GUAGUA NATIONAL COLLEGES

Guagua, Pampanga
COLLEGE OF NURSING

MANGILIMAN, DARLENE R. | BSN 2D | NCM 107

ESSENTIAL NEWBORN CARE

MDG 4:
REDUCE CHILD MORTALITY
Target: Reduce by two thirds, between 1990
and 2015, the child mortality rate:
- Reduce Under 5-mortality rate from 80.0 to
26.7 (per 1,000 LB)
Reduce Infant mortality rate from 57.0 to 19.0
(per 1,000 LB)

What is the Essential Newborn

Care Protocol?

❖ Series of time bound chronologically

ordered, standard procedures that a
baby receives from birth
❖ Simple, to-the-point, user-friendly,
globally accepted evidence-based
protocol to essential newborn care
focusing on the 1st week of life
❖ Doable even by a single health worker Immediate Essential Newborn Care
caring for both mother and newborn The First 90 Minutes

Immediate Essential Newborn Care

Time band: 2nd stage of labor
How is the Newborn Care Protocol
organized? ❖ At perineal bulging, with presenting
part visible Intervention:
❖ Prepare for the delivery Action:
➢ Ensure that delivery area is
❖ By time bands
draft-free and room
❖ With cross references to sections of the
temperature between 25-28°C.
WHO PCPNC Manual (2006)
➢ Wash hands with clean water
❖ With algorithms that represent clinical
and soap.
pathways
➢ Double glove just before
delivery.
 ❖ Call out time of birth.
❖ Dry the newborn thoroughly. Check the
Preparing to Meet the Baby's Needs
baby's breathing while drying. Remove
"Good care of the newborn begins with
wet cloth.
good preparation"
❖ Place the newborn on the mother's
abdomen in skin-to-skin contact. Cover
❖ Ensure all delivery equipment and the back with a dry blanket.
supplies, including newborn
resuscitation equipment, are available.
❖ Line up materials for delivery
according to sequence of use

Prepare for Delivery

Time: WITHIN THE 1ST 30 SECS
❖ 2 sets of sterile gloves
❖ Two clean and warm towels or cloth Intervention: Dry and provide warmth.
❖ Self inflating bag and mask (normal Action:
and small newborn)
❖ Suction device ● Use a clean, dry cloth to thoroughly
❖ Sterile cord clamp or ties dry the baby_ by wiping the face,
❖ Sterile forceps and scissors eyes, head, front and back of the
❖ Rolled up piece of cloth trunk, arms and legs.
❖ Bonnet ● Do a quick check of newborn's
❖ Clean dry warm surface breathing while drying.
● Remove the wet cloth.

BROKEN EQUIPMENT IS DANGEROUS DRYING THE NEWBORN

❖ Equipment must be checked daily and ● Stimulates the newborn to breathe

well before a delivery takes place. normally
❖ Resuscitation ● Minimizes heat loss
❖ equipment should always be close to ● During the 1st 30 seconds of
the delivery area drying/stimulation:
❖ Health workers must know how to use ● ‡Do not suction unless mouth/nose are
the equipment. obstructed with secretions or other
material
● ‡Do not ventilate unless the baby is
floppy and not breathing
STANDARD PRECAUTIONS A4
DO NOT REMOVE THE VERNIX.
• Always remember the importance of
observing precautions to help protect the
mother and baby and ourselves from infections
with bacteria, viruses including HIV

IMMEDIATE ESSENTIAL NEWBORN CARE

❖ Deliver the baby in prone position on

the mother's abdomen, face turned to
the side
 ●  yaline membrane disease
H
Time band: If after 30 secs of drying,
● Brain hemorrhage.
newborn is breathing or crying

Intervention: Skin -to-skin (STS) contact

WHEN SHOULD THE CORD BE CLAMPED
Action:
AFTER BIRTH?
● Avoid any manipulation, such as
routine suctioning.
● Place the newborn prone on the ● When the cord pulsations stop
mother's abdomen or chest ● Between 1 and 3 minutes
skin-to-skin. ● Between 30 secs - 1 minute in preterms
● Cover newborn's back with a blanket ● All of the above are appropriate
and head with a bonnet.
● Place identification band on ankle
Time band: If after 30 secs of drying,
newborn is NOT breathing or is gasping
IMMEDIATE SKIN TO SKIN CONTACT
Intervention: Re-position, suction and ventilate
What are the benefits of immediate Action:
skin-to-skin contact? ● Clamp and cut the cord immediately
● Call for HELP
● Provides warmth ● Transfer to a warm firm surface
● Increases overall duration of exclusive ● Inform the mother
breastfeeding ● Start resuscitation protocol
● Allows colonization with good bacteria
● All of the above
● Improves bonding
Time Band: 1 - 3 minutes
● Provides protection from infection by
exposure of the baby to good bacteria Intervention: Delayed or non-immediate
of the mother cord clamping
● Increases the blood sugar of the baby Action:
● Contributes to the overall success of ● Remove the first set of gloves
breastfeeding immediately prior to cord clamping.
● Clamp and cut the cord after cord
pulsations have stopped ( at 1 to 3
minutes)
EFFECT ON IMMUNOPROTECTION

Action: Initial Cord care

● Colonization with maternal skin flora
● Stimulation of the mucosa-associated ●  ut ties tightly around the cord at 2 cm
P
lymphoid tissue system. & 5 cm
● Ingestion of colostrum ● from the abdomen.
● Cut between ties with sterile
instrument.
RISKS OF HYPOTHERMIA ● Observe for oozing blood.
○ Do not apply any substance to the
stump
Hypothermia can lead to :
○ Do not bind or bandage the stump
○ Leave the stump uncovered
● I nfection
● Coagulation defects
Properly timed clamping of the umbilical
● Acidosis
cord = Reduces the risk of anemia in both
● Delayed fetal to newborn circulatory
term and preterm babies.
adjustment
 ➢ Term babies: less anemia in the
BABY
newborn
24-48 hrs after birth
➢ RR 0.2 (95% Cl 0.06, 0.6) ● Breathing
➢ NNT 7, (4.5- 20.8) ● warmth
➢ Preterms: less infant anemia
➢ RR 0.49 (95% CI 0.3, 0.81)
➢ NNT 3 (1.6 - 29.6) SKIN TO SKIN CONTACT &
➢ Preterms: less intraventricular INITIATION OF BREASTFEEDING
hemorrhage
➢ RR 0.59 (95% CI 0.35, 0.92)
➢ NNT 2 (1.4 - 9.8)
➢ To begin with the baby will want to
➢ No significant impact on postpartum
rest.
hemorrhage
➢ Rest period may take from a few
minutes to 30 or 40 minutes before the
Washing should be delayed until after 6
baby
hours
shows feeding cues.

● Washing exposes to hypothermia

● The vernix is a protective barrier to SIGNS OF READINESS TO BREASTFEED
bacteria such as E. coli and Group B
➔ Only once the newborn shows feeding
Strep
cues (e.g. opening of mouth, tonguing,
● Washing removes the crawling reflex
licking, rooting), make verbal
suggestions to the mother to
encourage her newborn to move
Time: WITHIN 90 min of age toward the breast e.g. nudging
➔ Help the mother and baby into a
comfortable position
Intervention: Provide breastfeeding support for
initiation of breastfeeding
Action:
➢ Leave the baby on the mother's chest INITIATION OF BREASTFEEDING
in skin-to-skin contact.
➢ Observe the newborn. ➢ Health workers should not touch the
➢ Place identification tag / bracelet on newborn unless there is a medical
the baby's ankle indication.
➢ Do not give sugar water, formula or
Maintain skin-to-skin contact uninterrupted
other prelacteals.
for at least 90 minutes after birth and until
➢ Do not give bottles or pacifiers.
the first thorough breastfeed is complete.
➢ Do not throw away colostrum.
➢ If the mother is HIV-positive, counsel
Monitor the mother and baby during the
the mother on breastfeeding
first hour after complete delivery of the
placenta.

➢ Never leave the woman and newborn THE FIRST BREAST FEED
alone
➢ Keep the mother and baby in the ➢ Check attachment and positioning
delivery room when the baby is feeding
➢ Record findings, treatments and ➢ Let the baby feed for as long as he
procedures in the labor record wants on both breasts
➢ Monitor every 15 minutes: ➢ Keep the mother and baby together
for as long as possible after delivery
Delay tasks such as weighing,
 immunizations, etc. until after the first
feed
Time: WITHIN 90 min of age

Interventions:
➢ Examine the baby
HIV AND IMMEDIATE NEWBORN CARE
➢ Check for birth injuries, malformations
or defects
➢ If the mother has HIV AIDS:
➢ universal precautions must be followed Action:
as with any other delivery and after ➢ Thoroughly examine the baby.
care. ➢ Weigh the baby and record.
➢ Her baby can have immediate ➢ Look for possible birth injury and/or
skin-to-skin contact malformation
➢ Breastfeeding can begin when the
baby is ready after delivery
➢ Do not give the baby any other food or
Time: WITHIN 90 min of age
drink
➢ Good attachment and positioning are Interventions: Cord care
vital Action:
➢ If replacement feeding, prepare ➢ Wash hands before and after cord
formula for the mother for the first few care,
feeds ➢ Put nothing on the stump.
➢ Fold diaper below stump. Keep cord
stump loosely covered with clean
Time: WITHIN 90 min of age clothes.
➢ If stump is soiled, wash it with clean
Intervention: Do eye care water and soap. Dry it thoroughly with
Action: clean cloth.
➢ Wipe the eyes
➢ Apply an eye antimicrobial within 1 Interventions: Provide additional care
hour of birth: for a small baby or twin
➢ 1% silver nitrate drops or Action:
➢ 2.5% povidone iodine drops or ➢ If the newborn is delivered 1 month
➢ 1% tetracycline ointment or early of is visibly small (1501 - 2499g)
erythromycin eye drops ➢ КМС
➢ Do not wash away the eye ➢ Special support for breastfeeding
antimicrobial ➢ Discharge planning

II. Essential Newborn Care Unnecessary Procedures

FROM 90 Min + 6 HRS Not routinely recommended for all
Time: FROM 90 Min - 6 HRS neonates

Intervention: Give Vitamin K prophylaxis 1. Routine suctioning

and Hepatitis B and BCG 2. Early bathing/washing
vaccinations at birth 3. Foot printing
Action: 4. Giving sugar water, formula or other
➢ Wash hands. pre lacteals and use of bottles and
➢ Inject a single dose of Vitamin K 1 mg pacifiers
IM. 5. Application of alcohol, medicines and
➢ Inject Hepatitis B vaccine IM and BCG other substances on the cord stump
intradermally. and bandaging the cord stump or
➢ Record. abdomen
 SUMMARY

ESSENTIAL NEWBORN CARE PROTOCOL

➢ Essential interventions in the first 90

minutes of life and up to 7 days of life
Pocket guide to the
➢ Emphasizes a core sequence of
PCPNC Manual
actions, performed methodically,
(WHO 2006)
step-by-step
➢ Some time-bound but doable even by
○ DOH issued
a single health worker caring for both
Administrative Order
mother and newborn.
2009-0025 on Dec.
1,2009 : Adopting New Policies and
Protocol On ENC
Immediate Newborn Care ○ Launched on Dec 7, 2009
First 90 Minutes of Life

➢ Call out time of birth.

➢ Deliver the baby prone on the mother's
abdomen
➢ Dry the newborn thoroughly. Check
breathing while drying.
➢ Remove wet cloth.
➢ Position the newborn on the mother's ○
abdomen in skin-to-skin contact. Cover
the back with a dry blanket.
➢ Remove first set of gloves.
➢ Clamp and cut the cord when
pulsations have stopped (1-3 minutes)
➢ 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.
➢ Do eye care