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Chapter3
Baby Chan is born at term. He is blue and has poor muscle tone. He doesn't cry.
Look for:
Breathing or crying Good muscle tone Colour pink
NO
NO NO
Check the heart rate Continue to bag at rate of about 40 breaths per minute Use oxygen if available Every 1-2 minutes stop and see if the pulse or breathing has improved.
History
Baby Chan was born at term. He came out not crying, blue and with poor muscle tone. He was reanimated for 2 minutes. Rupture of membranes happened at home, contractions were regular. His mother was in labour for a long period of time, but progressed to normal delivery in hospital. No chronic illness and no preeclampsia were diagnosed before. Chan is her first baby.
Monitoring
The newborn has to be monitored frequently Pay attention to child's breathing, muscle tone and ability to drink
Monitoring (continued)
In the days after birth the newborn may develop following problems (Ref. p. 51-52):
Convulsions check glucose treat with phenobarbital Apnoea oxygen by nasal catheter resuscitation with bag and mask Inability to suck feed with milk via a nasogastric tube
Supportive Care
If none of the problems described arise provide supportive care as for the normal newborn:
Give the baby to mother as soon as possible, place on chest or abdomen Cover the baby to prevent heat loss Encourage initiation of breastfeeding within the first hour Keep umbilical cord clean and dry Give vitamin K (phytomenadione), according to national guidelines 1 ampoule IM once Apply antiseptic ointment or antibiotic eye drops (e.g. tetracycline) to both eyes once (prophylaxis), according to national guidelines (Ref. p. 46, p. 50)
Breastfeeding support
Early and exclusive breastfeeding is very important for all newborns.
Breastfeeding support:
Encouragement Breastfeeding friendly environment Breastfeeding, assessment and counselling (Ref. p. 295)
Progress
Chan's motor tone has recovered well. After his mother was encouraged and counselled in breastfeeding, he started to suck. After some difficulties at the beginning he was sucking well. Before he was discharged home he also received oral polio, hepatitis B and BCG vaccines.
Follow-up
Baby Chan should receive regular clinical follow-up at first-level facilities to monitor: His clinical condition Growth Nutritional intake Immunization status
Summary
Be prepared for resuscitation at every delivery. Learn all steps of neonatal resuscitation by heart and train them whenever it is possible. Prognosis for the baby with perinatal asphyxia can be predicted by recovery of motor function and sucking ability. The prognosis is good for babies who respond quick to resuscitation. It is worse, if the baby has not recovered motor function and cannot suck spontaneously.