ESSENTIAL

NEWBORN
CARE
 OBJECTIVES

• to adequately prepare for a delivery by

assembling the necessary equipment, supplies
and personnel in an ideal environment
• to describe and carry out the evidence-based
care of a newborn baby at the time of birth
 BASIC NEEDS OF A NEWBORN

• TO BREATHE NORMALLY

• TO BE WARM

• TO BE PROTECTED

• TO BE FED
Phil. ENCC 3
 PREPARING FOR DELIVERY
1. NOTIFY APPROPRIATE STAFF

1. CHECK TEMPERATURE OF THE DELIVERY ROOM

1. ARRANGE NEEDED SUPPLIES IN LINEAR FASHION

1. CHECK RESUSCITATION EQUIPMENT

1. PERFORM HAND HYGIENE

1. WEAR STERILE GLOVES

AT PERINEAL BULGING
 ENVIRONMENT
• CHECK TEMPERATURE OF THE DELIVERY
ROOM *
• IDEAL TEMP: 25°C – 28°C
• CHECK FOR AIR DRAFTS
• TURN FANS AND AIR CONDITIONERS OFF
BEFORE THE DELIVERY

*NON-MERCURY THERMOMETER
 EQUIPMENT
• EQUIPMENT MUST BE CHECKED DAILY, BEFORE EVERY
DELIVERY

• RESUSCITATION EQUIPMENT SHOULD ALWAYS BE

CLOSE TO THE DELIVERY AREA

• HEALTH WORKERS MUST KNOW HOW TO USE THE

EQUIPMENT

• ARRANGE EQUIPMENT ACCORDING TO SEQUENCE OF

THEIR USE

• RESTOCK EQUIPMENT AFTER EVERY DELIVERY

LINEAR ARRANGEMENT OF INSTRUMENTS
 RESUSCITATION EQUIPMENT
• A NEWBORN-SIZED SELF-INFLATING BAG
• INFANT MASKS SIZES 0 AND 1
• A SUCTION DEVICE (MECHANICAL OR
ELECTRICAL OR MOUTH-OPERATED)
• OXYGEN SOURCE
• STETHOSCOPE
• A SUPPLY OF WARM TOWELS AND BLANKETS
 PERFORM HAND HYGIENE
• WASH HANDS WITH CLEAN WATER AND SOAP

• DOUBLE GLOVE JUST BEFORE DELIVERY

WITHIN 30 SECONDS AFTER DELIVERY

Call out the time of birth Deliver and place on the

mother’s abdomen
 Drying should be the first action,

IMMEDIATELY
for a full 30 seconds

unless the infant is both floppy/limp and

apneic
 IMMEDIATE AND THOROUGH DRYING
• IMMEDIATE DRYING:
▪ STIMULATES BREATHING
▪ PREVENTS HYPOTHERMIA
• HYPOTHERMIA CAN LEAD TO
▪ INFECTION
▪ COAGULATION DEFECTS
▪ ACIDOSIS
▪ DELAYED FETAL TO NEWBORN CIRCULATORY
ADJUSTMENT
▪ HYALINE MEMBRANE DISEASE
▪ BRAIN HEMORRHAGE
• TUNELL R., IN IMPROVING NEWBORN HEALTH IN D EVELOPING COUNTRIES, A. COSTELLO AND D. MANANDHAR, EDITORS. 2000,

• IMPERIAL COLLEGE PRESS: LONDON, UK. P. 207-220;

• TOLLINM,ETAL.. CELL MOL LIFE SCI 2005

 IMMEDIATE AND THOROUGH DRYING
• DRY THE NEWBORN THOROUGHLY FOR AT LEAST 30 SECONDS
o DO A QUICK CHECK OF BREATHING WHILE DRYING
o >95% OF NEWBORNS BREATHE NORMALLY AFTER BIRTH
 IMMEDIATE AND THOROUGH DRYING
• FOLLOW AN ORGANIZED SEQUENCE

• WIPE GENTLY, DO NOT WIPE OFF THE VERNIX

• REMOVE THE WET CLOTH, REPLACE WITH A DRY ONE
 IMMEDIATE AND THOROUGH DRYING
• IF BABY IS NOT BREATHING, STIMULATE BY
DRYING!

• DO NOT SLAP, SHAKE OR RUB THE BABY

• DO NOT VENTILATE UNLESS THE

BABY IS FLOPPY/LIMP AND NOT
BREATHING
• DO NOT SUCTION UNLESS THE
MOUTH/NOSE ARE BLOCKED
 GUIDELINES ON
BASIC NEWBORN RESUSCITATION
2012

• NO SUCTIONING FOR BABIES WHO ARE BREATHING ON THEIR

OWN, AMNIOTIC FLUID IS CLEAR
• IF NOT BREATHING, POSITIVE PRESSURE VENTILATION COULD
BE GIVEN, NOT SUCTIONING
• SUCTIONING SHOULD BE DONE ONLY IF VENTILATION IS NOT
ADEQUATE AND THERE ARE SECRETIONS

WHO. Dept. of Maternal, Newborn, Child and Adolescent Health. Guidelines on Basic Newborn Resuscitation.
Forthcoming.
ROUTINE NASAL AND OROPHARYNGEAL SUCTIONING
ADVERSE EFFECTS IF INEXPERTLY PERFORMED:
• APNEA (CESSATION OF BREATHING)
• VAGAL-INDUCED BRADYCARDIA (SLOW HEART RATE)
• SLOWER RISE IN OXYGEN SATURATIONS
• MUCOSAL TRAUMA WITH POSSIBLY AN INCREASED RISK FOR
INFECTION
S.N. Wallet al. Neonatal resuscitation in low-resource settings: What, who, and how to overcome
challenges to scale up? International Journal of Gynecology and Obstetrics 107 (2009) S47–S64

Gungor S, Teksoz E, Ceyhan T, Kurt E, Goktolga U, Baser IOronasopharyngeal suction versus no

suction in normal, term and vaginally born infants: a prospective RCT.Aust N Z J ObstetGynaecol.
2005 Oct;45(5):453-6.Turkey. [email protected]
Gungor S, Kurt E, Teksoz E, Goktolga U, Ceyhan T, Baser I.Oronasopharyngeal suction versus
no suction in normal and term infants delivered by elective cesarean section: a prospective RCTGynecolObstet
Invest. 2006;61(1):9-14. Epub 2005 Aug 19. Ankara, Turkey. [email protected]
EARLY SKIN-TO-SKIN CONTACT
 EARLY SKIN-TO-SKIN CONTACT
• GENERAL PERCEPTION IS THAT IT IS PURELY FOR MOTHER-BABY BONDING
• OTHER BENEFITS:

▪ PROVIDES WARMTH
▪ IMPROVES BONDING
▪ PROVIDES PROTECTION FROM INFECTION BY
EXPOSURE OF THE BABY TO GOOD BACTERIA OF
THE MOTHER
▪ INCREASES THE BLOOD SUGAR OF THE BABY
• MOORE E, ET AL. COCHRANE REV. 2007 JUL 18;(3).

• ANDERSON GC, ET AL. COCHRANE REV 2003;(2).

• BRANDTZAEG P. ANN N Y ACADSCI 2002;964:13–45

 EARLY SKIN-TO-SKIN CONTACT
• IF BREATHING OR CRYING:
• POSITION PRONE ON THE
MOTHER’S ABDOMEN OR CHEST
• COVER THE NEWBORN
• DRY LINEN FOR BACK
• BONNET FOR HEAD
• TEMPERATURE CHECK
• ROOM: 25-28 °C
• BABY: 36.5 – 37.5 °C
 PROPERLY TIMED CORD CLAMPING

BENEFITS:
• Allows the newborn to get a free blood
transfusion from the placenta
• Reduces the risk of anemia in both term and
preterm babies
• Reduces the need of transfusions and brain
hemorrhage in preterms
• CerianiCernadas ,et al. 2006;
• Rabe H, et al. 2004;
• McDonald SJ, et al. 2008;
• Hutton EK, et al. 2007;
• Kugelman A, et al. 2007
• Van Rheenen PF, et al. 2006
• Van Rheenen PF & Brabin BJ. 2006
 PROPERLY TIMED CORD CLAMPING
• AFTER THE UMBILICAL PULSATIONS HAVE STOPPED
REMOVE FIRST SET OF GLOVES
 PROPERLY TIMED CORD CLAMPING
• PUT PLASTIC CLAMP AT • PUT FORCEPS AT 5 CM
2 CM FROM THE FROM THE NEWBORN’S
NEWBORN’S ABDOMEN ABDOMEN
Properly Timed Cord Clamping
• Cut just above the clamp
with sterile instrument
 CARE OF THE CORD
• DO NOT MILK THE CORD TOWARDS THE BABY

• OBSERVE FOR THE OOZING OF BLOOD. IF BLOOD OOZES,

PLACE A SECOND TIE BETWEEN THE SKIN AND THE CLAMP

• DRY CORD CARE IS CURRENTLY RECOMMENDED

• DO NOT APPLY ANY SUBSTANCE ONTO THE
CORD
• DO NOT USE A BINDER OR “BIGKIS”
 ACTIVE MANAGEMENT OF THE
3RD STAGE OF LABOR

1. GIVE OXYTOCIN 10 MG IM TO MOTHER

AFTER EXCLUDING A SECOND BABY
2. APPLY GENTLE TRACTION TO THE CORD
GENTLE UTERINE MASSAGE

DELIVER THE PLACENTA

NON-SEPARATION OF NEWBORN FROM MOTHER FOR
EARLY BREASTFEEDING
• PLACE THE NEWBORN ON THE
MOTHER’S CHEST IN
SKIN-TO-SKIN CONTACT
• COVER THE BABY’S HEAD
WITH A HAT. COVER THE
MOTHER AND BABY WITH A
WARM CLOTH.
• INITIATE BREASTFEEDING
WHILE MAINTAINING SKIN-
TO-SKIN CONTACT.
• PLACE IDENTIFICATION BAND
ON ANKLE.
NON-SEPARATION OF NEWBORN FROM MOTHER
FOR EARLY BREASTFEEDING
• NEVER LEAVE THE MOTHER AND
BABY UNATTENDED
• MONITOR MOTHER & BABY
EVERY 15 MINS IN THE FIRST 1-2
HRS. ASSESS WARMTH AND
BREATHING.
▪ WARMTH: CHECK TO SEE IF
FEET ARE COLD TO TOUCH
IF NO THERMOMETER
▪ BREATHING: LISTEN FOR
GRUNTING, LOOK FOR CHEST
IN-DRAWING AND FAST
BREATHING
 SIGNS OF READINESS TO BREASTFEED
• WHEN THE NEWBORN
SHOWS FEEDING CUES
(EX. OPENING OF
MOUTH, TONGUING,
LICKING, ROOTING),
MAKE VERBAL
SUGGESTIONS TO THE
MOTHER TO
ENCOURAGE HER
NEWBORN TO MOVE
TOWARD THE BREAST
(EX. NUDGING)
A NEWBORN ATTACHING TO THE BREAST
(LATCHING ON)
 INITIATION OF BREASTFEEDING
• HEALTH WORKERS SHOULD NOT TOUCH THE
NEWBORN UNLESS THERE IS A MEDICAL INDICATION
• DO NOT GIVE SUGAR WATER, FORMULA OR OTHER
PRELACTEALS
• DO NOT GIVE BOTTLES OR PACIFIERS
• DO NOT THROW AWAY COLOSTRUM
• LET THE BABY FEED FOR AS LONG AS IT WANTS ON
BOTH BREASTS
Phil. ENCC 32
• EYE CARE, WEIGHING, BATHING, EXAMINATIONS, INJECTIONS SHOULD
BE DO NE AFTER THE FIRST FULL BREASTFEED IS COMPLETED

• INFORM THE MOTHER AND RECORD ALL ACTIONS

• POSTPONE BATHING UNTIL AT LEAST 6 HOURS

NON-SEPARATION OF NEWBORN FROM MOTHER

FOR EARLY BREASTFEEDING
 EYE CARE
ACTION:
• WIPE THE EYES
• APPLY AN EYE ANTIMICROBIAL WITHIN 1
HOUR OF BIRTH:
• 1% SILVER NITRATE DROPS OR
• 2.5% POVIDONE IODINE DROPS OR
• 1% TETRACYCLINE OINTMENT OR
ERYTHROMYCIN EYE DROPS • Do not wash away the
eye
antimicrobial
PHYSICAL EXAMINATION
INJECTIONS
 SPECIAL SITUATIONS
WHAT SHOULD BE DONE IF A BABY DOES NOT FEED
IN ONE HOUR AFTER BIRTH?
• HELP THE MOTHER TO INITIATE BREASTFEEDING
WITHIN 1 HOUR, WHEN BABY IS READY
• IF THE BABY DOES NOT FEED IN 1 HOUR, EXAMINE
THE BABY
• IF HEALTHY, LEAVE THE BABY WITH THE MOTHER
TO TRY LATER. ASSESS IN 3 HOURS, OR EARLIER IF
THE BABY IS SMALL.
 IF THE MOTHER HAS HIV/AIDS
• STANDARD PRECAUTIONS MUST BE FOLLOWED AS WITH
ANY OTHER DELIVERY AND AFTER CARE

• GIVE SPECIAL COUNSELLING TO THE MOTHER WHO IS HIV

POSTIVE REGARDING CHOICE OF FEEDING

• HER BABY CAN HAVE IMMEDIATE SKIN-TO-SKIN CONTACT AS

ANY OTHER MOTHER AND BABY

• IF MOTHER CHOSE REPLACEMENT FEEDING, EXPLAIN THE

RISKS OF DIARRHEA AND MALNUTRITION AND HOW TO
AVOID THEM

• TEACH THE MOTHER HOW TO FEED BABY BY CUP

Phil. ENCC 38
 HARM OF EARLY BATHING

• WASHING EXPOSES BABY TO HYPOTHERMIA

• THE VERNIX IS A PROTECTIVE BARRIER TO BACTERIA

SUCH AS E. COLI AND GROUP B STREP

• WASHING REMOVES THE CRAWLING REFLEX

[I] TOLLIN M, BERGSSON G, KAI-LARSEN Y, LENGQVIST J, SJOVALL J, GRIFFITHS W, SKULAVOTTIR G, HARALDSSON A, ET AL. VERNIX CASEOSA AS A
MULTICOMPONENT DEFENSE SYSTEM BASED ON POLYPEPTIDES, LIPIDS AND THEIR INTERACTIONS. CELL MOL LIFE SCI 2005; 62:2390 -2399
[II] RIGHARD L, ALADE M. EFFECT OF DELIVERY ROOM ROUTINES ON SUCCESS OF FIRST BREASTFEED. LANCET 1990; 336: 1105 -07
PERFORMING THE EINC PROTOCOL
 At least 4 antenatal visits
During Iron and folate supplementation
Pregnancy Tetanus Toxoid Vaccine
Prepare a BIRTH PLAN including PhilHealth & Unang Yakap

Identify women in PRETERM LABOR or at risk for PRETERM DELIVERY -

Upon Inject 1st dose of Antenatal Steroids
arrival at
Facility History, Physical Exam & BP, HR, RR. Obtain Birth Plan, Identify
Companion of choice, Stabilize if with complications
Encourage woman into a
IV fluid and NPO only when
comfortable position
During indicated
Labor Encourage mother to have oral
Use WHO Partograph to
fluids and light snacks monitor labor
Ensure room temperature at Arrange all instruments & needs in a
Prior to 25-28°C& eliminate air drafts linear fashion
Delivery Prepare NB resuscitation area &
Discuss care in the 1st hours check that equipment is clean,
functional and within easy reach
At Perineal Perform Proper Handwashing and put on 2 pairs of sterile gloves
Bulging NO routine episotomy, NO fundal pressure
 Time Mother Baby
Support the perineum with Call out time of birth and sex
Delivery controlled delivery of the head

Dry, check breathing

First 30 secs
Remove wet cloth for skin-to-
Give Oxytocin IM skin contact
After excluding a 2nd baby Feel for cord pulsation ,
1 minute to Clamp, cut cord
3 minutes Do controlled traction of cord
Return baby to prone position
with counter-traction
Massage the uterus gently

Examine birth canal and placenta

Support FIRST FULL BREASTFEED. Monitor DYAD q15 mins

20 minutes
onwards Continue uterine massage; Do eye care, examine, weigh, measure,
Monitor every 15 minutes inject Vit K, Hep B vaccine, BCG vaccine
(until first
breastfeed)
Transport to room TOGETHER

> 6 hours BREASTFEEDING SUPPORT Optional: Bathing > 24 hrs

EINC TRAINING VIDEO
 FOUR CORE STEPS IN
IMMEDIATE NEWBORN CARE