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Essential Newborn Care (ENC) The ENC Protocol is a step-by-step guide for health workers and medical practitioners issued by the Department of Health for implementation under Administrative Order 2009-0025. What are these step-by-step interventions? Immediate drying Using a clean, dry cloth, thoroughly dry the baby, wiping the face, eyes, head, front and back, arms and legs. Uninterrupted skin-to-skin contact Aside from the warmth and immediate bonding between mother and child, it has been found that early skin-to-skin contact contributes to a host of medical benefits such as the overall success of breastfeeding/colostrum feeding, stimulation of the mucosa—associated lymphoid tissue system, and colonization with maternal skin flora that can protect the newborn from sepsis and other infectious disease and hypoglycemia. Proper cord clamping and cutting Waiting for up three minutes or until the pulsations stop is found to reduce to chances of anemia in full term and pre-term babies. Evidence also shows that delaying cord clamping has no significant impact on the mother. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in The earlier the baby breastfeeds, the lesser the risk of death. Keeping the baby latched on to the mother will not only benefit the baby (see skin-to-skin contact) but will also prevent doing unnecessary procedures like putting the newborn on a cold surface for examination (thereby exposing the baby to hypothermia), administering glucose water or formula and foot printing (which increases risk of contamination from ink pads) and washing (the WHO standard is to delay washing up to 6 hours; the vernix protects the newborn from infection). On the other hand, necessary actions such as eye care, vitamin K administration must be timed. Eye care must be done after the infant has located the mother’s breast.
functional resuscitation equipment. The eight steps of essential newborn care Before you look at the eight steps of essential newborn care (ENC) you need to remember the importance of the ‘three cleans’ that you learned in Study Session 3 of the Labour and Delivery Care Module. vitamin K. days and weeks of life can determine whether they remain healthy. The care you give the baby and mother immediately after birth is simple but important. cord clamps.New Born Care Essential newborn care The majority of babies are born healthy and at term. Most babies breathe and cry at birth with no help. and tetracycline eye ointment. Skin-to-skin contact with the mother keeps her baby at the perfect temperature. These are clean hands. You will look at how to assess. cord tie. This basic care is called essential newborn care (ENC) and it includes immediate care at birth. so you should encourage and help the mother to keep the newborn baby warm in this way. You too should be gentle with the baby and keep the baby warm. . The care they receive during the first hours. razor blade. Remember that the baby has just come from the mother’s uterus. In this study session you will learn about the steps of immediate care which should be given to all babies at birth. care during the first day and up to 28 days. classify and treat newborns for birth asphyxia and low birth weight as well as how to monitor the mother’s condition closely in the minutes and hours after the birth. an environment that was warm and quiet and where the amniotic fluid and walls of the uterus gently touched the baby. syringe and needles. clean surface and clean equipment. All babies need basic care to support their survival and wellbeing. Your equipment should include two clean dry towels.
Dry the baby well. That is. or Not breathing at all. both sides of the chest will rise and fall equally at around 30–60 times per minute. Tell her the sex of the baby and congratulate her. Step 1 Deliver the baby onto the mother’s abdomen or a dry warm surface close to the mother. including the head. Step 3 Assess breathing and colour. Wipe the baby’s eyes. white substance which may be on the skin) as it protects the skin and may help prevent infection. gasping or there are less than 30 breaths per minute. If the baby needs resuscitation. quickly clamp or tie and cut the cord. Thus.Figure 2. leaving a stump at least 10 cm long for now and then start resuscitation immediately. using a clean.1 Drying and wrapping the newborn baby. while you are delivering the baby onto the mother’s abdomen and drying the baby. assess its breathing. then resuscitate. Resuscitation of a baby who is not breathing must start within one minute of birth. but the steps described here are ones that you can take simultaneously. you can assess breathing and colour and take urgent action if necessary.1). Continue to support and reassure the mother. It may sound as if you have a lot to do in one minute. check if the baby is: • • • • Breathing normally Having trouble breathing Breathing less than 30 breaths per minute. If a baby is breathing normally. if not breathing. . warm cloth. Step 2 Dry the baby’s body with a dry warm towel as you try to stimulate breathing. Functional resuscitation equipment should always be ready and close to the delivery area since you must start resuscitation within one minute of birth. Wrap the baby with another dry warm cloth and cover the head (Figure 2. Then wrap the baby with another dry cloth and cover the head. You will remember that you learned how to manage a newborn baby with birth asphyxia in Study Session 7 of the Labour and Delivery Care Module. immediately and then discard the wet cloth. Rub up and down the baby’s back. Do your best not to remove the vernix (the creamy. As you dry the baby. Drying often provides sufficient stimulation for breathing to start in mildly depressed newborn babies.
2). If the baby needs resuscitation.2 Tying and cutting the cord. Make sure that tie is well secured. Cut the cord between the ties: o o o 3. Use a small piece of cloth or gauze to cover the part of the cord you are cutting so no blood splashes on you or on others. Use a new razor blade. cut the cord immediately. wait for 7–3 minutes before cutting the cord. Cut the cord between the first and second tie. Either cut away from the baby or place your hand between the cutting instrument and the baby. Tie the first one two fingers away from the baby’s abdomen. or a boiled one if it has been used before. the thread you use to tie the cord must be clean. Do not put anything on the cord stump. Tie the cord securely in two places: o o o 2. Be careful not to cut or injure the baby. or sterile scissors. 1. .Figure 2. If not. Step 4 Tie the cord two fingers’ length from the baby’s abdomen and make another tie two fingers from the first one (Figure 2. Tie the second one four fingers away from the baby’s abdomen.
between the breasts. the baby can have the first sponge bath. The baby should not be bathed at birth because a bath can cool the baby dangerously. tables. Conduction: when the baby is placed naked on a cooler surface. The first skin-to-skin contact should last uninterrupted for at least one hour after birth or until after the first breastfeed.3 The newborn can lose heat in four ways. Safe Motherhood: Thermal Protection of the Newborn. walls. cold bed. Cover the baby’s head. 1.int/ hq/ 1997/ WHO_RHT_MSM_97. a Practical Guide. table. such as the floor. (Source: WHO. 2. Put the baby on the mother’s chest. 3.Step 5 Place the baby in skin-to-skin contact with the mother.3 below): • • • • Evaporation: when amniotic fluid evaporates from the skin. After 24 hours. Convection: when the baby is exposed to cool surrounding air or to a draught from open doors and windows or a fan. .who. cabinets. if the temperature is stabilised. for skin-to-skin warmth. (Hide tip)]) The warmth of the mother passes easily to the baby and helps stabilise the baby’s temperature.2. without actually being in contact with them. 1997. accessed fromhttp://whqlibdoc.pdf[Tip: hold Ctrl and click a link to open it in a new tab. The newborn loses heat in four ways (see Figure 2. Radiation: when the baby is near cool objects. Figure 2. cover with a warm cloth and initiate breastfeeding. weighing scales. Cover both mother and baby together with a warm cloth or blanket.
4 Initiating immediate breastfeeding. Warm transportation for a baby that needs referral. If everything is normal. For optimal breastfeeding you should do the following: 1. Immediate drying. 2. early and unlimited breastfeeding gives the newborn energy to stay warm. 1. 6. Help the mother at the first feed. 4. nutrition to grow. The steps to keep the newborn warm are called the warm chain. the mother should immediately start breastfeeding. Breastfeeding. Mother and baby together.Figure 2. 7. Help the mother begin breastfeeding within the first hour of birth (Figure 2. Warm the delivery room. Do not limit the length of time the baby feeds. and is sucking well.4). Step 6 Give eye care (while the baby is held by its mother). 3. . attachment. 2. Appropriate clothing/bedding. Bathing and weighing postponed. Make sure the baby has a good position. Skin-to-skin contact at birth. and antibodies to fight infection. 8. 5.
Repeat this step to put medication into the other eye. The steps for giving the baby eye care are these: First. Do not rinse out the eye medication. After following correct infection prevention steps. Then press the plunger to inject the medicine. There is also a study session on routes of injection in the Immunization Module. Eye care protects the baby from serious eye infection which can result in blindness or even death. You will be learning more about safe injection techniques in your practical skills training sessions. Step 8 Weigh the baby. Step 7 Give the baby vitamin K. Make sure not to let the medicine dropper or tube touch the baby’s eye or anything else (see Figure 2. If the baby weighs less than 1. 4. Hold one eye open and apply a rice grain size of ointment along the inside of the lower eyelid. .5). with the other hand stretch the skin on either side of the injection site and place the needle straight into the outside of the baby’s upper thigh (perpendicular to the skin). Weigh the baby an hour after birth or after the first breastfeed. wash your hands. 3.5 Putting tetracycline eye ointment into the eyes of the newborn baby.Figure 2. Wash your hands again. Shortly after breastfeeding and within one hour of being born. and then using tetracycline 1% eye ointment: 1. give the newborn eye care with an antimicrobial medication.500 gm you must refer the mother and baby urgently. 2. 1 mg by intramuscular injection (IM) on the outside of the upper thigh (while the baby is held by its mother).
Naegele's Rule assumes an average cycle length of 28 days. it does not account for leap years. Parikh's Formula is a calculation method that considers cycle duration. The rule estimates the expected date of delivery (EDD) by adding one year. which is not true for everyone.Naegele's Rule is a standard way of calculating the due date for a pregnancy. adjusting to the closest Friday produces 12 February. The result is approximately 280 days (40 weeks) from the LMP. Using the example above. EDD is calculated using . subtracting three months. subtracting three months and adding seven days to that date. which is exactly 280 days past 8 May. Calculation The rule estimates the expected date of delivery (EDD) (also called EDC. Example: LMP = 8 May 2009 +1 year = 8 May 2010 -3 months = 8 February 2010 +7 days = 15 February 2010 280 days past LMP is found by checking the day of the week of the LMP and adjusting the calculated date to land on the same day of the week. and adding seven days to the first day of a woman's last menstrual period (LMP). The calculation method does not always result in a 280 days because not all calendar months are the same length. The result is approximately 280 days (40 weeks) from the LMP. The calculated date (15 February) is a Monday. 8 May 2009 is a Friday. for estimated date of confinement) from the first day of the woman's LMP by adding 1 year.
Ex: LMP = 8/1/2007 --.) Age of gestation is simply the number of days that have past from the LMP from the current date. since fertilization). This new date estimates due date. subtract three months. then adding duration of previous cycles.measuring the crown rump length. or sliding wheel calculators are used to add 280 days to LMP. Computation of AOG Doctors commonly use "pregnancy wheels" to calculate the date of birth from the lastmenstrual period (LMP). Naegele's rule estimates 280 days [40 weeks] of pregnancy from the LMP. 80% of all pregnancies fall within 10 days of this calculation. (not 266 days. Source(s): I am an M. etc. or: Take the LMP date: add a year. Confirmation of dates is done with ultrasound in the (ideally) first trimester . This uses "Naegele's Rule".I subtracted 1 day because of February 29. then add seven days. In modern practice. reference cards. .Parikh's Formula by adding 9 months to LMP. 38 weeks. calculators.> Due date = 5/7/2008 (you'll notice the rule will fail because 2008 is a leap year . subtracting 21 days.D.
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