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MARY ANNE L. ILAO, M.D.,FPPS,DPSNbM 2010
MDG 4: Reduce Child Mortality
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
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
Immediate Essential Newborn Care The First 90 Minutes .
Immediate Essential Newborn Care Time band: 2nd stage of labor • At perineal bulging. • Double glove just before delivery. . • Wash hands with clean water and soap. with presenting part visible Intervention:Prepare for the delivery Action: • Ensure that delivery area is draft-free and room temperature between 25–28oC.
Preparing to Meet the Baby’s Needs “Good care of the newborn begins with good preparation” • Ensure all delivery equipment and supplies. • Line up materials for delivery according to sequence of use . are available. including newborn resuscitation equipment.
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 .
Phil. ENCC 11 .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.
viruses including HIV .STANDARD PRECAUTIONS A4 • Always remember the importance of observing precautions to help protect the mother and baby and ourselves from infections with bacteria.
Cover the back with a dry blanket. • Place the newborn on the mother’s abdomen in skin-to-skin contact. Remove wet cloth. face turned to the side • Call out time of birth. • Dry the newborn thoroughly.Immediate Essential Newborn Care • Deliver the baby in prone position on the mother’s abdomen. Check the baby’s breathing while drying. .
• Remove the wet cloth. front and back of the trunk. arms and legs. head. • Do a quick check of newborn’s breathing while drying. Action: • Use a clean. eyes. dry cloth to thoroughly dry the baby by wiping the face.Time: WITHIN THE 1ST 30 SECS Intervention: Dry and provide warmth. .
Drying The Newborn •Stimulates the newborn to breathe normally •Minimizes heat loss .
ENCC 16 .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.
Do not remove the vernix!!! .
• Place identification band on ankle .Time band: If after 30 secs of drying. such as routine suctioning. • Place the newborn prone on the mother’s abdomen or chest skin-to-skin. • Cover newborn’s back with a blanket and head with a bonnet. newborn is breathing or crying Intervention: Skin -to-skin (STS) contact Action: • Avoid any manipulation.
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 .
• Ingestion of colostrum .Skin-to-Skin Contact Effect on Immunoprotection • Colonization with maternal skin flora • Stimulation of the mucosa-associated lymphoid tissue system.
p. Costello and D.Risks of Hypothermia • Hypothermia can lead to : – Infection – Coagulation defects – Acidosis – Delayed fetal to newborn circulatory adjustment – Hyaline membrane disease – Brain hemorrhage. 2000. Editors. . UK. [i] Tunell R. Manandhar. Hypothermia: epidemiology and prevention. 207-220. Imperial College Press: London. in Improving Newborn Health in Developing Countries. A.
When should the cord be clamped after birth? A.1 minute in preterms All of the above are appropriate . C. B. When the cord pulsations stop Between 1 and 3 minutes Between 30 secs . D.
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 . newborn is NOT breathing or is gasping Intervention: Re-position.Time band: If after 30 secs of drying.
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. • Do not apply any substance to the stump • Do not bind or bandage the stump • Leave the stump uncovered . -Observe for oozing blood.
6) .6 .81) – NNT 3 (1.20. (4.3.8) • Preterms: less infant anemia – RR 0.49 (95% CI 0.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 0.5. 0.6) – NNT 7.2 (95% CI 0.06. 0.29.
McDonald SJ. et al.9.92) NNT 2 (1. 2008.35.Rabe H. Kugelman A. et al.Properly timed clamping of the umbilical cord Preterms: less intraventricular hemorrhage RR 0.4 .59 (95% CI 0.et al. 2007. 2007 Van Rheenen PF. et al. 2004.8) No significant impact on incidence of Post-partum hemorhage Ceriani Cernadas . et al. 0. Hutton EK. 2006. 2006 . et al. 2006 Van Rheenen PF & Brabin BJ.
coli and Group B Strep • Washing removes the crawling reflex [i] Tollin M. 336: 1105-07 . Bergsson G. Sjovall J. Kai-Larsen Y. lipids and their interactions.Washing should be delayed until after 6 hours • Washing exposes to hypothermia • The vernix is a protective barrier to bacteria such as E. Lancet 1990. Effect of delivery room routines on success of first breastfeed. Lengqvist J. Cell Mol Life Sci 2005. Vernix Caseosa as a multicomponent defense system based on polypeptides. 62:2390-2399 [ii] Righard L. Alade M. Griffiths W. Haraldsson A. Skulavottir G. et al.
Time: WITHIN 90 min of age Intervention: Provide breastfeeding support for initiation of breastfeeding Action: • Leave the baby on the mother’s chest in skin-to-skin contact. • Observe the newborn. • Place identification tag / bracelet on the baby’s ankle .
uninterrupted for at least 90 minutes after birth and until the first thorough breastfeed is complete .Maintain skin-to-skin contact .
treatments and procedures in the labor record • Monitor every 15 minutes: Baby • Breathing • warmth .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.
.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.
g. . opening of mouth. make verbal suggestions to the mother to encourage her newborn to move toward the breast e.SIGNS OF READINESS TO BREASTFEED • Only once the newborn shows feeding cues (e. rooting). nudging. licking.g. tonguing.
Help the mother and baby into a comfortable position .
• If the mother is HIV-positive. • Do not throw away colostrum. • Do not give bottles or pacifiers. counsel the mother on breastfeeding . • Do not give sugar water. formula or other prelacteals.Initiation of breastfeeding • Health workers should not touch the newborn unless there is a medical indication.
etc. immunizations. until after the first feed .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.
– 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.HIV and Immediate Newborn Care • If the mother has HIV/AIDS: – universal precautions must be followed as with any other delivery and after care. prepare formula for the mother for the first few feeds .
5% povidone iodine drops or – 1% tetracycline ointment or erythromycin eye drops • Do not wash away the eye antimicrobial .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.
Essential Newborn Care FROM 90 Min – 6 HRS .II.
. • Inject a single dose of Vitamin K 1 mg IM. • Record.Time: FROM 90 Min – 6 HRS Intervention: Give Vitamin K prophylaxis and Hepatitis B and BCG vaccinations at birth Action: • Wash hands. • Inject Hepatitis B vaccine IM and BCG intradermally.
• Weigh the baby and record. • Look for possible birth injury and/or malformation . malformations or defects Action: • Thoroughly examine the baby.Time: WITHIN 90 min of age Interventions: • Examine the baby • Check for birth injuries.
Keep cord stump loosely covered with clean clothes. Dry it thoroughly with clean cloth.Fold diaper below stump. .If stump is soiled.Time: WITHIN 90 min of age Interventions: Cord care Action: Wash hands before and after cord care. .Put nothing on the stump. . wash it with clean water and soap. .
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 .
Discharge planning .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 .
2. formula or other prelacteals and use of bottles and pacifiers 5.Unneccesary Procedures Not routinely recommended for all neonates 1. medicines and other susbstances on the cord stump and bandaging the cord stump or abdomen . 4. Application of alcohol. Routine suctioning Early bathing/washing Foot printing Giving sugar water. 3.
performed methodically.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. step-by-step • Some time-bound but doable even by a single health worker caring for both mother and newborn .
Cover the back with a dry blanket.Immediate Newborn Care First 90 Minutes of Life • Call out time of birth. Phil. ENCC . • Remove wet cloth. • Position the newborn on the mother’s abdomen in skin-to-skin contact. Check breathing while drying. • Deliver the baby prone on the mother’s abdomen • Dry the newborn thoroughly.
ENCC . Cover the mother and baby with a warm cloth. • Initiate breastfeeding while maintaining skin-to-skin contact.• Remove first set of gloves. • Clamp and cut the cord when pulsations have stopped ( 1-3 minutes) • Place the newborn on the mother’s chest in skin-to-skin contact • Cover the baby’s head with a hat. • Place identification band on ankle. • Do eye care Phil.
2009 : Adopting New Policies and Protocol On ENC • Launched on Dec 7.• Pocket guide to the PCPNC Manual (WHO 2006) • DOH issued Administrative Order 2009-0025on Dec. 2009 . 1.
Together. we can DoH it… before 2015 .
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