons for the higher rate of infant mortality and morbidity in preterm infants compared with full-term infants. The risk of complications increases with increasing immaturity.
The first few minutes
- Cooling of face and physical stimulation is a major stimuli to start breathing. Drying with a towel is very effective.
- The umbilical cord is clamped and cut cleanly close to the skin. Cord stump drops off.
- The plastic stump can be removed after 2 days.
- Failure of the cord to detach after 7 days indicates leukocyte adhesion deficiency.
The first hours
- Vitamin K IM to prevent hemorrhagic disease of the newborn.
- Hepatitis B vaccination
The first day
Infants sleep for most of the time and feed sometimes, but they must:
- Suck and swallow easily. If not consider congenital abnormality, hypoglycaemia or infection.
- Pass Urine. Boys not passing urine within the first 24 hours consider posterior urethral valves.
- Pass meconium within the first 48 hours. If not consider bowel obstruction or Hirschsprungs Disease
First examination (not discussed here)
The first week
- Feeding, stool and urine production normal
- Jaundice occurs in more than 50% of babies after the first 24 hours of age.
- Metabolic screening is performed for cystic fibrosis, hypothyroidusm, phenylketouria and other metabolic conditions from a heel prick.
- Screening for hearing problems – Swish Test
The first month
- Baby should gain 150-250g a week (~30g a day)
Preterm is defined as a neonate whose calculated gestational age from last menstrual period is <37 completed weeks.
Most preterm have low birth weights, but not all low birth weights are preterms. Birth weight terminology
Overview Breastfeeding is recommended as sole source of nutrition until 6 months of age. Solid food commencement advised age 6 months (can be earlier). Weight gain should be 150-200g/week in first 6 months (20-30g/day). Weight loss immediately post birth – should be regained by 2 weeks.
|Breast feeding Benefits
When is breast milk not enough?
- <35weeks and <2.5 kg – need Iron and Pentavite
- <33week and Low Birth weight – need fortifier with breast milk
- Top up formula feeds
- Motilium – enhances milk supply
|Remember Failure to Thrive is defined by crossing 2 or more centiles. Most common cause is non-organic problems (ie inadequate intake). Organic problems – (every medical problem you can imagine)|