Abhishek hd ENC

Essential Newborn Care
Presented by:-
Abhishek Hansda
Bsc Nursing 3rd Year
Disha Institute of Medical Sciences
Raipur(C.G)

INTRODUCTION:
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.

HEALTHY NEWBORN
A healthy infant born at term b/w 38-42 wks
should have average birth wt, cries immediately
following birth, establishes independent
rhythmic respiration & quickly adapts to the
changed environment.

DEFINITION
ACCORDING TO WHO
“Essential newborn care (ENC) is care that every
new born baby needs regardless of where it is
born or its size. ENC should be applied immediately
after the baby is born and continued for at least
the first 7 days after birth. Many ENC interventions
are simple and can be provided by a skilled birth
attendant (SBA) or a trained community health
worker (CHW) or traditional birth attendant (TBA)
or by a family member supporting the mother in a
healthy facility or at home.”

Universal Precautions & cleanliness
▪ Wash hands.
▪ Wear gloves.
▪ Protect yourself from blood and other body fluids during
deliveries.
▪ Practice safe sharps disposal.
▪ Practice safe waste disposal.
▪ Deal with contaminated laundry.
▪ Sterilize and clean contaminated equipment.

PREPARING FOR BIRTH
WASH YOUR HANDS
ESSENTIAL
▪ A draught free, warm room - temperature 250C +
▪ A clean, dry and warm delivery surface
▪ A radiant heater
▪ Two clean, warm towels/cloths: to dry, wrap or cover the newborn baby.
▪ A folded piece of cloth
▪ A suction device
▪ A newborn size self inflating bag, masks
▪ Laryngoscope
▪ Oxygen
▪ Disposables
▪ Medications
▪ A CLOCK

Care of the baby at the time of birth
(Until around 1 hour after birth)
• Provide routine care at birth for all
newborns
• Identify and manage newborns who may
need special care

Nursing Care after delivery
▪ Call out time of birth
▪ Place baby on mother’s abdomen
▪ Dry baby with warm clean sheet
▪ Wipe mouth and nose with clean cloth
▪ Assess baby’s breathing while drying
▪ Clamp cord after 1-3 min, cut with sterile instrument,
put sterile tie
▪ Put identity label on the baby

Nursing Care after delivery
▪ Examine for malformations/ birth injury
▪ Initiate breast feeding within 1 hour
▪ Record baby’s weight
▪ Give Inj Vit K 1mg IM ( 0.5 mg for preterm)
▪ Cover baby’s head with cloth.
▪ Cover mother and baby with warm cloth

Immediate cord care
▪ Clamp and cut cord with a sterile
instrument.
▪ Tie the cord between 2 to 3 cms from the
base and cut the remaining cord.
▪ Observe for oozing blood.
▪ DO NOT apply any substance to stump.
▪ DO NOT bind or bandage stump.
▪ Leave stump uncovered.

Maintenance of temperature:
 Immediately dry the infant under a radiant warmer
 Skin to skin contact with the mother.
 Keep neonates head covered.
 Rooming in (The baby should not be separated from the
mother)

Establishment of open airway:
(Majority of babies cry at birth & take spontaneous Respiration)
 When the head is delivered birth attendant immediately suction
the secretions, wipe mucus from face and mouth and nose.
Suction the mouth and nose by using bulb syringe
Keep head slightly lower than the body
Position the Baby on their backs or tilted to the side, but not on
their stomachs.

APGAR SCORING
CRITERIA 0 1 2
Respiration Absent Slow, irregular Good, crying
Heart rate Absent Slow (Below 100) More than 100
Muscle tone Flaccid Some flexion of
extremities
Active body movements
Reflex response No response Grimace Cry
Skin color Blue, pale Body pink, extremities
blue
Completely pink

TOTAL SCORE = 10
 No depression: 7-10
Mild depression: 4-6
Severe depression: 0-3

Newborn Identification:
Newborn Identification Before a baby leaves the delivery area,
identification bracelets with identical numbers are placed on the
baby and mother. Babies often have two, on the wrist and ankle.

The daily routine care of the
neonates are as follows:
 Warmth
 Breastfeeding
 Skin care & baby bath
 Care of umbilical cord
 Care of the eyes
 Clothing of the baby

General care
Observation
Taking anthropometric measurement
Immunization
Follow up & advice

WARMTH
Warmth is provided by keeping the baby dry & wrapping the
baby with adequate clothing in two layers, ensuring head &
extremities are well covered. Baby should kept by the side of the
Mother.
BREAST FEEDING
Breastfeeding The baby should be put to the mother’s
breast within half an hour of birth or as soon as possible
the mother has recovered from the exertion of labour.

Skin care & baby bath:
The skin should be cleaned off blood, mucus & meconium by
gentle wiping before he/she is presented to the mother. Baby
bath can be given at the hospital or home by using warm
water in a warm room gently & quickly.
First Bath: Once a baby's temperature has stabilized, the First
bath can be given.

CARE OF THE UMBILICAL CORD
 Keep the cord stump clean and dry.
 Topical application of antiseptics is usually not necessary
unless the baby is living in a highly contaminated area.

Care of the eyes. :
Eyes should be clean at birth & once in every day using sterile
cotton swabs soaked in sterile water or normal saline.
Separate swabs for each eye.

Clothing of the baby:
 The baby should be dressed with loose, soft & cotton cloths.
The frock should be open on the front or back for easy
wearing.
 Large button, synthetic frock and plastic or nylon napkin
should be avoided.

General care:
 Rooming –in
 gentle approach
 Aseptic technique
sensory stimulation
 tender& loving care.

Observation:
The baby should be kept in continuous observation twice
daily for detection of any abnormalities.

Measure weight
length
Head circumference
Chest circumference
Anthropometric measurement:

WEIGHT:
The average daily wt gain for healthy term babies is about 30gm/day in the
first month of life
 It is about 20gm/day in second month
10gm per day afterwards during the first year of life.
LENGTH: (from top of head to the heel with the leg fully extended)
Average range: 18-22 inches (46-56 cm)

Head circumference:
Head circumference (repeat after molding and caput
succedaneum are resolved). Average range: 33 to 35 cm (13-14
inches) Normally, 2 cm larger than chest circumference Place
tape measure above eyebrows and stretch around fullest part
of occipital at posterior fontanel.

Chest circumference (at the nipple line):
Average range: 30-33 cm (12-13 inches) Normally, 2 cm smaller
than head circumference Stretch tape measure around scapulae
and over nipple line.
Immunization:
Newborn should be immunized with BCG vaccine & ‘0’ dose of
‘OPV’. Hepatitis ‘B’ vaccine can be administered at birth as first
dose & other two doses in one month & 6 months of age.

Follow up & Advice:
Each infant should be followed up, at least once every month
for first 3 months & subsequently 3 month interval till one year
of age.

CARE OF NEWBORN IN POSTNATAL WARD

Postnatal environment
▪ Kept warm with no draughts from open doors or
windows. Temperature of 25 C required.
▪ Mother and her baby kept together in same bed
(rooming-in)
▪ Helps to form bonding, can respond quickly when
her baby wants to feed, reduces breastfeeding
difficulties

Ask the mother
▪ Do you or baby have any problems?
▪ Has infant passed stools, urine?
▪ Have you started breast feeding infant?
▪ Is there any difficulty in feeding infant?
▪ Do you have any pain while breast feeding?
▪ Have you given any other foods or drinks to
infant? If yes, what and how?

Examine the baby
▪ Count breaths in one minute
▪ Look for severe chest indrawing
▪ Look and listen for grunting
▪ Look at umbilicus. Is it red or draining pus?
▪ Look for skin pustules. Are there 10 or more
pustules or a big boil?

Examine the baby
• Measure axillary temperature (if not possible, feel
for fever or low body temperature)
• See if young infant is lethargic
• Look for jaundice. Are the face, abdomen or soles
yellow?
• Look for malformations

Assess Breastfeeding
If infant has not fed in previous hour, ask mother to
put her infant to breast. Observe the breastfeed
for 4 minutes.
• Is the infant able to attach?
To check attachment, look for:
- Chin touching breast
- Mouth wide open
- Lower lip turned outward
- More areola above than below the mouth

Assess Breastfeeding (contd)
▪ If not well attached, help mother to position so that
baby attaches well.
▪ Is the infant suckling effectively (that is, slow deep
sucks, sometimes pausing)?
▪ If not sucking well, then look for:
- ulcers or white patches in mouth (thrush)
▪ If there is difficulty or pain while feeding, then look
for
- Engorged breasts or breast abcess
- Flat or inverted, or sore nipples

HARMFUL TRADITIONAL PRACTICES FOR THE CARE OF
NEONATES
 use of unclean substance such as cow dung, mud on
umbilical card,
 immediate bathing,
use of prelacteal feeds,
application of kajal in the newborn eyes,
 instillation of oil drops into ears & nostrils,

during bathing the baby use of unhygienic herbal water,
 use of pacifiers,
 introduction of artificial feeding with diluted milk,
 giving opium & brandy to neonates
 use of readymade expensive formula foods.

Counsel the mother
• Keep baby warm
• Breastfeed frequently and exclusively
• Advise mother to wash hands with soap and
water after using toilet and after cleaning bottom
of baby.
• Advise mother regarding danger signs and care
seeking.

Follow-up
▪ Schedule postnatal visit within first week on day 3
and day 7 of delivery. Also visit on day 14, 21 and 28
if baby is LBW.
▪ Assess for growth and development and signs of
illnesses
▪ Health education of parents done
▪ Assessed at least once every month for 3 months
and subsequently 3 monthly till 1 year.

▪ Ineffective airway clearance related to nasal and oral
secretions from delivery.
▪ Ineffective thermoregulation related to environment and
immature ability for adaptation.
▪ Risk for injury related to immature defenses of the newborn.
▪ Risk for infection related to immature immune system
Nursing Diagnoses:

SUMMARY
▪ Basic care to support survival & wellbeing is ENC
▪ Ventilation must be initiated within 1st min of life
▪ Help to initiate breast feeding within 1st hr of birth
▪ Identify and refer neonates requiring special care
▪ Take all precautions to prevent infection, hypothermia and
counsel mother for the same
▪ Counsel mother for Danger signs, immunization & follow-up

Abhishek hd ENC

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Abhishek hd ENC