Essential Newborn Care.pdf

CARE OF NORMAL
NEWBORN/ESSENTIAL
NEWBORN CARE
(ENC)

Essential newborn care is
a comprehensive strategy
to reduce the death of
newborn through cost
effective interventions
before conception, during
pregnancy, immediately
after birth and postnatal
period

HEALTHY NEWBORN
 38 to 42 weeks
 Cries immediately after birth
 Establishes independent
rhythmic respiration
 Quickly adapts with the
extrauterine environment,
having an average birth weight
and no congenital anomalies

PHYSICAL CHARACTERISTICS OF
HEALTHY NEONATES
● WEIGHT: The average
weight of a normal full-
term newborn infant is
about 2.9 kg with a
variation of 2.5 to 3.9 kg or
more. The weight is very
variable from country-to-
country and in different
socio-economical status.

HEALTHY NEONATES
● LENGTH: At birth the
average crown heel
length of the term
infant is 50 cm with
the range of 48 to 53
cm. The length is a
more reliable criterion
of gestational age
than the weight.

HEALTHY NEONATES
● HEAD CIRCUMFERENCE:
The head circumference
is usually varies from 33
to 37 cm, with the
average of 35 cm.

HEALTHY NEONATES
● CHEST
CIRCUMFERENCE: The
chest circumference is
about 3 cm less than
head circumference.
The chest is rounded
rather than flattened
anteroposteriorly.

OTHERS:
 Posture: Partial flexion
 Skin:
• Pinkish but blueish hands and feet (acrocyanosis)
may present for a short time after birth.
• Covered with vernix caseosa and lanugo especially
at the back.
 Ear cartilage: firm and fully curved, showing good
elastic recoil
 Breast nodule: palpable, over 5 mm in diameter.
 Scrotum: adequate rugae with deep pigmentation
and palpable testes (at least one).
 Labia majora: covers the labia minora. The
 Sole of foot: prominent deep creases.

PHYSIOLOGICAL CHARACTERISTICS
OF HEALTHY NEONATES
● RESPIRATORY RATE:
 30 – 60 breaths per minute
 Can breathe both through nose and
mouth.
 Usually periodic, shallow but irregular.
 Usually thoracoabdominal without any
retractions and grunting.
● TEMPERATURE:
 36.5 - 37.5°c

PHYSIOLOGICAL CHARACTERISTICS
OF HEALTHY NEONATES
● HEART RATE:
 120 – 160 beats per minute
 Irregular and increased during
cry
 May reduce to 80 – 100 beats per
minute during sleep
● BLOOD PRESSURE:
 Ranges from 60 to 80 mm Hg
systolic and diastolic 25 to 40 mm Hg

OBJECTIVES OF NEONATAL
CARE
Initiation of normal breathing
Prevention of hypothermia
Initiation of breastfeeding
Protection from infection
Identification of danger signs

COMPONENTS OF ENC
IMMEDIATE
BASIC CARE OF
NEONATE
DAILY
ROUTINE CARE
OF NEONATE
The major goal of nursing care of the newborn
infant is to establish and maintain homeostasis

IMMEDIATE BASIC CARE OF
NEONATE
Maintenance of
TEMPERATURE
Initiation of
BREATHING
Establishment of
open AIRWAY
Maintenance of
CIRCULATION
T A
B C

STEPS: CARE OF NEONATE AT
BIRTH
1. Call out the time of
birth.
2. Deliver the baby onto a
warm, clean and dry
towel or cloth and keep
on mother's abdomen
or chest (between the
breasts).

STEPS: IMMEDIATE CARE OF
NEONATE
3. Wipe both the eyes
separately with
sterile swab.
4. Clamp and cut the
umbilical cord after
1 minute ,if baby
breathing well.

NEONATE
5. Immediately dry the
baby with a warm
clean towel or piece
of cloth.
6. Assess the baby's
breathing while
drying.

APGAR SCORING
A -
P -
G -
A -
R -
Appearance (Skin color)
Pulse (Pulse rate)
Grimace (Reflex irritability)
Activity (Muscle tone)
Respiration (Breathing)

NEONATE
7. Leave the baby between the mother's
breasts to start skin-to-skin care for at least
an hour.
8. Cover the baby's head with a cap. Cover the
mother and baby with a warm cloth.
9. Place an identity label/band on the baby.
10.Encourage mother to initiate breastfeeding
(within half an hour of birth).

Vitamin K Injection
 1 mg should be given IM to help prevent
hemorrhagic disease within 6 hours after birth.
 Every newborn with excessive bleeding should be
treated as having possible sepsis.

DAILY ROUTINE CARE OF
NEONATE
 Ensuring warmth
 Breastfeeding
 Skin care & Baby bath
 Care of the umbilical
cord
 Care of the eyes
 Clothing of the baby
 General care
 Observation
 Weight recording
 Immunization
 Follow-up & Advice

Ensuring warmth
● Keep baby dry and baby with adequate
clothing in two layers, ensuring head and
extremities are well-covered.
● Keep baby by the side of the mother(skin
to skin contact with mother)
● Bathing is avoided to prevent
hypothermia and infections. The normal
body temperature is 36.5 to 37.5 ⁰C
● Hypothermia is a body temperature of <36
°C

● Ambient atmospheric temperature (28–
32°C).
● Temperature should be recorded (by
axillary, skin or human touch method)
● Warmth to be maintained during transfer
● Oil massage provides insulation against
heat and prevents insensible water loss.
But it can be avoided during hospital stay
to prevent infections and better to
postpone till the baby is 3 to 4 weeks old.

Breastfeeding
● Put to the mother’s breast within half
an hour of birth or as soon as possible
● Should receive the colostrum during
first three days of life.
● Initially at interval of 1 to 2 hours and
then every 2 to 3 hours.
● Feeding on DEMAND
● Exclusive breastfeeding for first 6
months

Skin care & Baby bath
● Clean off blood, mucus and meconium by
gentle wiping. No vigorous attempts to
remove vernix caseosa
● No dip bath till umbilical stump falls off
● Bath with unmedicated soap and lukewarm
water
● Exposure to sun for Vitamin D, protecting
from UV light
● Talcum powder over axilla, groins and
buttocks to prevent rash

Care of umbilical cord
● Umbilical cord is tied 2cm from the stump base,
second clamp at 5 cm from the umbilical base
(which is 3 cm from the first clamp) and cut close
to the 2nd clamp.
● Do NOT apply anything on the stump; keep the
cord clean and dry
● Wipe clean with sterile swab stick from stump
base to the tip
● Dries and shrivels up and separates
by aseptic necrosis in 5 – 10 days

Care of eyes
• The eyes should be cleaned at
birth and once every day
using sterile cotton swabs
soaked in sterile water or
Normal saline.
• Clean from inner to the outer
canthus
• Each eye should be cleaned
using a separate swab.
• The routine use of local
antiseptic drops for
prophylaxis is not
recommended

Clothing of baby
• Dress with loose, soft and
cotton cloths which is open
on the front
• Large buttons, synthetic
frock and plastic or nylon
napkin should be avoided.
• A triangle of square piece
of thick, soft absorbent
cloth should be used as
napkin.
• The cloths should not be
tight specially around the
neck or abdomen.

Clothing of baby
• In winter, woollen or flannel
clothing should be used.
Woollen cloths should not
be stored with moth balls,
because there is chance of
severe jaundice in the baby
with G-6-PD deficiency.
• Baby clothing should always
be cleaned with light
detergent, and sun-dried to
prevent skin irritation.

General care
• Bedding-in/Rooming-
in in a well ventilated
room
• Allow to sleep in
supine to prevent SIDS
• Clean surroundings
• Stimulation with touch
and sound

Observation
• Observe twice daily for early detection of any
abnormalities.
• Temperature, pulses/heart rate, respiration,
feeding behaviors, stool, urine and sleeping
pattern should be assessed.
• Mouth, eyes, cord and skin should be looked for
any infections.

Weight Recording
• The average daily weight gain in healthy term babies is
about 30 g/day in the first month of life, about 20 g/day in
the second month and 10 g/day afterwards during the first
year of life.
• Most infants double their birth weight by 4 to 5 months.
• In the first week of life there is physiological loss of body
weight due to removal of vernix, mucus, blood, passage of
meconium and reduction of extracellular blood volume.
• Delay and unsatisfactory feeding is also contributing to
weight loss.
• With adequate breastfeeding, majority of the babies regain
the weight within 7 to 10 days of birth.

Immunization
• “0” dose OPV and BCG
• First dose HBV
• BCG and OPV should be
given within first week of
life.
• OPV preferably given after
3 days of age because
colostrum may interfere
with its uptake.

Follow-up & Advice
• Follow-up once every month for
first 3 months and subsequently
3 months interval till one year of
age.
• Follow-up is necessary for
assessment of growth and
development, early detection
and management of health
problems, and health education
for prevention of childhood
illnesses.

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