Topic 3 Peculiarities of a newborn and infant - PowerPoint Presentation

Slide1

Topic 3 Peculiarities of a newborn and infant and care in the children hospital. Disinfection and sterilization of articles of care for children

MINISTRY OF EDUCATION AND SCIENSEV.N. Karazin Kharkiv National UniversityMedical facultyDepartment of Pediatrics №2

Updated 2019 by ass. of prof. Shtrakh K.V.

Slide2

The neonatal period is the period of

the baby's adaptation to its extrauterine

life and is characterized

by

the

physiological

reconstruction

in

the

work

of

all

functional

systems

of

the

organism

:

appearance

of

inde­pendent

respiration

,

circulation

changes

,

formation

of

the

physical-chemical

parameters

of

blood

,

adaptation

to

enteral

feeding

(

breast­feeding

).

Essential care of the normal healthy neonates can be best provided by the mothers under supervision of nursing personnel or basic/ primary health care providers. About 80% of the newborn babies should be kept with their mothers rather than in a separate nursery.

Slide3

The general level of adaptation of a newborn to its new conditions should meet the basic indices of adaptation Indices of a newborn's adaptationIndicesNormal rangesHR

100-160 b p.mRR30-60/minSkin Colour

Pink. Central cyanosis is absentMovementsActive

Muscle Tone

Satisfactory

Temperature

36.5-37.5'C

Slide4

Care for a healthy newbornImmediately after its birth, one should

lay the baby on its mother's abdomen,

dry its head and body

with

a

warmed

sterile

diaper

,

put

a

clean

cap

and

socks

on

the

infant

and

cover

it

with

a

dry

clean

diaper

and

a

blanket

.

Amniotic

fluid

,

blood

and

meconium

are

to

be

removed

from

the

newborn's

skin

during

the

process

of

drying

.

Remains

of

the

labour

lubricant

should

not

be

removed

.

If

the

baby's

body

is

contaminated

with

in

-

ected

amniotic

fluid

,

the

infant

should

be

washed

in

boiled

water

and

oroughly

dried

,

but

without

any

supercooling

.

Slide5

The strategic location of the vernix on the fetal skin surface suggests participation in multiple overlapping functions required at birth, such as barrier to water loss, temperature regulation, and innate immunity. Vernix seems to perform various integral roles during transition of the fetus from intra-uterine to extra-uterine life.

Slide6

Care for a healthy newbornIt should be noted that in

the majority of cases newborns do

not require those medical

interventions

(

particularly

aspiration

of

mucus

from the oral cavity and nose), which were used before. If it becomes necessary, this manipulation is made with help of an electrical aspirator, because in such cases complications are less possible.

Slide7

When the umbilical cord stops pulsating,

but not later than 1 minute after

the baby's birth,

the

obstetrician

should

compress

and

transect the umbilical cord , having changed his sterile gloves. In case of its satisfactory state, the infant is moved onto its mother's chest. In such a way the "skin-to-skin" contact

is

realized

,

thereby

preventing

loss

of

warmth

and

facilitating

colonization

of

the

baby's

organism

with

its

mother's

microflora

.

When

searching

and

sucking

reflexes

appear

,

the

obstetrician

should

help

to

start

breast-feeding

soon

after

the

birth

.

Slide8

Care for a healthy newbornThe newborn's body temperature is taken

in the axillary area with an electronic

thermometer 30 minutes after the

birth

.

The

results

of

ther­mometry

are put down into the newborn's development chart (accounting form No. 097/O).After the "eye-to-eye" contact between the mother and her baby (but not later than during the first hour of its life), the obstetrician, having cleansed his

hands

,

should

carry

out

prevention

of

ophthalmia

in

the

new­born

by

means

of

0.5 %

erythromycin

or

1 %

tetracycline

ointment

(

taking

into

account

the

leading

part

of

Chlamydia

in

the

development

of

conjunc­tivitis

of

newborns

).

This

manipulation

is

performed

once

according

to

the

instructions

.

Slide9

Care for a healthy newbornThe "skin-to-skin" contact is made during two hours at the delivery room

(also known as Kangaroo Care) refers to the method of holding an infant in an upright and prone position, skin-to-skin, on the parent’s chest for a period of time.  Clothing or blankets are wrapped around the infant to provide a secure kangaroo-like pouch. After its completion the obstetrician should put the baby on the warmed swaddling table, compress the umbilical cord with a sterile dis­posable clamp and carries out anthropometric measurements.

Slide10

Benefits of "skin-to-skin" contact (KC improve include): • improved state organization including increased frequency and duration of sleep and less crying • increased weight gain

• decreased nosocomial infection • increased maternal milk volume and increased breast feeding at discharge • maintenance of skin temperature • less variability in heart rate and transcutaneous oxygen • decreased apnea and/or bradycardia

Slide11

Slide12

EquipmentComfortable and stable chair with arm rests and a high backPillowIf parents do not have a stretchy or button front top, provide a hospital gown to allow front openingBlankets and infant hatTapes to secure respiratory support tubingFootstoolMirrorProvide a quiet and calm environment, close doors and curtains to ensure privacy

Slide13

Infant preparation:Check the infant’s temperature (ensure normothermia) and place a woollen hat on the infant’s head if low birth weight, or previous temperature instabilityEnsure infant is nursed only in a nappyEnsure patency and security of intravenous lines and gavage tubesIf the infant usually requires an increase in oxygen during periods of handling, increase prior to initiating the transferNotify medical staff of contact timing if there were concerns over the infant’s stabilityDrain condensation from respiratory support tubing prior to moving the infantDisconnect skin temperature probe cables and set the radiant warmer or isolette to an appropriate air temperature to maintain the correct level of ambient heat.

Slide14

The most important conditions for providing a satisfactory state of the newborn consist in observing the "warm-chain" conditions, i.e. maintenance of the required temperature regimen. Any failure in maintaining the above thermal conditions increases a risk of development of hypoglycemia, metabolic acidosis, infections, respiratory disturbances and those of CNS in the newborn. The air temperature of +25- 28"C is regarded as the optimum one.

No draughts from open windows, doors and air conditioners or ventilators should be at the room.

Slide15

Care for a healthy newbornRooming-in

of mothers and their newborns at one

ward is carried out

from

the

moment

of

birth

till the moment of discharge from the mater­nity hospital. This includes the "skin-to-skin" contact between the mother and her baby at a delivery room, exclusively breast-feeding on the baby's demand, nursing of the infant by its mother with

involvement

of

her

family

members

and

assistance

of

the

medical

staff

,

as

well

as

grounded

minimization

of

medical

interventions

.

All

administrations

and

manipulations

(

vaccinations

,

examinations

for

phenylketonuria

,

hypothyroidism

,

etc

.)

shuld

be carried on at a rooming-in ward and

provided the mother has given her informed consent

Slide16

Care for the umbilical cord stump and the umbilical woundAs it was described before,

immediately after the baby's birth the umbilical

cord is to be compressed

and

transected

.

Two

hours

later

, a sterile disposable clamp should be applied on the stump of the umbilical cord at a distance of 0.3-0.5 cm from the umbilical ring. If the mother and her baby stay together, the umbilical cord stump is

not

treated

with

anything

.

As

soon

as

the

umbilical

cord

is

compressed

and

clamped

,

its

colonization

with

the

mother's

bacterial

flora

and

leukocyte

infiltration

begin

,

it

gradually

gets

dry

under

the

effect

of

air

,

becomes

hard

and

dark

.

The

physiological

term

for

the

umbilical

cord

stump

falling

off

is

from

5

to

15

days

.

Slide17

Slide18

Oral hygiene. It is not necessary to clean the mouth of a healthy infant, because, when sponging down, it is possible to easily injure the mucosa and cause an inflammatory process in it, but the hygiene of the oral cavity is required in oral moniliasis (candidiasis). Technique: by a separate bolster, moistened in 2% baking

soda solution, the oral mucosa is treated

in the following order

:

the

mucous

membranes

of

the

tongue, hard palate, cheeks, and vestibule.

Slide19

Brushing teethBy the age of 3 years, the child should be able to brush his teeth un­der an adult's supervision after a meal and before sleep, to brush the teeth in the morning and in the evening. Pediatric dentists now encourage this type of oral hygiene for all infants. Children's toothpaste is used by putting it on a child's toothbrush of an adequate size. The teeth are brushed from their external and internal sides by moving the toothbrush from up to down and from down to up. It is desirable that children rinse a mouth after every meal with warm water, better with an addition of some salt (a quarter of tsp of table salt per glass of water)

Slide20

The care for the

eyes is conducted 2 times a

day (in the morning and

in

the

evening

before

bathing

), and also whenever necessary. Some pediatricians advice to clean first with pure water from the inner corner to the outer one. In case of risk of the appearance of conjunctivitis or in seriously ill children, the eyes may

be

washed

with

furacilin

solution

(1:8000)

or

any

other

mild

disinfectant

.

Older

children

usually

make

the

toilet

of

their

eyes

when

washing

.

Techniques

:

The

healthy

eyes

are

cleaned

with

a

cotton

ball

,

soaked

in

some

boiled

water

.

Clean

the

eye

corners

,

by

wiping

gently

from

the

outside

corner

to

the

inside

corner

and

using

a

different

piece

of

cotton

for

each

eye

.

Slide21

Slide22

Peculiarities of child hygiene depending upon the sex and ageThe nose is

cleaned in the morning and daily

, and especially when a

baby

often

belches

or

has

catarrhal secretions from his nose.Techniques: For cleaning the nasal cavity, a thin flagellum of cotton wool is used. Before cleaning, the cotton flagellum is mois­tened with seed-oil and put into the nasal cavity

at

a

depth

of

1-1.5

cm

with

circular

movements

.

The

nasal

cavity

is

cleaned

with

different

flagellum

in

turn

.

Slide23

Peculiarities of child hygiene depending upon the sex and ageThe ear

care is carried out on demand. Usually

, this treatment involves the

auricle

.

The

ears

are

cleaned

with cotton wool moistened with boiled water. There is no way for using hard things (sticks, matches) that can damage the skin of the external acoustic meatus and ear drum. The manipulations require much attention and great care.

Techniques

.

Drawing

off

the

auricle

backwards

and

upwards

with

her

left

hand

,

a

nurse

places

a

bundle

into

the

acoustic

meatus

,

making

a

number

of

spinning

movements

,

and

then

extracts

the

bundle

.

When

it

is

necessary

,

the

bundle

is

changed

and

the

manipulation

is

repeated

.

Slide24

The ear careWhen necessary, the flagellum is changed

and the manipulation is repeated. During the

first year of the

baby's

life

,

it

is

enough

to treat only its auricle.If a plug of cerumen is revealed in the external acoustic meatus, the former should be removed. For this purpose, some drops of 3 % hydrogen peroxide solution are put in the ear

and

the

smoothed

plug

is

removed

with

help

of

a

cotton

turunda

by

means

of

its

rotations

.

In

case

of

devel­opment

of

complications

during

the

removal

of

a

plug

of

cerumen

,

this

manipulation

is

carried

out

by

an

ENT

specialist

.

Slide25

The care for nails. Fingernails

and toenails are to be cleaned.

Many hospitals do not

allow

nails

to

be

trimmed

without a special physician's order. Oil or lotion may be applied to irritated areas. Nails are trimmed timely, unless once a week, so that the length of their free edge does not exceed 1.0-1.5 mm. Nails are

trimmed

carefully

,

only

with

scissors

having

blunt

ends

;

on

the

fingers

circularly

,

and

on

the

toes

in

a

straight

line

across

(

to

prevent

ingrown

to

enail

- a

condition

,

in

which

edg­es

of

toenails

push

into

the

skin

).

After

the

finishing

of

nails

,

the

trimming

scissors

are

dried

with

cotton

wool

moistened

with

70 %

ethyl

alcohol

or

another

disinfectant

.

Slide26

The care for hair. The

newborn infant's hair should be brushed daily

with an infant brush or

other

soft-bristle

brush

.

No

regular

brushes meant for older children or adults should be used as they can be too harsh for the newborn infant's delicate scalp. It is generally not necessary to apply oil or lotion to the scalp. A few minutes

of

brushing

the

hair

stimu­lates

the

scalp

.

It

is

not

necessary

to

wash

the

newborn

infant's

hair

daily

.

The

hair

can usually be washed about every 3 or 4 days and can be done after the infant's bath.

Slide27

Provision for physiological evacuations. The

pediatric department exercises everyday supervision over

its ill children's evacuations

with

their

relevant

recording

in

case histories. The nurses should quantify the infant's feces every day, assess their character (doughy, solid or thin), timely inform the physician about any pathological admixtures in the feces, frequent defecations or

their

absence

,

and

record

these

data

in

treatment

sheet

.

Slide28

In order to prevent development of

intertrigo, it is recommended to

intimately wash the

infant

with

warm

water

after

each defecation and urination; girls, in particular, from the front backwards, so that their fecal masses should not get into the vulvar cleft. For the purpose

of

a

more

thorough

cleaning

of

the

skin

,

cotton

wool

tampons

are

used

.

It

is

enough

to

carefully

dry

the

skin with blotting movements using a soft

diaper

after

an

intimate

washing

;

if

any

problems

develop

in

the

process

of

caring

for

infants

'

skin

,

all

natural

folds

of

the

skin

are

treated

with

some

baby

oil

or

sterilized

vegetable

oil

;

baby

creams

can

be

used

too

.

Agents

for

skin

treatment

are

to

be

chosen

individually

.

Slide29

NAPPY CAREThe perineal environment is prone to changes in the skin barrier causing skin irritation. Increased moisture, prolonged contact with irritants, and an alkaline skin surface may contribute to skin breakdown. Nappy changes should occur at regular intervals (where clinically appropriate) to avoid irritation to the perineal skin environment Evaluation of the perineal area is required at each nappy change to ensure early identification of perineal dermatitis and candida infections .Disposable nappies are preferred 

Cotton balls or disposable towels with warm water are the preferred cleansing method  

Slide30

The removal of barrier creams between nappy changes is not necessary, rather apply another layer. Barrier creams containing plant extracts and/or fragrance should be avoided Risk factors for perineal dermatitis include: Frequent stooling; antibiotic use; malabsorption;

opiate withdrawal; abnormal rectal sphincter toneOlive oil or a pH neutral cleanser may be used if stools are dry and difficult to remove 

Wipes should be avoided (if required they should be free from alcohol and fragrance) Barrier creams should be used on all infants at risk of perineal dermatitis at every nappy change as well as at the first sign of erythema or skin breakdown

Slide31

EMOLLIENTS  Emollients restore lipid levels, improve hydration, preserve natural moisturising factors and offer significant buffering capacity to normalise skin pH and maintain skin microbiome.Apply an emollient twice daily at the first sign of dryness, fissures or flaking Emollients should be applied as a preventative therapy daily to newborns with a family history of

atopy Maintain sterility by ordering patient specific containers or decanting products on to paper towel prior to application Emollient use is not associated with negative thermal effects or burns when used in conjunction with phototherapy or radiant heat Emollient use may interfere with the use of adhesives

Slide32

Provide a Safe sleep environmentMake sure the infant’s head and face remain uncovered during sleepInfants should not be slept on sheepskins or other soft surfaces. A firm mattress covered by a sheet is the recommended sleep surface.Infants nursed on an ‘air mattress’ require cardio-respiratory monitoring and constant nurse observation.Nests are potential sources of airway obstruction and entrapment. When a ‘nest’ is deemed necessary for infant development, cardio-respiratory monitoring is required.Prevent the infant from slipping down under the blankets

Cot flat

Slide33

Position infant with ‘feet to the end of the bed’Blankets firmly tucked in to the height of the chestthe wrap should come no higher than the infants shoulder. Use a light weight material like muslin or cotton, to avoid overheatingif the infant is rolling (from approximately 4 months of age), swaddling is no longer appropriate due to entrapment risk.Hats should not be worn, once the infant has been transferred to an open cot. If the infant requires more than a singlet, jumpsuit and one blanket for temperature control.Refer to Temperature managementInfants are not to be put to sleep in prams or bouncers;No toys in the cot;

Slide34

The notions about disinfection and sterilization of objects for nursing childrenDecontamination is any process that renders an item safe and fit for reuse; it will always involve cleaning and may involve disinfection and/or sterilization.Sterilization is rendering an item free from micro-organisms with a very high level of quality assurance.Disinfection is a process resulting in a reduction in the number of infectious agents to a level considered safe.Cleaning is a process that entails physical removal of micro-organisms and anything else that is not part of an item.

Slide35

When a child is admitted to hospital, it

is allowed to use individual objects

to care for him.

If

these

are

not

available

, the department tableware and objects are used. In order to prevent any spread of infectious diseases, the medical staff, who nurses infants, should strictly observe the rules of cleansing and sterilization of objects for

nursing

(

thermometers

,

chamber

pots

,

toys

,

teats

,

bottles

,

tables

for

swaddling

,

etc

.).

Slide36

For the purpose of cleansing thermometers, only

specially intend­ed disinfectants should be used. Only

undamaged thermometers may be submerged

into

disinfectant

solutions

.

S

mall

toys are completely submerged into a disinfectant process solution. After the end of their exposure they are washed with running water during 3 minutes, wiped and kept in a closed drawer. Large toys are wiped with rags

,

moistened

in

a

disinfectant

solution

.

Soft

toys

are

cleaned

with

a

brush

,

moistened

in

a

process

solution

too

.

Then

the

toys

are

washed with running water and dried out.

Slide37

The tableware, used for nursing infants (bottles, measuring glasses, cups, etc.), should be individual and thoroughly cleansed after each use. Empty bottles are soaked

in 2 % baking soda solution, then washed inside

with a special brush

and

rinsed

twice

with

hot

water. Clean bottles are placed on metal grids with their openings down. When the excess wa­ter has trickled down, the bottles are put into a hot-air sterilizer for 50-60 minutes.lt is also possible to sterilize bottles

by

boiling

.

For

this

purpose

,

af­ter

washing

they

are

placed

inside

a

special

vessel

,

covered

with

warm

water

and

boiled during 20-25 minutes. Then they are cooled, transferred With forceps on a dry tray, put with their

openings

down

and

covered

with

a

clean

napkin

.

In

this

way

they

are

kept

for

next

use

.

Slide38

Following any feeding, teats should be washed

in running water and boiled for 10-15 minutes

. In cases of teats

for

general

use

,

after

feeding

at first the remaining mixture or milk should be removed, then fat by means of soaking in 2 % baking soda solution or some agent, specially intended for this purpose; after that the teats are well rinsed and decontaminated by

boiling

for

30

minutes

.

Teats

are

to

be

kept

in

a

sterile

hermetic

glass

vessel

.

After

examination

of

any

baby

or hygienic procedures at a pediatric department, its paramedical personnel should cleanse the table for swaddling, as

well

as

the

objects

touched

by

the

ill

infant

(

an

oilcloth

pillow

and

mattresses

,

oilcloth

sheets

)

and

furniture

(

couches

,

chairs

,

etc

.),

with

2 %

Chloranthoin

solution

or

another

disinfectant

.

The

sheets

,

used

for

nursing

,

are

to

be

changed

after

each

ill

infant

too

.

Bedpans

and

chamber

pots

are

washed

with

hot

water

and

detergents

after

each

use

and

then

cleansed

with

special

disinfectants

in

ac­cordance

with

instructions

for

their

use

.

Slide39

Breast pump milk collection kits should not be reused by different mothers unless they have been sterilized in a Sterile Services Department between these different users.When used by the same mother, a detergent wash followed by thorough rinsing and drying after each use gives acceptable decontamination for most circumstances, as long as it is performed correctly.Additional decontamination precautions to washing, rinsing and drying may be used if indicated by local risk assessments and on advice from the departmental clinicians and Infection Prevention and Control Teams. The microbiological quality of the rinse water is an important consideration, particularly for infants on neonatal units.

Slide40

If bottle brushes or breast/nipple shields are used, they should be for use by one mother only. Decontamination should be by the processes used for breast pump milk collection kits.Dummies (soothers, pacifiers or comforters) needed for non-nutritive sucking by infants on neonatal units, should be for single infant use. Manufacturers should provide these dummies ready-to-use and individually packaged. They must be discarded at least every 24 hours or immediately if soiled with anything other than the baby’s saliva. No attempt should be made to decontaminate the dummies, either before or during use.

Slide41

Hand HygieneAll personnel who handle newborn infants should perform an initial scrub from fingertips to elbows using soap and water, alcohol-based hand cleansers may be used. Jewelry (except wedding bands) and watches should be removed before hand washing and should remain off until contact with the newborn is finished. Sleeves of clothing should remain above the elbows during hand hygiene and while caring for patients. After the initial washing and before and after handling patients or their equipment, hands should be washed for 15 seconds with soap and water, or a golf ball-sized spray of alcoholbased foam. Hand hygiene should be performed before entering and after exiting patient rooms.

Slide42

Slide43

Gloves Use of gloves is determined by individual hospital infection control policies. Hand hygiene should be performed before gloving and after glove removal. Masks, head covers, beard bags, and sterile gowns should be worn when placing umbilical catheters and percutaneous lines.

Slide44