Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_37_библиотеки_им_акад_М_И_Перельмана
.pdf
CHAPTER 5 Immediate Newborn Care After Birth
https://t.me/medicina_free
129
Professional care providers are only temporary
caregivers. It is our responsibility to help parents
become confident, primary caregivers of their
own infants. Actively involving parents in the
care and treatment of their newborn further
solidifies their position as primary caregivers.
125
Encouraging active parental involvement enhances
the parents’ self-esteem and confidence in their abilities; thus our actions must tell and reassure the parents, “You are able to care for this baby.” An RCT
comparing the ability of parents to perform the
baby’s first bath in the mother’s room versus a nurse
bathing the baby in the admission nursery found
no difference in temperature changes irrespective
of who bathed the baby or where the bath was
125
given.
The newborn heat loss experienced with
bathing was significant and returned to normal in 1
BOX
5.5
• Every encounter with the parents is a teaching opportunity, so that by the time
• Teach parents how to care for the newborn’s skin, umbilicus, and circum-
• Teach parents about the nutritional needs of their newborn, how to
• Teach parents how to take an axillary temperature on their newborn and
• The presence and clinical significance of jaundice are determined before
• Teach parents the importance of follow-up care, either at a clinic, physi-
• Give parents the newborn immunization record with documentation of
• Teach parents appropriate safety precautions:
• Verbal and written information about recognizing signs and symptoms of a
• Proper use of car seats including positioning with supports, facing the rear in
PARENT/CAREGIVER TEACHING
of discharge, parents are totally competent to care for their infant. Assess each
individual family’s ability to care for their infant and readiness for discharge.
cision site and the appropriate urination/stooling patterns for newborns.
breast/bottle feed, and how to burp their baby. Develop a feeding plan
with the parents for the late-preterm infant, and teach parents how and
why to adhere to the plan for a late-preterm infant.
maintain the axillary temperature between 36.5° and 37.4°C (97.7°
and 99.3°F) with clothes, blankets, and an appropriate environmental
temperature.
discharge (see Chapter 21), appropriate follow-up care has been determined, and the importance is stressed to parents. Parents are taught how
to assess jaundice at home.
cian’s office, or home visit: (a) within 24 to 48 hours after discharge for
late-preterm infants,69 (b) within 48 hours (if discharged at ≤48 hours
of age),23 or (c) within 3 to 5 days after discharge.
what immunizations their infant has received and the importance of follow-up for childhood immunizations.
“sick”/“ill” infant, how the infant acts, and whom to notify.
the backseat, middle of rear seat, preferably with an adult seated next to the
preterm to enable ongoing observation of the infant during travel.
69,168
87
hour. Parents in the study wanted the opportu-
nity to bathe their infants and gained confidence
in their parenting skill/ability. With the super-
vision of the nurse, ensuring an environment to
reduce heat loss (e.g., warm, draft-free room, temperature assessment, warm water, use of kangaroo
care after the bath) and using the bath as a teaching
opportunity, parents can bathe their own infants.
At discharge, performing the physical examination in the room with the parents offers a
final opportunity to teach, counsel, and advise
them before they take their new baby home.
Information about feeding, cord care, bathing, elimination patterns, safety, signs of illness, medications,
and the importance of follow-up care is essential
for parents of a full-term, healthy newborn (Box
5.5). It is also essential for parents taking home an
• Proper positioning supine for safe sleep: “Back to Sleep.” Model “Back
to Sleep” by placing babies who are in cribs only on their backs to
sleep. All care providers (e.g., parents, grandparents, day care providers, babysitters) should sleep babies supine (see Chapter 13).
• Use of skin-to-skin care for full term infant is soothing, calming, and rec-
ommended.54 A 50-minute session of skin-to-skin care at 5 to 7 weeks
of age has been shown to decrease an infant’s salivary cortisol level
prior to a bath.21 Skin-to-skin contact must be done safely—position
infant prone on adult chest with head turned to one side, face visible
with nose and mouth uncovered; neck is straight, not bent, and head is
in the “sniffing” position; legs are flexed, and the baby is covered with a
blanket. Adults do not sleep while the baby is in skin-to-skin contact.
• Importance of a smoke-free environment because secondhand smoke is
associated with an increased risk for developing health problems.
• NEVER shake the baby! Babies are shaken by frustrated caregivers when
the infant continues to cry. Dangers of shaking infants include blindness,
brain damage, developmental delays, seizures, paralysis, and death.
(See Resource Materials for Parents at the end of this chapter.) Education
of parents about normal sleep and crying patterns, techniques for soothing infants, possible medical causes for crying, and parent self-care advice
lowers parental depression and enhances parent confidence in caregiving.
• Information, in writing, about all medications for their infant including
name, action, dose, route, side effects, and schedule (see Chapter 10).
• Proper swaddling technique: Safe swaddling includes positioning the baby’s
extremities in slight flexion and abduction; baby should be able to freely
move lower extremities. Placing an infant’s hips and knees in an extended
position with swaddling increases the risk of hip dysplasia and dislocation.
• Teach parents the importance of their own self-care: need for adequate
sleep/rest, nutrition/hydration, privacy, stress management, recreation,
and sex.
73
97
UNIT TWO Support of the Neonate130
https://t.me/medicina_free
infant after prolonged hospitalization. In addition,
a modified version of the Brazelton examination
on all neonates enables parents to become familiar
with a newborn’s competencies for reacting to and
shaping his or her environment and with strategies
for parental intervention. Developing written materials for parents about normal newborn care and
documenting teaching sessions and return demonstrations ensure that no important information is
forgotten (see Chapter 31 for discharge planning
and teaching strategies).
REFERENCES
1. Abeling BA, Thacker AD. The impact of kangaroo care on pain
in term newborns receiving intramuscular injections. Proceedings of the 2013 AWHONN Convention. J Obstet Gynecol
Neonatal Nurs. 2013;42:S89.
2. Academy of Breastfeeding Medicine Protocol Committee.
ABM clinical protocol Peripartum breastfeeding management
for the healthy mother and infant at term (revision June 2008).
Breastfeed Med. 2013;8(6):469.
3. Academy of Breastfeeding Medicine Protocol Committee.
ABM clinical protocol No. 23: non-pharmacologic management of procedure-related pain in the breastfeeding infant.
Breastfeed Med. 2010;5(6):315.
4. Ackerman L, Menezes A. Spinal congenital dermal sinuses: a
30-year experience. Pediatrics. 2003;112(3 Pt 1):641.
5. Aghdas K, Talat K, Sepideh B. Effect of immediate and continuous mother-infant skin-to-skin contact on breastfeeding
self-efficacy of primiparous women: a randomized control trial.
Women Birth. 2014;27(1):37.
6. Allen MC, Capute A. Tone and reflex development before
term. Pediatrics. 1990;85(3 Pt 2):393.
7. Als H, Butler S, Kosta S, McAnulty G. The assessment of
preterm infants’ behavior (APIB): furthering the understanding and measurement of neurodevelopmental competence
in preterm infants. Ment Retard Develop Disabil Res Rev.
2005;11(1):94.
8. American Academy of Pediatrics and American College of
Obstetricians and Gynecologists. Guidelines for Perinatal Care.
8th ed. Elk Grove, IL: The Academy; 2017.
9. American Academy of Pediatrics Committee on Fetus and
Newborn. Levels of neonatal care. Pediatrics. 2012;139(3):587.
Reaffirmed in Pediatrics. 2015;136(5):e1418.
10. American Academy of Pediatrics: Committee on Fetus and
Newborn; American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. The Apgar score. Pediat-
rics. 2015;136(4):819.
11. American Academy of Pediatrics. Section on breastfeeding: breastfeeding and the use of human milk. Pediatrics.
2012;129(3):e827.
12. Anderzén-Carlsson A, Lamy ZC, Eriksson M. Parental
experiences of providing skin-to-skin care to their newborn
infant—part 1: a qualitative systematic review. Int J Stud Health
Well-Being. 2014a;9:24906.
13. Anderzén-Carlsson A, Lamy ZC, Tingvall M, Eriksson M.
Parental experiences of providing skin-to-skin care to their
newborn infant: part 2: a qualitative meta-synthesis. Int J Qual
Stud Well-Being. 2014b;9:24907.
14. Association of Women’s Health, Obstetric and Neonatal Nurses:
Evidence-Based Clinical Practice Guideline: Neonatal Skin Care. 3 rd
ed. Washington, DC: AWHONN; 2013.
15. Association of Women’s Health, Obstetric and Neonatal
Nurses. Practice brief No. 5: immediate and sustained skin-toskin care for term newborns. J Obstet Gynecol Neonatal Nurs
2016;45(6):842.
16. Ballantyne M, Benzies KM, McDonald S, Magill-Evans J,
Tough S. Risk of developmental delay: comparison of late
preterm and full term Canadian infants at age 12 months. Early
Hum Dev. 2016;101:27.
17. Ballard JL, Khoury JC, Wedig K, et al. New Ballard score,
expanded to include extremely premature infants. J Pediatr.
1991;119(3):417.
18. Baron IS, Weiss BA, Baker R, et al. Subtle adverse effects of late
preterm birth: a cautionary tale. Neuropsychhology. 2014;28(1):11.
19. Battaglia FC, Lubchenco LO. A practical classification of
newborn infants by weight and gestational age. J Pediatr.
1967;71(2):159.
20. Behring A, Vezeau T, Fink R. Timing of the newborn first bath:
a replication. Neonatal Netw. 2002;22(1):39.
21. Beijers R, Cillessen L, Zijlmans MA. An experimental study on
mother-infant skin-to-skin contact in full-terms. Infant Behav
Dev. 2016;43:598.
22. Beiranvand S, Valizadeh F, Hosseinabadi R, Poumia Y. The effects of skin-to-skin contact on temperature and breastfeeding
successfulness in full-term newborns after cesarean delivery. Int
J Pediatr. 2014;846486.
23. Benitz W, the American Academy of Pediatrics Committee on
Fetus and Newborn: Hospital stay for healthy term newborn
infants. Pediatrics. 2015:135(5):8948.
24. Benzies KM, Magill-Evans J, Ballantyne M, Kurilova J.
Longitudinal patterns of early development in Canadian late
preterm infants: a prospective cohort study. J Child Health Care.
2017;21(1):85.
25. Bergstrom A, Byaruhanga R, Okong P. The impact of newborn
bathing on the prevalence of neonatal hypothermia in Uganda:
a randomized controlled trial. Acta Paediatr. 2005;94(10):1462.
26. Bergstrom A, Okong P, Ransjo-Arvidson AB. Immediate maternal thermal response to skin-to-skin care of newborn. Acta
Paediatr. 2007;96(5):655.
27. Besser L, Sabag-shaviv L, Yitshak-Sade M, et al. Medically
indicated late preterm delivery and its impact on perinatal
morbidity and mortality: a retrospective population-based study.
J Matern Fetal Neonatal Med. 2019;32(19):3278.
28. Bigelow A, Power M, MacLellan-Peters J, et al. Effect of
mother/infant skin-to-skin contact on postpartum depressive
symptoms and maternal physiologic stress. J Obstet Gynecol
Neonatal Nurs. 2012;41(3):369.
29. Bigelow AE, Power M, Gillis DE, et al. Breastfeeding, skin-toskin contact and mother-infant interactions over infants’ first
three months. Infant Ment Health. 2014;35(1):51.
30. Brady K, Bulpitt D, Chiarelli C. An interprofessional quality
improvement project to implement maternal/infant skin-toskin contact during cesarean delivery. J Obstet Gynecol Neonatal
Nurs. 2014;43(4):488.
31. Brazelton TB, Nagest JK. Neonatal Behavioral Assessment Scale.
3rd ed. London: Mac Keith Press; 1995.
32. Briana DD, Boutsikou M, Boutsikou T, et al. Novel bioactive substances in human colostrum: could they play a
role in postnatal adaptation? J Matern Fetal Neonatal Med.
2017;30(5):504.
CHAPTER 5 Immediate Newborn Care After Birth
https://t.me/medicina_free
131
33. Brimdyr K, Cadwell K, Stevens J, Takahashi Y. An implementation algorithm to improve skin-to-skin practice in the first
hour after birth. Matern Child Health. 2018;14(2):e12571.
34. Brimdyr K, Cadwell K, Widstrom A, et al. The association
between common labor drugs and suckling when skin-to-skin
during the first hour after birth. Birth. 2015;42(4):319.
35. Brogan J, Rapkin G. Implementing evidence-based neonatal
skin care with parent-performed, delayed immersion baths.
Nurs Womens Health. 2017;21(6):442.
36. Brown HK, Speechley KN, Macnab J, et al. Neonatal morbidity
associated with late preterm and early term birth: the roles of
gestational age and biological determinants of preterm birth. Int
J Epidemiol. 2014;43(3):802.
37. Brown PA, Kaiser KL, Nailon RE. Integrating quality improvement and transitional research models to increase exclusive
breastfeeding. J Obstet Gynecol Neonatal Nurs. 2014;43(5):545.
38. Buck Louis GM, Eunice Kennedy Shriver National Institute of
Child Health and Human Development Fetal Growth Studies’
Research Team, Grewal J. Clarification of estimating fetal
weight between 10-14 weeks gestation, NICHD Fetal Growth
Studies. Am J Obstet Gynecol. 2017;217(1):96.
39. Buck Louis GM, Grewal J, Albert PS, et al. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J
Obstet Gyecol. 2015;213(4):449.
40. Bulut C, Gur soy T, Ovali F. Short-term outcomes and mortality of late preterm infants. Balkan Med J. 2016;33(2):198.
41. Cadwell K, Brimdyr K, Phillips R. Mapping, measuring, and analyzing the process of skin-to-skin contact and early breastfeeding
in the first hour after birth. Breastfeed Med. 2018;13(7):485.
42. Caka SY, Gözen D. Effects of swaddled and traditional tub
bathing methods on crying and physiologic responses of
newborns. J Spec Pediatr Nurs. 2018;23(1):e12202. https://doi.
org/10.1111/jspn.12202. [Epub ahead of print].
43. Carbajal R, Veerapen S, Couderc S, et al. Analgesic effect
of breastfeeding in term infants: randomized trial. Br Med J.
2003;326(7379):13.
44. Centers for Disease Control and Prevention. Prevention of
perinatal group B streptococcal disease: revised guidelines from
CDC. MMWR. 2010;59(RR-10)(1):2010.
45. Centers for Disease Control and Prevention. Strategies to Prevent
Obesity and Other Chronic Diseases: the CDC Guide to Support
Breastfeeding Mothers and Babies. Atlanta, GA: US Department of
Health and Human Services; 2013. Available at: www.cdc.gov/
breastfeeding. Accessed April 24, 2017.
46. Chan E, Leong P, Malouf R, Quigley MA. Long-term cognitive and school outcomes of late-preterm and early-term births:
a systematic review. Child Care Health Dev. 2016;42(3):297.
47. Chen EM, Gau ML, Liu CY, Lee TY. Effects of father-neonate
skin-to-skin contact on attachment: a randomized controlled
trial. Nurs Res Pract. 2017;8612024:2017.
48. Cheong JL, Doyle LW, Burnett AC, et al. Association between
moderate and late preterm birth and neurodevelopment and
social-emotional development at age 2 years. JAMA Pediatr.
2017;171(4):e164805.
49. Chi Luong K, Long Nguyen T, Huynh Thi DH, Carrara HP,
Bergman NJ. Newly born low birthweight infants stabilize
better in skin-to-skin contact than when separated from
their mothers: a randomized controlled trial. Acta Paediatr.
2016;105(4):381.
50. Chiou ST, Chen LC, Yeh H, et al. Early skin-to-skin contact,
rooming-in, and breastfeeding: a comparison of the 2004 and
2011 national surveys in Taiwan. Birth. 2014;41(1):33.
51. Christensson K, Bhat GJ, Amadi BC, Eriksson B, Hojer B.
Randomised study of skin-to-skin versus incubator care
for rewarming low-risk hypothermic neonates. Lancet.
1998;352(9134):1115.
52. Christensson K, Cabrera T, Christensson E, et al. Separation
distress call in the human neonate in the absence of maternal
contact. Acta Paediatr. 1995;84(5):468.
53. Clayton PE, Cianfarani S, Czernichow P, et al. Management of
the child born small for gestational age through to adulthood: a
consensus statement of the International Societies of Pediatric
Endocrinology and the Growth Hormone Research Society. J
Clin Endocrinol Metab. 2007;92(3):804.
54. Cleveland L, Hill CM, Pulse WS, et al. Systematic review of
skin-to-skin care for full term, healthy newborns. J Obstet
Gynecol Neonatal Nurs. 2017;46(6):857.
55. Colwell A. To bathe or not to bathe: the neonatal question.
Neonatal Netw. 2015;34(4):216.
56. Cong X. Skin-to-skin care is effective and safe intervention to reduce procedural pain in neonates. Evid Based Nurs.
2017;20(4):113.
57. Cong X, Ludington-Hoe S, Vazquez V, et al. Ergonomic procedure for heel sticks and shots in kangaroo care (skin-to-skin)
position. Neonatal Netw. 2013;32(5):353.
58. Cong X, Ludington-Hoe SM, Hussain N, et al. Parental oxytocin responses during skin-to-skin contact in pre-term infants.
Early Human Dev. 2015;91(7):401.
59. Cordero L, Giannone P, Rich J. Mean arterial blood pressure in
very low birth weight (801-1500 g) concordant and disconcordant twins during the first day of life. J Perinatol. 2003;23(7):545.
60. Crockett LK, Brownell MD, Heaman MI, Ruth CA, Prior
HJ. Examining early childhood health outcomes of children
born late preterm in urban Manitoba. Matern Child Health.
2017;21(12):2141.
61. Crossland D, Furness J, Abu-Harb M, et al. Variability of four
limb blood pressures in normal neonates. Arch Dis Child Fetal
Neonatal Ed. 2004;89(4):F325.
62. Davidoff MJ, Dias T, Damus K, et al. Changes in the gestational
age distribution among US singleton births: impact on rates of
late preterm birth, 1992 to 2002. Semin Perinatol. 2006;30(1):8.
63. De Alba-Romero C, Camano-Gutierrez I, Lopez-Hernandez
P, et al. Postcesarean section skin-to-skin contact of mother and
child. J Hum Lact. 2014;30(3):283.
64. De Carolis MP, Pinna G, Cocca C, et al. The transition from
intra to extra-uterine life in late preterm infant: a single-center
study. Ital J Peds. 2016;42(1):87.
65. Donovan EF, Tyson JE, Ehrenkranz RA, et al. Inaccuracy of Ballard scores before 28 weeks’ gestation. J Pediatr.
1999;135(2 Pt 1):147.
66. Dubowitz L, Dubowitz V, Mercuri E. The neurologic assessment of the preterm and full-term newborn infant. In: Clinics
in Developmental Medicine, no. 148. London: University Press;
1999.
67. Dueker G, Chen J, Cowling C, Haskin B. Early developmental
outcomes predicted by gestational age from 35 to 41 weeks.
Early Human Dev. 2016;103:85.
68. Engle W. A recommendation for the definition of “late
preterm” (near-term) and the birth weight gestational age
classification system. Semin Perinatol. 2006;30(1):2.
69. Engle W, Tomashek KM. Wallman C, and the Committee on
Fetus and Newborn: “Late-preterm” infants: a population
at risk. Pediatrics. 2007;120:1390. Reaffirmed in Pediatrics.
2018;142(3):e20181836.
UNIT TWO Support of the Neonate132
https://t.me/medicina_free
70. Erlandsson K, Christensson K, Fagerberg I. Fathers’ lived experiences of getting to know their baby while acting as primary caregivers immediately following birth. J Perinat Educ. 2008;17(2):28.
71. Erlandsson K, Dsilna A, Fagerberg I, et al. Skin-to-skin care
with the father after cesarean birth and its effect on newborn
crying and prefeeding behavior. Birth. 2007;34(2):105.
72. Ewing AC, Ellington SR, Shapiro-Mendoza CK, Barfield WD,
Kourtis AP. Full-term small-for-gestational-age newborns in
the US: characteristics, trends and morbidity. Maternal Child
Health J. 2017;21(4):786.
73. Feldman-Winter L, Goldsmith JP, Committee on Fetus and
Newborn; Task Force on Sudden Infant Death Syndrome. Safe
sleep and skin-to-skin care in the neonatal period for healthy
term newborns. Pediatrics. 2016;138(3):e20161889.
74. Feldman R. Mother-infant skin-to-skin contact (kangaroo
care): theoretical, clinical and empirical aspects. Infants Young
Child. 2004;17:145.
75. Ferreira E, Carcellar AM, Agogue C, et al. Effects of selective
serotonin reuptake inhibitors and venlafaxine dur ing pregnancy
in term and preterm neonates. Pediatrics. 2007;119(1):52.
76. Ferreira M, Vaz T, Aparicio G, Duarte J. OC20–Skin-toskin contact in the first hour of life. Nurs Child Young People.
2016;28(4):69.
77. Finigan V, Long T. Skin-to-skin contact: multicultural
perspectives on birth fluids and birth “dirt. Int Nurs Res.
2014;61(2):270.
78. Frederick AC, Busen NH, Engebretson JC, et al. Exploring the
skin-to-skin contact experience during cesarean section. J Am
Assoc Nurs Pract. 2016;28(1):31.
79. Gouchon S, Gregori D, Picotto A, et al. Skin-to-skin contact
after cesarean delivery: an experimental study. Nurs Res.
2010;59(2):78.
80. Grassley JS, Tivis R, Finney J, Chapman S, Bennett S. Evaluation of a designated family bonding time to decrease interruptions and increase exclusive breastfeeding. Nurs Womens Health.
2018;22(3):219.
81. Graves BW, Haley MM. Newborn transition. J Midwifery Wom-
ens Health. 2013;58(6):662.
82. Geerts CC, Grobbee DE, van der Ent CK, et al. Tobacco smoke
exposure of pregnant mothers and blood pressure in their newborns: results from the wheezing illnesses study Leidsche Rijn
birth cohort. Hypertension. 2007;50(3):572.
83. Gray L, Watt L, Blass E. Skin-to-skin contact is analgesic in
healthy newborns. Pediatrics. 2000;105(1):e14.
84. Gregson S, Meadows J, Teakle P, Blacker J. Skin-to-skin contact
after elective caesarean section: investigating the effect on
breastfeeding rates. Br J Midwifery. 2016;24:18.
85. Guala A, Boscardini L, Visentin R, et al. Skin-to-skin in
cesarean birth and duration of breastfeeding: a cohort study.
ScientificWorldJournal. 2017;2017:1940756.
86. Gupta P, Mital R, Kumar B, et al. Physical growth, morbidity
profile and mortality among healthy late preterm neonates.
Indian Pediatr. 2017;54(8):629.
87. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines
for Health Supervision of Infants, Children and Adolescents. 4th ed.
Elk Grove Village, IL: American Academy of Pediatrics; 2017.
88. Hakala M, Kaakinen P, Kaanainen M, et al. The realization of
BFHI Step 4 in Finland—initial breastfeeding and skin-to-skin
contact according to mothers and midwives. Midwifery. 2017;50:27.
89. Haataja P, Korhonen P, Ojala R, et al. Hospital admissions for
lower respiratory tract infections in children born moderately/
late preterm. Pediatr Pulmonol. 2018;53(2):209.
90. Heinonen K, Lahti J, Sammallahti S, et al. Neurocognitive outcome in young adults born late-preterm. Dev Med Child Neurol.
2018;60(3):267.
91. Hernandez JA, Thilo E. Routine care of the full-term newborn. In: Osborn LC, DeWitt TG, First LR, et al. Pediatrics. St
Louis, MO: Mosby; 2005.
92. Hornman J, DE Winter AF, Kerstjens JM, Bos AF, Reijmeveld
SA. Stability of developmental problems after school entry of
moderately-late preterm and early preterm-born children. J
Pediatr. 2017;187:73.
93. Hubbard JM, Gattman KR. Parent-infant skin-to-skin contact
following birth: history, benefits, and challenges. Neonatal Netw.
2017;36(2):89.
94. Hughes KN, Rodriguez-Carter J, Hill J, Miller D, Gomez
C. Using skin-to-skin contact to increase exclusive breastfeeding at a military medical center. Nurs Womens Health.
2015;19(6):478.
95. Institute of Medicine. Preterm Birth: Causes, Consequences, and
Prevention. Washington, DC: National Academies Press; 2006.
96. International Childbirth Education Association. ICEA Position
paper: skin-to-skin contact, 2015. Available at: http://icea.org/
wp-content/uploads/2016/01/Skin_to_Skin_Contact_PP.pdf
Accessed May 4, 2017.
97. International Hip Dysplasia Institute. Swaddling position statement. Available at: www.hipdysplasia.org/for-physicians/pediatri-
cians-and-primary-careproviders. Accessed August 7, 2018.
98. Isayama T, Lewis-Mikhael AM, O’Reilly D, Beyene J, Mc Donald SD. Health services use by late preterm and ter m
infants from infancy to adulthood: a meta-analysis. Pediatrics.
2017;140(1):e20170266.
99. Jacob J, Lehne M, Mischker A, et al. Cost effects of preterm
birth: a comparison of health care costs associated with early
preterm, late preterm, and full-term birth in the first 3 years
after birth. Eur J Health Econ. 2017;18(8):1041.
100. Johnston CC, Campbell-Yeo M, Disher T, et al. Skin-to-skin
care for procedural pain in neonates. Cochrane Database Syst
Rev. 2017;2:CD008435.
101. Kaminski J, Hall W. The effect of soothing music on neonatal
behavioral states in the hospital newborn nursery. Neonatal
Netw. 1996;15(1):45.
102. Keefe M. Comparison of neonatal nighttime sleep-wake patterns
in nursery vs. rooming-in environments. Nurs Res. 1987;36(3):114.
103. Kelly PA, Classen KA, Crandell CG, et al. Effect of timing of
first bath on a healthy newborn’s temperature. J Obstet Gynecol
Neonatal Nurs. 2018;47(5):608.
104. Kim SA, Lee SM, Kim BJ, et al. The risk of neonatal respiratory
morbidity according to the etiology of late preterm delivery. J
Perinat Med. 2017;45(1):129.
105. Kiserud T, Piaggio G, Carroli G, et al. The World Health
Organization fetal growth charts: a multinational longitudinal
study of ultrasound biometric measurements and estimated fetal
weight. PLoS Med. 2017;14(3):e1002220.
106. Knight AK, Craig JM, Theda C, et al. An epigenetic clock
for gestational age at birth based on blood methylation data.
Genome Biol. 2016;17(1):203.
107. Kollmann M, Aldrian L, Scheuchenegge A, et al. Early skin-toskin contact after cesarean section: a randomized clinical pilot
study. PLoS One. 2017;12(2):e0168783.
108. Koopman I, Callaghan-Koru JA, Alaofin O, Argani CH, Farzin
A. Early skin-to-skin contact for healthy full-term infants after
vaginal and caesarean delivery: a qualitative study on clinician
perspectives. J Clin Nurs. 2016;25(9-10):1367.
CHAPTER 5 Immediate Newborn Care After Birth
https://t.me/medicina_free
133
109. Koops BL, Morgan LJ, Battaglia FC. Neonatal mortality risk
in relation to birthweight and gestational age: update. J Pediatr.
1982;101:969.
110. Kristoffersen L, Stoen R, Hansen LF, Wilhelmsen J, Bergseng
H. Skin-to-skin care after birth for moderately preterm infants.
J Obstet Gynecol Neonatal Nurs. 2016;45(3):339.
111. Kuller JM. Update on newborn bathing. Newborn and Infant
Nurs Rev. 2014;14(4):166.
112. Kumar M, Paes B. Epidural opioid analgesia and neonatal
respiratory depression. J Perinatol. 2003;23(5):425.
113. Lasswell SM, Barfield WD, Rochat RW, Blackmon L. Perinatal
regionalization for very low-birth-weight and preterm infants:
a meta-analysis. JAMA. 2010;304(9):992.
114. Lau Y, Tha PH, Ho-Lim SST, et al. An analysis of the effects of
intrapartum factors, neonatal characteristics, and skin-to-skin
contact on early breastfeeding initiation. Matern Child Nutr.
2018;14(1):e12492.
115. Linares AM, Wambach K, Rayens MK, et al. Modeling the
influence of early skin-to-skin contact on exclusive breastfeeding in a sample of Hispanic immigrant women. J Immigr Health.
2017;19(5):1027.
116. Lubchenco LO, Searls DT, Brazie JV, et al. Neonatal mortality
risk: relationship to birthweight and gestational age. J Pediatr.
1972;81:814.
117. Ludington-Hoe S, Cong X, Hashemi F. Infant crying: nature,
physiologic consequences, and select interventions. Neonatal
Netw. 2002;21(2):29.
118. Lund C. Bathing and beyond: current bathing controversies for newborn infants. Adv Neonatal Care. 2016;16(suppl
5S):S13.
119. Manuck TA, Rice MM, Bailit JL, et al. Eunice kennedy shriver
national institute of child health and human development
maternal-fetal medicine units network. Preterm neonatal morbidity, and mortality by gestational age: a contemporary cohort.
Am J Obstet Gynecol. 2016;215(1):103.
120. March of Dimes. 2013 Premature Birth Report Card. MOD
Perinatal Center; 2013.
121. Martin JA, Osterman JK. Describing the increase in preterm
births in the United States, 2014–2016. NCHS Data Brief.
2018;312:1.
122. McCallie KR, Gaikwad NW, Castillo Cuadrado ME, et al.
Skin-to-skin contact after birth and the natural course of
neurosteroid levels in healthy term newborns. J Perintol.
2017;37(5):591.
123. McIntire DD, Leveno KJ. Neonatal mortality and morbidity
rates in late preterm births compared with births at term. Obstet
Gynecol. 2008;111(1):35.
124. Medoff-Cooper B, Holditch-Davis D, Verklan MT, et al. Newborn clinical outcomes of the AWHONN Late Preterm Infant
Research-Based Practice Project. J Obstet Gynecol Neonatal
Nurs. 2012;41(6):774.
125. Medves J, O’Brien B. The effect of bather and location of first
bath on maintaining thermal stability in newborns. J Obstet
Gynecol Neonatal Nurs. 2004;33(2):175.
126. Mendez-Figueroa H, Truong VT, Pedroza C, Chauhan
SP. Large for gestational age infants and adverse outcomes
among uncomplicated pregnancies at term. Am J Perinatol.
2017;34(7):655.
127. Mendez-Figueroa H, Truong VT, Pedroza C, Chauhan SP.
Morbidity and mortality in small-for-gestational-age infants:
a secondary analysis of nine MFMU network studies. Am J
Perinatol. 2017;34(4):323.
128. Moore ER, Anderson GC, Berman N. Early skin-to-skin
contact for mothers and their healthy infants. Cochrane Database
Syst Rev. 2016;11:CD003519.
129. Moran-Peters JA, Zauderer CR, Goldman S, Baierlein J,
Smith AE. A quality improvement project focused on women’s
perceptions of skin-to-skin contact after cesarean birth. Nurs
Womens Health. 2014;18(4):294.
130. Morelius E, Ortenstrand A, Theodorsson E, Frostell A. A
randomized trial of continuous skin-to-skin contact after
preterm birth and the effects on salivary cortisol, parental stress,
depression, and breastfeeding. Early Hum Dev. 2015;91(1):63.
131. Mori R, Khanna R, Pledge D, et al. Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers. Pediatr Int. 2010;52(2):161.
132. Morisaki N, Zhang X, Ganchimeg T, et al. Provider-initiated
delivery, late preterm birth and perinatal mortality: a secondary
analysis of the WHO multicountry survey on maternal and
newborn health. BMJ Glob Health. 2017;2(2):e000204.
133. Murray SR, Shenkin SD, McIntosh K, et al. Long ter m
cognitive outcomes of early (37–38 weeks) and late preterm
(34–36 weeks) births: a systematic review. Wellcome Open Res.
2017;2:101.
134. Moster D, Lie RT, Markestad T. Long-term medical
and social consequences of preterm birth. N Engl J Med.
2008;359(3):262.
135. Nagai S, Yonemoto N, Rabesandratana N, et al. Long-term
effects of earlier initiated continuous Kangaroo Mother Care
(KMC) for low-birth-weight (LBW) infants in Madagascar.
Acta Paediatr. 2011;100(12):e241.
136. National Institutes of Health. National Institute of Child
Health and Human Development Workshop: optimizing care
and long-term outcome of near-term pregnancy and near-term
newborn infants. 2005. Available at: www.nichd.nih.gov
137. Ngo TTM, Moufarrej MN, Rasmussen MH, et al. Noninvasive
blood tests for fetal development predict gestational age and
preterm delivery. Science. 2018;360(6393):1133.
138. Nimbalkar AS, Patel DV, Nimbalkar SM, et al. Infant and
young child feeding practices in infants receiving skin-to-skin
care at birth: follow-up of randomized cohort. J Clin Diagn Res.
2016;10(12):SC09.
139. Nimbalkar A, Patel D, Sethi A, Nimbalkar S. Effect of skinto-skin care to neonates on pulse rate, respiratory rate SpO2
and blood pressure in mothers. Indian J Physiol Pharmacol.
2014b;58(2):174.
140. Nimbalkar SM, Patel V, Patel D, et al. Effect of early skin-toskin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control
trial. J Perinatol. 2014a;34(5):364.
141. Nyqvist KH, Anderson GC, Bergman N, et al. Towards universal Kangaroo Mother Care: recommendations and report
from the First European Conference and Seventh International Workshop on Kangaroo Mother Care. Acta Paediatr.
2010;99(6):820.
142. Olsson E, Ahlsen G, Eriksson M. Skin-to-skin contact reduces
near infrared spectroscopy pain responses in premature infants
during blood sampling. Acta Paediatr. 2016;105(4):376.
143. Olsson E, Eriksson M, Anderzen-Carlsson A. Skin-to-skin
contact facilitates more equal parenthood—a qualitative study
from fathers’ perspective. J Pediatr Nurs. 2017;34:e2.
144. O’Reilly M, Filter M, Kaplin-Kalisz C. Skin-to-skin contact
in the OR between partners and newborns: no cost and low
technology. Neonatal Intens Care. 2015;28:32.
UNIT TWO Support of the Neonate134
https://t.me/medicina_free
145. Papageorghiou AT, Ohuma EO, Altman DG, et al.
International standards for fetal growth based on serial
ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet.
2014;384(9946):869.
146. Park JH, Chang YS, Ahn SY, Sung SI, Park WS. Predicting
mortality in extremely low birth weight infants: comparison
between gestational age, birth weight, Apgar score, CRIB
II score, initial and lowest serum albumin levels. PLoS One.
2018;13(2):e0192232.
147. Paz Levy D, Sheiner E, Wainstock T, et al. Evidence that children born at early term (37–38 6/7 weeks) are at increased risk
for diabetes and obesity-related disorders. Am J Obstet Gynecol.
2017;217(5):588.
148. Phillips R. Uninterrupted skin-to-skin contact immediately
after birth. Newborn Infant Nurs Rev. 2013;13:67.
149. Polic B, Bubic A, Mestrovic J, et al. Emotional and behavioral outcomes and quality of life in school-age children
born as late preterm: retrospective cohort study. Croat Med J.
2017;58(5):332.
150. Posthuma S, Korteweg FJ, van der Ploeg JM, et al. Risks and
benefits of the skin-to-skin cesarean section—a retrospective
cohort study. J Matern Fetal Neonatal Med. 2017;30(2):159.
151. Raju TN. Moderately preterm, late preterm and early term
infants: research needs. Clin Perinatol. 2013;40(4):791.
152. Richards JL, Kramer MS, Deb-Rinker P, et al. Temporal trends
in late preterm and early term birth rates in 6 high-income
countries in North America and Europe and association
with clinician-initiated obstetric interventions. JAMA.
2016;316(4):410.
153. Robiquet P, Zamiara PE, Rakza T, et al. Observation of
skin-to-skin contact and analysis of factors linked to failure
to breastfeed within 2 hours after birth. Breastfeed Med.
2016;11:126.
154. Ryckman KK, Berberich SL, Dagle JM. Predicting gestational
age using neonatal metabolic markers. Am J Obstet Gynecol.
2016;214(4):515.
155. Sammallahti S, Heinonen K, Andersson S, et al. Growth after
late-preterm birth and adult cognitive, academic, and mental
health outcomes. Pediatr Res. 2017;81(5):767.
156. Sanchez Luna M, Fernandez-Perez C, Bernal JL, Elola FJ.
Spanish population-study that healthy late preterm infants
had worse outcomes one year after discharge than term-born
infants. Acta Paediatr. 2018. 10.1111apa.14254. [Epub ahead of
print].
157. Saxton A, Fahy K, Rolfe M, et al. Does skin-to-skin contact
and breast feeding at birth affect the rate of primary postpartum haemorrhage: results of a cohort study. Midwifery.
2015;31(11):1110.
158. Schneider LW, Crenshaw JT, Gilder RE. Influence of immediate skin-to-skin contact during cesarean surgery on rate of
transfer of newborns to NICU for observation. Nurs Womens
Health. 2017;21(1):28.
159. Schwartz R. Effect of position on oxygenation, heart rate, and
behavioral state in the transitional newborn infant. Neonatal
Netw. 1993;12:73.
160. Schwarz EB, Brown JS, Creasman JM, et al. Lactation and
maternal risk of type 2 diabetes: a population- based study. Am
J Med. 2010;123(9):863.e1.
161. Shah P, Kaciroti N, Richards B, Oh W, Lumeng JC. Developmental outcomes of late preterm infants from infancy to
kindergarten. Pediatrics. 2016;138(2). pii: e20153496.
162. Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or
breast milk for procedural pain in neonates. Cochrane Database
Syst Rev. 2012;12:CD004950.
163. Sharma A. Efficacy of early skin-to-skin contact on the rate
of exclusive breastfeeding in term neonates: a randomized
controlled trial. Afr Health Sci. 2016;16(3):790.
164. Shorey S, He HG, Morelius E. Skin-to-skin contact by fathers
and the impact on infant and paternal outcomes: an integrative
review. Midwifery. 2016;40:207.
165. Simonse E, Mulder PG, van Beek RH. Analgesic effect of
breast milk versus sucrose for analgesia during heel lance in late
preterm infants. Pediatrics. 2012;129(4):657.
166. Smit M, Dawson JA, Ganzeboom A, et al. Pulse oximetry in
newborns with delayed cord clamping and immediate skin-toskin contact. Arch Dis Child Fetal Neonatal Ed. 2014;99(4):F309.
167. Smith ER, Hurt L, Chowdhury R, Neovita Study Group, et al.
Delayed breastfeeding initiation and infant survival: a systematic
review and meta-analysis. PLoS One. 2017;12(7):e0180722.
168. Snell BJ, Gardner SL. Care of the Well Newborn. Burlington, MA:
Jones and Bartlett Learning; 2016.
169. Sobel H, Silvestri M, Mantaring J, et al. Immediate newborn
care practices delay thermoregulation and breastfeeding initiation. Acta Paediatr. 2011;100(8):1127.
170. Spittle AJ, Walsh JM, Potter C, et al. Neurobehaviour at
term-equivalent age and neurodevelopmental outcomes at 2
years in infants born moderate-to-late preterm. Dev Med Child
Neurol. 2017;59(2):207.
171. Spong CY. Defining “term” pregnancy: recommendations
from the Defining “Term” Pregnancy Workgroup. JAMA.
2013;309(23):2445.
172. Srivastava S, Gupta A, Bhatnagar A, Dutta S. Effect of very
early skin-to-skin contact on success at breastfeeding and
preventing early hypothermia in neonates. Indian J Public Health.
2014;58(1):22.
173. Stene-Larsen K, Lang AM, Landholt MA, Latal B, Vollrath ME.
Emotional and behavioral problems in late preterm and early
term births: outcomes at child age of 36 months. BMC Pediatr.
2016;16(1):196.
174. Stevens J, Schmied V, Burns E, Dahlen H. Immediate or early
skin-to-skin contact after a caesarean section: a review of the
literature. Matern Child Nutr. 2014;10(4):456.
175. Stevens J, Schmied V, Burns E, Dahlen H. A juxtaposition of
birth and surgery: providing skin-to-skin contact in the operating theatre and recovery. Midwifery. 2016;37:41.
176. Stoll BJ, Hansen NI, Bell EF, et al. Eunice kennedy shriver
national institute of child health and human development neonatal research network: trends in care practices, morbidity, and
mortality of extremely preterm neonates, 1993–2012. JAMA.
2015;314(10):1039.
177. Stone S, Prater L, Spencer R. Facilitating skin-to-skin contact
in the operating room after cesarean birth. Nurs Womens Health.
2014;18(6):486.
178. Stout MJ, Demaree D, Merfeld E, et al. Neonatal outcomes
differ after spontaneous and indicated preterm birth. Am J
Perinatol. 2018;35(5):494.
179. Stuebe AM, Jegier BJ, Schwarz EB, et al. An online calculator
to estimate the impact of changes in breastfeeding rates on
population health and costs. Breastfeed Med. 2017;12(10):645.
180. Svensson KE, Velandia MI, Matthiesen AS, et al. Effects of
mother-infant skin-to-skin contact on severe latch-on
problems in older infants: a randomized trial. Int Breastfeed J.
2013;8(1):1.
CHAPTER 5 Immediate Newborn Care After Birth
https://t.me/medicina_free
135
181. Takahashi Y, Tamakoshi K, Matsushima M, Kawabe T. Comparison of salivary cortisol, heart rate, and oxygen saturation
between early skin-to-skin contact with different initiation
and duration times in healthy, full-term infants. Early Hum Dev.
2011;87(3):151.
182. Thavarajah H, Flatley C, Kumar S. The relationship between
the five minute Apgar score, mode of birth and neonatal outcomes. J Matern Fetal Neonatal Med. 2018;31(10):1335.
183. Thunqvist P, Gustafsson PM, Schultz ES, et al. Lung function at
8 and 16 years after moderate-to-late preterm birth: a prospective cohort study. Pediatrics. 2016;137(4). pii: e20152056.
184. Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ, et al.
Differences in mortality between late preterm and term
singleton infants in the United States, 1995–2002. J Pediatr.
2007;151:450.
185. Turenne JP, Heon M, Alta M, Faessler J, Doddridge C. Educational intervention for an evidence-based nursing practice of
skin-to-skin contact at birth. J Perinat Educ. 2016;25(2):116.
186. Tveiten L, Diep LM, Halversen T, Markestad T. Respirator y
rate during the first 24 hours of life in healthy term infants.
Pediatrics. 2016;137(4):e20152326.
187. UNICEF and the World Health Organization: Capture the
moment: early initiation of breastfeeding, Geneva, Switzerland, 2018,
UNICEF and WHO. Available at: https://data.unicef.org/
resources/capture-the-moment/. Accessed August 2, 2018.
188. United States Preventive Services Task Force. Ocular prophylaxis for gonococcal ophthalmia neonatorum: preventive
medication. 2018. Available at: https://www.uspreventiveser-
vicestaskforce.org/Page/Document/draft- recommendationstatement/ocular-prophylaxis-for-gonococcal-ophthalmianeonatorum-preventive-medication1. Accessed September
13, 2018.
189. Usher R, McLean F, Scott KE, et al. Judgment of fetal age. II.
Clinical significance of gestational age and an objective method
for its assessment. Pediatr Clin North Am. 1966;13(3):835.
190. Varda KE, Behnke R. The effect of timing of initial bathing
on newborns’ temperature. J Obstet Gynecol Neonatal Nurs.
2003;29(1):27.
191. Varela N, Munoz P, Tessier R, et al. Indian fathers and their
premature baby—an early beginning: a pilot study of skin-toskin contact, culture and fatherhood. Fathering. 2014;12:211.
192. Velandia M, Matthisen AS, Uvas-Moberg K. Nissen E. Onset of
vocal interaction between parents and newborns in skin-toskin contact immediately after elective cesarean section. Birth.
2010;37(3):192.
193. Verger R. Kangaroo mother care could save millions of lives in
poor countries. Newsweek Global. 2014;163:73.
194. Vila-Candel R, Duke K, Sor iano-Vidal FJ, Castro-Sanchez E.
Affect of early skin-to-skin mother-infant contact in the maintenance of exclusive breastfeeding. J Hum Lact. 2018;34(2):304.
195. Vilchez G, Hoyos LR, Maldonado MC, et al. Risk of neonatal
mortality according to gestational age after elective repeat
cesarean delivery. Arch Gynecol Obstet. 2016;294(1):77.
196. Visruthan NK, Agarwal P, Sriram B, Rajadural VS. Neonatal
outcome of the late preterm infant (34 to 36 weeks): the Singapore story. Ann Acad Med Singapore. 2015;44(7):235.
197. Vittner D, Cong X, Ludington-Hoe SM, McGrath JM. A
survey of skin-to-skin contact with perinatal nurses. Appl Nurs
Res. 2017;33:19.
198. Wagner DL, Lawrence S, Xu J, Melsom J. Retrospective chart
review of skin-to-skin contact in the operating room and administration of analgesic and anxiolytic medication to women
after Cesarean birth. Nurs Womens Health. 2018;22(2):116.
199. Wariyar U, Tin W, Hey E. Gestational assessment assessed. Arch
Dis Child. 1997;77(3):F216.
200. Weiner GM, Zaichkin J, eds. Textbook of Neonatal Resuscitation.
7th ed. Elk Grove Village, IL: American Academy of Pediatrics
and American Heart Association; 2016.
201. Widstrom A, Wahlberg V, Matthiesen AS. Short-term effects of
early suckling and touch of the nipple on maternal behavior.
Early Human Dev. 1990;21:153.
202. Wilson K, Hawken S, Murphy MS, et al. Postnatal prediction
of gestational age using newborn fetal hemoglobin levels. EBio-
Medicine. 2017;15:203.
203. World Health Organization. Thermal protection of the
newborn: a practical guide, 1997. Available at: www.who.int/
reproductive-health/publications/MSM_97_2_Thermal_protection_of_the_newborn/index.htm. Accessed October 3,
2018.
204. Woythaler M, McCormick MC, Mao WY, Smith VC. Late
preterm infants and neurodevelopmental outcomes at kindergarten. Pediatrics. 2015;136(3):424.
205. Wu CS, Sun Y, Nohr EA, Olsen J. Trends in all cause mortality
across gestational age in days for children born at term. PLoS
One. 2015;10(12):e0144754.
206. Yorifuji J, Yorifuji T, Nagai S, et al. Craniotabes in normal
newborns: the earliest sign of subclinical vitamin D deficiency. J
Clin Endocrinol Metab. 2008;93(5):1784.
207. Yuksel B, Ital I, Balaban O, et al. Immediate breastfeeding and
skin-to-skin contact during cesarean section decreases maternal
oxidative stress: a prospective randomized case-control study. J
Matern Fetal Neonatal Med. 2016;29(16):2691.
208. Zeitlin J, Manktelow BN, Piedvache A, et al. Use of evidence
based practices to improve survival without severe morbidity
for very preterm infants: results from the EPICE population
based cohort. BMJ. 2016;354:i2976.
209. Zhang TW, Lin FT, Song YY, Wang LX, Cai YJ. Early intellectual developmental outcome of late preterm infants. Zhongguo
Dang Dai Er KeZa Zhi. 2017;19(2):142.
210. Zwedberg S, Blomquist J, Sigerstad E. Midwives’ experiences with mother-infant skin-to-skin contact after a caesarean
section: “fighting an uphill battle”. Midwifery. 2015;31(1):215.
RESOURCE MATERIALS FOR
PROFESSIONALS
Association of Women’s Health, Obstetric, and Neonatal Nurses. As-
sessment and Care of the Late Preterm Infant: Evidence-Based Clinical
Practice Guideline. 2nd ed. Washington, DC: AWHONN; 2018.
Brimdyr K. Skin-to-Skin in the First Hour After Birth: Practical
Advice for Staff after Vaginal and Cesarea n Birth (DV D).
Available at https://www.amazon.com/Skin-First-Hour-
After-Birth/dp/801EXGCR14. Accessed September 30, 2018.
Francis K, Pugsley L. Care through the newborn’s eyes. J Obstet
Gynecol Neonatal Nurs. 2018;32(1):80.
Institute of Medicine. Preterm Birth: Causes, Consequences and Preven-
tion. Washington, DC: National Academies Press; 2006.
Landwehr AC. Skin-to-skin education for operating room staff,
2015. Scholar Works @ University of Arkansas, Fayetteville.
Available at: https://scholarworks.uark.edu/cgi/viewcontent.
cgi?article=1019&. Accessed September 30, 2018.
March of Dimes Continuing Education Nursing Modules. Assessment
of Risk in the Term Newborn, 2nd ed. Cultural Competence: An Essential
Journey for Perinatal Nurses. Understanding the Behavior of Term Infants.
The Premature Infant: Nursing Assessment and Management.
UNIT TWO Support of the Neonate136
https://t.me/medicina_free
March of Dimes. Elimination of Non-Medically Indicated (Elective) De-
liveries Before 39 Weeks’ Gestational Age: Quality Improvement Toolkit.
White Plains, NY: March of Dimes; 2012.
National Perinatal Association. Multidisciplinary guidelines for care
of late-preterm infants, 2012. Available at: www.nationalperinatal.
org/Resources/LatePretermGuidelinesNPA.pdf. Accessed Sep-
tember 30, 2018.
South R, Staebler S. Baby Steps to Home (2018 Update). Available at:
www.babystepstohome.com. Accessed May 4, 2018.
RESOURCE MATERIALS FOR PARENTS
American Academy of Pediatrics. Parent Education Materials: Care
of the Uncircumcised Penis—Fact Sheet. Circumcision: Information for
Parents. Diaper Rash. Early Arrival: Information for Parents of Premature
Infants. Infant Sleep Positioning and SIDS—Fact Sheet.
American Academy of Pediatrics. In Shelov S, ed: Your Baby’s First
Year. 4th ed. Elk Grove Village, IL: The Academy; 2015.
Brazelton TB. Baby Basics (video) and Home Before You Know It (Video).
Cambridge, MA: Vida Health Communications; 2004.
Brimdyr K. The Magical Hour: Holding Your Baby Skin-to-Skin in the
First Hour after Birth (DVD). East Sandwich, MA: Healthy Children Project; 2011.
International Hip and Dysplasia Institute. Hip-Healthy Swaddling. Are
You Swaddling Your Baby Properly? Available at: www.hipdysplasia.
org. Accessed on October 3, 2018.
Jana LA, Shu J. Heading Home with Your Newborn. 3rd ed. Elk Grove
Village, IL: American Academy of Pediatrics; 2015.
March of Dimes. Why the last weeks of pregnancy count. Brain
development card and/or flyer. Available at: www.marchofdimes.
com/catalog.
Newborn Channel: www.thenewbornchannelnow.com.
6
https://t.me/medicina_free
HEAT BALANCE
SANDRA L. GARDNER AND BETSY H. CAMMACK
daptation to extrauterine life involves the
newborn infant in a series of biologic adjust-
A
conditions. Prime among these is the accommodation
to a new thermal environment that represents a
distinct “cold challenge.” Failure to adjust to this cold
stress has historically been recognized, particularly in
premature and low-birth-weight (LBW) infants, with
the development of variable degrees of hypothermia
and increased morbidity and mortality rates. At birth, the
body temperature of the newborn infant will approximate or slightly exceed that of the mother. Within
minutes of birth, however, core temperature begins to
fall precipitously, particularly in infants with birth weights
less than 1500 g. These infants have a diminished
capacity for metabolic heat production, a high surface area to volume ratio, and immature epidermal
barrier leading to extraordinarily high evaporative
heat losses. Consequently, they are highly vulnerable
to the development of hypothermia. Thermal man-
agement has become a cornerstone in neonatal
intensive care. Earlier studies conducted in term and
preterm infants worldwide concluded that maintenance
of body temperature through control of the thermal
environment is paramount for the reduction of morbidity and mortality risks in LBW infants.
clinicians have gained insight into the physiology
of thermoregulation and developed the technology
to maintain thermal neutrality in the tiniest and
sickest neonates.
modern neonatal intensive care units (NICUs) have
the expertise and equipment to avoid or minimize
the consequences of inadequate thermoregulation,
determining the most appropriate ways of getting
the best temperature balance (normothermia) is
the subject of ongoing investigation. This chapter
discusses the current knowledge of the physiology
ments to a totally new set of environmental
102,105,114
Over the past several decades, researchers and
65,89,93,132,135
Although the staff of
and pathophysiology of neonatal thermoregulation
and techniques used not only to prevent heat loss
but also to manage heat balance.
HISTORICAL MILESTONES
The first incubator for neonates was introduced in
the early 1830s. Dr. Stephane Tarnier, Chairman
of Obstetrics of the University of Paris, first
applied the principle of graded incubation (commonly used in chick embryos) in developing a
covered incubator chamber that has been widely
recognized as the first attempt to systematically
provide a warmed environment for premature
infants. In 1835 in St. Petersburg, Russia, Von
Ruehl introduced an incubator described as a
double-walled box that circulated warmed water
within the interspace.
and Auvard, modified Tarnier’s incubator by adding a thermometer and regulatory alarms to alert
the infant’s nurse attendant to either increase or
decrease the incubator’s prescribed temperature.
The care of newborns was delegated to Madame
Henry, Midwife-in-Chief, who oversaw the building of a pavilion specifically for the care of
these weakling newborns.
12 incubators, in which fragile newborns were
warmed over a hot-water reservoir attached to
an external source of heat. These were impressive
first steps in attempting to control the fragile heat
balance of weak preterm infants. Over the next 60
years, in Tarnier’s and Budin’s clinic, refinements
of incubation techniques resulted in an increased
survival from 38% to 66% in infants weighing
between 1200 and 2000 g. Dr. Tarnier’s successor,
Dr. Budin, continued this important early practice
of neonatology, focusing on the home care of these
110
Tarnier’s students, Budin
128
This pavilion housed
23,90,97
BLUE type highlights content that is particularly applicable to clinical settings.
137
UNIT TWO Support of the Neonate138
https://t.me/medicina_free
high-risk babies. Alexandre Lion improved the
design of incubators and charged spectators a fee
to see them in action, which led to a very popular
show at the Berlin Exposition of 1896. An associate of Lion, Martin Couney, brought the incubator shows to the United States, where Dr. Joseph
DeLee adopted the technology and opened an
“incubator station” in 1900 at the Chicago Lyingin Hospital. Nearly all of the large expositions in
America hosted “Incubator Baby Side Shows.”
These began in 1898 with the Trans-Mississippi
Exposition and continued on to the New York
World’s Fair in 1939.
Dr. Couney’s display of incubators at Luna
Park on Coney Island and at a second park named
Dreamland hosted premature babies from New
York hospitals that lacked the facilities to care for
them. These infants were lined up under heaters in
incubators, and they breathed filtered air. At least
8000 babies passed through these incubators, and at
least 6000 were saved. Servocontrolled radiant heat
in incubators was initially reported by Agate and
Silverman in 1963.
110
Today’s radiant warmer is an evolution from the
original idea of Agate and Silverman. Radiant
energy as the sole source of heat from an overhead
panel was described in 1969 by Due and Oliver.
Widespread use of the warmer in the delivery
room was readily accepted and soon led to its use
in the NICU. The factors that affect heat loss and
heat production were elucidated. As intensive care
became more readily available, easy accessibility to
the infants became increasingly necessary and the
open warmer became more readily used.
66
Changes in the radiant warmer have included
the introduction of incubators that are interchangeable with and convert to radiant warmers. The use
of humidification in the incubators has also been
improved to allow for varying humidification based
on the infant’s gestational age and weight. These
new beds allow the caregiver to rotate the mattress
360 degrees for easy patient access and provide
an in-bed scale. In recent years, new approaches
to thermal care of the newborn preterm baby
have been extensively studied,* including occlusive
wrapping, placing on heated mattresses, and skinto-skin (kangaroo) care. The role and clinical significance of these approaches will be discussed later.
* References 10, 24, 47, 57, 64, 65, 75, 89, 97
PHYSIOLOGIC
CONSIDERATIONS
Animals that maintain their body temperature within a
narrow range through a wide range of environmental
temperatures are known as homeotherms. Humans, as
homeotherms, maintain a “normal” body temperature by balancing the amount of heat lost
from the body with the amount of heat generated
from within the body. Our ability to cope with
changing thermal environments improves physically
and physiologically with age. Eventually we are physically able to move to a different place with a more
suitable environment or dress more appropriately
when the temperature is uncomfortable.
Babies, especially preterm or small-for-gestational-age (SGA) babies, of course cannot physically
respond as older children would, and even their
physiologic responses are different and limited. Adults
lose some thermoregulatory control during rapid-eye-movement sleep. Although newborn infants
spend much time in active sleep, their thermoregulatory control is not impaired during this period of active
sleep,71 which indicates the developmental importance
of both thermoregulation and active sleep in the maturation of newborn infants.
Neutral Thermal Environment
Physiologic responses to a cold environment include
metabolic reactions that consume substrate and oxygen and result in heat production. A neutral thermal
temperature is the body temperature at which an
individual baby’s oxygen consumption is minimized (Fig. 6.1). Thus a minimal amount of the
baby’s energy is expended for heat maintenance,
and energy is conserved for other basic functions
and for growth. Minimal metabolic activity is possible
within a narrow range of temperatures, so temperatures
that are too high or too low add stress and increase
metabolic rate. Extreme deviations from this range
overwhelm the thermoregulatory mechanisms, leading
to body temperature imbalances and potentially death.
The goal in controlling a neonate’s environment
is to minimize energy expended by him or her to
maintain a “normal” temperature, thus eliminating
thermal stress. This neutral thermal environment
is the sum total of factors at which a baby with a
normal body temperature has a minimal metabolic
rate and therefore minimal oxygen consumption
(Fig. 6.2). Both traditional indirect calorimetry and
Соседние файлы в папке Библиотека им академика М.И. Перельмана