Essential Newborn Care

Objectives
By the end of this session, the learner
should
•be able to discuss the problem of child
mortality focusing on neonatal mortality
•know preventive interventions to address
the above
•be able to discuss the immediate
newborn care practices that save lives
MILLENNIUM

5 4
 The Philippines is one of

42countries that account

for 90% of global under-five
mortality
82,000
Filipino children die annually
Most could have lived
 Essential
Newborn Care
Protocol was
developed to
address these
issues
What Immediate
Newborn Care
Practices Save
Lives?
Every Newborn Has Needs

 To breathe normally
 To be warm
 To be protected
 To be fed
 Providing Warmth:
Check the Environment
 Check temperature of the
delivery room*
 Ideal temp: 25 – 28°C

 Check for air drafts

 Turn air conditioner off at time
of delivery
*non-mercury thermometer
After a baby is born, what should be the
first action performed?

A • Clamp and cut the cord

B • Dry the baby

C • Suction the baby’s mouth and nose

D • Do foot printing
After a baby is born, what should be the
first action performed?

A • Clamp and cut the cord

B • Dry the baby

C • Suction the baby’s mouth and nose

D • Do foot printing
Drying should be the first action,
IMMEDIATELY
for a full 30 seconds
unless the infant is both floppy/limp and apneic
Immediate Thorough Drying

 Immediate drying:
Stimulates Breathing
Prevents hypothermia
Tunell R., in Improving Newborn Health in Developing Countries, A. Costello and D. Manandhar, Editors. 2000,
Imperial College Press: London, UK. p. 207-220;
TollinM,etal.. Cell Mol Life Sci 2005
 Immediate Thorough Drying

 Dry the newborn thoroughly for at least 30

seconds
 Do a quick check of breathing while drying
 >95% of newborns breathe normally after birth

 Follow an organized sequence

 Wipe gently, do not wipe off the vernix
 Remove the wet cloth, replace with a dry one
 Immediate Thorough Drying

 If baby 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 by
secretions
 During drying and stimulation of the baby,
your rapid assessment shows that the baby
is crying.
What is your next action?
A • Suction the baby’s mouth and
nose

B • Clamp and cut the cord

C • Do skin-to-skin contact

D • Do early latching on
 During drying and stimulation of the baby,
your rapid assessment shows that the baby
is crying.
What is your next action?
A • Suction the baby’s mouth and
nose

B • Clamp and cut the cord

C • Do skin-to-skin contact

D • Do early latching on
Early Skin-to-Skin Contact
 General perception is purely for
mother-baby bonding
 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
When should the cord be
clamped after birth?
A • When the cord pulsations stop

B • Between 1 and 3 minutes

C • Not less than 1 minute in terms

and preterms not needing PPV

D • All of the above are appropriate

When should the cord be
clamped after birth?
A • When the cord pulsations stop

B • Between 1 and 3 minutes

C • Not less than 1 minute in terms

and preterms not needing PPV

D • All of the above are appropriate

Properly-Timed Cord Clamping
 When preparing for delivery, don 2 pairs
of gloves after thorough handwashing
 Remove the first set of gloves
 Palpate the umbilical cord
 Wait 1-3 minutes or until cord pulsations
have stopped.
 Properly-Timed Cord
Clamping

•Clamp cord  Clamp again at •Cut the cord

using a sterile 5 cm from the close to the
plastic clamp or base plastic clamp
tie at 2 cm from
the umbilical base
 2cm 3cm

BABY
Care of the Cord
 DRY cord care is recommended.
 Do not apply any substance onto the cord

 Do not use a binder or “bigkis”

 Observe for the oozing of blood. If blood
oozes, place a second tie between the skin and
the clamp
Washing the Baby in the
First 6 Hours is
Protective.

TRUE FALSE
Washing the Baby in the
First 6 Hours is
Protective.

TRUE FALSE
 Washing

 Vernix
 protective barrier to E.coli and Group B Strep

 Early washing
 Hinders crawling reflex
 Can lead to hypothermia
 infection, coagulation defects, acidosis, delayed
fetal to newborn circulatory adjustment,
hyaline membrane disease, brain hemorrhage

Tunell R., Cell Mol Life Sci 2005; 62:2390-99; Righard L, Alade M. Lancet 1990; 336: 1105-07.
What is the approximate
capacity of a
A newborn’s
stomach?
B
C
D
What is the approximate
capacity of a
A newborn’s
stomach?
B
C
D
 How long after birth is a
newborn ready to breastfeed?

A •immediately
B •5-10 minutes
C •10-20 minutes
D •20-60 minutes
 How long after birth is a
newborn ready to breastfeed?

A •immediately
B •5-10 minutes
C •10-20 minutes
D •20-60 minutes
 Non-separation of Newborn from
Mother for Early Breastfeeding

 Weighing, bathing, eye care, examinations, injections

should be done after the first full breastfeed is
completed
 Postpone bathing until at least 6 hours
Non-separation of
Newborn from
Mother

 Never leave the mother and baby unattended

 Monitor mother and baby q15 minutes in the first 1-2

hrs. Assess breathing and warmth.

 Breathing: listen for grunting, look

for chest in- drawing and fast
breathing
 Warmth: check to see if feet are cold to
touch if no thermometer
 Early and
Appropriate
Breastfeeding
Initiation
 Leave the newborn between the mother’s
breasts in continuous skin-to-skin contact
 The baby may want to rest for 20-30 mins
and even up to 120 minutes before showing
signs of readiness to feed
 Early and Appropriate
Breastfeeding Initiation
 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 he/she wants on
both breasts
 Early and Appropriate
Breastfeeding Initiation
 Help the mother and baby into a comfortable position

 Observe the newborn

 Once the newborn shows feeding cues, ask the mother to

encourage her newborn to move toward the breast
 Support Continued and
Exclusive Breastfeeding
 After delivery, mother
is moved onto a
stretcher with her
baby and transported
to Recovery Room,
mother-baby ward or
private room
 Breastfeeding support
is continued
 Support Continued and
Exclusive Breastfeeding
 Counsel on positioning
 Newborn’s neck is not
flexed or twisted
 Newborn is facing the
breast
 Newborn is close to
mother’s body
 Newborn’s whole body is
supported
 Support Continued and
Exclusive Breastfeeding
 Counsel on
attachment and
suckling
 Mouth wide open
 Lower lip turned
outwards
 Baby’s chin touching
breast
 Suckling is slow,
deep with some
pauses
Proper Breastfeeding Hold
 Look for a quiet place
 Find a most relaxed position for mother
 Provide adequate back support
 Support feet
 Do not hunch shoulders
 Do not “scissor” the breast
Cradle Hold
Cross Cradle Hold
Cradle vs. Cross Cradle Hold
Underarm Hold
 Football hold
 Baby is held like a
clutch bag
 Nose further away
from the breast
 Baby’s trunk is
secure beside
mother’s trunk
Breastfeeding after Caesarian
Side-Lying Position
Side-Lying
Position
E.O. 51 and its rIRR: The DON’Ts
DO NOT REQUEST or ACCEPT
from Milk Companies or their representatives:
 Gifts of any sort
 Samples or products covered under the Milk Code
 Posters, other promotional materials or direct
promotions of products covered under the code
within your Health Facility, Community, Barangays,
Events, etc.
 Sponsorships without permission from FDA
 Endorsements of products covered by the Milk Code
THANK YOU!

MARY KRIS D. JIMENEZ RN