MADR-E-MEHARBAN INSTITUTE OF NURSING SCIENCES AND

RESEARCH

RESUSTATION AND IMMEDIATE NEW BORN CARE, ESSENTIAL

NEW BORN CARE AND INITIATE BREAST FEEDING
(Guidelines of National Neonatology Forum Of India)

SUBMITTED TO;
Dr. Muneera Bashir
Mrs. Khurshida Akhter
Mad-re-Maharban College of nursing

PRESENTED BY;
Mrs .SHUGUFTA HAMID
IST year M.Sc. Nursing
Obstetrics and Gynecological Nursing
 IMMEDIATE CARE OF THE BABY AT BIRTH
The immediate care of the baby /newborn is based
on the knowledge, transitional requirements and
capabilities of the midwife. Chances of the heat loss
by convection, radiation, and evaporation are very
high and hence appropriate preparations must be
made for the provision of an optimal thermal
environment in the delivery room which would
facilitate a successful transition to extra uterine life.
Switching off the fan prior to delivery helps to
minimize heat loss by convection. Closing the
curtains in the room helps in the reductions of
radiant heat loss.
Definition:
Essential Newborn Care(ENC) is care that every
newborn baby needs regardless of where it is born
or its size. ENC should be apllied 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
health facility or at home
The individual steps are briefly explain
below:
Call out the time of birth. It is
important to tell loudly the time of
birth-this helps in accurate recording of
the time and more importantly, alerts
other personnel in case any help is
needed
• Receive the baby onto a
warm, clean and dry towel
or cloth on a warm dry
surface. The baby should
be delivered onto a warm,
clean and dry towel and
kept on mother’s chest. If
this is not possible, the
baby should be kept in a
clean, warm, safe place
close to the mother.
SUCTION
Clamp and cut the umbilical cord:
• The umbilical cord
should be clamped after
1 to 3 minutes using a
sterile , disposable
clamp or a sterile tie
and cut using a sterile
blade about 2 cm (1-
inch) away from the
skin.
Cord cut and clamp
Immediately dry the baby with a warm clean towel or
piece of cloth; wipe the eyes. The baby should be
thoroughly dried to prevent from getting cold ( this would
be explained in the module on ‘Thermal protection’). Blood
or meconium on the baby’s skin should be wiped away;
however, the white greasy substance covering the baby
(vernix) should not be wiped off. Because this vernix helps
to protect the baby’s skin and gets reabsorbed very quickly.
Assess the baby’s breathing while drying. At the time of
drying itself, the baby’s breathing should be assessed. A
normal newborn should be crying vigorously or breathing
regularly at a rate of 40-60 breaths per minute. If the baby
is not breathing well, then the steps of resuscitation have
to be carried out as explained in the lesson on
‘Resuscitation’
Wipe both the eyes (separately) with sterile
gauze. Clean the eyes using sterile gauze/
cotton. Use separate gauze for each eye. Wipe
from the medial side (inner canthus) to the
lateral side (outer canthus).
Leave the baby between the mother;s
breasts to start skin-to-skin care. Once the
cord is cut , the baby should be placed
between the mother’s breasts to initiate skin-
to-skin care. This will help in maintaining the
normal temperature of the baby as well as in
promoting early breast feeding.
Kangaroo mother care
 Warm chain

• Warm delivery room

• Immediate drying
• Skin to skin contact at birth
• Breastfeeding
• Bathing and weighing postponed
• Appropriate clothing
• Mother and baby together
• Warm transportation
Place an identify label on the baby. This helps in easy
identification of the baby, avoiding any confusion. The label
should be placed on the wrist or ankle.
Cover the baby’s head with a cap. Cover the mother and
the baby with a warm cloth. Both the mother and the
baby should be covered with a warm cloth, especially if the
delivery room is cold (temperature less than 250C ). Since
head is the major contributor to the surface area of the
baby, a newborn baby’s head should be covered with a cap
to prevent loss of heat.
Encourage the initiation of breastfeeding. Breast feeding
should be initiated within one hour of birth in all babies.
 Evaluation
of the Newborn at Birth
 ASSESS 0 1

HEART RATE Absent Below 100

RESPIRATION Absent Slow

Muscle TONE Flaccid Some flexion

REFLEX IRRITABILITY No response Grimace

Body pink,
COLOR Blue all over
Extremities blue
 Breastfeeding
Help mother to initiate breastfeeding within
first hour of birth
Help mother at first feed
Ensure
-Good position
-Good attachment
-Effective suckling
RESUSCITATION
Resuscitation is the process of correcting
physiological disorders (such as lack of
breathing or heartbeat) in an acutely
unwell patient. It is an important part of
intensive care medicine, trauma surgery
and emergency medicine. Well known
examples are cardiopulmonary
resuscitation and mouth-to-mouth
resuscitation.
 Resuscitation

• All babies must be assessed for need of

resuscitation at birth
• At least 1 person skilled in providing
resuscitation must be present
• Ventilation must start within 1 minute of
birth
• First golden minute
Supplies and Equipments
Though the need for resuscitation can be anticipated in
some situation, there are occasions when a baby is born in
poor condition without forewarning. It is essential that
resuscitation equipment’s are always available and in
working order in the delivery room and nursery area in
close proximity to oxygen and suction outlets. The
equipments and medications should include those that
will provide adequate ventilation or resuscitation,
thermoregulation, correction of hypoglycemia, fluids and
electrolytes ,plasma expanders and cardiac stimulants .
The personnel in attendance at the delivery of a baby must
be familiar with the equipments and resuscitation
techniques. A list of essential equipments includes the
following.
 Beg and Mask Ventilation/ positive Pressure Ventilation
Indications
Infant apneic
Heart rate less than 100bpm.
Procedure
The newborn should be on his/ her back with
neck slightly extended.
A tight seal to be formed over the
infant’s mouth and nose:
Ventilate at the rate of 40-50 per minute with 20-25 cm
H2O pressure
Ventilate for 15-30 seconds and evaluate
Have an assistant to evaluate, listen to the heart rate for 6
seconds and multiply by 10.
 Chest Compressions

Chest compressions consist of rhythmic

compression of the sternum that compresses the
heart against the spine, increases the
intrathoracic pressure and circulates blood to the
vital organs.
Chest compressions must always be
accompanied by ventilation with 100% oxygen to
assure that the circulating blood is well
oxygenated.
Procedure
Site: Lower third of the sternum below
an imaginary line between the two nipples.
Depth: Depress the sternum to a depth
of 1/2 -3/4 inch at a rate of 100-120bpm.
Rate: 100-120bpm. Coordinate heart
compression with ventilation.
Discontinue when infant can
maintain heart rate above 80 by ventilation
alone.
Chest Compressions
Endotracheal Intubation
SUMMMARY AND CONCLUSION
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