LUDHIANA, Nov 24 — Neonatal mortality constitutes about 50 per cent of the infant mortality and it continues to be on the rise for the last two decades. About 70 per cent deliveries are still not conducted by the trained personal in developing countries like India. Thus the awareness of good primary care becomes essential. Primary neonatal care means first contact and initial care of the neonate by mother, family members, traditional birth attendants or family physician.
A recent study conducted by Dr B.K. Jain, Reader, Department of Paediatrics, DMCH, informs that if proper primary care is done, the mortality rate can certainly be decreased. The basic antenatal care is the prime step in this direction. The health of a baby depends upon the nutrition and proper antenatal care of the mother. During the first trimester of pregnancy, the mother should strictly avoid taking medications as a safeguard against the development of congenital malformations. The pregnant woman should take adequate nutrition (25 percent extra calories for the baby) in the form of fresh green vegetables, pulses, seasonal fruits, milk and milk products. The widespread belief that excessive
intake of food during pregnancy is associated with a large baby and difficult delivery is ill-found and must be discouraged.
Other than this, the mother should be physically, mentally and emotionally prepared during pregnancy to provide breast feeding as soon as the baby is born. The delivery should be conducted by a trained birth attendant preferably at a health post. A disposable sterile kit should be used to prevent any kind of infection. The baby with a weak cry or cyanosis can be stimulated by flicking at the sole or rubbing at the back. Vigorous slapping at the back and throwing water on the face should be avoided. The attendant should have the knowledge of providing mouth-to-mouth or mask breathing to the babies who are unable to establish effective ventilation.
The study reveals that the first clinical examination of the baby is undertaken after the baby stabilises. The objective is to record weight and maturity of the baby, checking its sucking
behaviour, identify any congenital abnormality and any signs of illness. A neonatal needs much more warm environment than needed by the adult. Environmental temperature needed is 32-360 C for a naked baby and low birth weight baby.
A neonate who generally comes from the sterile intrauterine environment is threatened with infection after birth by his care providers. The cord should be cut with a sterile blade or knife and should be tied with sterile thread. There should be a proper temperature check-up, colour, activity, breathing and umbilicus regularly. Monitoring must be done more frequently during the first week. Identification and management of minor illness like aggravated physiological jaundice, mild diarrhoea, umbilical sepsis, pyoderma and conjunctivitis must be well known to all primary health professionals.
The danger signs are deep or early onset of jaundice, cyanosis, apnea, breathing difficulty, persistent green vomiting, profuse diarrhoea, abdominal, distention, hypothermia, fever, excessive cry, seizures, congenital malformations of failure to pass urine within 24 hours of life. A sick baby may need to be taken from the home to a hospital or from a small to big hospital for appropriate treatment.
