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    Unang Yakap

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    Helen Grace Avila
    This document outlines the essential newborn care protocol, which provides standard procedures for caring for newborns from birth to the first week of life. It details immediate newborn care actions that should be taken within the first 90 minutes, including drying the baby, maintaining skin-to-skin contact, delayed cord clamping, eye care and initiation of breastfeeding. Subsequent newborn care from 90 minutes to 6 hours includes vitamin K administration, hepatitis B and BCG vaccinations, examination and weighing of the baby, and cord care. The goal is to provide simple, evidence-based newborn care globally to help reduce child mortality.

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    Unang Yakap

    Uploaded by

    Helen Grace Avila
    917 views57 pages
    This document outlines the essential newborn care protocol, which provides standard procedures for caring for newborns from birth to the first week of life. It details immediate newborn care actions that should be taken within the first 90 minutes, including drying the baby, maintaining skin-to-skin contact, delayed cord clamping, eye care and initiation of breastfeeding. Subsequent newborn care from 90 minutes to 6 hours includes vitamin K administration, hepatitis B and BCG vaccinations, examination and weighing of the baby, and cord care. The goal is to provide simple, evidence-based newborn care globally to help reduce child mortality.

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    This document outlines the essential newborn care protocol, which provides standard procedures for caring for newborns from birth to the first week of life. It details immediate newborn care actions that should be taken within the first 90 minutes, including drying the baby, maintaining skin-to-skin contact, delayed cord clamping, eye care and initiation of breastfeeding. Subsequent newborn care from 90 minutes to 6 hours includes vitamin K administration, hepatitis B and BCG vaccinations, examination and weighing of the baby, and cord care. The goal is to provide simple, evidence-based newborn care globally to help reduce child mortality.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    917 views57 pages

    Unang Yakap

    Uploaded by

    Helen Grace Avila
    This document outlines the essential newborn care protocol, which provides standard procedures for caring for newborns from birth to the first week of life. It details immediate newborn care actions that should be taken within the first 90 minutes, including drying the baby, maintaining skin-to-skin contact, delayed cord clamping, eye care and initiation of breastfeeding. Subsequent newborn care from 90 minutes to 6 hours includes vitamin K administration, hepatitis B and BCG vaccinations, examination and weighing of the baby, and cord care. The goal is to provide simple, evidence-based newborn care globally to help reduce child mortality.

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    Essential Newborn Care

    MARY ANNE L. ILAO, M.D.,FPPS,DPSNbM 2010

    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 caring for both mother and newborn
    Phil.ENCC

    How is the Newborn Care Protocol organized?


    By time bands With cross references to sections of the WHO PCPNC Manual (2006) With algorithms that represent clinical pathways

    Phil.ENCC

    Immediate Essential Newborn Care


    The First 90 Minutes

    Immediate Essential Newborn Care


    Time band: 2nd stage of labor At perineal bulging, with presenting part visible Intervention:Prepare for the delivery Action: Ensure that delivery area is draft-free and room temperature between 2528oC. Wash hands with clean water and soap. Double glove just before delivery.

    Preparing to Meet the Babys Needs


    Good care of the newborn begins

    with good preparation


    Ensure all delivery equipment and supplies, including newborn resuscitation equipment, are available. Line up materials for delivery according to sequence of use

    Prepare for Delivery


    2 sets of sterile gloves Two clean and warm towels or cloth Self inflating bag and mask (normal and small newborn) Suction device Sterile cord clamp or ties Sterile forceps and scissors Rolled up piece of cloth Bonnet Clean dry warm surface

    Broken equipment is dangerous

    Equipment must be checked daily and well before a delivery takes place. Resuscitation equipment should always be close to the delivery area Health workers must know how to use the equipment.
    Phil. ENCC 11

    STANDARD PRECAUTIONS A4
    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 mothers abdomen, face turned to the side Call out time of birth. Dry the newborn thoroughly. Check the babys breathing while drying. Remove wet cloth. Place the newborn on the mothers abdomen in skin-to-skin contact. Cover the back with a dry blanket.

    Time: WITHIN THE 1ST 30 SECS


    Intervention: Dry and provide warmth. Action: Use a clean, dry cloth to thoroughly dry the baby by wiping the face, eyes, head, front and back of the trunk, arms and legs. Do a quick check of newborns breathing while drying. Remove the wet cloth.

    Drying The Newborn

    Stimulates the newborn to breathe normally Minimizes heat loss

    Drying the newborn


    During the 1st 30 seconds of drying/stimulation: Do not suction unless mouth/nose are obstructed with secretions or other material Do not ventilate unless the baby is floppy and not breathing

    Phil. ENCC

    16

    Do not remove the vernix!!!

    Time band: If after 30 secs of drying, newborn is breathing or crying


    Intervention: Skin -to-skin (STS) contact Action: Avoid any manipulation, such as routine suctioning. Place the newborn prone on the mothers abdomen or chest skin-to-skin. Cover newborns back with a blanket and head with a bonnet. Place identification band on ankle

    Immediate skin-to-skin contact

    Immediate skin-to-skin contact

    Skin-to-Skin Contact
    Provides warmth Improves bonding Provides protection from infection by exposure of the baby to good bacteria of the mother Increases the blood sugar of the baby Contributes to the overall success of breastfeeding

    Skin-to-Skin Contact
    Effect on Immunoprotection Colonization with maternal skin flora Stimulation of the mucosa-associated lymphoid tissue system. Ingestion of colostrum

    Risks of Hypothermia
    Hypothermia can lead to : Infection Coagulation defects Acidosis Delayed fetal to newborn circulatory adjustment Hyaline membrane disease Brain hemorrhage.
    [i] Tunell R. Hypothermia: epidemiology and prevention, in Improving Newborn Health in Developing Countries, A. Costello and D. Manandhar, Editors. 2000, Imperial College Press: London, UK. p. 207-220.

    When should the cord be clamped after birth?


    A. B. C. D. When the cord pulsations stop Between 1 and 3 minutes Between 30 secs - 1 minute in preterms All of the above are appropriate

    Time band: If after 30 secs of drying,

    newborn is NOT breathing or is gasping


    Intervention: Re-position, suction and ventilate Action: Clamp and cut the cord immediately Call for HELP Transfer to a warm firm surface Inform the mother Start resuscitation protocol

    Time Band: 1 3 minutes


    Intervention: Delayed or non-immediate cord clamping Action: Remove the first set of gloves immediately prior to cord clamping. Clamp and cut the cord after cord pulsations have stopped ( at 1 to 3 minutes)

    Action: Initial Cord care


    -Put ties tightly around

    the cord at 2 cm & 5 cm from the abdomen. -Cut between ties with sterile instrument. -Observe for oozing blood. Do not apply any substance to the stump Do not bind or bandage the stump Leave the stump uncovered

    Properly timed clamping of the umbilical cord


    Reduces the risk of anemia in both term and preterm babies
    Term babies: less anemia in the newborn 24-48 hrs after birth
    RR 0.2 (95% CI 0.06, 0.6) NNT 7, (4.5- 20.8)

    Preterms: less infant anemia


    RR 0.49 (95% CI 0.3, 0.81) NNT 3 (1.6 - 29.6)

    Properly timed clamping of the umbilical cord


    Preterms: less intraventricular hemorrhage
    RR 0.59 (95% CI 0.35, 0.92) NNT 2 (1.4 - 9.8)

    No significant impact on incidence of Post-partum hemorhage


    Ceriani Cernadas ,et al. 2006;Rabe H, et al. 2004; McDonald SJ, et al. 2008; Hutton EK, et al. 2007; Kugelman A, et al. 2007 Van Rheenen PF, et al. 2006 Van Rheenen PF & Brabin BJ. 2006

    Washing should be delayed until after 6 hours


    Washing exposes to hypothermia The vernix is a protective barrier to bacteria such as E. coli and Group B Strep Washing removes the crawling reflex

    [i] Tollin M, Bergsson G, Kai-Larsen Y, Lengqvist J, Sjovall J, Griffiths W, Skulavottir G, Haraldsson A, et al. Vernix Caseosa as a multicomponent defense system based on polypeptides, lipids and their interactions. Cell Mol Life Sci 2005; 62:2390-2399 [ii] Righard L, Alade M. Effect of delivery room routines on success of first breastfeed. Lancet 1990; 336: 1105-07

    Time: WITHIN 90 min of age


    Intervention: Provide breastfeeding

    support for initiation of breastfeeding Action:


    Leave the baby on the mothers chest in skin-to-skin contact. Observe the newborn. Place identification tag / bracelet on the babys ankle

    Maintain skin-to-skin contact


    - uninterrupted for at least 90 minutes after birth and until the first thorough breastfeed is complete

    Monitor the mother and baby during the first hour after complete delivery of the placenta
    Never leave the woman and newborn alone Keep the mother and baby in the delivery room Record findings, treatments and procedures in the labor record Monitor every 15 minutes: Baby Breathing warmth

    SKIN TO SKIN CONTACT & INITIATION OF BREASTFEEDING


    To begin with the baby will want to rest. Rest period may take from a few minutes to 30 or 40 minutes before the baby shows feeding cues.

    SIGNS OF READINESS TO BREASTFEED


    Only once the

    newborn shows feeding cues (e.g. opening of mouth, tonguing, licking, rooting), make
    verbal suggestions to the mother to encourage her newborn to move toward the breast e.g. nudging.

    Help the mother and baby into a comfortable position

    Initiation of breastfeeding
    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. If the mother is HIV-positive, counsel the mother on breastfeeding

    The first breast feed


    Check attachment and positioning when the baby is feeding Let the baby feed for as long as he wants on both breasts 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

    HIV and Immediate Newborn Care


    If the mother has HIV/AIDS: universal precautions must be followed as with any other delivery and after care. Her baby can have immediate skin-to-skin contact Breastfeeding can begin when the baby is ready after delivery Do not give the baby any other food or drink Good attachment and positioning are vital If replacement feeding, prepare formula for the mother for the first few feeds

    Time: WITHIN 90 min of age


    Intervention: Do eye care Action: Wipe the eyes Apply an eye antimicrobial within 1 hour of birth:
    1% silver nitrate drops or 2.5% povidone iodine drops or 1% tetracycline ointment or erythromycin eye drops

    Do not wash away the eye antimicrobial

    II. Essential Newborn Care


    FROM 90 Min 6 HRS

    Time: FROM 90 Min 6 HRS


    Intervention: Give Vitamin K prophylaxis and Hepatitis B and BCG vaccinations at birth Action: Wash hands. Inject a single dose of Vitamin K 1 mg IM. Inject Hepatitis B vaccine IM and BCG intradermally. Record.

    Time: WITHIN 90 min of age


    Interventions:

    Examine the baby Check for birth injuries, malformations or defects


    Action: Thoroughly examine the baby. Weigh the baby and record. Look for possible birth injury and/or malformation

    Time: WITHIN 90 min of age


    Interventions: Cord care Action:
    Wash hands before and after cord care. - Put nothing on the stump. - Fold diaper below stump. Keep cord stump loosely covered with clean clothes. - If stump is soiled, wash it with clean water and soap. Dry it thoroughly with clean cloth.

    Time: WITHIN 90 min of age


    Interventions: Provide additional care

    for a small baby or twin


    Action: If the newborn is delivered 2 months earlier or weighs <1500 grams, refer to a hospital

    Time: WITHIN 90 min of age


    Interventions: Provide additional care

    for a small baby or twin


    Action: If the newborn is delivered 1 month early of is visibly small (1501 2499g) - KMC - Special support for breastfeeding - Discharge planning

    Unneccesary Procedures
    Not routinely recommended for all neonates
    1. 2. 3. 4. Routine suctioning Early bathing/washing Foot printing Giving sugar water, formula or other prelacteals and use of bottles and pacifiers 5. Application of alcohol, medicines and other susbstances on the cord stump and bandaging the cord stump or abdomen

    SUMMARY Essential Newborn Care Protocol


    Essential interventions in the first 90 minutes of life and up to 7 days of life Emphasizes a core sequence of actions, performed methodically, step-by-step Some time-bound but doable even by a single health worker caring for both mother and newborn

    Immediate Newborn Care First 90 Minutes of Life


    Call out time of birth. Deliver the baby prone on the mothers abdomen Dry the newborn thoroughly. Check breathing while drying. Remove wet cloth. Position the newborn on the mothers abdomen in skin-to-skin contact. Cover the back with a dry blanket.
    Phil. ENCC

    Remove first set of gloves. Clamp and cut the cord when pulsations have stopped ( 1-3 minutes) Place the newborn on the mothers chest in skin-to-skin contact Cover the babys 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
    Phil. ENCC

    Pocket guide to the PCPNC Manual (WHO 2006) DOH issued Administrative Order 2009-0025on Dec. 1,2009 : Adopting New Policies and Protocol On ENC

    Launched on Dec 7, 2009

    Together, we can DoH it before 2015

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