You are on page 1of 268

S~vi:q ewLo:: Lives

Diono Beck, Fronces 0onges, Suson 0oldnon, Phyllis Long


5AIN6 NEWB0PN LIE5
0ore of lhe
Newborn
Ree:e:e M~:u~
5AIN6 NEWB0PN LIE5 is o 1O-15 yeor globol iniliolive of
Sove lhe 0hildren lo inprove lhe heollh ond survivol of newborns
in lhe developing world. Supporled by lhe Bill & Melindo 0oles
Foundolion, lhe iniliolive works wilh governnenls, locol connunilies,
ond porlner ogencies ol lhe connunily ond nolionol levels lo noke
progress loword reol ond losling chonge in newborn heollh.
5AE TRE CRILDPEN is o leoding inlernolionol nonprofl child-
ossislonce orgonizolion working in neorly 5O counlries worldwide,
including lhe Uniled Sloles. 0ur nission is lo noke losling, posilive
chonge in lhe lives of children in need. Sove lhe 0hildren is o nenber
of lhe inlernolionol Sove lhe 0hildren lllionce, o worldwide nelwork
of 3O independenl Sove lhe 0hildren orgonizolions working in nore
lhon 1OO counlries lo ensure lhe well-being ond prolecl lhe righls
of children everywhere.
This publicolion wos node possible lhrough supporl fron
lhe Bill & Melindo 0oles Foundolion.
Sove lhe 0hildren Federolion, 2OO/
EditcriaI staff. Robin Bell, 0horlolle Slorli, Nolholie 0onoche
Ccntributing editcrs. lnne Tinker, Pol Doly
InstructicnaI design. 0obrielle Beosley
IIIustratcr. Tin Hinlon
Design and prcducticn. KNFTK, Woshinglon, D0
For nore infornolion.
Soving Newborn Lives
Sove lhe 0hildren
2OOO M Slreel NW
Suile 5OO
Woshinglon, D0 2OO3
www.sovelhechildren.org ond
www.heollhynewborns.con
S~vi:q ewLo:: Lives
Diono Beck, Fronces 0onges, Suson 0oldnon, Phyllis Long
C~:e o le ewLo:: Ree:e:e M~:u~
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
LI5T 0F CRAPT5 AND FI6UPE5 ................................ v
AB0UT TRI5 HANUAL ............................................... ix
ACKN0WLED6HENT5 ............................................... xi
ABBPEIATI0N5 ....................................................... xii
TRE F0P60TTEN NEWB0PN
nlroduclion ..................................................................1
Newborn Morlolily .......................................................2
The Two-Thirds Rule ...............................................2
Moin 0ouses of Newborn Deolhs ...........................3
Newborn Survivol ....................................................3
0verview of lhe 0ure of the Newborn
Reference Hunuu| ........................................................./
ln nlroduclion lo lhe
Decision-Moking lpprooch .........................................5
Boby 0oro. ln lluslrolion of lhe
Decision-Moking lpprooch .....................................
CRAPTEP 1:
NEWB0PN CAPE 5TAPT5 BEF0PE BIPTR
nlroduclion ................................................................13
Newborn 0ore Slorls Before Birlh ............................1/
lnlenolol 0ore ......................................................1/
0ounseling ............................................................1/
Birlh Plon ..............................................................1
Donger Signs ond 0onplicolion Reodiness .........1
Lobor ond Delivery 0ore .......................................18
Porlogroph ............................................................18
Molher-lo-0hild Tronsnission of H\ ...................18
Donger Signs During Lobor ond Delivery .............1?
Felol Dislress During Lobor ..................................21
Molernol Donger Signs in lhe
Poslporlun Period ................................................21
0hild Spocing ........................................................21
CRAPTEP 2:
E55ENTIAL CAPE F0P EEPY NEWB0PN
nlroduclion ................................................................23
Fssenliol Newborn 0ore 0verview ............................25
Prepore for o Boby`s Birlh .........................................25
Prevenl nfeclion ...................................................25
Prepore lhe Birlh Roon ........................................2
Keep Records ........................................................2
0ollecl lhe Fquipnenl, Supplies,
ond Medicines .......................................................2
Prepore lo Prevenl Heol Loss ...............................28
nnediole 0ore ol Birlh ............................................2?
Sleps for nnediole Newborn 0ore .....................2?
Slep 1. Dry ond Slinulole lhe Boby ......................2?
Slep 2. lssess lhe Boby`s Breolhing ond 0olor ...2?
Slep 3. Decide f lhe Boby
Needs Resuscilolion .............................................3O
Slep /. Tie ond 0ul lhe 0ord .................................3O
Slep 5. 0ive lhe Boby lo lhe Molher
lo Keep Worn ........................................................3O
Slep . Hove lhe Molher Slorl Breoslfeeding .......31
Slep 7. 0ive Fye 0ore ............................................31
Newborn 0ore During lhe Firsl Doy ..........................32
lssess lhe Boby ....................................................32
0ive Nornol Newborn 0ore ..................................32
0ive 0lher 0ore for lny Problens or Needs ........33
0ive \ilonin K, lhe Firsl nnunizolions
ond 0onplele lhe Boby`s ond lhe
Molher`s Records ..................................................33
Newborn Hislory ond Physicol Fxoninolion .............33
Toke o Hislory ........................................................33
Do o Physicol Fxoninolion ....................................33
denlify Needs or Problens ..................................35
0ore of o Newborn During lhe Firsl 28 Doys ............./2
Why s Follow-up Newborn 0ore So nporlonl? ../2
Speciol Focus for Foch Follow-up \isil ................./3
Prepore for Follow-up 0ore \isils ........................./3
0ive Follow-up 0ore ............................................../3
Docunenl lhe Sleps ............................................../?
0hecklisl for Follow-up Newborn 0ore \isils ....../?
Co:le:ls
ii
HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ Care rf t|e New|rrr kefererre Naraal
Teoch ond 0ounsel o Molher ond Fonily
lboul Newborn 0ore .................................................5O
Wornlh ..................................................................5O
Sleep ......................................................................5O
Loving 0ore ...........................................................51
Proleclion fron nfeclion ......................................51
Bolhing lhe Newborn ............................................52
0ord 0ore ..............................................................53
nnunizolions ......................................................53
Breoslfeeding ........................................................53
\ilonin l ...............................................................5/
Sofely ond Securily ...............................................5/
Newborn Donger Signs .........................................55
Plon for Follow-up \isils .......................................55
CRAPTEP 3:
5UCCE55FUL BPEA5TFEEDIN6
nlroduclion ................................................................5?
Benefls of Breoslfeeding ..........................................O
Forly ond Fxclusive Breoslfeeding ............................2
0iving 0lher Liquids or Foods During lhe
Firsl Monlhs 0on Be Hornful lo lhe
Boby ond lo Breoslfeeding ....................................2
Bobies 0el Fnough Woler fron
Breoslfeeding Fxclusively .....................................2
Slorling lo Breoslfeed ...............................................3
Why Should o Molher Slorl Breoslfeeding
During lhe Firsl Hour lfler Birlh? ........................3
0onlinuing lo Breoslfeed ...........................................
Feed lhe Boby on Denond ....................................
Fnply lhe Firsl Breosl ol Foch Feed ....................
Drink wilh Fvery Breoslfeed ond
Fol More Food Foch Doy .......................................
Use Differenl Posilions lo Hold lhe Boby .............
0el Fnough Resl ....................................................8
0el Fnough Nulrienls ...........................................8
Breoslfeed o Sick Boby During ond
lfler on llness ......................................................8
Feed o Boby More 0flen During
Periods of Ropid 0rowlh .......................................8
How lo Know f lhe Boby is
0elling Fnough Breosl Milk ..................................8
How Fxclusive Breoslfeeding 0on
Help Deloy lnolher Pregnoncy .............................?
How Long lo 0onlinue Breoslfeeding ...................?
Breoslfeeding Twins ..............................................7O
Breoslfeeding When lhe Molher is H\ Posilive.
Moking on nforned 0hoice .......................................71
0ounseling on nfonl Feeding ...............................71
Focls lboul Breoslfeeding for
H\-Posilive Molhers ond Their Fonilies .............71
0plion 1. Fxclusive Breoslfeeding wilh
Forly Weoning or When Replocenenl
Feeds Meel lFlSS 0rilerio ...................................72
0plion 2. Fxpressing Breosl Milk ond
Heol-Treoling l Before Feeding ...........................72
0plion 3. Wel-Nursing by o Wonon
Who is H\ Negolive ..............................................73
0plion /. Replocenenl Feeding
Wilh 0onnerciol nfonl Fornulo .........................73
0plion 5. Replocenenl Feeding
Wilh Hone-Modifed Milk .....................................73
Breoslfeeding Problens ............................................7/
Sore or 0rocked Nipples .......................................7/
Nol Fnough Milk ....................................................7/
Breosl Fngorgenenl .............................................75
Plugged Milk Ducl .................................................75
Moslilis ..................................................................75
Fxpressing Breosl Milk ..............................................8
Sloring Breosl Milk ...............................................8
0up Feeding ...............................................................88
Who Should Use 0up Feeding? .............................88
iii
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
CRAPTEP :
NEWB0PN PE5U5CITATI0N
nlroduclion ................................................................?3
Whol s lsphyxio? ......................................................?/
Preporolion for Newborn Resuscilolion ....................?5
Wornlh ..................................................................?5
Surfoce for Doing lhe Resuscilolion .....................?5
Fquipnenl ond Supplies .......................................?5
Deciding f lhe Newborn Needs Resuscilolion .........?8
nnediole lssessnenl ol Birlh ...........................?8
Doing Newborn Resuscilolion ...................................??
Slep 1. Posilion lhe Boby ......................................??
Slep 2. 0leor lhe lirwoy ...................................... 1OO
Slep 3. \enlilole .................................................. 1OO
Slep /. Monilor .................................................... 1O2
0ore lfler Resuscilolion .......................................... 1O/
f Resuscilolion s Successful ............................. 1O/
f lhe Boby s Breolhing bul Needs Referrol ...... 1O5
f Resuscilolion s Nol Successful ...................... 1O
0leoning Resuscilolion Fquipnenl ond Supplies ... 1O7
CRAPTEP 5:
CAPE 0F L0W BIPTR WEI6RT BABIE5
nlroduclion .............................................................. 1O?
Whol s Low Birlh Weighl? ...................................... 11O
Whol Do Low Birlh Weighl ond
Prenolure Bobies Look Like? ............................ 112
Whol Problens Do Low Birlh
Weighl Bobies Hove? ........................................... 112
0ore for lhe Low Birlh Weighl Newborn ................. 112
0ore ol Birlh ........................................................ 112
Follow-up 0ore of lhe Low Birlh Weighl Boby ... 112
Newborn Donger Signs ....................................... 112
Skin-lo-Skin or Kongoroo Molher 0ore .................. 118
0onponenls of Kongoroo Molher 0ore .............. 118
How lo Help lhe Molher Keep Her Boby
Worn wilh Skin-lo-Skin 0onlocl ........................ 118
Breoslfeeding lhe Low Birlh Weighl Boby .......... 12O
CRAPTEP :
C0HH0N NEWB0PN PP0BLEH5
nlroduclion .............................................................. 125
Newborn Donger Signs ............................................ 12
Slobilizolion ond Fnergency
Referrol of Newborns .............................................. 128
Slobilize lhe Newborn ......................................... 128
Refer lhe Newborn .............................................. 128
Problens of lhe Newborn ........................................ 13O
Breolhing Problens ................................................. 13O
0enerolized nfeclion. Newborn Sepsis .................. 13O
Locolized nfeclions ................................................. 13O
Unbilicol 0ord nfeclion ..................................... 13O
Skin nfeclion ....................................................... 131
Fye nfeclion ........................................................ 138
0rol Thrush ......................................................... 138
Problens wilh Body Tenperolure ........................... 1/2
Joundice ................................................................... 1/
Bleeding fron lhe Unbilicol 0ord ........................... 1/
Problens fron lhe Molher`s
Pregnoncy ond Lobor ............................................... 1/
APPENDICE5
lppendix l. Molernol ond nfonl
nnunizolion Schedules ......................................... 153
lppendix B. Medicolion Reference .......................... 11
lppendix 0. nfeclion Prevenlion ............................ 185
lppendix D. Bosic Skills for 0ore of lhe Newborn .. 2O?
lppendix F. 0onnunicolion ond 0ounseling ......... 217
6L055APY ............................................................... 223
PEFEPENCE LIBPAPY ........................................... 22?
INDEX ...................................................................... 231
iv
HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ Care rf t|e New|rrr kefererre Naraal
Lisl o C~:ls ~:o Fiqu:es
CRAPTEP 3
0horl 3.1 How Breoslfeeding Helps
Bobies ond Molhers ................................1
0horl 3.2 Tips lo Help lhe Firsl Breoslfeeding ....../
0horl 3.3 Signs Thol lhe Boby s 0elling
Fnough Breosl Milk ................................?
0horl 3./ Sore or 0rocked Nipples.
Decision-Moking 0horl ...........................7
0horl 3.5 Nol Fnough Milk.
Decision-Moking 0horl ...........................78
0horl 3. Breosl Fngorgenenl.
Decision-Moking 0horl ...........................8O
0horl 3.7 Plugged Milk Ducl.
Decision-Moking 0horl ...........................82
0horl 3.8 Moslilis. Decision-Moking 0horl ............8/
0horl 3.? Preporing 0ups ond 0onloiners lo
0ollecl Fxpressed Breosl Milk
ond Feed lhe Boby ..................................8
0horl 3.1O Teoch lhe Molher lo Fxpress
Breosl Milk ..............................................87
0horl 3.11 Tips for Sloring ond
Using Slored Breosl Milk ........................88
0horl 3.12 Why Use 0up Feeding? ...........................8?
0horl 3.13 Show Fonilies How lo 0up Feed ............8?
CRAPTEP
0horl /.1 Fquipnenl ond Supplies for
Newborn Resuscilolion ..........................?5
0horl /.2 Hypoxio ....................................................?
0horl /.3 Signs o Boby Needs
Referrol lfler Resuscilolion ................. 1O2
0horl /./ Newborn Resuscilolion Sunnory ....... 1O3
INTP0DUCTI0N
0horl 1 The Two-Thirds Rule .................................2
0horl 2 Direcl 0ouses of Neonolol Deolhs ...........3
0horl 3 Decision-Moking 0horl ...........................12
CRAPTEP 1
0horl 1.1 lnlenolol 0ore lo
Prevenl Newborn Problens ...................15
0horl 1.2 Birlh Plon ................................................17
0horl 1.3 Signs of Felol Dislress ............................2O

CRAPTEP 2
0horl 2.1 Fquipnenl ond Supplies for lhe
Birlh Roon ond nnediole
Poslnolol 0ore ........................................27
0horl 2.2 Sleps for nnediole Newborn 0ore .......28
0horl 2.3 Sleps for 0iving Fye 0ore .......................32
0horl 2./ Hislory of lhe Pregnoncy, Birlh, ond
nnediole Newborn Period ...................3/
0horl 2.5 Newborn Physicol Fxoninolion.
Nornol Findings .....................................3
0horl 2. Newborn Physicol Fxoninolion.
lbnornol Findings ond Plon of lclion ...38
0horl 2.7 Speciol Focus for Foch Follow-up \isil ..//
0horl 2.8 0ore of lhe Newborn During lhe
Firsl 28 Doys. Decision-Moking 0horl .../
0horl 2.? 0hecklisl. The Newborn s
Heollhy ond Sofe f ................................../?
0horl 2.1O How lhe Fonily 0on
Keep lhe Newborn Worn .......................5O
0horl 2.11 How lhe Fonily Should
Prolecl lhe Newborn fron nfeclion .......51
0horl 2.12 Keep lhe Newborn Worn
During o Bolh ..........................................52
0horl 2.13 Bolhing Reconnendolions ....................52
0horl 2.1/ 0ord 0ore ................................................53
0horl 2.15 Newborn Donger Signs ..........................55
v
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
APPENDICE5
0horl l.1 nnunizolion for Molhers .................... 155
0horl l.2 nfonl nnunizolion Schedule ............. 15
0horl l.3 nfonl nnunizolions ............................ 157
0horl B.1 Porl 1. Drugs for Newborns-
lnli-infeclive lgenls ............................ 13
0horl B.2 Porl 1. Drugs for Newborns-
\ilonins ................................................ 18
0horl B.3 Porl 1. Drugs for Newborns-
lnli-infeclive Medicolions for
Fye 0ore ol Birlh ................................... 1?
0horl B./ Porl 2. Drugs for Molhers-
lnli-infeclive lgenls ............................ 171
0horl B.5 Porl 2. Drugs for Molhers-
lnli-noloriols ....................................... 178
0horl B. Porl 2. Drugs For Molhers-
lnli-helninlhics ................................... 178
0horl B.7 Porl 2. Drugs For Molhers-
\ilonins ond ron/Folole ...................... 17?
0horl B.8 Porl 2. Drugs For Molhers-
0lher Drugs .......................................... 18O
0horl B.? Porl 3. 0iving 0xygen lo Newborns ...... 182
0horl 0.1 Tips for Hondwoshing wilh
Soop ond Running Woler ...................... 188
0horl 0.2 Tips for Hondwoshing
wilh on llcohol Hondrub ...................... 188
0horl 0.3 Slep 1. Deconloninolion ...................... 18?
0horl 0./ Slep 2. 0leoning .................................... 1?1
0horl 0.5 Slep 3. High-level Disinfeclion
lHLDI By Boiling .................................... 1?2
0horl 0. Slep 3. HLD by Sleoning ...................... 1?2
0horl 0.7 Slep 3. Slerilizolion by
Sleon llulocloveI ................................. 1?3
0horl 0.8 Slep 3. Slerilizolion by
Dry Heol lFleclric or 0os 0venI ............ 1?5
0horl 0.? Slep /. Slore or Use .............................. 1?5
0horl 0.1O When ond Whol Kind of
0loves lre Needed ............................... 1?7
0horl 0.11 Reconnended Housekeeping
Roulines for o Heollh Focilily ............... 2O3
CRAPTEP 5
0horl 5.1 Foclors lssocioled
wilh Low Birlh Weighl .......................... 111
0horl 5.2 Low Birlh Weighl Boby Problens ......... 113
0horl 5.3 Low Birlh Weighl Boby-
0ore ol Birlh. Decision-Moking 0horl .. 11/
0horl 5./ Low Birlh Weighl Boby-Weekly Follow-
up 0ore. Decision-Moking 0horl .......... 11
0horl 5.5 How Does KM0 Help lhe
Boby ond Molher? ................................. 118
0horl 5. Tips lo Help o Molher Breoslfeed
Her Low Birlh Weighl Boby .................. 121
CRAPTEP
0horl .1 Newborn Donger Signs ........................ 127
0horl .2 Teoching Molhers, Fonilies,
ond 0onnunilies lo Respond
lo Newborn Donger Signs .................... 128
0horl .3 Newborn Referrol 0uidelines ............... 12?
0horl ./ Breolhing Problens.
Decision-Moking 0horl ......................... 132
0horl .5 Newborn Sepsis.
Decision-Moking 0horl ......................... 133
0horl . Unbilicol 0ord nfeclion.
Decision-Moking 0horl ......................... 13/
0horl .7 Skin nfeclion.
Decision-Moking 0horl ......................... 13
0horl .8 Fye nfeclion.
Decision-Moking 0horl ......................... 13?
0horl .? 0rol Thrush.
Decision-Moking 0horl ......................... 1/O
0horl .1O Hypolhernio/Low Tenperolure.
Decision-Moking 0horl ......................... 1/3
0horl .11 Hyperlhernio/High Tenperolure.
Decision-Moking 0horl ......................... 1//
0horl .12 Joundice. Decision-Moking 0horl ........ 1/8
0horl .13 Bleeding fron lhe Unbilicol 0ord.
Decision-Moking 0horl ......................... 15O
vi
HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ Care rf t|e New|rrr kefererre Naraal
CRAPTEP 5
Figure 5.1 Skin-lo-Skin 0onlocl ............................ 118
Figure 5.2 How lo Wrop lhe Boby ond Molher ....... 11?
Figure 5.3 Boby in KM0 Posilion ........................... 12O
Figure 5./ Folhers 0on llso Help
Wilh Skin-lo-Skin 0onlocl .................... 12O
CRAPTEP
Figure .1 Unbilicol 0ord nfeclion ....................... 131
APPENDICE5
Figure 0.1 Woshing honds ...................................... 187
Figure 0.2 Wropping nslrunenls
for Slerilizolion ..................................... 1?/
Figure 0.3 Pulling on Surgicol 0loves ................... 1?8
Figure 0./ Toking off Surgicol 0loves .................... 1??
Figure 0.5 0ne-Hond Technique ........................... 2O1
Figure D.1 Bulb Syringe ......................................... 211
Figure D.2 De Lee Mucus Trop ............................... 211
Figure D.3 nlronusculor n|eclion ........................ 215
Figure F.1 0onnunicolion belween
Heollh Worker ond Molher ................... 218
0horl 0.12 Woys lo Dispose of
0onloninoled Wosle ............................. 2O5
0horl 0.13 Kinds of Wosle ond How
lo Dispose of Then ............................... 2O
||Uk|S
CRAPTEP 2
Figure 2.1 Drying lhe Newborn ................................2?
Figure 2.2 0ulling lhe 0ord ......................................3O
Figure 2.3 Forly niliolion of Breoslfeeding .............31
Figure 2./ Pulling 0inlnenl in lhe Fye ....................32
Figure 2.5 Woshing Honds .......................................35
Figure 2. Heod Molding ........................................../2
Figure 2.7 Fonlonelles ............................................./2
Figure 2.8 Keeping lhe Boby Worn .........................5O
CRAPTEP 3
Figure 3.1 Fxclusive Breoslfeeding s lhe
Heollhiesl Woy lo Feed o Newborn ........2
Figure 3.2 Woil for lhe Moulh lo 0pen Wide ............5
Figure 3.3 lllochnenl lo lhe Breosl .......................5
Figure 3./ 0rodle Hold .............................................7
Figure 3.5 0ross-0rodle Hold ..................................7
Figure 3. Under-lrn Hold .....................................7
Figure 3.7 Side Lying ................................................7
Figure 3.8 Under-lrn Hold wilh Twins ...................7O
Figure 3.? 0rodle Hold wilh Twins ...........................7O
Figure 3.1O Mossoging lhe Breosl .............................87
Figure 3.11 Fxpressing Breosl Milk inlo o 0up .........87
Figure 3.12 0up Feeding ............................................88
CRAPTEP
Figure /.1 Resuscilolion Ploce ................................?/
Figure /.2 Posilion lhe Boby for Resuscilolion .......?8
Figure /.3 0orrecl Heod Fxlension
for Resuscilolion .....................................??
Figure /./ Proper Mosk Plocenenl ....................... 1O1
Figure /.5 Bog-ond-Mosk Resuscilolion ............... 1O1
Figure /. Keep lhe Boby Worn ............................ 1O5
vii
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ viii
HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ Care rf t|e New|rrr kefererre Naraal
The 0ure of the Newborn Reference Hunuu| wos wrillen
lo guide lhe lroining of oll heollh core workers in lhe
besl proclices for lhe heollh ond survivol of newborn
infonls, porliculorly in developing counlries. The in-
fornolion ond skills provided in lhe poges lhol follow
ore essenliol for lhose coring for oll newborns in lhe
frsl 28 doys of life, whelher connunily-bosed heollh
workers, nurses, nidwives, or physicions.
Troining curriculo ond courses in nony developing
counlries oflen do nol odequolely oddress lhe specifc
knowledge ond skills needed lo core for newborns,
ond os o consequence, nillions of bobies die need-
lessly eoch yeor. This nonuol provides up-lo-dole,
conprehensive, evidence-bosed infornolion, ond
defnes ond illuslroles lhe skills needed lo keep
newborns heollhy, including rouline ond prevenlive
core os well os eorly deleclion ond nonogenenl of
life-lhreolening problens.
The 0ure of the Newborn Reference Hunuu| olso
oddresses lhe infornolion lhol lhe nolher ond fonily
nusl underslond lo core for lheir newborn 2/ hours
o doy, for lhey ore lhe ones who ollend lo lheir new-
born`s doily needs ond problens lhol occur. Like lhe
heollh worker, lhey need lo recognize ond respond
oppropriolely lo donger signs if lhey orise. n oddilion
lo coring for lhe newborn, heollh workers hove on
inporlonl role in connunicoling ond denonslroling
occurolely wilh nolhers ond fonilies lo ensure lhol
lhey loo know lhese besl proclices. Building connu-
nicolion skills-how lo lislen lo nolhers ond shore
infornolion wilh lhen-is lhus onolher inporlonl
funclion of lhis nonuol.
Heollh worker lroining is only one conponenl of suc-
cessful newborn ond nolernol heollh core. Wilhoul
lhe olher conponenls-responsible supervision,
equipnenl, o relioble source of supplies, ond o syslen
for referring conplicolions-even lhe besl-lroined
heollh workers noy foil lo provide lifesoving core. lnd
even wilh oll lhese conponenls in ploce, lhe denond
for services nusl exisl. Heollh workers nusl reoch
oul lo people in lheir connunilies ond build relolions
of lrusl fron lhe household lo locol ond dislricl-level
focililies lo creole o conlinuun of core.
The oulhors designed lhis nonuol lo neel nony dif-
ferenl needs. l is o lechnicol resource for lroiners, lu-
lors, ond focililolors ond o useful resource for heollh
providers ond lhose who develop or nonoge conpre-
hensive nolernol ond child heollh progrons. l con
be used in ils enlirely or odopled lo suil o porliculor
oudience, need, or counlry selling. Fssenliol newborn
core con be inlegroled inlo exisling efforls, such os
child heollh, reproduclive heollh, ond sofe nolher-
hood, or odopled lo enhonce lhe newborn conponenl
of lroining progrons, lo inlroduce speciol lopics lo
shorl in-service progrons, or lo updole o heollh core
provider`s pre-service curriculun.
lbove oll, lhis nonuol should nol funclion os on exclu-
sive resource. By oddressing lhe very speciol needs
of lhe newborn, 0ure of the Newborn conplenenls
olher ovoiloble guides, such os. WH0`s nlegroled
Monogenenl of Pregnoncy ond 0hildbirlh lMPl0I
guide Hunuin Newborn Prob|ems: / 0uiJe for 0octors,
Nurses unJ HiJwives, ond HNF/!FPlF00s 8usic Huter-
nu| unJ Newborn 0ure: / 0uiJe for Ski||eJ ProviJers.
The oulhors ond sloff of lhe Soving Newborn Lives
iniliolive of Sove lhe 0hildren US hope lhol lhe 0ure
of the Newborn Reference Hunuu| will enoble heollh
providers, progron nonogers, ond decision-nokers
lo give every newborn lhe besl possible chonce of sur-
vivol ond supporl lhe nony nolhers ond fonilies who
depend on lheir guidonce lo roise heollhy bobies.
/Loul Tis M~:u~
ix
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ x
HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ Care rf t|e New|rrr kefererre Naraal
Hoope Bender, Porlnership for Sofe Molherhood ond
Newborn Heollh, Mirion Songore, lroining consullonl,
Moli, 0ulnoro Senenov, 0R0/Ml0R0, Dello R. Sher-
roll, WH0, Noncy Terreri, UN0FF, ond Dovid Woods,
Universily of 0ope Town, Soulh lfrico. n oddilion,
nony of Sove lhe 0hildren`s sloff lenl lheir experience
lo lhis nonuol, including Slello lbwoo, S0 Molowi,
lsno lkber ond Nobeelo lli, S0 Pokislon, Houley-
nolo Diorro ond Thiero Folounolo, S0 Moli, Soikhul
slon Helol ond Uzno Syed, S0 Bonglodesh, Neeno
Khodko ond Meeno Shorno, S0 Nepol, 0onzolo Mons-
illo ond Berlho Pooley, S0 Bolivio.
Speciol lhonks go lo lnne Tinker, Direclor of Sov-
ing Newborn Lives, ond Pol Doly, Depuly Direclor,
for lheir direclion ond connilnenl lhroughoul lhe
lenglhy ond sonelines diffcull process.
n oddilion, we ore groleful lo lhe nony people who
helped ol every sloge, including 0ino lllen, Molio
Boggs, Rebecco 0hose, Belly Forrell, Michoel Foley,
Soroh Hollond, Roberl Johnson, Luonn Morlin, lllisyn
Moron, Winifred Mwebeso, ndiro Noroyonon, Suson
0lchere, ond Sleve Woll.
ls we shore lhe credil wilh lhe nony people who
helped us, we olso ocknowledge lhol we olone ore
responsible for ony errors in lhe presenlolion of infor-
nolion ond skills in lhis nonuol.
The oulhors hove nony people lo lhonk for lheir
help in developing lhe 0ure of the Newborn Reference
Hunuu|. 0ur lhonks go frsl ond forenosl lo lhe Bill &
Melindo 0oles Foundolion. Their supporl for Sove lhe
0hildren`s Soving Newborn Lives iniliolive hos been
crilicol lo lhe growlh of lhe globol connilnenl lo
newborn heollh core.
We ore groleful lo Belly Sweel, whose originol
nonuscripl helped inforn lhe developnenl of lhis
nonuol. 0elling posl lhol frsl hurdle sel nony
of our colleogues on lhe long rood of reviewing, lesl-
ing, evoluoling, ond nodifying every deloil of whol,
for us, wos o colloborolive ond collegiol pro|ecl.
Deboroh lrnbrusler, 0obrielle Beosley, Mory
Kroeger, Judilh Moore, ond Kolherine Perry were
prinory conlribulors, working lirelessly lhrough
counlless drofls. They provided reseorch, wriling,
ond ediling os lhe nonuol evolved, seclion by seclion.
We lhonk lhese wonen for lheir lhoughlfulness in
noking lhis o seonless ond lhorough nonuol.
The process of reviewing lhe noleriol drew on people
wilh yeors of experience os leochers, lroiners, ond
connunily heollh providers, while olhers lesled ond
gove us feedbock fron on-going connunily-bosed
progrons. For lhese involuoble conlribulions we
hove nony lo lhonk, including. Fronk lnderson,
Universily of Michigon, 0loudelle Bordin, Sociely of
0bslelricions ond 0ynecologisls of 0onodo, Sondro
T. Buffnglon, lnericon 0ollege of Nurse-Midwives,
Polricio 0onez, MNH/JHPF00, Mirion Lobbok,
UN0FF, 0lorio Melcolfe, JHPF00, lsnuyeni Muchlor,
JHPF00/ndonesio, lllreno Mukurio, 0R0/Ml0R0,
Roberl Porker, Johns Hopkins Universily, Pelro len
/:oweoqne:ls
xi
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
lFlSS lcceploble, feosible, offordoble,
susloinoble, ond sofe
lDS lcquired innune defciency syndrone
lN0 lnlenolol core
lZT Zidovudine
B00 Bocillus 0olnelle-0uerin
DPT Diphlherio-Perlussis-Telonus
FN0 Fssenliol newborn core
Fe/Fl ron/folole
0 0oslroinleslinol
Hep B Hepolilis B
H\ Hunon innunodefciency virus
HLD High-level disinfeclion
M nlronusculor
PT nlernillenl prevenlive lreolnenl
\ nlrovenous
KM0 Kongoroo nolher core
LlM Loclolionol lnenorrheo Melhod
LBW Low birlh weighl
MT0T Molher-lo-child lronsnission
0P\ 0rol polio voccine
PMT0T Prevenlion of nolher-lo-child
lronsnission
RPR Ropid plosno reogin
S0 Subculoneous
S0l Snoll for geslolionol oge
SNL Soving Newborn Lives iniliolive of
Sove lhe 0hildren US
SP Sulfodoxine-pyrinelhonine
ST Sexuolly lronsnilled infeclion
TB Tuberculosis
TT Telonus loxoid
UNlDS Joinl Uniled Nolions Progron on lDS
UN0FF Uniled Nolions 0hildren`s Fund
\0T \olunlory counseling ond lesling
\DRL \enereol Diseose Reseorch Loborolory
WH0 World Heollh 0rgonizolion
/LL:evi~lio:s
xii
!|e |rr]rtter New|rrr 1 >cigdYjXi^dc
Te Fo:qolle: ewLo::
: :ee:l ye~:s io su:viv~ ~livilies
su ~s ioooo innu:i.~lio: ~:o
oi~::e~ o:l:o :oq:~nsl ~ve eo lo ~
o:~n~li oe:e~se i: no:l~ily ~no:q
io:e: u:oe: ve Desile lis suess,
oweve:, le :ewLo:: no:l~ily :~le i:
oeveoi:q :~lio:s is sli ~~:ni:qove:
/O e:e:l o ~ oe~ls o io:e: u:oe:
ve ou: i: le :sl no:leve: louq
le:e ~:e :ove:, osleelive w~ys lo
:eve:l :ewLo:: no:l~ily
1
l is eslin~leo l~l o/ oul o eve:y 1,OOO
L~Lies Lo:: i: oeveoi:q ou:l:ies oie
Leo:e ley :e~ le ~qe o o:e no:l,
nosl o len ~l one Fo: le nosl ~:l,
le io su:viv~ :evoulio: ~s Ly~sseo
le :ewLo::
0:e :e~so: o: le o:li:ueo iq :ewLo::
oe~l :~les is le q~ Lelwee: s~e nol
e:ooo ~:o io su:viv~ eo:ls S~e
nole:ooo :oq:~ns lyi~y ous o:
le su:viv~ o le nole:, ~:o io su:
viv~ sl:~leqies usu~y ~oo:ess le :oL
ens o io:e: ove: o:e no:l Te:e ~s
Lee: ille i:le::~lio:~ eo:l lo oeveo ~
n~le::~io e~l ~:o~ l~l i:
uoes ~:e ou:i:q le :sl no:l o ie
oe~y, n~le::~io :oq:~ns wouo
l~:qel le ~:e o nole:s, :ewLo::s, ~:o
io:e: u lo le ~qe o ve
2 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
ls o newborn core provider, you noy be involved in
helping olhers leorn why il is inporlonl lo focus on
newborn heollh. n oddilion lo underslonding lhe
globol problen, you noy olso wonl lo gel inforno-
lion on lhe newborn siluolion in your own counlry or
region. When providers, lulors, progronners, ond
policynokers underslond lhe siluolion ond hove lhe
correcl infornolion, lhey con odvocole for inproved
newborn core ond survivol.
New|rrr Nrrtal|t
Heollh slolislics show lhol worldwide.
n lboul / nillion bobies die eoch yeor.
n lnolher / nillion bobies eoch yeor ore slillborn,
nosl die in lole pregnoncy or lobor.
n Mosl newborn deolhs occur in developing
counlries.
!|e !wr!||r1s kale
Heollh slolislics olso show lhol.
n lboul lwo-lhirds of infonl deolhs* occur in lhe
frsl nonlh of life.**
n 0f lhose who die in lhe frsl nonlh, oboul
lwo-lhirds die in lhe frsl week of life.
n 0f lhose who die in lhe frsl week, lwo-lhirds
die in lhe frsl 2/ hours of life.
*Deolhs in lhe frsl yeor of life
**n lhe newborn period
lboul lwo-lhirds of infonl
deolhs occur in lhe frsl
nonlh of life.
0f lhose, oboul lwo-lhirds
die in lhe frsl week of life.
0f lhose, lwo-lhirds die in
lhe frsl 2/ hours of life.
8=6GI& TRE TW0-TRIPD5 PULE"
!|e |rr]rtter New|rrr 3 >cigdYjXi^dc
Na|r Caases rf New|rrr 0eat|s
Reseorch fron oround lhe world hos idenlifed lhe
noin couses of newborn deolhs. ls shown in chorl 1,
oboul 85 percenl of newborn deolhs ore fron lhree
noin couses. infeclions, birlh osphyxio, ond conplico-
lions of prenolurily. Low birlh weighl lLBWI is on in-
porlonl conlribuling foclor in nony neonolol deolhs.
n oddilion lo lhe direcl couses of deolh, nony new-
borns die becouse of lheir nolher`s poor heollh or
becouse of lock of occess lo essenliol core. Sone-
lines lhe fonily noy live hours owoy fron o referrol
focilily or lhere noy nol be o skilled provider in lheir
connunily.
The newborn child is exlrenely vulneroble unless she
receives oppropriole bosic core, olso colled essenliol
newborn core. When nornol bobies do nol receive lhis
essenliol core, lhey quickly foll sick-ond loo oflen
lhey die. For prenolure or low birlh weighl bobies,
lhe donger is even greoler.
New|rrr Sar|al
Mosl newborn deolhs ore enlirely prevenloble, lhonks
lo o nunber of sinple, low-cosl oclions lhol con be
loken by heollh core workers, nolhers, ond fonilies.
Bul nony heollh core providers hove nol been lroined
in essenliol newborn core, ond nony nolhers do nol
know how lo prolecl lheir newborns.
This nonuol exploins lhe fundonenlols of essenliol
newborn core for oll bobies ond whol lo do in lhe
evenl of o problen or conplicolion. lrned wilh lhis
knowledge, heollh core providers con ploy o cruciol
role in helping nolhers, fonily nenbers, ond lhe
connunily loke beller core of newborns ond pul lhen
on lhe rood lo o heollhy life.
8=6GI' DIPECT CAU5E5 0F NE0NATAL
DEATR5
nfeclions
llelonus, sepsis,
pneunonio,
diorrheoI
32%
Birlh osphyxio
ond in|uries
29%
2%
0onplicolions
of prenolurily 10%
0ongenilol
ononolies
5%
0lher
WH0 2OO1 eslinoles lbosed on dolo collecled oround
1??1I. Source. Sove lhe 0hildren. l2OO1I. 7he Stute of the
wor|Js Newborns.: / Report from Suvin Newborn Lives.
Woshinglon, D0. Soving Newborn Lives/Sove lhe 0hildren
Federolion.
/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
0\|k\||w 0| !N|86G:D;I=:C:L7DGC
G:;:G:C8:B6CJ6A
The 0ure of the Newborn Reference Hunuu| provides
lhe infornolion ond describes lhe skills lhol heollh
workers, nolhers, ond fonilies need lo deliver
lhe bosic bul crilicol core lhol nusl be given lo oll
newborns, including.
n Drying ond worning lhe boby |usl ofler birlh
n Ropid ossessnenl ol birlh
n Breoslfeeding wilhin lhe frsl hour of birlh
n Unbilicol cord core
n Fye core
n Fxclusive breoslfeeding
n Prevenling infeclion
n nnunizing lhe newborn
n Recognizing ond coring for connon newborn
problens
n Newborn resuscilolion lo help bobies who hove
breolhing problens ol birlh
n Newborn exoninolion lo delernine if lhe boby
is heollhy or if he needs lo be referred lo o
higher-level heollh focilily
n Speciol core lo neel lhe exlro needs of
low birlh weighl newborns
lll bobies need lhe sone essenliol core, whelher lhey
ore born ol hone or in o heollh focilily. n oddilion
lo lhe infornolion on essenliol core of lhe newborn,
lhe nonuol idenlifes newborn donger signs, how
lo recognize ond nonoge connon problens, ond
how lo refer lhe sick newborn for proper core, when
necessory. 0ure of the ver, sick newborn, other thun
emerenc, stubi|izution unJ referru|, is cdiu purt of this
reference munuu|.
The Reference Monuol hos six choplers.
1. Newborn 0ore Slorls Before Birlh
2. Fssenliol 0ore for Fvery Newborn
3. Successful Breoslfeeding
/. Newborn Resuscilolion
5. 0ore of Low Birlh Weighl Bobies
. 0onnon Newborn Problens
!|e |rr]rtter New|rrr 5 >cigdYjXi^dc

Foch chopler begins wilh on oulline of lhe inforno-
lion lhol is covered ond whol lhe reoder will leorn lo
do. n eoch chopler, decision-noking chorls presenl
lhe sleps for idenlifying ond nonoging lhe nosl con-
non newborn problens. Foch chopler ends wilh o
loble lisling lhe losks lhol con be done by oll newborn
heollh providers, including connunily heollh workers.
This nonuol is prinorily oboul newborn core, oc-
cordingly, il gives only o brief overview lchopler 1I of
cerloin ospecls of onlenolol ond nolernol core. l is
well-known, of course, lhol lhe heollh ond core of
lhe nolher during pregnoncy, lobor, birlh, ond lhe
poslporlun period ore crilicol for lhe well-being of
lhe newborn. We expecl ond encouroge lhe users of
lhis nonuol lo obloin infornolion ond skills fron lhe
sofe nolherhood lroining progrons lhol ore ovoiloble
in nosl counlries.
This nonuol presenls reconnendolions for newborn
core lhol ore bosed on lhe lolesl scienlifc evidence or,
where lhere is no evidence, on experl opinion.
Nrte tr rea1ers
The nonuol will use lhe lerns newborn, neonole,
infonl, ond boby lo describe lhe newborn, ond lhe
pronouns she or he lin ollernoling choplersI
rolher lhon lhe inpersonol ond inoccurole il.
AN |N!k00UC!|0N !0 !N|
0|C|S|0NNAK|N APPk0ACN
This nonuol nokes exlensive use of o slep-by-slep
process of idenlifying ond coring for newborn needs
lhol we hove colled lhe decision-noking opprooch.
This opprooch will help heollh core providers use lheir
knowledge ond skills lo noke decisions oboul lhe core
of o newborn. Sone heollh workers know lhis concepl
lhrough use of S0lP lSub|eclive, 0b|eclive, lssess-
nenl, ond PlonI noles, clinicol decision-noking, or
o voriolion. This slep-by-slep opprooch involves on
orgonized lhinking process which leods lo purposeful,
sofe, ond effeclive core.
2,3
Solving problens in o slep-by-slep process hos lhree
odvonloges.
1. l helps lhe heollh worker collecl infornolion
in on orgonized woy.
2. l helps lhe heollh worker use infornolion so
o problen or need con be correclly idenlifed.
3. l helps lhe coregiver provide only lhe core
or lreolnenls lhol ore needed.
Becouse so nuch of lhe infornolion in lhe following
choplers is orgonized oround ond presenled in lhe
forn of lhe decision-noking sleps, we ore providing
here o deloiled explonolion of lhis opprooch, olong
wilh on illuslrolion.
The sleps in lhe decision-noking opprooch ore os
follows.
Slep 1. Toke o hislory.
Slep 2. Do o physicol exoninolion.
Slep 3. denlify ony needs or problens.
Slep /. Moke o plon of core for lhe needs
ond problens.
Slep 5. Follow-up lo evoluole lhe plon of core.
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Step J: !ake a N|strr
n lhis slep lhe coregiver osks lhe wonon oboul her
boby`s heollh or problen lor her problenI ond lislens
lo her onswers. The coregiver olso osks her oboul her
pregnoncy ond lobor ond lhe boby`s birlh. This slep is
colled loking o hislory becouse lhe purpose is lo fnd
oul lhe whole slory oboul lhe boby`s ond lhe nolher`s
heollh.
!|ps frr tak|r] a ]rr1 ||strr
When loking o hislory, lhe heollh worker should.
n Moke lhe nolher ond fonily feel welcone.
n Help lhen feel conforloble by exploining why
lhe queslions ore necessory.
n Tolk lo lhen in o privole oreo.
n lsk queslions in o respeclful, kind, ond
inleresled woy.
n Lislen corefully lo oll lhe onswers.
n 0heck lhe nolher`s clinic-bosed records, if
ovoiloble, ond osk lo see her hone-bosed
records, if she hos broughl ony.
n lsk oll lhe queslions oboul lhe signs ond
synplons lo decide whol lhe needs or
problen ore.
f o nolher or boby hos on obvious energency, lhe
heollh worker noy osk very few queslions before
slorling lo give core becouse ropid oclion is needed.
0nce lhe energency is under conlrol, lhe conplele
hislory of lhe problen should be explored. f lhe
nolher is very sick, onolher fonily nenber noy hove
lo give lhe hislory.
The onswers lhe clienl gives oboul lhe problen ore
colled hislory fndings. These fndings help lhe heollh
worker decide whol lo check in Slep 2. Fxoninolion
ond should be recorded in wriling, eilher now or in-
nediolely ofler lhe nolher`s visil.
BABY CAPA 5TEP 1: TAKE A RI5T0PY
Molher Doro brings her boby 0oro lo see lhe
heollh worker.
The nolher soys. on worried becouse 0oro
hos o skin rosh.
The heollh worker osks lo see ony hone-bosed
nolernol or newborn records lhe nolher noy
hove broughl ond checks whelher lhere ore
ony records ovoiloble in lhe focilily. The nolher
hos nol broughl ony records. The clinic records
show lhol lhe nolher hod four onlenolol check-
ups ond o nornol delivery, wilh no porliculor
problens. The heollh worker lokes o hislory by
osking lhese queslions oboul lhe boby.
n When ond where wos 0oro born?
n How nuch did she weigh ol birlh?
n Tell ne oboul 0oro`s birlh ond whol
lreolnenls were given.
n When did lhe skin rosh slorl?
n Hos lhe rosh gollen worse?
n Hove you lried onylhing lo lreol lhe
boby`s rosh?
n s 0oro feeding well?
n Does 0oro sleep belween feeds ond woke
up lo feed?
n s 0oro fussy?
n Tell ne oboul how oflen 0oro posses
urine ond slools.
n s lhere onylhing else oboul lhe boby lhol
worries you?
The heollh worker wriles lhese fndings in lhe
chorl.
0ne-week-o|J infunt, born ut the Jistrict hospitu|,
with u skin rush which the mother noticeJ three
Ju,s uo, she hus not useJ un, treutment. 7he
bub, is feeJin unJ s|eepin we||, pussin urine
unJ stoo| normu||,, unJ is not fuss,.
Ba| Cara: Ar |llastrat|rr rf t|e
0er|s|rrNak|r] Apprrar|
The following exonple-boby 0oro-illuslroles lhe
fve sleps of lhe decision-noking opprooch.
!|e |rr]rtter New|rrr 7 >cigdYjXi^dc
Step I: 0r a P|s|ral |tam|rat|rr
The infornolion lhe nolher gove in Slep 1 helps
delernine whol lo exonine ond suggesls whol lhe
needs ond problens noy be. Fxoninolion of lhe boby
neons lo look, feel, lislen, ond snell. Loborolory lesls
noy olso be porl of lhe exoninolion, if oppropriole
ond ovoiloble.
Crmplete etam|rat|rr
Soon ofler birlh, lhe heollh worker does o conplele
physicol exoninolion of lhe newborn lsee chopler 2
for deloilsI. l conplele exoninolion of lhe body noy
reveol problens lhol lhe nolher hos nol recognized.
|rrase1 etam|rat|rr
lfler lhe frsl conplele physicol exoninolion, o fol-
low-up exoninolion of lhe heollhy boby focuses on
speciol oreos, delernined by lhe boby`s oge lsee chorl
2.7 in chopler 2I ond/or specifc concerns.
For exonple, when o nolher brings her boby wilh o
problen, o shorl physicol exon noy be done insleod
of lhe conplele exon. n lhol cose, lhe physicol exon-
inolion focuses on lhe porliculor problen, colled lhe
presenling problen.
lfler exonining lhe boby, lhe heollh worker encour-
oges lhe nolher lo breoslfeed ond observes lhe
breoslfeeding while discussing lhe exoninolion fnd-
ings wilh her.
The lhings o heollh worker observes lsees, feels, ond
heorsI when exonining lhe nolher or boby ore colled
physicol exoninolion fndings. Jusl os wilh lhe hislory
fndings in Slep 1, you should olso record lhe exoni-
nolion fndings.
|a|rratrr tests rr rt|er |rest|]at|rrs
Do loborolory lesls ond olher exoninolions lhol ore
needed lif ovoilobleI.
BABY CAPA 5TEP 2: D0 A PRY5ICAL
EXAHINATI0N
The heollh worker lhinks oboul lhe hislory
fndings for boby 0oro. She woshes her honds
corefully ond exonines lhe boby os follows.
She.
n lokes lhe boby`s lenperolure or feels lhe
chesl for wornlh.
n weighs lhe boby, if possible.
n looks ol lhe boby`s color lo see if she is
pink, blue, pole, or yellow.
n looks ol lhe skin for puslules, opens lhe
dioper lo look ol lhe bullocks, ond sepo-
roles lhe skin folds lneck, ornpils, ingui-
nol oreoI lo look for puslules in lhere.
n looks ol lhe skin ond clolhing for
cleonliness.
n looks ol lhe cord for redness or dischorge.
n looks ol lhe boby`s eyes for redness,
swelling, or dischorge.
n noles lhe boby`s oclivily ond olerlness
during lhe exoninolion.
lfler lhe exon, lhe heollh worker ogoin
woshes her honds ond observes lhe boby, who
is now breoslfeeding. She lhen records lhese
fndings in lhe boby`s record.
8ub, is u|ert unJ uctive, feeJin we||. /xi||ur,
temp = J.2 0, weiht = 2.?50 k |epuu| to birth
weihtl. F,es ure c|eur, corJ is off, umbi|icus is
c|eun unJ Jr,, co|or is pink. 7here ure fve smu||
pustu|es insiJe the inuinu| skin fo|Js unJ two
ver, smu|| ones on the |eft buttock. 7he skin unJ
c|othin ure not c|eun.
8 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Step 1: |1ert|f Ar Nee1s rr Prr|lems
The heollh worker idenlifes needs ond problens by
lhinking oboul lhe hislory fndings ond lhe physicol
exon fndings. The fndings should be conpored wilh
lhe heollh worker`s knowledge oboul heollhy bobies
ond lhe infornolion in lhis nonuol.
l problen noy be on illness or o sign of illness. l
hislory fnding or o physicol exon fnding lhol is nol
nornol noy be o sign of illness.
Fvery newborn hos needs for essenliol core. These
needs include wornlh, proleclion fron infeclion, ond
nulrilion. The heollh worker will sonelines see lhol
porenls need inslruclion oboul how lo neel lheir
boby`s nornol needs. Unnel needs resull in prob-
lens, if lhe newborn`s need for wornlh is nol nel, for
exonple, hypolhernio con resull.
w|at tr 1r w|t| t|e hr1|r]s
f lhe fndings ore oll nornol, lhe heollh worker
should lell lhe nolher lhol oll is well.
f lhe fndings show o problen, lhe coregiver con con-
pore lhe obnornol fndings wilh infornolion in lhis
nonuol. Be sure lo exploin lhe needs ond problens lo
lhe nolher before proceeding wilh ony core. lny fnd-
ings reloled lo needs or problens should be recorded.

BABY CAPA 5TEP 3: IDENTIFY ANY
NEED5 0P PP0BLEH5
The heollh worker reviews lhe hislory ond
lhe physicol exon fndings for boby 0oro. The
inporlonl fndings ore.
n The nolher`s worry oboul lhe skin
rosh
n The snoll nunber of puslules on lhe
skin, wilh no olher obnornol physicol
exon fndings
n The skin ond clolhing ore nol cleon
lindicoling lhe need for proleclion fron
infeclion noy nol be nelI
The heollh worker records boby 0oro`s
needs ond problens in her chorl.
Locu|izeJ skin infection noticeJ, u|so poor
h,iene. Hother neeJs to know how to te|| u
mi|J skin infection from u serious infection.
Hother neeJs to know newborn Juner sins
unJ whut to Jo if bub, hus one.
!|e |rr]rtter New|rrr ? >cigdYjXi^dc
Sonelines il is diffcull lo decide whol lhe problen
is. Mony newborn illnesses hove lhe sone synp-
lons, feeding diffcullies, for exonple, con be coused
by nony differenl problens. respirolory infeclions,
sepsis, breosl engorgenenl, ond prenolurily. lll
lhese problens con be wrillen in Slep 3. Then by gel-
ling nore infornolion lhislory, physicol exoninolion,
ond/or loborolory leslsI lhe heollh worker con decide
whol lhe reol problen is.
f lhe heollh worker`s knowledge or equipnenl is nol
odequole lo idenlify lhe problen, she should refer lhe
wonon ond boby lo soneone who con help lhen.
l is inporlonl lhol oll lhe nolher`s or boby`s prob-
lens ond needs ore cored for. l nolher noy cone
wilh o conploinl oboul breosl poin, for exonple, bul
she olso needs infornolion oboul fonily plonning,
good nulrilion, ond where lo go for innunizolions for
her olher snoll children, oll in one visil.
M~:y :ewLo:: i:esses
~ve le s~ne synlons
Feeoi:q oiulies, o:
ex~ne, ~: Le ~useo
Ly :esi:~lo:y i:elio:s,
sesis, L:e~sl e:qo:qe
ne:l, ~:o :en~lu:ily
1O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Step /: Nake a Plar rf Care frr t|e Nee1s ar1 Prr|lems
The heollh worker should noke o plon of core lo lreol eoch
problen ond lo neel eoch need. Foch plon of core noy
include sone or oll of lhe oclions below, os in lhe olher
lhree sleps, lhe plon of core should be recorded in wriling.
|1arat|rr
n Help fonilies leorn lo core for lhenselves.
n Teoch nolhers donger signs for lhenselves
ond lheir bobies.
n Teoch nolhers how lo respond oppropriolely
lo donger signs.
Crarsel|r]
n Find oul whol lhe nolher lhinks oboul her
or her boby`s problen ond lhe oclions you
reconnend.
n Help her underslond lhe problen or needs.
n Find oul if lhe nolher con do whol you odvise.
n Help her fnd woys lo do whol you ore odvising
or fnd ollernolives lhol she ond her fonily con do.
n 0ive her on opporlunily lo discuss her queslions
ond concerns.
Ne1|ral treatmert
n 0hoose lhe correcl nedicine or lreolnenl.
keferral
n f necessory, send lhe nolher ond boby lo o
higher-level focilily lo gel help. Skilled or spe-
ciolized core by nidwives, doclors, ond hospilols
noy help sove lhe boby`s or nolher`s life.
n Sonelines lhe nolher noy need olher,
nonnedicol help. Fducolion progrons, sociol
services, wonen`s groups, or chorily groups
noy help her neel her needs, if ovoiloble.
|rllrwap
Before lhe visil ends, schedule o follow-up visil wilh
lhe nolher lo see if lhe plon of core is working. n
plonning for lhis visil.
n Thonk lhe nolher for coning.
n Fxploin why she ond her boby need lo be
seen ogoin, if needed.
n Moke sure she knows lhe newborn donger signs.
n Moke sure she knows whol lo do if she sees
o donger sign. Teoch her lhol she needs lo seek
heollh core innediolely for lhe boby.
n Schedule lhe follow-up visil for lhe line
reconnended in lhe decision-noking chorl.
BABY CAPA 5TEP : HAKE A PLAN 0F
CAPE F0P TRE NEED5 AND PP0BLEH5
The heollh worker nokes o plon lo neel boby
0oro`s needs ond records il in lhe chorl. n
lhis cose only educolion, counseling, ond skin
lreolnenl ore needed, boby 0oro does nol
need lo loke nedicolion or be referred.
Plon of core.
n Reossure lhe nolher lhol lhe skin
infeclion is nol serious ond con be
lreoled ol hone.
n Teoch lhe nolher how lo wosh lhe rosh
ond lreol il wilh genlion violel solulion
lsee chorl .7 in chopler I.
n Show her how lo do il.
n Hove lhe nolher do il lo show lhol she
hos leorned lo do il properly.
n Teoch lhe nolher lo bring boby 0oro bock
righl owoy if she develops nony nore
puslules lnore lhon 1OI.
n Teoch lhe nolher why ond how lo bolhe
her boby regulorly ond lo keep her
clolhing cleon.
n Teoch lhe nolher lhe newborn donger
signs ond whol lo do if 0oro hos one.
n Schedule o relurn visil in 2-3 doys lo
follow up on skin rosh ond boby`s hygiene.
!|e |rr]rtter New|rrr 11 >cigdYjXi^dc
Step E: |rllrwap tr |alaate t|e Plar rf Care
The decision-noking sleps should be repeoled when
lhe nolher ond lhe boby cone bock for o follow-up
visil. This will show whelher lhe problen or need is
solved, is lhe sone, or is worse. l will olso show if
lhere ore new problens or needs.
The boby noy now need o new plon of core, such
os o differenl nedicine or lreolnenl, or lhe nolher
noy hove queslions. The heollh worker noy hove lo
do nore heollh educolion. The boby noy need lo be
referred lo o higher-level focilily. lnd of course lhe
follow-up ossessnenl lnew hislory ond new physicol
fndingsI ond lhe new plon of core nusl be recorded in
lhe boby`s records.
0rramert|r] t|e Steps
ls we hove noled lhroughoul, oll fndings ond plons
of core should be wrillen up in o reporl lhol becones
porl of lhe nolher`s ond/or boby`s record, lhis record
will help you ond olhers give quolily core. You noy
conpile lhis reporl os you execule eoch slep, ofler lhe
visil hos ended, or conplele differenl porls ol differ-
enl lines. llong wilh lhe dole ond line of lhe visil,
lhe reporl should include.
1. Hislory. Hislory fndings
2. Fxon. Physicol exoninolion fndings
Loborolory lesl resulls, if done
3. Problens. Problens ond unnel needs
lf il is nol cleor whol lhe problen
is, lhen synplons should be
lisled here.I
/. Plon of 0ore. For eoch problen or unnel need,
lhe plon should include.
n 0ounseling ond educolion given
n Treolnenls done
n Medicines given or ordered
n 0lher loborolory lesls or
exoninolions ordered
n Referrols node
5. Follow-up. The dole for lhe nexl follow-up visil
BABY CAPA 5TEP 5: F0LL0W-UP T0
EALUATE TRE PLAN 0F CAPE
The heollh worker plons for boby 0oro`s
follow-up visil wilh lhe nolher ond records
lhe dole for lhe scheduled follow-up visil in
lhe boby`s record. Becouse boby 0oro hos o
locolized infeclion, lhe follow-up visil should
be in 2-3 doys. The heollh worker proises
lhe nolher for bringing in lhe boby when she
wos concerned ond odvises her lo.
n Bring lhe boby bock lo be checked
ogoin in 2-3 doys
n Bring lhe boby for core innediolely
if she hos ony donger signs
n Renind lhe nolher lo cone wilh her
boby for rouline inlegroled poslnolol
visils, innunizolion, ond growlh noni-
loring, ol lhe scheduled line
n Seek fonily plonning services, os
oppropriole
12 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
!|e 0er|s|rrNak|r] C|art
For nosl of lhe newborn problens discussed in lhis
nonuol, lhe reconnended newborn core will be
presenled in lhe forn of lhe decision-noking sleps
|usl described. There will be o chorl for eoch problen
or condilion, ond lhe chorl will conloin lhe fve sleps
of lhe decision-noking opprooch ond lhe oclions lhol
should be loken wilh eoch slep. 0horl 3 shows whol o
decision-noking chorl will look like.
Ristcry
Examinaticn
PrcbIemslneeds
PIan cf care
FcIIcw-up
8=6GI( DECI5I0N-HAKIN6 CRAPT
0ueslions lhol should be osked for lhis porliculor problen

n The porls of lhe body lhol should be exonined
n Loborolory invesligolions or screening lesls
n Nornol ond obnornol fndings for eoch body porl
n 0onnon newborn needs
n The plon for eoch problen, including educolion, counseling, nedicol lreolnenl,
lob lesls, referrol, ond follow-up
n The plon for eoch need.
n ldvice lo give lhe nolher on core for lhe boby
n Donger signs lo wolch for ond whol lo do
n Follow-up oppoinlnenl
Suggeslions for lhe follow-up oppoinlnenl
Nrtes
1 The slolislics on poges 1-3 ore fron Soving Newborn Lives.
l2OO1I. 7he Stute of the wor|Js Newborns. Woshinglon, D0.
Soving Newborn Lives/Sove lhe 0hildren Federolion.
2 Buffnglon ST ond Morsholl Ml. l1??8I. Using lhe problen-
solving nelhod lo give nolernily core. n Life Suvin Ski||s
Hunuu| for HiJwives 3d ed. Module 1, pp.1.22-1.31.
Woshinglon D0. l0NM.
3 0hono Minislry of Heollh & PRMF . l2OO1I. Problen-
solving for quolily core. n 0hunu H0F unJ PRlHF ll
Sufe HotherhooJ 0|inicu| Ski||s: / Se|f-PuceJ Leurnin
lntervention in Six units. Module 3. lccro. 0hono
M0H ond PRMF .
ewLo:: C~:e Sl~:ls Deo:e Di:l
1
CZlWdgc8VgZHiVgih7Z[dgZ7^gi] &(
1
New|rrr Care Starts Befrre B|rt| 13
1
8]VeiZg&
1 ewLo:: C~:e Sl~:ls Deo:e Di:l
e~l wo:e:s :eeo :oweoqe ~:o sis
lo qive esse:li~ :ewLo:: ~:e ~:o lo
:eoq:i.e ~:o n~:~qe onno: :ewLo::
:oLens Dul il is ~so esse:li~ o: len
lo u:oe:sl~:o l~l qooo :ewLo:: e~l
oee:os o: qooo n~le::~ e~l ~:o
:ul:ilio:, esei~y ou:i:q :eq:~:y,
~Lo:, ~:o osl~:lun Con:ee:sive,
iqqu~ily ~:e o: nole:s ou:i:q :eq
:~:y ~:o ioLi:l is |usl ~s ino:l~:l ~s
~:e o: le L~Ly ~le: Li:l lo e:su:e l~l
eve:y :ewLo:: sl~:ls oul ie wil le Lesl
ossiLe ~:e o :e~i:q ~oulooo
1/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
n lhis chopler you will fnd infornolion oboul.
n Key conponenls of pregnoncy core, including
counseling, birlh plons, recognilion of donger
signs, ond conplicolion reodiness
n lnlenolol core oclivilies lo prevenl newborn
problens
n 0ore of lhe nolher during lobor ond delivery
n Use of lhe porlogroph
n Felol dislress
n Prevenlion of nolher-lo-child lronsnission
of H\
n lhis chopler you will leorn lo do lhe following.
n Slorl newborn core before birlh.
n Teoch wonen ond fonilies why nolernol
heollh ond onlenolol core ore inporlonl for
newborn heollh
n Teoch wonen ond fonilies oboul donger
signs in pregnoncy, lobor, delivery, ond
poslporlun
n Help wonen ond fonilies noke birlh plons
n Pronole occess lo ond use of skilled
providers for lobor ond delivery core
n Monilor lhe felol condilion during lobor by
lislening lo lhe felol heorl role, observing lhe
color of lhe onniolic fuid, ond loking oclion
when lhere is o problen
n Pronole child spocing
N|wB0kN CAk| S!Ak!S B||0k| B|k!N
Newborn heollh core slorls long before birlh. l slorls
wilh coring for pregnonl nolhers. During pregnoncy
o nolher needs lo be odequolely nourished, free fron
infeclions, ond nonilored for conplicolions. Pregnonl
nolhers should olso hove occess lo prevenlive neo-
sures, lreolnenl when needed, ond heollh counsel-
ing/odvice, including educolion oboul donger signs.
During lobor ond delivery, energency obslelric core is
porliculorly crilicol lo lreol life-lhreolening conplico-
lions. 0ood core during pregnoncy, lobor, ond birlh is
lhe frsl slep in good newborn core.
Arteratal Care
l heollhy nolher is nosl likely lo hove o heollhy
full-lern boby who will survive. l nolher who is nol
heollhy during pregnoncy noy nol be oble lo neel oll
her boby`s needs. The gools of onlenolol core ore lo
keep lhe nolher heollhy, help prevenl problens like
low birlh weighl ond newborn infeclions, ond hove o
nornol delivery. 0urrenl reconnendolions include
o nininun of four visils slorling no loler lhon lhe
fourlh nonlh of pregnoncy.
0erloin onlenolol oclivilies con help prevenl specifc
newborn problens lsee exonples in chorl 1.1I.
Crarsel|r]
ndividuolized counseling ond heollh odvice ore lwo
inporlonl conponenls of core in lhe onlenolol period.
Pregnonl nolhers need heollh infornolion on severol
lopics, including nulrilion, prevenlion of sexuolly
lronsnilled infeclions lSTsI, breoslfeeding, plonning
for birlh, including possible conplicolions, ond fonily
plonning for ofler lhe birlh.
New|rrr Care Starts Befrre B|rt| 15
1
8]VeiZg&
8=6GI&#& ANTENATAL CAPE T0 PPEENT NEWB0PN PP0BLEH5
ANTENATAL CAPE ACTI0N
n Molernol innunizolion wilh lelonus loxoid
lsee lppendix lI
n Syphilis screening lwilh RPR or \DRLI ond
lreolnenl if posilive lsee lppendix B I
n Screening ond lreolnenl for olher sexuolly
lronsnilled infeclions
n Molorio prevenlion.
n nlernillenl prevenlive lreolnenl lPTI
for nolorio lsee lppendix BI
n Use of inseclicide-lreoled bed nels
n Screening for H\ ond onlirelrovirol lheropy in
pregnoncy, lobor, ond poslporlun if posilive lsee
seclion on nolher-lo-child lronsnission of H\I
n Screening ond lreolnenl for onenio ond hookworn
n Micronulrienl supplenenlolion lvilonin l, iron,
folole, iodineI
NEWB0PN PP0BLEH IT HAY PPEENT
n Neonolol lelonus
n lborlion, slillbirlh, congenilol syphilis
n Newborn gonococcol or chlonydio eye
infeclions, sepsis
n lborlion, prenolurily, low birlh weighl
n H\ lronsnission lo lhe felus or newborn
n Low birlh weighl
n Low birlh weighl, prenolurily, spinol
cord defecls, crelinisn
1 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
B|rt| Plar
l birlh plon is on oclion plon lhol is developed by lhe
wonon ond her fonily nenbers. l is sonelines
colled o birlh preporedness plon or o birlh ond
conplicolions plon. l is nol usuolly o wrillen docu-
nenl. Rolher, il is on ongoing discussion wilh lhe
wonon ond her fonily lo ensure lhol she ond her
boby will receive oppropriole core pronplly ol lhe
line of birlh ond if conplicolions orise before or ofler
lhe birlh. Hoving o birlh plon con nininize choos ol
lhe line of birlh ond increose lhe likelihood lhol lhe
wonon ond her boby will receive oppropriole, linely
core. The ideo of o birlh plon should be inlroduced
ol lhe wonon`s frsl onlenolol visil ond reviewed/up-
doled wilh her during relurn visils.
0ar]er S|]rs ar1 Crmpl|rat|rr kea1|ress
Though nosl pregnoncies ore nornol, il is essenliol
lhol lhe wonon ond lhe fonily recognize when sone-
lhing is wrong. They olso need lo be prepored lo loke
quick ond oppropriole oclion if lhere is o conplico-
lion or on energency. During her onlenolol visils, lhe
heollh worker con work wilh lhe wonon ond her fon-
ily lo plon for possible conplicolions. When o nolher
develops o conplicolion during pregnoncy, bolh her
life ond lhe boby`s life noy be in donger. Donger signs
indicole serious or life-lhreolening problens ond
lhe urgenl need for nedicol core, ond lhey should be
inlroduced ol lhe frsl visil ond reinforced lhroughoul
lhe pregnoncy. ldvise lhe wonon ond her fonily lo
seek core innediolely, doy or nighl, if she hos ony
donger sign. Renenber. lhere ore differenl donger
signs for pregnoncy, lobor, delivery, ond lhe poslno-
lol period.
!|e 1ar]er s|]rs tr lrrk frr |r pre]rarr are:
n Bleeding fron lhe vogino
n Severe heodoches/blurred vision
n 0onvulsions/loss of consciousness
n Severe obdoninol poin
n Fever
n Ruplured nenbrones wilhoul onsel of lobor
wilhin 18 hours
n Foul-snelling or yellowish/green/brown
voginol dischorge
n Loss of felol novenenl
/ovise le won~: ~:o
e: ~niy lo see ~:e
inneoi~ley, o~y o:
:iql, i se ~s ~:y
o~:qe: siq:
New|rrr Care Starts Befrre B|rt| 17
1
8]VeiZg&
HAKE PLAN5 F0P
Apprcpriate
pIace cf birtb
and referraI
5kiIIed
attendant
Transpcrtaticn
Needed items
FamiIy and
ccmmunity
suppcrt
Ccsts
WRAT T0 INCLUDE
Depending on lhe wonon`s condilion ond siluolion, lhe heollh worker noy need lo
reconnend birlh in o specifc level of heollh core focilily, or sinply supporl lhe wonon
in giving birlh where she chooses. The nolher olso needs help in idenlifying on
oppropriole focilily lo go lo if donger signs orise.
The heollh worker should discuss lhe need for o skilled birlh ollendonl, if possible,
soneone lroined lo ensure lhol lobor ond delivery progress nornolly ond lo nonoge
conplicolions if lhey orise. The wonon olso needs lo know how lo conlocl lhe skilled
ollendonl or focilily when needed.
The heollh worker should help lhe fonily plon how lo hove lronsporlolion ovoiloble
even ol odd hours ond in bod weolher. They noy need lo noke odvonce orrongenenls
wilh o vehicle owner.
Fcr tbe mctber. sonilory pods/clolhs, soop, cleon clolhes.
Fcr tbe newbcrn. new rozor blode, cord lies, blonkels, diopers, clolhes.
Fxploin why il is inporlonl lo keep ilens cleon ond logelher for eosy relrievol.
The fonily needs lo discuss ond orronge in odvonce for.
n l conponion of lhe nolher`s choice lo supporl her during birlh
n Soneone lo core for lhe fonily ond household in lhe nolher`s obsence
n How lo noke decisions if lhe noin fonily decision-noker is obsenl in on energency
n ln oppropriole blood donor who will be ovoiloble in cose of on energency
n How lo occess connunily resources ond supporl
The heollh worker should discuss lhe need lo hove noney ovoiloble lond how nuchI
for such lhings os.
n Tronsporlolion, if needed
n Poying for lhe birlh ollendonl ond/or focilily services
8=6GI&#' BIPTR PLAN
18 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
|a|rr ar1 0el|er Care
deolly every birlh should be ollended by o skilled
provider, lroined ond equipped lo hondle conplico-
lions. Unforlunolely, lhis is for fron possible ol lhe
presenl line. Mony counlries suffer fron severe
shorloges of lroined nolernol-newborn core profes-
sionols. The few nidwives, nurses, obslelricions, ond
pediolricions lhol ore ovoiloble ore usuolly ossigned
lo referrol cenlers lo noke lhe besl use of lheir skills.
These skilled providers usuolly core for wonen ond
bobies wilh conplicolions or problens. The no|orily
of nornol birlhs ond newborn core loke ploce ol hone
wilhoul lroined providers ond in prinory core cenlers.
Regordless of lhe ploce of birlh, oll personnel who
ollend birlhs ond core for newborns should use cleon
delivery proclices ond hove lhe knowledge ond skills
lo provide essenliol core lo every boby, including rec-
ognilion ond referrol of problen coses.
Partr]rap|
The porlogroph is o sinple chorl used lo nonilor
lobor ond lhe condilion of nolher ond boby during lo-
bor ond delivery. l includes o groph for recording lhe
progress of lobor over line. llerl ond lclion lines
prinled on lhe groph enoble lhe birlh ollendonl lo
eosily idenlify when lobor is nol progressing nornolly.
f o wonon`s progress crosses one of lhese lines, il
neons lhol sonelhing is wrong ond lhol she needs
pronpl ollenlion ond, in sone coses, lifesoving oclion.
Birlh ollendonls ol oll levels should be loughl lo use
lhe porlogroph lo noke decisions oboul lhe nonoge-
nenl of lobor ond birlh, especiolly when lronsporl lo o
referrol cenler noy be long or coslly.
Nrt|ertrC||l1 !rarsm|ss|rr rf N|\
Molher-lo-child lronsnission lMT0TI is lhe biggesl
source of H\ infeclion in young children. n resource-
liniled counlries, il is eslinoled lhol opproxinolely
OO,OOO H\-infecled infonls ore born eoch yeor lol
leosl 1,OO every doyI. Forlunolely, reseorch hos be-
gun lo show us woys lo prevenl lhis infeclion.
Molher-lo-child lronsnission con hoppen in lhree woys.
n During pregnoncy
n During childbirlh
n Through breoslfeeding
Wilhoul prevenlive oclions, oboul 35 oul of 1OO infonls
born lo H\-posilive nolhers will conlrocl lhe virus
lhrough MT0T. lboul 15 of lhese 35 ore infecled
lhrough breoslfeeding. For infornolion on how lo
reduce lhe risk of MT0T lhrough breoslfeeding, see
chopler 3.
0erloin core proclices con dininish lhe risk of MT0T
during pregnoncy, lobor, delivery, ond lhe innedi-
ole newborn period. UNlDS, WH0, ond UN0FF hove
been lhe leoders in developing guidelines for MT0T
inlervenlion progrons. Their reconnendolions en-
phosize volunlory counseling ond lesling l\0TI during
onlenolol core, sofe delivery proclices, counseling on
breoslfeeding oplions for H\-posilive wonen, ond
where ovoiloble, shorl-course onlirelrovirol drug lher-
opy for H\-posilive nolhers ond/or lheir newborns.
\olunlory counseling ond lesling is on inlernolionolly
occepled course of oclion for o person who wonls lo
fnd oul his or her H\ slolus. \olunlory neons lhol
lhe nolher, nol lhe heollh provider, decides whelher
or nol lo hove lhe lesl. Supporl lhe nolher in wholev-
er decision she nokes. f lesled, lhe nolher will hove
lhe chonce lo discuss lhe lesl wilh o lroined counselor
before ond ofler lhe resulls. Molhers who lesl posilive
will olso need oddilionol counseling on breoslfeeding
oplions ond drug lheropy.
Sofe delivery proclices which prolecl lhe boby involve
ovoiding invosive procedures whenever possible ond
include.
n No orlifciol ruplure of nenbrones lo
shorlen lobor
n No rouline episiolonies
n No use of vocuun exlroclion ond forceps for
delivery, unless obsolulely necessory
n No rouline suclioning of lhe newborn
New|rrr Care Starts Befrre B|rt| 1?
1
8]VeiZg&
Sofe delivery proclices designed lo prolecl heollh work-
ers, nolhers, fonily nenbers, ond olso bobies include.
n Use of slondord precoulions lhondwoshing ond
weoring of gloves, eye proleclion, ond proleclive
opronsI ol every delivery
n Prevenling blood sproying fron lhe unbilicol
cord during culling
n Sofe hondling ond disposol of lhe plocenlo
n Slringenl opplicolion of infeclion prevenlion
guidelines in lhe birlh selling. proper decon-
loninolion, cleoning, ond high-level disinfeclion
or slerilizolion of equipnenl, sofe disposol
of wosles
l wonon con be infecled for severol nonlhs before
her H\ lesl lurns posilive. l is inpossible lo know for
cerloin lhol soneone does nol corry lhe virus. There-
fore, use sofe delivery proclices ol ever, birlh.
n oddilion, wonen who ore known lo be H\ posi-
live should receive onlirelrovirol llR\I lheropy lif
ovoiloble ond indicoledI during pregnoncy, lobor, ond
poslporlun. Their newborns should olso receive lR\
drugs during lhe frsl doys of life. Follow your counlry
prolocols. Becouse lhis is such o new oreo of concern,
specifc onlirelrovirol lreolnenl guidelines chonge
ropidly os new reseorch unfolds. For lhe nosl cur-
renl reconnendolions, see o lisling of websiles in lhe
generol references ol lhe end of lhis chopler.
0ar]er S|]rs 0ar|r] |a|rr ar1 0el|er
0erloin conplicolions of lhe lobor ond birlh process
con lhreolen lhe life of lhe nolher or lhe unborn boby.
lll pregnonl wonon ond fonilies should be loughl
lo recognize lhe following donger signs ond lo seek
heollh core innediolely if ony of lhese signs oppeor.
!|e 1ar]er s|]rs |r la|rr ar1 1el|er are:
n Prolonged lobor over 12 hours
n Lobor before lhe conplelion of lhe eighlh nonlh
of pregnoncy l37 weeksI
n Boby in on obnornol posilion lbreech, lronsverseI
n \oginol bleeding
n Severe heodoche/visuol dislurbonces/
convulsions lflsI
n Fever ond/or foul-snelling voginol dischorge
\ou:l~:y ou:sei:q ~:o
lesli:q is ~: i:le::~lio:
~y ~eleo ou:se o
~lio: o: ~ e:so: wo
w~:ls lo :o oul is o:
e: \ sl~lus
2O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
5I6N 0F FETAL DI5TPE55
Felol heorl role below 12O or obove 1O
when lhe wonon is nol in lobor
Felol heorl role below 1OO or obove 18O
Thick neconiun-sloined fuid
ACTI0N T0 TAKE
lJentif, unJ treut possib|e muternu| cuuses us puick|, us possib|e.
f lhe heorl role does nol relurn lo nornol, focililole innediole
referrol.
lmmeJiute|, increuse ox,en to the bub,:
n Help lhe wonon chonge her posilion lshe should nol lie
on her bockI.
n 0ive her oxygen if ovoiloble l/- L per ninuleI.
n 0ive lhe wonon fuids by noulh ond/or \.
n Disconlinue oxylocin drip, if opplicoble.
0uick|, iJentif, unJ treut the unJer|,in cuuse of fetu| Jistress,
if possib|e.
0heck fetu| heurt rute uuin, if sti|| not normu|:
n Refer innediolely lo o higher-level of core.
n f referrol is nol feosible, deliver lhe boby os quickly os possible
ond, ol lhe sone line, prepore lo resuscilole.
lf fetu| heurt rute is ubnormu|, proceeJ us ubove.
f heorl role is nornol.
n Monilor closely.
n Prepore lo suclion lhe boby os soon os lhe heod is delivered.
n Prepore for possible resuscilolion lsee chopler /I.
8=6GI&#( 5I6N5 0F FETAL DI5TPE55
New|rrr Care Starts Befrre B|rt| 21
1
8]VeiZg&
|etal 0|stress 0ar|r] |a|rr
Birlh ollendonls should nonilor lhe condilion of lhe
boby during lobor by counling lhe felol heorl role lsee
lppendix DI ol frequenl regulor inlervols levery 15-3O
ninulesI during lobor ond delivery, ond by observing
lhe color of lhe onniolic fuid.
l nornol felol heorl role is oboul 12O-1O beols per
ninule, bul noy vory fron 1OO-18O, especiolly during
conlroclions. l nornol felol heorl role noy slow dur-
ing o conlroclion bul relurns lo nornol when lhe con-
lroclion is over. Lislen lo lhe felol heorl role lhrough
ol leosl lhree conlroclions lor for one full ninule if
lhe wonon is nol in loborI lo delernine if lhe role is
nornol.
l felol heorl role below 1OO or obove 18O is o sign lhol
lhe boby is in dislress. Felol dislress is on energency
ond needs lo be lreoled quickly or lhe boby will die or
suffer broin donoge.
S|]rs rf fetal 1|stress |rrla1e:
n Felol heorl role less lhon 12O or obove 1O
before lobor begins
n Felol heorl role below 1OO
n Felol heorl role obove 18O
n Thick neconiun-sloined onniolic fuid
Naterral 0ar]er S|]rs |r t|e Prstpartam Per|r1
lfler lhe birlh, lhe boby conlinues lo depend on her
nolher for core, nourishnenl, ond proleclion fron
infeclion in order lo survive. 0erloin poslporlun con-
plicolions lhreolen lhe life of lhe nolher. n focl, nosl
nolernol norlolily occurs during lhe poslporlun pe-
riod. f lhe nolher should die, lhe boby`s risk of dying
increoses signifconlly, lo oboul 1O lines lhe risk for
o boby whose nolher did nol die. To help prevenl lhis
leoch nolhers ond fonilies lo recognize poslporlun
donger signs ond, os olwoys, lo seek core innediolely
if o donger sign develops.
Naterral 1ar]er s|]rs tr lrrk frr |r t|e prstpartam per|r1
n Heovy voginol bleeding
n lbdoninol poin, fever, ond/or foul-snelling
voginol dischorge
n Severe heodoche, visuol dislurbonces,
convulsions lflsI
n Hol, red, poinful oreo or lunp in breosl ond fever
C||l1 Spar|r]
Reseorch hos shown lhol when wonen spoce lheir
pregnoncies ol leosl 3-5 yeors oporl, lhe survivol of
lheir newborns ond children increoses dronolicolly.
Molhers who spoce lheir pregnoncies inprove lheir
own heollh ond nulrilionol slolus os well os lhe heollh
of lheir children. 0ood nolernol nulrilion increoses
lhe chonces lhol subsequenl bobies will be heollhy.
0ounseling oboul nulrilion, fonily plonning nelhods,
ond birlh spocing is lherefore on inporlonl porl of
nolernol core ofler delivery.
22 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
TA5K5 F0P ALL REALTR W0PKEP5: NEWB0PN CAPE 5TAPT5 BEF0PE BIPTR
Slorl newborn core before birlh.
1 Prevenl newborn problens by providing onlenolol core.
n Molernol lelonus innunizolion
n Molorio prevenlion lPT, bed nelsI
n Screening ond lreolnenl for STs
n Screening for H\ ond prevenlion of nolher-lo-child lronsnission of H\
wilh onlirelrovirol lheropy
n Screening ond lreolnenl for onenio, hookworn
n Micronulrienl supplenenlolion in pregnoncy lvilonin l, iron, folole, iodineI
2 Teoch wonen ond fonilies oboul donger signs in pregnoncy, lobor ond
delivery, poslporlun, ond in lhe newborn.
3 Help wonen ond fonilies noke birlh plons.
/ Pronole occess lo ond use of skilled providers for delivery core.
5 Use porlogrophs lo nonilor lobor ond lo idenlify wonen ond bobies who
need pronpl inlervenlion lo sove lheir lives.
Monilor felol condilion during lobor by lislening lo lhe felol heorl role ond by
observing lhe color of lhe onniolic fuid, ond ocl when lhere is o problen.
7 Pronole child spocing.
ereral kefererres
Kinzie B ond 0onez P. l2OO/I. 8usic Huternu| unJ Newborn 0ure:
/ 0uiJe for Ski||eJ ProviJers. Bollinore, MD. MNH Progron/JH-
PF00.
World Heollh 0rgonizolion. l1??I. Perinolol Morlolily. o lisling
of ovoiloble infornolion. 0enevo. WH0. lWH0/FRH/MSM/?.7I
World Heollh 0rgonizolion. l2OOOI. Hunuin 0omp|icutions in
Prenunc, unJ 0hi|Jbirth: / uiJe for miJwives unJ Joctors.
0enevo. WH0. lWH0/RHR/OO.7I
World Heollh 0rgonizolion. l2OO1I. /ntenutu| 0ure RunJomizeJ
7riu|: Hunuu| for the lmp|ementution of the New HoJe|. 0enevo.
WH0. lWH0/RHR/O1.3OI
World Heollh 0rgonizolion. l2OO/I. Scu|in up untiretroviru| theru-
p, in resource |imiteJ settins-200J Revision. 0enevo. WH0.
World Heollh 0rgonizolion. l2OO/I. /ntiretroviru| Jrus unJ the
prevention of mother-to-chi|J trunsmission of Fl\ infection in
resource-construineJ settins. Reconnendolions for use, 2OO/
Revision lDRlFTI. 7 Jonuory 2OO/. 0enevo.WH0
|rterret kefererres
For lhe nosl currenl reconnendolions on onlirelrovirol
lreolnenl ond MT0T, regulorly visil lhe following websiles.
www.who.inl/reproduclive-heollh/rlis/nlcl
www.unoids.org
www.unicef.org/oids
www.who.inl/reproduclive-heollh/rlis/neviropine.hln
|for informution on use of nevirupinel
www.oidsinfo.nih.gov/guidelines
|for informution on use of ziJovuJine j/Z7jl
2
Esse:li~ C~:e Fo: Eve:y ewLo::
2
>cigdYjXi^dc '(
:hhZci^VaCZlWdgc8VgZDkZgk^Zl '*
EgZeVgZ[dgV7VWnh7^gi] '*
>bbZY^ViZ8VgZVi7^gi] '.
CZlWdgc8VgZ9jg^c\i]Z;^ghi9Vn ('
CZlWdgc=^hidgnVcY
E]nh^XVa:mVb^cVi^dc ((
8VgZd[VCZlWdgc9jg^c\i]Z
;^ghi'-9Vnh )'
IZVX]VcY8djchZaV
Bdi]ZgVcY;Vb^an
6WdjiCZlWdgc8VgZ *%
|ssert|al Care frr |er New|rrr 23
2
8]VeiZg'
/l Li:l le :ewLo:: nusl ~o~l quiy lo
ie oulsioe le ule:us Te :ewLo::s Looy
nusl n~e n~:y ~:qes, wi Leqi: ~l
Li:l ~:o o:li:ue l:ouqoul le :ewLo::
e:ioo Te :sl ~:o nosl ino:l~:l
~:qe is lo sl~:l L:e~li:q 0le: ~:qes
~:e. :equ~li:q is ow: Looy lene:~lu:e,
eeoi:q, ~:o oeveoi:q le ~Liily lo ql
i:elio:s innu:e syslenl
Te :sl wee ~:o no:l o le :ewLo::s
ie ~:e ~ line o :is Mo:e l~: ~ o ~
:ewLo:: oe~ls ~e: i: le :sl seve:
o~ys, ~:o ~louq le :is o oe~l oe
:e~ses ~s line ~sses, eve:y :ewLo::
:eeos ~:eu ~lle:lio: ou:i:q le :sl
no:l o ie
\e: le :ewLo:: ~s :eove:eo :on
Li:l ~:o is w~:n ~:o L:e~li:q :o:n~y,
le nole: ~:o ~niy sl~:l lo l~e ove: le
L~Lys ~:e le ~e o Li:l w~s le
one, n~e su:e le nole: is ~Le lo
~:e o: ~:o eeo le L~Ly Leo:e you e~ve
len Li:l loo ~e i: ~ e~l ~:e
~iily, oo le s~ne le~i:q ~:o ou:se
i:q Leo:e le nole: ~:o L~Ly qo one
2 Esse:li~ C~:e Fo: Eve:y ewLo::
2/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Newborn core lokes ploce in hones, heollh core focil-
ilies lheollh cenlers or hospilolsI, ond in lhe connu-
nily. ls o heollh worker who ollends birlhs ond cores
for newborns, you will be oble lo sove newborn lives,
ossess lhe boby`s heollh, ond provide core lo neel lhe
boby`s needs. You will olso help nolhers ond fonilies
leorn lo core for lheir newborns, recognize problens,
ond gel oppropriole core.
n lhis chopler you will fnd infornolion oboul.
n Fssenliol newborn core lwhol il includes,
purpose, when ond where lo give coreI
n Preporolions for o birlh linfeclion prevenlion,
environnenl, resuscilolion equipnenl, supplies
including nedicinesI
n nnediole core of o newborn ldry, ossess,
worn, breoslfeed, cord core, eye coreI
n lssessnenls ond core of o newborn during lhe
frsl 28 doys
n Nornol ond obnornol boby exoninolion fndings
n Whol porenls need lo know oboul essenliol
newborn core.
n Needs of bobies fron birlh lo 28 doys
n How lo keep lhe boby worn
n How lo prolecl lhe boby fron infeclion
n How lo bolhe lhe newborn
n How lo core for lhe cord ond unbilicus
n Whol innunizolions lhe newborn needs
ond when
n How ond why lo proclice exclusive breosl-
feeding
n The breoslfeeding nolher`s need for vilonin l
n How lo recognize newborn donger signs
n lhis chopler you will leorn lo do lhe following.
n Prepore lhe roon for cleon birlh
n 0olher lhe equipnenl, supplies, ond nedicines
needed for innediole newborn core
n 0ive innediole core ol birlh.
n Dry ond slinulole lhe newborn
n lssess lhe boby`s breolhing ond color
n Pul lhe newborn in skin-lo-skin conlocl wilh
lhe nolher ond keep lhe boby worn
n Help lhe nolher slorl breoslfeeding wilhin
lhe frsl hour
n Tie ond cul lhe cord
n 0ive eye core
n lssess ond core for o newborn during lhe
frsl doy
n Do lhe frsl newborn physicol exoninolion
n lssess ond core for lhe newborn during lhe frsl
28 doys lol 2-3 doys, 7 doys, ond 28 doysI
n Teoch ond counsel lhe nolher ond fonily oboul
core of lhe newborn ond donger signs
n Supporl ond leoch lhe nolher ond fonily oboul
breoslfeeding
n Teoch ond counsel lhe nolher ond fonily
oboul core of o boby wilh obnornol exoninolion
fndings
|ssert|al Care frr |er New|rrr 25
2
8]VeiZg'
|SS|N!|A| N|wB0kN CAk| 0\|k\||w
Mosl bobies ore born heollhy ond ol lern. The core
lhey receive during lhe frsl hours, doys, ond weeks of
life con delernine whelher lhey renoin heollhy. ll-
lhough sone bobies noy require speciol ollenlion lfor
exonple, lhose who ore sick or prenolureI, oll bobies
need bosic core lo help ensure lheir survivol ond well-
being. This bosic core is colled essenliol newborn core
lFN0I ond includes.
n nnediole core ol birlh
n 0ore during lhe frsl doy
n 0ore up lo 28 doys
The noin purpose of essenliol newborn core is lo
keep every boby heollhy. This neons.
n Helping lhe nolher neel lhe boby`s bosic needs
lwornlh, nornol breolhing, feeding, infeclion
prevenlionI
n Moking sure lhe boby breoslfeeds wilhin lhe
frsl hour
n ldvising/encouroging lhe nolher lo breoslfeed
exclusively
n Delecling signs of problens so lhol eorly oclion
con be loken
n ldvising lhe nolher ond fonily oboul boby core
ond donger signs
n Moking plons for conlinuing core linnunizolions,
growlh noniloringI
Tbe same IeveI and quaIity cf essentiaI newbcrn care
can be given aImcst anywbere, by famiIies and by
beaItb wcrkers.
Pk|PAk| |0k A BAB'S B|k!N
f you ore lhe heollh provider who cores for o wonon
in lobor, you need lo prepore for lhe birlh. Whelher
you ore in o hone or in o heollh core focilily, lhe
preporolions ore olnosl lhe sone.
l is inporlonl lo prepore lhe environnenl, equip-
nenl, ond supplies lhol ore needed for lhe core of o
newborn ol birlh. Then you will be reody lo prevenl
problens such os infeclions ond low lenperolure
lhypolhernioI ond you will be reody lo ocl quickly lo
lreol problens such os osphyxio llrouble breolhing
or gelling enough oxygenI. Your preporolion should
include lhe following oclions.
Preert |rfert|rr
lccording lo lhe World Heollh 0rgonizolion, oboul 32
percenl of newborn deolhs ore coused by infeclion.
Where hygiene is poor, newborns noy becone infecl-
ed wilh boclerio or olher orgonisns which con couse
serious infeclions in lhe skin, unbilicol cord, lungs,
goslroinleslinol lrocl, broin, or blood. Therefore, pre-
venling infeclion is essenliol lo newborn core.
1,2
nfeclion prevenlion proclices help prevenl lronsnis-
sion of infeclion lo or fron lhe boby, nolher, or heollh
worker. They reduce lhe risk of possing diseoses
such os hepolilis B ond H\/lDS. Use lhe following
infeclion prevenlion proclices for every conlocl wilh o
nolher or boby.
n Wosh your honds oflen. Hondwoshing is lhe eosi-
esl ond nosl effeclive woy lo prevenl possing gerns.
n 0onsider every person os possibly infeclious.
n Use lhese lhree infeclion prevenlion sleps lo
prepore equipnenl, supplies, linens, ond surfoc-
es before lhe boby is born.
n Deconloninolion
n 0leoning
n High-level disinfeclion or slerilizolion
n Weor gloves when louching onylhing wel.
broken skin, nucous nenbrones, blood, or
olher body fuids.
n Prolecl yourself fron sploshes or spills of blood
ond onniolic fuid, weor eye proleclion, shoes, o
focenosk, ond on opron.
n Dispose of wosles sofely lplocenlos, blood,
needles, ond olher shorp equipnenl such os
blodes or broken glossI.
nfeclion prevenlion proclices ore exploined in deloil
in lppendix 0.
2 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Keep kerrr1s
Hove o pen ond lhe following forns reody for record-
ing infornolion when you core for lhe nolher ond
boby.
n Newborn record cord
n nnunizolion cords
n Molher`s records of onlenolol core, lobor, ond
delivery
Fvery birlh should be recorded. This includes slill-
birlhs ond bobies who die in lhe eorly newborn period,
whelher ol hone or in o focilily.
Crllert t|e |a|pmert, Sappl|es, ar1 Ne1|r|res
Prepore lhe equipnenl ond supplies for lhe birlh
roon ond innediole poslnolol core lisled in chorl 2.1
on lhe nexl poge.
Prepare t|e B|rt| krrm
Prepore lhe roon for birlh in lhe hone or lhe heollh
focilily. Moke sure lhe roon is.
CIean. Use lhe lhree infeclion prevenlion sleps lde-
scribed in lppendix 0I lo prepore lhe roon, equip-
nenl, ond supplies.
Warm. The lenperolure of lhe roon should be worn,
heol lhe roon, if il is cold, ond close doors or windows
lo prevenl drofls.
Ligbt. The heollh worker nusl be oble lo see lhe
newborn lo check color ond breolhing. f lhere is nol
enough nolurol lighl, use condles, o lonp, or onolher
lighl source.
Private. n lhe hone lel lhe nolher decide who will
be presenl for lhe birlh. Provide os nuch privocy os
possible by using curloins ond/or closing doors ond
windows os needed. n o heollh focilily use o curloin
or screen lo give lhe nolher privocy. f possible, ollow
her lo hove lhe supporl of lhe person of her choice
during lhe focilily birlh.
|ssert|al Care frr |er New|rrr 27
2
8]VeiZg'
8=6GI'#& E0UIPHENT AND 5UPPLIE5 F0P TRE BIPTR P00H AND IHHEDIATE P05TNATAL CAPE
Furniture
o Bed or nol for lhe nolher
o 0leon surfoce or ploce for lhe equipnenl
o 0lock or wolch wilh second hond
o Lighl source
Linens fcr mctber
o Bed linen ond worn blonkels
o Mocinlosh or ploslic sheel lo pul under lhe
nolher
o Fxlro clolhs lo use os perineol pods
o 0leon clolhes for ofler lhe birlh
Linens fcr baby
o l clolh or lowel for drying lhe newborn
o Worn clolhs for covering lhe newborn
o 0leon boby clolhes
Infecticn preventicn equipment and suppIies
o 0leon running woler lfron o lop or pilcherI, soop,
ond hond lowel
o 0leoning clolhs
o O.5% chlorine solulion, for deconloninolion
lsee lppendix 0I
o 0overed conloiner for wosle disposol
o Punclure-resislonl conloiner for shorps disposol
o 0ne or lwo buckels for housekeeping
o l snoll brush for cleoning inslrunenls
o 0loves
o Slove ond fuel
o Pol for boiling woler
Birtbing equipment and suppIies
o Proleclive clolhing. gloves lcon be cleon or
slerileI, opron, eye proleclion
o Fquipnenl ond supplies lo do newborn resuscilolion
lsee chopler /I
o Delivery kil conloining cord lies, lwo cord clonping
inslrunenls lif ovoilobleI, ond new or cleon
lboiledI rozor blode or slerile scissors for culling
lhe cord
o Felol slelhoscope
o 0onloiner for lhe plocenlo
o Scole lo weigh lhe newborn if ovoiloble
o 0ouze pods
o Fye drops or oinlnenl
o 0xylocin lif ovoilobleI
28 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
8=6GI'#' 5TEP5 F0P IHHEDIATE
NEWB0PN CAPE
5tep 1 Dry ond slinulole lhe boby.
5tep 2 lssess lhe boby`s breolhing ond color.
5tep 3 Decide if lhe boby needs resuscilolion.
Sleps 1-3 oll hoppen ol olnosl lhe sone line
5tep Tie ond cul lhe cord.
5tep 5 Ploce lhe boby in skin-lo-skin conlocl
wilh lhe nolher
5tep Hove lhe nolher slorl breoslfeeding.
5tep 7 0ive eye core.
Prepare tr Preert Neat |rss
Newborns lose heol ropidly ofler birlh. Leoving lhe
wornlh of lhe ulerus, lhe wel newborn loses heol in-
nediolely os he od|usls lo nuch colder surroundings.
Heol loss noy leod lo hypolhernio ond lhe risk of
deolh. The birlh ollendonl nusl be prepored lo keep
lhe newborn worn ol birlh ond lo prevenl heol loss.
This is inporlonl in worn clinoles os well os cool
clinoles.
Newborns hove innolure lenperolure-reguloling
syslens. They connol regulole lheir lenperolure like
odulls con. Therefore, lhey oflen hove diffcully noin-
loining o nornol body lenperolure. They lose body
heol quickly if lhey ore wel, uncovered, exposed lo
drofls, or if lhey ore ploced on or neor o cool surfoce.
3

Think oboul lhis ond plon for il before lhe birlh so you
con prevenl il fron hoppening.
!|e warm C|a|r
/
n Keep lhe birlhploce worn, ol leosl 25 0 l77 FI,
ond ovoid drofls. Worn lhe roon before lhe
boby is born.
n nnediolely ofler lhe birlh, dry lhe boby wilh
o worn lowel. Mosl cooling hoppens in lhe frsl
ninules ofler birlh. n lhe frsl 1-2 ninules,
lhe newborn noy lose enough heol for his body
lenperolure lo foll 2 0, which is very dongerous.
n Keep lhe boby lying on lhe nolher`s obdonen
or chesl for oll core. f lhis is nol possible, pul
lhe boby on o worn surfoce ond keep lhe boby
covered.
n Pul lhe boby in skin-lo-skin conlocl wilh lhe
nolher for ol leosl 2 hours ofler birlh. 0over
bolh wilh o worn clolh.
n Help lhe nolher breoslfeed lhe boby os soon os
possible, bul ol leosl wilhin one hour of birlh.
n Woil for ol leosl hours ond preferobly 2/, lo
bolhe lhe boby. Woil longer if. 1I lhe boby feels
cold or lhe oxillory lenperolure is below 3 0
l?.8 FI, 2I lhe environnenl is cold, 3I lhe new-
born is low birlh weighl, or /I lhe boby is unwell.
n Dress lhe boby in lighl, loose, worn clolhing. l
boby needs ol leosl 1-2 nore loyers lhon on
odull in lhe sone clinole. The nunber of loyers
depends on roon wornlh. lboul 25 percenl of
lhe boby`s heol loss con cone fron lhe heod,
so cover lhe boby`s heod wilh o hol or clolh.
Loslly, cover lhe boby wilh o lighl, worn cover
or blonkel.
|ssert|al Care frr |er New|rrr 2?
2
8]VeiZg'
;><JG:'#& DPYIN6 TRE NEWB0PN
1. Dry lhe boby`s body
2. Dry lhe boby`s heod well
3. Discord lhe wel clolh
/. Wrop lhe boby in o cleon, dry clolh,
covering heod
n l is inporlonl lhol on infonl sloys worn
lhroughoul lhe newborn period. Keep lhe
nolher ond boby logelher in o worn roon ond
encouroge breoslfeeding on denond.
n Keep lhe boby worn during lronsporlolion, if
referred. Pul lhe boby skin-lo-skin wilh lhe
nolher or onolher odull ond cover bolh wornly.
The boby`s lenperolure should be checked dur-
ing lhe referrol, if possible.
n Teoch bolh heollh workers ond fonilies oboul
lhe risks of low lenperolure/hypolhernio ond
how lo prevenl il.
|NN|0|A!| CAk| A! B|k!N
Mosl bobies breolhe ond cry ol birlh wilh no help. The
core you give innediolely ofler birlh is sinple bul
inporlonl. Renenber lhol lhe boby hos |usl cone fron
lhe nolher`s ulerus. l wos worn ond quiel in lhe uler-
us, ond lhe onniolic fuid ond wolls of lhe ulerus genlly
louched lhe boby. You loo should be genlle wilh lhe boby
ond keep lhe boby worn. Skin-lo-skin conlocl wilh lhe
nolher keeps lhe boby ol lhe perfecl lenperolure.
n lhe following poges you will fnd lhe sleps of inne-
diole core which should be given lo oll bobies ol birlh.
Sleps 3 ond / will be inlerrupled by resuscilolion if
lhe boby needs help lo slorl breolhing. nnediole
core for lhe nolher includes delivery of lhe plocenlo
os soon os possible ofler lying ond culling lhe cord.
Monilor lhe nolher`s condilion closely in lhe ninules
ond hours ofler lhe birlh.
Step J. 0r ar1 St|malate t|e Ba|
Dry lhe boby, including lhe heod, innediolely. Rub up
ond down lhe boby`s bock, using o cleon, worn clolh.
Do your besl nol lo renove lhe vernix llhe creony,
while subslonce which noy be on lhe skinI os il pro-
lecls lhe skin ond noy help prevenl infeclion.
Step I. Assess t|e Ba|'s Breat||r] ar1 Crlrr
ls you dry lhe boby, check lo see if lhe boby is.
1I breolhing, 2I hoving lrouble breolhing, or 3I nol
breolhing. Look ol lhe boby`s color. The foce ond chesl
3O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
;><JG:'#' CUTTIN6 TRE C0PD
should be pink, nol groy or blue. n dorker-skinned
bobies, you con ossess lhe color of lhe longue, lips,
ond nucous nenbrones, lhey should be pink, nol
groy or blue. l boby`s pink skin color is o good sign
of odequole breolhing ond circulolion. l blue color of
lhe longue, lips, ond lrunk is o sign of o lock of oxygen
in lhe blood. l bluish color of only lhe honds ond feel
noy be presenl for 1-2 doys ofler birlh ond usuolly
does nol indicole o lock of oxygen.
Step 1. 0er|1e |f t|e Ba| Nee1s kesasr|tat|rr
f lhe boby is nol breolhing, is breolhing less lhon 3O
breolhs per ninule, or is gosping, he needs resuscilo-
lion. n lhol cose, quickly clonp or lie ond cul lhe cord,
leoving o slunp ol leosl 1O cn long for now. Pul lhe boby
on o fol, worn surfoce ond slorl resuscilolion quickly.
0oll for help becouse o second person is needed lo core
for lhe nolher lsee chopler /, Newborn ResuscilolionI.
f lhe boby does nol need resuscilolion, go on lo lhe
nexl sleps.
Step /. !|e ar1 Cat t|e Crr1
1. Tie lor clonpI lhe cord securely in lwo ploces.
n Tie lhe frsl one lwo fngers owoy fron lhe
boby`s obdonen.
n Tie lhe second one four fngers owoy fron lhe
boby`s obdonen.
2. 0ul lhe cord belween lhe lies.
n Use o new rozor blode, or o boiled one if il
hos been used before, or slerile scissors.
n Use o snoll piece of clolh or gouze lo cover
lhe porl of lhe cord you ore culling so no
blood sploshes on you or on olhers.
n Be coreful nol lo cul or in|ure lhe boby. Filher
cul owoy fron lhe boby or ploce your hond
belween lhe culling inslrunenl ond lhe boby.
3. Do nol pul onylhing on lhe cord slunp.

Step E. Plare t|e Ba| |r Sk|rtrSk|r Crrtart
w|t| t|e Nrt|er
The wornlh of lhe nolher posses eosily lo lhe boby
ond helps slobilize lhe boby`s lenperolure.
|ssert|al Care frr |er New|rrr 31
2
8]VeiZg'
;><JG:'#( EAPLY INITIATI0N 0F
BPEA5TFEEDIN6
1. Pul lhe boby on lhe nolher`s chesl for skin-lo-
skin wornlh.
2. 0over bolh nolher ond boby logelher wilh o
worn clolh or blonkel.
3. 0over lhe boby`s heod.
The odvonloges of skin-lo-skin conlocl ore os follows.
n The nolher keeps lhe boby worn. Her body is
lhe perfecl lenperolure.
n The closeness belween lhe nolher ond lhe boby
helps lhe nolher becone olloched lo her boby.
n The conlocl helps noke eorly breoslfeeding
successful.
5,,7
f lhe nolher does nol wonl direcl skin-lo-skin con-
locl, dry ond wrop lhe boby. Moke sure lhe heod is
covered ond pul lhe boby nexl lo lhe nolher.
l is inporlonl lo deloy or defer lhe frsl bolh. The
boby should nol be bolhed ol birlh becouse o bolh con
cool hin dongerously. lfler o nininun of hours,
preferobly 2/ hours, he con hove his frsl sponge bolh,
if his lenperolure hos slobilized. lSee chorl 2.13 ond
Bolhing lhe Newborn on poge 52.I
Step . Nae t|e Nrt|er Start Breastfee1|r]
f everylhing is nornol.
1. Do nol seporole lhe nolher ond boby for
weighing unlil ofler lhe boby hos breoslfed.
2. Help lhe nolher begin breoslfeeding wilhin lhe
frsl hour of birlh.
8,?
l sludy of eorly breoslfeed-
ing found lhol nosl newborns were reody lo feed
belween 15 ond 55 ninules ofler birlh.
1O
3. Help lhe nolher ol lhe frsl feed lsee chopler
3I. Moke sure lhe boby hos o good posilion, ol-
lochnenl, ond suck. Do nol linil lhe line lhe
boby feeds, eorly ond unliniled breoslfeeding
gives lhe newborn energy lo sloy worn, nulrilion
lo grow, ond onlibodies lo fghl infeclion.
Step I. |e |e Care
Shorlly ofler breoslfeeding ond wilhin 1 hour ofler
birlh, give lhe newborn eye core wilh on onlinicrobiol
nedicolion lsee chorl 2.3 on poge 32I. Fye core pro-
lecls lhe boby fron serious eye infeclion.
32 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
N|wB0kN CAk| 0Uk|N !N| ||kS! 0A
The frsl doy of life is o line of nony chonges inside
lhe boby`s body. For lhol reoson coreful observolion
ond core ore inporlonl.
Assess t|e Ba|
lssess every 3O ninules lo 1 hour for ol leosl hours
or unlil lhe newborn is sloble ond sloys worn ond pink.
0heck lhe boby during lhe frsl doy for lhe following.
Breatbing. The nornol boby breolhes 3O-O lines
o ninule wilh no gosping, grunling, or indrowing
of lhe chesl.
Warmtb. 0heck if lhe boby is worn.
n Use o lhernoneler lo loke on oxillory
lenperolure or
n Feel lhe boby`s obdonen or bock wilh your
hond ond conpore his lenperolure lo lhol of o
well person.
CcIcr. 0heck lhol lhe longue, lips, ond nucous nen-
brones linside lhe noulhI ore pink.
BIeeding. 0heck lhe cord for bleeding. ls lhe cord
dries, lhe lie noy becone loose. f lhe lie is loose, pul
on gloves ond lie lhe cord ogoin lighlly.
lssessnenl of lhe boby on lhe frsl doy olso includes
o conplele hislory ond physicol, which ore described
on lhe nexl poge.
|e Nrrmal New|rrr Care
Keep lhe boby worn.
n 0onlinue lo keep lhe boby in skin-lo-skin
conlocl wilh lhe nolher.
n 0over bolh nolher ond boby wilh o blonkel.
n 0over lhe boby`s heod wilh o clolh or hol.
Supporl breoslfeeding.
n 0onlinue lo supporl ond leoch lhe nolher how
lo breoslfeed.
8=6GI'#( 5TEP5 F0P 6IIN6 EYE CAPE
1. Wosh your honds.
2. Use one of lhese eye core nedicolions.
n Silver nilrole solulion 1%, or
n Polyvidone-iodine solulion 2.5%, or
n Telrocycline 1% eye oinlnenl.
3. Hold one eye open ond ollow one drop of
nedicolion lo foll inlo lhe eye. f you ore us-
ing oinlnenl, pul o ribbon of oinlnenl olong
lhe inside of lhe lower eyelid. Moke sure nol
lo lel lhe nedicine dropper or lube louch
lhe boby`s eye or onylhing else.
/. Repeol lhis slep lo pul nedicolion inlo lhe
olher eye.
5. Do nol rinse oul lhe eye nedicolion.
;><JG:'#) PUTTIN6 0INTHENT IN TRE EYE
|ssert|al Care frr |er New|rrr 33
2
8]VeiZg'
Teoch lhe nolher ond lhe fonily.
n How lo check lhe boby`s breolhing, wornlh,
ond color
n How lo look for ony bleeding fron lhe cord
n How lo core for lhe cord
n How lo keep lhe boby worn
|e 0t|er Care frr Ar Prr|lems rr Nee1s
See.
n Newborn Physicol Fxoninolion. lbnornol
Findings ond Plon of lclion lchorl 2., poge 38I
n Teoch ond 0ounsel o Molher ond Fonily oboul
Newborn 0ore lpoge 5OI
n 0onnon Newborn Problens lchopler ,
poge 125I
|e \|tam|r K, t|e ||rst |mmar|tat|rrs, ar1 Crmplete t|e
Ba|'s ar1 t|e Nrt|er's kerrr1s
0n lhe doy of birlh, give vilonin K, 1 ng M. 0ive lhe
frsl innunizolions occording lo your counlry`s in-
nunizolion schedule ond prolocols. Reconnended
newborn innunizolions include.
n B00
n Polio
n Hepolilis B
These con oll be given on lhe doy of birlh or os soon
os possible. See lppendix l for nfonl nnunizolion
Schedule ond o lisl of websiles for up-lo-dole infor-
nolion.
Moke sure lhe birlh is recorded ond o birlh cerlifcole
is prepored. Record oll fndings ond lreolnenls, ond
record oll slillbirlhs ond eorly newborn deolhs.
N|wB0kN N|S!0k AN0
PNS|CA| |KAN|NA!|0N
!ake a N|strr
l heollhy nolher is very inporlonl for oplinol growlh
developnenl ond birlh of lhe infonl. The core o wonon
receives in pregnoncy, lobor, ond birlh will offecl lhe
heollh of lhe newborn. Therefore be sure lo check
lhe nolher`s records lif ovoilobleI. l is inporlonl lo
collecl infornolion on lhe nolher`s ond boby`s hislory
lo know if lhe boby needs speciol ollenlion ond lo help
delernine whol core lo give lhe newborn lsee chorl
2./I.
0r a P|s|ral |tam|rat|rr
The purpose of lhe physicol exon is lo fnd oul if lhe
boby is heollhy ond if lhe boby hos ony heollh needs or
problens. Woil unlil lhe boby is oble lo keep o nornol
body lenperolure llhe boby feels worn or hos on
oxillory lenperolure of 3-37 0 l?.8-?8. FI before
doing o newborn exoninolion. You con woil up lo
hours.
Before slorling lhe exon, prepore lhe following
equipnenl.
n Thernoneler
n Wolch or clock wilh o second hond
n Scole for weighing, if ovoiloble
n 0leon clolhes
n 0loves, if ovoiloble
3/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
8=6GI'#) RI5T0PY 0F TRE PPE6NANCY, BIPTR, AND IHHEDIATE NEWB0PN PEPI0D
lsk lhe nolher ond reod lhe nolher`s ond boby`s re-
cords lif ovoilobleI lo fnd lhe following infornolion.

1. lny nolernol heollh problens lhol noy offecl
lhe boby. Did lhe nolher receive lreolnenl for lhe
problen during pregnoncy? The boby noy need
loborolory lesls or lreolnenl. Look for.
n Tuberculosis
n Fever during lobor
n Bog of wolers broken nore lhon 18 hours
before delivery
n Molorio
n lny olher infeclions such os hepolilis B or 0
n Syphilis or olher sexuolly lronsnilled infeclions
n H\/lDS
2. The nelhod, line, ond ploce of delivery.
n Record lhe line ond ploce of delivery.
n f you suspecl lhe delivery did nol occur in
cleon condilions, look for signs of infeclion.
n f lhe boby did nol hove o nornol voginol
delivery in o cepholic presenlolion, look for
effecls of birlh lrouno.
n n cose of cesoreon or inslrunenlol delivery,
look for lhe effecls of lhe procedure or
oneslhelic nedicolions.
3. Wos lhe onniolic fuid yellow, brown, or green?
n f lhe onniolic fuid wos yellow, brown or
green, lhe boby noy hove ospiroled neco-
niun-sloined fuid during lhe birlh.
n Look for signs of respirolory diffcully, which
con be coused by neconiun ospirolion.
/. Wos newborn resuscilolion done?
n f yes, lhe boby is ol risk for respirolory
problens, hypolhernio, low blood sugor, sep-
sis, ond olher problens in lhe frsl hours ond
doys. The boby needs lo be corefully wolched
during lhis line.
5. Hos lhe boby possed slool or urine?
n The boby should poss urine ond neconiun
llhe frsl dork, slicky sloolI wilhin lhe frsl 2/
hours.
n f lhere is no slool or no urine, look for obdoninol
dislenlion ond signs of dehydrolion, ond check
lo see whelher lhe boby is sucking properly on
lhe breosl.
. How nony lines hos lhe boby breoslfed?
n The boby should feed ol lhe breosl ol leosl
eighl lines in 2/ hours lol leosl every 3 hoursI.
n l low birlh weighl boby needs lo feed nore
oflen, ol leosl every 2-2 1/2 hours.
7. Does lhe boby loke lhe breosl well ond suck
vigorously?
n Poor sucking is o newborn donger sign, il is
one of lhe frsl signs of newborn sepsis.
n The nolher noy need help leorning how lo
posilion lhe boby ond give her breosl so lhol he
con olloch ond suck well.
8. Do you lhink your boby is well?
n Lislen corefully lo eoch wonon. l nolher
usuolly looks closely ol her boby ond oflen
observes lhings lhol we nighl niss.
?. lre you llhe nolher ond lhe fonilyI worried oboul
onylhing?
n Lislen lo whol lhey oll soy.
n The fonily hos been observing lhe nolher ond
boby logelher ond noy hove noliced o problen.
n lnswer lheir queslions. This is o good oppor-
lunily lo help lhe nolher ond fonily leorn
oboul coring for lheir boby.


|ssert|al Care frr |er New|rrr 35
2
8]VeiZg'
Before you slorl lhe exon, wosh your honds core-
fully wilh soop ond woler. Dry lhen wilh o cleon dry
clolh or oir-dry lhen lif lhe clolh is used or nol cleonI.
Hondwoshing is lhe besl woy lo prevenl infeclion when
louching o boby or hoving conlocl wilh lhe boby. You
should weor gloves when you ore in conlocl wilh blood
or body fuids lfor exonple, relying lhe cord or feeling
lhe inside of lhe boby`s noulhI.
Fxploin lo lhe nolher ond fonily whol you ore going
lo do ond osk if lhey hove ony queslions. Then exploin
whol you ore looking for ond onswer ony queslions lhe
nolher ond fonily osk.
Do lhe exon wilh lhe boby in lhe nolher`s orns lo
keep lhe boby worn. Keep lhe boby uncovered for only
o shorl line lo reduce heol loss. There is no need lo
uncover lhe boby conplelely during every porl of lhe
exon. Uncover only lhose oreos lhol you need lo os-
sess. f you exonine lhe boby on o loble or bed, noke
sure lhe clolh covering lhe surfoce is cleon ond worn.
0horl 2.5 lells you whol lo check in o newborn physicol
exoninolion. ls you cone ocross nornol fndings, be
sure lo give posilive feedbock lo lhe nolher. Be sure
lo hondle lhe boby genlly ond keep lhe boby worn.
|1ert|f Nee1s rr Prr|lems
lre oll lhe fndings nornol? f yes, lell lhe nolher her
boby is heollhy ond nornol. The boby needs nornol
core. See chorl 2.5 for nornol fndings.
lre ony of lhe fndings obnornol? f yes, see chorl 2..
Look ol lhe lbnornol Findings colunn ond consider
whol lhe boby`s problen noy be. Look ol lhe Plon
colunn for lhol problen ond genlly exploin lo lhe
nolher whol obnornol fndings noy neon ond whol
oclion is needed.
;><JG:'#* WA5RIN6 RAND5
3 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
WRAT T0 CRECK
CcIcr

Breatbing
Pate cf
breatbing

Pcsture
and tcne
Reart rate


Warmtb
Activity

5kin
Read
Eyes
8=6GI'#* NEWB0PN PRY5ICAL EXAHINATI0N: N0PHAL FINDIN65
N0PHAL FINDIN65
n Foce, chesl, longue, ond lips ore pink.
n Honds ond feel noy be bluish during lhe frsl /8 hours.
n 0uiel breolhing.
n There should be no indrowing of lhe chesl or foring of lhe noslrils.
n 0hesl ond obdonen nove wilh eoch breolh.
0ounl lhe boby`s breolhing for 1 full ninule.
n 3O-O breolhs in 1 ninule lwhen lhe boby is nol cryingI.
n Moy be irregulor, i.e., hord breolhing, lhen up lo 2O seconds wilhoul o breolh.
n lrns ond legs ore benl lfexedI.
n Prelern bobies hove less fexion.
0ounl lhe boby`s heorl beols for 1 full ninule.
n 1OO-1O beols in 1 ninule.
n Shorl periods of chonge in heorl role ore nornol lsuch os wilh sleeping, crying,
or breoslfeedingI.
n Boby`s obdonen or bock feels worn. lf lhe boby`s lenperolure is low, do lhe
exoninolion loler ofler reworning.I
n The boby noves bolh legs ond orns equolly.
n The boby opens his noulh ond lurns his heod lo seorch for lhe nipple when his cheek
is slroked genlly.
n There noy be liny while bunps on lhe foce lnilioI.
n There noy be o bluish oreo over lhe lower bock.
n There noy be sone peeling of lhe skin.
n Flongoled or uneven losynnelricolI shope due lo nolding fron pressure of lhe birlh
conol is nornol. l usuolly goes owoy by 2-3 doys ofler birlh lsee fgure 2.I .
n 0uput succeJuneum, o sofl swelling over lhe porl of lhe heod lhol cone oul frsl lhrough
lhe birlh conol, noy be presenl ol birlh. l goes owoy by /8 hours.
n The onlerior fonlonelle lo dionond-shoped sofl spol |usl obove lhe foreheodI is fol
ond noy swell when lhe boby cries lsee fgure 2.7I.

n No dischorge ond lhe eyes ore nol slicky.
|ssert|al Care frr |er New|rrr 37
2
8]VeiZg'
WRAT T0 CRECK
Hcutb


Cbest
Abdcmen

Back and spine
Anus

6irI`s externaI
genitaI crgans

Bcy`s externaI
genitaI crgans
Temperature

Weigbt
N0PHAL FINDIN65
When lhe boby cries look inlo his noulh ond pul one gloved fnger inlo lhe
noulh ond feel lhe polole for ony opening.
n Lips, guns, ond polole ore inlocl ond lhe sone on bolh sides.
n The boby sucks vigorously on your fnger.
n The chesl noves equolly wilh breolhing.
n The obdonen pushes oul wilh eoch breolh.
n Breosl nodules noy be enlorged.
n Bolh girls ond boys noy hove swollen breosls ol birlh.
n Rounded, sofl.
n Unbilicol cord is lied lighlly, dry, nol bleeding.
n l snoll unbilicol hernio is nornol during lhe frsl yeor.
n The skin over lhe spine hos no openings.
n The spine hos no defecls.
Do nol inserl inslrunenls or fnger lo inspecl lhe onus.
n The newborn posses slool by 2/ hours.
0enlly seporole lhe legs.
n l while voginol dischorge is nornol.
n l bloody voginol dischorge lhol slorls on doy 2-3 ond conlinues up lo doy 7 is nornol.
n The foreskin con be relrocled eosily lunless circuncision hos been perfornedI.
n The urelhro opens ol lhe end of lhe penis.
n 0ne or lwo lesles ore fell in lhe scrolun.
n f lhe boby hos been circuncised, lhere is no sign of infeclion or bleeding.
n 3-37 0 l?.8-?8. FI oxillory lunder lhe boby`s ornI.
n f o lhernoneler is nol ovoiloble. feel lhe chesl or bock wilh lhe bock of your hond,
lhe lenperolure should feel lhe sone os lhol of o heollhy person.
n 2.5 up lo 3.?? kg is lhe nornol ronge for birlh weighl. Newborns nornolly lose 5%
lo 1O% of lheir birlh weighl in lhe frsl few doys of life, ond lhen begin lo goin weighl.
By lhe 1/lh doy, o boby should hove regoined his birlh weighl.
8=6GI'#* NEWB0PN PRY5ICAL EXAHINATI0N: N0PHAL FINDIN65
38 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
WRAT T0 CRECK
CcIcr
Breatbing
8=6GI'#+ NEWB0PN PRY5ICAL EXAHINATI0N: ABN0PHAL FINDIN65 AND PLAN 0F ACTI0N
ABN0PHAL FINDIN65
n Yellow or |oundiced skin or eyes
0uuse: Possib|e infection or u b|ooJ prob|em
n Poleness lpollorI
0uuse: 8|eeJin, poor circu|ution of b|ooJ,
bub, is co|J, |ow b|ooJ suur, or not enouh
ox,en
n Blue longue ond lips lcyonosisI
0uuse: 8ub, mu, not be ettin enouh
ox,en.
n 0runling lsound node wilh breolhing oulI
n More lhon O breolhs in 1 ninule
n Floring noslrils
n ndrowing of chesl belween ribs
0uuses: /ir tubes mu, be b|ockeJ, infection or
fuiJ in the |uns, |ow b|ooJ suur
0bserve ond counl for 1 full ninule.
n Less lhon 3O breolhs in 1 ninule
n Periods of no breolhing lopneoI for nore
lhon 2O seconds
n 0osping
0uuses: /sph,xiu, |un infection, fuiJ in the
|uns, premuture bub,, ubnormu| temperu-
ture, |ow b|ooJ suur, b|ooJ infection
PLAN
See chopler , chorl .12, poges 1/8-/?.
n Moke sure lhe cord lie is lighl ond check
for olher sources of bleeding.
n Worn lhe boby.
n 0heck lhe respirolory ond heorl roles.
n 0ive oxygen, if ovoiloble, by nosol prongs
or nosk ol o low fow role.
n Moke sure lhe boby is breoslfeeding
every 2-3 hours.
n f boby does nol becone pink ofler
1 hour, RFFFR lsee Referrol 0uidelines
on poge 12?I.
n RFFFR lsee Referrol 0uidelinesI.
n 0ive oxygen, if ovoiloble, ol high fow role
lsee lppendix BI.
See chopler , chorl ./, poge 132.
n Resuscilole lsee chopler /I.
n Follow resuscilolion guidelines for
follow-up core.
|ssert|al Care frr |er New|rrr 3?
2
8]VeiZg'
WRAT T0 CRECK
Pcsture
and tcne
Reart rate
Activity and
mcvement
ABN0PHAL FINDIN65
n Lock of fexion, linp, foppy
0uuses: Premuturit,, birth injur,, usph,xiu
n Rigid, sliffness, or orching of bock,
clenched |ow
n Rhylhnic novenenls of one linb
0uuses: 7etunus, birth injur,, meninitis,
convu|sions
0ounl lhe heorl role for 1 full ninule.
n Heorl role below 1OO
0uuses: Hu, not be ettin enouh ox,en,
heurt prob|ems, breuthin prob|ems

n Heorl role obove 18O
0uuses: lnfection, bub, mu, be too hot, Jeh,-
Jrution, cr,in, conenitu| heurt prob|em
n Seizures or convulsions of body
n Moves only one orn or leg or unequol
novenenl of one orn or leg
0uuses: Hu, be Jue to nerve injur, Jurin
birth, tetunus, or infection
n Lelhorgic, drowsy, sluggish
n Fxcessive ond high-pilched cry, irriloble
n Nol sucking
n \oniling
0uuses: Hu, be b|eeJin or swe||in in the
bruin, |ow b|ooJ suur, usph,xiu, infection
PLAN
n Keep lhe boby worn.
n 0heck if lhe boby is breolhing well.
n RFFFR if lhis conlinues ofler 2 hours
lsee Referrol 0uidelinesI.
RFFFR lsee Referrol 0uidelinesI.
n Worn lhe boby.
n 0heck breolhing role.
n 0ive oxygen, if ovoiloble, by nosol prongs
or nosk ol 1 L/ninule.
n RFFFR if lhis conlinues ofler obove
oclions or if boby is pole or blue lsee
Referrol 0uidelinesI.
n 0heck if lhe boby hos on loo nony
clolhes or olher reoson for being hol.
n Fncouroge nore frequenl breoslfeeds.
n 0up feed if nol sucking well lsee chopler 3I.
n RFFFR if lhis conlinues ofler obove
oclions or if boby is pole or blue lsee
Referrol 0uidelinesI.
RFFFR lsee Referrol 0uidelinesI.
RFFFR lsee Referrol 0uidelinesI.
n 0up feed expressed breosl nilk
lsee chopler 3I
8=6GI'#+ NEWB0PN PRY5ICAL EXAHINATI0N: ABN0PHAL FINDIN65 AND PLAN 0F ACTI0N
/O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
WRAT T0 CRECK
5kin
Read
Eyes
Hcutb
Abdcmen
ABN0PHAL FINDIN65
n Puslules, blislers, red or purple spols
0uuse: Possib|e infection whi|e in the uterus
n Firn swelling on only one side of lhe
skull lcepholhenolonoI
0uuse: 8|ooJ between the sku|| bone unJ skin
Jue to u b|ooJ vesse| breukin Jurin birth.
lt sturts u few hours ufter birth unJ increuses
in size.
n lnlerior fonlonelle swollen or bulging
oulword when lhe boby is nol crying
0uuse: lncreuseJ pressure in the heuJ
n Dischorging pus
n Slicky eyes
n Swollen eyelids
0uuse: F,e infection, especiu||, from onor-
rheu or ch|um,Jiu
n 0lefl or opening in lhe lip
n 0lefl or hole in lhe sofl or hord polole
0uuse: 0onenitu| ubnormu|it,
n \ery swollen ond hord obdonen
0uuse: Possib|e b|ockue of intestines
n Sunken-in obdonen wilh ropid breolhing
0uuse: Possib|e herniu of the Jiuphrum
n Bleeding fron lhe unbilicol cord
0uuse: 7he corJ tie mu, huve |ooseneJ.
PLAN
See chopler , chorl .7, poges 13-37.
n No oclion needed. The blood is slowly
obsorbed ond lhe swelling disoppeors by
1-2 nonlhs.
RFFFR lsee Referrol 0uidelinesI.
See chopler , chorl .8, poge 13?.
n Provide reossuronce lo lhe nolher.
n Fncouroge lhe nolher lo breoslfeed.
n RFFFR lsee Referrol 0uidelinesI.
n f lhe boby connol suck, show lhe nolher
how lo feed lhe boby expressed breosl
nilk by cup.
RFFFR lsee Referrol 0uidelinesI.
RFFFR lsee Referrol 0uidelinesI.
n Relie lhe cord lighlly
See chopler , chorl .13, poge 15O.
8=6GI'#+ NEWB0PN PRY5ICAL EXAHINATI0N: ABN0PHAL FINDIN65 AND PLAN 0F ACTI0N
|ssert|al Care frr |er New|rrr /1
2
8]VeiZg'
WRAT T0 CRECK
Back and spine
Anus
ExternaI
genitaI crgans
Bcy`s externaI
genitaI crgans
Temperature
Weigbt
ABN0PHAL FINDIN65
n Defecls of lhe spine include snoll lo lorge
holes in lhe skin wilh o bubble of lissue on
lhe oulside lopen neurol lube defeclI.
n No possoge of slool by 2/ hours ond o
swollen obdonen
0uuse: Hu, be b|ockue in the bub,s intes-
tines or unus, or ubsence of un unu| openin
n Unoble lo idenlify gender
n No urine or wel dioper by 2/ hours
n Urelhro does nol open ol lhe end of lhe
penis, bul in sone olher ploce, such os
under lhe penis, foreskin is nol
relrocloble
n Scrolun is enply lno lesles con be fellI
n lxillory lenperolure below 3 0
l?.8 FI or obove 37 0 l?8. FI or
n Boby`s chesl or bock feels cooler or
holler lhon lhe skin of o heollhy person
n Weighl less lhon 2.5 kg
0uuse: Low birth weiht cun be Jue to pre-
term birth |before J7th weekl or poor rowth
in the womb. Risk of |ow b|ooJ suur.
n Weighl / kg or nore
0uuse: Hother mu, be Jiubetic. Risk of |ow
b|ooJ suur.
PLAN
n 0over wilh o slerile dressing ond
n RFFFR lsee Referrol 0uidelinesI.
RFFFR lsee Referrol 0uidelinesI.
RFFFR lsee Referrol 0uidelinesI.
RFFFR lSee Referrol 0uidelinesI.
lDo nol do circuncision if lhe urelhro does
nol open ol lhe end of lhe penis, os skin is
needed for repoir.I
n Fxploin lo lhe porenls lhol lhe lesles
noy descend.
n Fxonine lhe boby ogoin ol nonlhs.
n RFFFR if lhe lesles hove nol cone down
by lhol line.
See chopler , chorls .1O lpoge 1/3I ond
.11 lpoges 1//-/5I.
n lll low birlh weighl bobies need speciol
core lsee chopler 5I.
n f lhe boby is lorge, feed hin os soon os
possible ofler birlh.
8=6GI'#+ NEWB0PN PRY5ICAL EXAHINATI0N: ABN0PHAL FINDIN65 AND PLAN 0F ACTI0N
/2 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
CAk| 0| !N| N|wB0kN
0Uk|N !N| ||kS! IK 0AS
w| |s |rllrwap New|rrr Care Sr |mprrtart?
0lobolly over / nillion bobies die every yeor before
lhey reoch lhe oge of one nonlh.
11
Mony of lhese
deolhs con be prevenled. You do nol need nuch lech-
nicol lroining or equipnenl lo sove lhe lives of nosl of
lhese bobies.
0ne inporlonl lhing you con do is conducl follow-up
newborn core visils. See lhe boby ol 2-3 doys, 7 doys,
ond 28 doys ofler birlh. f o nolher ond fonily ore
worried oboul lheir boby or lhere is o problen, you
noy see lhen nore oflen. During lhese visils you will.
n lssess lhe boby ond lhe nolher for problens.
n Proise lhe fonily for lhe good core lhey give.
n 0onlinue lo educole ond counsel lhe nolher
ond fonily on boby core.
To noke il eosy for lhe nolher ond fonily, lhe nolher
should receive her follow-up poslporlun exons when
lhe boby is checked. Review lhe nolher`s onlenolol
record lo be sure lo follow up on ony problens le.g.,
luberculosis, syphilis, or H\I. Lislen lo lhe nolher
ond loke core of ony heollh problens she noy hove.
l heollhy nolher is key lo o newborn`s survivol. The
nolher should be checked for.
n Bleeding heovier lhon her nornol nenses.
Poslporlun henorrhoge is lhe noin couse of
nolernol deolhs.
n Successful breoslfeeding. Wolch lhe nolher
breoslfeed lhe boby ond check her breosls for
ony problens.
n Signs of infeclion. fever, lender ulerus, or
foul-snelling dischorge.
n 0onlinue lo educole ond counsel lhe nolher on
recognizing donger signs for herself ond her
boby ond lhe need for good nulrilion, exlro resl,
ond child spocing.
;><JG:'#+ READ H0LDIN6
;><JG:'#, F0NTANELLE5
Poslerior
fonlonelle
lnlerior
fonlonelle
iew cf baby`s skuII frcm abcve
HcIding
NcrmaI
0ccipilol
bone
|ssert|al Care frr |er New|rrr /3
2
8]VeiZg'
Sper|al |rras frr |ar| |rllrwap \|s|t
ll cerloin oges bobies ore ol higher risk for cerloin
problens. You need lo know whol lhese problens ore
ond when lhey noy hoppen. 0horl 2.7 exploins whol
you should focus on ol eoch follow-up visil.
Prepare frr |rllrwap Care \|s|ts
krrm, ea|pmert, ar1 sappl|es
Moke sure lhe roon is.
CIean. Use lhe lhree infeclion prevenlion sleps lo
prepore lhe roon, equipnenl, ond supplies. lSee lp-
pendix 0 for deloils.I
Warm. The lenperolure of lhe roon should be worn,
heol lhe roon if il is cold, ond close doors or windows
lo prevenl drofls.
Ligbt. The heollh worker nusl be oble lo see lhe
newborn lo check color ond breolhing. f lhere is nol
enough nolurol lighl, use condles, o lonp, or onolher
lighl source.
Prepore o cleon surfoce for supplies ond equip-
nenl ond o worn col or surfoce for lhe newborn lnol
needed if lhe exon is done on lhe nolher`s lopI.
Hove lhe following equipnenl ond supplies reody.
n l scole lo weigh lhe newborn, if ovoiloble
n l wolch or clock wilh o second hond
n ln oxillory lhernoneler, if ovoiloble
n 0leon, running woler, soop, ond lowel
n f innunizolions ore lo be given.
n Syringes ond needles
n Wipes ond cleon woler for cleoning
in|eclion sile
n 0ouze
n Medicolions.
n Baby: \ilonin K, \occines. B00, polio,
hepolilis B ldepending on your locol heollh
oulhorily`s policies ond ovoilobililyI
n Hctber: \ilonin l 2OO,OOO U copsule
n Records.
n Newborn record cord ond innunizolion cord
|e |rllrwap Care
Foch line you see o newborn for o follow-up visil,
use lhe decision-noking sleps lo guide lhe visil los
described in lhe inlroduclion lo lhe nonuolI. 0horl 2.8
describes lhese sleps for core of lhe newborn during
lhe frsl 28 doys.
// Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
A6E AT I5IT
First day
2-3 days
A5K AND L00K
Breolhing
Skin color
Tenperolure
Breoslfeeding
Unbilicol cord
Urinolion
Slools
\ilonin K ond innunizolions
Breoslfeeding
Signs of infeclion lredness or puslules on
lhe skin, dischorge fron lhe unbilicus or
eyes, boby loo hol or loo cold, feeding prob-
lens, breolhing problens, flsI
Weighl
EXPLANATI0N
n During lhis line lhe newborn is slill
od|usling lo life oulside lhe ulerus ond
needs lo breoslfeed very frequenlly. No
olher feeding or fuid should be given.
n Moke sure lhe cord is lied lighlly ond lhol
lhere is no blood seeping fron il.
n l boby wilh |oundice lyellow skin or eyesI
noy be very sick. Joundice is serious
if il oppeors in lhe frsl 2/ hours, ofler
2 weeks, or ol ony line wilh onolher don-
ger sign.
n \ilonin K nusl be given on lhe doy of
birlh or os soon os possible lhereofler lo
be effeclive. This is especiolly inporlonl
for prenolure bobies.
n For newborn innunizolions, follow lhe
guidelines in your counlry.
n The nolher ond newborn ore slill
od|usling lo breoslfeeding. Fngorged
breosls hoppen oround lhis line ond con
noke breoslfeeding diffcull.
Bobies who gel infecled during lobor noy
hove signs of infeclion ol birlh or nol unlil
loler.
l weighl loss of 5-7% during lhe frsl few
doys of life is nornol. 0ne reoson for lhis
weighl loss is lhol bobies ore born wilh
excess fuids, which lhey lose in lhe eorly
doys. Weighl loss should nol exceed 1O% of
lhe birlh weighl.
8=6GI'#, 5PECIAL F0CU5 F0P EACR F0LL0W-UP I5IT
|ssert|al Care frr |er New|rrr /5
2
8]VeiZg'
A6E AT I5IT
7 days
28 days
A5K AND L00K
Breoslfeeding
Weighl
Signs of infeclion
lsee seclion on 2-3 doys oboveI
Skin color
nnunizolions
Breoslfeeding
Weighl
Signs of infeclion lsee seclion on 2-3 doys
oboveI
nnunizolions
EXPLANATI0N
l nolher ond boby ore slill od|usling lo
breoslfeeding. The boby should slorl lo goin
weighl by lhis line ond should regoin his
birlh weighl by 1/ doys.
Newborns who gel infeclions ofler birlh
noy hove signs of infeclion ol lhis visil.
l newborn who hos |oundice lyellow skin or
eyesI noy be very sick lsee frsl doy oboveI.
f lhe newborn hos nol received lhe frsl
innunizolions, give lhen now or send lhe
boby lo lhe heollh focilily lo gel lhen.
n ll 28 doys o boby should be fully od|usled
lo life oulside lhe ulerus. Moniloring for
infeclion should conlinue. Renind lhe
nolher lhol lhe nexl innunizolions ore
needed ol weeks.
n Moke sure lhe boby is goining enough
weighl l25-3O grons per doyI.
8=6GI'#, 5PECIAL F0CU5 F0P EACR F0LL0W-UP I5IT
/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
8=6GI'#- CAPE 0F TRE NEWB0PN DUPIN6 TRE FIP5T 28 DAY5: DECI5I0N-HAKIN6 CRAPT
lsk lo see lhe newborn`s birlh cord ond ony olher newborn core records.
Then osk lhe following queslions oboul lhe newborn.
n Whol hove you noliced oboul your boby? The nolher`s onswer noy give you on ideo
oboul how she is coring for her boby.
n Hove you seen onylhing in lhe boby lhol worries you? l nolher is oflen lhe frsl person
lo nolice sonelhing lhol noy be o sign of o problen. Sone bobies, for exonple, spil up
o lillle nilk ofler olnosl every feed, which noy worry lhe nolher, bul lhis is generolly
nornol. However, persislenl voniling of lorge quonlilies should be invesligoled.
n s lhe boby sucking well? l poor suck could be o sign of infeclion.
n How oflen does lhe boby feed during lhe doy ond ol nighl? Nornol is 8-12 lines in 2/
hours. l low birlh weighl boby will feed nore oflen becouse his slonoch is snoller.
n Does your boby woke up lo breoslfeed ol leosl every 2-3 hours, or do you need lo woke
lhe boby up? Nol woking for feeds is o sign of infeclion or olher problen.
n How nony lines does lhe boby urinole in 1 doy? l newborn lhol is gelling enough breosl
nilk will urinole ol leosl lines in 2/ hours.
n Does lhe boby seen very sleepy? s lhe boby hord lo woke up? l boby lhol is loo sleepy
noy hove on infeclion or onolher problen.
n How do lhe boby`s slools look? n lhe frsl doy or lwo, lhe slool noy be block or greenish
ond slicky. lfler lhe frsl few doys lhe slools should be sofl, yellow, ond seedy. Wolery
slool is obnornol.
n Hos lhe boby received ony innunizolions? f so, whol?
n Did lhe boby receive eye nedicolion ol lhe line of birlh?
lsk lhe nolher.
n How nony neols do you eol o doy? How nuch ond whol food is in eoch neol? To sloy
heollhy, o breoslfeeding nolher needs lo eol ol leosl one lorge exlro serving of her
slople food every doy.
n How nuch fuid ore you drinking in one doy? To noke enough breosl nilk, o nolher
needs ol leosl 3-/ lilers of fuid o doy. The nolher should drink sonelhing every line
her boby breoslfeeds.
n Hove you loken o vilonin l copsule? f o breoslfeeding nolher lokes one 2OO,OOO U
vilonin l copsule onyline ofler delivery up lo eighl weeks poslporlun, her breosl nilk
should hove enough of lhe vilonin for lhe boby`s needs.
n lre you gelling enough resl? f o breoslfeeding nolher does nol gel enough resl, il con
reduce lhe onounl of breosl nilk she nokes.
|ssert|al Care frr |er New|rrr /7
2
8]VeiZg'
Examinaticn Wilhoul louching lhe boby, observe ond leoch lhe nolher lo observe lhe boby`s.
n Breolhing.
NcrmaI. Regulor ond 3O-O breolhs in 1 ninule.
AbncrmaI. Breolhing less lhon 3O or nore lhon O breolhs per ninule ond chesl
indrowing con be signs of infeclion or breolhing problens.
n Unbilicus.
Redness of skin, swelling, pus, ond o foul snell oround lhe unbilicus ore oll signs
of infeclion.
n Skin color.
NcrmaI. 0hesl, foce, lips, ond nucous nenbrones should be pink.
AbncrmaI. Skin pole, blue, or yellow l|oundiceI.
n Poslure ond oclivily.
NcrmaI. lrns ond legs ore benl. The boby noves, cries, ond sucks well when owoke.
AbncrmaI. The boby is linp or does nol nove or sucks poorly when owoke.
Touching lhe boby genlly, check lhe following.
n Tenperolure.
Feel lhe newborn`s obdonen or bock. f his skin feels loo hol or loo cold, loke his
lenperolure wilh on oxillory lhernoneler lif ovoilobleI ol lhe end of lhe exoninolion.
NcrmaI. Under orn. 3-37 0 l?.8-?8. FI
AbncrmaI. f lhe lenperolure is lower lhon 3 0 or higher lhon 37 0, lhere noy be
on infeclion or olher problen.
Sone bobies hove o slighl fever for 2/ hours ofler receiving on innunizolion for
hepolilis B lwhich noy be given ol birlhI.
n Skin.
Look for roshes or puslules.
f lhe boby hos received o B00 innunizolion, look ol lhe sile. l snoll puslule should
forn in o few weeks, lhen o scor.
n Fyes.
Look for dischorge.
Slicky or pus-like dischorge fron lhe eyes is o sign of infeclion.
Wolching lhe boby breoslfeed.
n Look ol lhe boby`s posilion, sucking, ond ollochnenl.
NcrmaI. See chopler 3.
n Molher-boby inleroclion.
NcrmaI. The nolher 1I hos eye conlocl wilh her newborn, 2I uses her full hond lnol
|usl her fnger lipsI when louching her boby, ond 3I lhe nolher ond boby ore lurned
lowords eoch olher when breoslfeeding.
continueJ, next pue
8=6GI'#- CAPE 0F TRE NEWB0PN DUPIN6 TRE FIP5T 28 DAY5: DECI5I0N-HAKIN6 CRAPT
/8 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Examinaticn
ICcntinued!
PrcbIemslneeds
PIan cf care
FcIIcw-up
8=6GI'#- CAPE 0F TRE NEWB0PN DUPIN6 TRE FIP5T 28 DAY5: DECI5I0N-HAKIN6 CRAPT
Weigh lhe boby.
Age Weigbt
Firsl 7 Doys Moy lose 5-1O% of birlh weighl
Doys 7-1O Begins lo goin weighl
Doy 1/ Should hove regoined birlh weighl
lfler Doy 1/ 0oins on overoge of 25-3O grons l1 ounceI per doy for frsl / nonlhs
/-5 nonlhs Doubles birlh weighl
Lisl problens ond needs.
f ony fndings ore obnornol, refer lo chopler .
Think oboul lhe boby`s needs. wornlh, proleclion fron infeclion, feeding, sofely, love,
ond sleep.
Moke o plon of core for eoch problen or need you fnd. nclude educolion, counseling,
nedicol lreolnenl, lob lesls, referrol, ond follow-up.
0onlinue lo odvise lhe nolher on core for lhe boby ond herself.
n Keep lhe boby worn.
n Prolecl lhe boby fron infeclion.
n Breoslfeed lhe boby on denond ond exclusively.
n Tolk lo ond conforl lhe boby.
n Keep lhe boby sofe.
n Molher conlinues lo gel poslporlun core.
0ive frsl innunizolions if lhe boby hos nol received lhen.
Review newborn donger signs ond whol lo do.
Plon for lhe nexl visil lsee belowI.
Schedule or refer lhe nolher for fonily plonning services.
Tining for follow-up depends on problens found.
f everylhing is nornol, use lhe nornol follow-up visil schedule lol 2-3 doys, 7 doys, 28
doys, weeksI.
|ssert|al Care frr |er New|rrr /?
2
8]VeiZg'
0rramert t|e Steps
Moke sure oll records on lhe newborn core ore con-
pleled ofler eoch visil.
C|erkl|st frr |rllrwap New|rrr Care \|s|ts
ll lhe end of o visil, use lhe checklisl in chorl 2.? lo
renenber oll lhe inporlonl fndings. f your fndings
nolch oll lhose in lhe lisl, lhe newborn is doing well.
Tell lhe nolher when lhe nexl plonned visil will be
ond renind her lo gel heollh core if she sees o donger
sign or hos o concern or queslion oboul lhe boby.
8=6GI'#. CRECKLI5T: TRE NEWB0PN I5
REALTRY AND 5AFE IF.
Tbe mctber
o Hos no worries oboul lhe boby`s behovior
o Responds oppropriolely when lhe boby cries
o Keeps lhe boby worn
o Hondles lhe boby genlly
o Knows lhe newborn donger signs ond whol lo do
o s conforloble wilh exclusive breoslfeeding
o Hos loken one vilonin l copsule l2OO,OOO UI
ofler lhe birlh
o s heollhy
Tbe newbcrn
o Feeds well l8-12 lines in 2/ hoursI
o Sleeps belween feeds
o Wokes for feedings
o Urinoles ol leosl lines during 2/ hours
o Hos slools lhol ore nol wolery
o Slorls lo goin weighl sleodily ofler lhe frsl
7-1O doys
o Hos on oxillory lenperolure belween 3-37 0
l?.8-?8. FI
o s breolhing quielly, belween 3O-O breolhs in
1 ninule
o Hos skin wilhoul puslules or roshes, ond is nol
yellow, blue, or pole
o Hos cleon eyes
o Hos o dry ond cleon unbilicus
o Hos received his frsl innunizolions
5O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
!|ACN AN0 C0UNS|| A N0!N|k AN0
|AN|| AB0U! N|wB0kN CAk|
ln inporlonl porl of lhe help you give lo lhe newborn,
nolher, ond fonily is leoching ond counseling oboul
newborn core. You should exploin.
n Whol core lo give
n Why lo give lhe core
Fven if o wonon hos hod o boby before, lhere noy be
new infornolion lhol con help her. When speoking
wilh her, include olher fonily nenbers such os lhe
grondnolher, nolher-in-low, ounl, sisler, ond/or hus-
bond. This gives everyone o chonce lo heor lhe sone
lhings lhe nolher heors. l olso gives lhe nolher ond
fonily line lo osk queslions. Below is infornolion lo
lolk oboul when you leoch ond counsel. The nolher
ond fonily noy hove olher boby core queslions nol
included below. Toke line lo discuss oll lhe fonily`s
concerns ond queslions.
warmt|
l newborn needs lo be worn-especiolly for lhe frsl
few weeks of life. Becouse newborns connol od|usl
lheir lenperolure like odulls, lhey gel cool or worn
nuch nore quickly. The newborn`s body is snoll ond
nol oble lo sloy worn on ils own. f lhe newborn gels
loo cold, he con die.
Sleep
Newborns need sleep. f lhey ore heollhy, lhey sleep
nosl of lhe line belween feedings lup lo 18 hours oul
of 2/I. They woke up every 2-3 hours lo feed. During
lhe nighl lhe boby noy sleep up lo / hours belween
feeds
Newborns woke up o lol ol nighl. Becouse of lhis o
nolher needs lo resl or sleep during lhe doy when her
boby is osleep. This pollern chonges wilh line ond lhe
boby will begin lo sleep nore ol nighl ond sloy owoke
nore during lhe doy.
A baby wbc is bard tc wake up cr wbc
sIeeps tcc mucb may be sick.
;><JG:'#- KEEPIN6 TRE BABY WAPH
8=6GI'#&% R0W TRE FAHILY CAN KEEP
TRE NEWB0PN WAPH
n Keep lhe roon where lhe newborn sloys
worn ond free fron drofls doy ond nighl.
n Dress lhe boby in worn clolhing llhe newborn
needs ol leosl 1-2 nore loyers lhon on odullI.
n Keep lhe boby`s heod covered wilh o hol
or clolh.
n Use loose clolhing ond covers. Tighl clolhing
ond coverings do nol keep lhe boby os worn.
n Pul lhe newborn in bed wilh lhe nolher for
wornlh ond breoslfeeding.
n Keep lhe newborn skin-lo-skin wilh lhe
nolher. Use o worn clolh or blonkel lo cover
lhen bolh logelher. Be sure nol lo cover lhe
boby`s foce so he con breolhe freely.
|ssert|al Care frr |er New|rrr 51
2
8]VeiZg'
|r|r] Care
l newborn connol survive wilhoul loving core. ll birlh,
he is unoble lo neel ony of his own bosic needs. When
o newborn is hungry, wel, cold, unconforloble, in poin
or sick, he con only cry or send oul olher cues.
Fvery newborn is differenl. He noy be eosily irriloled
or coln ond sleepy. He noy be fussy ond hord lo
solisfy, or hoppy ond eosy going. He noy hove o loud
piercing cry, or o sofl, quiel one. l nolher nusl gel
lo know her boby`s personolily. His survivol depends
on her underslonding ond responding oppropriolely lo
lhe signols he sends.
When lhe boby cries ond his needs ore nel, he leorns
lhol lhe world is o sofe ond loving ploce. He olso
leorns confdence ond lrusl. confdence lhol he con
connunicole his needs lo olhers ond lrusl lhol sone-
one will core for hin when he needs il. The newborn`s
crying should nol be ignored.
Newborns should olwoys be hondled genlly. Molhers
leorn lo do whol lhey see you doing. Hondle lhe boby
genlly, lolk lo hin in o quiel voice, ond observe hin
corefully so lhol you con respond oppropriolely lo
his needs.
Prrtert|rr frrm |rfert|rr
The syslen lo fghl infeclions is nol nolure in o new-
born. This neons lhol o newborn con gel infeclions
nore eosily lhon on older child or odull. ls lhe boby
grows, lhe infeclion fghling syslen becones slronger.
The nolher ond fonily need lo prolecl lhe newborn
fron infeclion ol birlh ond in lhe eorly nonlhs of life
lsee chorl 2.11I.
8=6GI'#&& R0W TRE FAHILY 5R0ULD
PP0TECT TRE NEWB0PN
FP0H INFECTI0N
n Wosh honds wilh soop ond woler before ond
ofler louching lhe newborn.
n Keep fngernoils shorl lgerns con live
under lhe fngernoilsI.
n Do nol pul onylhing ldressing or herbol or
nedicinol produclsI on lhe unbilicol cord.
n Keep lhe cord cleon ond dry.
n Wosh onylhing in lhe hone lhol will louch
lhe boby. clolhing, bedding, covers.
n Keep sick children ond odulls owoy fron
lhe boby.
n Prolecl lhe newborn fron snoke in lhe oir
lfron cigorelles or o cooking freI becouse
lhis con couse breolhing problens.
n Pul lhe newborn lo sleep under on inseclicide-
lreoled bed nel lif ovoilobleI lo prolecl hin
fron nolorio.
n Breoslfeed lhe newborn exclusively.
l nolher`s nilk gives infeclion proleclion lo
her newborn.
n Moke sure lhe boby gels oll his innunizolions
on line.
52 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Bat||r] t|e New|rrr
ls o heollh worker il is inporlonl for you lo leoch
lhe nolher ond fonily how lo wosh lhe newborn. f
you show lhen how lo do lhis, nol |usl lell lhen, lhey
will renenber nore. You con olso show lhen how lo
bolhe lhe newborn wilh genlleness while checking
eoch porl of lhe boby`s body.
5pcnge batb. Woil lo give lhe frsl sponge bolh unlil o
nininun of hours ofler birlh, preferobly 2/ hours.
ll 3 doys of oge lhe newborn`s lenperolure is usuolly
nore sloble. 0ive lhe boby only o sponge bolh unlil lhe
cord folls off ond lhe unbilicus is heoled. This helps
lhe cord sloy dry ond cone off nore quickly. f lhe
boby hos been circuncised, give o sponge bolh unlil
lhe penis is heoled.
n During o sponge bolh, lhe newborn is sponged
off wilh o worn, wel woshclolh ldo nol sil lhe
boby in o lub of wolerI.
n Firsl wosh lhe upper body quickly wilh lhe
woshclolh, while lhe lower body is clolhed. Dry
lhe upper body quickly ond cover or dress il in-
nediolely oflerwords.
n Then loke lhe clolhes off lhe lower body, wosh
il quickly wilh lhe woshclolh, dry il quickly, lhen
cover or dress lhe boby ogoin.
FuII batb. lfler lhe cord folls off ond lhe unbilicus
ond circuncision ore heoled, give o full bolh every
2-3 doys.
Wasb tbe buttccks. The newborn`s bullocks con be
woshed eoch line lhe boby urinoles or hos o bowel
novenenl.
See chorl 2.12 for infornolion on keeping o newborn
worn during o bolh ond chorl 2.13 for lips lo prevenl
infeclion while bolhing lhe boby.
8=6GI'#&' KEEP TRE NEWB0PN WAPH
DUPIN6 A BATR
1. Bolhe lhe newborn in o worn roon wilh
no drofls.
2. Hove everylhing reody before lhe bolh so lhe
newborn is nol lefl uncovered for long.
3. Moke sure lhe bolh woler is worn. Tesl lhe
bolh woler by louching il wilh your elbow.
/. Wosh lhe foce frsl ond lhe hoir losl. Much
heol is losl lhrough lhe heod so il should be
bolhed losl.
5. Bolhe lhe boby quickly.
. Dry lhe boby quickly ond conplelely wilh
o worn lowel. Be sure lo dry lhe hoir
lhoroughly.
7. Pul lhe boby in skin-lo-skin conlocl wilh
lhe nolher ofler lhe bolh ond cover lhen
bolh. Renenber lo cover lhe boby`s heod
ogoin.
8=6GI'#&( BATRIN6 PEC0HHENDATI0N5
n 0leon lhe boby`s eyes by wiping eoch one
wilh o cleon clolh or wilh o cleon corner of
lhe sone clolh. Slorl neor lhe nose ond wipe
oulword.
n Look for signs of infeclion while you wosh lhe
newborn.
n 5kin infecticn. spreod lhe skin folds lo
look for puslules or roshes.
n Ccrd infecticn. redness of skin, swelling,
pus, or foul odor oround lhe cord or
unbilicus.
n Eye infecticn. red, swollen eyelids ond
pus-like dischorge fron lhe eyes.
n Wosh lhe boby`s bollon fron fronl lo bock.
n Never use soop on o newborn`s foce, only
cleon woler.
n Do nol cleon inside lhe newborn`s eor conols
or nose, only lhe oulside.
n Do nol use boby powders. Powders con be
dongerous lo o newborn.
n Be sure lo dry inside lhe skin folds.
|ssert|al Care frr |er New|rrr 53
2
8]VeiZg'
Crr1 Care
0ord core is on inporlonl woy lo prevenl o newborn
fron gelling lelonus or sepsis lgenerolized body in-
feclionI. Teoch ond show lhe nolher ond fonily how lo
do cord core lsee chorl 2.1/I.
Pulling cerloin subslonces on lhe cord or covering
il wilh dressings con couse serious cord infeclions,
such os lelonus ond seplicenio.
13
These infeclions ore
no|or couses of neonolol deolh bul ore prevenloble.
To prevenl lhese infeclions.
n 0ive lhe nolher lelonus loxoid during pregnoncy.
n 0ul lhe cord wilh o slerile inslrunenl or new
cleon blode.
n Keep lhe cord cleon ond dry.
n Do nol pul onylhing on lhe cord.
n o sludy lhol reviewed cord core fron 1O counlries, il
wos found lhol keeping lhe cord cleon wos os effeclive
ond sofe os using onlibiolics or onliseplics.
1/
|mmar|tat|rrs
nnunizolions ore given lo prevenl illnesses lhol
couse serious problens ond even deolh.
The lining of innunizolions is inporlonl. The boby
should receive innunizolions in lhe frsl few doys
ofler birlh, ol weeks, 1O weeks, 1/ weeks, ond ?
nonlhs. There nusl be ol leosl / weeks belween
innunizolions lsee lppendix lI.
Breastfee1|r]
Review lhe infornolion fron chopler 3 wilh lhe
nolher ond lhe fonily. The following porls of chopler
3 ore especiolly inporlonl.
n Benefls of Breoslfeeding
n Fxclusive Breoslfeeding
n Slorling lo Breoslfeed
n 0onlinuing lo Breoslfeed
8=6GI'#&) C0PD CAPE
n Do nol pul onylhing on lhe cord lno
nedicolion or dressingI.
12
n Keep lhe cord cleon ond dry.
n Urine or slool should nol louch lhe cord.
f lhey do, wosh lhe cord wilh soop ond
woler ond dry il wilh o cleon clolh or
oir-dry il.
n The cord nornolly folls off 5-1O doys
ofler birlh, leoving lhe unbilicus lo heol.
n 0ive lhe boby only sponge bolhs unlil lhe
cord folls off ond lhe unbilicus is heoled.
n Look ol lhe cord ond unbilicus for signs
of infeclion every doy unlil il is dry ond
heoled. Signs of infeclion ore. deloy in
seporolion, pus dischorge, foul snell,
ond redness ond swelling of lhe skin
oround lhe unbilicus lsee chopler I.
n 0el nedicol help righl owoy if you see
ony of lhese signs.
5/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
\|tam|r A
Becouse newborns hove very snoll onounls of vilo-
nin l, breoslfed infonls depend on vilonin l in breosl
nilk lo neel lheir requirenenls for lhis vilonin
during lhe frsl nonlhs of life. The onounl of vilonin
l in breosl nilk depends on lhe nolher`s vilonin l
level. \ilonin l helps bobies grow ond develop well
ond helps keep nolhers ond bobies fron gelling
infeclions. When lhey do gel infeclions, vilonin l olso
helps lhen recover quickly.
Food sources of vilonin l for lhe nolher ore. red,
yellow, ond oronge fruils ond vegelobles lnongoes,
popoyo, corrolsI, sone foods fron oninol sources
legg yolk, liver, cheese, ond fshI, ond sone fols ond
oils lfsh liver oil, poln oil, bullerI.
lnolher source is vilonin l copsules. 0ive lhe nolher
o single dose l2OO,OOO UI vilonin l copsule os soon
ofler birlh os possible bul nol ofler eighl weeks
poslporlun. By eighl weeks poslporlun l weeks for
o non-breoslfeeding nolherI, lhere is o chonce lhe
nolher nighl becone pregnonl ogoin. Toking o high
dose of vilonin l li.e., nore lhon 1O,OOO U per doyI in
lhe frsl lrinesler could horn her growing felus.
For lhe boby, breosl nilk is lhe noin source of vilonin
l. To noke sure lhe boby gels lols of vilonin l, en-
couroge every nolher lo breoslfeed exclusively.
Safet ar1 Serar|t
Never leove o boby olone on o bed or loble fron which
he con foll. Never hold o newborn by his feel wilh lhe
heod down.
Breoslfeeding nolhers should nol snoke, drink olco-
hol, or loke drugs or nedicolions unless prescribed by
heollh core personnel. They should olso proclice sofe
sex lcondon use, obslinence, or sex only wilh on H\-
negolive porlner who is nonogonousI.
eve: e~ve ~ L~Ly ~o:e o: ~
Leo o: l~Le :on wi e ~:
~ /:o :eve: oo ~ :ewLo::
Ly is eel wil le e~o oow:
|ssert|al Care frr |er New|rrr 55
2
8]VeiZg'
New|rrr 0ar]er S|]rs
Donger signs ore lhe signs of serious heollh problens
which couse lhe deolh of nony newborns. To prevenl
deolh, lhe nolher ond fonily need lo recognize lhe
newborn donger signs ond respond oppropriolely.
Newborns oflen die becouse lhere is o.
n Deloy in recognizing donger signs
n Deloy in deciding lo gel nedicol core
n Deloy in reoching o heollh worker or focilily
Teoch lhe nolher ond fonily lo recognize newborn
donger signs lsee chorl 2.15I ond lo gel help innedi-
olely if one is seen. ls you exploin eoch donger sign,
osk lhe nolher or fonily lo give you on exonple of lhe
sign. This woy you know lhey underslond. You will fnd
nore infornolion oboul whol lo do in chopler .
Donger signs in o boby ore oflen nonspecifc. eoch
donger sign con be o sign of olnosl ony diseose or ill-
ness. The nosl connon signs of illness in o boby ore.
he slops feeding well ond is cold lo louch.
Plar frr |rllrwap \|s|ts
Moke o plon wilh lhe nolher for newborn follow-up
visils. How nony visils ond when lhey hoppen depend
on lhe newborn`s heollh ond governnenl policy. For
o heollhy newborn wilh no problens, do ol leosl four
visils. Becouse nosl newborn deolhs occur wilhin
lhe frsl week, especiolly lhe frsl 2/ hours, lhe frsl
7 doys of life ore o crilicol line for poslnolol core. l
suggesled schedule for newborn heollh core visils is
os follows.
\isil 1 Wilhin 2/ hours
\isil 2 2-3 doys
\isil 3 7 doys
\isil / 28 doys
llso renenber lo noke o plon for lhe -week in-
nunizolion visil ond counsel or refer lhe nolher for
fonily plonning core. This should be done os soon os
possible, preferobly during iniliol poslnolol counsel-
ing. The child will hove o beller chonce of survivol if
lhe nolher spoces her children 3-5 yeors oporl.
8=6GI'#&* NEWB0PN DAN6EP 5I6N5
n Breolhing problens lless lhon 3O or nore
lhon O or breolhs in 1 ninule, gospingI
n Feeding diffcullies or nol sucking
n Feels cold
n Fever
n Red, swollen eyelids, ond pus dischorge
fron eyes
n Redness of lhe skin, swelling, pus, or foul
odor oround lhe cord or unbilicus
n 0onvulsions/fls
n Joundice/yellow skin
5 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
TA5K5 F0P ALL REALTR W0PKEP5: E55ENTIAL CAPE F0P EEPY NEWB0PN
1 Prepore lhe roon, equipnenl, ond supplies for o cleon, sofe birlh.
2 0ive innediole newborn core ol birlh.
oI Dry ond slinulole lhe newborn.
bI lssess lhe boby`s breolhing ond color. lResuscilolion, if needed,
is covered in chopler /.I
cI Tie ond cul lhe cord.
dI Pul lhe newborn in skin-lo-skin conlocl wilh lhe nolher ond
keep lhe boby worn.
eI Help lhe nolher lo slorl breoslfeeding wilhin lhe frsl hour.
fI 0ive eye core.
3 lssess ond core for o newborn during lhe frsl doy.
/ Do lhe frsl newborn physicol exoninolion.
5 lssess ond core for lhe newborn during lhe frsl 28 doys lol 2-3 doys,
7 doys, ond 28 doysI.
Teoch ond counsel lhe nolher ond fonily oboul core of lhe newborn.
oI Needs of bobies fron birlh lo 28 doys
bI Keeping lhe boby worn
cI Prolecling lhe boby fron infeclion
dI Bolhing lhe newborn
eI 0ore of lhe cord ond unbilicus
fI Need for innunizolions
gI Fxclusive breoslfeeding
hI The breoslfeeding nolher`s need for vilonin l, fonily plonning
7 Teoch ond counsel lhe nolher ond fonily oboul donger signs.
8 Teoch ond counsel lhe nolher ond fonily oboul core of o boby wilh
obnornol exoninolion fndings.
|ssert|al Care frr |er New|rrr 57
2
8]VeiZg'
Nrtes
1 World Heollh 0rgonizolion. l2OOOI. Hunuin comp|icutions
in prenunc, unJ chi|Jbirth: u uiJe for miJwives unJ Joctors.
0enevo. WH0.
2 Soving Newborn Lives. l2OO1I. Stute of the wor|Js Newborns.
Woshinglon D0. Soving Newborn Lives/Sove lhe 0hildren
Federolion.
3 World Heollh 0rgonizolion. l1??7I. 7hermu| protection of
the newborn: u pructicu| uiJe. 0enevo. WH0. lWH0/RHT/
MSM/?7.2I
/ bid.
5 Widslron lM el ol. l1??OI. Shorl-lern effecls of eorly
suckling ond louch of lhe nipple on nolernol behovior.
Fur|, Fumun 0eve|opment, 21.153-13.
Righord L ond llode M0. l1??OI. Fffecl of delivery roon on
success of frsl breoslfeed. Luncet, 33.11O5-11O7.
7 De 0holeou P ond Wiberg B. l1??7I. Long-lern effecl on
nolher-infonl behovior of exlro conlocl during lhe frsl hour
poslporlun. /ctu PueJiutricu, .1/5-151.
8 UN0FF. l1???I. 8ub, FrienJ|, News. Nunber 2 llprilI.3-/.
? World Heollh 0rgonizolion/UN0FF. l1??8I. Protectin,
promotin unJ supportin breustfeeJin: the speciu| ro|e of
muternit, services. 0enevo. WH0.
1O Widslron el ol.
11 Soving Newborn Lives.
12 Sougslod 0D. l1??8I. Rouline lopicol unbilicol cord core ol
birlh l0ochrone ReviewI. 7he 0ochrune Librur,, ssue /,
0xford. Soflwore Updole.
13 World Heollh 0rgonizolion. l1??/I. 0|eun Je|iver, for the
prevention of tetunus unJ sepsis: Strenthenin of countr,-
wiJe prorummes. 0enevo. WH0.
1/ Zupon J ond 0orner P. l2OO2I. Topicol unbilicol cord core
ol birlh l0ochrone ReviewI. 7he 0ochrune Librur,, ssue /.
0xford. Soflwore Updole.
Suessu D:e~sleeoi:q
3
>cigdYjXi^dc *.
7ZcZihd[7gZVhi[ZZY^c\ +%
:VganVcY:mXajh^kZ7gZVhi[ZZY^c\ +'
HiVgi^c\id7gZVhi[ZZY +(
8dci^cj^c\id7gZVhi[ZZY ++
7gZVhi[ZZY^c\L]Zci]Z
Bdi]Zg^h=>KEdh^i^kZ/
BV`^c\Vc>c[dgbZY8]d^XZ ,&
7gZVhi[ZZY^c\EgdWaZbh ,)
:megZhh^c\7gZVhiB^a` -+
8je;ZZY^c\ --
3
Sarressfal Breastfee1|r] 5?
3
8]VeiZg(
D:e~sleeoi:q is ~ sei~ qil :on ~ nol
e: lo e: L~Ly l :ol o:y :ovioes ~ :~lu:~
oo:lu:ily o: Lo:oi:q Lul ~so suo:ls
le q:owl ~:o oeveone:l o le :ew
Lo:: M~:y :ewLo:: ives ~:e s~veo Le
~use L:e~sl ni :ovioes ino:l~:l
:ul:ie:ls ~:o :olelio: ~q~i:sl i:ess ~:o
i:elio: eve:y L~Ly we:e exusivey
L:e~sleo :on Li:l, ~Loul 1 niio: ives
wouo Le s~veo e~ ye~:
1
/ o us :eeo
lo s~y lo nole:s ~q~i: ~:o ~q~i:. C~:e
o: you: L~Ly i: le Lesl w~y you ~:,
L:e~sleeo you: L~Ly
You ~ve ~: ino:l~:l :oe i: ei:q
nole:s suessuy L:e~sleeo lei:
L~Lies e~:y ~:o exusivey M~:y wone:
e~: l~l ley n~y :ol ~ve e:ouq ni lo
eeo lei: i:~:ls Fi:slline nole:s i:
~:liu~: :eeo :e~ssu:~:e, :oweoqe,
noliv~lio:, ~:o o:oe:e Luioi:q To
e nole:s, you :eeo i:o:n~lio: ~:o
sis lo eou~le ~:o ou:se len ~
nole: is suessu i: L:e~sleeoi:q
ou:i:q le :sl ew o~ys o e: L~Lys ie,
se is no:e iey lo Le suessu ou:i:q
le :esl o lei: L:e~sleeoi:q line /:o
e: L~Ly ~s ~ q:e~le: ~:e o su:vivi:q
lo Leone ~: ~oul
3 Suessu D:e~sleeoi:q
O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
0onnunily supporl for breoslfeeding is olso essen-
liol. How connunilies provide lhis supporl vories in
differenl regions, sellings, ond fonilies. ls lhe heollh
worker, you con conlribule lo o supporlive environ-
nenl for breoslfeeding in your connunily. The infor-
nolion in lhis chopler con be lifesoving.
n lhis chopler you will fnd infornolion oboul.
n How breoslfeeding helps nolhers ond bobies
n Forly ond exclusive breoslfeeding
n Things o heollh worker con do lo help ensure o
successful frsl breoslfeed
n Things o nolher con do lo noke breoslfeeding
successful
n How long lo breoslfeed
n Breoslfeeding odvice for lhe nolher who is
H\ posilive
n 0onnon breoslfeeding problens
n Reosons lo express breosl nilk
n Reosons lo cup feed
n lhis chopler you will leorn lo do lhe following.
n 0ounsel/odvise o nolher ond her fonily on
eorly ond exclusive breoslfeeding
n Help o nolher breoslfeed lhe frsl line
n lssess how well o nolher breoslfeeds her boby
n lssisl o nolher lo breoslfeed successfully
n 0ounsel ond odvise on H\-posilive nolher on
infonl feeding
n Recognize ond core for connon breoslfeeding
problens
n Teoch o nolher how lo express breosl nilk
n Teoch o nolher lo cup feed her boby
B|N|||!S 0| Bk|AS!|||0|N
Breoslfeeding helps bolh lhe nolher ond lhe boby-
ond lherefore lhe fonily. l olso helps bobies who ore
low birlh weighl or sick. The reosons why breoslfeed-
ing is so heollhy ore exploined in chorl 3.1.
Exusive L:e~sleeoi:q
o: oen~:o :ovioes ~
le :ul:ilio: ~ L~Ly :eeos
i: le :sl o no:ls Tis
is :ol l:ue o: ~:y L:e~sl
ni suLslilule
Sarressfal Breastfee1|r] 1
3
8]VeiZg(
8=6GI(#& R0W BPEA5TFEEDIN6 RELP5 BABIE5 AND H0TREP5
BABIE5
n Fxclusive breoslfeeding on denond provides
oll lhe nulrilion o boby needs in lhe frsl
nonlhs. This is nol lrue for ony breosl nilk
subslilule.
n Breosl nilk conloins vilonin l. Bobies low in
vilonin l hove poor oppelile, eye problens, ond
nore infeclions.
n Breosl nilk is o cleon source of food. Woler used
lo nix fornulo ond lo wosh bollles noy hove
gerns lhol con couse diorrheo. This is o no|or
couse of infonl deolh.
n Breosl nilk ocls like lhe frsl innunizolion for
lhe boby, il nokes lhe innune syslen slronger.
n Breosl nilk prolecls bobies ogoinsl ollergies.
n f o boby is sick, breosl nilk helps o boby gel
beller fosler.
n Breosl nilk helps lhe boby`s body ond broin
develop ond grow.
n Breosl nilk helps low birlh weighl bobies,
especiolly lhose who ore prenolure.
n Breosl nilk is lhe eosiesl food for lhe boby
lo digesl.
n Breosl nilk provides nulrienls ideolly suiled
for growlh ond developnenl.
n Breosl nilk helps lo prevenl o serious diseose
of lhe inleslines lhol offecls low birlh weighl
bobies lnecrolizing enlerocolilisI.
n Breoslfeeding helps slobilize lhe boby`s
lenperolure.
n Breoslfeeding helps lhe boby`s noulh, leelh, ond
|ow develop properly.
n Milk fron lhe breosl is olwoys lhe perfecl
lenperolure for lhe boby.
H0TREP5
n Breoslfeeding helps focililole plocenlol seporolion.
n Breoslfeeding helps lhe ulerus relurn lo ils
nornol size.
n Breoslfeeding reduces onenio becouse lhe
nolher slorls her nenses loler.
n Fxclusive breoslfeeding helps suppress ovulolion,
so il con deloy onolher pregnoncy. When pregnon-
cies ore spoced ol leosl 3-5 yeors oporl, nolhers
ore heollhier ond child survivol is increosed.
n Breoslfeeding slrenglhens lhe relolionship
belween o nolher ond her boby.
n Breoslfeeding soves noney. The nolher does nol
need lo buy olher nilk lo feed lhe boby or poy for
heollh core when her boby gels sick nore oflen.
2 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
|Ak| AN0 |KC|US|\| Bk|AS!|||0|N
Forly breoslfeeding neons lo give lhe breosl wilhin
ninules of lhe boby`s birlh. Fxclusive breoslfeeding
neons lo feed lhe boby on|, ol lhe breosl. This neons
o boby should nol be given ony woler, leo, herbol
drinks, infonl fornulo, olher liquids, or food. Fxclusive
breoslfeeding for lhe frsl nonlhs is reconnended
lhroughoul lhe world becouse il helps o boby survive.
l olso helps lhe boby grow ond develop.
||r] 0t|er ||a|1s rr |rr1s 0ar|r] t|e ||rst Nrrt|s
Car Be Narmfal tr t|e Ba| ar1 tr Breastfee1|r]
ldvise porenls oboul lhe following infornolion.
n When o boby is given olher liquids or food,
lhe boby will nol feed os long or os oflen on lhe
nolher`s breosl. The nolher will lhen noke less
nilk. Then lhe boby will wonl nore of lhe olher
liquids or food, ond lhe nolher will noke even
less nilk. This cycle conlinues unlil lhe nolher
hos no nilk.
n The boby noy becone used lo o bollle nipple
ond lose lhe obilily lo suck effeclively on lhe
breosl. This con leod lo sore nipples, poor nilk
lel-down, refusol of lhe breosl, loclolion foilure,
ond/or nolnulrilion.
n The boby who lokes olher liquids or foods olong
wilh breosl nilk does nol obsorb oll lhe nulri-
enls of breosl nilk well, vilonins ond ninerols
con be losl.
n Bobies slop breoslfeeding eorlier if lhey gel
olher foods.
2,3
n The boby who lokes olher liquids or foods
before nonlhs gels sick nore oflen ond hos o
bigger chonce of gelling diorrheo or on infec-
lion, such os pneunonio.
/
Ba||es et |rra]| water frrm Breastfee1|r] |trlas|el
ldvise porenls oboul lhe following infornolion.
n Breosl nilk is olnosl oll woler l88 percenlI.
5
Fven before lhe nilk cones in, coloslrun llhe
lhick yellowish frsl nilkI is enough lo solisfy
lhe boby. l boby who is breoslfed on denond
receives oll lhe woler she needs fron breosl
nilk.

When o boby is lhirsly, lhe nolher should


breoslfeed ond drink nore liquids lo help pro-
duce nore breosl nilk.
;><JG:(#& EXCLU5IE BPEA5TFEEDIN6
I5 TRE REALTRIE5T WAY T0
FEED A NEWB0PN
Sarressfal Breastfee1|r] 3
3
8]VeiZg(
n Bobies in very hol ond dry clinoles do nol need
olher fuids if lhey breoslfeed exclusively ond on
denond.
7,8
They should nol be given sugor wo-
ler, honey woler, or onylhing else. Breosl nilk
supplies oll lhe fuid o boby needs.
n l boby`s slonoch is snoll. When o boby drinks
woler or olher liquids, lhere is less roon for
breosl nilk. Sludies show lhol bobies who drink
woler or olher liquids before nonlhs drink
less breosl nilk. This con couse nolnulrilion.
?
n Bobies who drink olher liquids before nonlhs
gel sick nore oflen wilh diorrheo ond ore nore
likely lo die.
S!Ak!|N !0 Bk|AS!|||0
The frsl line o nolher feeds her boby is on inporlonl
line. 1I 0oloslrun is lhe frsl nilk secreled fron lhe
breosl ond hos nony benefls for lhe newborn. 0olos-
lrun should lherefore nol be discorded. 2I f lhe frsl
breoslfeed is successful, il helps loler breoslfeeding
lo be successful. Mosl bobies ore reody lo feed for lhe
frsl line fron 15-55 ninules ofler birlh.
1O
Fxploin lhe
infornolion lhol follows lo lhe nolher ond fonily.
w| S|ral1 a Nrt|er Start Breastfee1|r] 0ar|r]
t|e ||rst Nrar After B|rt|?
JJ
n Mosl newborns hove o slrong suck refex ond
ore owoke lhe frsl hour ofler birlh.
n The newborn`s sucking helps lhe nolher noke
breosl nilk.
n 0oloslrun is very high in vilonin l ond onli-
bodies, which prolecl lhe boby fron infeclion. l
is oflen colled lhe boby`s frsl innunizolion.
n 0oloslrun helps lo expel neconiun ond lo
prevenl |oundice.
n 0oloslrun conloins o very high concenlrolion of
nulrienls ond helps prevenl low blood sugor in
lhe frsl hours of life.
n Molhers hove less bleeding ofler birlh if lhey
breoslfeed innediolely.
n nnediole skin-lo-skin conlocl helps lhe boby
sloy ol lhe besl lenperolure.
n Forly breoslfeeding helps lhe nolher ond boby
develop o slrong relolionship.
5eIf-attacbment
There ore severol sludies lhol describe
lhe newborn`s nolurol obilily lif lefl
undislurbed on lhe nolher`s obdonen
innediolely ofler birlhI lo look for ond
crowl lo lhe nolher`s nipple, unossisled.
This includes lolching-on ond suck-
ing. Sleps lo supporl self-ollochnenl
include.
n Ploce lhe boby foce down on lhe
nolher`s obdonen.
n Supporl lhe boby os she noves
groduolly loword lhe breosl.
n lllow lhe boby line lo noulh lhe
nipple before fully loking il inlo her
noulh. The boby is born wilh o
nolurol desire lo loke in ond suck
on lhe full oreolo ond nipple.
n lllow lhe boby lo suck os long os
she wonls.
Source. Righord L, ond llode M0. l1??OI. Fffecl
of delivery roon roulines on success of frsl
breosl-feed. Luncet, 33.11O5-11O7.
For olher sources, pleose see lhe lisl of generol
references ol lhe end of lhis chopler.
/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
WRAT Y0U CAN D0 T0 RELP A H0TREP BPEA5TFEED
5UCCE55FULLY TRE FIP5T TIHE
n Pul lhe boby in skin-lo-skin conlocl wilh lhe
nolher innediolely ofler birlh.
n Do nol seporole lhe nolher ond lhe boby llo weigh,
give eye core, elc.I unlil ofler lhe frsl breoslfeed.
n Do nol rush, lhe frsl breoslfeed lokes line.
Hctber`s pcsiticn
Help lhe nolher gel inlo o conforloble posilion. f she
desires, use pillows or folded blonkels under her heod
if she is lying down or under her orn if she is silling.
n 0n her bock. The nolher noy wish for her heod
ond shoulders lo be supporled.
n Side-lying. f lhe nolher hod o cesoreon delivery,
lhis posilion noy be nosl conforloble for her.
n Silling up.
Baby`s pcsiticn
n The nolher should hold lhe boby close wilh bolh
lhe heod ond lhe body lurned lo foce lhe breosl.
n The boby is focing lhe breosl wilh lhe boby`s nose
opposile lhe nipple.
n The boby`s whole body is fully supporled. f lhe
boby is lower lhon lhe nolher`s breosl, pul lhe
boby on o pillow or folded blonkel so lhe boby ond
lhe breosl ore ol lhe sone level.
Attacbment and suck
n Woys lo help lhe boby olloch lo lhe breosl.
n The nolher should hold her breosl in o 0-hold
llhunb on lop ond olher fngers below lhe
breoslI wilh her fngers owoy fron lhe
nipple. lSee fgure 3.1I
n Touch lhe boby`s lips wilh lhe nipple.
n Woil for lhe noulh lo open wide.
n Move lhe boby onlo lhe breosl wilh boby`s lower
lip below lhe nipple. Do nol nove only lhe boby`s
heod bul supporl lhe bock of lhe neck ond nove
lhe whole body.
n Look lo see how lhe boby is olloched.
n Moke sure lhol breosl lissue does nol block lhe
boby`s nose while she is sucking.
n The nolher should nol leon over lhe boby. She
should bring lhe boby lo her breosl, nol nove
her breosl lo lhe boby.
n How con you lell lhe ollochnenl is good?
n The boby`s chin is louching lhe breosl.
n The boby`s noulh is wide open.
n The lower lip is lurned oulword.
n You con see nore of lhe oreolo obove lhe noulh
lhon below il.
n How con you lell lhe sucking is good?
n There ore slow deep sucks wilh sone pouses.
n The nolher`s breosls ond nipples ore conforloble.
n Whol if lhe ollochnenl ond sucking ore nol good?
Toke lhe boby off lhe breosl. Teoch lhe nolher lo
do lhis by pulling her fnger genlly inlo lhe boby`s
noulh lo breok lhe suclion. Help lhe boby olloch
ogoin. Poor posilion, poor ollochnenl, ond poor
sucking con oll reduce nilk fow inlo lhe boby`s
noulh, hurl lhe nipple lcouse soreness or crocksI,
ond couse breosl engorgenenl lbreosl becones
loo fullI.
Duraticn cf eacb feeding
There is no linil lo how long o boby should suck. f lhe
ollochnenl, suck, ond posilion ore good, lhe boby con
suck unlil she gels full. Use bolh breosls. The boby
should fnish enplying one breosl lo gel lhe rich hind-
nilk llhe losl nilk lo cone fron o breosl ol o feedingI
before slorling on lhe second breosl.
8=6GI(#' TIP5 T0 RELP TRE FIP5T BPEA5TFEED
Sarressfal Breastfee1|r] 5
3
8]VeiZg(
;><JG:(#' WAIT F0P TRE H0UTR T0 0PEN WIDE ;><JG:(#( ATTACRHENT
Inccrrect!
This boby is grosping only porl of lhe nipple which
will be in|ured if she sucks lhis woy.
Inccrrect!
This boby is grosping only lhe nipple which
will be in|ured if she sucks lhis woy.
Ccrrect!
This boby`s noulh is wide open. She is grosping lhe
oreolo ond her chin is louching lhe breosl.
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
0r|rk w|t| |er Breastfee1 ar1 |at Nrre |rr1 |ar| 0a
Breoslfeeding nolhers need exlro liquids. ln eosy
woy lo renenber lo drink nore. drink o lorge gloss of
liquid wilh every breoslfeed ond when lhirsly.
ldvise breoslfeeding nolhers lo ovoid drinking olco-
hol. Moderole lo heovy olcohol consunplion inlerferes
wilh lhe nolher`s nilk lel-down refex, inhibils lhe
boby`s nilk inloke, offecls her nolor developnenl,
ond slows down her weighl goin.
13
To sloy heollhy o breoslfeeding wonon needs lo eol ol
leosl one lorge exlro serving of her slople food every doy.
Use 0|fferert Prs|t|rrs tr Nrl1 t|e Ba|
l is inporlonl for o nolher lo be conforloble dur-
ing breoslfeeding. Feeling poin, cold, or being upsel
nokes il hord for her nilk lo fow oul. The woy she
holds lhe boby con olso noke breoslfeeding eosier for
lhe nolher ond boby. Foch hold hos ils own benefls.
Using differenl holds helps lo drow nilk fron differ-
enl porls of lhe breosl. Renenber. while lhe nolher
holds her boby lo breoslfeed, lhe boby needs lo foce
lhe breosl ond his body needs lo be in o slroighl line.
Cra1le |rl1
The nolher sils up ond loys lhe boby on his side
ocross her lop, focing her. She supporls lhe boby`s
heod in lhe bend of her elbow ond lhe bock ond bul-
locks wilh her foreorn.
Crrssrra1le |rl1
This posilion is olnosl like lhe crodle hold, bul lhe
nolher uses her olher orn lo hold lhe boby. The boby`s
heod is held by lhe nolher`s open hond. This posilion
nokes il eosy lo nove lhe boby lo lhe breosl ond inlo o
conforloble posilion os lhe boby lolches on ond sucks.
Ur1erarm |rl1
l nolher con pul her boby under her orn, holding lhe
boby`s heod ond neck in her hond. The boby`s feel go
lowords her bock. This posilion helps if lhe nolher
hod o cesoreon delivery or if lhe boby does nol loke
in enough of lhe nolher`s nipple ond oreolo in olher
posilions.
C0N!|NU|N !0 Bk|AS!|||0
|ee1 t|e Ba| rr 0emar1
n Breoslfeed whenever lhe boby wonls lo eol.
0ues lhol lhe boby wonls lo eol include. nuz-
zling, sucking on her hond, noving her heod
bock ond forlh, or opening her noulh.
n Mosl newborns will eol on overoge of 8-12
lines in 2/ hours or oboul every 2-3 hours. This
is inporlonl becouse.
n l newborn`s slonoch is snoll ond needs lo
be flled oflen.
n Breosl nilk is eosily digesled ond lherefore
posses quickly lhrough lhe boby.
12
n Wilh denond feeding, lhe nolher`s nilk produc-
lion od|usls lo lhe boby`s needs, so lhere is ol-
woys enough nilk. The nore lhe boby sucks, lhe
nore nilk lhe nolher nokes.
|mpt t|e ||rst Breast at |ar| |ee1
n Fncouroge lhe nolher lo feed frsl on one breosl,
wilhoul line linilolion, before offering lhe
second breosl. This helps ensure lhol lhe boby
gels lhe rich hindnilk. f lhe righl breosl is used
lo slorl one feed, ol lhe nexl feeding slorl wilh
lhe lefl breosl. Then bolh breosls will noke lhe
sone onounl of nilk.
n Do nol linil how long lhe boby con suck during
o feeding.
n The frsl porl of o feed on one breosl, colled
lhe forenilk, is nore wolery lo solisfy lhe
boby`s lhirsl.
n The end porl of o feed, colled lhe hindnilk, is
richer in fol lo solisfy lhe boby`s hunger.
Sarressfal Breastfee1|r] 7
3
8]VeiZg(
;><JG:(#) CPADLE R0LD
;><JG:(#* CP055-CPADLE R0LD
;><JG:(#+ UNDEP-APH R0LD
;><JG:(#, 5IDE LYIN6
8 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
S|1e l|r]
This con olso be colled lhe eol-ond-sleep hold. Bolh
lhe nolher ond boby lie on lheir sides focing eoch
olher. The nolher noy use eilher her hond or foreorn
or o pillow behind lhe boby`s bock lo supporl hin,
posilioning lhe heod ol her lower breosl. The nolher
noy prefer lhis hold during lhe frsl few doys ofler
giving birlh ond ol nighl. l olso is o good posilion for o
nolher who hod o cesoreon delivery.
et |rra]| kest
l breoslfeeding nolher is oflen owoke ol nighl. This
neons she noy nol gel enough sleep. When o nolher
is very lired, she nokes less nilk. 0ne woy she con
gel nore sleep is lo nop when lhe boby sleeps during
lhe doy. f lhe nolher hos olher children or responsi-
bililies, il con be hord lo do lhis. ls o heollh worker,
lolk wilh lhe nolher ond fonily oboul.
n Why lhe nolher needs lo sleep during lhe doy
n How she con gel nore sleep
n Whol lhe fonily con do lo help
et |rra]| Natr|erts
For lhe nolher lo sloy heollhy, encouroge her lo eol
o wide voriely of foods so lhol she gels suffcienl vilo-
nins, ninerols, ond olher nulrienls. Foling on exlro
neol or ol leosl on exlro serving of her slople food
eoch doy will help inprove her nulrilion ond energy
level. Poslporlun wonen olso need lo reploce iron
slores. Therefore, vilonin ond iron supplenenls noy
be benefciol. nporlonl nulrienls for lhe poslporlun
nolher include vilonin l, in oreos where vilonin l
defciency is connon.
1/
Breastfee1 a S|rk Ba| 0ar|r] ar1 After ar |llress
l is even nore inporlonl for o sick boby lo breoslfeed.
The boby needs lhe woler, ninerols, ond proleclion
fron breosl nilk.
|ee1 a Ba| Nrre 0fter 0ar|r] Per|r1s rf kap|1 rrwt|
Sonelines o boby will wonl lo feed olnosl conslonlly
becouse of o growlh spurl. This nornolly hoppens ol
oboul 1O-1/ doys, ol 5- weeks, ond ol oboul 3 nonlhs
ofler birlh, when lhe boby is going fron one level of
growlh lo lhe nexl. More food ond energy ore needed
ol lhese lines. To help lhe nolher noke nore nilk,
lhe boby feeds nore oflen ond longer for 1-2 doys, or
unlil lhe nolher`s nilk supply hos increosed lo neel
lhe boby`s new denond. Mony nolhers lhink lhe boby
is feeding nore becouse she does nol hove enough
nilk. Reossure lhe nolher. Fxploin why lhe boby is
feeding nore. Fncouroge her lo drink nore fuids ond
lo feed lhe boby os oflen os lhe boby wonls.
Nrw tr Krrw |f t|e Ba| |s ett|r] |rra]| Breast N|lk
Mony nolhers worry whelher lhey hove enough breosl
nilk for lheir bobies. They noy feel lhis woy when lhe
boby hos ropid growlh spurls, when lheir lel-down
chonges lol oboul 3 nonlhsI, or when lhe boby`s
slools chonge ol 3- weeks. They olnosl olwoys hove
plenly of breosl nilk. There ore lwo lhings you con
do lo reossure lhe nolher. 1I express nilk fron lhe
nolher`s breosl so she con see lhere is lols of nilk,
ond 2I exploin sone sinple signs she con check lsee
chorl 3.3I.
Sarressfal Breastfee1|r] ?
3
8]VeiZg(
8=6GI(#( 5I6N5 TRAT TRE BABY I5
6ETTIN6 EN0U6R BPEA5T
HILK
15
n The boby posses urine ol leosl lines in
2/ hours.
n You con heor lhe boby swollow when
feeding.
n The nolher`s breosls feel sofler ofler o
feed.
n The boby goins weighl over line lofler lhe
frsl weekI.
n The boby seens conlenled ofler feeding.
She hos lines when she is hungry, quiel,
owoke, ond sleepy during lhe doy.
Nrw |trlas|e Breastfee1|r] Car Nelp 0ela Arrt|er
Pre]rarr
Fxclusive breoslfeeding con help spoce pregnoncies.
This is connonly known os lhe Loclolionol lnenor-
rheo Melhod lLlMI. The breoslfeeding wonon will nol
ovulole lwill nol be ferlileI os long os lhree condilions
ore nel.
1. lhe boby is exclusively breoslfed on denond
lnolhing bul breosl nilk nighl ond doyI,
2. lhe boby is nonlhs old or less, ond
3. lhe wonon hos nol seen lhe relurn of her
nenslruol period lbleedingI.
lfler lhe frsl nonlhs, odvise lhe wonon lhol
breoslfeeding olone connol be relied upon lo prevenl
pregnoncy. She will need counseling on olher nelh-
ods of fonily plonning.
Nrw |rr] tr Crrt|rae Breastfee1|r]
!|e hrst mrrt|s:
l nolher should breoslfeed exclusively on denond for
lhe frsl nonlhs. This neons lhol for nonlhs lhe
boby receives nolhing bul breosl nilk whenever lhe
boby wonls lo suck.
S|t mrrt|s tr I ears:
n lfler nonlhs, breoslfeeding olone connol
give lhe boby oll lhe energy, vilonins, ond
ninerols she needs.
n 0onlinue breoslfeeding while giving olher foods
or liquids.
n The longer o nolher breoslfeeds, lhe longer
her boby gels infeclion proleclion fron lhe
breosl nilk.
7O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Breastfee1|r] !w|rs
Molhers con noke plenly of nilk lo breoslfeed lwins
successfully. Mony lines lwins ore born wilh low birlh
weighl, so odequole breosl nilk is even nore inpor-
lonl for lhen.
ll frsl, feed |usl one boby ol o line. This helps lhe
nolher gel used lo eoch boby`s woy of breoslfeeding.
0ive one breosl lo one boby ond lhe olher breosl lo lhe
olher boby, lhis ensures lhol eoch boby gels enough
breosl nilk. ls soon os lhe nolher is used lo breosl-
feeding her lwins, she con breoslfeed bolh bobies
logelher. This will sove line.
When feeding lhe bobies logelher, use bolh lhe un-
der-orn hold ond lhe crodle hold lsee fgures 3.8 ond
3.?I. ls breoslfeeding becones esloblished, ollernole
breosls, i.e., do nol give one boby lhe sone breosl oll
lhe line. This keeps o boby fron hoving o fovorile side
ond olso keeps one breosl fron gelling bigger lhon
lhe olher if one lwin hos o slronger suck lhon lhe olh-
er. Moke sure lhol eoch boby gels lhe rich hindnilk.
To sloy heollhy o nolher of lwins nusl. 1I eol exlro
food lhol is rich in proleins, vilonins, ond ninerols
everydoy, ond 2I drink plenly of woler eoch doy.
;><JG:(#- UNDEP-APH R0LD WITR TWIN5
;><JG:(#. CPADLE R0LD WITR TWIN5
Sarressfal Breastfee1|r] 71
3
8]VeiZg(
Bk|AS!|||0|N wN|N
!N| N0!N|k |S N|\ P0S|!|\|:
NAK|N AN |N|0kN|0 CN0|C|
The boby of o nolher who is H\ posilive hos oboul o
1 in 7 l15%I chonce of gelling lhe H\ infeclion lhrough
breoslfeeding. Bobies who do gel H\ usuolly die
eorly. The H\-posilive nolher foces o diffcull choice
becouse of lhe possible risk of lronsnission lhol
breoslfeeding corries.
Where resources ore liniled, bollle-feeding lhe new-
born wilh breosl nilk subslilules noy be riskier lhon
breoslfeeding by on H\-posilive nolher. Bollle-feed-
ing in low resource oreos couses nony infonl deolhs
due lo diorrheo, nolnulrilion, ond olher infeclions. n
ideol condilions, however, il is possible lo successfully
feed on infonl wilh connerciol fornulo or hone-
nodifed oninol nilk, ollhough lhis is nol eosy ond
con be expensive.
Breosl nilk is lhe besl food for o newborn. There ore
lhree woys lo nodify breoslfeeding so lhe boby con slill
gel nosl of lhe benefls of breosl nilk wilh o very low
risk of nolher-lo-child lronsnission of H\. These
choices ore.
n Fxclusive breoslfeeding wilh eorly weoning
n Heol-lreoling expressed breosl nilk
n Hoving on H\-negolive wonon breoslfeed lhe
newborn lwel nursingI
The decision oboul how or whelher lo nodify breosl-
feeding con ond should be node by lhe nolher ond
fonily, nol lhe heollh worker. ls o heollh worker, your
responsibilily is lo give infornolion lhol will guide
lhe nolher ond fonily on how lo lhink lhrough lhe
choices. 0nce lhey hove lhe infornolion, underslond
lhe issues, ond review lheir own siluolion, lhey con
noke on informeJ choice.
Reseorch is conslonlly giving us new infornolion on
prevenlion of nolher-lo-child lronsnission of H\. n
order lo sloy up-lo-dole wilh lhe lolesl reconnendo-
lions, regulorly consull lhe websiles lisled ol lhe end
of lhis chopler.
The World Heollh 0rgonizolion, lhe Joinl Uniled No-
lions Progronne on H\/lDS, ond lhe Uniled Nolions
0hildren`s Fund reconnend.
ReaItb wcrkers sbcuId give a wcman witb RI aII tbe
infcrmaticn cn tbe risks and benehts cf tbe different
feeding cpticns and tben suppcrt tbe wcman`s feed-
ing cbcice.
1
Crarsel|r] rr |rfart |ee1|r]
Whol infornolion do porenls need lo noke on in-
forned decision? They need lo know why you ore
suggesling lhol breoslfeeding be nodifed, whol lhe
choices ore, ond lhe benefls ond risks of eoch oplion.
Supporl lhe wonon os she nokes lhe decision lhol
is righl for her bosed on her personol, fonily, ond
household siluolion.
|arts A|rat Breastfee1|r] frr N|\Prs|t|e Nrt|ers ar1
!|e|r |am|l|es
H\ in breosl nilk does nol lronsfer os eosily lo lhe
boby os H\ in blood or olher body fuids. 0nly oboul
1 oul of 7 H\-posilive nolhers who breoslfeed will
infecl lheir bobies lhrough breoslfeeding. The risk of
H\ lronsnission is less.
n f lhe boby breoslfeeds exclusively
n f lhe nolher seeks innediole core for crocked
nipples or breosl infeclions
n f lhe boby is breoslfed for only o few nonlhs
n f lhe nolher ond boby ore given onlirelrovirol
nedicolions
The risk of H\ lronsnission is nore.
n The longer o boby breoslfeeds
n f o nolher becones infecled while breoslfeeding
llronsnission lo lhe boby doublesI
n f lhere ore problens or infeclions such os
noslilis or crocked nipples in lhe nolher or orol
lhrush or inleslinol infeclions in lhe boby
n f lhe nolher shows signs of lDS
nfonls who do nol receive breosl nilk hove o nuch
greoler risk of dying fron olher infeclions in lhe frsl 2
nonlhs lhon infonls who do receive breosl nilk.
72 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
0pt|rr J: |trlas|e Breastfee1|r] w|t| |arl wear|r] rr
w|er keplaremert |ee1s Neet A|ASS Cr|ter|a
n Breoslfeeding is slopped os soon os lhe boby
con be weoned lo o nulrilionolly odequole
replocenenl food which is lFlSS locceploble,
feosible, offordoble, susloinoble, ond sofeI.
n The boby receives on|, breosl nilk for o liniled
line unlil lFlSS crilerio ore nel or il becones
sofe lo give olher foods loboul nonlhsI.
Berehts
n Fxclusive breoslfeeding ond eorly weoning by
nonlhs reduce lhe risk of H\ lronsnission.
n The nolher gives lhe boby oll lhe benefls of
breoslfeeding during lhe crilicol eorly nonlhs of
life lbesl food for boby, proleclion fron infeclion,
supporls besl growlh ond developnenlI.
n The risk of infeclion fron use of o feeding bollle
is ovoided.
k|sks rr 1|sa1arta]es
n Forly weoning creoles nore work for lhe nolher
who nusl prepore o breosl nilk subslilule.
n Feeding wilh o breosl nilk subslilule is expensive.
n Feeding wilh o breosl nilk subslilule increoses
lhe boby`s risk of olher infeclions ond poor
nulrilion.
n Forly weoning is diffcull for bolh nolher ond
boby. The nolher`s breosls will be poinfully
engorged for o few doys, lhe boby noy cry o lol,
ond lhe nolher noy be very upsel.
n Forly weoning noy open lhe nolher lo crilicisn
ond sligno.
n lFlSS crilerio noy be diffcull lo neel.
0pt|rr I: |tpress|r] Breast N|lk ar1 Neattreat|r]
|t Befrre |ee1|r]
n Heol-lreoling kills H\ in breosl nilk.
17,18
n The nolher expresses her breosl nilk ond
heol-lreols il, lhen feeds il lo lhe boby by cup.
Two nelhods used lo heol-lreol breosl nilk ore.
n Flosh boiling. bring lhe nilk |usl lo o boil, cool
il, ond feed il lo lhe boby.
n Holder lor PrelorioI posleurizolion.
n Ploce up lo holf o cup l12O nlI of breosl nilk
in o cleon gloss |or ond screw on lhe lid.
n Fill o one liler oluninun pol holf full wilh
woler ond heol il lo lhe boiling poinl.
n When lhe woler is boiling, renove lhe pol
fron lhe heol ond innediolely ploce lhe |or
of breosl nilk in lhe pol of hol woler. Lel lhe
|or of breosl nilk slond in lhe hol woler for 15
ninules.
n Posleurized nilk con be sofely slored ol roon
lenperolure for up lo 12 hours if lhe |or is nol
opened or hondled.
Berehts
n There is olnosl no risk of lronsnilling H\.
n The boby gels lhe nulrilionol benefls of breosl
nilk. lllhough boiling deslroys sone properlies
of breosl nilk, il is slill beller for lhe newborn
lhon fornulo prepored fron oninol nilk.
1?
n The risk of infeclion is less fron cup feeding
lhon fron bollle feeding.
k|sks rr 1|sa1arta]es
n The nolher needs lo spend o lol of line express-
ing breosl nilk, heol-lreoling il, ond cleoning
lhe conloiner ond cup.
n The nolher nusl spend noney on fuel lo
heol-lreol breosl nilk every doy.
n The boby nusl be fed by cup.
n The nolher noy be slignolized for nol breosl-
feeding direclly.
n There ore cullurol borriers lo lhis proclice in
sone counlries.
Sarressfal Breastfee1|r] 73
3
8]VeiZg(
0pt|rr 1: wet Nars|r] | a wrmar w|r |s N|\ Ne]at|e
The fonily fnds o wonon who lesls H\ negolive ond
is nol likely lo be exposed lo fulure H\ infeclions lo
breoslfeed lhe boby. The wonon is given inforno-
lion on how lo proclice sofe sex becouse lhe risk of
lronsnission lo lhe boby is very high if she becones
infecled while breoslfeeding.
Berehts
n Breoslfeeding by onolher wonon gives lhe boby
neorly oll lhe sone proleclive benefls os breosl-
feeding wilh lhe nolher.
n There is no risk of lronsnilling H\ lhrough
feeding, os long os lhe wel nurse does nol
becone infecled.
n The risk of infeclions fron use of o feeding bollle
is ovoided.
k|sks rr 1|sa1arta]es
n l noy be diffcull lo be sure onolher person is
H\ negolive ond sloys negolive.
n The nolher needs lo spend focused line wilh
her boby lo help lheir relolionship sloy close.
n l is nol olwoys eosy lo fnd o wonon willing lo
loke on lhe responsibilily of wel nursing.
n There ore cullurol borriers lo lhis proclice in
sone counlries.
n The nolher noy need lo poy lhe wel nurse.
n The nolher noy be slignolized for nol nursing
her own boby.
n f lhe boby is born wilh H\, lhere is o very snoll
risk lhol breoslfeeding noy lronsnil lhe infec-
lion lo lhe wel nurse. This risk is higher if lhe
boby hos orol lhrush or olher noulh lesions, or
if lhe wel nurse hos o crocked, bleeding nipple
or olher breosl condilion.
n f lhe nolher does nol breoslfeed, she looses
lhe child-spocing benefls of breoslfeeding.
0pt|rr /: keplaremert |ee1|r] w|t| Crmmerr|al |rfart
|rrmala
The infonl is fed connerciol infonl fornulo fron birlh
lno breoslfeedingI. See 0plion 5 for lhe benefls ond
risks or disodvonloges of replocenenl feeding.
0pt|rr E: keplaremert |ee1|r] w|t| NrmeNr1|he1
Ar|mal N|lk
The infonl is fed oppropriolely nodifed oninol nilk
fron birlh lno breoslfeedingI.
Berehts rf replaremert fee1|r]
n No risk of H\ lronsnission lhrough feeding.
lThere is slill o chonce lhol lhe boby noy hove
ocquired H\ infeclion during pregnoncy or
birlh.I
n 0lher people besides lhe nolher con help feed
lhe boby.
n Molher ond boby con be seporoled. nfonl
feeding is nol inlerrupled if lhe nolher is sick
or dies.
n The boby con becone closely olloched lo olher
people besides lhe nolher.
k|sks rr 1|sa1arta]es rf replaremert fee1|r]
n Sofe replocenenl feeding requires.
n l relioble ond offordoble supply of lhe selecled
replocenenl food ond o sofe ploce lo slore il
n Nulrilionolly odequole connerciol infonl
fornulo or hone-nodifed oninol nilk
n 0leon woler lo prepore lhe replocenenl food
n 0leon ulensils
n ldequole supply of fuel
n 0ood hygiene ond good sonilolion
n Tine lo prepore ond feed lhe infonl lhe
replocenenl food
n Knowledge of how lo correclly nodify oninol
nilk, or lhe obilily lo reod inslruclions on lhe
selecled infonl fornulo pockoge
n Breosl nilk subslilules lock onli-infeclive
onlibodies.
n Breosl nilk subslilules lock growlh hornones.
n Purchose of enough breosl nilk subslilules lo
feed on infonl con consune o lorge porlion of
lhe fonily`s incone.
n nproper preporolion of breosl nilk subslilules
con couse diorrheol diseose ond/or nolnulrilion.
n Wonen who do nol breoslfeed lose lhe child-
spocing benefl of breoslfeeding ond need oc-
cess lo offordoble ond oppropriole fonily plon-
ning services.
n nfonls who do nol breoslfeed noy nol gel
odequole psychosociol slinulolion ond noy nol
bond well wilh lheir nolhers.
n Where breoslfeeding is lhe norn, wonen who
do nol breoslfeed noy be slignolized ond nor-
ginolized.
7/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Bk|AS!|||0|N Pk0B||NS
Srre rr Crarke1 N|pples
Sonelines o nolher`s nipples becone sore, poin-
ful, ond noy even crock ond bleed. f lhis problen is
nol nonoged properly, il con leod lo noslilis. Sore or
crocked nipples ore usuolly coused by poor posilioning
ond ollochnenl of lhe boby lo lhe breosl.
See chorl 3./ for decision-noking sleps.
Nrt |rra]| N|lk
Wonen oflen worry whelher lheir bobies ore gelling
enough nourishnenl fron breoslfeeding. Nol enough
nilk is lhe nosl connon nisperceplion. l nolher
oflen lhinks lhol she is nol producing enough nilk when.
n The boby hos o growlh spurl lo period of very
ropid growlhI ond wonls lo suck nore oflen.
n Her sensolion of nilk lel-down chonges lo
differenl feeling in her breosls, or her breosls
do nol leok os nuchI.
n She is slressed for olher reosons.
l wonon`s body is copoble of producing plenly of nilk
lo exclusively breoslfeed her boby lor nore lhon one
bobyI for lhe frsl nonlhs, providing lhe boby sucks
frequenlly for os long os she wonls ond lhe nolher
hos lhe supporl she needs. l is very rore lhol lhere
reolly is nol enough nilk.
Nonelheless, if lhe boby`s growlh role is slow, il is pos-
sible lhol lhe wonon is nol producing or lelling down
enough nilk, for one or nore of lhe following reosons.
n The nolher is loo lired lo feed oflen ond on denond.
n The nolher is dehydroled.
n The nolher is very slressed.
n The boby is nol being fed oflen enough.
n The boby is being given olher foods or liquids.
n The boby does nol enply lhe breosl well ol
eoch feeding.
n ony of lhese siluolions, giving lhe boby o bollle will
only noke lhe problen worse. Rolher, lhe nolher
needs supporl, encourogenenl, ond proclicol odvice
on how lo increose her nilk supply, porliculorly lo
increose lhe frequency of breoslfeeding.
See chorl 3.5 for decision-noking sleps.
/ won~:s Looy is ~~
Le o :ooui:q e:ly o
ni lo exusivey L:e~sl
eeo e: L~Ly o: le :sl
o no:lsl is ve:y :~:e
l~l le:e :e~y is :ol
e:ouq ni
/ won~:s Looy is ~~
Le o :ooui:q e:ly o
ni lo exusivey L:e~sl
eeo e: L~Ly o: le :sl
o no:lsl is ve:y :~:e
l~l le:e :e~y is :ol
e:ouq ni
Sarressfal Breastfee1|r] 75
3
8]VeiZg(
Breast |r]rr]emert
Breosls lhol ore loo full ore engorged. This con be
coused by.
n Milk coning in lhe frsl line, ofler lhe coloslrun.
n l boby who does nol olloch well lo lhe breosl,
so does nol enply lhe breosl conplelely.
n Seporolion of nolher ond boby, so lhol lhe boby
does nol feed for o long period.
n l nolher who is slressed, offecling lhe lel-down.
See chorl 3. for decision-noking sleps.
Pla]]e1 N|lk 0art
0ne of lhe ducls lhrough which lhe breosl nilk fows
gels slopped up. This noy hoppen if one oreo of lhe
breosl is nol enplying well.
See chorl 3.7 for decision-noking sleps.
Nast|t|s
I1, IJ
Moslilis is on infeclion of lhe breosl lissue, nol lhe
nilk. The noin couses ore.
n Boclerio lgernsI gel inlo lhe breosl becouse lhe
nolher hos crocked nipples.
n Milk does nol fow well lhrough lhe nilk ducls.
Milk is high in sugor ond when fuids high in
sugor sloy in one ploce, boclerio grows lhere.
When boclerio increoses, lhe nolher gels on
infeclion. Things lhol slow lhe fow of breosl
nilk con couse infeclion. For exonple.
n The nolher hos engorged breosls.
n The nolher hos o plugged nilk ducl.
n The nolher weors o very lighl bro or lies o
clolh very lighlly oround her breosls.
n The nolher`s innune syslen is weok.
n The nolher is in poor heollh ond noy be
nolnourished.
n The nolher is slressed.
See chorl 3.8 for decision-noking sleps.
Te nole: :eeos
suo:l, e:ou:~qene:l,
~:o :~li~ ~ovie o:
ow lo i::e~se e: ni
suy, ~:liu~:y lo
i::e~se le :eque:y
o L:e~sleeoi:q
7 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
8=6GI(#) 50PE 0P CPACKED NIPPLE5: DECI5I0N-HAKIN6 CRAPT
Ristcry
Exam
PrcbIemslneeds
lsk lhe nolher.
n Whol ore you feeling? The nolher`s nipples noy be sore or even poinful.
n When does il hurl? Poin is noliced when lhe boby is frsl pul lo lhe breosl ol lhe
beginning of o feed.
Fxonine lhe breosls ond nipples. lhe nipples noy be red, crocked, ond/or bleeding.
0bserve lhe boby breoslfeeding. if lhe boby`s posilion ond ollochnenl ore nol good, il con
couse sore or crocked nipples.
n s lhe boby`s body close lo lhe nolher`s body?
n s lhe boby`s chin louching lhe breosl?
n s lhe boby`s noulh wide open?
n s lhe lower lip lurned oulword?
n s nore of lhe oreolo seen obove lhe boby`s noulh lhon below il?
n lsk if lhe nolher`s breosls ond nipples conforloble?
Sore or crocked nipples
0lher problens lo lhink oboul.
n Thrush. This is o fungus or yeosl infeclion lhol will couse lhe nipples lo be red. However,
lhe boby usuolly olso hos lhrush in her noulh, wilh while polches on lhe nucous
nenbrones ond lhe longue. The boby wilh lhrush noy nol wonl lo eol becouse of o
sore noulh. lSee chopler .I
Sarressfal Breastfee1|r] 77
3
8]VeiZg(
PIan cf care


FcIIcw-up
Moke sure lhe boby`s posilion, ollochnenl, ond suck ore good.
f lhe ollochnenl or posilion ore nol good, hove lhe nolher loke lhe boby off lhe breosl ond
lry ogoin. lTeoch lhe nolher lo loke lhe boby off lhe breosl by pulling her fnger genlly inlo
lhe boby`s noulh lo breok lhe suclion.I Use o differenl posilion if necessory.
0ive lhe nolher porocelonol for poin 3O ninules before breoslfeeding. She con loke o
5OO ng loblel every /- hours ofler o neol.
ldvise lhe nolher lo.
n Fnsure lhol lhe boby lolches on lollochesI properly.
n Use differenl posilions while breoslfeeding. side lying, cross-crodle hold,
under-orn hold. This noves pressure lo differenl porls of lhe nipple.
n lpply expressed breosl nilk on lhe nipples ofler o feed or bolh, lhen oir-dry lhen.
n Keep lhe nipples cleon ond dry, bul do nol use soop on lhe nipples.
n Fxpose lhe breosls lo sunshine for 1O ninules 2-3 lines o doy.
n Slorl feeding wilh lhe breosl lhol is less sore.
n 0o not stop breustfeeJin. The boby con suck fron o nipple lhol is bleeding,
unless lhe nolher is H\ posilive.
n f lhe nolher is H\ posilive, she should nol breoslfeed her boby on o bleeding nipple.
f she hos o crocked nipple lhol bleeds, leoch her lo express ond discord lhe nilk fron
lhol breosl unlil lhe crock heols. Then lhe boby con loke bolh breosls ogoin.
n 0nly in severe coses should lhe nolher slop lo resl o nipple for 2/ hours. During
lhis line she nusl express breosl nilk fron lhe offecled breosl. She con cup feed lhe
boby wilh lhe expressed breosl nilk ond olso breoslfeed fron lhe breosl lhol hos no
nipple problen.
See lhe nolher ond lhe boby ogoin in 2-3 doys.
Repeol lhe obove hislory ond exon ond delernine if your odvice hos been helpful. f nol,
lhe nolher noy need oddilionol supporl or referrol for feeding problens.
8=6GI(#) 50PE 0P CPACKED NIPPLE5: DECI5I0N-HAKIN6 CRAPT
78 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Exam
8=6GI(#* N0T EN0U6R HILK: DECI5I0N-HAKIN6 CRAPT
lsk lhe nolher oboul herself.
n How ore you feeling? f she is very lired, lhe nolher noy noke less nilk becouse she
does nol breoslfeed oflen enough. The obilily lo lel-down nilk is olso reduced if she
is lired.
n How nuch do you drink in one nornol doy? l breoslfeeding wonon needs lo drink every
line she is lhirsly. lsk her lo olso drink o lorge gloss every line she breoslfeeds.
n Do your breosls feel full before breoslfeeding ond enply oflerwords? The breosls should
feel full before ond sofl ond enply ofler eoch feeding.
n Do your breosls leok nilk ol lines? Mosl wonen hove less leokoge ofler lhe frsl few
nonlhs. This does nol neon lhol lhey hove less nilk. Firsl-line nolhers leok nore
oflen lhon experienced breoslfeeders.
lsk lhe nolher oboul lhe boby.
n How oflen does lhe boby breoslfeed? l is inporlonl for lhe boby lo breoslfeed ol leosl
every 2-3 hours in lhe eorly weeks.
n s lhe boby only breoslfeeding, or is she olso loking olher liquids or foods? Toking olher
liquids or food will reduce how nuch nilk is node ond reduce lhe benefls of breoslfeeding.
n How old is lhe boby? Bobies go lhrough growlh spurls when lhey need lo feed nore oflen
lo increose lhe nolher`s nilk produclion. This oflen hoppens oround 1O-1/ doys, ol 5-
weeks, ond ol oboul 3 nonlhs.
n s lhe boby very fussy? This could be o sign lhe boby is nol gelling enough nilk.
n How nuch does lhe boby sleep? Does she woke lo feed in lhe nighl? l boby who is loo
sleepy lo feed every 2-3 hours noy be sick.
Wolch lhe boby breoslfeed. f lhe boby`s ollochnenl ond sucking ore nol good, lhe nolher
noy noke less nilk.
Weigh lhe boby. f lhe boby`s weighl goin is less lhon il should be, lhe boby noy nol be
gelling enough when eoling, or she noy be ill.
Sarressfal Breastfee1|r] 7?
3
8]VeiZg(
PrcbIemslneeds
PIan cf care


FcIIcw-up
The boby is nol gelling enough nilk. Lisl lhe couse of nol enough nilk, if known.
The nolher lhinks she does nol hove enough nilk, even lhough lhe boby is gelling enough.
f needed, counsel ond help lhe nolher wilh posilion ond boby ollochnenl.
Reossure lhe nolher lhol she con noke lols of nilk.
ldvise lhe nolher lo.
n Resl nore.
n Drink nore fuids lwilh every neol ond every breoslfeedingI.
n Feed lhe boby on denond, ol leosl every 2-3 hours, nore oflen if lhe boby wonls lo suck.
n Lel lhe boby feed for os long os possible on eoch breosl.
n Feed on|, ol lhe breosl.
n Sloy in bed ond keep lhe boby wilh her so lhe boby con feed oflen during lhe line she is
lrying lo increose her nilk supply.
Nole. l usuolly only lokes 2/-/8 hours lo increose breosl nilk.
Reossure lhe nolher lhol she hos enough nilk for her boby.
n Show her o record of lhe boby`s weighl goin lgrowlh chorlI ond exploin lhol lhe boby`s
weighl goin is nornol.
n Fxpress o lillle nilk fron her breosls lo show her lhol she is producing nilk.
n Fxploin nornol growlh spurls ond chonges in lhe lel-down refex over line.
n To reossure her lhol lhe boby is growing well, hove her bring hin bock for weekly
weighing, if possible.
See lhe nolher ond boby in 3 doys. Repeol lhe obove hislory ond exon. 0onsider schedul-
ing weekly visils lo nonilor weighl goin. ldvise lhe nolher lo relurn if lhe problen wors-
ens or if lhere ore ony donger signs.
8=6GI(#* N0T EN0U6R HILK: DECI5I0N-HAKIN6 CRAPT
8O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Exam
PrcbIemslneeds
8=6GI(#+ BPEA5T EN60P6EHENT: DECI5I0N-HAKIN6 CRAPT
lsk lhe nolher.
n Whol do you feel in your breosls? Fngorged breosls ore hord, swollen, ond poinful.
n How oflen does lhe boby breoslfeed?
n How long ogo did you give birlh? Fngorgenenl usuolly hoppens oboul 2-3 doys ofler birlh,
if lhe boby is nol breoslfed for o long period, or if lhe wonon ond boby ore seporoled.
n Do you hove ony fever, chills, or one oreo of lhe breosl lhol hos o lunp, is red, ond is
hol? These queslions ore lo rule oul olher problens, such os o breosl infeclion. Fn-
gorgenenl noy be occonponied by o low fever lup lo 38 0 or 1OO./ FI losling nol nore
lhon 2/ hours. f lhe fever losls nore lhon /8 hours, suspecl noslilis.
Fxonine bolh breosls. Fngorged breosls ore hord, swollen, ond poinful. Usuolly bolh
breosls becone engorged ol lhe sone line.
Look ol lhe boby breoslfeeding. See whelher lhe boby is olloching ond sucking well.
Breosl engorgenenl
0lher problens lo lhink oboul.
n Hastitis. Usuolly slorls 1O doys or nore ofler birlh, wilh fever, one oreo of redness,
ond heol. Usuolly only one breosl is offecled.
n PIugged miIk duct. No fever, lhe nolher feels well excepl for one hord swollen oreo
of one breosl.
Sarressfal Breastfee1|r] 81
3
8]VeiZg(
PIan cf care
FcIIcw-up
Fxploin lo lhe nolher how lo reduce breosl engorgenenl.
ldvise her lo.
n Before eoch breoslfeed, pul hol wel cleon clolhs on lhe breosls for 5-1O ninules or
loke o worn shower.
n Before eoch breoslfeed, hond-express o snoll onounl of nilk before pulling lhe
boby lo lhe breosl. This soflens lhe oreo oround lhe nipple llhe oreoloI ond helps nilk
fow, noking il eosier for lhe boby lo olloch.
n Breoslfeed oflen, ol leosl every 2-3 hours. f lhe boby is nol oble lo suck, express nilk
every 2-3 hours. lFngorged breosls lhol ore nol enplied con becone infecled.I
n ll eoch feed, enply lhe frsl breosl before offering lhe olher breosl lo lhe boby.
n f lhe breosls slill feel full ofler o breoslfeed, encouroge lhe boby lo feed longer or
express breosl nilk for o few ninules lunlil lhe breosls feel soflerI.
n Help close lhe nilk ducls ond noke lhe breosls nore conforloble ofler breoslfeeding
by pulling o cold clolh on bolh breosls for 5-1O ninules ofler breoslfeeding.
ldvise lhe nolher on olher conforl neosures for engorgenenl.
n lvoid lighl-flling bros.
n lpply cold conpresses lo lhe breosls belween feedings lo help reduce swelling ond poin.
n Pul cold cobboge leoves on lhe breosls.
22, 23
n Wosh ond dry cobboge leoves wilh cleon woler.
n 0runple lhe leoves wilh your hond lo crush veins before using.
n Pul one or nore leoves on eoch breosl lo conplelely cover lhen lincluding under
lhe ornI.
n Weor o bro or lie on o clolh lo hold lhe leoves in ploce.
n Weor lhe leoves unlil lhey becone sofl.
n Toke porocelonol 5OO ng by noulh 3 lines o doy os needed.
n Fxploin lhe signs of breosl infeclion, ond lhol lhe nolher should see o heollh worker
if she hos ony signs of infeclion.
n Poin, redness, heol, o lunp in one breosl, fever ond chills
Nol needed if engorgenenl slops ond lhere is no sign of o breosl infeclion.
8=6GI(#+ BPEA5T EN60P6EHENT: DECI5I0N-HAKIN6 CRAPT
82 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Exam
PrcbIemslneeds
8=6GI(#, PLU66ED HILK DUCT5: DECI5I0N-HAKIN6 CRAPT
lsk lhe nolher.
n Whol ore you feeling? Synplons include o lunp in one breosl lhol noy be sore
when louched. The wonon usuolly does nol hove o fever.
n Where do you feel lhe lunp? 0flen il is in lhe ouler porl of lhe breosl.
Fxonine bolh breosls. l plugged nilk ducl couses o lunp in one breosl wilhoul
redness or heol.
Toke lhe nolher`s lenperolure. l plugged nilk ducl does nol couse o fever.
Plugged nilk ducl
0lher problens lo lhink oboul.
n Engcrgement. Slorls 2-3 doys ofler birlh, possibly wilh o low fever lup lo 38 0 or
1OO./ FI losling up lo 2/ hours, lhere is no one oreo of redness ond heol, bolh breosls
ore offecled.
n Hastitis. Slorls 1O doys or nore ofler birlh, wilh fever, one oreo of redness ond heol,
generolly only one breosl is offecled.
Sarressfal Breastfee1|r] 83
3
8]VeiZg(
PIan cf care


FcIIcw-up
Reossure lhe nolher lhol she con reduce lhe breosl lunp ond poin.
ldvise her lo.
n Before eoch breoslfeed, pul hol, wel, cleon clolhs on bolh breosls for 5-1O ninules.
n Before eoch breoslfeed, genlly nossoge lhe breosl lhol hos lhe plugged nilk lube.
Move lhe hond lhol is doing lhe nossoge over lhe plugged oreo loword lhe nipple.
n Breoslfeed fron lhe breosl lhol hos lhe plugged nilk ducl frsl.
n Fncouroge lhe boby lo feed longer fron lhe breosl lhol hos o plugged nilk ducl.
n f lhe plugged nilk ducl is in lhe ouler breosl, use lhe under-orn hold posilion while
feeding. This drows nore nilk fron lhe ouler breosl.
n Do nol weor o lighl bro or lie o clolh lighlly oround lhe breosls.
Fxploin lhe signs of o breosl infeclion, ond lhol she needs lo see o heollh worker if she hos
ony sign of infeclion.
n Poin, redness, heol, o lunp in one breosl, fever ond chills
Nol needed if lhe plugged ducl opens ond lhere is no sign of o breosl infeclion.
8=6GI(#, PLU66ED HILK DUCT5: DECI5I0N-HAKIN6 CRAPT
8/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Exam
PrcbIemslneeds
8=6GI(#- HA5TITI5: DECI5I0N-HAKIN6 CRAPT
lsk lhe nolher.
n Whol ore you feeling? Synplons noy include breosl poin, body oches ond poins,
foligue, fever ond chills.
n How long ogo did you deliver? Moslilis usuolly slorls 1O or nore doys ofler delivery.
Fxonine bolh breosls. Moslilis couses o hol, red, poinful oreo or lunp in lhe breosl ond
usuolly only one breosl is infecled.
Toke lhe nolher`s lenperolure. Moslilis couses fever. There noy be ropid onsel of fever,
which con becone very high l38.5 0/1O1 F or higherI.
Moslilis
0lher problens lo lhink oboul.
n Engcrgement. Slorls 2-3 doys ofler birlh. There is no one oreo of redness ond heol, bolh
breosls ore offecled. There noy be low fever lup lo 38 0 or 1OO./ FI lhol does nol losl
nore lhon 2/ hours.
n PIugged miIk duct. No fever, lhe nolher feels well excepl for poin in porl of one breosl.
Sarressfal Breastfee1|r] 85
3
8]VeiZg(
PIan cf care


FcIIcw-up
0ive lhe nolher cne of lhe following nedicines for 1O doys by noulh. 0loxocillin is frsl choice.
n 0loxocillin 5OO ng every hours, or
n Frylhronycin 25O ng every 8 hours, or
n lnoxicillin 5OO ng every 8 hours, or
n lnpicillin 5OO ng every hours
ldvise lhe nolher lo.
n Before breoslfeeding, pul hol, wel, cleon clolhs over lhe infecled oreo for 5-1O ninules.
n Before breoslfeeding, genlly nossoge lhe infecled breosl fron lhe ouler breosl in
lowords lhe nipple, over lhe infecled oreo.
n Breoslfeed oflen levery 2 hoursI slorling wilh lhe infecled breosl.
n Feed lhe boby longer fron lhe infecled breosl.
n f lhe infeclion is in lhe ouler breosl, use lhe under-orn hold while feeding. This drows
nore nilk fron lhe ouler breosl.
n Sloy in bed ond keep lhe boby wilh you lo feed oflen.
n Drink lols of woler lol leosl / lilers o doyI.
n Toke porocelonol for poin l5OO ng loblel every /- hoursI.
Signs lhol lhe infeclion is gelling beller include less fever ond less breosl poin.
ExpIain danger signs. f lhere is o hord round lunp in lhe breosl lhol does nol go owoy
or if lhe infeclion does nol gel beller ofler 2 doys of onlibiolics, go lo o higher-level heollh
focilily for core.
See lhe nolher ogoin in 2 doys.
Refer lo o higher-level heollh focilily if she slill hos fever or o hord, poinful lunp
in lhe breosl.
/ breust ubscess |pocket of pusl mu, Jeve|op. 7his neeJs other treutment. /n ubscess thut is
not treuteJ is ver, Junerous!
8=6GI(#- HA5TITI5: DECI5I0N-HAKIN6 CRAPT
8 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
|KPk|SS|N Bk|AS! N||K
l is inporlonl lo leoch oll nolhers how lo express
breosl nilk. Fxpressing breosl nilk con be inporlonl
when.
n The nolher is nol oble lo breoslfeed. This con
hoppen if lhe nolher is sick, if she is nol wilh
her boby, or if lhe boby connol suck yel.
n The breosls becone engorged when lhe nolher`s
nilk cones in on doy 2 or doy 3 poslporlun. f
lhe breosls ore very engorged, lhe boby noy be
unoble lo grosp lhe nipple unless sone of lhe
nilk is expressed.
n The nolher wonls lo slinulole her body lo
noke nore nilk.
Before expressing breosl nilk, leoch lhe nolher lo
cleon ond boil o cup ond o conloiner. The cup is used
lo feed lhe nilk lo lhe boby. The conloiner is used lo
slore lhe breosl nilk.
Strr|r] Breast N|lk
At rrrm temperatare
n ll 1?-22 0 l-72 FI, up lo 1O hours
n ll 2 0 l78 FI, up lo hours
2/
n f il is holler lhon 2 0 l78 FI, only 1-2 hours
|r a refr|]eratrr
n ll O-/ 0 l32-3? FI, up lo 2/-/8 hours
25
|r a freeter
n f lhe freezer is inside o refrigerolor llenperolure
noy differ due lo door opening frequenllyI, up lo
2 weeks
n n o seporole deep freezer ol -18 0 lO FI,
for up lo 3 nonlhs
2
8=6GI(#. PPEPAPIN6 CUP5 AND
C0NTAINEP5 T0 C0LLECT
EXPPE55ED BPEA5T HILK
AND FEED TRE BABY
1. Before eoch use, wosh o cup ond o conloiner
wilh soop ond woler, noke sure oll nilk is
renoved.
2. Boil lhe cup ond conloiner.
n Use o pol wilh o lid.
n Pul lhe cup ond conloiner inlo lhe pol.
n Fill lhe pol wilh woler so il covers lhe cup
ond conloiner.
n Heol woler unlil boiling ond pul on lhe lid.
n Boil for 1O ninules.
3. Pour lhe woler oul of lhe pol wilhoul
louching lhe cup ond conloiner.
/. Leove lhe cup ond conloiner in lhe pol unlil
needed. Keep lhe pol covered.
Sarressfal Breastfee1|r] 87
3
8]VeiZg(
8=6GI(#&% TEACR TRE H0TREP T0 EXPPE55
BPEA5T HILK
1. Find o privole ploce where lhe nolher con relox.
l helps for lhe boby lo be neor or for lhe nolher
lo lhink oboul her boby.
2. Hove lhe nolher wosh her honds well wilh soop
ond woler. Wosh your honds olso.
3. Pul cleon, worn, wel clolhs on lhe breosls for 5
ninules lo help open lhe nilk lubes, if needed.
/. Show lhe nolher how lo nossoge her breosls
fron lhe oulside lowords lhe nipple lo help bring
nilk down.
5. Be reody wilh o lcleoned ond boiledI cup or
conloiner wilh o wide opening.
. To express nilk, leoch lhe nolher lo.
n Hold lhe breosl in o 0-hold llhunb on lop
ond olher fngers below lhe breoslI, wilh fn-
gers ond lhunb owoy fron lhe nipple.
n Leon slighlly forword so lhe nilk will go inlo
lhe conloiner.
n Press lhunb ond olher fngers in loword
lhe body.
n Squeeze lhunb ond olher fngers logelher.
n Press ond releose. Try using lhe sone rhylhn
os lhe boby sucking.
n Be polienl, even if no nilk cones ol lhe
beginning.
n Move her honds oround lhe breosl so nilk is
expressed fron oll oreos of lhe breosl.
n Fxpress lhe nilk fron one breosl for ol leosl
3-5 ninules unlil lhe fow slows, lhen express
fron lhe olher breosl, ond lhen repeol for bolh
breosls.
n l does nol noller which hond is used. You noy
use bolh honds.
7. ldvise her lhol expressing nilk con loke 2O-3O
ninules or longer in lhe beginning.
;><JG:(#&% HA55A6IN6 TRE BPEA5T
;><JG:(#&& EXPPE55IN6 BPEA5T HILK
INT0 A CUP
88 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
CUP |||0|N
0up feeding neons using o cup lo feed o boby. 0up
feeding is nuch beller lhon using eilher o bollle or o
cup ond spoon. See chorl 3.12 for lhe reosons why lhis
is so.
w|r S|ral1 Use Cap |ee1|r]?
0up feeding con be used for ony boby who is nol feed-
ing direclly on lhe breosl. l is ideol for.
Babies wbcse mctbers wcrk cr must be separated
frcm tbem. l nolher con express her nilk while she
is owoy fron her boby. She should collecl ond lrons-
porl il in o wide-noulhed |or, which con be eosily
cleoned ond boiled. The nolher`s nilk should be prop-
erly slored ond cup fed lo lhe boby when lhe nolher
is owoy.
Lcw birtb weigbt babies. 0up feeding con be used for
low birlh weighl bobies who ore prenolure ond nol
reody lo breoslfeed. 7hese bubies ure ub|e to swu||ow
before the, cun suck. They noy nol hove lhe slrenglh
lo suck long enough ol lhe breosl for o whole feeding.
0iving lhe resl of lhe breosl nilk by cup conpleles lhe
feeding.
Babies witb mcutb prcbIems IcIeft paIate!. lllhough
nosl bobies wilh clefl lip ond/or clefl polole con
breoslfeed successfully, sone hove lrouble sucking ol
lhe breosl.
Babies wbcse mctbers are iII cr deceased.
8=6GI(#&& TIP5 F0P 5T0PIN6 AND U5IN6
5T0PED BPEA5T HILK
lfler expressing breosl nilk, lhe nolher con
feed il lo lhe boby righl owoy or sove il for loler.
Fresh breosl nilk hos lhe highesl quolily. f lhe
breosl nilk nusl be soved, odvise lhe nolher
ond fonily lo.
n Use eilher o gloss or hord ploslic conloiner
wilh o lorge opening ond o lighl lid lo slore
breosl nilk.
n Use o conloiner ond lid which hove been
boiled for 1O ninules.
n f lhe nolher is lilerole, leoch her lo wrile
lhe line ond dole lhe nilk wos expressed
lor norning, oflernoon, eveningI on lhe
conloiner before sloring.
n Slore 2-/ ounces lO-12O nlI of nilk in one
conloiner, enough for one feeding, so os nol
lo wosle breosl nilk. Show lhe fonily how
2-/ ounces lO-12O gronsI of fuid flls o cup
sinilor lo lhe one lhey will be using.
n Slore lhe nilk in lhe coolesl ploce possible.
;><JG:(#&( CUP FEEDIN6
Sarressfal Breastfee1|r] 8?
3
8]VeiZg(
8=6GI(#&' WRY U5E CUP FEEDIN6?
Better tban a bcttIe
n 0up feeding is eosier for sone low birlh weighl
bobies who ore prenolure.
n 0up feeding prepores o boby lo breoslfeed loler,
lhe noulh oclion is nore like lhe oclion of
breoslfeeding.
n The boby con conlrol lhe feed lhow fosl, how
nuch, when lo reslI.
n l does nol need speciol equipnenl.
n Preporolion ond cleon-up ore eosy.
Better tban a cup and spccn
27
n The feeding is fosler.
n Nol os nuch nilk is spilled.
n l is nol os eosy for o boby lo gel nilk in her lungs.
n Forced feeding wilh o spoon con couse donoge
lo o boby`s noulh.
8=6GI(#&( 5R0W FAHILIE5 R0W T0 CUP FEED
1. Posilion lhe boby. lwoken lhe boby ond hold her
porlly silling in your lop. Supporl lhe boby`s
shoulders ond neck wilh your hond, so you hove
conlrol over her heod.
2. Hold o snoll cup of nilk, holf-flled, lo lhe
boby`s lips.
n Tip lhe cup so lhe nilk |usl reoches lhe lips.
n The cup should resl lighlly on lhe boby`s
lower lip.
n The cup edges should louch lhe ouler porls
of lhe boby`s upper lip.
3. The boby will becone olerl ond open her noulh
ond eyes.
n l low birlh weighl boby noy slorl lo loke up
lhe nilk wilh her longue.
n l full-lern or older boby will suck or sip lhe
nilk, spilling sone of il.
/. Do nol pour lhe nilk inlo lhe boby`s noulh.
Keep lhe cup ol lhe boby`s lips, lelling lhe boby
loke lhe nilk.
5. When lhe boby hos hod enough, lhe boby will
close her noulh ond refuse lo loke nore.
n l boby who hos nol loken enough noy loke
nore ol lhe nexl feeding, or
n The nolher noy increose how oflen she feeds.
. ldvise lhe nolher lo hold lhe boby lo her
shoulder ond rub lhe boby`s bock lo help hin burp
lbring up windI.
7. Meosure lhe boby`s inloke over 2/ hours rolher
lhon ol eoch feeding.
?O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
TA5K5 F0P ALL REALTR W0PKEP5: BPEA5TFEEDIN6
1 Teoch ond counsel o nolher ond/or fonily on breoslfeeding.
oI How breoslfeeding helps nolhers ond bobies, inporlonce of coloslrun
bI Fxclusive breoslfeeding
n Whol il is
n How il con help lhe boby, lhe nolher, ond breoslfeeding
cI How lo slorl lhe frsl breoslfeed
n Tining
n Posilion
n lllochnenl
dI How lo breoslfeed successfully
n Denond feeding
n Use bolh breosls
n Woys lo hold lhe boby
n nporlonce of resl
n nporlonce of fuids ond nulrilion lincluding vilonin l ond olher supplenenlsI
n Breoslfeeding o sick boby
n ncreosed growlh periods
n How lo lell o boby is gelling enough nilk
n How long lo conlinue breoslfeeding
n Breoslfeeding lwins
eI Recognize breoslfeeding problens
n Sore, crocked nipples
n Nol enough nilk
n Breosl engorgenenl
n Plugged nilk lubes
n Moslilis
fI Breoslfeeding oplions if lhe nolher is H\ posilive
2 Help o wonon breoslfeed lhe frsl line.
3 Help o wonon esloblish her nilk supply.
/ Teoch o nolher how lo express nilk.
5 Teoch o nolher ond fonily how lo cup feed lheir boby.
0ore for nolhers wilh selecled breoslfeeding problens using lhe decision-noking sleps.
oI Sore, crocked nipples
bI Nol enough nilk
cI Breosl engorgenenl
dI Plugged nilk ducls
eI Moslilis
Sarressfal Breastfee1|r] ?1
3
8]VeiZg(
Nrtes
1 UN0FF. l1???I. 8reustfeeJin: FounJution for u Feu|th,
Future. New York. UN0FF.
2 Hill PD, Hunenick SS, Brennon ML, el ol. l1??7I. Does eorly
supplenenlolion offecl long-lern breoslfeeding? 0|inicu|
PeJiutrics, 3lI.3/5-35O.
3 Fnkin M, Keirse MJN0, Neilson J, 0rowlher 0, Duley L,
Hodnell F, ond Hofneyr J. l2OOOI. / uiJe to effective cure in
prenunc, unJ chi|Jbirth. 3d ed. 0xford. 0xford Universily
Press.
/ Linkoges Pro|ecl. l2OO2I. Fxc|usive 8reustfeeJin: 7he 0n|,
wuter Source oun lnfunts NeeJ. Woshinglon, D0. lcodeny
for Fducolionol Developnenl.
5 Lowrence R. l1??/I. 8reustfeeJin: / uiJe for the meJicu|
profession. /lh ed. Sl. Louis. Mosby.
Linkoges Pro|ecl. l2OO2I.
7 Sochdev HPS el ol. l1??1I. Woler supplenenlolion in
exclusively breoslfed infonls during sunner in lhe lropics.
Luncet, 337.?2?-?33.
8 0oldberg NM ond ldons F. l1?83I. Supplenenlory woler
for breosl-fed bobies in o hol ond dry clinole-nol reolly o
necessily. /rch 0is 0hi|J, 58.73-7/.
? 0lover J ond Sondilonds M. l1??OI. Supplenenlolion of
breoslfeeding infonls ond weighl loss in hospilol. ! Fumun
Luctution, l/I.13-1.
1O Widslron lM el ol. l1??OI. Shorl-lern effecls of eorly
sucking ond louch of lhe nipple on nolernol behovior.
Fur|, Fumun 0eve|opment, 21.153-13.
11 Linkoges Pro|ecl. l2OO1I. Fucts for FeeJin: RecommenJeJ
Pructices to lmprove lnfunt Nutrition Jurin the First Six Honths.
Woshinglon, D0. lcodeny for Fducolionol Developnenl.
12 bid.
13 lnericon lcodeny of Pediolrics. l2OO1I. 0onnillee on
Drugs. The Tronsfer of Drugs ond 0lher 0henicols inlo
Hunon Milk. PeJiutrics, 1O8l3I.77-78?.
1/ Linkoges Pro|ecl. l2OOOI. Fucts for FeeJin: 8reust Hi|k:
/ criticu| source of vitumin / for infunts unJ ,oun chi|Jren.
Woshinglon, D0. lcodeny for Fducolionol Developnenl.
15 Linkoges Pro|ecl. l1??? FebruoryI. RecommenJeJ feeJin
unJ Jietur, pructices to improve infunt unJ muternu| nutrition.
Woshinglon, D0. lcodeny for Fducolionol Developnenl.
1 0uoy Ll ond Ruff lJ. l2OO1I. H\ ond nfonl Feeding-ln
0ngoing 0hollenge. !/H/, 28l1?I. 2/2-/.
17 0honlry 0M el ol. l2OOOI. Fffecls of lipolysis or heol lreolnenl
on H\-1 provirus in breosl nilk. ! /cpuir lmmune 0efc
S,nJr, 2/l/I. 325-32?.
18 sroel-Bollord Kl el ol. l2OO2 NovenberI. Zimbubweun
uttituJes unJ resource uccessibi|it, us u meusure of the
feusibi|it, of heut-treutin expresseJ breust mi|k for
prevention of mother to chi|J trunsmission of Fl\.
lnericon Public Heollh lssociolion 13Olh lnnuol Meeling.
lbslrocl No. /3//7.
1? Morrison P. l1???I. H\ ond infonl feeding. To breoslfeed
or nol lo breoslfeed. The dilenno of conpeling risks, Porl .
8reustfeeJin Review. 7l2I.5-13.
2O Felherslon 0. l2OO1I. Moslilis in Locloling Wonen. Physiology
or Polhology? 8reustfeeJin Review, ? l1I.5-12.
21 Linkoges Pro|ecl. l2OO1I. Frepuent|, uskeJ puestions:
8reustfeeJin unJ Fl\//l0S. Woshinglon, D0. lcodeny for
Fducolionol Developnenl.
22 Roberls KL. l1??5I. l conporison of chilled cobboge leoves
ond chilled gelpocks in reducing breosl engorgenenl.
! Fumun Luctution. 11.17-2O.
23 Snowden HM, Renfrew MJ, ond Woolridge MW. l2OO2I.
Treolnenls for breosl engorgenenl during loclolion.
lThe 0ochrone ReviewI 7he 0ochrune Librur,. ssue /.
0xford. Updole Soflwore Lld.
2/ Borger J ond Bull Pl. l1?87I. 0onporison of lhe bocleriol
conposilion of breosl nilk slored ol roon lenperolure ond
slored in lhe refrigerolor. lnt ! 0hi|Jbirth FJuc, 2.2?-3O.
25 Reporl of lhe ld Hoc 0roup on nfonl Feeding in Fnergencies.
l1??? MoyI. lnfunt FeeJin in Fmerencies: Po|ic,, Strute, &
Pructice. Dublin, relond. Fnergency Nulrilion Nelwork.
2 bid.
27 Honosh M el ol. l2OO1 JulyI. 0n cup feeJin to the lFF0
Strute, Puper. N.p.. nfonl Feeding in Fnergencies 0roup
lFF0I.
?2 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
ereral kefererres
Jeffery BS ond Mercer K0. l2OOO luguslI. Prelorio posleuri-
solion. o polenliol nelhod for lhe reduclion of poslnolol nolher-
lo-child lronsnission of lhe hunon innunodefciency virus.
! 7rop PeJiutr, /l/I.21?-23.
Jeffery BS, Sono-Pilloy P, Mokin J, ond Moolnon 0. l2OO3
luguslI. The effecl of Prelorio Posleurizolion on bocleriol
conloninolion of hond-expressed hunon breoslnilk. ! 7rop
PeJiutr, /?l/I.2/O-/.
Jeffery BS, Webber L, Mokhondo KR, ond Frosnus D. l2OO1
DecenberI. Delerninolion of lhe effecliveness of inoclivolion
of hunon innunodefciency virus by Prelorio posleurizolion.
! 7rop PeJiutr, /7lI.3/5-?.
King, F. Sovoge. l1?85I. Fe|pin Hothers to 8reust FeeJ. Noirobi,
Kenyo. lfricon Medicol ond Reseorch Foundolion llMRFFI.
Kroeger M. l2OO3I. lmpuct of 8irthin Pructices on 8reustfeeJin:
Protectin the Hother unJ 8ub, 0ontinuum. Boslon. Jones
ond Borllell.
Linkoges. llpril 2OO/I. lnfunt FeeJin 0ptions in the 0ontext of
Fl\. Woshinglon, D0. The Linkoges Pro|ecl, lcodeny for Fduco-
lionol Developnenl.
Pon lnericon Heollh 0rgonizolion. l2OO3I. 0uiJin princip|es
for comp|ementur, feeJin of the breustfeJ chi|J. Woshinglon, D0.
PlH0, WH0.
Ron|os-lrvidson l, Mollhieson l, 0unillo L, el ol. l2OO1I.
Huternu| unu|esiu Jurin |ubor Jisturbs newborn behuvior: effects
on breustfeeJin, temperuture, unJ cr,in. 8irth 28 l1I. 5-12.
World Heollh 0rgonizolion. l2OO3I. 0ommunit,-8useJ Struteies
for 8reustfeeJin Promotion unJ Support in 0eve|opin 0ountries.
0enevo. WH0.
World Heollh 0rgonizolion. l1???l. FviJence for the 7en Steps to
Successfu| 8reustfeeJin. 0enevo. WH0. lWH0/0HD/?8.?I.
World Heollh 0rgonizolion. l2OO3l. 0|obu| Strute, for lnfunt unJ
oun 0hi|J FeeJin. 0enevo. WH0.
WH0/UNlDS/UNFPl/UNH0R/UN0FF/Fl0/WFP/lFl/
World Bonk. Fl\ unJ lnfunt FeeJin: Frumework for Priorit,
/ction. 0enevo. WH0.
|rterret kefererres
www.who.inl/child-odolescenl-heollh//publicolions/
Nulrilion/BF0.hln
7his is the wF0 /0-hour breustfeeJin counse|in course.
www.who.inl/child-odolescenl-heollh/NUTRT0N/H\infonl.hln
7his wF0 site focuses on Fl\ unJ infunt feeJin. 8reustfeeJin is u
primur, focus. /ccess to six importunt Jocuments is proviJeJ.
www.who.inl/child-odolescenl-heollh/publicolions/NUTRT0N/
H\FFronework.hln
/ cruciu| Jocument he|pin countries to reconize how the, must
tuke breustfeeJin proper|, into uccount ut the sume time us the,
initiute meusures to reJuce postnutu| Fl\ trunsmission.
H\ ond nfonl Feeding. 0uidelines for decision-nokers
www.who.inl/child-odolescenl-heollh/publicolions/NUTRT0N/
SBN?2/15?122.hln
|/ttention: for some mui| s,stems this |ink miht be JiviJeJ
into two purtsl
H\ ond nfonl Feeding. l guide for heollh-core nonogers ond
supervisors
www.who.inl/child-odolescenl-heollh/publicolions/NUTRT0N/
SBN?2/15?123/.hln
|/ttention: for some mui| s,stems this |ink miht be JiviJeJ
into two purtsl
www.who.inl/reproduclive-heollh/rlis/nlcl
7his wF0 site proviJes eneru| informution on mother-to-chi|J
trunsmission of Fl\, us we|| us wF0 recommenJutions for untiret-
roviru| Jru use |Nevirupinel to prevent H707. lt u|so contuins
u PH707 month|, pub|icutions report.
ewLo:: Resusil~lio:

>cigdYjXi^dc .(
L]Vi>h6he]nm^V4 .)
EgZeVgVi^dc[dgCZlWdgc
GZhjhX^iVi^dc .*
9ZX^Y^c\>[i]ZCZlWdgc
CZZYhGZhjhX^iVi^dc .-
9d^c\CZlWdgcGZhjhX^iVi^dc ..
8VgZ6[iZgGZhjhX^iVi^dc &%)
8aZVc^c\GZhjhX^iVi^dc
:fj^ebZciVcYHjeea^Zh &%,
New|rrr kesasr|tat|rr ?3

8]VeiZg)
/Loul 1O e:e:l o ~ :ewLo::s :eeo
:esusil~lio: ~l Li:l
1
e~:y 1 niio:
L~Lies oie e~ ye~: Le~use ley oo :ol
L:e~le :o:n~y ~l Li:l
Z
\e: ~ L~Ly
~::ol L:e~le, u:qe:l n~:~qene:l is
:eeoeo Fo: n~:y L~Lies, le:eo:e,
:ewLo:: :esusil~lio: ~: Le ies~vi:q
0xyqe: is ino:l~:l lo eve:y ~:l o le
un~: Looy Du:i:q :eq:~:y ~ L~Ly
:eeives oxyqe: :on le nole:s Looo
l:ouq le ~e:l~ /le: Li:l, le
L~Ly qels oxyqe: l:ouq le u:qs Ly
L:e~li:q Fo: nosl L~Lies lis ~:qe
~e:s wiloul ~:y :oLens, sone
L~Lies, oweve:, :eeo e lo sl~:l o:
o:li:ue L:e~li:q Tis e is ~eo
:esusil~lio:
ewLo:: Resusil~lio:
?/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
n lhis chopler you will fnd infornolion oboul.
n Whol osphyxio is
n Why o heollh core worker should u|wu,s be
reody lo do newborn resuscilolion ol ever, birlh
n Whol you need lwornlh, cleon surfoce, equip-
nenl, ond suppliesI lo do newborn resuscilolion
n Signs lhol o boby needs resuscilolion
n Sleps of resuscilolion
n When lo slop newborn resuscilolion
n 0ore of o boby ofler resuscilolion.
n f lhe resuscilolion is successful
n f lhe boby is breolhing, bul needs referrol
n f lhe resuscilolion is nol successful
n lhis chopler you will leorn lo do lhe following.
n Prepore o ploce, equipnenl, ond supplies
for resuscilolion
n 0leor lhe noulh ond nose of o newborn if lhere
is neconiun in lhe onniolic fuid
n Recognize on osphyxioled newborn
n Resuscilole on osphyxioled newborn
n Monilor ond core for o newborn ofler resuscilolion
n 0ounsel o nolher ond fonily ofler resuscilolion
n 0ounsel o nolher ond fonily if o newborn dies
n Deconloninole, cleon, ond disinfecl equipnenl
ond supplies for resuscilolion
wNA! |S ASPNK|A?
lsphyxio is when lhe boby does nol begin or susloin
odequole breolhing ol birlh. There ore nony reosons
o boby noy nol breolhe ol birlh. Mosl of lhe line il
hoppens when o boby hos hypoxio, which is exploined
in chorl /.2 on poges ?-?7.
;><JG:)#& PE5U5CITATI0N PLACE
New|rrr kesasr|tat|rr ?5

8]VeiZg)
Pk|PAkA!|0N |0k N|wB0kN
k|SUSC|!A!|0N
You connol olwoys lell which bobies will hove osphyxio
ol birlh. Therefore, you nusl be prepored lo do new-
born resuscilolion ol u|| birlhs. When lhings ore nol
prepored, line is losl. f o few ninules poss before lhe
boby slorls lo breolhe, he con suffer broin donoge or
die. Preporolions include. worning lhe resuscilolion
oreo, preporing o cleon surfoce for lhe resuscilolion,
ond collecling equipnenl ond supplies. Be prepored
lo cul lhe cord innediolely if lhe boby needs resusci-
lolion.
warmt|
Keeping o newborn boby worn soves his energy for
breolhing. There ore nony woys lo keep o boby worn.
n Keep lhe roon worn ond free fron drofls
ond fons.
n f possible do lhe resuscilolion neor o heol
source.
n n o heollh core focilily, use o heoler or lighl
bulb obove lhe boby, lurn lhe heoler or lonp
on before lhe delivery ond keep il on during
resuscilolion.
n Dry lhe boby innediolely ofler birlh ond renove
lhe wel clolh.
n Use o worn clolh lo wrop lhe boby, including
lhe heod, while keeping his foce ond upper
chesl uncovered.
n Keep lhe boby`s heod covered.
Sarfare frr 0r|r] t|e kesasr|tat|rr
Use o fol surfoce lhol is cleon, dry, ond covered wilh
o worn clolh, such os o loble.
|a|pmert ar1 Sappl|es
0horl /.1 lisls lhe equipnenl ond supplies you will
need for newborn resuscilolion.
8=6GI)#& E0UIPHENT AND 5UPPLIE5
F0P NEWB0PN PE5U5CITATI0N
llwoys use o bog ond nosk for resuscilolion if
ovoiloble.*
n Newborn-sized self-infoling resuscilolion
bog llnbu bogI ond focenosks.
n Bog volune should be 25O-/OO nl
n Focenosks should be.
Size 1 for o nornol weighl newborn
Size O for o snoll newborn lbelow 2.5 kgI
n Two pieces of gouze or cleon clolh
n 0ne lo dry lhe boby`s noulh ond nose oreo
n 0ne lo use os o proleclive borrier if doing
noulh-lo-noulh ond nose resuscilolion
n Three pieces of clolh
n 0ne lo dry lhe boby
n 0ne lo cover lhe boby ofler drying
n 0ne lo roll ond pul under lhe boby`s
shoulders loplionolI
n l cop lo cover lhe boby`s heod
n l clock or wolch
n Suclion equipnenl. bulb, nucus exlroclor
lDe LeeI, or nechonicol suclion
n 0loves. f ovoiloble ldo nol need lo be slerileI
n 0xygen. f ovoiloble. 0xygen is nol needed
for successful resuscilolion
* f o lube-ond-nosk device is used for resuscilolion,
follow your locol prolocol on how lo use il.
? Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Wbat is bypcxia?
Wben can
bypcxia bappen?
Wbat causes
bypcxia?
5igns cf fetaI
bypcxia
8=6GI)#' RYP0XIA
3

Nol enough oxygen in lhe body lissues
n During pregnoncy
n During lobor ond birlh
n lfler birlh
Hypoxio con occur for nony reosons. Sone foclors lhol noy leod lo felol or
neonolol hypoxio include.
n During pregnancy. nolernol hyperlension, diobeles, infeclion, sickle cell diseose,
ond oslhno lnolernol hypoxioI
n Intrapartum. prelern lobor, prolonged or obslrucled lobor, prolopsed cord,
plocenlo previo, plocenlol obruplion, odninislrolion of norcolics ond oneslhelics, ospiro-
lion of neconiun, obnornol presenlolion of lhe felus, diffcull or inslrunenlol delivery
n 0tber factcrs. prelern or posl-lern birlh, nulliple geslolion, cord or plocenlo
problens which inpede blood fow
Hypoxio leods lo felol dislress, which offecls lhe felol heorl role ond con slinulole lhe
releose of neconiun inlo lhe onniolic fuid.
l felol heorl role below 1OO or obove 18O indicoles hypoxio or felol dislress for sone
olher reoson.
Meconiun-sloined onniolic fuid is olso o sign of felol dislress.
New|rrr kesasr|tat|rr ?7

8]VeiZg)
Rcw tc beIp
prevent bypcxia
Rcw tc identify
bypcxia in Iabcr
Rcw tc treat bypcxia
during Iabcr
When o pregnonl wonon lies on her bock, lhe fow of blood lo lhe ulerus decreoses.
Fncouroge o wonon not lo lie on her bock, especiolly during lobor.
denlify ond slobilize/lreol ony nolernol problens during lobor lhigh blood pressure,
diobeles, infeclionsI.
denlify ond nonoge obslrucled lobor, nolpresenlolions, ond olher problens eorly.
0heck lhe felol heorl role every 3O ninules in oclive lobor, every 15 ninules
ofler full dilololion.
f lhe felol heorl role is below 1OO or obove 18O per ninule or is eilher folling or rising
signifconlly, lhe boby noy hove hypoxio.
1. ncreose oxygen lo lhe boby.
o. lsk lhe wonon lo lie on her lefl side. This posilion increoses lhe oxygen lhol goes
lo lhe boby.
b. 0ive lhe wonon fuids by noulh ond/or \.
c. 0ive oxygen lif ovoilobleI.
d. Disconlinue oxylocin drip, if one is running.
2. 0heck lhe felol heorl role ogoin.
3. denlify ony nolernol foclors ond lreol occordingly.
/. Prepore lo do resuscilolion, os ol ony delivery.
f lhe felol heorl role is slill nol nornol, deliver lhe boby os soon os possible if lhis con
be done quickly ond sofely, olherwise, RFFFR.
8=6GI)#' RYP0XIA
3
?8 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
0|C|0|N || !N| N|wB0kN
N||0S k|SUSC|!A!|0N
|mme1|ate Assessmert at B|rt|
For nosl bobies, lhe innediole core you give ol lhe
nonenl of birlh is enough lo slinulole lhe boby lo
slorl breolhing. Renenber lo olwoys.
1. Thoroughly dry ond slinulole lhe boby, rubbing
hin oll over, especiolly up ond down lhe bock or
lrunk wilh o worn, dry clolh. Flicking lhe soles
of lhe feel noy olso help. 0lher forns of slinu-
lolion noy be hornful.
2. Discord lhe wel clolh ond wrop lhe boby quickly
in onolher worn, dry clolh lo keep hin worn.
3. Look ol lhe boby lo see if he is breolhing or crying.
/. Decide if lhe boby needs resuscilolion. f he is
nol breolhing, is breolhing poorly lless lhon
3O breolhs per ninuleI, or is gosping, he needs
resuscilolion.
;><JG:)#' P05ITI0N TRE BABY
F0P PE5U5CITATI0N
New|rrr kesasr|tat|rr ??

8]VeiZg)
;><JG:)#( C0PPECT READ EXTEN5I0N
F0P PE5U5CITATI0N
0orrecl
ncorrecl. over-exlended
ncorrecl. under-exlended
00|N N|wB0kN k|SUSC|!A!|0N
f lhe boby does nol respond lo slinulolion, begin
resuscilolion innediolely. 0onlinuing loclile slinulo-
lion lo lhe newborn who is nol breolhing wosles line.
Resuscilolion nusl be slorled os soon os you see
lhol lhe boby is osphyxioled. 0uickly clonp lor lie if
you hove no clonpsI ond cul lhe cord, leoving o cord
slunp ol leosl 1O cn long for now.
ls you prepore lo resuscilole, briefy lolk lo lhe nolher.
l nolher usuolly knows sonelhing is wrong when
she does nol heor her boby cry. Fxploin lhol lhe boby
needs help wilh breolhing ond lhol you will give lhol
help. lsk onolher heollh worker or fonily nenber lo
sloy wilh lhe nolher lo give enolionol supporl ond lo
wolch for ond help wilh ony bleeding.
Step J: Prs|t|rr t|e Ba|
n Ploce lhe boby on his bock on o fol surfoce.
n Posilion lhe heod so lhol lhe neck is slighlly
exlended. You noy pul o rolled clolh under
lhe shoulders lo noinloin lhe posilion.
n The resuscilolion surfoce should be well lil
ond worn.
n Keep lhe boby`s heod ond lower body covered lo
keep hin worn.
1OO Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Step 1: \ert|late
For bog-ond-nosk venlilolion use lhe proper size
nosk lo cover lhe boby`s noulh ond nose. To venlilole.
hold lhe nosk wilh one hond lo ensure on oirlighl seol
using one or lwo fngers of lhe sone hond lo hold lhe
chin ond keep lhe heod slighlly exlended. Squeeze lhe
bog wilh lhe olher hond lSee fgure /.5I.
For noulh-lo-noulh venlilolion use your noulh lwilh
o piece of gouze over lhe boby`s nose ond noulhI lo
cover lhe boby`s noulh ond nose. To venlilole, breolhe
o noulhful of oir inlo lhe boby. Renenber lhol lhe
boby`s lungs ore snoll. When doing noulh-lo-noulh
venlilolion use only oir fron your noulh ond nol your
lungs.
\enlilole once or lwice, wolching lo see if lhe boby`s
chesl rises. f lhe chesl does nol rise, check lhe
boby`s posilion, reposilion lhe boby, your noulh or lhe
nosk, ond lry ogoin unlil you gel lhe chesl lo rise wilh
eoch breolh. f necessory, repeol suclioning.
n \enlilole oboul /O lines in 1 ninule.
n lfler 1 ninule, slop lo see if lhe boby slorls lo
breolhe independenlly.
n 0onlinue venlilolion unlil lhe boby sponloneously
cries or breolhs.
When lhe boby`s breolhing is nornol, slop venlilolion
ond conlinue lo nonilor lhe boby closely. The cord
should now be securely lied ond cul lo lhe proper
lenglh.
f lhere is no breolhing or gosping ofler 2O ninules,
slop venlilolion. The boby hos died.
Step I: Clear t|e A|rwa
n Wipe off lhe boby`s foce wilh o cleon piece
of gouze or clolh.
n Suclion lhe boby.
n Bulb suclion noy be used lsee lppendix DI.
Discord lhe bulb syringe ofler use.
n Mechonicol suclion wilh o De Lee-lype
suclion device or nucus exlroclor.
n Mochine suclion con be used wilh o cleon sofl
suclion lube or colheler, size 12F. The suc-
lion pressure of lhe nochine should nol be
nore lhon 13O cn woler or 1OO nn Hg.
n llwoys suclion lhe boby`s noulh frsl ond
lhen lhe nose.
n Suclion only while pulling lhe suclion lube
oul, nol while pulling il in.
n Do nol suclion deep in lhe lhrool os lhis noy
couse lhe boby`s heorl lo slow or lhe boby
noy slop breolhing.
n Do nol inserl o suclion lube or bulb nore lhon
5 cn inlo lhe noulh or 3 cn inlo lhe nose.
n f lhe onniolic fuid wos sloined wilh neconiun
lyellow or greenish colorI, genlly suclion oul
lhe noulh ond nose os soon os lhe heod is born
ond while il is slill on lhe perineun lbefore lhe
shoulders energeI.
n 0uickly reossess lhe breolhing ofler you hove
posilioned lhe boby ond cleored lhe oirwoy.
n f lhe boby is breolhing wilhoul diffcully,
no furlher resuscilolion sleps ore needed.
0o lo Slep /.
n f lhe boby is hoving lrouble breolhing or is
nol breolhing, begin venlilolion. 0o lo Slep 3.
n Signs lhe boby is hoving lrouble breolhing
include.
n 0osping lshorl, diffcull breolhs lhol produce
o sound when lhe boby breolhes inI. 0osping is o
sign of o serious problen ond requires lhe sone
nonogenenl os obsenl breolhing.
n Breolhing less lhon 3O breolhs per ninule,
wilh or wilhoul ony of lhe following.
n ndrowing of lhe chesl lwhen lhe boby
breolhes in, oreos belween lhe ribs ore
pulled inI
n 0runling lo sound lhe boby nokes when
breolhing oulI
n Shollow irregulor breolhing
New|rrr kesasr|tat|rr 1O1

8]VeiZg)
;><JG:)#) PP0PEP HA5K PLACEHENT
Inccrrect mask pIacement
This nosk is loo lorge ond will nol noke o lighl fl.
Inccrrect mask pIacement
This nosk only covers lhe noulh. The nosk nusl
cover bolh noulh ond nose.
C0PPECT mask pIacement
This nosk covers bolh noulh ond nose.
;><JG:)#* BA6-AND-HA5K PE5U5CITATI0N
1O2 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Step /: Nrr|trr
0losely nonilor o boby who hod resuscilolion or who
hos poor color, even if he oppeors lo be breolhing well.
n Wolch for breolhing problens. grunling,
indrowing of lhe chesl, foring of lhe noslrils,
ropid breolhing lgreoler lhon O breolhs per
ninuleI, slow breolhing lless lhon 3O breolhs
per ninuleI, blue or pole color. f lhe boby is
hoving diffcully breolhing, give oxygen
if ovoiloble.
n Keep lhe boby worn ond dry. Defer lhe frsl
bolh for ol leosl hours unlil lhe boby is worn,
sloble, ond breolhing nornolly.
n f lhe boby`s breolhing ond color ore good,
give hin lo his nolher, skin-lo-skin, for conlin-
ued wornlh, slinulolion, ond breoslfeeding os
soon os possible.
n If tbe baby`s ccnditicn detericrates, transfer
rapidIy tc a bcspitaI fcr medicaI care.
I5ee cbart .3.!
8=6GI)#( 5I6N5 A BABY NEED5
PEFEPPAL AFTEP
PE5U5CITATI0N
n Nol susloining odequole breolhing lless
lhon 3O breolhs in 1 ninuleI or gosping.
conlinue resuscilolion efforls during
lronsporl
n More lhon O breolhs in 1 ninule
n ndrowing of lhe chesl
n 0runling lsound node when breolhing oulI
n The boby`s longue ond lips ore blue or lhe
whole body is pole or bluish.
New|rrr kesasr|tat|rr 1O3

8]VeiZg)
Pcsiticn
CIear airway
entiIate
Hcnitcr
8=6GI)#) NEWB0PN PE5U5CITATI0N 5UHHAPY
Ploce lhe boby on his bock wilh lhe neck slighlly exlended.
n 0leor lhe oirwoy by wiping oul lhe noulh wilh gouze.
n Suclion lhe boby`s nose ond noulh.
n Reossess lhe boby`s breolhing.
n Use bog ond nosk lor noulh-lo-noulh ond nose if bog ond nosk ore nol ovoilobleI
lo venlilole ol /O breolhs per ninule.
n Reossess lhe boby`s breolhing ofler 1 ninule.
n 0onlinue lo venlilole unlil lhe boby breolhes independenlly.
n Slop ofler 2O ninules if lhe boby hos nol responded.
n Keep lhe boby worn lskin-lo-skinI.
n Defer lhe bolh for ol leosl hours ofler lhe boby is sloble.
n Breoslfeed os soon os possible.
n Wolch for signs of o breolhing problen. ropid, lobored, or noisy breolhing, poor color.
n f o breolhing problen occurs, slinulole, give oxygen lif ovoilobleI, ond refer.
1O/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
CAk| A|!|k k|SUSC|!A!|0N
|f kesasr|tat|rr |s Sarressfal
Crarsella1|se
n Tolk wilh lhe nolher ond fonily oboul lhe resus-
cilolion. lnswer ony queslions lhey noy hove.
n Teoch lhe nolher lo check her newborn for
breolhing ond wornlh ond lo conlocl lhe heollh
worker if ony fndings ore obnornol.
n Fncouroge lhe nolher lo breoslfeed os soon
os possible. Bobies who hove diffcully breolhing
use o lol of energy. Breoslfeeding will help give
lhe newborn nore energy.
n Fncouroge lhe nolher lo keep lhe newborn
worn by keeping lhe boby skin-lo-skin.
n Fxploin lo lhe nolher ond fonily how lo recognize
newborn donger signs ond how lo gel core in-
nediolely if lhe boby hos ony donger signs.
|e rare
n Tie lhe cord securely ond cul il lo lhe
proper lenglh.
n 0heck lhe newborn hourly for ol leosl
hours for.
n Breolhing problens lless lhon 3O or nore
lhon O breolhs in 1 ninule, indrowing of lhe
chesl, grunling, or gospingI
n 0olor. blue longue or lips, pole or bluish skin
n Tenperolure lhol is loo low loxillory len-
perolure below 3 0/?.8 FI or loo high
loxillory lenperolure obove 37 0/?8. FI
n 0ive nornol core for o newborn lsee chopler 2I.
kerrr1
n The newborn`s condilion ol birlh
n Whol you did during lhe resuscilolion
n How long lhe resuscilolion look
n Resulls of lhe resuscilolion
n The core you gove ofler lhe resuscilolion
0r frllrwap
lsk lhe nolher lo bring her boby for o follow-up visil
on doy 2-3.
D~Lies wo ~ve oiuly
L:e~li:q use ~ ol o e:e:qy
D:e~sleeoi:q wi e qive le
:ewLo:: no:e e:e:qy
New|rrr kesasr|tat|rr 1O5

8]VeiZg)
|f t|e Ba| |s Breat||r] |at Nee1s keferral
lfler lhe resuscilolion, lhe boby noy need
speciol help.
Crarsella1|se
n Tolk wilh lhe nolher ond fonily oboul lhe
resuscilolion ond how lhe boby is doing now.
lnswer ony queslions lhey noy hove.
n Fxploin lhol lhe boby needs speciol core.
n f lhe boby needs lo be referred lo onolher
focilily, send lhe nolher ond boby logelher.
n Fxploin lo lhe nolher lhol she should breosl-
feed os soon os possible ond during lhe referrol.
However, lhis noy nol be possible if lhe boby is
nol breolhing well.
n Fxploin why ond how lo keep lhe boby worn.
n Keep lhe boby`s heod covered.
n f possible, pul lhe boby skin-lo-skin wilh
lhe nolher ond cover bolh lhe nolher ond
boby wilh worn blonkels.
|e rare
n 0onlinue lo resuscilole lhe boby, if needed.
n Keep hin worn ond nonilor his breolhing ond
color.
n 0ive oxygen, if ovoiloble. 0onlinue oxygen during
lronsporl, if possible.
n lrronge for referrol.
kerrr1s
n Prepore records for referrol lsee oboveI.
n Prepore records lo be kepl ol your focilily ond
hone-bosed records lo be kepl by lhe fonily.
0r frllrwap
lsk lhe nolher lo bring her boby bock for o follow-up
visil ofler lhe boby`s problen is resolved.
;><JG:)#+ KEEP TRE BABY WAPH
1O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
|f kesasr|tat|rr |s Nrt Sarressfal
f lhe boby is nol breolhing or gosping ofler 2O
ninules, slop resuscilolion. The boby hos died. The
nolher ond fonily will need nuch supporl. Be coring
ond genlle when lolking lo lhe fonily.
Crarsella1|se
n Tolk wilh lhe nolher ond fonily oboul lhe
resuscilolion ond lhe boby`s deolh. lnswer ony
queslions lhey noy hove.
n 0ive lhe nolher ond fonily core lhol is cullurolly
occeploble. Be sensilive lo lheir needs.
n Find oul whol lhey wish lo do wilh lhe boby`s
body.
n Fxploin lo lhe nolher ond fonily lhol.
n The nolher will need resl, supporl, ond o
good diel ol hone.
n The nolher should nol relurn lo o full
worklood loo eorly.
n The nolher`s breosls will becone full oround
doy 2-3. She noy hove o nild fever for o doy
or lwo. She noy do lhe following lo shorlen
lhe line lhe breosls will be full.
n Bind lhe breosls wilh o lighl bro or clolh
unlil lhere is no nilk in lhe breosls.
n Do nol express nilk or slinulole lhe
breosls.
n The nolher noy feel very enolionol ond cry o
lol. The nornol chonges in o wonon`s hor-
nones ofler pregnoncy con noke her feel very
sod, worried, or irriloble. Becouse of lhe boby`s
deolh, lhe feelings noy be worse lhon usuol.
Fncouroge lhe nolher ond fonily lo speok wilh
o heollh worker if lhey wish lo lolk.
0r frllrwap
lsk lhe nolher lo relurn for o poslporlun visil eorly
lwilhin lhree weeksI os ovulolion will resune soon
since she is nol breoslfeeding. ll lhol line odvise her
lo use o fonily plonning nelhod unlil she is physicolly
ond enolionolly reody lo becone pregnonl ogoin. f
possible, give poslporlun core ol o ploce owoy fron
olher poslporlun nolhers in order lo provide privocy
for lhe fonily during lhe grieving process. The nolher
ond fonily noy fnd il poinful lo be cored for onong
nolhers wilh heollhy newborns.
o:n~ ~:qes i: ~ won~:s
o:no:es ~le: :eq:~:y ~:
n~e e: ee ve:y s~o, wo::ieo,
o: i::il~Le
New|rrr kesasr|tat|rr 1O7

8]VeiZg)
kerrr1s
Do lhe required recording ond nolifcolion for o boby`s
birlh ond deolh ond conplele ony olher required
nedicol records for lhe delivery.
C||AN|N |0U|PN|N! AN0 SUPP|||S
Fquipnenl ond supplies used for infonl resuscilolion
noy be conloninoled by body fuids fron bolh lhe
nolher ond lhe boby. Fverylhing needs lo be cleoned
correclly lo prolecl heollh workers ond olher bobies
fron infeclion. Use lhe lhree infeclion prevenlion
sleps. deconloninolion lsooking in o deconlonino-
lion solulionI, cleoning lwoshing wilh soop ond wolerI,
ond high-level disinfeclion lboiling, oulocloving, or
dry heol lreolnenlI for lhe ilens lisled below lsee
lppendix 0I.
n Disposoble ilens. Deconloninole disposoble
ilens such os gouze, bulb syringe, gloves,
suclion colhelers, elc. for 1O ninules before
discording in o sofe ploce.
n Reusoble suclion colheler or gloves. Do lhe
lhree infeclion prevenlion sleps ldeconlonino-
lion, cleoning, ond high-level disinfeclionI.
n 0lolhs ond linen. Wosh, oir- or sun-dry, iron,
lhen slore in o cleon, dry ploce.
n Toble or surfoce used for resuscilolion. Wipe
wilh deconloninolion solulion ond lhen wosh
wilh soop ond woler. lir-dry.
/s le nole: lo :elu:: o:
~ osl~:lun visil /l l~l line
~ovise e: lo use ~ ~niy
~::i:q neloo u:li se is
ysi~y ~:o enolio:~y :e~oy
lo Leone :eq:~:l ~q~i:
1O8 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Nrtes
1 Sougslod 0D. l1??8I. Proclicol ospecls of resusciloling
osphyxioled newborn infonls. Fur ! PeJiutr, 157lSuppl. 1I.
S11-S15.
2 World Heollh 0rgonizolion. l1??5I. wor|J Feu|th Report.
0enevo. WH0.
3 World Heollh 0rgonizolion. l2OO3I. Hunuin newborn
prob|ems: u uiJe for Joctors, nurses unJ miJwives
|lnteruteJ munuement of prenunc, unJ chi|Jbirthl.
0enevo. WH0. lWH0/RHR/OO.7I
ereral kefererres
lnericon Heorl lssociolion. l2OOOI. 0uidelines 2OOO for cordiopul-
nonory resuscilolion ond energency cordiovosculor core. nler-
nolionol consensus on science. 0ircu|ution lSuppl.I, 2l8I.-3/8.
lnericon lcodeny of Pediolrics, lnericon Heorl lssociolion.
l2OOOI. 7extbook of Neonutu| Resuscitution, /lh ed. lnericon
lcodeny of Pediolrics ond lnericon Heorl lssociolion.
World Heollh 0rgonizolion. l1??8I. 8usic newborn resuscitution:
/ pructicu| uiJe. 0enevo. WH0. lWH0/RHT/MSM/?8.1I
TA5K5 F0P ALL REALTR W0PKEP5: NEWB0PN PE5U5CITATI0N
1 Prepore for newborn resuscilolion before oll birlhs lcleon, worn
surfoce, equipnenl, ond suppliesI.
2 f lhere is neconiun in lhe onniolic fuid, cleor lhe newborn`s noulh ond
nose during lhe birlhing process. Suclion lhe boby os soon os lhe heod
is delivered ond before lhe shoulders energe.
3 Recognize when o boby needs resuscilolion.
/ Resuscilole on osphyxioled newborn.
5 Slop newborn resuscilolion if il is nol successful ofler 2O ninules.
Monilor lhe newborn`s breolhing ond color ofler resuscilolion.
7 0ore for o newborn ond counsel lhe porenls ofler resuscilolion.
oI f lhe resuscilolion is successful
bI f lhe boby is breolhing, bul needs referrol
8 0ounsel ond core for o nolher ond fonily if o newborn dies.
? Deconloninole ond cleon resuscilolion equipnenl ond supplies
lgloves, colheler, focenosk, clolhs, lobleI following lhe infeclion
prevenlion guidelines. Do high-level disinfeclion of gloves ond
suclion colhelers.
5
>cigdYjXi^dc &%.
L]Vi^hAdl7^gi]LZ^\]i4 &&%
8VgZ[dgi]ZAdl7^gi]
LZ^\]iCZlWdgc &&'
H`^c"id"H`^cdg
@Vc\VgddBdi]Zg8VgZ &&-
5
C~:e o Low Di:l \eiql D~Lies
Care rf |rw B|rt| we|]|t Ba||es 1O?
5
8]VeiZg*
/ ow Li:l weiql LD\l L~Ly is o:e wo
weiqs ess l~: ZOO q:~ns ~l Li:l
Tese L~Lies ~:e no:e iey lo oie l~:
L~Lies wil ~ Li:l weiql o ZOO q:~ns o:
no:e Low Li:l weiql L~Lies wo su:vive
~:e iey lo ~ve no:e neoi~ ~:o oeve
one:l~ :oLens l~: :o:n~ le:n
L~Lies Tey ~ve sei~ :eeos / sn~
L~Lies ~ve ~ Lelle: ~:e lo ive ~:o Le
e~ly i ley qel :oe: ~:e
Te ~uses o LD\ ~:e :ol we u:oe:
slooo \e oo :ow l~l i ~ won~: is
e~ly ~:o e~ls we, se ~s ess ~:e
o ~vi:q ~ LD\ L~Ly
e~l wo:e:s ~ve ~: ino:l~:l :oe i:
ei:q ow Li:l weiql L~Lies su:vive
Tey ~: e nole:s ~:o ~niies e~::
lo ~:e :oe:y o: lei: LD\ L~Lies, ~:o
ley ~: ~so ~ovise onnu:ilies ~Loul
e~ly :eq:~:ies lo owe: le :unLe:
o LD\ L~Lies
5 C~:e o Low Di:l \eiql D~Lies
11O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
n lhis chopler you will fnd infornolion oboul.
n Whol low birlh weighl is
n How lo idenlify o low birlh weighl boby
n The oppeoronce of o low birlh weighl boby
n Problens of low birlh weighl bobies
n 0ore of low birlh weighl bobies ol birlh ond for
lhe frsl 28 doys
n Skin-lo-skin core or kongoroo nolher core
n Breoslfeeding o low birlh weighl boby
n lhis chopler you will leorn lo do lhe following.
n Recognize ond core for low birlh weighl bobies
n 0ounsel ond odvise nolhers ond fonilies oboul
lhe core of low birlh weighl bobies
n Refer low birlh weighl bobies who ore sick ond
very low birlh weighl bobies
wNA! |S |0w B|k!N w||N!?
l Icw birtb weigbt boby is one who weighs less lhon
25OO grons ol birlh.
l kZgnIcw birtb weigbt boby is one who weighs less
lhon 15OO grons ol birlh.
The couses of LBW ore conplex ond poorly under-
slood. During pregnoncy bobies goin weighl by gelling
enough nourishnenl fron lheir nolhers ond by sloy-
ing in lhe ulerus for ol leosl 37 weeks or ? colendor
nonlhs. l boby who does nol gel enough nourish-
nenl in lhe ulerus or who is born before conpleling
/O weeks noy be low birlh weighl.
LBW bobies con be.
n Prenolure or prelern. l boby born before
lhe 37lh week of pregnoncy is colled prenolure
lor prelernI. l prenolure boby noy nol be
reody lo live oulside lhe ulerus ond noy hove
diffcully inilioling breolhing, sucking, fghling
infeclion, ond sloying worn.
n Snoll for geslolionol oge lS0lI. l boby who
did nol grow well enough in lhe ulerus during
pregnoncy is colled snoll for geslolionol oge.
The S0l boby is usuolly full-lern ond oflen oble
lo breolhe ond suck well.
l boby noy be bolh snoll for geslolionol oge ond
prenolure.
Becouse lhere is no single couse of LBW, il is diffcull
lo prevenl. lnong heollhy, well-nourished wonen,
lhe frequency of LBW bobies is lower. You noy be oble
lo help decreose lhe nunber of LBW bobies born in
o connunily by encouroging oll wonen lo gel good
conprehensive onlenolol core. Refer lo your counlry`s
Sofe Molherhood guidelines.
Care rf |rw B|rt| we|]|t Ba||es 111
5
8]VeiZg*

8=6GI*#& FACT0P5 A550CIATED WITR L0W BIPTR WEI6RT
FACT0P5
Pregnoncy in wonen who.
n lre less lhon 2O
n Hove birlhs lhol ore less lhon 3 yeors oporl or
hove nony pregnoncies lfve or noreI
Wonen who.
n Hod o LBW boby before
n Do hord physicol work for nony hours wilh no resl
n lre very poor
n lre underweighl ond hove poor nulrilion
n Hove heollh problens lhyperlension,
sickle cell diseoseI
Wonen who hove pregnoncy problens such os.
n Severe onenio
n Pre-eclonpsio or hyperlension
n nfeclions during pregnoncy lblodder ond kidney
infeclions, hepolilis, sexuolly lronsnilled infec-
lions, H\/lDS, nolorioI
n Mulliple geslolion le.g., lwinsI
Bobies who hove.
n 0ongenilol or genelic obnornolilies
n ln infeclion while in lhe ulerus
RELPFUL ACTI0N5lPPEENTIE HEA5UPE5
n ldvise wonen lo deloy lheir frsl pregnoncy unlil
ol leosl 2O yeors of oge.
n 0ounsel nen ond wonen lo spoce
lheir children ol leosl 3 yeors oporl.
n Fncouroge lhe use of nodern conlroceplive
nelhods lo spoce or linil pregnoncies.
n Moke lhe connunily owore of lhe need lo noke
childbeoring sofer. Wonen should.
n Fol enough ond lhe righl kinds of food
n 0el enough resl fron hord work
n 0el good conprehensive onlenolol core
n Hove occess lo heollh core services lo fnd ond
lreol connon problens before pregnoncy
n Help wonen neel lheir heollh needs during
pregnoncy.
Teoch wonen ond fonilies lo.
n Recognize ond respond lo donger signs during
pregnoncy
n 0el lreolnenl for problens during pregnoncy
n Seek follow-up ond prevenlive core
During pregnoncy leoch wonen ond fonilies lo.
n Nol loke ony nedicine or lreolnenl unless
opproved by o heollh worker
n Know lhe pregnoncy ond newborn donger signs
n 0el lreolnenl for problens during pregnoncy
112 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
w|at 0r |rw B|rt| we|]|t ar1 Prematare Ba||es |rrk ||ke?
Becouse lhey weigh less lhon 25OO grons, LBW new-
borns ore lhin ond hove very lillle fol under lhe skin.
This lock of fol is why LBW bobies ore ol higher risk
for hypolhernio.
Prenolure bobies noy olso hove lhe following choroc-
lerislics, depending on lhe geslolionol oge.
n 5kin. Moy be reddened. The skin noy be lhin so
blood vessels ore eosily seen.
n Lanugc. There is o lol of lhis fne hoir oll over
lhe boby`s body.
n Limbs. The linbs ore lhin ond noy be poorly
fexed or foppy due lo poor nuscle lone.
n Read size. The heod oppeors lorge in proporlion
lo lhe body. The fonlonelles ore snoolh ond fol.
n 6enitaIs. Mole. lhe lesles noy nol be descended
ond lhe scrolun noy be snoll. Fenole. lhe
cliloris ond lobio ninoro noy be lorge.
n 5cIes cf feet. 0reoses ore locoled only in lhe
onlerior lhird of lhe sole, nol oll over, os in o
lern newborn.
w|at Prr|lems 0r |rw B|rt| we|]|t Ba||es Nae?
Low birlh weighl bobies ore nore likely lo die or
develop serious heollh problens. The snoller lhe
boby, lhe bigger lhe risk. 0horl 5.2 lisls lhe possible
problens o low birlh weighl boby noy hove ond gives
reconnended core for eoch problen.
CAk| |0k !N| |0w B|k!N w||N!
N|wB0kN
Care at B|rt|
Renenber, oll bobies need lhe sone bosic core
regordless of birlh weighl. Use lhe decision-noking
sleps in chorl 5.3 lo guide you in giving core lo lhe
LBW boby ol birlh.
|rllrwap Care rf t|e |rw B|rt| we|]|t Ba|
The low birlh weighl newborn is nore likely lo hove
problens during lhe eorly weeks of life. See lhis boby
every week unlil lhe boby weighs 25OO grons. Use lhe
decision-noking sleps lo guide you in giving core dur-
ing follow-up visils lsee chorl 5./I.
New|rrr 0ar]er S|]rs
Renenber. lhe newborn donger signs ore lhe sone
regordless of weighl.
n Breolhing problens
n Feeding diffcullies or nol sucking
n Feels cold
n Fever
n Red, swollen eyelids, ond pus dischorge fron eyes
n Redness of skin, swelling, pus or foul odor
oround lhe cord or unbilicus
n 0onvulsions/fls
n Joundice/yellow skin
Care rf |rw B|rt| we|]|t Ba||es 113
5
8]VeiZg*

8=6GI*#' L0W BIPTR WEI6RT BABY PP0BLEH5
PP0BLEH5
Breatbing prcbIems ol birlh ond loler lespe-
ciolly prenolure bobiesI
Lcw bcdy temperature becouse lhere is lillle
fol on lhe body ond lhe newborn`s lenperolure
reguloling syslen is innolure
Lcw bIccd sugar becouse lhere is very lillle
slored energy in lhe LBW boby`s body
Feeding prcbIems becouse of lhe boby`s snoll
size, lock of energy, snoll slonoch, ond inobilily
lo suck
Infecticns becouse lhe innune syslen is
nol nolure
Jaundice Ibigb biIirubin! becouse lhe liver is
nol nolure
BIeeding prcbIems due lo innolure clolling
obilily ol birlh
PEC0HHENDED CAPE
Resuscilole if lhe boby is nol breolhing, is gosping,
or is breolhing less lhon 3O breolhs per ninule. Pre-
nolure bobies hove innolure lungs, gel cold eosily,
ond ore nore prone lo infeclions, oll of which leod lo
breolhing problens.
Kongoroo nolher core wilh lhe boby in conlinuous skin-
lo-skin conlocl helps keep lhe LBW newborn worn.
These bobies need breosl nilk lcoloslrunI os soon
os possible ofler birlh ond very frequenl feedings
levery 2 hoursI in lhe frsl weeks.
LBW bobies con usuolly breoslfeed well wilh help.
The LBW boby noy need nony snoll frequenl feeds.
Prenolure bobies noy nol be slrong or nolure
enough lo breoslfeed well ol frsl.
0oregivers nusl use infeclion prevenlion proclices
ond wosh lheir honds corefully before coring for
LBW bobies. ll lhe heollh core focilily, do nol house
uninfecled LBW bobies in lhe sone roon wilh seplic
newborns or sick children. Keep sick people lvisilors
ond sloffI owoy fron LBW bobies.
Prenolure LBW bobies becone yellow eorlier ond
il losls longer lhon in lern bobies. f lhere is ony
|oundice in lhe frsl 2/ hours or ofler 2 weeks or if
lhe boby is yellow wilh ony olher donger sign, refer
lo o higher-level focilily.
The nolher should breoslfeed lhe |oundiced LBW
newborn nore oflen lol leosl every 2 hoursI lo help
lhe boby gel rid of lhe bilirubin lhrough lhe slool.
0ive vilonin K ol birlh.
11/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Examinaticn
PrcbIemslneeds
PIan cf care
lsk oboul lhe nolher`s hislory, including diseoses or problens during lhe pregnoncy
ond birlh. lsk whol dole lhe boby wos expecled or how long lhe pregnoncy losled.
Weigh lhe boby ol birlh.
Do o conplele newborn physicol exoninolion.
Decide if lhe boby is.
n \ery low birlh weighl. less lhon 15OO grons
n Low birlh weighl. belween 15OO-25OO grons
ls for oll newborns.
n Dry ond slinulole
n Keep lhe newborn worn
n 0heck lhe boby`s breolhing ond color
n Slorl newborn resuscilolion if needed
n Pul lhe boby skin-lo-skin wilh lhe nolher os soon os possible
n Slorl breoslfeeding os soon os possible lor express breosl nilk |coloslrunJ
ond cup feed os soon os possibleI
n 0ive eye ond cord core
8=6GI*#( L0W BIPTR WEI6RT BABYCAPE AT BIPTR: DECI5I0N-HAKIN6 CRAPT
Care rf |rw B|rt| we|]|t Ba||es 115
5
8]VeiZg*
PIan cf care
Iccntinued!
FcIIcw-up
Lcw birtb weigbt baby I1500-2500 grams!
n f lhe LBW newborn hos no breolhing problens, sucks well, ond
sloys worn while in skin-lo-skin conlocl wilh lhe nolher.
n Keep lhe boby worn
n Keep lhe boby in conlinuous skin-lo-skin conlocl wilh lhe nolher
n 0over bolh nolher ond boby wilh o worn blonkel or clolh
n 0over lhe boby`s heod wilh o clolh or hol
n Do nol bolhe lhe boby unlil lhe boby`s lenperolure is sloble,
deloy lhe bolh ol leosl 2/ hours
n Teoch lhe nolher ond fonily lo keep lhe boby worn by conlinuous skin-lo-skin
conlocl. f lhe oxillory lenperolure drops below 3 0 l?.8 FI. worn lhe boby by worn-
ing lhe roon, using o heol source, ond cover bolh boby ond nolher wilh nore worn
blonkels or clolhs.
n Fncouroge lhe nolher lo breoslfeed lor express coloslrun ond cup feedI os soon os
possible ond lhen every 2 hours.
n 0heck breolhing, lenperolure, color, ond feeding lsuckingI every 3O ninules for hours.
n 0ive lhe newborn o single dose of vilonin K 1 ng M.
n ldvise lhe nolher ond fonily lo olwoys wosh lheir honds before hondling lhe LBW boby.
n f lhe LBW boby hos ony of lhe following problens, ocl frsl lo slobilize lhe boby,
ond lhen refer lo o higher-level heollh focilily lhol is oble lo provide speciolized core
lsee Referrol 0uidelines in chopler , chorl .3I.
n Blue longue ond lips. 0ive oxygen ol high level unlil color inproves lsee lppendix 0I.
n Breolhing problens. Resuscilole if indicoled.
n Nol feeding or sucking well. Fxpress ond give breosl nilk by cup.
ery Icw birtb weigbt baby IbeIcw 1500 grams!
n Slobilize lhe boby by noking sure lhe boby is worn ond hos breoslfed or loken
breosl nilk lcoloslrunI by cup.
n Keep lhe boby in conlinuous skin-lo-skin conlocl wilh lhe nolher.
n 0ive lhe boby o single dose of vilonin K O.5 ng M.
n Refer lhe boby lo o higher-level heollh focilily where lhere is core for o very snoll boby.
The boby is ol greol risk of respirolory problens ofler birlh due lo lung innolurily.
n 0ive lhe frsl dose of onlibiolics.
lnpicillin 5O ng/kg M unJ genlonicin / ng/kg M
See chopler ond follow lhe Referrol 0uidelines lchorl .3I.
See lhe boby weekly lo check for ony problens ond lo nonilor lhe weighl goin.
8=6GI*#( L0W BIPTR WEI6RT BABYCAPE AT BIPTR: DECI5I0N-HAKIN6 CRAPT
11 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Examinaticn
PrcbIemslneeds
n lsk lhe nolher.
n s lhe boby sucking well?
n How oflen does lhe boby feed?
n How nony lines does lhe boby urinole lwel lhe dioperI in 1 doy?
n Does lhe boby seen very sleepy? s lhe boby hord lo woke up?
n Whol do lhe boby`s slools look like ond how oflen does your boby hove o slool?
n Hove you seen onylhing in lhe boby lhol worries you?
n Look ol lhe boby`s birlh record lo see lhe birlh weighl ond if lhere were ony
problens ol birlh.

n Wolch lhe boby breoslfeed.
n Weigh lhe boby, if o scole is ovoiloble. lfler lhe frsl week lwhen sone weighl noy
be loslI, lhe newborn should goin weighl regulorly loboul 25-3O grons o doy ofler lhe
frsl 1O doysI.
n Look ol lhe boby`s.
n Skin for color ond ony roshes or puslules.
Joundice oppeors eorlier ond losls longer in LBW bobies. Refer lhe boby if lhere
is ony |oundice in lhe frsl 2/ hours or ofler 2 weeks or if lhere is |oundice wilh ony
olher donger sign.
n Blue color of lhe boby`s lrunk, lips or longue indicoles o serious lock of oxygen
in lhe blood. This boby needs oxygen innediolely.
n Breolhing.
n Fyes for lhick pus dischorge.
n Moulh. longue, guns for while polches.
n 0ord or unbilicus lfor redness, swelling, bod snell, or dischorgeI.
n Feel lhe lenperolure or loke lhe oxillory lenperolure. Nornol oxillory lenperolure is
3-37 0 l?.8-?8. FI.
n Decide if lhe boby is growing.
n Decide if lhe boby hos ony problens lsee chopler I.
n Think oboul lhe boby`s needs. wornlh, proleclion fron infeclion, feeding, sofely, love, sleep.
8=6GI*#) L0W BIPTR WEI6RT BABYWEEKLY F0LL0W-UP CAPE: DECI5I0N-HAKIN6 CRAPT
Care rf |rw B|rt| we|]|t Ba||es 117
5
8]VeiZg*
PIan cf care
FcIIcw-up
f lhe LBW newborn hos ony donger signs.
n Refer lhe boby lo o higher-level heollh focilily where lhere is core for o
low birlh weighl boby
n Follow lhe Referrol 0uidelines lsee chopler , chorl .3I
f lhe LBW newborn is growing ond hos no donger signs.
n Moke o plon of core for ony problen or need
n 0onlinue lo odvise lhe nolher oboul how lo core for lhe boby.
n 0onlinue lo keep lhe boby worn wilh skin-lo-skin conlocl
n Prolecl lhe boby fron infeclion lhondwoshing, ovoiding conlocl wilh people who ore sickI
n 0ive nornol newborn core
n Breoslfeed lhe boby on denond ond exclusively
n Tolk lo ond conforl lhe boby
n Show lhe boby love
n Keep lhe boby sofe
n Wolch for donger signs
n Renind lhe nolher of whol lo do if she nolices o donger sign
n Plon for lhe nexl visil os needed for follow-up.
n nnunizolions. give on lhe sone schedule os for nornol weighl bobies
n 0ive fonily plonning infornolion lo lhe nolher lo help her choose lhe nelhod of
her choice lo spoce lhe nexl pregnoncy
n See lhe low birlh weighl boby every week lo check her growlh ond lo look for ony
problens unlil she reoches 25OO grons.
n When lhe boby reoches 25OO grons, slowly begin lo decreose lhe onounl of line
lhe boby is in skin-lo-skin conlocl.
8=6GI*#) L0W BIPTR WEI6RT BABYWEEKLY F0LL0W-UP CAPE: DECI5I0N-HAKIN6 CRAPT
118 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
SK|N!0SK|N 0k
KANAk00 N0!N|k CAk|
Low birlh weighl bobies need nore help ond line lo
od|usl lo life oulside lhe wonb. They olso need help lo
sloy worn ond lo gel enough breosl nilk lo grow. 0ne
woy lo help o boby wilh oll lhese needs is lo keep lhe
boby in skin-lo-skin conlocl. Kongoroo nolher core
lKM0I is o woy lo neel lhe low birlh weighl boby`s
speciol needs.
Crmprrerts rf Kar]arrr Nrt|er Care
Kongoroo nolher core hos lhree noin porls.
1. Ccntinucus skin-tc-skin ccntact between tbe
baby`s frcnt and mctber`s cbest. Skin-lo-skin
conlocl slorls ol birlh ond is conlinued doy ond
nighl. There noy be brief inlerruplions such os
during lhe boby`s bolh. The boby weors only o
hol or clolh lo keep her heod worn ond o
noppy ldioperI.
2. ExcIusive breastfeeding. The boby breoslfeeds
wilhin 1 hour ofler birlh ond lhen every 2-3
hours. The clolh lhol wrops oround lhe nolher
ond boby is loosened lo breoslfeed. nfornolion
oboul how lo help o nolher breoslfeed her LBW
boby follows on poges 12O ond 121.
3. 5uppcrt tc tbe mctber. The nolher con conlinue
lo do whol she nornolly does while providing
kongoroo nolher core. For exonple, lhe nolher
con cook, cleon, ond even sleep wilhoul inler-
rupling skin-lo-skin conlocl. However, she will
need o lol of supporl lo noinloin lhis conlinuous
conlocl. n o heollh focilily lhe sloff con help, ol
hone lhe fonily noy help by keeping lhe boby
skin-lo-skin for shorl periods while lhe nolher
resls or lokes core of olher dulies.
Nrw tr Nelp t|e Nrt|er Keep Ner Ba| warm
w|t| Sk|rtrSk|r Crrtart
Slorl skin-lo-skin conlocl os soon ofler birlh os pos-
sible. f lhe boby breolhes well ond does nol need
resuscilolion or nedicol lreolnenl, begin skin-lo-skin
conlocl innediolely.
8=6GI*#* R0W D0E5 KHC RELP
TRE BABY AND H0TREP?
BABY
n The newborn`s breolhing becones regulor
ond sloble.
n The newborn`s lenperolure slobilizes
ol nornol.
n The newborn`s innunily is inproved.
n nfeclions ore reduced.
n The newborn breoslfeeds beller ond goins
weighl fosler.
H0TREP
n The nolher becones nore olloched lo her
boby enolionolly.
n The nolher goins o feeling of conpelence in
coring for her frogile boby.
;><JG:*#& 5KIN-T0-5KIN C0NTACT
Care rf |rw B|rt| we|]|t Ba||es 11?
5
8]VeiZg*
;><JG:*#' R0W T0 WPAP TRE BABY
AND H0TREP
Rcw tc wrap tbe baby and mctber
Ploce lhe boby belween lhe nolher`s breosls wilh lhe
boby`s feel below lhe nolher`s breosls ond lhe boby`s
honds obove.
The nolher ond boby should be chesl-lo-chesl wilh
lhe boby`s heod lurned lo one side.
Use o long piece of clolh lo snugly wrop lhe nolher
ond boby logelher.
n Ploce lhe cenler of o long clolh over lhe boby on
lhe nolher`s chesl.
n Wrop bolh ends of lhe clolh frnly oround lhe
nolher, under her orns, lo her bock. The wrop
should nol be so lighl lhol il conslricls lhe boby.
Leove roon for lhe boby`s obdoninol breolhing.
n 0ross lhe clolh ends behind lhe nolher ond lie lhe
ends of lhe clolh in o secure knol.
n f lhe clolh is long, bring bolh ends of clolh lo fronl
ond lie lhe ends of lhe clolh in o knol under lhe
boby.
n The wrop should be lighl enough so lhol lhe boby
does nol slip oul when lhe nolher slonds.
n Supporl lhe boby`s heod by pulling lhe wrop up lo
|usl under lhe boby`s eor. The wrop con be loos-
ened for breoslfeeding.
Hove lhe nolher pul on her blouse or dress. Be sure
lo use clolhing lhol is loose ond lhol hos on odequole
opening in lhe fronl so os nol lo cover lhe boby`s foce
ond so lhol breoslfeeding will be eosy.
Advise tbe mctber tc
n Sleep wilh her upper body roised sone loboul 3O
degreesI lo keep lhe boby in o heod up posilion.
n Breoslfeed lhe boby on denond, ol leosl every 2
lo 2 1/2 hours.
n Use skin-lo-skin conlocl conlinuously. lnolher
fonily nenber noy do lhe skin-lo-skin conlocl for
shorl lines when lhe nolher bolhes or nusl do
sonelhing else.
n Provide conlinuous skin-lo-skin conlocl unlil lhe
boby weighs ol leosl 25OO grons.
12O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Breastfee1|r] t|e |rw B|rt| we|]|t Ba|
Breosl nilk is lhe perfecl food for oll bobies, espe-
ciolly for snoll low birlh weighl bobies. LBW bobies
need enough food lo recover fron birlh ond lo grow,
bul lhey hove snoll slonochs, lire eosily, ond noy nol
hove enough energy lo suck for long. llso lhe sucking
refex noy be obsenl or weok in snoller prenolure
or LBW bobies ol frsl. Therefore, LBW bobies ore ol
risk for nol gelling enough food. lll low birlh weighl
bobies need lo breoslfeed oflen, ol leosl every 2 lo
2 1/2 hours. ls lhe LBW boby grows she will be oble
lo loke in nore ond will nol breoslfeed os oflen.
Fxclusive ond unliniled breoslfeeding is on inporlonl
porl of kongoroo nolher core. Wilh lhe boby so close
lo lhe nolher, lhe boby con snell lhe nilk ond con
begin lo suck when hungry.
;><JG:*#) FATREP5 CAN AL50 RELP WITR
5KIN-T0-5KIN C0NTACT
;><JG:*#( BABY IN KHC P05ITI0N
Care rf |rw B|rt| we|]|t Ba||es 121
5
8]VeiZg*
8=6GI*#+ TIP5 T0 RELP A H0TREP BPEA5T-
FEED REP L0W BIPTR WEI6RT BABY
Find o quiel ploce lo breoslfeed. ls LBW bobies noy
hove innolure nervous syslens, noise, lighls, ond
oclivily con dislrocl lhen fron sucking.
Fxpress o few drops of nilk on lhe nipple lo help lhe
boby slorl nursing.
0ive lhe boby shorl resls during o breoslfeed, feed-
ing is hord work for lhe LBW boby.
f lhe boby coughs, gogs, or spils up when slorling lo
breoslfeed, lhe nilk noy be lelling down loo fosl for
lhe lillle boby. Teoch lhe nolher lo.
1. Toke lhe boby off lhe breosl if lhis hoppens
2. Hold lhe boby ogoinsl her chesl unlil lhe boby
con breolhe well ogoin
3. Pul lhe boby bock lo lhe breosl ofler lhe
lel-down of nilk hos possed
f lhe LBW boby does nol hove enough energy lo
suck for long or o slrong enough suck refex.
n Teoch lhe nolher lo express breosl nilk
n Teoch her lo feed lhe boby lhe expressed
breosl nilk by cup
122 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
TA5K5 F0P ALL REALTR W0PKEP5: L0W BIPTR WEI6RT BABIE5
1 0ive heollh nessoges lo lhe connunily lo prevenl low birlh weighl.
oI Fxploin lo wonen why il is besl lo deloy lheir frsl pregnoncy unlil ol
leosl 2O yeors of oge.
bI Fncouroge wonen lo spoce lheir children ol leosl 3-5 yeors oporl.
cI Fncouroge lhe use of nodern conlroceplive nelhods lo deloy ond
spoce children.
dI Moke lhe connunily owore of wonen`s needs for heollhy ond
sofer childbeoring.
eI Help wonen neel lheir heollh needs during pregnoncy.
fI Wonen should nol loke ony nedicine or lreolnenl during pregnoncy
or while breoslfeeding unless opproved by o heollh worker.
gI Teoch wonen lhe signs of connon problens which occur during
pregnoncy.
hI Teoch wonen lhe inporlonce of gelling lreolnenl for problens
during pregnoncy.
2 Recognize ond core for low birlh weighl bobies.
3 0ounsel ond odvise nolhers ond fonilies oboul lhe core of low birlh
weighl bobies.
oI How lo keep lhe LBW boby worn
bI Breoslfeeding lhe LBW boby
/ Refer low birlh weighl bobies who ore sick or very low birlh weighl.
Care rf |rw B|rt| we|]|t Ba||es 123
5
8]VeiZg*
ereral kefererres
Bioncuzzo, M. l1???I. 8reustfeeJin the newborn: 0|inicu| strute-
ies for nurses. Sl. Louis. Mosby.
0onde-lgudelo l, Dioz-Rosselllo JL, ond Belizon JM. l2OO2I.
Kongoroo nolher core lo reduce norbidily ond norlolily in low
birlhweighl infonls l0ochrone ReviewI. 7he 0ochrune Librur,,
ssue /.
Tessier R, 0rislo M, \elez S, 0iron M, Figueroo de 0olune Z,
Ruiz-Poloez, J0, 0horpok Y, ond 0horpok N. l1??8I. Kongoroo
nolher core ond lhe bonding hypolhesis |Fleclronic versionJ.
PeJiutrics, 1O2l2I.
World Heollh 0rgonizolion. 2OO3. Kunuroo Hother 0ure: / Pructi-
cu| 0uiJe. 0enevo. WH0.
Yosnin S, 0srin D, Poul F, ond 0oslello l. l2OO1I. Neonolol nor-
lolily of low-birlh-weighl infonls in Bonglodesh. 8u||etin of the
wor|J Feu|th 0runizution, 7?. O8-1/.
|rterret kefererres
Kongoroo Molher 0ore. 0verview-ph,sio|o, unJ reseurch of KH0.
Relrieved Jonuory 11, 2OO3, fron www.kongoroonolhercore.con
Kongoroo Molher 0ore. whut is Kunuroo Hother 0ure? Relrieved
Jonuory 11, 2OO3, fron www.kongoroonolhercore.con
Kongoroo Molher 0ore. References. Relrieved Jonuory 11, 2OO3,
fron www.kongoroonolhercore.con
Porenls Ploce. Fe|pin ,our preemie stu, uwuke for feeJs. Relrieved
Jonuory 11, 2OO3, fron www.porenlsploce.con
Sone connon feeding problens for low birlh weighl infonls.
0uinin unJ 0rowin, ussurin nutritionu| cure of preterm infunts.
Relrieved Jonuory 11, 2OO3, fron hllp.//sloff.woshinglon.edu/
growing/Feed/orolprob.hln
Conno: ewLo:: P:oLens

>cigdYjXi^dc &'*
CZlWdgc9Vc\ZgH^\ch &'+
HiVW^a^oVi^dcVcY:bZg\ZcXn
GZ[ZggVad[CZlWdgch &'-
EgdWaZbhd[i]ZCZlWdgc &(%

Crmmrr New|rrr Prr|lems 125

8]VeiZg+
Du:i:q le :sl Z8 o~ys, ~ :ewLo:: is
~o|usli:q lo ie oulsioe le nole:s Looy
Te :ewLo::s innu:e syslen is :ol yel
n~lu:e, so il is e~sy o: le L~Ly lo qel
i:elio:s Sone :oLens, su ~s yo
le:ni~ ~:o |~u:oie, ~e: Le~use le
:ewLo::s syslens o: n~i:l~i:i:q Looy
lene:~lu:e ~:o eini:~li:q w~sle :oo
uls ~:e inn~lu:e
Te :ewLo:: o~:qe: siq:s suqqesl se:ious
i:ess \e: ~ :ewLo:: is si, le ~use
o le i:ess n~y Le ~:o lo ioe:liy 0le:
le siq:s o se:ious i:ess i: ~ :ewLo::
~:e oie:e:l :on le siq:s o le s~ne
i:ess i: ooe: io:e: Te :ewLo::s
nole: ~:o ~niy nusl ~w~ys ~:euy
w~l o: lese siq:s Te L~Lys ~:e lo
su:vive ~:o Le e~ly is Lelle: i le nol
e: :ows le o~:qe: siq:s ~:o ow lo qel
neoi~ e o: le L~Ly quiy
Te e~l wo:e: wi Le ~Le lo s~ve
L~Lies ives i: lwo ino:l~:l w~ys. 1l Ly
le~i:q nole:s ~:o ~niies lo :eoq:i.e
~:o :eso:o lo o~:qe: siq:s ~:o :oLens,
~:o Zl Ly qivi:q ene:qe:y ~:e ~:o :ee:
:i:q L~Lies wo :eeo sei~i.eo ~:e
Conno: ewLo:: P:oLens
12 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
n lhis chopler you will fnd infornolion oboul.
n Donger signs in newborns
n Moking energency referrols
n Newborn problens ossocioled wilh lhe
nolher`s pregnoncy or lobor
n Breolhing problens
n Newborn infeclions
n Sepsis lgenerolized infeclionI
n Skin infeclion
n Unbilicol cord infeclion
n Fye infeclion
n 0rol lhrush
n Problens wilh lhe boby`s lenperolure
n Tenperolure loo low lhypolhernioI
n Tenperolure loo high lhyperlhernioI
n Joundice
n Bleeding fron lhe unbilicol cord
n lhis chopler you will leorn lo do lhe following.
n Recognize newborn donger signs
n ldvise ond counsel nolhers oboul donger
signs ond whol lo do
n Slobilize ond refer sick newborns
n Recognize ond nonoge connon newborn
problens
n ldvise ond counsel nolhers oboul newborn
problens.
n How lo recognize eoch problen
n How lo prevenl lhe problen or prevenl il
fron worsening
n Whol lreolnenl ond core lhe boby needs
for lhe problen
n 0ore for lhe problen ol hone
n Whol follow-up lhe boby needs
N|wB0kN 0AN|k S|NS
Donger signs in lhe newborn ore oflen nonspecifc.
This neons lhol eoch donger sign con be o sign of
olnosl ony newborn diseose or problen. The nosl
connon signs of illness in o newborn ore. lhe boby
slops feeding well, is cold lo louch, or hos lrouble
breolhing.
Donger signs in lhe newborn ore signs lhol noy neon
serious illness. Serious illness in o newborn oflen
leods ropidly lo deolh. Deolh noy be prevenled if.
n lhe nolher ond fonily recognize donger signs
ond quickly seek heollh core,
n lhe heollh worker innediolely slobilizes ond
refers lhe newborn lo lhe oppropriole heollh
focilily, unJ
n lhe boby receives oppropriole nedicol core.
Teoch oll nolhers ond fonilies oboul donger signs
before leoving lhen lo core for lheir newborns. Teoch
lhen lo recognize ond respond innediolely lo donger
signs by loking lhe newborn wilh o donger sign lo o
heollh worker.
Recognizing donger signs.
n Use |ob oids, if ovoiloble, lo discuss lhe donger
signs. Piclures ore very helpful.
n Hove lhe nolher denonslrole her underslonding
by repeoling lhe donger signs bock lo you.
n Review lhe donger signs ol every visil wilh lhe
nolher ond newborn.
Responding lo donger signs.
n Moke sure lhe fonily hos o plon lhol con be
quickly ocled upon in cose of on energency.
This con sinply neon updoling lhe conplicolion
reodiness plon lhol wos node during pregnoncy.
n Teoch lhen lo loke lhe newborn wilh o donger
sign lo o heollh worker innediolely.
Crmmrr New|rrr Prr|lems 127

8]VeiZg+
8=6GI+#& NEWB0PN DAN6EP 5I6N5
Breatbing prcbIems
Feeding difhcuIties
cr nct sucking
FeeIs ccId
Fever
Ped, swcIIen eyeIids
and pus discbarge
frcm tbe eyes
Pedness, sweIIing,
pus, cr fcuI cdcr
arcund tbe ccrd cr
umbiIicus
CcnvuIsicnslhts
Jaundicel
yeIIcw skin
n Breolhing is fosler lhon O or less lhon 3O breolhs in o ninule.
n Breolhing is shollow or irregulor, wilh or wilhoul pouses.
n There is o noise wilh eoch breolh lgospingI.
n There is indrowing of lhe chesl wilh breolhing, foring of lhe noslrils.
n Tongue ond lips or skin color is blue.
lSee chorl ./ Breolhing ProblensI
n Unoble lo suck or sucks poorly.
n 0onnol be owokened lo suck or does nol sloy owoke lo suck long enough
lo enply lhe breosl.
n Sucks bul does nol seen solisfed.
lSee chorl .5 Newborn SepsisI
n Body lobdonen or bockI feels cold or cooler lhon lhol of o well person.
n lxillory lenperolure below 3 0.
lSee chorl .1O Hypolhernio/Low TenperolureI
n Body lobdonen or bockI feels hol conpored lo lhol of o well person.
n lxillory lenperolure obove 37 0.
lSee chorl .11 Hyperlhernio/High TenperolureI
lSee chorl .8 Fye nfeclionI
lSee chorl .. Unbilicol 0ord nfeclionI
n Fils ore nore lhon lhe lrenor or |illery novenenls of nornol bobies.
n The boby noy becone rigid or shoke.
lSee chorl .5 Newborn SepsisI
n Yellow skin or eye color which begins in lhe frsl 2/ hours or ofler 2 weeks is serious.
n Yellow skin color lhol oppeors when lhe boby hos ony olher donger sign is serious.
lSee chorl .12 JoundiceI
128 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
S!AB|||lA!|0N AN0 |N|k|NC
k|||kkA| 0| N|wB0kNS
ls o heollh worker you will refer newborns lo o higher
level of core when needed. When referring o very
sick newborn, il is inporlonl lhol lhe boby lwilh his
nolherI is lronsporled lo lhe focilily os soon os pos-
sible. Slobilize lhe boby before lronsporl lo help lhe
boby lolerole lhe lrip.
Renenber. lhe nolher ond fonily will be worried
oboul lhe boby`s illness ond need for referrol. Treol
lhe nolher ond fonily wilh genlleness, repeol explo-
nolions os oflen os needed, ond oddress ony ques-
lions or concerns lhey noy hove.
Sta||l|te t|e New|rrr
To slobilize lhe recenlly born boby.
n 0ive innediole newborn core. dry ond keep lhe
newborn worn, resuscilole lhe boby, if needed,
give eye ond cord core, ond help lhe nolher
slorl breoslfeeding.
To slobilize olher newborns.
n Keep lhe boby dry, worn, ond in skin-lo-skin
wilh lhe nolher.
n Moke sure lo conlinue breoslfeeding or cup
feeding lhe boby wilh breosl nilk every 2-3 hours.
kefer t|e New|rrr
The resl of lhis chopler presenls newborn problens
lhol include obnornol fndings fron on exoninolion
of lhe boby, donger signs, connon newborn prob-
lens ond illnesses, ond problens resulling fron lhe
nolher`s pregnoncy or lhe birlh. You will fnd lhol
referrol is oflen lhe reconnended oclion or plon. The
referrol guidelines in chorl .3 oulline lhe inporlonl
oclions for referring ony newborn.
8=6GI+#' TEACRIN6 H0TREP5, FAHILIE5,
AND C0HHUNITIE5 T0 PE5P0ND
T0 NEWB0PN DAN6EP 5I6N5
n Fxploin lhe newborn donger signs in lhe
connunily`s locol longuoge.
n Use piclures lo exploin lhe donger signs.
n 0ive prinled infornolion or piclures lo
porenls lo help lhen renenber lhe newborn
donger signs.
n ldvise lhen lhol quick lreolnenl soves lives.
Deloy increoses lhe risk of deolh.
n Help porenls ond connunilies plon how
lo gel nedicol core in cose lhe boby hos o
donger sign.
n Plon how lo loke lhe boby slroighl lo lhe
hospilol or lo lhe closesl heollh focilily for
energency core ond referrol.
n Plon for noney lo gel lronsporl in cose
of energency ond lo poy for heollh core
services.
n To prevenl deloy, plon whol lo do if lhe
folher or olher key decision-noker is
nol ol hone when lhe boby shows o
donger sign.
Crmmrr New|rrr Prr|lems 12?

8]VeiZg+
8=6GI+#( NEWB0PN PEFEPPAL 6UIDELINE5
Fxploin lhe reoson for referrol lo lhe nolher ond fonily. llso exploin lhol o higher level of core con prob-
obly sove lhe boby`s life. Be polienl in onswering oll lheir queslions.
Arranging transpcrt and nctifying tbe referraI center
n lrronge lronsporl wilhoul deloy.
n Send lhe nolher ond boby logelher.
n Moke sure lhol o fonily nenber or friend goes wilh lhe nolher ond lhe boby.
n f possible nolify lhe referrol cenler oboul lhe boby`s condilion ond lhe eslinoled line of orrivol.
f lhe nolher hos |usl given birlh, olso nenlion lhol o newly delivered wonon is being referred
wilh lhe sick newborn.
Preparing tc transfer tbe newbcrn
n 0ive ony energency lreolnenls before sending lhe boby lo lhe referrol focilily. Fnergency lreolnenls
ore oullined in lhe Plon of 0ore seclion of lhe decision-noking chorls for connon problens which
follow in lhis chopler.
n 0ive o frsl dose of onlibiolics before referrol if serious infeclion is suspecled.
n For o boby 2 kg or nore.
onpicillin 5O ng/kg M ond genlonicin 5 ng/kg M
n For o boby less lhon 2 kg.
onpicillin 5O ng/kg M ond genlonicin / ng/kg M
n Slobilize lhe boby wilh breoslfeeding ond worning lskin-lo-skinI.
Caring fcr tbe newbcrn during transpcrt
n Keep lhe newborn worn during lronsporl. Keep lhe boby in skin-lo-skin conlocl wilh lhe nolher ond
cover lhen bolh wilh worn clolhes. f lhe clinole is very hol, fewer loyers of clolhing ore needed.
Prolecl lhe boby fron direcl sun, dusl, ond wind.
n Fncouroge lhe nolher lo breoslfeed during lhe lronsporl.
Dccumenting tbe referraI
n 0onplele o referrol forn or wrile o referrol nole including. 1I fndings of your exoninolion, 2I lhe reoson
for lhe referrol, 3I oll lreolnenls ond nedicines given, /I lhe line ond dole, ond 5I your none.
n Be sure lo cleorly record lhe dose ond line onlibiolics were given in lhe boby`s records ond on
lhe referrol forn.
n Send lhe pregnoncy, lobor, delivery, ond newborn records lo lhe referrol cenler.
If tbe referraI is deIayed, impcssibIe, cr tbe parents refuse
n 0onlinue lo supporl lhe fonily.
n 0onlinue lreolnenl, including onlibiolic lheropy, using ovoiloble resources.
n f o boby hos breolhing problens, conlinue giving oxygen lif ovoilobleI ol o low fow role, unless
olherwise indicoled.
13O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Pk0B||NS 0| !N| N|wB0kN
Breat||r] Prr|lems
Birlh osphyxio ond resuscilolion innediolely ofler
birlh ore discussed in chopler /. Breolhing problens
con olso slorl hours or doys ofler birlh. These noy be
coused by infeclion, heorl or lung diseose, obnornol
body lenperolure, low blood sugor, or olher illnesses.
When lhe newborn hos o breolhing problen, oll his
energy is used lrying lo gel enough oxygen inlo lhe
body. This neons lhol lhe newborn does nol hove
enough energy lo keep worn, lo grow, or lo fghl off
infeclions. Breolhing problens, lherefore, oflen leod
lo deolh.
See chorl ./.
|rfert|rrs
nfeclions ore one of lhe no|or couses of newborn
deolh, even lhough lhey con be prevenled ond lreoled.
l is inporlonl lo renenber lhol snoll, unlreoled,
locolized infeclions con spreod ond becone serious
life-lhreolening infeclions.
ereral|te1 |rfert|rr: rew|rrr seps|s
Sepsis is on infeclion offecling lhe whole body. The
infeclion noy be in lhe blood lseplicenioI or in one or
nore orgons of lhe body. 0rgonisns lhol couse sepsis
noy enler lhe boby during pregnoncy, during lobor ond
birlh, or ofler birlh. They con spreod lhrough lhe body
fron on infeclion of lhe skin, or cord, or olher orgon.
Sepsis is o serious illness ond con quickly couse deolh.
Rcw tc beIp prevent newbcrn sepsis
n Treol o nolher`s infeclions during pregnoncy.
n Use cleon delivery proclices during lobor
ond birlh.
n Use infeclion prevenlion sleps during lobor,
birlh, ond poslnolol core.
n Wosh your honds before ond ofler hondling
eoch newborn.
n Teoch lhe nolher ond fonily lo use infeclion
prevenlion sleps, especiolly hondwoshing.
n Treol o nolher wilh onlibiolics during lobor if
she hos signs of infeclion or prolonged ruplure
of lhe bog of wolers lnore lhon 18 hoursI.
n Treol o newborn wilh onlibiolics ofler birlh if
lhe nolher hod fever during lobor.
n Breoslfeed lhe newborn exclusively.
n Do nol bring lhe boby inlo conlocl wilh sick
people. solole o sick newborn fron heollhy ones.
n Teoch lhe nolher ond fonily lo keep lhe boby
owoy fron sick people.
See chorl .5.
|0CA||l|0 |N||C!|0NS
l locolized infeclion is on infeclion in o cerloin porl of
lhe boby`s body lcord, skin, eye, or noulhI. lny new-
born infeclion is serious becouse il con spreod quickly
lhrough lhe newborn`s snoll body ond couse neonolol
sepsis. 0uick ond correcl lreolnenl of locolized infec-
lions noy prevenl sepsis ond possible deolh.
Um||l|ral Crr1 |rfert|rr
This is on infeclion oround lhe unbilicol cord or lhe
unbilicus. This infeclion con eosily poss lhrough lhe
cord inlo lhe resl of lhe boby`s body ond leod lo sepsis
ond deolh, if lreolnenl is deloyed or nol given. f sub-
slonces such os powder, cloy, dirl, or dung ore pul on
lhe cord, lhere is o donger of lelonus or sepsis, which
oflen leod lo deolh.
Crmmrr New|rrr Prr|lems 131

8]VeiZg+
;><JG:+#& UHBILICAL C0PD INFECTI0N
Nrw tr preert am||l|ral rrr1 |rfert|rr
n llwoys use infeclion prevenlion sleps during
birlh ond newborn core.
n 0ul lhe cord wilh slerile scissors or o new
rozor blode.
n Keep lhe unbilicol cord uncovered, cleon,
ond dry. lvoid pulling onylhing on lhe cord.
n 0ive only sponge bolhs ldo nol innerse lhe
boby in wolerI unlil ofler lhe cord folls off
ond heols.
See chorl ..
Sk|r |rfert|rr
nfeclion of lhe newborn`s skin couses snoll puslules
lpus-flled blislersI on lhe skin. l skin infeclion lhol is
nol lreoled noy spreod. l skin infeclion con becone
serious ond develop inlo o deeper infeclion or blood
infeclion lseplicenioI, which ore life lhreolening.
Nrw tr preert a sk|r |rfert|rr
n llwoys use infeclion prevenlion sleps for birlh
ond poslnolol core.
n Do nol wosh off lhe vernix lcreony while
subslonce on o newborn`s skinI ofler birlh, lhe
vernix prolecls lhe newborn`s skin.
n llwoys wosh your honds before ond ofler
hondling eoch newborn.
n Teoch lhe nolher ond fonily lo wosh lheir
honds before coring for lheir newborn.
n Teoch lhe nolher ond fonily lo keep lhe boby`s
roon, covers, ond clolhing cleon.
n Keep fies owoy fron lhe newborn.
n Teoch lhe nolher how lo bolhe lhe boby.
See chorl .7.
132 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Examinaticn
PrcbIemslneeds
PIan cf care

FcIIcw-up
8=6GI+#) BPEATRIN6 PP0BLEH5: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n lsk lhe nolher.
n When ond where wos lhe boby born?
n Were lhere ony problens during lobor or birlh?
n Did lhe boby breolhe ond cry innediolely ol birlh?
n Did lhe boby need ony help lo slorl or conlinue breolhing?
n When did lhe breolhing problen slorl?
n Hos il gollen worse?
n Whol olher synplons hove you noliced?
n Fxonine breolhing ond skin color.
n Look for obnornol fndings.
n Ropid breolhing. nore lhon O breolhs in 1 ninule.
n Slow breolhing. less lhon 3O breolhs in 1 ninule.
n rregulor breolhing wilh respirolory pouses.
n ndrowing of lhe chesl wilh eoch breolh.
n 0osping.
n 0runling lnoisy breolhingI.
n Floring of lhe noslrils.
n Blue or pole skin color. lBlue lips ond longue ore serious signs of lock of oxygen.
This boby needs oxygen innediolely, if ovoiloble, ol o high fow role.I
Breolhing problen
n Resuscilole lhe boby who breolhes less lhon 3O lines in 1 ninule, is gosping, or
who hos slopped breolhing lsee chopler /I.
n f lhe boby hos blue lips ond longue, lhere hos been o lock of oxygen for sone
line. For lhis boby, increose lhe concenlrolion of oxygen lo o high fow role ond
conlinue unlil lhe blue color is gone, lhen refer.
n For olher breolhing problens give oxygen, if ovoiloble, ol o noderole fow role.
n Slobilize lhe boby lworning, frequenl breoslfeeding, skin-lo-skin conlocl
wilh lhe nolherI.
n Refer lhe boby, following lhe Referrol 0uidelines.
n 0ive o slorling dose of onlibiolics.
n For o boby 2 kg or nore.
onpicillin 5O ng/kg M ond genlonicin 5 ng/kg M
n For o boby less lhon 2 kg.
onpicillin 5O ng/kg M ond genlonicin / ng/kg M
n Keep lhe newborn worn during lronsporl.
n 0ive oxygen during lronsporl if ovoiloble.
Supporl lhe fonily in following heollh core odvice for lhe boby.
Crmmrr New|rrr Prr|lems 133

8]VeiZg+
Ristcry
Examinaticn
PrcbIemslneeds
PIan cf care

FcIIcw-up
8=6GI+#* NEWB0PN 5EP5I5: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n lsk lhe nolher.
n When ond where lhe boby wos born
n f she hod o fever during lobor
n f she hod o ruplure of nenbrones for nore lhon 18 hours before delivery
n f lhe newborn hos one or nore of lhe following problens.
n Poor feeding
n Lelhorgy or nol woking for feeds
n Hislory of convulsions or fls
n Diffcully breolhing
n Yellow color of lhe skin ond eyes
n Fye, skin, or cord infeclion
Fxonine lhe boby conplelely. Look for.
n Diffcully woking up lhe boby
n Nol oble lo suck or poor sucking
n Ropid or slow breolhing, indrowing of chesl wilh breolhing
n Periods of opneo losling nore lhon 2O seconds
n Pole, grey or blue color lblue longue or lips is seriousI
n Hypolhernio or fever
n Linp or rigid linbs
n Joundice
n Dislended obdonen
n Signs of eye, skin, or cord infeclion
The signs of infeclion in lhe newborn ore oflen diffcull lo recognize becouse lhey ore nol
specifc. The fndings lisled obove con be coused by olher problens besides infeclion.
n Slobilize lhe newborn by noking sure lhe boby is worn ond hos breoslfed.
n 0up feed lhe boby if he is unoble lo breoslfeed lsee chopler 3I
n Refer lhe boby, following lhe Referrol 0uidelines.
n 0ive o slorling dose of onlibiolics.
n For o boby 2 kg or nore.
onpicillin 5O ng/kg M ond genlonicin 5 ng/kg M
n For o boby less lhon 2 kg.
onpicillin 5O ng/kg M ond genlonicin / ng/kg M
Supporl lhe fonily in following heollh core odvice when lhe newborn relurns hone
fron lhe referrol focilily.
13/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Examinaticn
PrcbIemslneeds
8=6GI+#+ UHBILICAL C0PD INFECTI0N: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n lsk lhe nolher.
n Did you receive lelonus innunizolion during pregnoncy?
n When ond where wos lhe boby born?
n Whol wos used lo cul lhe cord?
n Wos onylhing pul on lhe cord ol birlh or since lhen?
n Hos lhe newborn hod ony donger signs? lReview lhe donger signs wilh lhe nolher.I
n When did you frsl nolice lhis problen? Hos il gollen worse?
n Fxonine lhe cord ond obdonen. Look for.
n Moisl cord
n Droinoge of pus wilh o bod snell
n Red, swollen, infoned skin oround lhe unbilicus
n Dislended obdonen lo sign lhol lhe boby is developing sepsisI
n 0heck for olher signs of newborn sepsis lsee chorl .5I.
LccaIized umbiIicaI ccrd infecticn
n The unbilicus hos no pus dischorge or foul snell.
n Redness ond swelling oround lhe skin of lhe unbilicus does nol exlend nore lhon 1 cn.
n There noy be o deloy of cord seporolion or heoling. lNornolly lhe cord folls off by lhe
end of lhe frsl week, ond lhe unbilicol sile heols quickly ofler lhol.I
n The boby hos no signs of sepsis.
5ericus umbiIicaI ccrd infecticn
n There is pus dischorge fron lhe unbilicus, deloyed cord seporolion or heoling p|us
redness of skin ond swelling which exlends nore lhon 1 cn oround lhe unbilicus.
n The skin oround lhe unbilicus noy olso be hordened.
n f boby hos signs of sepsis such os o dislended obdonen, lhe infeclion is very serious.
Crmmrr New|rrr Prr|lems 135

8]VeiZg+
PIan cf care

FcIIcw-up
LccaIized umbiIicaI ccrd infecticn
n Treol lhe unbilicus/cord slunp os follows.
1. Prepore boiled woler which hos been ollowed lo cool, cleon clolhs, soop, ond
genelion violel O.5% solulion.
2. f onliseplics ore ovoiloble, lhey noy be used in ploce of soop ond woler for
cleoning lhe cord slunp. 2.5% polyvidone iodine, or /% chlorhexidine gluconole, or
O-?O% elhyl or isopropyl olcohol.
3. Wosh your honds wilh cleon soop ond woler ond dry lhen on o cleon lowel.
/. Wosh lhe cord slunp ond unbilicol oreo genlly wilh lukeworn boiled woler, clolhs,
ond soop or wilh cleon clolhs ond on onliseplic, if ovoiloble.
5. Dry lhe cord slunp ond unbilicol oreo wilh o cleon clolh.
. lpply genlion violel O.5% lo lhe cord slunp ond unbilicus.
7. Wosh your honds ogoin ofler opplying lhe genelion violel.
n Teoch lhe nolher lo do lhis lreolnenl / lines o doy for 3 doys.
n Renind lhe nolher lo use coreful hondwoshing before ond ofler coring for lhe boby.
n ldvise lhe nolher lo opply only genlion violel lo lhe cord slunp ond lhe skin oround il.
n ldvise lhe nolher lhol genlion violel will sloin clolhes ond skin.
n ldvise lhe nolher lo seek nedicol core innediolely if.
n lhe problen does nol inprove ofler 3 doys
n lhe boby hos ony donger signs
n lhe oreo oround lhe cord becones hordened
n redness ond swelling increose or
n lhe obdonen becones dislended.
5ericus umbiIicaI ccrd infecticn
n Slobilize lhe newborn by noking sure lhe boby is worn ond hos breoslfed or cup fed.
n Refer lhe boby, following lhe Referrol 0uidelines.
n 0ive o slorling does of onlibiolics.
n For o boby 2 kg or nore.
onpicillin 5O ng/kg M ond genlonicin 5 ng/kg M
n For o boby less lhon 2 kg.
onpicillin 5O ng/kg M ond genlonicin / ng/kg M
n f skin puslules ore presenl, lreol for skin infeclion.
LccaIized umbiIicaI ccrd infecticn
0heck lhe newborn in 2 doys.
n f lhe newborn is well ond hos no signs of serious unbilicol cord infeclion, odvise lhe
nolher lo conlinue lhe genlion violel lreolnenl for o lolol of 3 doys.
n f lhe newborn is nol well or hos signs of serious unbilicol cord infeclion or sepsis.
n Follow lhe obove plon of core for serious unbilicol cord infeclion ond referrol
8=6GI+#+ UHBILICAL C0PD INFECTI0N: DECI5I0N-HAKIN6 CRAPT
13 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Examinaticn
PrcbIemslneeds
8=6GI+#, 5KIN INFECTI0N: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n The nolher noy reporl.
n The boby hos o rosh
n The boby seens well olherwise
n The boby feeds well
n lsk lhe nolher.
n When ond where lhe boby wos born
n Hislory of lhe lobor ond birlh
n Whelher lhe newborn hos ony donger signs
n When she frsl noliced lhe problen ond if il hos worsened since lhen
n Whol she hos pul on lhe rosh

n Fxonine oll of lhe boby`s skin, including lhe dioper oreo. Seporole lhe skin folds lo
look inside lhe creoses of lhe neck, orns, ornpils, groin, ond legs.
n Toke lhe newborn`s oxillory lenperolure or feel lhe boby wilh your hond.
n Look for.
n Skin puslules lred spols or blislers which conloin pusI
n Look ol lhe whole body lo see how nony puslules ore presenl
n lll olher fndings ore nornol. There ore no donger signs. There is no fever
or hypolhernio.
LccaIized skin infecticn
n Fewer lhon 1O puslules, or lhe puslules cover less lhon holf of lhe body
n No donger signs or obnornol fndings
n No signs of sepsis
5ericus skin infecticn
l is o serious problen if lhere ore nony puslules, if lhey cover nore lhon holf of lhe
body, or if lhere is ony donger sign, especiolly ony sign of sepsis.
Crmmrr New|rrr Prr|lems 137

8]VeiZg+
PIan cf care

FcIIcw-up
LccaIized skin infecticn
n Treol lhe skin os follows.
1. Prepore boiled woler which hos been ollowed lo cool, cleon clolhs, soop, ond
genlion violel O.5% solulion.
2. f onliseplics ore ovoiloble, lhey noy be used in ploce of soop ond woler for
cleoning lhe skin. 2.5% polyvidone iodine, or /% chlorhexidine gluconole, or
O-?O% elhyl or isopropyl olcohol.
3. Wosh your honds wilh cleon soop ond woler ond dry lhen on o cleon lowel.
/. Wosh lhe skin genlly wilh lukeworn boiled woler, clolhs, ond soop lo renove
oll dirl ond pus, including ony dry crusls. 0r use on onliseplic wilh cleon clolhs,
if ovoiloble.
5. Dry lhe skin wilh o cleon clolh.
. lpply genlion violel O.5% lo lhe offecled skin.
7. 0n conplelion wosh your honds ogoin.
n Teoch lhe nolher lo do lhis lreolnenl / lines o doy for 5 doys, using cleon
clolhs eoch line.
n Renind lhe nolher lo use coreful hondwoshing before ond ofler coring for lhe boby.
n ldvise lhe nolher lo opply only genlion violel lo lhe skin.
n ldvise lhe nolher lo seek nedicol core innediolely if lhe boby hos ony donger
signs or if nore puslules develop.
n Record lhe nunber of puslules ond lheir dislribulion llocolion on lhe bodyI in lhe chorl.
5ericus skin infecticn
n Slobilize lhe newborn by noking sure lhe boby is worn ond hos breoslfed or cup fed.
n Refer lhe boby, following lhe Referrol 0uidelines.
n 0ive o slorling does of onlibiolics.
n For bobies of ony weighl.
cloxocillin 5O ng/kg M
n f cloxocillin is nol ovoiloble.
n For o boby 2 kg or nore.
onpicillin 5O ng/kg M ond genlonicin 5 ng/kg M
n For o boby less lhon 2 kg.
onpicillin 5O ng/kg M ond genlonicin / ng/kg M
n Record lhe nunber of puslules ond lheir dislribulion llocolion on lhe bodyI in lhe chorl.
LccaIized skin infecticn
n See lhe newborn ogoin in 5 doys.
n f nosl of lhe puslules ore slill presenl, bul lhey hove nol spreod ond lhe boby does
nol hove ony donger signs, give cloxocillin by noulh.
n 0loxocillin 5O ng/kg or 2nl/kg every 8 hours for 5 doys.
n 0heck lhe boby.
n f lhe newborn hos no donger signs ond if lhere ore fewer puslules, odvise lhe
nolher lo give lhe genlion violel lreolnenl unlil lhe puslules ore gone.
n f lhe newborn hos ony donger sign or if lhe puslules ore nore or hove spreod.
n Follow lhe plon of core for serious skin infeclion obove
8=6GI+#, 5KIN INFECTI0N: DECI5I0N-HAKIN6 CRAPT
138 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
|e |rfert|rr
ln eye infeclion is on infeclion of lhe lining of lhe eyes.
The eyelids becone swollen ond red, ond lhere is fuid
or pus in lhe eyes. Mony differenl orgonisns couse eye
infeclions. Sone sexuolly lronsnilled infeclions of lhe
nolher, such os gonorrheo ond chlonydio, con couse
newborn eye infeclion. These ond olher orgonisns con
infecl lhe boby during birlh. Less serious eye infeclions
noy be coused by gerns fron lhe boby`s surroundings.
See chorl .8.
0ral !|ras|
Thrush is on infeclion of lhe noulh coused by o fungus
or yeosl. The lhrush fungus lives in wel, worn ploces.
l is nornol lo hove o lillle of lhis fungus in our noulhs.
This fungus con olso grow in lhe vogino. ll cerloin lines
il con grow so nuch lhol il couses on infeclion. Bobies
con gel lhis infeclion eosily in lhe frsl few nonlhs of life,
since lheir innune syslen is nol well developed.
Nrw 1res t|ras| affert t|e rew|rrr ar1 t|e mrt|er?
Thrush covers lhe newborn`s nucous nenbrones
ond longue wilh o while cooling. l nokes lhe noulh
poinful so lhe boby noy nol be oble lo feed, even
lhough he is hungry. l boby con becone very ill
quickly becouse of poor feeding. This lhen couses
weighl loss ond dehydrolion. The infeclion con olso
go lhrough lhe boby`s slonoch ond inleslines ond inlo
lhe slool. When lhis hoppens lhe infeclion con spreod
lo lhe boby`s bullocks, cousing o poinful red rosh. l is
inporlonl lo lreol lhrush os soon os possible.
The fungus infeclion con olso poss lo lhe nolher`s nipples.
The nolher will nolice lhol her nipples ore sore ond red.
She will feel breosl poin when lhe boby breoslfeeds.
Nrw tr preert t|ras|:
The nolher should be encouroged lo breoslfeed exclu-
sively fron birlh. This will lronsfer innune subslonces
fron lhe nolher lo lhe newborn. Teoch lhe nolher lo.
n Wosh her honds before ond ofler coring for lhe boby
n Wosh onylhing lhol will louch lhe newborn
lcups, clolhingI
n 0el nedicol core for ony signs of lhrush os soon
os possible
See chorl .?.
Crmmrr New|rrr Prr|lems 13?

8]VeiZg+
Ristcry
Examinaticn
PrcbIemslneeds
PIan cf care

FcIIcw-up

8=6GI+#- EYE INFECTI0N: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n Find oul if silver nilrole drops were used for eye core lsilver nilrole con
irrilole lhe eye, cousing redness, swelling, ond sonelines o wolery dischorgeI.
n lsk lhe nolher.
n When ond where wos lhe boby born?
n Did lhe boby receive eye lreolnenl ol birlh?
n When did lhe problen slorl? Hos il gollen worse?
n Whol hos been done for lhe problen?
n Did you receive ony onlenolol core?
Fxonine lhe eyes ond eyelids ond look for.
n Swollen, red eyelids, wilhoul pus
n Swollen, red eyelids wilh dischorge of pus fron one or bolh eyes
n Fyelids lhol ore sluck shul
Nole. if onsel of synplons is wilhin 1-2 doys ofler birlh ond silver nilrole wos used for
eye core, no lreolnenl is needed. This is likely o chenicol irrilolion fron lhe silver nilrole.
Follow inslruclions for cleoning lhe eyes.
Fye infeclion
Ped cr swcIIen eyes witb nc pus
1. Prepore cleon clolhs ond boiled woler. Boil woler ond lel il cool.
2. You noy olso use slerile nornol soline solulion, if ovoiloble, lo cleon lhe boby`s eyes.
3. Wosh your honds wilh cleon woler ond soop, lhen dry lhen wilh o cleon lowel or
oir-dry lhen. Use gloves, if ovoiloble.
/. Dip o piece of cleon clolh inlo lhe boiled woler or soline solulion ond genlly swob lhe eye
fron inner lo ouler corner lo renove crusl ond dischorge. Use eoch piece of clolh only once.
5. Repeol slep 3 obove for lhe second eye, using onolher piece of clolh or o differenl
corner of lhe sone clolh. Use eoch piece of clolh or corner of lhe clolh only once.
. Wosh your honds when you ore done.
7. Repeol / lines doily unlil lhe problen is resolved.
8. f lhe problen conlinues for nore lhon / doys, bul lhere is slill no pus.
n lpply 1% lelrocycline oinlnenl lo lhe offecled eye / lines doily
n 0ive erylhronycin O.5 nl/kg every hours by noulh for 1/ doys
Ped cr swcIIen eyes witb pus discbarge:
n Refer lhe boby, following lhe Referrol 0uidelines.
n For o boby less lhon 7 doys old who hos nol been lreoled wilh onlibiolics, lreol for eye
infeclion due lo gonorrheo. 0ive o single dose of onlibiolics before referrol. ceflrioxone
5Ong/kg M ldo nol give nore lhon 125 ngI
n Refer lhe nolher for ST screening ond lreolnenl for her ond porlner.
n Becouse lhe newborn hos been referred, lhe follow-up core con be done ol lhe
nexl rouline visil.
n Teoch lhe nolher how lo give eye core. See plon of core obove.
1/O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Examinaticn
PrcbIemslneeds
8=6GI+#. 0PAL TRPU5R: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n lsk lhe nolher.
n Does lhe boby feed well? lThrush oflen couses feeding problens becouse
il nokes sucking poinful.I
n s lhe boby frelful or fussy? lThrush con couse lhe boby lo be fussy becouse of
poin ond hunger.I
n lre your nipples sore or poinful when lhe boby nurses?
n f lhe nolher soys yes lo ony of lhese queslions, osk.
n When did lhis problen slorl?
n f il hos been o problen for o long line, il is nore likely lhol lhe nolher olso hos lhrush
on her breosls ond lhol lhe boby noy hove lhrush on lhe bullocks.
n 0bserve lhe boby breoslfeeding.
n Fxonine inside lhe boby`s noulh.
f lhere ore while polches on lhe nucous nenbrones or longue.
n Use o longue depressor or o piece of gouze wropped oround your fngerlips lo genlly
lry lo wipe lhen owoy.
n Milk curds wipe owoy eosily wilhoul lrouno lo lhe nucous nenbrones.
n Thrush polches slick lo lhe nucous nenbrones ond ore hord lo wipe owoy.
n The nucous nenbrones under ond oround lhe lhrush polches ore red ond bleed eosily.
n Fxonine lhe boby`s bullocks.
n f lhrush spreods fron lhe noulh lo lhe inleslines, lhere noy be o red rosh
on lhe bullocks.
n Fxonine lhe nolhers`s nipples.
n f lhrush spreods lo lhe nolher, her nipples ore red ond lender.
Thrush in lhe boby`s noulh, on his bullocks, or on lhe nolher`s nipples.
Crmmrr New|rrr Prr|lems 1/1

8]VeiZg+
PIan cf care

FcIIcw-up
Baby`s mcutb
n 0ive nyslolin 1OO,OOO unils/nl suspension. drop 1-2 nl inlo lhe boby`s noulh / lines
eoch doy, conlinuing unlil 2 doys ofler lhe lhrush hos disoppeored.
n 0r lreol lhe noulh wilh genlion violel O.5% solulion / lines o doy, conlinuing unlil
2 doys ofler lhe lhrush hos disoppeored. Teoch lhe nolher lo.
1. Use o cleon clolh lo opply eoch lreolnenl.
2. Wosh her honds wilh cleon woler ond soop, lhen dry lhen wilh o cleon lowel
or oir-dry lhen.
3. Wrop o cleon, sofl clolh oround her forefnger ond pour on genlion violel. Be coreful
when using genlion violel becouse il sloins skin ond clolhing.
/. Wipe inside lhe boby`s noulh lond lhen lhe bullocks if lhey ore olso infecledI wilh lhe
clolh sooked in genlion violel.
5. Discord lhe used clolh.
. Wosh her honds ogoin when done.
Baby`s buttccks
n lpply nyslolin creon or genlion violel solulion ol every dioper chonge,
conlinuing unlil 3 doys ofler lhe rosh is gone.
n Fxpose lhe bullocks lo oir if lhe lenperolure is worn enough.
Hctber`s nippIes
n Hove lhe nolher opply nyslolin creon lo her nipples ond oreolos ofler breoslfeeding for
os long os lhe boby is being lreoled.
n Teoch lhe nolher lo keep her nipples dry when nol breoslfeeding. Loose clolhing will
ollow oir lo dry lhe nipples.
n See lhe boby ogoin in 2 doys.
n f inproving keep doing lhis lreolnenl unlil 2-3 doys ofler lhrush is heoled lsee oboveI.
n f nol inproving refer lhe boby, following lhe Referrol 0uidelines.
8=6GI+#. 0PAL TRPU5R: DECI5I0N-HAKIN6 CRAPT
1/2 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Prr|lems w|t| Br1 !emperatare
The newborn`s nornol oxillory lenperolure is be-
lween 3 0 ond 37 0 l?.8-?8. FI. The newborn
connol regulole body lenperolure well. Therefore,
ol birlh ond for lhe frsl few doys ond weeks of life,
lhe boby`s nolher ond fonily nusl help lhe boby
sloy worn.
Nprt|erm|allrw temperatare
ln oxillory lenperolure below 3 0 l?.8 FI is loo
low or loo cold for lhe newborn. This is colled hypo-
lhernio. Hypolhernio noy occur soon ofler birlh un-
less lhe boby is prolecled lsee chopler 2 for inforno-
lion oboul how lo prevenl hypolhernioI.
Causes cf bypctbermialIcw temperature:
n The roon is loo cool.
n The boby is in o drofl.
n The newborn is wel.
n The boby is uncovered, even for o shorl line.
n The boby is ploced on o cold surfoce or neor
o cold woll or window.
n The boby hos on infeclion.
n The boby is nol feeding well.
n The boby hod birlh osphyxio ond does nol
hove enough energy lefl lo keep worn.
Rcw dces a Icw temperature affect tbe newbcrn?
f lhe low lenperolure is nol quickly recognized ond
lreoled, lhe boby`s condilion gels worse. Long periods
of hypolhernio noy be folol for lhe newborn.
n The skin hordens ond becones red, especiolly
on lhe bock ond lhe linbs.
n The foce becones brighl red.
Ncte. This is o serious sign ond con be nisloken
for o sign of good heollh.
n The heorl does nol work well.
n The respirolions noy becone irregulor.
n Bleeding occurs, especiolly in lhe lungs.
n There noy be |oundice.
1
n Wilhoul lreolnenl, deolh follows.
See chorl .1O.
Npert|erm|al||]| temperatare
High lenperolure occurs when lhe newborn`s oxillory
lenperolure goes obove 37 0 l?8. FI. l is nol os
connon in newborns os hypolhernio, bul il is |usl os
dongerous. The couses of high lenperolure ore.
n The boby is dehydroled fron nol feeding.
n The roon is loo hol.
n The boby hos on loo nony covers or clolhes.
n The boby hos on infeclion.
Rcw dces a bigb temperature affect tbe baby?
High lenperolure lhyperlhernioI noy couse.
n Dehydrolion or loss of body woler
n 0onvulsions or fls
n Shock
n 0ono ond deolh
Rcw tc prevent a bigb temperature
n Breoslfeed lhe newborn frequenlly or feed
breosl nilk by cup if lhe boby is unoble lo suck.
n Keep lhe boby owoy fron sources of excessive
heol ond direcl sunlighl.
n f lhe boby feels hol, renove o loyer of clolhing.
n Prevenl infeclion.
See chorl .11.
Crmmrr New|rrr Prr|lems 1/3

8]VeiZg+
Ristcry
Examinaticn
PrcbIemslneeds
PIan cf care

FcIIcw-up
8=6GI+#&% RYP0TREPHIAlL0W TEHPEPATUPE: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n lsk lhe nolher.
n lboul her lobor ond birlh hislory
n f her boby is lelhorgic, nol olerl, or nol oclive
n f she hos noliced lhol lhe boby is cold, osk when she frsl noliced il, ond if she
hos lried lo reworn lhe boby ond if so, how
n f lhe boby hos ony olher donger signs
n Fxonine lhe boby`s lenperolure ond oclivily.
n Look for.
n Low lenperolure. Feel lhe boby`s skin lobdonen or bockI wilh your hond,
or if you hove o lhernoneler, loke lhe oxillory lenperolure.
n The boby feels cold when conpored lo nornol odull skin.
n The oxillory lenperolure is below 3 0.
n Linp or foppy lhypolonicI lone.
n Poor sucking or feeding.
n l weok cry.
n Slow ond shollow breolhing.
n Slow heorl role lbelow 1OO beols per ninuleI.
Hypolhernio
Reworn lhe boby quickly. Follow lhese sleps.
1. Moke sure lhe roon is worn ond free of drofls.
2. Renove cold or wel clolhes ond ploce lhe boby skin-lo-skin wilh lhe nolher.
0over his heod. 0over lhe nolher ond boby wilh lhe nolher`s worn clolhes ond o
worn blonkel or clolhs.
3. Fncouroge breoslfeeding. Fnergy is needed lo noke body heol. f lhe boby is loo weok
lo suck ol lhe breosl, give expressed breosl nilk by cup.
/. 0heck lhe lenperolure hourly.
5. 0heck for signs of infeclion.
2
n f lhe boby does nol respond lo reworning wilhin 2 hours, refer lo o
higher-level heollh focilily.
n Before referrol, give lhe frsl dose of onlibiolics.
n For o boby 2 kg or nore.
onpicillin 5O ng/kg M ond genlonicin 5 ng/kg M
n For o boby less lhon 2 kg.
onpicillin 5O ng/kg M ond genlonicin / ng/kg M
n Tronsporl lhe boby lo lhe heollh focilily wropped in skin-lo-skin conlocl wilh lhe
nolher, os described obove.
1// Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Examinaticn
PrcbIemslneeds
8=6GI+#&& RYPEPTREPHIAlRI6R TEHPEPATUPE: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n lsk lhe nolher.
n lboul her lobor ond birlh hislory
n Whelher she hod o fever during lobor or prolonged ruplure of nenbrones
lnore lhon 18 hoursI
n The nolher noy reporl lhol lhe boby is.
n Reslless
n Lelhorgic lnol ocliveI
n Hol, hos o fever
n Fxonine lhe boby`s lenperolure, oppeoronce, ond oclivily.
n Look for.
n The boby`s oxillory lenperolure is obove 37 0 lobove ?8. FI.
n The boby`s skin feels hol.
n The boby`s breolhing is ropid lover O breolhs per ninuleI.
n The boby`s heorl role is ropid lover 1O beols per ninuleI.
n The foce is fushed ond lhe orns ond legs ore red.
n The boby is reslless or lelhorgic.
n The boby oppeors dehydroled.
n When lhe skin is pinched up, il goes down slowly.
n 0heck lhe boby for signs of infeclion.
High lenperolure or hyperlhernio
Crmmrr New|rrr Prr|lems 1/5

8]VeiZg+
PIan cf care

FcIIcw-up
n Move lhe boby owoy fron ony sources of heol such os direcl sunlighl, o fre,
or on eleclric heoler.
n Undress lhe boby.
n Bolhe lhe boby in worn lnol coldI woler. The woler lenperolure should be |usl
below lhe boby`s body lenperolure. Bolhing lhe boby should lower lhe lenperolure
quickly, os soon os lhe lenperolure is nornol, dry, dress, ond wrop lhe boby up ogoin.
n 0ive frequenl breoslfeeds, or give expressed nilk by cup if lhe boby will nol suck.
Renenber. lhe boby is ol high risk of dehydrolion by losing body woler.
n 0heck lhe boby`s lenperolure every hour, if his lenperolure is slill obnornol
ofler 2 hours, or if lhe lenperolure rises ogoin, refer.
n Refer lo o higher-level heollh focilily lfollowing lhe Referrol 0uidelinesI if.
n lhe boby hos ony sign of infeclion,
n lhe boby oppeors dehydroled lpersislenl skin fold, sunken eyes or fonlonelle,
dry longue or nucous nenbronesI, or
n lhe boby hos ony olher donger sign.
n Before referrol, give lhe frsl does of onlibiolics.
n For o boby 2 kg or nore.
onpicillin 5O ng/kg M ond genlonicin 5 ng/kg M
n For o boby less lhon 2 kg.
onpicillin 5O ng/kg M ond genlonicin / ng/kg M
n Reninder. your referrol nole should include infornolion oboul lreolnenl ond ony
nedicolions given lwhol nedicolion, dose, ond line givenI.
n f lhe lenperolure relurns lo nornol, lhe boby is feeding well, ond lhere ore no olher
problens, leoch lhe nolher how lo check lhe infonl`s lenperolure lby feeling lhe bodyI
ol hone ond how lo prolecl lhe boby fron overheoling. Hove her relurn wilh lhe boby if
lhere ore ony donger signs or if lhe boby`s lenperolure goes up ogoin.
No need for follow-up unless lhe problen oppeors ogoin or if lhere ore olher donger signs
8=6GI+#&& RYPEPTREPHIAlRI6R TEHPEPATUPE: DECI5I0N-HAKIN6 CRAPT
1/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
!aar1|re
Joundice is o yellow color of lhe skin ond/or lhe eyes.
l noy be physiologic lnornolI |oundice or serious
ldongerousI |oundice.
n nornol bobies |oundice sonelines slorls ofler
lhe second poslnolol doy ond goes owoy by 2 weeks.
This is colled physiologic |oundice. l is coused by
lhe boby`s body breoking down exlro red blood cells
ofler birlh. When lhe red blood cells breok down, lhey
releose o subslonce colled bilirubin. The bilirubin
couses lhe yellow color. The boby`s liver usuolly gels
rid of lhe exlro bilirubin ond lhen posses il oul of lhe
body in lhe slool. The heollh of lhe newborn is nol of-
fecled by physiologic |oundice.
The newborn boby gels rid of bilirubin slowly becouse
lhe liver is innolure. Fxlro bilirubin nokes lhe skin
ond eyes yellow. The yellow color slorls frsl on lhe
heod ond noves down lhe body os lhe bilirubin level
increoses.
Serious |oundice occurs when lhe bilirubin in lhe
blood becones very high. For exonple. o boby wilh o
blood diseose or sepsis noy noke loo nuch biliru-
bin, o boby lhol is low birlh weighl lless lhon 25OOgI
or prenolure, nol sucking well, or nol possing slool,
noy nol be oble lo gel rid of lhe bilirubin. f lhe boby
hos serious |oundice, lhe exlro bilirubin noy offecl lhe
boby`s broin ond couse broin donoge.
Ycu kncw tbe jaundice is sericus wben tbe
yeIIcw ccIcr:
n slorls during lhe frsl 2/ hours of life,
n offecls orns ond legs on doy 2,
n offecls honds ond feel on doy 3 or lhereofler,
n losls longer lhon 2 weeks, or
n occurs wilh onolher donger sign.
Rcw tc prevent brain damage frcm
sericus jaundice:
n Refer bobies lo gel nedicol core for ony sign of
serious |oundice
n Follow up bobies closely if lhey ore ol risk for
serious |oundice.
n Low birlh weighl bobies
n Bobies wilh problens ol birlh, such os lhose
needing resuscilolion
n Bobies wilh ony signs of infeclion
n Bobies who do nol feed well
See chorl .12.
Blee1|r] frrm t|e am||l|ral rrr1
Bleeding fron lhe unbilicol cord is o problen of lhe
frsl doy or lwo of life. The cord lie or clonp noy
becone loose os lhe cord begins lo dry, so il slorls lo
bleed. lfler lhe cord dries up, il will no longer bleed.
The boby`s snoll body does nol hove nuch blood.
Losing o snoll onounl of blood is serious for lhe boby
ond con couse deolh.
See chorl .13.
Prr|lems frrm t|e mrt|er's pre]rarr ar1 la|rr
f o nolher hod ony of lhe following heollh problens
during pregnoncy or lobor, lhe boby needs lreolnenl
lo prevenl infeclion. Review lhe nolher`s records lo
check for problens. f lhere is no onlenolol record,
osk lhe nolher if she hod ony of lhese problens dur-
ing lhe pregnoncy or lobor.
n Syphilis
n Tuberculosis
n H\
n Molernol infeclion in lobor
5ypbiIis
Syphilis is o sexuolly lronsnilled infeclion which
oflen leods lo oborlion, slillbirlh, prelern lobor, low
birlh weighl, ond felol infeclion. The nolher noy
be infecled wilhoul nolicing ony synplons. Syphilis
infecls lhe felus of on infecled nolher who does nol
gel lreolnenl during pregnoncy. The unlreoled boby
noy develop long-lern developnenlol ond neurologi-
col disobililies.
The newborn mu, show signs of congenilol syphilis
wilhin o few weeks or nonlhs of birlh. These signs
include.
n Snuffes lobslrucled breolhing lhrough lhe noseI
n 0rocks ond fssures oround lhe noulh, nose,
ond onus
n Skin roshes or blislers ond peeling on lhe polns
of lhe honds ond soles of lhe feel
n Dislended obdonen
n Respirolory dislress
n Joundice
The newborn noy develop olher serious conplicolions
if lhe syphilis is nol lreoled.
Crmmrr New|rrr Prr|lems 1/7

8]VeiZg+
f lhe nolher is suspecled of hoving syphilis, or if she
hod o posilive syphilis lesl l\DRL or RPRI in pregnon-
cy bul did nol receive lreolnenl, or wos reinfecled.
n Refer lhe boby lo o focilily where diognosis ond
lreolnenl is ovoiloble
n 0ive lhe boby o single dose of benlhozine penicillin
5O,OOO unils/kg M ol birlh
n ldvise lhe porenls lhol lhe boby needs oddilionol
lreolnenl ond follow-up
n Refer lhe nolher ond her porlner for screening
ond lreolnenl
TubercuIcsis
Tuberculosis lTBI is o lung infeclion. l is possed when
o sick person coughs gerns inlo lhe oir lhol olher
people breolhe. TB con spreod lo olher porls of lhe
body, noy losl for nony yeors, ond con loke o long
line lo cure. The wonon`s poor heollh noy slow lhe
growlh ond developnenl of lhe felus.
Ncte. Treoling o pregnonl or breoslfeeding nolher
wilh slreplonycin hos o hornful effecl on her boby.
f lhe nolher hos luberculosis ond wos spulun-
posilive wilhin 2 nonlhs of lhe birlh, refer lhe new-
born ond lhe nolher lo o higher-level heollh focilily
for lreolnenl. The nolher should slill be odvised lo
breoslfeed her child.
RIlAID5
The hunon innunodefciency virus lH\I slowly
deslroys o person`s obilily lo fghl infeclions leoding lo
ocquired innune defciency syndrone llDSI. People
wilh H\/lDS gel infeclions coused by gerns lhol
would nol usuolly couse diseose in heollhy people.
The H\-infecled nolher is likely lo be nolnourished
during pregnoncy which noy couse poor felol growlh,
low birlh weighl, or felol deolh in lhe ulerus.
l nolher`s H\ infeclion con be possed lo her boby
during pregnoncy, during lobor ond delivery, ond
poslnololly lhrough breosl nilk. Seven or 8 oul of 1O
H\-posilive wonen will give birlh lo bobies who ore
nol infecled wilh H\. However, oll bobies born of H\-
posilive wonen corry lhe nolernol H\ onlibody unlil
oge 12-18 nonlhs. This neons lhol lhe slondord H\
lesl connol show whelher o boby hos H\ unlil ol leosl
12 nonlhs of oge lofler lhe nolernol H\ onlibodies
hove goneI. There ore lesls for bobies os young os 3-/
nonlhs of oge, bul lhey ore nol ovoiloble everywhere.
ln H\-posilive boby will look heollhy ol birlh bul will
becone sick fosler lhon on odull wilh H\. This is be-
couse o newborn`s innune syslen is nol os slrong os
on older person`s. Mony H\-posilive bobies will slorl
lo becone ill during lheir frsl yeor.
3
USE 0F /TRETR0\R/LS F /\/L/DLEl The likelihood of
nolher-lo-child lronsnission of H\ con be reduced
signifconlly by odninislering onlirelrovirols lo lhe
nolher during pregnoncy ond lobor ond lo lhe boby
during lhe newborn period. \orious onlirelrovirol
nedicolions exisl ond differenl prolocols for odninis-
lering lhen ore being sludied. These nedicolions ore
expensive ond nol olwoys ovoiloble. f you hove occess
lo onlirelrovirols, follow your counlry`s clinicol guide-
lines or prolocols for giving lhen lo pregnonl wonen,
wonen in lobor, ond newborns.
Becouse you con never know for sure whelher or nol o
wonon hos been infecled wilh H\, you should core for
every newborn os if lhe nolher is H\ posilive. lSee
lhe seclion on Molher-lo-0hild Tronsnission of H\ in
chopler 1 ond lhe seclion on Breoslfeeding When lhe
Molher is H\ Posilive. Moking on nforned 0hoice in
chopler 3.I
HaternaI infecticn in Iabcr
f lhe nolher hod signs of ocule infeclion in lobor, lhe
boby is ol risk for sepsis ond should be lreoled wilh
onlibiolics. There is o high risk of nolernol infeclion
if lhe nenbrones ruplured nore lhon 18 hours prior
lo lhe boby`s birlh. Signs of ocule nolernol infeclion
during lobor include.
n Fever
n 0hills
n Foul-snelling voginol dischorge
C/RE F0R TE E\D0R.
n Slobilize lhe newborn by noking sure lhe boby
is worn ond hos breoslfed.
n Refer lhe boby, following lhe Referrol 0uidelines.
n 0ive o frsl dose of onlibiolics.
n For o boby 2 kg or nore.
onpicillin 5O ng/kg M ond
genlonicin 5 ng/kg M
n For o boby less lhon 2 kg.
onpicillin 5O ng/kg M ond
genlonicin / ng/kg M

1/8 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Examinaticn
PrcbIemslneeds
8=6GI+#&' JAUNDICE: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n lsk lhe nolher.
n When did she frsl see lhe yellow color? Physiologic |oundice is seen ofler lhe frsl
2/ hours ond is gone by 2 weeks.
n Does lhe boby hove ony olher donger sign? Joundice noy be o sign of o serious infeclion.
n How is lhe boby feeding ond behoving? f behovior ond feeds ore nornol, lhe boby
probobly hos physiologic |oundice.
n s lhe boby possing urine ond slool? f lhe boby is feeding well, possing urine ond
slool will gel rid of lhe bilirubin.
n Fxonine lhe boby`s whole body in good doylighl. Joundice is hord lo see in orlifciol or
poor lighl.
n Look for.
n The skin ond lhe lining of lhe eyes ore yellow.
n 0heck lo see how nuch of lhe body is yellow.
n Toke lhe oxillory lenperolure. The boby noy hove fever or hypolhernio if infeclion
is lhe problen.
n 0heck for dehydrolion lpersislenl skin fold, dry noulh, sunken fonlonelleI. l boby
wilh dehydrolion noy nol be oble lo gel rid of bilirubin.
PbysicIcgic jaundice cf tbe newbcrn
n Slorls ofler lhe frsl 2/ hours ond is gone by 2 weeks
5ericus jaundice cf tbe newbcrn
n Slorls during lhe frsl 2/ hours or losls nore lhon 2 weeks l3 weeks in o prenolure bobyI
n Joundice of lhe orns ond legs on doy 2
n Joundice of lhe honds ond feel on doy 3 ond lhereofler
n lny |oundice wilh onolher donger sign
Crmmrr New|rrr Prr|lems 1/?

8]VeiZg+
PIan cf care

FcIIcw-up
PbysicIcgic jaundice cf tbe newbcrn
n No lreolnenl or referrol is needed, ollhough you need lo ossess lhe boby`s |oundice
in o few doys.
n ldvise lhe nolher.
n Reossure lhe nolher lhol lhe boby is nornol ond lhol lhe yellow color will
slowly disoppeor.
n Keep lhe boby worn.
n Keep breoslfeeding oflen ond exclusively. Drinking lols of breosl nilk will help lhe
boby gel rid of lhe bilirubin lhrough lhe slool. The nolher should olso drink lols of
fuids lo noke nore breosl nilk.
n Wolch lhe boby for ony olher donger sign.
n Review wilh lhe nolher lhe donger signs ond whol lo do.
n 0el nedicol core for ony signs of serious |oundice
5ericus jaundice cf tbe newbcrn
n Breoslfeed lhe boby frequenlly
n Refer lhe boby, following lhe Referrol 0uidelines.
n 0ive o slorling dose of onlibiolics.
n For o boby 2 kg or nore.
onpicillin 5O ng/kg M ond genlonicin 5 ng/kg M
n For o boby less lhon 2 kg.
onpicillin 5O ng/kg M ond genlonicin / ng/kg M
PbysicIcgic jaundice cf tbe newbcrn
n See lhe boby ogoin in 2-3 doys lo noke sure lhe |oundice is going owoy.
n Refer lo o higher-level heollh focilily if signs of serious |oundice oppeor.
5ericus jaundice cf tbe newbcrn
n lfler lreolnenl, follow up ol lhe usuol lines lo noke sure lhe boby is growing ond
hos no olher problens.
8=6GI+#&' JAUNDICE: DECI5I0N-HAKIN6 CRAPT
15O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Ristcry
Examinaticn
PrcbIemslneeds
PIan cf care

FcIIcw-up
8=6GI+#&( BLEEDIN6 FP0H TRE UHBILICAL C0PD: DECI5I0N-HAKIN6 CRAPT
n Review lhe nolher`s ond boby`s records if ovoiloble.
n f lhe nolher reporls bleeding fron lhe cord, osk.
n The hislory of her lobor ond lhe birlh
n Whol line she frsl noliced lhe bleeding
n f she hos noliced bleeding fron onywhere else such os urine or slool
n How nuch lhe boby hos bled
n f she hos noliced ony olher synplons
Fxonine lhe boby.
n Look ol lhe onounl of blood losl.
n Look ol lhe cord lie.
n 0heck lhe boby for olher signs of o problen fron blood loss.
n Pole skin
n Lelhorgy ldrowsy ond unresponsiveI
n Ropid breolhing
n Ropid heorl role
n Look for olher signs of bleeding, such os blood in urine or slool or unexploined bruises.
Bleeding fron lhe cord
BIeeding frcm tbe ccrd
n Wosh your honds, pul on cleon exon or slerile gloves, if ovoiloble.
n Relie lhe cord lighlly wilh o new cleon lie.
n Look ol lhe cord every 15 ninules for 2 hours lo noke sure lhere is no nore bleeding.
n ldvise lhe nolher lo wolch for ony donger signs ond lo breoslfeed frequenlly.
f bleeding persisls, or lhere ore olher siles of bleeding, or lhere ore olher problens fron
blood loss.
n 0ive vilonin K, 1 ng M. l0ive O.5 ng for o boby below 15OO grons.I
n Refer lhe boby, following lhe Referrol 0uidelines.
n f o lol of blood hos been losl, lhe boby noy hove onenio. Refer.
n See lhe boby ogoin ol doy 2-3 lo check for olher heollh problens. ls ol every visil,
review donger signs wilh lhe nolher.
Crmmrr New|rrr Prr|lems 151

8]VeiZg+
TA5K5 F0P ALL REALTR W0PKEP5: C0HH0N NEWB0PN PP0BLEH5
1 0ounsel lhe nolher ond fonily on newborn donger signs ond referrol.
oI Donger signs
n Whol lhe donger signs ore
n Whol lo do if o donger sign is seen
bI Referrol
n Preporolions llronsporl, who should go wilh lhe nolher or bobyI
n Whol lo do during lhe referrol
2 Slobilize ond refer newborns wilh donger signs.
3 0ounsel lhe nolher ond fonily on prevenlion ond nonogenenl of
connon newborn problens.
oI Breolhing problens
bI nfeclions
n Newborn sepsis/generolized infeclion
n Unbilicol cord infeclion
n Skin infeclion
n Fye infeclion
n 0rol lhrush
cI Problens wilh body lenperolure
n Tenperolure loo low
n Tenperolure loo high
dI 0lhers
n Joundice
n Bleeding fron lhe unbilicol cord
eI Problens fron lhe nolher`s pregnoncy ond lobor
/ 0ive core lo newborns who hove lhe problens lisled obove,
using lhe decision-noking sleps.
152 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Nrtes
1 World Heollh 0rgonizolion. l1??I. 0ure in Normu| 8irth:
u pructicu| uiJe. 0enevo. WH0.
2 bid.
3 Yeorgin P. l2OO2I. HeJicu| 0onsiJerutions: 0|inicu| Hunuement
of the Fl\ lnfecteJ /Ju|t. lllonlo, 0l. Soulheosl lDS Troining
ond Fducolion 0enler, Fnory Universily.
ereral kefererres
Burns ll, Lovich R, Moxwell J, ond Shopiro K. l1??7I. where
women Fuve No 0octor: / heu|th uiJe for women. Berkeley, 0l.
The Hesperion Foundolion.
Seidel HM, Rosenslein BJ, ond Polhok l. l2OO1I Primur, 0ure of
the Newborn l3rd ed.I. Sl Louis. Mosby.
Soulh lfrico Nolionol Deporlnenl of Heollh. l1??8I. StunJurJ
treutment uiJe|ines unJ essentiu| meJicution |ist for South /fricu:
PueJiutric hospitu| |eve|. Prelorio. Nolionol Deporlnenl
of Heollh.
UN0FF. l1??8 SeplenberI. Pronoling rolionol use of nedico-
lions ond correcl cose nonogenenl in bosic heollh services.
7he Prescriber. No. 1 & 17.
World Heollh 0rgonizolion. l2OO3I. Hunuin newborn prob|ems:
/ uiJe for Joctors, nurses unJ miJwives. lnteruteJ munuement
of prenunc, unJ chi|Jbirth. 0enevo. WH0. lWH0/RHR/OO.7I
World Heollh 0rgonizolion. l2OOOI. Hunuement of the chi|J with u
serious infection or severe mu|nutrition. 0enevo. WH0. lWH0/
F0H/0lH/OO.1I
World Heollh 0rgonizolion. l2OOOI. Hunuin comp|icutions in
prenunc, unJ chi|Jbirth: / uiJe for miJwives unJ Joctors. lnte-
ruteJ munuement of prenunc, unJ chi|Jbirth. 0enevo. WH0.
lWH0/RHR/OO.7I
World Heollh 0rgonizolion. l2OOOI .7echnicu| seminur: Sick ,oun
infunt. 0enevo. WH0. lWH0/F0H/0lH 1O.1OI
World Heollh 0rgonizolion. l1??I. Fssentiu| Newborn 0ure.
0enevo. WH0. lWH0/FRH/MSM/?.13I
|rterret kefererres
Medline Plus Heollh nfornolion. 0entiun \io|et |7opicu|l.
Relrieved Decenber, 2OO2, fron www.nln.nih.gov
Micronedix. 0entiun \io|et. Relrieved Decenber, 2OO2, fron
www.heollhyroods.con/nylibrory/dolo/ollcoredex/hln/
oneO23O.osp
0gino M ond Poslernok M. ln.d.I. Newborn Sepsis. Huss 0eneru|
Fospitu| for 0hi|Jren website. Relrieved Decenber, 2OO2, fron
www.ngh.horvord.edu/children/prof/nicu/newbornsepsis.hln
/e:oies
6eeZcY^m6/BViZgcVaVcY>c[Vci
>bbjc^oVi^dcHX]ZYjaZh &*(
6eeZcY^m7/BZY^XVi^dcGZ[ZgZcXZ &+&
6eeZcY^m8/>c[ZXi^dcEgZkZci^dc &-*
6eeZcY^m9/7Vh^XH`^aah[dg
8VgZd[i]ZCZlWdgc '%.
6eeZcY^m:/8dbbjc^XVi^dc
VcY8djchZa^c\ '&,
6eeZcY^m6 Naterral ar1 |rfart |mmar|tat|rr Sr|e1ales 153
A
A M~le::~ ~:o :~:l nnu:i.~lio: Seoues
15/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
AN!|NA!A| !|!ANUS !0K0|0 SCN|0U||
To prolecl lhe nolher ond newborn fron lelonus, il
is inporlonl lo give lelonus loxoid lTTI during preg-
noncy-ol leosl lwo doses of lelonus loxoid voccine ol
leosl four weeks oporl, wilh lhe losl dose ol leosl lwo
weeks before delivery.
Provide lhe wonon wilh o cord, or updole her exisling
one, ond inforn her when lhe nexl in|eclion is due.
6eeZcY^m6 Naterral ar1 |rfart |mmar|tat|rr Sr|e1ales 155
A
Use
6iving tbe
Immunizaticn
Nctes
Dangers
TETANU5 T0X0ID ITT!
0ive during pregnoncy lo prevenl lelonus of nolher ond newborn.
Telonus Toxoid. O.5 nl M or subculoneous.
n TT1-Firsl conlocl or frsl lN0 visil
n TT2-/ weeks loler
For lifelong proleclion, give 5 doses of TT using lhe following schedule.
n TT1 ond TT2 os obove
n TT3- nonlhs ofler TT2
n TT/-1 yeor ofler TT3
n TT5-1 yeor ofler TT/
TT1 should be given ol frsl conlocl wilh o wonon of childbeoring oge or frsl onlenolol visil.
Side effecls. heodoche, chills, lenperolure elevolion, swelling, soreness ol ploce of in|eclion
nnunizolions given lo lhe nolher ore nol hornful lo her boby.
8=6GI6#& IHHUNIZATI0N F0P H0TREP5
15 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
8=6GI6#' INFANT IHHUNIZATI0N
5CREDULE
BIPTR B00 - 0P\ - Hepolilis B
WEEK5 DPT - 0P\ - Hepolilis B
10 WEEK5 DPT - 0P\ - Hepolilis B
1 WEEK5 DPT - 0P\ - Hepolilis B
Abbreviaticn Immunizaticn
800 8uci||us 0u|mette-0uerin |to prevent 78l
0P\ 0ru| Po|io \uccine
0P7 0iphtheriu-Pertussis-7etunus
|t |s |mprrtart tr rrte t|at:
n There nusl be on inlervol of ol leosl /
weeks before giving lhe nexl dose of nosl
innunizolions.
n Differenl innunizolions con be given on lhe
sone doy, bul be sure lo give eoch in|eclion in
o seporole in|eclion sile.
n Do nol nix differenl voccines in one syringe. Use
o differenl syringe ond needle for eoch voccine.
n Sone counlries follow o lhree-dose insleod of o
four-dose schedule of hepolilis B voccine,
depending on lhe prevolence of lhe diseose.
The nosl inporlonl dose for prevenling
perinolol hepolilis B is lhe birlh dose.
n n sone counlries innunizolion ogoinsl Fue-
mophi|us infuenzue lype B lHiBI is provided lo
prolecl infonls ogoinsl pneunonio coused by
lhis gern. HiB innunizolion is given ol , 1O,
ond 1/ weeks.
n Follow your own counlry`s innunizolion sched-
ule, ovoilobilily of voccines ond reconnendo-
lions noy be differenl.
6eeZcY^m6 Naterral ar1 |rfart |mmar|tat|rr Sr|e1ales 157
A
Use
6iving tbe
Immunizaticn
Nctes
Dangers
continueJ, next pue
REPATITI5 B IRep B!
To prevenl hepolilis B
Hep B. O.5 nl M in lhe lhigh
0ive 3 lines.
n n lhe frsl few doys
n ll weeks
n ll 1/ weeks
BC6
To prevenl luberculosis
B00. O.O5 nl inlrodernol in upper lefl
orn
0ive only one line
Keep lhe sile dry for 2/ hours ofler lhe
in|eclion.
Do nol expose lhe sile lo people wilh
open culs os live boclerio noy be
lronsferred.
Side effecls. locol obscess, swollen
lynph glonds.
B00 in|eclion evenluolly resulls in o
snoll scor.
Do nol give lo.
n l boby wilh synplonolic H\/lDS
infeclion
n l boby receiving isoniozid becouse
B00 is inoclivoled by isoniozid
0ive B00 2 weeks ofler lhe course of
isoniozid ends.
8=6GI6#( INFANT IHHUNIZATI0N5
158 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Use
6iving tbe
Immunizaticn
Nctes
Dangers
0PAL P0LI0 I0P!
To prevenl polio
0P\. lwo drops by noulh on lhe longue
0ive / lines.
n n lhe frsl few doys
n ll weeks
n ll 1O weeks
n ll 1/ weeks
l chonge in nedicolion color fron pink
lo yellow is due lo sloroge ol cold
lenperolure. This does nol chonge lhe
nedicolion.
DIPRTREPIA-PEPTU55I5-TETANU5 IDPT!
To prevenl diphlherio, perlussis
ond lelonus
DPT. O.5 nl M
0ive 3 lines.
n ll weeks
n ll 1O weeks
n ll 1/ weeks
Do nol give DPT2 or DPT3 lo o child who
hod convulsions, shock, or olher odverse
reoclions ofler lhe nosl recenl dose.
nsleod give DT lDiphlherio-TelonusI, if
ovoiloble.
Do nol give DPT lo o child wilh recurrenl
convulsions or onolher oclive neuro-
logicol diseose of lhe cenlrol nervous
syslen.
8=6GI6#( INFANT IHHUNIZATI0N5
6eeZcY^m6 Naterral ar1 |rfart |mmar|tat|rr Sr|e1ales 15?
A
ereral kefererres
Uniled Nolions 0hildren`s Fund. l2OO2I. Fucts for Life. New York.
Joinl efforl of UN0FF, WH0, UNFS00, UNFPl, UNDP, UNlDS,
WFP, ond lhe World Bonk.
|rterret kefererres
To obloin lhe conplele UN0FF Fucts for Life docunenl
ond nore info.
www.unicef.org/ff/index.hlnl
To obloin lhe chopler on innunizolions fron lhe
Fucts for Life docunenl.
www.unicef.org/ff/pdf/foclsforlife-en-porl7.pdf
www.unicef.org/ff/O/1.hln
To obloin up-lo-dole infornolion on innunizolions.
www.cdc.gov/nip l0D0`s Nolionol nnunizolion ProgronI
www.innunizolioninfo.org lNolionol Nelwork for nnunizolion
nfornolionI
www.unicef.org/ lUN0FFI
www.who.inl/voccines/
Ne1|rat|rr kefererre 11
B

6eeZcY^m7
Tis ~e:oix qives ~ooilio:~ i:o:n~lio:
~Loul neoi~lio:s ne:lio:eo i: le 8VgZ
d[i]ZCZlWdgcGZ[ZgZcXZBVcjVa ~:o ole:
neoi~lio:s useo onno:y o: :ewLo::s
~:o nole:s Ree: lo you: o~ i:i~
quioei:es o: neoi~lio:s ~:o ooses lo Le
useo i: you: i:i~ selli:q
B Meoi~lio: Ree:e:e
12 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
PAk! J: 0kUS |0k N|wB0kNS
w| Are New|rrrs Nrre ||kel tr Nae
Narmfal 0ra] |fferts?
Drugs nusl be used very corefully in bobies. New-
borns ore nore likely lo hove loxic or hornful effecls
fron drugs becouse lheir bodies ore innolure. New-
borns ore ol greoler risk fron drug effecls becouse.
n They do nol hove well-developed syslens
for breoking down ond using lhe nedicolions.
n Their kidneys ore innolure ond connol gel
rid of nedicolions pronplly.
n The prenolure boby is less nolure ond ol even
greoler risk for horn fron lhe effecls of drugs.
||r] Ne1|rat|rrs tr New|rrrs
n By mcutb: Medicolions ore obsorbed slowly
fron lhe newborn`s inlesline. This con leod lo
overdose.
n By intramuscuIar IIH! injecticn:
n lbsorplion of lhe drug fron lhe ploce of
in|eclion depends on lhe fow of blood. f
lhe newborn is cold, lhe blood fow will be re-
duced ond lhe drug will be poorly obsorbed.
n When giving on M in|eclion, renenber oll
newborns hove snoll nuscles, ond prelern
infonls hove even snoller nuscles.
n Repeoled M in|eclions noy couse slerile
obscesses.
n Subculoneous in|eclions ore generolly nol
given lo newborns becouse lhey hove so lillle
subculoneous lissue.
n By intravencus II!: Sonelines il is odvised lo
give drugs lo newborns by \ infusion ldripI lo be
sure lhe drug fows lhrough lhe whole body.
Ne1|rat|rr kefererre 13
B

6eeZcY^m7
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
continueJ, next pue
AHPICILLIN
To prevenl or lreol infeclion lsepsisI
0iven wilh genlonicin
lnpicillin. 5O ng/kg M or \ for 1O
doys or unlil well for / doys.
n lge 1-7 doys. every 12 hours
n lge over 7 doys. every 8 hours
Dosoge is differenl for neningilis
only-refer if suspecled.
Bobies` kidneys ore innolure ond work
slowly. To ovoid overdose, give lhe drug
ol longer inlervols lo prelern ond very
young newborns. Shorlen lhe inlervol os
lhe boby nolures. lfler o boby is / weeks
old, onpicillin con be given every hours.
5OO ng viol - 5 nl slerile woler = 5 nl
conloining 1OO ng onpicillin per nl.
Use ol once.
BENZATRINE BENZYLPENICILLIN
To prevenl neonolol syphilis if lhe nolher
hod o posilive RPR or \DRL lesl during
pregnoncy ond did nol receive lreolnenl
during lhe pregnoncy, wos lreoled inod-
equolely or lreolnenl slolus is unknown.
For bobies showing no signs of syphilis.
Benzolhine penicillin.
75 ng/kg
l1OO,OOO unils/kgI M os o single dose
Refer lhe newborn lo o focilily for
diognosis ond nore exlensive lreolnenl
if newborn shows signs of congenilol
syphilis or drug is nol ovoiloble.
f lhe nolher hos nol been lreoled,
refer her ond her porlner for lreolnenl.
8=6GI7#& PAPT 1: DPU65 F0P NEWB0PN5ANTI-INFECTIE A6ENT5
1/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
CEFTPIAX0NE
To lreol eye infeclion due lo gonorrheo
0eflrioxone. 5O ng/kg
M os o single dose
lnoy olso be given \I
Moxinun dose = 125 ng
f ceflrioxone is nol ovoiloble use.
n Kononycin 25 ng/kg M in o
single dose lnoxinun dose 75 ngI
0R
n Speclinonycin 25 ng/kg M in o
single dose lnoxinun dose 75 ngI
EPYTRP0HYCIN
To lreol eye infeclion due lo chlonydio
Frylhronycin. 12.5 ng/kg by noulh
every hours for 1/ doys
8=6GI7#& PAPT 1: DPU65 F0P NEWB0PN5ANTI-INFECTIE A6ENT5
Ne1|rat|rr kefererre 15
B

6eeZcY^m7
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
continueJ, next pue
6ENTAHICIN
To prevenl or lreol infeclion received
during lobor
To lreol newborn sepsis
0iven wilh onpicillin
lin o seporole syringeI

Baby`s weigbt is 2 kg cr mcre:
0enlonicin. 5 ng/kg M or \ doily
for 1O doys
Baby`s weigbt is Iess tban 2 kg:
0enlonicin. / ng/kg M or \ doily
for 1O doys
Age cver 8 days lony weighlI.
0enlonicin. 7.5 ng/kg M or \ once doily
for 1O doys or 3.5 ng/kg every 12 hours
For \ use, give slowly, over 2O-3O
ninules, ofler onpicillin hos been infused.
See noles for onpicillin.
Do nol nix in lhe sone bollle or
syringe wilh penicillin.
Moy be loxic lo heoring ond kidneys when
used for o long period of line.
6ENTIAN I0LET
To lreol lhrush, o fungus, or yeosl infec-
lion of lhe noulh
To lreol yeosl or fungus llhrushI skin
infeclion of lhe bullocks
To lreol o locolized skin or unbilicol
cord infeclion.
llso see nyslolin
0enlion violel. O.5% lonly for infonlsI
solulion in woler.
n Hcutb: Wipe in lhe noulh / lines
doily unlil 2 doys ofler lhe polches
ore gone.
n Buttccks: Wipe on lhe skin / lines
doily unlil 3 doys ofler lhe rosh is
gone.
n 5kin: lpply lo lhe offecled oreo /
lines doily for 5 doys.
n UmbiIicus: lpply lo lhe cord slunp
ond unbilicus / lines doily for 3 doys.
0enlion violel nusl hove conlocl wilh lhe
fungus or boclerio, so il hos lo be op-
plied direclly onlo lhe longue ond guns
or skin.
0enlion violel sloins clolhing ond skin,
use core when opplying lhe solulion.
Do nol lel lhe boby drink genlion violel.
0enlion violel solulion con couse skin
irrilolion ond donoge if lhe solulion is
slronger lhon 1% or if lhe nedicolion is
used loo oflen.
8=6GI7#& PAPT 1: DPU65 F0P NEWB0PN5ANTI-INFECTIE A6ENT5
1 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
I50NIAZID
To prevenl newborn luberculosis
infeclion if lhe nolher hos TB
soniozid. 5 ng/kg once doily by noulh
unlil newborn reoches weeks of oge.
ll weeks, refer boby for evoluolion lo
delernine whelher or nol isoniozid con
be conlinued lo conplele nonlhs of
lreolnenl.
Supplied os syrup. 5O ng/5 nl
Side effecl. diorrheo
soniozid inoclivoles B00
ldeloy B00 voccine unlil 2 weeks
ofler lhe course of isoniozid endsI.
f B00 wos olreody given, repeol 2 weeks
ofler lhe course of isoniozid ends.
NY5TATIN
To lreol lhrush, o noulh infeclion
coused by yeosl or fungus
To lreol yeosl or fungus llhrushI
skin infeclion of lhe bullocks
llso see genlion violel
Nyslolin orol suspension 1OO,OOO unils
per nl.
n Hcutb: Poinl or wipe in lhe noulh
every / hours unlil 2 doys ofler lhe
polches ore gone.
Nyslolin oinlnenl.
n Buttccks: lpply ol eoch nopkin chonge
unlil 3 doys ofler lhe rosh is gone.
When frsl opplied lhis nedicolion gives
sone disconforl.
Side effecl. skin irrilolion
8=6GI7#& PAPT 1: DPU65 F0P NEWB0PN5ANTI-INFECTIE A6ENT5
Ne1|rat|rr kefererre 17
B

6eeZcY^m7
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
NEIPAPINE
Baby cf mctber witb RI: To reduce lhe
risk of nolher-lo-child H\ lronsnission
Neviropine. 2 ng/kg by noulh in o
single dose wilhin 3 doys of birlh
For up-lo-dole guidelines.
www.who.inl/reproduclive-heollh/
rlis/neviropine.hln
ZID0UDINE IAZT!
Baby cf mctber witb RI: To reduce lhe
risk of nolher-lo-child H\ lronsnission
Zidovudine. 2 ng/kg by noulh. Slorl ol
8-12 hours of oge.
n Full-lern. every hours
n Prenolure. every 8-12 hours
0onlinue for weeks.
Use if zidovudine wos loken by lhe
nolher for / weeks before birlh.
For up-lo-dole guidelines.
www.oidsinfo.nih.gov/guidelines
8=6GI7#& PAPT 1: DPU65 F0P NEWB0PN5ANTI-INFECTIE A6ENT5
18 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
ITAHIN K
To prevenl or lreol bleeding due lo lock of vilonin
K in newborns
Baby`s weigbt is cver 1500 gm:
0ive vilonin K 1 ng M.
Baby`s weigbt is Iess tban 1500 gm:
0ive vilonin K O.5 ng M.
0ive one dose.
Usuolly given once, bul noy be repeoled in
hours lo lreol o bleeding problen.
8=6GI7#' PAPT 1: DPU65 F0P NEWB0PN5ITAHIN5
Ne1|rat|rr kefererre 1?
B

6eeZcY^m7
AppIy cne cf tbe fcIIcwing eye treatments witbin cne bcur after birtb tc prevent eye infecticn.
Dc nct tcucb eye witb tip cf cintment tube cr drcpper.
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
5ILEP NITPATE
50LUTI0N 1%
To prevenl eye infeclion
ol birlh
Pul 1 drop inlo
eoch eye.
Do nol rinse oul drops.
Moy couse eye
irrilolion.
TETPACYCLINE 1%
0INTHENT
To prevenl eye infeclion
ol birlh
lpply lo inside
of lower lid of
eoch eye.
P0LYID0NE-I0DINE
50LUTI0N 2.5%
To prevenl eye infeclion
ol birlh
Pul 1 drop inlo
eoch eye.
Nol o frsl choice due lo
insuffcienl sludies.
8=6GI7#( PAPT 1: DPU65 F0P NEWB0PN5ANTI-INFECTIE HEDICATI0N5 F0P EYE CAPE AT BIPTR 8=6GI7#' PAPT 1: DPU65 F0P NEWB0PN5ITAHIN5
17O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
PAk! I: 0kUS |0k N0!N|kS
ereral a|1el|res frr Safe Use rf 0ra]s frr Nrt|ers
Drugs nusl be used very corefully in nolhers who
ore pregnonl or breoslfeeding. The drugs lisled in lhis
oppendix ore considered sofe for nolhers if used os
direcled. Reod lhe infornolion under Noles/lllerno-
lives ond Dongers lo fnd sofely inslruclions. Refer
lo your locol guidelines for nedicolions ond doses lo
be used in your clinicol selling.
Safe Use rf 0ra]s 0ar|r] Pre]rarr
Mosl drugs loken by o pregnonl wonon reoch her
boby lhrough lhe plocenlo. Therefore, wonen should
ovoid loking ony drugs during pregnoncy whenever
possible. Bul if drug lreolnenls ore unovoidoble, ol-
woys consull lhe nonufoclurer`s producl infornolion
before prescribing ony drug for o pregnonl wonon.
Sone drugs, for exonple, should never be used dur-
ing pregnoncy, olhers ore dongerous lo give in lhe
frsl lrinesler, bul noy be used loler in pregnoncy.
Safe Use rf 0ra]s frr Breastfee1|r] Nrt|ers
Mosl drugs loken by o breoslfeeding nolher reoch
her boby lhrough lhe breosl nilk.
n f lhe drug is connonly prescribed for infonls,
il is sofe lo loke while nursing becouse lhe boby
generolly gels o nuch lower dose fron lhe nilk
lhon he would fron loking il direclly. Fxonples
ore nosl onlibiolics, such os onoxycillin.
n Drugs considered sofe during pregnoncy ore
usuolly sofe lo loke while nursing.
n Drugs lhol ore nol obsorbed fron lhe
goslroinleslinol lrocl lslonoch or inleslinesI ore
usuolly sofe. Mony of lhese drugs ore in|ecled,
such os heporin, insulin, ond lidocoine or olher
locol oneslhelics.
Ne1|rat|rr kefererre 171
B

6eeZcY^m7
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
continueJ, next pue
AH0XICILLIN
Hctber pcstpartum:
To lreol noslilis
lnoxicillin. 5OO ng
by noulh, every 8 hours for 1O doys
Risk of ollergic reoclion. Do nol give lo
wonen wilh ollergy lo penicillin.
AHPICILLIN
Hctber in Iabcr:
To prevenl infeclion if lhe bog of wolers
hos been broken for nore lhon 18 hours
before birlh.
To lreol lobor infeclion, use os 1 of 3
onlibiolics wilh.
n 0enlonicin
n Melronidozole
Hctber pcstpartum:
To lreol noslilis
Hctber in Iabcr:
lnpicillin. 2 gn \ every hours
unlil delivery
f lhe nolher hos o fever ofler delivery,
conlinue onpicillin unlil lhere is no fever
for 2/ hours.
Hctber pcstpartum:
lnpicillin. 5OO ng by noulh
every hours for 1O doys
Hctber in Iabcr:
Monilor for fever ofler delivery.
Side effecls. diorrheo
Hctber pcstpartum:
Side effecls. diorrheo
See penicillin 0.
Hctber in Iabcr:
Risk of ollergic reoclion. Do nol give lo
wonen wilh ollergy lo penicillin.
Hctber pcstpartum:
Risk of ollergic reoclion. Do nol give lo
wonen wilh ollergy lo penicillin.
8=6GI7#) PAPT 2: DPU65 F0P H0TREP5ANTI-INFECTIE A6ENT5
172 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
BENZATRINE PENICILLIN
To lreol syphilis or posilive syphilis lesl
lRPR or \DRL leslI during pregnoncy
Benzolhine penicillin.
2./ nillion unils M in o single dose
0ive lhis os 2 in|eclions in seporole siles
l1.2 nillion unils in eoch bullockI.
Be sure lo refer nolher`s porlner
for lreolnenl.
Risk of ollergic reoclion. Do nol give
lo wonen wilh ollergy lo penicillin.
CL0TPIHAZ0LE IANTIFUN6AL!
Nipple infeclion coused by
yeosl/fungus llhrushI
llso see nyslolin
0lolrinozole creon, lolion, or lopicol
solulion 1%. lpply lo skin of nipple/
oreolo 2 lines doily for 1/ doys.
l is nol necessory lo wosh
nedicine off before breoslfeeding.
lvoid conlocl wilh boby`s eyes.
8=6GI7#) PAPT 2: DPU65 F0P H0TREP5ANTI-INFECTIE A6ENT5
Ne1|rat|rr kefererre 173
B

6eeZcY^m7
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
continueJ, next pue
CL0XACILLIN
Hctber pcstpartum:
To lreol noslilis
0loxocillin. 5OO ng by noulh every
hours for 1O doys
Side effecls. nouseo, obdoninol
disconforl
Risk of ollergic reoclion. Do nol give lo
wonen wilh ollergy lo penicillin.
EPYTRP0HYCIN
Hctber witb preterm, preIabcr rupture
cf tbe bag cf waters: To prevenl infeclion
Hctber pcstpartum: To lreol noslilis
Hctber witb preterm, preIabcr rupture
cf tbe bag cf waters:
Frylhronycin. 25O-5OO ng by noulh
every hours for 1O doys
Hctber pcstpartum:
Frylhronycin. 25O ng by noulh every
8 hours for 1O doys
Toke on on enply slonoch for beller
effecl. Moy loke wilh food if 0 upsel
occurs.
Side effecls. nouseo, obdoninol
disconforl
Frylhronycin con usuolly be given lo
wonen who ore ollergic lo penicillin.
8=6GI7#) PAPT 2: DPU65 F0P H0TREP5ANTI-INFECTIE A6ENT5
17/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
6ENTAHICIN
Hctber in Iabcr: To lreol infeclion, use
os 1 of 3 onlibiolics wilh.
n lnpicillin
n Melronidozole
0enlonicin. 5 ng/kg every 2/ hours
\ unlil delivery
f lhe nolher hos o fever ofler delivery,
conlinue genlonicin unlil lhere is no fever
for 2/ hours.
Moke sure lhe wonon`s fuid inloke is good.
Monilor for fever ofler delivery.
Toxic lo heoring ond kidneys
6ENTIAN I0LET
To lreol nipple infeclion coused by yeosl/
fungus llhrushI
0enlion violel. O.5 or 1% solulion
Wipe on lhe skin of lhe nipple/
oreolo 2 lines doily unlil signs ore gone.
Do nol wosh off of lhe nipple
before breoslfeeding.
0enlion violel sloins skin ond clolhing.
0enlion violel solulion con couse skin
irrilolion ond donoge if lhe solulion is
slronger lhon 1% or if lhe nedicolion is
used loo oflen.
8=6GI7#) PAPT 2: DPU65 F0P H0TREP5ANTI-INFECTIE A6ENT5
Ne1|rat|rr kefererre 175
B

6eeZcY^m7
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
continueJ, next pue
HETP0NIDAZ0LE
Hctber in Iabcr: To lreol infeclion, use
os 1 of 3 onlibiolics wilh.
n lnpicillin
n 0enlonicin
Melronidozole. 5OO ng \
every 8 hours unlil delivery
f lhe nolher hos o fever ofler delivery,
conlinue nelronidozole unlil lhere is no
fever for 2/ hours.
Monilor for fever ofler delivery.
NY5TATIN
To lreol nipple infeclion coused by
yeosl/fungus llhrushI
llso see clolrinozole
Nyslolin creon.
lpply lo nipple/oreolo lwo lines
doily ofler breoslfeeding, conlinue
for 3 doys ofler signs ore gone.
l is nol necessory lo wosh off of lhe
nipple before breoslfeeding.
8=6GI7#) PAPT 2: DPU65 F0P H0TREP5ANTI-INFECTIE A6ENT5
17 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
NEIPAPINE
Hctber witb RI: To reduce risk of
nolher-lo-child H\ lronsnission
Neviropine. 2OO ng by noulh os o single
dose ol onsel of lobor
For up-lo-dole guidelines.
hllp.//www.who.inl/reproduclive-heollh/
rlis/neviropine.hln
PENICILLIN 6
Hctber during Iabcr: To reduce lhe
risk of ulerine infeclion when lhe bog
of wolers is broken for over 18 hours,
give penicillin 0 or onpicillin.
llso see onpicillin
Penicillin 0. 2 nillion unils \ every
hours unlil delivery
Risk of ollergic reoclion. Do nol give lo
wonen wilh ollergy lo penicillin.
8=6GI7#) PAPT 2: DPU65 F0P H0TREP5ANTI-INFECTIE A6ENT5
Ne1|rat|rr kefererre 177
B

6eeZcY^m7
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
ZID0UDINE IAZT!
Hctber witb RI:
To reduce lhe risk of nolher-lo-child H\
lronsnission
Lcng ccurse:
5tart at 1-3 weeks: Zidovudine. 2OO ng by
noulh 3 lines o doy levery 8 hoursI or 3OO ng
every 12 hours. 0onlinue unlil lhe onsel of lobor.
During Iabcr: Zidovudine. 2 ng/kg \ over 1 hour
ol onsel of lobor, lhen 1 ng/kg every hour unlil
delivery
5bcrt ccurse:
5tart at 3 weeks: Zidovudine. 3OO ng by noulh
lwice doily
During Iabcr: Zidovudine. 3OO ng by noulh every 3
hours fron onsel of lobor unlil delivery
For up-lo-dole guidelines. www.oidsinfo.nih.gov/
guidelines
8=6GI7#) PAPT 2: DPU65 F0P H0TREP5ANTI-INFECTIE A6ENT5
178 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
5ULFAD0XINE-PYPIHETRAHINE I5P!
nlernillenl prevenlive lreolnenl for folciporun nolorio
Sulfodoxine-pyrinelhonine. Dose is 3 loblels. 0ive ol leosl 2 doses during pregnoncy
os follows.
n 0ne dose ol lhe frsl onlenolol visil lofler / nonlhsI
n 0ne dose ol lhe nexl one or lwo onlenolol visils, bul nol nore oflen lhon nonlhly.

lllernolives.
n Mefoquine 25O ng by noulh weekly, slorl in second lrinesler
n 0hloroquine 5OO ng eoch week for 2 weeks slorling ol frsl onlenolol visil
Do nol give SP before 1 weeks l/ nonlhsI of pregnoncy.
Follow specifc counlry guidelines on inlernillenl prevenlive lreolnenl since drug
resislonce vories fron ploce lo ploce.
Do nol give SP lo wonen who ore ollergic lo sulfo drugs.
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
HEBENDAZ0LE
Hctber during pregnancy: 0onlrol of hookworn
Mebendozole. 5OO ng in o single dose by noulh during lhe second lrinesler
lllernolives.
n llbendozole. o single dose of /OO ng ofler lhe frsl lrinesler
n llvendozole
n Levonisole
n Pyronlel
Do nol loke during frsl lrinesler.
f hookworn is highly endenic lgreoler lhon 5O percenl prevolenceI, loke on oddilionol
dose in lhe lhird lrinesler of pregnoncy.
8=6GI7#* PAPT 2: DPU65 F0P H0TREP5ANTI-HALAPIAL5
8=6GI7#+ PAPT 2: DPU65 F0P H0TREP5ANTI-RELHINTRIC5
Ne1|rat|rr kefererre 17?
B

6eeZcY^m7
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
ITAHIN A
Hctbers: 0iven lo wonen who live in
oreos where lhere is vilonin l defciency.
\ilonin l is needed lo fghl infeclion
ond prevenl nighl blindness.
Molhers poss vilonin l lo lheir bobies
in breosl nilk.
\ilonin l.
Pregnant wcmen: \ilonin l. 0ne
1O,OOO U copsule doily lhroughoul
pregnoncy
0R
\ilonin l. 0ne 25,OOO U copsule
weekly ofler lhe lhird nonlh ond unlil
lhe birlh
Pcstpartum:
\ilonin l. 0ne 2OO,OOO U copsule dur-
ing lhe frsl 8 weeks ofler delivery l
weeks if nol breoslfeedingI
Prolecl lhe drug fron lighl. Slore in on
oreo owoy fron direcl lighl, such os in
o cupboord.
Do nol give nore lhon lhe doses lisled.
Fxcess Joses Jurin prenunc, mu,
cuuse mu|formutions in the bub,.
Do nol give in frsl lrinesler.
ln overdose in lhe nolher noy couse
nouseo, voniling, noloise, heodoche.
Dc nct give tc a baby: bobies younger
lhon nonlhs of oge gel vilonin l
fron breosl nilk.
IP0NlF0LATE IFElFA!
To prevenl ond lreol onenio in
pregnoncy
Ferrous sulfole. 32O ng lO ng el-
enenlol ironI ond /OO ncg lo 1 ng of
folole by noulh doily
Side effecls. block slools, conslipolion,
0 upsel ond nouseo
Toke Fe/Fl loblels wilh vilonin 0 or food
high in vilonin 0 lo increose obsorplion.
Teo, coffee, ond colos inhibil iron
obsorplion.
Toblels ore poisonous lo snoll chil-
dren. Keep loblels in o sofe ploce.
8=6GI7#, PAPT 2: DPU65 F0P H0TREP5ITAHIN5 AND IP0NlF0LATE
18O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Use
6iving tbe Drug
Nctesl
AIternatives
Dangers
PAPACETAH0L IACETAHIN0PREN!
To relieve poin ond fever
Porocelonol. 325-5O ng
by noulh every /- hours
Do nol give lo o nolher wilh liver diseose
or donoge.
8=6GI7#- PAPT 2: DPU65 F0P H0TREP5
0TREP DPU65
Ne1|rat|rr kefererre 181
B

6eeZcY^m7
PAk! 1: |\|N 0K|N !0 A N|wB0kN
f o boby needs oxygen, follow lhese guidelines.
n Moke sure lhe boby receives lhe correcl
onounl of oxygen becouse.
n Too nuch oxygen, over line, con donoge
lhe newborn`s lungs ond eyes, especiolly
if lhe boby is very prenolure lless lhon 35
weeksI.
n Too lillle oxygen con donoge lhe newborn`s
orgons ond noy leod lo deolh.
n Feeding nusl conlinue during oxygen lheropy.
Feeding nelhods noy include breoslfeeding,
or giving expressed breosl nilk by cup, or by
nosogoslric lube.
f ol oll possible, help lhe nolher lo breoslfeed while
lhe boby conlinues lo receive oxygen. f lhis is nol
possible, lry disconnecling lhe oxygen briefy while
you observe lhe breoslfeeding. f lhe boby becones
pole, or blue, or hos signs of diffcully breolhing, slop
lhe feeding ond reconnecl lhe oxygen innediolely.
Reossure lhe nolher ond lhen feed lhe boby wilh
expressed breosl nilk by cup, if possible.
f lhe boby is seriously ill ond connol lolerole orol
feeds, feed lhe boby breosl nilk lhrough o nosogoslric
lube. Slorl lhe boby on direcl breoslfeeding os soon
os possible.
n When lhe boby`s breolhing slorls lo inprove,
groduolly decreose lhe fow of oxygen.
n Disconlinue oxygen when lhe boby`s
respirolory role is nornol l3O-O breolhs per
ninuleI ond lhere ore no signs of diffcull
breolhing. Then observe lhe boby closely.
n f lhe longue ond lips renoin pink, do nol give
ony nore oxygen. Then observe for blue
longue ond lips lcenlrol cyonosisI every 15
ninules for lhe nexl hour. Keep lhe boby in
lhe focilily for ol leosl 2/ hours of noniloring
ofler lhe oxygen is disconlinued.
n f blue longue ond lips oppeor ogoin, reslorl
oxygen ond prepore for referrol. This boby
needs speciolized core ond oxygen during
lronsporl lo lhe referrol focilily.
182 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
FIcw and
Ccncentraticn
Advantages
Disadvantages
NA5AL PP0N65
n Low = O.5 L per ninule
n Moderole = O.5-1 L
per ninule
n High = nore lhon 1 L
per ninule
n l low fow of oxygen is
required lo deliver lhe
desired concenlrolion
n 0on deliver o conslonl
concenlrolion of oxygen
if opplied correclly
n 0xygen odninislrolion
con conlinue lhrough
breoslfeeding
n Requires speciol
prongs for use on
newborn bobies
n Requires fow-conlrol
device lhol ollows low
fow
n Direcls cold oxygen
inlo boby`s lungs
FACE HA5K
n Low = 1 L per ninule
n Moderole = 1-2 L
per ninule
n High = nore lhon 2 L
per ninule
n 0xygen odninislrolion
con be slorled quickly
ond eosily
n 0onvenienl for
odninislering oxygen
for shorl periods of
line
n 0orbon dioxide con
occunulole if lhe fow
role is low or lhe nosk
is snoll
n Breoslfeeding is nol
possible while lhe
nosk is in ploce
n Diffcull lo keep lhe
nosk in ploce
NA5AL CATRETEP
n Low = O.5 L per ninule
n Moderole = O.5-1 L
per ninule
n High = nore lhon 1 L
per ninule
n l low fow of oxygen is
required lo deliver lhe
desired concenlrolion
n 0on deliver o conslonl
concenlrolion of oxy-
gen if opplied correclly
n 0xygen odninislrolion
con conlinue lhrough
breoslfeeding
n Requires fow-conlrol
device lhol ollows low
fow
n Direcls cold oxygen
inlo boby`s lungs
8=6GI7#. PAPT 3: 6IIN6 0XY6EN T0 NEWB0PN5
1
Ne1|rat|rr kefererre 183
B

6eeZcY^m7
FIcw and
Ccncentraticn
Advantages
Disadvantages
INCUBAT0P
n f using o heod box
inside lhe incubolor,
follow inslruclions for
heod box.
n f connecling oxygen
direclly lo lhe incubo-
lor, follow lhe nonu-
foclurer`s inslruclions.
n Worns lhe oxygen
n Disodvonloges of giving
oxygen direclly inlo lhe
incubolor.
n 0xygen is wosled
becouse o high fow
of oxygen is required
lo deliver lhe de-
sired concenlrolion
lo lhe boby
n Diffcull lo noinloin
oxygen concenlro-
lion when lhe incu-
bolor porlholes ore
open for core ond
procedures
n Direcl breoslfeeding
is nol possible
READ B0X
n Low = 3 L per ninule
n Moderole = 3-5 L per
ninule
n High = nore lhon 5 L
per ninule
n Worns lhe oxygen
n 0on give o high
concenlrolion of
oxygen
n High fow of oxygen
required lo ochieve
desired concenlrolion
n Direcl breoslfeeding is
nol possible
8=6GI7#. PAPT 3: 6IIN6 0XY6EN T0 NEWB0PN5
18/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Nrte
1 0horl B.? wos odopled fron. World Heollh 0rgonizolion.
l2OO3I. Monoging newborn problens. l guide for doclors,
nurses ond nidwives. nlegroled Monogenenl of Pregnoncy
ond 0hildbirlh. 0enevo. WH0.
ereral kefererres
Foucher Ml ond Jockson 0. l1??2I. Phornoceulicol preporo-
lions. l review of drugs connonly used during lhe neonolol
period. ! Nurse HiJwifer,, 37l2 Suppl.I 7/-8.
0oren 0 ond 0ohen MS. l1??5I. Speciu| uspects of perinutu| unJ
peJiutric phurmuco|o,. n. Kolzung B0. 8usic unJ c|inicu| phur-
muco|o, llh ed. pp ?13-?1?I. Norwolk,0T. lpplelon-Longe.
World Heollh 0rgonizolion. l2OOOI. Hunuement of the chi|J with
u serious infection or severe mu|nutrition. 0enevo. WH0. lWH0/
F0H/0lH/OO.1I
World Heollh 0rgonizolion. l2OOOI. Hunuin comp|icutions in
prenunc, unJ chi|Jbirth: / uiJe for miJwives unJ Joctors.
nlegroled Monogenenl of Pregnoncy ond 0hildbirlh. 0enevo.
WH0. lWH0/RHR/OO.7I
World Heollh 0rgonizolion. l2OO3I. Hunuin newborn prob|ems:
/ uiJe for Joctors, nurses unJ miJwives. nlegroled Monogenenl
of Pregnoncy ond 0hildbirlh. 0enevo. WH0.
|rterret kefererres
Norlhern Neonolol Nelwork. l2OOOI. Neonolol Fornulory l3d
ed.I. lccessed Jonuory 2O, 2OO3, fron www.neonololfornulory.
con
|rfert|rr Preert|rr 185
C
6eeZcY^m8
:elio:s ~use n~:y :ewLo:: oe~ls
Tis is Le~use le L~Lys innu:e syslen
le syslen l~l qls i:elio:sl is :ol
uy oeveoeo ~l Li:l e~l wo:e:s ~:e
~so ~l :is o qelli:q i:elio:s Le~use
ley ~ve o:l~l wil ~lie:ls wo n~y
~ve i:elio:s
e~l wo:e:s ~: :eve:l i:elio:s ~:o
le~ ~niies ow lo :eve:l i:elio:s
Foowi:q sine i:elio: :eve:lio: sles
ou:i:q e~l ~:e ~l one o: i: ~ ~iily
~: s~ve ives
C :elio: P:eve:lio:
18 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
CAUS|S 0| |N||C!|0NS
nfeclion is coused by snoll, invisible gerns growing
ond nulliplying in lhe body. There ore nony kinds of
gerns. boclerio, viruses, fungi, ond porosiles. When
gerns enler lhe body, lhe innune syslen works lo
kill lhen ond prevenl illness. f gerns ore slrong or
nunerous, lhey noy loke over ond couse infeclion
even in o heollhy person`s body. Newborns ond people
who ore olreody sick, nolnourished, or who hove
weok innune syslens do nol hove o slrong obilily
lo kill gerns. They becone sick wilh infeclions nore
eosily. nfeclious gerns ore possed in differenl woys.
!rar||r]
Touching on ob|ecl lhol is dirly or conloninoled
spreods gerns ond conloninoles lhe honds. l cul on
lhe hond ollows gerns lo enler lhe body ond couse
on infeclion. Wilhoul hondwoshing, gerns con olso be
possed on lo olhers by louching.
Blrr1 rr |r1 serret|rrs
Sone infeclious gerns live in lhe blood or body secre-
lions lH\, hepolilis BI ond con be possed on.
n By o nolher lo her boby during pregnoncy,
birlh, or wilh breoslfeeding
n Through sexuol conlocl
n By conlocl wilh blood or onniolic fuid fron on
infecled person. The blood or fuid enlers lhe
body of o person who is nol infecled lhrough.
n ln open sore, nucous nenbrone, or eye
n Receiving blood fron or shoring needles wilh
on infecled person
A|r
0lher infeclious gerns ore coughed inlo lhe oir by on
infecled person ond possed lo olhers who breolhe in
lhe oir.
|rr1 ar1 water
0erns lhol live in food or woler poss lo people who eol or
drink lhe conloninoled food or woler.
wN0 |S A! k|SK |0k |N||C!|0N AN0 N0w
Nealt| wrrkers
n 0onloninoled needles or olher shorp
inslrunenls lshorpsI noy punclure skin.
n 0onloninoled fuids lblood or olher body
fuidsI noy splosh on nucous nenbrones
leyes, nose, or noulhI.
n nfeclious gerns noy enler broken skin ldue
lo culs, scrolches, rosh, chopped skin, or fungol
infeclionsI.
Nrt|ers ar1 |a||es
n Molhers ond bobies ore ol risk when heollh
workers do nol wosh lheir honds belween po-
lienls ond procedures.
n They ore ol risk when used inslrunenls ond
olher ilens ore nol cleoned ond processed
correclly.
Crmmar|t
nproper disposol of nedicol wosle lincluding
conloninoled dressings, lissue, plocenlo, needles,
syringesI creoles o risk lo lhe connunily. 0onloni-
noled wosle ilens con be found by children or olhers,
in open gorboge dunps or on lhe ground.
S!AN0Ak0 Pk|CAU!|0NS !0
Pk|\|N! PASS|N |N||C!|0NS
Mony infeclions con be prevenled by consislenlly us-
ing slondord precoulions. These ore rouline proce-
dures lhol prolecl bolh heollh workers ond polienls
fron conlocl wilh infeclious noleriols.
Using slondord precoulions neons lo olwoys.
n 0onsider every person polenliolly infeclious
leven lhe boby ond nedicol sloffI.
n Wosh your honds.
n Weor proleclive clolhing when needed
lgloves, eye proleclion, oprons, closed shoesI.
n Prevenl in|uries wilh shorps.
n Process polienl core inslrunenls ond
equipnenl sofely.
n Keep polienl core roons cleon.
n Dispose of wosles sofely.
n Hondle, lronsporl, ond process used/dirly
linens sofely.
|rfert|rr Preert|rr 187
C
6eeZcY^m8
Follow slondord precoulions wilh ever, polienl,
whelher or nol you lhink lhe polienl nighl hove on
infeclion. This is inporlonl becouse il is nol olwoys
possible lo lell who is infecled. 0flen infecled people
do nol know if lhey ore infecled.
NAN0wASN|N
Hond conlocl is lhe nosl connon woy lo poss infec-
lions, ond hondwoshing is lhe nosl inporlonl woy
lo reduce lhe spreod of infeclions. Wosh your honds
whenever lhere is o chonce lhol your honds nighl be
conloninoled. llwoys wosh your honds under lhe fol-
lowing circunslonces.
n nnediolely when you orrive ol lhe heollh
focilily or polienl`s hone
n Before exonining o nolher or boby
n Before pulling on gloves for procedures
n Before leoving lhe heollh focilily or lhe
polienl`s hone
n Before eoling
n lfler exonining eoch polienl
n lfler louching ony inslrunenl or ilen lhol
nighl be conloninoled wilh blood or olher body
fuids, or ofler louching nucous nenbrones
n lfler you hondle blood, urine, or slool
n lfler renoving ony kind of gloves lhonds
con becone conloninoled if gloves conloin
liny holes or leorsI
n lfler using lhe loilel or lolrine
There ore lwo kinds of hondwoshing used in coring for
nolhers ond bobies.
1I hondwoshing wilh soop ond running woler, ond
2I using on olcohol hondrub.
Dc nct use cbIcrine bIeacb directIy cn tbe bands. l
is exlrenely irriloling ond dries oul lhe skin, cousing
crocks ond fssures lhrough which gerns con enler.
Dc nct wasb ycur bands in a basin cf standing water,
even if on onliseplic such os Dellol or Sovlon hos been
odded. 0erns grow ond nulliply in slonding woler.
;><JG:8#& WA5RIN6 RAND5
188 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
8=6GI8#& TIP5 F0P RANDWA5RIN6 WITR
50AP AND PUNNIN6 WATEP
Randwasbing witb scap and water remcves germs and
sciI sucb as dirt, bIccd, feces, and ctber bcdy materiaIs.
5teps fcr bandwasbing:
1. Wel honds wilh RUNNN0 WlTFR. When o running
woler lop is nol ovoiloble, use.
n l buckel wilh o lop, or
n l buckel ond pilcher. 0ne person pours cleon
woler over lhe honds of lhe person who is woshing.
n See 0horl 0.2 for use of olcohol hondrub if
no cleon woler is ovoiloble.
2. Rub honds logelher wilh soop lo lolher, covering
oll surfoces.
3. Weove soopy, wel fngers ond lhunbs logelher ond
slide lhen bock ond forlh.
/. Rinse honds under RUNNN0 WlTFR unlil oll soop
is gone.
5. Dry honds wilh o cleon lowel or oir-dry lhen if no
cleon lowel is ovoiloble.
. When woshing honds before o procedure, do nol
louch ony uncleon surfoces before louching lhe
polienl, louching cleon inslrunenls, or before pul-
ling on gloves.
=VcYlVh]^c\h]djaYiV`Z/
&*'%hZXdcYh. Before ond ofler nosl oclivilies such
os exonining o boby, conlocl wilh o polienl, or using
lhe loilel or lolrine.
'(b^cjiZh. f your honds ore very dirly wilh blood,
olher orgonic noleriol lsuch os when your gloves hove
been lornI, or dirl.
8=6GI8#' TIP5 F0P RANDWA5RIN6 WITR
AN ALC0R0L RANDPUB
An aIccbcI bandrub is very effective in
kiIIing ncrmaI germs.
Wben nct tc use. ln olcohol hondrub is nol effeclive in
renoving dirl, blood, feces, or olher body noleriols.
Woshing wilh soop ond woler renoves lhese noleriols.
Rcw tc make an aIccbcI bandrub. Becouse olcohol
used by ilself dries lhe skin ond con noke il crock,
nix olcohol os follows wilh on ingredienl lo noislurize
lhe skin.
n 1OO nl of O-?O % olcohol
n 2 nl of glycerin, propylene glycol, or sorbilol
Rcw tc use:
n Pour 3-5 nl l1 leospoonI of lhe olcohol
hondrub inlo lhe poln of your hond.
n Rub honds logelher, including belween
fngers ond under noils, unlil dry.
lfler using lhis nelhod 5-1O lines, you will need lo
renove lhe build-up of noislurizer lsuch os glycerinI
fron your skin. Wosh off wilh soop ond woler.
|rfert|rr Preert|rr 18?
C
6eeZcY^m8
Pk0C|SS|N |NS!kUN|N!S
AN0 0!N|k |!|NS
nslrunenls ond olher ilens such os reusoble gloves,
reusoble syringes, ond cord lies nusl be processed so
lhey do nol poss infeclion when used. Proper process-
ing includes lhe following sleps.
Slep 1. Deconloninolion
Slep 2. 0leoning
Slep 3. High-level disinfeclion lHLDI or slerilizolion
Slep /. Sloroge ond use
l is inporlonl lo do lhese sleps in lhe correcl order
for severol reosons.
Slep 1. Deconloninolion nusl be done frsl lo
noke ilens sofer lo louch.
Slep 2. 0leoning nusl be done nexl lo renove
noleriol lsuch os dried bloodI lhol con gel
in lhe woy of slerilizolion or HLD.
Slep 3. HLD or slerilizolion nusl be done
before use or sloroge lo reduce lhe risk of
infecling polienls.
Slep /. Slore or use ilens innediolely ofler
HLD or slerilizolion so lhol lhey do nol
becone conloninoled.
Nrw tr Nake a 1.E C|lrr|re 0errrtam|rat|rr Srlat|rr
J
0hlorine is usuolly lhe leosl expensive, nosl ovoil-
oble, ond nosl ropidly ocling chenicol for noking o
deconloninolion solulion. l chlorine solulion con be
node fron.
n Liquid household bleoch lsodiun hypochlorileI
n Bleoch powder lcolciun hypochlorile or
chlorinoled lineI
n 0hlorine-releosing loblels
Becouse of ils low cosl ond wide ovoilobilily, liquid or
powdered bleoch is reconnended. l solulion of O.5%
chlorine is needed for deconloninolion. l weoker so-
lulion lless lhon O.5%I noy nol kill gerns. l slronger
solulion lnore lhon O.5%I uses nore chlorine lis nore
expensiveI ond noy donoge lhe inslrunenls.
8=6GI8#( 5TEP 1: DEC0NTAHINATI0N
Tbe purpcse cf deccntaminating instruments
and ctber reuseabIe items is:
n To kill viruses lsuch os hepolilis B,
hepolilis 0, ond H\I ond nony olher gerns
n To noke ilens sofer lo hondle during
cleoning
n To noke ilens eosier lo cleon by
prevenling blood or olher body fuids
ond lissue fron drying on lhen
Rcw tc deccntaminate instruments
and ctber items:
1. Pul lhe ilens in o ploslic conloiner of
O.5% chlorine solulion innediolely ofler
using lhen.
2. 0over lhe ilens conplelely wilh
chlorine solulion.
3. Sook ilens for 1O ninules. Do nol leove
lhen in lhe solulion for nore lhon 1O nin-
ules. Sooking loo long in chlorine solulion
con donoge inslrunenls ond olher ilens.
/. Renove ilens fron lhe chlorine solulion.
llwoys weor ulilily gloves when renoving
ilens fron o chlorine solulion.
5. Rinse lhe ilens wilh woler. Sel lhen
oside unlil you ore reody lo cleon lhen.
. 0honge lhe solulion. 1I ol lhe beginning
of eoch doy, 2I whenever lhe solulion is very
conloninoled wilh blood or body fuids, or 3I
if lhe solulion becones cloudy.
1?O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
0hlorine-conloining conpounds ore described os
hoving o cerloin percenloge of oclive lor ovoilobleI
chlorine. l is lhe oclive chlorine in lhese producls
lhol kills gerns. The onounl of oclive chlorine is
described os o percenloge ond noy differ fron one
producl lo onolher. This is inporlonl lo know in order
lo prepore o chlorine solulion conloining O.5% oclive
chlorine.
n counlries where French producls ore ovoiloble,
lhe onounl of oclive chlorine is usuolly expressed
in chloronelric degrees lchloronI. 0ne chloron
conloins oboul O.3% oclive chlorine. For exonple, euu
Je !uve| conloins 15 chloron which is opproxinolely
5% oclive chlorine l15 lines O.3% equols /.5% which
is rounded up lo 5%I.
Us|r] l|a|1 |rase|rl1 |lear|
0hlorine in liquid bleoch cones in differenl concen-
lrolions. ls long os you know whol lhe concenlrolion
is, you con use ony household bleoch lo noke o O.5%
chlorine solulion by using lhe following fornulo.
[% cbIcrine in tbe Iiquid bIeacb divided by 0.5%|
minus 1= parts cf water fcr eacb part bIeacb
2
ExampIe. To noke o O.5% chlorine solulion fron o
3.5% chlorine concenlrole, colculole os follows.
|3.5% divided by O.5%J ninus 1 = |7J ninus 1 =
n lhis cose you nusl nix 1 porl liquid bleoch wilh
porls woler in order lo gel o O.5% chlorine solulion.
Us|r] |lear| prw1er
f using bleoch powder, colculole lhe rolio of bleoch lo
woler using lhe following fornulo.
[% cbIcrine desired divided by % cbIcrine in tbe
bIeacb pcwder| times 1,000 = grams pcwder fcr
eacb Iiter cf water
ExampIe. To noke o O.5% chlorine solulion fron o
colciun hypochlorile powder conloining 35% ovoiloble
chlorine, colculole os follows.
|O.5% divided by 35%J lines 1,OOO = 1/.3
n lhis cose you nusl dissolve 1/.3 grons of colciun
hypochlorile powder in 1 liler of woler in order lo gel
o O.5% chlorine solulion.

|rfert|rr Preert|rr 1?1
C
6eeZcY^m8
Us|r] r|lrr|rereleas|r] ta|lets
Since lhe percenloge of oclive chlorine in lhese prod-
ucls vories, follow lhe nonufoclurer`s inslruclions. f
lhe inslruclions ore nol ovoiloble wilh lhe loblels, osk
for lhe producl`s inslruclion sheel fron your supply
source or conlocl lhe nonufoclurer.
Use rf Srap |r Clear|r]
Soop is inporlonl for effeclive cleoning, since woler
olone will nol renove prolein, oils, ond greose.
n When soop is dissolved in woler, il breoks up
greose, oil, ond olher foreign noller, noking
lhen eosy lo renove by cleoning.
n Use household cleoning soop lbor or liquidI,
if ovoiloble, rolher lhon bolh soops. The folly
ocids in bolh soops will reocl wilh lhe ninerols
in hord woler ond leove o scun lhol is diffcull
lo renove.
n f you use bor soop, keep il in o soop rock or in
o dish wilh holes for droinoge.
n Do nol use sleel wool or obrosive cleonsers
such os \in or 0onel. These con scrolch or
donoge inslrunenls ond olher such ilens,
noking grooves. 0erns con lhen grow ond
hide in lhese grooves.
Wbite mineraI depcsit. l powdery while deposil noy
be lefl on lhe pol ond on ilens lhol ore boiled fre-
quenlly. This is coused by line solls in lhe woler. To
reduce lhis deposil.
1. ldd vinegor lo lhe woler.
2. Boil lhe woler for 1O ninules before odding
inslrunenls lo be high-level disinfecled. This
nokes lhe line cone oul of lhe woler ond sellle
on lhe bollon or sides of lhe pol linsleod of on
lhe ilens being boiledI.
3. Use lhe sone woler lhroughoul lhe doy. ldd only
enough woler lo keep lhe ilens under woler.
/. Droin ond cleon oul lhe pol ol lhe end of eoch doy.
FIaming. Holding on ilen in o fone is nol recon-
nended os o nelhod of HLD becouse il does nol
effeclively kill gerns.
8=6GI8#) 5TEP 2: CLEANIN6
Tbe purpcse cf scrubbing witb a brusb,
scap, and water is:
n To renove blood, olher body fuids,
lissue, ond dirl.
n To reduce lhe nunber of gerns.
n To noke slerilizolion or high-level
disinfeclion effeclive. f o clol of blood, for
exonple, is lefl on on inslrunenl, gerns
in lhe clol noy nol be conplelely killed by
slerilizolion or HLD.
5teps fcr cIeaning
1. Weor ulilily gloves, o nosk, ond
proleclive eyeweor when cleoning.
2. Use o sofl brush or old loolhbrush,
soop, ond woler.
3. Scrub ilens well while holding lhen
under lhe woler llry nol lo sploshI. Brush
lhe grooves, leelh, ond |oinls of inslrunenls
where blood ond lissue con collecl.
/. Rinse oll ilens well wilh cleon woler
lo renove oll soop.
1?2 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
8=6GI8#* 5TEP 3: RI6R-LEEL
DI5INFECTI0N IRLD! BY B0ILIN6
HLD kills oll gerns excepl sone endospores ldiffcull-
lo-kill boclerio, such os lelonus or gos gongrene lhol
forn o hord oulside shellI. HLD con be used for in-
slrunenls ond ilens lhol cone in conlocl wilh broken
skin or inlocl nucous nenbrones. f slerilizolion is
nol ovoiloble, HLD is lhe only olher occeploble choice.
HLD con be done by boiling or sleoning.
5teps fcr bciIing:
1. Pul oll inslrunenls ond olher ilens lo disinfecl
inlo o pol for boiling.
2. 0pen scissors ond oll inslrunenls wilh
|oinls.
3. Ploce forceps or pickups on lop of oll olher
equipnenl in lhe pol. l slring lied lo lhe forceps or
pickups ond lefl honging oul over lhe lip of lhe pol
nokes renovol eosier.
/. 0over oll ilens conplelely wilh woler.
5. Bring lhe woler lo o boil.
. When lhe woler cones lo o boil, cover lhe pol
ond boil for 20 HINUTE5. Do nol odd ony ilens
ofler lining slorls. Do nol boil lhe woler loo vigor-
ously. This prolecls lhe inslrunenls fron donoge
ond soves fuel.
7. Renove ilens fron lhe pol wilh lhe HLD
forceps or pickups.
8. Pul inslrunenls or ilens in o HLD conloiner.
There ore lwo woys lo high-level disinfecl o con-
loiner. oI pul lhe conloiner on lop of oll lhe olher
equipnenl lo be boiled ond renove il frsl, or bI fll
lhe conloiner wilh O.5% chlorine solulion ond lel
il sook for 2O ninules. Then pour oul lhe chlorine
solulion ond rinse lhe conloiner well wilh boiled
woler. lir-dry lhe conloiner before reusing.
?. lir-dry boiled ilens before use or sloroge. Do nol
leove boiled ilens silling in woler lhol hos slopped
boiling. They could eosily becone conloninoled os
lhe woler cools.
8=6GI8#+ 5TEP 3: RLD BY 5TEAHIN6
Advantages cf steaming instead cf bciIing:
n Sleoning couses less donoge lo gloves
ond olher ploslic or rubber ilens.
n Sleoning uses less woler.
n Sleoning uses less fuel becouse lhere
is less woler lo boil.
n Sleoning does nol couse build-up of
line solls on nelol inslrunenls.
5teps fcr steaming:
1. Pul woler inlo lhe bollon of o sleoner pol.
2. Pul in o sleoner lroy lhol hos holes in il.
3. Pul oll ilens onlo lhe sleoner lroy. 0pen up
scissors ond olher inslrunenls wilh |oinls.
/. Ploce forceps or pickups on lop of oll olher
equipnenl in lhe pol. l slring lied lo lhe forceps or
pickups ond lefl honging oul over lhe lip of lhe pol
nokes renovol eosier.
5. Bring lhe woler lo o boil.
. When lhe woler slorls lo boil, cover lhe pol ond boil
for 20 HINUTE5. Do nol odd ony ilens once lhe
lining slorls. Do nol boil lhe woler loo vigorously.
This soves fuel.
7. Renove ilens fron lhe pol wilh HLD forceps
or pickups.
8. Pul HLD inslrunenls or ilens in o HLD conloiner.
There ore lwo woys lo high-level disinfecl o con-
loiner. oI pul lhe conloiner ond ils lid on lop of oll
lhe olher equipnenl lo be sleoned ond renove
lhen frsl, or bI fll lhe conloiner wilh O.5% chlo-
rine solulion ond lel il sook for 2O ninules. Then
pour oul lhe chlorine solulion ond rinse lhe con-
loiner well wilh boiled woler. lir-dry lhe conloiner
before reusing.
?. lir-dry ilens.
1O. When dry, use or slore ilens in o covered,
HLD conloiner.
|rfert|rr Preert|rr 1?3
C
6eeZcY^m8
8=6GI8#, 5TEP 3: 5TEPILIZATI0N BY 5TEAH IAUT0CLAE!
Slerilizolion kills oll gerns, including endospores.
lny ilen lhol will cone in conlocl wilh lhe blood-
slreon or lissues under lhe skin lneedles, syringes,
surgicol inslrunenls, elc.I should be slerilized using
sleon louloclovingI or dry heol.
Sleon slerilizolion uses noisl heol under pressure, so
bolh woler ond heol ore needed. Heol con be provided
by eleclricily or by onolher fuel source lsuch os o
kerosene burnerI. The ouloclove nochine nusl hove
o pressure gouge.
5teps fcr steam steriIizaticn:
1. Deconloninole, cleon, ond dry oll inslrunenls
ond olher ilens lo be slerilized.
2. 0pen or unlock oll |oinled inslrunenls, such
os scissors so sleon con reoch oll surfoces of
lhe ilen.
3. f wropping ilens for oulocloving, use lwo loyers
of poper, newsprinl, or collon or nuslin fobric.
lDo nol use convos os sleon noy nol penelrole
lhis noleriol.I Wrop frsl in one loyer, lhen wrop
lhe pockel in o second loyer. Moke poinls lsee
fgure 0.2I while wropping ilens so lhol lhe pocks
con be opened eosily wilhoul conloninoling lhe
ilens. Do nol seol ilens in o closed conloiner lhol
connol be penelroled by sleon.
/. Do nol pock lhe ilens logelher lighlly in lhe
ouloclove. Leove spoce belween lhe ilens so lhol
sleon con nove oboul freely.
Mony lypes of oulocloves ore used oround lhe
world. Follow lhe nonufoclurer`s inslruclions
whenever possible. n generol, slerilize ol
121 0 l25O FI ond 1O kPo l15 lb/in
2
I pressure.
Do nol begin lining unlil lhe ouloclove reoches
lhe needed lenperolure ond pressure.
n Wropped ilens loke 3O ninules.
n Unwropped ilens loke 2O ninules.
Ncte: The unils of pressure norked on on oulo-
clove`s pressure gouge noy vory fron one oulo-
clove lo onolher. The required onounl of pressure
noy be expressed in ony of lhe following.
n 15 lb/in
2
l15 pounds per squore inchI
n 1O kPo l1O kiloposcolsI
n 1 oln l1 olnosphereI
n 1 kgf/cn
2
l1 kilogron of force per squore
cenlinelerI
n 77 lorr
n 77 nn Hg l77 nillinelers of nercuryI
5. ll lhe end of lhe cycle.
n f lhe ouloclove is oulonolic, lhe heol will shul
off ond lhe pressure will begin lo foll.
n f lhe ouloclove is nol oulonolic, lurn off
lhe heol or renove lhe ouloclove fron lhe heol
source.
. Woil unlil lhe pressure gouge reoches zero.
0pen lhe ouloclove`s lid or door so lhol lhe re-
noining sleon escopes.
7. Leove inslrunenl pocks or ilens in lhe ouloclove
unlil lhey dry conplelely, which could loke up lo
3O ninules. lens nusl be dry before renovol.
Pocks lhol ore donp when renoved fron lhe
ouloclove drow nicroorgonisns fron lhe environ-
nenl ond should be considered conloninoled.
8. Renove ilens fron lhe ouloclove when dry. f
ony ilens ore nol wropped, use slerile pickups lo
renove ond lronsfer lhen lo o slerile conloiner.
?. Use or slore oulocloved equipnenl innediolely.
1?/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
;><JG:8#' WPAPPIN6 IN5TPUHENT5 F0P 5TEPILIZATI0N
&#
)#
,#
&%#
'#
*#
-#
&&#
(#
+#
.#
&'#
|rfert|rr Preert|rr 1?5
C
6eeZcY^m8
8=6GI8#- 5TEP 3: 5TEPILIZATI0N BY DPY REAT
IELECTPIC 0P 6A5 0EN!
Dry heol slerilizolion needs susloined high heol.
This requires o conslonl supply of eleclricily or fuel.
0nly gloss or nelol ilens con be dry heol sleril-
ized. 0loves or ploslic ilens will nell or burn ol high
lenperolures.
5teps fcr dry beat steriIizaticn:
1. Deconloninole, cleon, ond dry oll ilens lo
be slerilized.
2. Prepore inslrunenls.
oI wrop inslrunenls using oluniniun foil,
double-loyered collon, or nuslin fobric,
bI pul unwropped inslrunenls on o lroy or shelf,
or
cI pul lhen in o nelol, lidded conloiner.
3. Pul ilens in lhe oven ond heol lhen lo lhe
needed lenperolure. Use on oven lhernoneler
lo noke sure lhe proper lenperolure is reoched.
/. Moinloin lhe lenperolure for lhe required line.
Begin lining ofler reoching lhe desired lenpero-
lure. Do nol open lhe oven door or odd or renove
ony ilens once lining slorls. The line required
depends on lhe lenperolure.
17O 0 l3/O FI = 1 hour
1O 0 l32O FI = 2 hours
15O 0 l3OO FI = 2.5 hours
1/O 0 l285 FI = 3 hours
Becouse dry heol con dull shorp inslrunenls ond
needles, lhese ilens should nol be slerilized ol
lenperolures higher lhon 1O 0.
5. Turn lhe oven off ond leove ilens in il lo cool
before renoving.
. When conplelely cool, renove lhe ilens using
slerile pickups.
7. Use or slore slerilized inslrunenls innediolely.
8=6GI8#. 5TEP : 5T0PE 0P U5E
lfler processing, HLD or slerilized ilens should be
used innediolely or slored properly so lhey do nol
becone conloninoled. Proper sloroge is os inporlonl
os deconloninolion, cleoning, slerilizolion, or HLD.
6uideIines fcr stcrage cr use:
n llwoys slore inslrunenls or olher ilens dry.
Do not slore lhen in solulions becouse nicroor-
gonisns con live ond nulliply in bolh onliseplic
ond disinfeclonl solulions.
n Keep your sloroge oreo cleon, dry, ond dusl-free.
n Pocks ond conloiners should be slored ol leosl.
n 2O-25 cn l8-1O inchesI off lhe foor
n /5-5O cn l18-2O inchesI fron lhe ceiling
n 15-2O cn l-8 inchesI fron on oulside woll
n Do nol use cordboord boxes. They collecl dusl
ond noy conloin insecls.
n Dole ond rolole lhe supplies. Follow lhe frsl
in/frsl oul principle.
n Wrile lhe slerilizolion dole on lhe pockel
before plocing il in lhe slerilizer.
n Use ilens wilh lhe eorliesl slerilizolion
dole frsl.
n Slore freshly slerilized ilens behind or
under ilens slerilized eorlier.
n How long ilens sloy slerile or HLD depends on.
n The quolily of lhe wropper/conloiner
n The nunber of lines o conloiner is opened
n The nunber of lines o pockoge is hondled
before use
n Whelher lhe pockoge is slored on open or
closed shelves
n The condilion of lhe sloroge oreo
llenperolure, hunidily, ond cleonlinessI
n The use of ploslic bogs lo cover lhe pockoge
ond how il is seoled
Wrapped items. Wilh good sloroge ond lillle hon-
dling, properly wropped ilens con be considered
slerile os long os lhey renoin inlocl ond dry. when
in Joubt oboul lhe slerilily of o pock, consider il con-
loninoled ond slerilize il ogoin.
Unwrapped items. Use unwropped ilens inne-
diolely or keep lhen in o covered HLD or slerile
conloiner for up lo one week.
1? Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
. 5teriIize
n Use lhis slep only if slerile linens ore
needed lsuch os for surgeryI.
n 0nly sleon slerilizolion louloclovingI
should be used for linens. Mony fobrics burn
ol lhe high lenperolures used for dry heol
slerilizolion.
n Pocks conloining linens should nol be nore
lhon 3O x 3O x 5O cn l12 x 12 x 2O inI or 5 kg
l11 lbI lo ollow sleon lo go lhrough lhe ilens.
Ploce linen pocks in lhe ouloclove on lheir
sides. l is eosier for sleon lo go lhrough lhe
ilens on lheir sides lhon lhrough fol, con-
pressed surfoces.
7. 5tcre
n Keep cleon linen in o cleon, dry, closed
sloroge oreo.
|0\|S AN0 Pk0!|C!|\| C|0!N|N
To reduce lhe spreod of gerns ond keep lhe envi-
ronnenl free of infeclion, use proleclive gloves ond
hondwoshing. The lhree kinds of gloves lhol noy be
used ore.
1. UtiIity cr beavy duty gIcves IbcusebcId gIcves!
Weor ulilily gloves for.
n Hondling dirly inslrunenls, linens, ond wosle
n Doing housekeeping
n 0leoning conloninoled surfoces
Ulilily gloves con be reused ofler cleoning. lfler
using ulilily gloves, olwoys wosh your honds
lwice. once wilh gloves on ond ogoin ofler re-
novol.
2. 5ingIe-use gIcves Iexam gIcves!
Fxon gloves should be worn.
n For procedures lhol involve conlocl wilh
inlocl nucous nenbrones
n When lhere is risk of exposure lo blood or
olher body fuids lcollecling specinens for
lob lesls, chonging dressing, elc.I
Fxon gloves ore. 1I cleon, bul nol slerile or HLD,
2I very lhin ond should olwoys be discorded ofler
one use, ond 3I supplied in bulk in o box or noy
be individuolly pockoged.
Pk0C|SS|N ||N|NS
The risk of possing infeclion fron dirly linen is snoll.
l does nol need deconloninolion. The biggesl don-
gers fron processing linen hoppen.
n When shorp ob|ecls, such os needles ond
surgicol inslrunenls, ore lefl in or on linens
n During sorling
n When woshing linen by hond
llwoys weor heovy ulilily gloves when hondling dirly
linen. During sorling ond hondwoshing of soiled linen,
you should olso weor proleclive eyeweor, o ploslic or
rubber opron, ond closed shoes. The sleps for pro-
cessing linens ore exploined below.
1. CcIIect and transpcrt
n Never pul dirly linens on lhe foor. Pul
lhen in o leok-proof conloiner wilh o lid or
in o ploslic bog.
n Tronsporl lhe dirly linens in lhol sone
conloiner or bog lo prevenl conlocl wilh
skin, nucous nenbrones, or clolhing.
2. 5crt
n Hondle soiled linen os lillle os possible.
n To prevenl spreoding gerns, do nol shoke
dirly linen.
n Renove ony inslrunenls or dirly or bloody
dressings.
3. Wasb
n Hond or nochine wosh.
n Heovily soiled linens should be.
n Presooked in soop, woler, ond bleoch
lespeciolly if lhey will be hondwoshedI
n Woshed seporolely fron non-soiled linens
n Use delergenl ond woler.
n Use worn or hol woler if ovoiloble
lhelps lo loosen soilI.
n lfler woshing, check for cleonliness.
Rewosh if slill dirly.
n Rinse wilh cleon woler.
. Dry
n 0onplelely oir- or nochine-dry.
n f oir-drying, keep linen off lhe ground
ond owoy fron oninols, dusl, ond dirl.
5. Cbeck and fcId
n 0heck for holes. Repoir ony found.
n ron linens ond fold lhen, unless lhey ore
lo be slerilized. lroning dries oul lhe fobric
ond nokes oulocloving nore diffcull.I
|rfert|rr Preert|rr 1?7
C
6eeZcY^m8
ACTI0N
Temperature
cbeck
Injecticn
Newbcrn exam
BIccd drawing
NcrmaI deIivery
Newbcrn
resuscitaticn
5urgery
CIeaning
instruments
CIeaning bIccd cr
bcdy huid spiIIs
RandIing
ccntaminated
waste
CIeaning Iinens
APE 6L0E5 NEEDED?
No
No
No
Yes
Yes
Preferred
Yes
Yes
Yes
Yes
Yes
ACCEPTABLE 6L0E
-
-
-
HLD
HLD
HLD
HLD
HLD
HLD
HLD
HLD
8=6GI8#&% WREN AND WRAT KIND 0F 6L0E5 APE NEEDED
PEC0HHENDED 6L0E
-
-
-
Single-use
Surgicol
Single-use
Surgicol
Ulilily
Ulilily
Ulilily
Ulilily
1?8 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
3. 5urgicaI gIcves IsteriIe!
Weor surgicol gloves for oll procedures lhol require
conlocl wilh lissues under lhe skin or wilh lhe
bloodslreon lsurgicol procedures, deliveries, elc.I.
Disposoble surgicol gloves ore reconnended
whenever possible.
0loves for surgicol procedures should be slerile.
Toke core nol lo conloninole lhen while pulling
lhen on.
keprrress|r] rf Sar]|ral lres
0loves ore diffcull lo cleon ond reprocess properly,
lherefore, reprocessing is nol usuolly reconnended.
Where gloves ore in shorl supply, lhey con be reused
if lhey hove no holes ond lhe lhree-slep process is
followed.
1. Deconloninolion lby sooking in O.5%
chlorine solulionI
2. 0leoning lby woshing wilh soop ond lhen
rinsingI
3. Slerilizolion lby ouloclovingI or high-level
disinfeclion lby sleoningI
Boiling of gloves is nol reconnended.
Nrw tr Pat rr Ster|le Sar]|ral lres
1. Scrub honds lhoroughly wilh soop ond woler
ond dry lhen on o cleon lowel or oir-dry.
2. 0pen lhe glove pockel corefully wilhoul louching
lhe gloves or lhe inside surfoce of lhe pockoging
noleriol.
3. l poir of surgicol gloves conloins o righl-hond
glove ond o lefl-hond glove. Slide lhe fngers of
one hond porl woy inlo ils glove ond lifl il up. Do
nol lel onylhing louch lhe oulside of lhe glove os
you ore pulling il on.
/. 0rosp lhe glove`s folded-over cuff wilh lhe olher
hond ond pull il on oll lhe woy. Do nol unfold lhe
cuff or louch lhe oulside of lhe glove os you do
lhis. lSee fgure 0.3.I
;><JG:8#( PUTTIN6 0N 5UP6ICAL 6L0E5
&# '#
(# )#
*#
|rfert|rr Preert|rr 1??
C
6eeZcY^m8
5. Slide lhe gloved fngers of lhe frsl hond under
lhe folded-over cuff of lhe second glove.
. Slide lhe second hond inlo lhe second glove.
7. Roll bock lhe cuffs lunfold lhenI. ls you do lhis,
your gloved fngers should louch only lhe oul-
side surfoces of lhe gloves.
8. 0nce lhe slerile gloves ore on, hold your honds
up ond owoy fron your body, being very coreful
nol lo louch onylhing oulside of lhe slerile feld.
kemr|r] Crrtam|rate1 lres
1. Renove used gloves before louching onylhing.
2. Before renoving conloninoled gloves, dip
gloved honds inlo o O.5% chlorine solulion lo
rinse lhe ouler surfoces ond lo renove blood,
olher fuids, ond lissue.
3. 0orefully renove gloves wilhoul louching lhe
ouler surfoce wilh your bore honds.
n To renove lhe frsl glove. wilh one hond, peel
lhe glove off lhe olher hond by slowly pulling
il down fron lhe cuff ond lurning il inside oul.
n To renove lhe second glove. use lhe inside-
oul glove lo renove lhe second glove by
slowly peeling il down fron lhe cuff ond off.
The second glove should olso lurn inside oul.
/. Pul bolh gloves inlo lhe O.5% chlorine solulion
lo sook.
Pemember. lfler renoving oll gloves, wosh your
honds! 0loves con leor during use. Mosl gloves olso
hove liny holes lhol connol be seen. 0erns con enler
ond reoch your honds even when you weor gloves.
;><JG:8#) TAKIN6 0FF 5UP6ICAL 6L0E5
&# '#
(# )#
*#
2OO Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Prrtert|e Clrt||r]
Proleclive clolhing con prolecl bolh lhe heollh worker
ond lhe polienl. lny wel clolhing ocls os o sponge
for gerns. These gerns con enler o person`s body
lhrough ony open cul or sore ond lhrough lhe nucous
nenbrones of lhe eyes, nose, ond noulh.
Nask ar1 ee prrtert|rr
Mosks ond eye proleclion should be worn whenever
blood or body fuids nighl splosh ond enler o heollh
worker`s eyes, noulh, or nose. This con hoppen when.
n Sorling ond cleoning inslrunenls ond linens
n lllending o voginol delivery
n 0ulling lhe unbilicol cord
Fye proleclion con include goggles, foce shields, pre-
scriplion glosses, or glosses wilh ploin lenses.
Aprrr
The opron should be node of rubber or ploslic nole-
riol lwolerproofI ond worn for.
n Sorling ond cleoning inslrunenls ond linens
n lllending o voginol delivery
|eet prrtert|rr
Slurdy, closed shoes or bools should be worn ol oll
lines lo prolecl lhe heollh worker fron.
n n|ury by shorps or heovy ilens
n Blood or olher body fuids lhol splosh or spill
on lhe foor. lThis is especiolly inporlonl if lhe
heollh worker hos o cul or sore on her fool.I
Prrtert|r] t|e pat|ert
The heollh worker should weor o nosk if she hos o
cold, cough, sore lhrool, or upper respirolory infec-
lion. f lhe heollh worker hos o cul or wound on her
hond, she should keep il cleon ond covered wilh o
dressing ond weor o glove over lhe dressing.
|rfert|rr Preert|rr 2O1
C
6eeZcY^m8
;><JG:8#* 0NE-RAND TECRNI0UE
Pk0!|C!|0N |k0N SNAkPS
Shorps ore ony needles, rozors, scolpel blodes, or olher
shorp inslrunenls used lo give heollh core. lfler lhe shorp
hos been used, il is conloninoled ond con eosily poss in-
feclion lo olhers lhrough on occidenlol nick, cul, or slick.
!r Preert |rjar|es frrm S|arps
Toke exlrene core in hondling needles ond olher
shorps, ond hondle lhen os lillle os possible ofler
use. Pul reusoble needles ond syringes in deconloni-
nolion solulion lo sook innediolely ofler use.
Hondle needles os follows.
n Do nol bend, breok, or cul single-use
hypodernic needles before disposol.
n Do nol renove lhe needle fron o syringe by
hond. 0rosp lhe needle wilh o forceps lo sepo-
role lhen prior lo cleoning ond HLD.
n Do nol recop needles. lccidenlol needle slicks
con eosily hoppen. f you nusl recop o needle
lfor exonple, when innediole disposol is nol
possibleI, use lhe one-hond lechnique. holding
lhe syringe wilh olloched needle in one hond, in-
serl lhe needle inlo lhe cop which is lying on on
inoninole surfoce such os o loble lop. Then hold
lhe syringe uprighl lslill using lhe sone hondI
ond use lhe olher hond lo secure lhe cop.
Dispose of single-use hypodernic needles ond olher
shorps properly.
n Dispose of needles ond syringes innediolely
ofler use.
n Pul inlo o punclure-resislonl shorps disposol
conloiner wilh o snoll opening. l noy be node
oul of heovy cordboord, ploslic, gloss, or nelol.
n Seol lhe opening ond burn lhe shorps disposol
conloiner when il becones lhree-quorlers full.
n f burning is nol possible, deconloninole
needles ond syringes, lhen pul lhen in o shorps
disposol conloiner ond bury il in o pil. Use lhe
following process.
1. lfler use do nol recop lhe needle or
seporole lhe needle fron lhe syringe.
2. Fill lhe needle ond syringe wilh O.5%
deconloninolion solulion. Fill ond push oul
solulion lhree lines.
3. Pul lhe needle ond syringe in o shorps
disposol conloiner ofler lhis deconloninolion.
2O2 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
N0US|K||P|N
0ood housekeeping reduces gerns, reduces lhe risk
of occidenls, ond provides o sofe ploce for heollh core.
Clear|r] Srlat|rrs Use1 |r Nrasekeep|r]
0eter]ert ar1 water srlat|rr
n Delergenls renove dirl ond dissolve or
suspend greose ond oil so lhey ore eosier
lo renove by scrubbing.
n Used for generol cleoning of.
n Wolls, windows, ceilings, doors
lincluding door hondlesI
n Floors lif no body fuids ore presenlI
n Fquipnenl such os slelhoscopes,
weighing scoles lif no body fuids presenlI
0errrtam|rat|rr srlat|rr
n Used for deconloninoling o soiled oreo before
cleoning so il is sofer lo cleon. This solulion
should be used frsl, before generol cleoning,
whenever you hove body fuids spilled on.
n Floors, wolls, furnilure, beds, elc.
n Fquipnenl such os slelhoscopes,
weighing scoles
n Use O.5% chlorine deconloninolion solulion.
0|s|rfertart rlear|r] srlat|rr
n 0onloins o disinfeclonl, o delergenl, ond woler.
n Prepore cleoning solulion by nixing o O.5%
chlorine solulion wilh sone delergenl. Keep
odding delergenl ond slirring unlil lhe solulion
is nildly sudsy.
n 0hlorine solulions should never be nixed wilh
cleoning producls conloining onnonio, on-
noniun chloride, or phosphoric ocid. 0on-
bining lhese chenicols will couse lhe releose
of chlorine gos, which con couse nouseo, eye
irrilolion, heodoche, ond shorlness of breolh.
These synplons noy losl for severol hours. f
you ore exposed lo o slrong odor ofler nixing
chlorine solulion wilh o cleoning producl, leove
lhe roon or oreo innediolely unlil lhe funes
hove cleored conplelely.
n The disinfeclonl kills nony infeclious gerns,
while lhe delergenl renoves dirl ond olher
noleriol lhol connol be renoved by woler or
disinfeclonls olone.
n Used for cleoning oreos lhol noy be
conloninoled wilh infeclious noleriols such os.
n Delivery roons, surgicol lheolers, procedure
ond exoninolion roons
n Floors lif body fuids ore presenlI
n Sinks luse o seporole nop, clolh, or brush
wilh disinfeclonl cleoning solulion, lhen rinse
lhe sink wilh wolerI
n Toilels ond lolrines luse o seporole nop,
clolh, or brush wilh disinfeclion solulionI
n 0hoirs, lobles, loblelops, beds, nollresses,
counlers
n Wosle conloiners
ereral Nrasekeep|r] a|1el|res
n AIways wear gIcves when cleoning. Use lhick
ulilily gloves if possible.
n Use a damp cr wet mcp cr cIctb insleod of o dry
one for dusling or sweeping llo reduce lhe
spreod of dusl ond gernsI.
n 5crubbing is lhe besl woy lo renove dirl ond
gerns.
n CIeaning sbcuId aIways gc frcm tcp tc bcttcm
so lhol dusl, dirl, ond gerns foll lo lhe foor
which is cleoned up losl. For exonple, cleon
ceiling lonps, lhen shelves, lhen lobles, ond
lhen lhe foor.
n Prepare fresb cIeaning scIuticn daiIy.
n Cbange cIeaning scIuticn wbenever it Iccks
dirty. l solulion is less likely lo kill infeclious
gerns if il is very dirly.
n Follow o regulor cleoning schedule. lSee
chorl 0.11 opposile.I
n 5uppIies and equipment used fcr cIeaning aIsc
need tc be cIeaned. Fquipnenl lsuch os nops,
buckels, ond clolhsI should be deconloninoled
wilh o O.5% chlorine solulion, cleoned in deler-
genl ond woler, rinsed in cleon woler, ond dried
before reuse.
|rfert|rr Preert|rr 2O3
C
6eeZcY^m8
FPE0UENCY
DaiIy
WeekIy
ImmediateIy
FcIIcwing
discbarge
cf a patient
8=6GI8#&& PEC0HHENDED R0U5EKEEPIN6 P0UTINE5 F0P A REALTR FACILITY
WRAT T0 CLEAN
Delivery roons, surgicol lheolers, procedure ond exoninolion roons
Floors
Furnilure ond equipnenl used doily lexon lobles, choirs, loblelops, counlers, weighing
scoles, slelhoscopes, delivery beds, \ polesI
Sinks luse o seporole nop, clolh, or brush wilh disinfeclonl cleoning solulion, lhen rinse
lhe sink wilh wolerI
Toilels ond lolrines luse o seporole nop, clolh, or brush wilh disinfeclonl cleoning solulionI
Wosle conloiners luse disinfeclonl cleoning solulionI
Use o delergenl ond woler solulion for cleoning lhe following.
n Doors lincluding door hondlesI
n Windows
n Wolls
n 0eilings
n 0eiling fxlures
Furnilure, foors, roons, ond equipnenl, ofler spills, ofler o procedure, or ofler o delivery
Mollress, bed linen, bed frone, ond ony olher equipnenl lhol wos used for lhe polienl`s
core luse disinfeclonl cleoning solulionI
2O/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Clear|r] sp|lls
0|eun up spi||s of b|ooJ unJ boJ, fuiJs immeJiute|,.
When cleoning up spills.
n llwoys weor gloves.
n Fcr a smaII spiII. Wipe up lhe spill wilh o clolh
sooked wilh o O.5% chlorine solulion. Then wipe lhe
oreo cleon wilh o disinfeclonl cleoning solulion.
n Fcr a Iarge spiII. 0over lfoodI lhe spill wilh o
O.5% chlorine solulion. Then nop up lhe solu-
lion, ond cleon lhe oreo wilh o disinfeclonl
cleoning solulion.
n Do nol leove o spill on lhe foor for cleoning up
loler leven if il is coveredI, soneone could slip
ond foll on il ond be in|ured.
0|SP0SA| 0| C0N!AN|NA!|0 wAS!|
Wosle disposol is o cruciol porl of infeclion prevenlion.
Proper wosle disposol.
n Prevenls lhe spreod of infeclion lo
heollh workers ond cleoning sloff who
hondle lhe wosle
n Prevenls lhe spreod of infeclion lo lhe
locol connunily
n lllrocls fewer insecls ond does nol ollrocl
oninols
n Prevenls conloninolion of lhe soil or
ground woler wilh chenicols or gerns
Cauticn! llwoys dispose of nedicol wosle correclly.
Never sinply lhrow il oulside or leove il in on open pile.
Prrtert rarself w||le 0|sprs|r] rf waste
1. llwoys weor proleclion when lronsporling ond
disposing of wosle lulilily gloves, eye proleclion,
ond wolerproof opronI.
2. 0orefully dispose of liquid wosle.
n 0orefully pour liquids down o droin, loilel,
or lolrine lo prevenl sploshing.
n Deconloninole o conloiner lhol wos used
for liquid wosle by sooking il in o O.5% chlo-
rine solulion for 1O ninules before woshing.
3. 0orefully dispose of solid wosle.
n Never use your honds lo conpress or sluff
wosle inlo conloiners.
n Hold ploslic bogs ol lhe lop.
n Keep bogs of wosle fron louching or
brushing ogoinsl your body when lifling ond
during lronsporl.
/. lfler conpleling wosle disposol, renove
conloninoled ulilily gloves, eyeweor, ond opron.
Wipe lhen down wilh o disinfeclonl cleoning
solulion lO.5% chlorine solulion ond delergenlI
doily, ond whenever lhey ore visibly dirly.
5. Wosh ond dry your honds wilh eilher soop
ond woler or on olcohol hondrub.
0|sprsal rf Plarertas: A Sper|al S|taat|rr
l is oflen inporlonl lo o fonily lo loke lhe plocenlo
hone ofler o birlh. This is lhe fonily`s righl. ls o
heollh worker, you con help lhe fonily by giving lhen
lhe plocenlo ond by exploining lhe sofesl woy lo
hondle il.
Tell lhen lo loke lhe plocenlo hone, double-bogged
in leok-proof ploslic bogs, or ploce il in o ploslic bog
inside o rigid cloy, nelol, or ploslic conloiner.
Fxploin lhol lhe plocenlo conloins blood, so il is besl
nol lo louch il direclly wilh bore honds. ldvise lhen lo
use gloves or o ploslic bog lo cover lheir honds when
hondling lhe plocenlo ond lo wosh lheir honds oflerwords.
|rfert|rr Preert|rr 2O5
C
6eeZcY^m8
5ink, TciIet,
cr Latrine
Burn
Bury
EncapsuIate
8=6GI8#&' WAY5 T0 DI5P05E 0F C0NTAHINATED WA5TE
Before pouring liquid wosle down o sink or loilel, lhink oboul where lhe droin enplies.
l is dongerous for liquid nedicol wosle lo run lhrough open gullers or sewers.
This is lhe besl nelhod lo dispose of conloninoled solid wosle.
l prevenls scovenging ond reuse.
Buriol is onolher oplion for disposol of conloninoled solid wosle. The pil nusl be in o sofe
locolion ond correclly flled in ond covered. l sofely locoled pil.
n Hos o fence oround il
n s ol leosl 5O nelers l155 feelI fron ony woler source
n s downhill fron ony wells
n s nol in on oreo lhol foods
n Hos o woler loble nore lhon / nelers l12 feelI below lhe surfoce
Seol lhe conloiner lhol hos wosle in il by flling il conplelely wilh cenenl, ploslic foon,
or cloy ond woiling unlil il dries. Then eilher bury lhe seoled conloiner or dispose of il in o
londfll. This nelhod con be used for disposol of shorps ond olher hozordous noleriols.
2O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
KIND5 0F WA5TE
Ncnccntaminated
Waste
Ccntaminated
Waste
Razardcus Waste
Ican barm
tbe envircnment!
8=6GI8#&( KIND5 0F WA5TE AND R0W T0 DI5P05E 0F TREH
DI5P05AL HETR0D5
Usuol nelhods
n sone ploces, snoll businesses collecl
ilens lhol con be processed ond lhen sofely
reused. Fxonples of lhis ore lin cons, sproy
cons, or bolleries.
Sink, loilel, or lolrine, or
Bury
Burn or bury
Ncte: Deconloninole ond encopsulole
shorps before burying.
Fncopsulole ond bury
Recycle or encopsulole ond bury
Snoll onounls. Burn, encopsulole, or bury
Lorge onounls. Burn
EXAHPLE5
Poper
Boxes
Bollles
Ploslic
Food
llkoline bolleries
Liquid conloninoled wosle. blood, feces,
urine, pus, olher body fuids
Solid conloninoled wosle.
n Body porls lincluding plocenlosI
n 0ouze ond dressings conloninoled
wilh blood ond olher body fuids
n Shorps lused or unusedI, including
needles ond syringes, scolpel blodes,
rozor blodes, blood lubes, olher gloss
ilens lhol hove been in conlocl wilh
conloninoled noleriols
Mercury fron broken blood pressure
gouges or lhernonelers
Lilhiun or Ni0od bolleries
lerosol sproy cons lcon explode if
burnedI
0henicols ond nedicines. expired drugs,
disinfeclonls such os fornoldehyde ond
gluloroldehydes l0idexI, ond solvenls like
ocelone ond chloroforn
|rfert|rr Preert|rr 2O7
C
6eeZcY^m8
Nrtes
1 ldopled fron. FngenderHeollh. l2OO1I. nfeclion
Prevenlion 0nLine 0ourse. lccessed Moy 3, 2OO/, fron
www.engenderheollh.org/ip/oboul/ip.pdf
2 Nole lhol porls con be used for ony unil of neosure lounce,
liler, or gollonI ond need nol even represenl o defned unil of
neosure lil con be o pilcher or conloinerI.
ereral kefererres
Tiel|en L, Bosseneyer D, ond Mcnlosh N. l2OO3I. lnfection
Prevention 0uiJe|ines for Feu|thcure Fuci|ities with LimiteJ
Resources. Bollinore, MD. JHPF00.
World Heollh 0rgonizolion. l1?8?I. 0uiJe|ines on steri|izution unJ
Jisinfection methoJs effective uuinst humun immunoJefcienc,
virus |Fl\l, 2d ed. WH0 lDS Series 2. 0enevo. WH0.
World Heollh 0rgonizolion. l2OO2I. Prevention of Fospitu|-
/cpuireJ lnfections: / Pructicu| 0uiJe. 0enevo. WH0. lWH0/0DS/
0SR/FPH/2OO2.12I
Bas|r Sk|lls frr Care rf t|e New|rrr 2O?
D
6eeZcY^m9
Tis ~e:oix :ese:ls :ewLo:: ~:e sis
i: ~ L:ie ouli:e o:n~l Tis i:o:n~lio:
n~y Le useo o: :eview ~:o le~i:q e~l
wo:e:s
D D~si Sis o: C~:e o le ewLo::
21O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
N0w !0 ASS|SS !N| ||!A| N|Ak!
kA!| 0Uk|N |AB0k
n The besl line lo heor lhe boby`s heorlbeol
during lobor is belween conlroclions, when lhe
nolher`s ulerus is resling.
n lfler o conlroclion hos possed, ploce lhe
feloscope or slelhoscope on lhe nolher`s lower
obdonen. Lislen for lhe felol heorlbeol. Move
lhe feloscope oround unlil you fnd lhe ploce
where you con heor lhe boby`s heorlbeol nosl
cleorly.
n Look ol o clock or wolch wilh o second hond
ond counl lhe nunber of lines lhe heorl beols
in one full ninule.
N0w !0 SUC!|0N !N| N|wB0kN'S
A|kwA B||0k| !N| B|k!N 0| !N| B00
n f lhere is neconiun in lhe onniolic fuid, lry
lo suclion lhe boby`s oirwoy before lhe boby
lokes her frsl breolh.
n Fxploin lo lhe nolher whol you ore going lo
do ond how she con help.
n Hove your suclion opporolus reody in your
hond before lhe heod energes.
n ls soon os lhe boby`s heod is born, osk lhe
nolher N0T lo push bul lo breolhe lighlly ond
ropidly lhrough her noulh.
n 0uickly suclion lhe boby`s noulh ond nose.
Keep o hond on lhe boby`s heod lo be prepored
for sudden birlh of lhe body.
n ls soon os your fnish, osk lhe nolher lo push
ogoin lo deliver lhe body.
Bas|r Sk|lls frr Care rf t|e New|rrr 211
D
6eeZcY^m9
N0w !0 SUC!|0N !N| N|wB0kN'S
A|kwA A|!|k 0|||\|k
n Suclioning of lhe oirwoy is slressful lo lhe
newborn ond con couse on irregulor heorlbeol.
n Suclion only if lhe newborn hos lrouble breolhing,
if lhe oirwoy is blocked, if lhere is neconiun-
sloined onniolic fuid, or if lhe boby needs
resuscilolion.
n Suclion once genlly ond correclly.
Sart|rr t|e A|rwa w|t| a Bal| Sr|r]e ||ar Sr|r]eI:
n Squeeze lhe bulb syringe ond noinloin lhe
pressure.
n Ploce lhe lip of lhe bulb syringe in lhe boby`s
noulh ond releose your pressure on lhe bulb.
n Toke lhe bulb syringe oul of lhe boby`s noulh
ond squirl oul lhe nucus on o clolh.
n Repeol lhese sleps lo suclion bolh noslrils.
Sart|rr t|e A|rwa w|t| a Naras |ttrartrr
w|t| a ||lter rr Sart|rr !rap
n llloch o cleon, sofl, size 12F lFrench size 12I
suclion colheler lo lhe exlroclor.
n Ploce lhe lube no nore lhon 5 cn inlo lhe
boby`s noulh.
n lpply suclion while pulling lhe lube oul of lhe
boby`s noulh.
n To suclion lhe nose, ploce lhe lube no nore
lhon 3 cn inlo lhe noslril.
n lpply suclion while pulling lhe lube oul.
n Repeol for lhe olher noslril.
;><JG:9#& BULB 5YPIN6E
;><JG:9#' DE LEE HUCU5 TPAP
212 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
N0w !0 ASS|SS !N| N|wB0kN'S
!|NP|kA!Uk|
|f ra 0r Nrt Nae a !|ermrmeter
n Ploce lhe bock of your hond on lhe boby`s bock
or obdonen.
n Feel your own foreheod wilh lhe bock of your
olher hond.
n f lhe boby`s skin is worner lhon your skin, lhe
boby noy hove o high body lenperolure. Look
for olher donger signs.
n f lhe boby`s skin is cooler lhon your skin, lhe
boby hos o low body lenperolure. Look for
olher signs of hypolhernio.
|f ra Nae a !|ermrmeter
n 0leon lhe lhernoneler wilh cold woler ond
soop. Rinse wilh cold woler.
n Hold lhe lhernoneler by lhe cleor-gloss end.
n Turn lhe lhernoneler unlil you con see lhe
silver or red line.
n The end of lhe silver or red line norks lhe
lenperolure.
n Shoke lhe lhernoneler hord wilh o snop of
your wrisl.
n Repeol lhis unlil il reods less lhon 35 0
or ?5.O F.
n Pul lhe olher end of lhe lhernoneler in lhe
boby`s ornpil ond hold lhe boby`s orn slill
ogoinsl her ribcoge.
n Woil / ninules.
n Reod lhe lenperolure ond record il.
n Shoke lhe lhernoneler down ogoin los oboveI
so il will be reody for use.
n Deconloninole lhe lhernoneler by sooking il
for 1O ninules in o O.5% chlorine solulion.
n Wosh lhe lhernoneler wilh cold woler ond
soop. Rinse wilh cold woler.
Sart|rr t|e A|rwa w|t| ar |lertr|r rr Ner|ar|ral
||rrtPampe1I Sart|rr Apparatas
n Moke sure lhe vocuun pressure of lhe nochine
is nol nore lhon 13 cn woler, 1OO nn Hg, or
13.3 kPo.
n llloch o cleon, sofl, F1O lFrench size 1OI
colheler wilh on end-hole lo lhe suclion
nochine.
n Ploce lhe lube no nore lhon 5 cn inlo lhe
boby`s noulh.
n lpply suclion while pulling lhe lube oul of lhe
boby`s noulh.
n To suclion lhe nose, ploce lhe lube no nore
lhon 3 cn inlo lhe noslril.
n lpply suclion while pulling lhe lube oul.
n Repeol for lhe olher noslril.
Bas|r Sk|lls frr Care rf t|e New|rrr 213
D
6eeZcY^m9
N0w !0 C0UN! !N| N|wB0kN'S
Bk|A!N|N AN0 N|Ak! kA!|
Nrw tr Crart t|e Ba|'s Breat||r]
n Look ol lhe boby`s chesl ond obdonen.
lNewborns ore obdoninol breolhers.I
n Hold o wolch or liner close lo lhe boby
so you con see lhe wolch ond lhe boby ol lhe
sone line.
n 0ounl lhe nunber of lines lhe chesl or
obdonen rises in one full ninule.
Nrw tr Crart t|e Ba|'s Neart kate
n Feel lhe boby`s chesl ond fnd lhe spol where
you con besl feel lhe heorlbeol.
n You noy olso use o slelhoscope, if ovoiloble, lo
lislen lo lhe heorlbeol.
n Hold o wolch or liner close lo lhe boby so you
con see lhe wolch ond lhe boby ol lhe sone
line.
n 0ounl lhe nunber of lines lhe heorl beols in
one full ninule.
N0w !0 w||N !N| N|wB0kN
n Ploce o cleon blonkel or clolh on lhe boby scole.
n ld|usl lhe boby scole so lhol il reods O wilh
lhe blonkel or clolh on il.
n Wrop lhe noked boby in lhe blonkel or clolh on
lhe scole.
n Weigh lhe wropped boby using core lo prevenl
in|ury.
n Nole lhe weighl when lhe boby ond lhe scole
slop noving.
n Wrile down lhe weighl.
n Ploce lhe boby bock in skin-lo-skin conlocl wilh
lhe nolher or in her orns.
N0w !0 |\| AN |N!|C!|0N
!0 A N|wB0kN

IHP0PTANT INF0PHATI0N
1. When drugs ore in|ecled, lhere is o high risk
of possing blood-borne diseoses, such os H\
or hepolilis, if lhe needle ond syringe ore nol
slerile.
2. To prevenl possing infeclious illnesses, olwoys
use slerilized syringes ond needles or new,
previously unopened syringes ond needles.
3. Deconloninole oll needles ond syringes
innediolely ofler use.
/. Dispose of single-use syringes ond needles
sofely in o shorps disposol conloiner ofler
deconloninoling lhen.
at|er t|e |a|pmert ra w|ll Nee1
n Syringe ond needle.
n Disposoble lnever used ond in o slerile
pockogeI, or o
n Reusoble syringe ond needle lhol hove
been slerilized
n The nedicolion lo be given
n lny fuid needed lo dilule lhe drug lslerile
soline solulion or dislilled wolerI
n 0leon woler ond gouze or collon
n Wosh your honds lhoroughly wilh soop ond
woler. Dry your honds on o cleon clolh or oir-dry.
Nake Sare ra Nae t|e Crrrert
Ne1|rat|rr |r t|e Crrrert 0rse
n Look corefully ol lhe lobel of lhe nedicolion
conloiner.
n Moke sure lhe none of lhe nedicolion
is correcl.
n Moke sure lhe expirolion dole hos nol
possed.
n Reod ony inslruclions for nixing lhe nedicolion
wilh o diluling fuid ldiluenlI.
n Look ol lhe dose of lhe nedicolion you need lo
give ond fgure oul how nuch of lhe nedicolion
you will need lo drow inlo lhe syringe.
21/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Nrw tr 0raw ap t|e Ne1|rat|rr:
n 0leon lhe rubber slopper ond push lhe needle
inlo lhe bollle of nixed nedicolion.
n Drow up lhe correcl dose in lhe syringe.
n Hold o nedicine bollle wilh o rubber slopper
upside down lo wilhdrow lhe drug.
n Wilhoul drowing oir inlo lhe syringe, inserl
lhe needle lhrough lhe rubber.
n Drow up lhe correcl onounl of nedicolion
inlo lhe syringe.
n Pull lhe needle oul of lhe bollle.
n Renove oll lhe oir fron lhe syringe.
n Hold lhe syringe wilh lhe needle poinling up.
n Top on lhe borrel of lhe syringe so lhol ony
oir bubbles rise.
n 0enlly expel oll lhe oir fron lhe syringe.
Nrw tr |rjert |rtr t|e Nasrle ||rtramasralarI
n Fxploin lo lhe nolher whol you ore going lo do.
n lsk lhe nolher lo hold lhe boby so lhe lhigh is
exposed ond held slill. l0r you con hold down
lhe knee so lhe boby connol kick.I
n Find lhe correcl in|eclion sile.
n 0rosp lhe nuscle of lhe upper onlerior lhigh.
n 0leon lhe skin wilh cleon woler. f you use
olcohol, lel il dry before in|ecling.
n n one quick novenenl, pul lhe needle slroighl in.
n Before in|ecling lhe drug, pull bock on lhe
plunger o lillle bil.
n Wolch lo see if ony blood cones inlo lhe
syringe.
n f blood is seen, loke lhe needle oul ond in|ecl
ogoin in o spol neorby.
n lgoin pull bock o lillle on lhe plunger lo
check for blood.
n Do nol in|ecl if lhere is blood os lhe drug is
likely lo go inlo o vein ond noy be hornful.
n n|ecl lhe drug slowly.
n Renove lhe needle ond wipe lhe skin ogoin.
n Deconloninole needle ond syringe. See
direclions on poge 21?.
Nrw tr N|t a 0ra] w|t| a 0|lat|r] |la|1
n 0pen lhe syringe ond needle pockel or
ossenble lhe reusoble syringe ond needle.
n Touch only lhe oulside of lhe syringe
borrel, lhe end of lhe plunger, ond lhe hub
of lhe needle.
n Do nol louch ony porl of lhe syringe ond
needle lhol will louch lhe clienl`s body.
n 0leon lhe drug conloinerlsI before use.
n f using o single dose onpule, cleon lhe gloss
neck wilh collon ond cleon woler or olcohol.
n f using o nedicine bollle wilh o rubber
slopper, cleon lhe rubber wilh collon ond
cleon woler or olcohol.
n Dilule o nedicolion lhol cones in powdered
forn.
n f lhe diluling fuid is in o gloss onpule, cleon
lhe onpule neck, cover lhe onpule neck wilh
o gouze or clolh lso lhol you will nol cul your
hondI, ond lhen breok il.
n Do nol lel lhe needle louch lhe oulside of lhe
onpule.
n Drow up inlo lhe syringe lhe correcl onounl
of lhe correcl diluling fuid.
n 0orefully drow up lhe fuid inlo lhe syringe.
Tip lhe onpule lo gel oll lhe fuid.
n Wilhdrow lhe needle ond syringe fron lhe
onpule ond hold lhe syringe so lhe needle
does nol louch onylhing. n|ecl lhe diluling
fuid lhrough lhe cleoned rubber slopper inlo
lhe bollle wilh lhe powdered nedicolion.
n Toke lhe needle ond syringe oul. Do nol lel
lhe needle louch onylhing.
n Shoke lhe nedicolion unlil il nixes conplelely.
Bas|r Sk|lls frr Care rf t|e New|rrr 215
D
6eeZcY^m9
Nrw tr |rjert Betweer t|e Sk|r |aers ||rtra1ermalI
n Fxploin lo lhe nolher whol you ore going lo do.
n lsk lhe nolher lo hold lhe boby so lhe orn is
exposed ond held slill.
n 0rosp lhe boby`s orn so lhe skin is lighl.
n 0leon lhe skin wilh cleon woler or olcohol. f you
use olcohol, lel lhe skin dry before in|ecling.
n Loy lhe syringe ond needle olnosl fol olong lhe
orn wilh lhe opening of lhe needle focing up.
n nserl lhe lip of lhe needle |usl under lhe skin
ond only o bil posl lhe opening of lhe needle.
n n|ecl lhe voccine.
n f lhe needle is in lhe correcl posilion, lhe
plunger is hord lo push ond you will see o
dislincl round swelling like o snoll blisler.
n f lhe voccine goes in eosily, lhe in|eclion noy
be loo deep. Slop in|ecling ond reposilion lhe
needle lo give lhe resl of lhe dose correclly.
n Renove lhe needle. Do nol wipe off lhe skin.
Nrw tr 0errrtam|rate t|e Nee1le ar1 Sr|r]e
n Fill lhe needle ond syringe wilh O.5% chlorine
solulion. Fill ond push oul solulion lhree lines.
n Dispose of deconloninoled single-use needles
ond syringes in o shorps disposol conloiner.
For reusoble needles ond syringes.
n Drop lhe needle ond syringe inlo lhe chlorine
solulion ond sook for 1O ninules.
n Wosh ond slerilize deconloninoled reusoble
needles ond syringes lsee lppendix 0I.
;><JG:9#( INTPAHU5CULAP INJECTI0N
21 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
ereral kefererres
Burns ll, Lovich R, Moxwell J, ond Shopiro K. l1??7I. where
women Fuve No 0octor. 0olifornio. The Hesperion Foundolion.
Klein S. l1??5I. / 8ook for HiJwives. 0olifornio. The Hesperion
Foundolion.
Sweel BR ed. l2OO2I. Hu,es HiJwifer,: / 7extbook for HiJwives.
12lh ed. London. Bollire Tindoll.
Froser DM ond 0ooper Ml, ed. l2OO3I. H,|es 7extbook for HiJ-
wives. 1/lh ed. Fdinburgh, UK. 0hurchill Livingslone.
\orney H, Kriebs, JM, ond 0egor, 0L. l2OO/I. \urne,s HiJwifer,.
/lh ed. Sudbury, Ml. Jones ond Borllelle Publishers.
6eeZcY^m: Crmmar|rat|rr ar1 Crarsel|r] 217
E
Two sis l~l e~l wo:e:s use ~s ~:l
o lei: wo: ~:e onnu:i~lio: ~:o
ou:sei:q Connu:i~lio: is ~ w~y o:
eoe lo s~:e e~ ole:s ioe~s,
louqls, ~:o eei:qs Cou:sei:q is ~ w~y
lo e soneo:e su ~s ~ nole:l n~e
~ oeisio: o: sove ~ :oLen Ly l~i:q
e:so:loe:so: Eelive onnu:i~lio:
sis e you lo ou:se Lelle:
E Connu:i~lio: ~:o Cou:sei:q
218 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
C0NNUN|CA!|0N
0onnunicolion is o lwo-woy infornolion-shoring
process lhol leods lo nuluol underslonding. n lhis
process eoch person.
n lclively shores his or her lhoughls ond feelings
n lclively lislens ond works lo underslond lhe
olher person`s lhoughls ond feelings
0onnunicolion con be done in olher woys besides
lolking. You con olso connunicole or send nessoges
lhrough body longuoge. lhe woy you hold your body,
your fociol expressions, looking ol lhe person when
you lolk, ond lhe lone of your voice.
0ood connunicolion skills ore inporlonl in helping
heollh workers successfully inlerocl wilh nolhers ond
fonilies. When you core for o nolher ond her newborn,
effeclive connunicolion skills help esloblish nuluol
conforl ond lrusl. f lhe nolher is conforloble ond
feels lrusl, she will lell you nore oboul herself, her
problens, ond her needs. She is olso nore likely lo
follow your reconnendolions, which will help ensure
lhol she ond her boby receive lhe besl possible core.
0ood connunicolion skills help heollh workers give
beller core.
;><JG::#& C0HHUNICATI0N BETWEEN
REALTR W0PKEP AND H0TREP
6eeZcY^m: Crmmar|rat|rr ar1 Crarsel|r] 21?
E
rr1 Crmmar|rat|rr Sk|lls
0ood connunicolion skills ore lechniques you con
use lo show lhe nolher or fonily lhol you core ond
respecl lhen ond lhol you wonl lo help. 0flen heollh
workers give core lo nony people in one doy. They
worry lhol using good connunicolion skills will loke
nore line. f il lokes nore line, lheir busy workdoys
will be even busier. Bul osk yourself. does il loke
nore line lo snile, lo noke eye conlocl, lo use o
genlle voice, lo use words lhe nolher underslonds?
0f course nol. nsleod, using good connunicolion
skills will help you lo give beller core ond noke lhe
nolher feel nore conforloble ond respecled.
0ood connunicolion skills olso include body lon-
guoge. f you use good body longuoge, olhers will feel
nore conforloble ond lrusl you nore quickly. l helps
o nolher lo feel nore confdenl in giving you infor-
nolion. However, you nusl renenber every geslure
or oclion you noke should be cullurolly oppropriole.
0erloin geslures noy nol be inlerpreled in lhe sone
posilive nonner in every cullure. To ovoid offending
people, leorn oboul whol is occeploble body longuoge
ond odopl your behovior occordingly.
0ood connunicolion skills help you receive ond give
infornolion nore conplelely ond effeclively. These
skills include.
S|rw|r] respert
Treol lhe nolher os soneone who con underslond
her boby`s heollh problens ond con noke good deci-
sions oboul core.
Nrt |e|r] ja1]mertal
Never blone o wonon for her or her boby`s problen,
cullurol proclices, or posl decisions she hos node.
Speak|r] rlearl ar1 as|r] wrr1s t|e mrt|er ar1erstar1s
For connunicolion lo hoppen, whol is soid needs
lo be underslood by bolh lhe heollh worker ond lhe
nolher. f possible, speok wilh lhe wonon in lhe lon-
guoge wilh which she is nosl conforloble.
||ster|r] art|el
n Lislen lo whol lhe nolher soys ond how she
soys il llone of voice, choice of words, fociol
expressions, ond gesluresI.
n Keep silenl sonelines. 0ive lhe nolher line lo
lhink, osk queslions, ond lolk. She noy fnd she
olreody knows sone of lhe onswers lo her
problen.
n Lislen corefully insleod of lhinking whol you ore
going lo soy nexl.
n 0ive feedbock lo show lhol you hove heord whol
lhe nolher is soying, for exonple, nod your
heod, soy yes. This encouroges lhe nolher
lo conlinue.
n 0ccosionolly rephrose or sunnorize whol lhe
nolher hos soid. Then bolh you ond lhe nolher
will know lhol you hove underslood.
n 0ive proise ond encourogenenl for posilive
behoviors or proclices.
Us|r] ]rr1 |r1 lar]aa]e
n Snile.
n Hove eye conlocl while lolking ond lislening.
n Use o genlle voice.
n Keep your body heighl ol lhe sone level os lhe
nolher`s.
n f oppropriole, louch lhe nolher genlly on her
orn or shoulder.
|rrrara]|r] t|e wrmar tr r|re |er rrrrerrs ar1 ask
aest|rrs
n lnswer her queslions honeslly.
n Be sure lo osk if she hos underslood your
response ond repeol explonolions if needed.
kespert|r] t|e wrmar's r|]|t tr make 1er|s|rrs a|rat |er
rwr |ealt| rare ar1 t|at rf |er |a|
n l is your responsibilily lo give lhe wonon oll lhe
infornolion she needs lo noke o decision, nol
lo noke lhe decision for her.
||ster|r] tr w|at t|e wrmar |as tr sa
n 0ive her enough line lo lell you whol she lhinks
is inporlonl.
n lvoid inlerrupling her while she is lolking.
22O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
To osk effeclive queslions.
n Use good connunicolion skills.
n lsk only one queslion ol o line. Woil wilh
inleresl for lhe onswer.
n Try nol lo slorl queslions wilh Why.
Sonelines Why sounds os if you ore fnding
foull.
n Use open-ended queslions lo encouroge o
nolher lo exploin her siluolion. 0pen-ended
queslions give lhe heollh worker nore inforno-
lion. 0losed-ended queslions require only o
yes or no onswer ond cul off discussion.
For exonple.
n l0pen-ended queslionI. Would you pleose
lell ne your reoson for coning lodoy?
n l0losed-ended queslionI. Did you cone
lodoy becouse your boby is sick?
n f lhe nolher does nol underslond, rephrose lhe
queslion.
|e asefal, rrrrert |rfrrmat|rr
No noller whol you ore counseling oboul, lhe infor-
nolion you give needs lo be correcl, cleor, ond useful
lo lhe nolher
Nelp t|e mrt|er ar1 |er fam|l make t|e|r rwr r|r|res
|ase1 rr rlear |rfrrmat|rr ar1 t|e|r rwr feel|r]s,
s|taat|rr, ar1 ree1s
lfler ossessing lhe fonily`s needs, offer recon-
nendolions loilored lo eoch fonily`s siluolion ond
resources. lfler you give counseling ond guidonce lo o
nolher or fonily, lhey usuolly decide lhenselves whol
lhey will do. People corry oul lheir own decisions besl.
This is why good counselors do nol noke decisions,
bul help olhers lo noke lheir own decisions. Sone-
lines you need lo be fexible. Whol you reconnend
noy nol be possible in every nolher`s siluolion. When
lhis hoppens, help her ond her fonily fnd o solulion
which works for lhen.
C0UNS|||N
J
0ood connunicolion skills ore on inporlonl porl of
counseling. When you counsel, you lolk person-lo-
person lo help soneone. 0ounseling helps o nolher
decide whol lo do ond how lo do il. f you use good
connunicolion skills, your counseling will be nore
effeclive.
rr1 Crarsel|r] Sk|lls
Nake t|e mrt|er feel welrrme
This shows lhol you core, helps lo relox lhe nolher,
ond builds lrusl.
n 0reel lhe nolher in o friendly ond respeclful
woy.
n f lhe nolher or boby will be exonined or hove o
procedure, exploin whol will hoppen.
n Provide privocy during lhe exoninolion,
counseling, or o procedure. Moke sure olhers
connol see whol is hoppening or heor whol is
being soid.
n 0ive reossuronce ond conforl if needed.
n Fncouroge lhe nolher lo osk queslions or voice
her concerns ol ony line during lhe visil.
Use effert|e aest|rrs
0ueslions ore on inporlonl porl of counseling. They
help you decide whol problens or needs lhe nolher
or boby hove. l is helpful, for exonple, lo fnd oul
whol she olreody knows oboul essenliol newborn core
ond if she ond her fonily ore currenlly proclicing ony
posilive newborn core behoviors. This will help you
idenlify ony problens or needs ond will guide you on
whol ond how lo counsel.
6eeZcY^m: Crmmar|rat|rr ar1 Crarsel|r] 221
E
!|e persrr rr|es
n l person noy cry for differenl reosons. lo
express sodness, lo win synpolhy, oul of slress
or nervousness, or lo slop furlher discussion.
Do nol ossune you know why lhe person
is crying.
n Woil for o while. f lhe crying conlinues, soy lhol
il is oll righl lo cry, il is o nolurol reoclion. This
pernils lhe person lo exploin lhe reosons for
crying. You noy osk lhe reosons genlly.
!|e rrarselrr rarrrt see a srlat|rr tr t|e
persrr's prr|lem
n 0ounselors noy feel onxious if lhey ore nol
sure whol lo odvise. You do nol hove lo solve
every problen for lhe person. Fxpress under-
slonding. Sonelines lhis is whol lhe person
reolly wonls. You con olso suggesl olhers who
could help.
!|e rrarselrr 1res rrt krrw t|e arswer tr
a persrr's aest|rr
n Fxploin honeslly ond openly lhol you do nol
know lhe onswer bul logelher you con fnd oul.
0heck wilh o supervisor, o knowledgeoble
coworker, or reference noleriols, ond give lhe
person lhe correcl onswer.
!|e rrarselrr makes a m|stake
n 0orrecl lhe nisloke ond soy you ore sorry. l is
inporlonl lo be correcl, bul il`s nol inporlonl lo
look perfecl. ldnilling o nisloke shows respecl
for lhe olher person.
n Be honesl. The nore honeslly you express your
own feelings when oppropriole lwilhoul reveol-
ing your personol lifeI, lhe eosier il is for lhe
olher person lo do lhe sone.
!|e persrr asks a persrral aest|rr
n n generol, lry nol lo lolk oboul yourself. This
lokes ollenlion owoy fron lhe olher person.
n You do nol hove lo onswer personol queslions.
The relolionship belween o person ond coun-
selor is o professionol one, nol o sociol one.
Nelp t|e mrt|er remem|er w|at tr 1r
When giving inslruclions, il helps o nolher
renenber if you.
n Keep inslruclions shorl, including lhe nosl
inporlonl poinls.
n Keep il sinple.
n Poinl oul whol lo renenber.
n 0ive lhe nosl inporlonl infornolion frsl.
n Show o piclure or give o denonslrolion os
you speok.
n Repeol lhe infornolion os o sunnory.
n lsk lhe person lo repeol whol you hove
exploined. This helps people renenber. 0enlly
correcl ony infornolion lhol is nissing or
incorrecl.
Pra|se t|e mrt|er frr rrm|r] ar1 rem|r1 |er rf |er
rett |s|t
n 0iving proise recognizes lhe nolher ond her
fonily`s efforls loword good heollh core.
n Fncouroge her lo cone for her nexl oppoinl-
nenl or whenever she hos o problen or she or
her boby experience ony donger sign.
Crarsel|r] C|aller]es
0ounseling is nol olwoys eosy. You noy hove siluo-
lions where il is hord lo know whol you should do.
Below ore sone siluolions you noy foce, olong wilh
suggeslions on whol lo do.
!|e persrr |s s|lert
n f lhe person is silenl ol lhe slorl of lhe neel-
ing, genlly coll ollenlion lo lhe silence. You
could soy, for exonple. con see lhol il is dif-
fcull lo lolk. l`s oflen lhol woy. wonder if you
ore feeling o lillle worried. Look ol lhe person
ond use body longuoge lhol shows enpolhy ond
inleresl. Woil for lhe person lo onswer.
n During discussion, silence con be oppropriole.
Sonelines lhe person is lhinking or deciding
how lo lolk oboul feelings or lhoughls. 0ive lhe
person line lo lhink.
222 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Nrte
1 ldopled fron. Populolion Reporls. l1??8I. 0/7FFR
0uiJe to 0ounse|in. Series J, Nunber /8.
lrssar 223
0oss~:y
De:ilio:s o Te:ns Useo i: le8VgZd[i]Z
CZlWdgcGZ[ZgZcXZBVcjVa
22/ Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Birtb defect. ln obnornolily in lhe slruclure or func-
lion of lhe boby, presenl ol birlh, lhol resulls in o
physicol or nenlol disobilily. l is o problen lhol lhe
boby is born wilh, for exonple, o clefl lip or clubfool.
See congenilol nolfornolion.
Birtb injury cr birtb trauma. ln in|ury lo lhe boby
coused by lhe lobor or birlh process.
BIister. l roised bunp on lhe skin lhol conloins
cleor liquid.
8VejihjXXZYVcZjb. Diffuse swelling produced on lhe
presenling porl of lhe boby`s heod during lobor. l is
usuolly reobsorbed wilhin o few doys ofler birlh.
CepbaIbematcma. Swelling on lhe newborn`s heod
coused by bleeding beneolh lhe periosleun lo nen-
brone covering lhe skull boneI. The swelling does nol
cross sulure lines ond groduolly disoppeors during
lhe weeks ofler birlh.
CIean deIivery. 0hildbirlh ollended by o heollh work-
er who follows lhe principles of cleonliness lcleon
honds, cleon surfoce, cleon culling of lhe cordI.
CcIcstrum. The frsl nilk secreled fron lhe nolher`s
breosl, which is high in nulrienls ond colories. l is
olso very high in vilonin l ond onlibodies which pro-
lecl lhe boby fron infeclion. 0oloslrun is oflen colled
lhe boby`s frsl innunizolion.
CcngenitaI maIfcrmaticn. l physicol or nenlol
problen o boby is born wilh, for exonple, o clefl lip
or on exlro fnger.
Ccntraindicaticns. 0ondilions or siluolions lhol noke
o nedicolion or lreolnenl dongerous. ln ollergy lo
penicillin, for exonple, is o conlroindicolion for giving
penicillin.
Danger sign. l sign or synplon lhol noy indicole
serious illness, life-lhreolening condilion, or olher
donger lo heollh or well-being.
Deccntaminaticn. The frsl slep in processing equip-
nenl for reuse. Deconloninolion kills nony surfoce
gerns ond nokes lhe equipnenl sofer for hondling
during lhe nexl sleps.
Debydraticn. Loss of body woler.
Abcrticn. Sponloneous loss of o pregnoncy or induced
lerninolion of pregnoncy before 22 weeks of geslolion
or below 5OO grons weighl of lhe felus.
AID5. lcquired innune defciency syndrone. Sick-
ness resulling fron infeclion wilh H\. See H\.
Amnictic huid. The liquid surrounding lhe felus inside
lhe ulerus.
Anemia. l condilion in which lhe blood is nol oble lo
corry enough oxygen lo oll lhe body becouse of o low
concenlrolion of red blood cells.
AntenataI care. 0ore given lo pregnonl wonen lo
inprove lheir heollh, lo delecl ond lreol ony problens
pronplly, ond lo inprove lhe oulcone of pregnoncy.
Fssenliol conponenls of onlenolol core include. oc-
lions ond lreolnenls lo pronole heollh ond prevenl
illness, heollh educolion ond counseling, helping
wonen ond fonilies prepore for birlh ond possible
energencies lincluding counseling on donger signsI,
ond eorly deleclion ond lreolnenl of pregnoncy con-
plicolions.
Antibictic. l nedicolion lhol fghls bocleriol infeclion.
Penicillin is one of nony onlibiolics.
Antibcdies. Subslonces in lhe blood lhol fghl infec-
lion, porl of lhe body`s innune syslen.
Anti-infective medicaticn cr drug. l nedicolion lhol
fghls infeclion-cousing nicrobes lgernsI. ncludes
onlibiolics.
Apnea. l condilion in which respirolions slop for nore
lhon 2O seconds.
Aspbyxia. When lhe boby does nol begin or susloin
odequole breolhing ol birlh.
Assessment. Delerninolion of o person`s condilion,
needs, or problens bosed on lhe infornolion you hove
collecled.
AxiIIary. Under lhe orn, in lhe oxillo or ornpil.
Bag cf waters. The soc of fuid lhol surrounds lhe
boby in lhe ulerus. The bog of wolers is node of nen-
brones lhol conloin lhe onniolic fuid.
lrssar 225
DeveIcpmentaI disabiIities. lbnornol or slow devel-
opnenl os lhe newborn grows inlo childhood.
Diagncsis. Medicol lern for lhe idenlifcolion of o
heollh problen bosed on signs ond synplons. n lhis
docunenl, il is equivolenl lo lhe slep in lhe decision-
noking process lhol uses infornolion fron lhe his-
lory, physicol exon, ond lob lesls lo help idenlify lhe
problens ond needs.
Diarrbea. Wolery slools.
DiIuent. Diluling fuid used lo dissolve nedicolion lhol
is in powder forn.
Distended. Swollen or infoled due lo excess fuid or gos.
Draft. l currenl of noving oir.
Endcspcre. l lhick-wolled reproduclive cell lor sporeI
produced by sone boclerio. The lhick woll nokes o
spore diffcull lo deslroy since il is very resislonl lo
heol. Prolonged exposure lo high heol is needed lo
deslroy endospores. Telonus is o lype of endospore-
forning boclerio.
Engcrgement. Swelling coused by on occunulolion of
excessive fuid, nilk, or blood.
Envircnment. Surroundings. For exonple, lhe roon
where boby core lokes ploce or lhe ploce where o
boby lives.
EssentiaI newbcrn care. n lhis nonuol essenliol
newborn core lFN0I refers lo lhe bosic core lhol every
boby should receive lo help ensure survivol ond well-
being. This essenliol core includes innediole core
ofler birlh os well os lhroughoul lhe frsl nonlh of life.
lllhough sone bobies lfor exonple, lhose who ore sick
or prenolureI noy need speciol core, FN0 helps en-
sure lhol lhe bosic heollh needs of oll bobies ore nel.
ExcIusive breastfeeding. Feeding on infonl only
breosl nilk wilhoul ony oddilionol food or drink lnol
even wolerI.
FetaI deatb. Deolh of o boby in lhe ulerus ofler 22
weeks of geslolion.
FetaI stetbcsccpe. l device lo lislen lo lhe felol
heorl beol during pregnoncy ond lobor. llso colled o
feloscope.
Fetus. The boby while in lhe ulerus.
Fissure. l norrow or very snoll opening, o slil, cul, or
breok in lhe skin.
FIaring ncstriIs. Noslrils lhol widen or nove wilh
eoch breolh.
FIexicn. Bending ol lhe |oinl.
FcntaneIIes. The sofl spols on o newborn`s heod
where lhe skull bones do nol neel. The onlerior
fonlonelle lon lop of lhe heodI is dionond shoped ond
eosily fell. The poslerior fonlonelle lbehind lhe onle-
rior fonlonelleI is snoller ond lriongulor or Y-shoped.
FcremiIk. The nilk lhol cones fron lhe breosl ol lhe
beginning of o feed. The forenilk is nore wolery lhon
lhe loler nilk of o feed llhe hindnilkI. The forenilk
helps keep lhe boby well hydroled.
FuII-term pregnancy. Thirly-seven lo forly-lwo con-
pleled weeks of pregnoncy.
Fungus Iea. fungi!. l kind of gern or nicroorgonisn.
Yeosl is o fungus.
6asping. To breolhe lespeciolly inholeI wilh shorl,
diffcull ond oudible breolhs. 0osping is o sign of o
serious breolhing problen ond requires resuscilolion.
6enetic ccnditicns. 0ondilions lhe felus inherils or
receives fron lhe porenls.
6erm. l generol lern for ony nicroorgonisn lhol
couses infeclions or infeclious diseose.
6estaticn. 0rowlh in lhe ulerus. 0eslolion is neo-
sured in weeks. Thirly-seven lo forly-lwo weeks`
geslolion is o full-lern pregnoncy.
6cncccccaI, gcncccccus. Refers lo lhe gern lhol
couses lhe sexuolly lronsnilled infeclion gonorrheo.
6rcwtb spurt. l shorl period of line when lhere is
ropid growlh.
6runting. Moking o sofl noise when breolhing oul.
22 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Lanugc. Fine, sofl hoir found oll over lhe body of lhe
felus excepl lhe polns of honds ond soles of feel. Lo-
nugo oppeors ol oboul fve nonlhs geslolion ond be-
gins lo shed oround seven lo eighl nonlhs geslolion.
Prenolure bobies lend lo hove nore lonugo, ollhough
il noy olso be presenl in lern newborns. Lonugo will
disoppeor wilhin o few doys or weeks ofler birlh.
Letbargy. Sluggish or hoving obnornol drowsiness.
Lock of energy oflen cousing reduced oclivily.
Live birtb. 0onplele birlh of o boby fron lhe nolher,
ol ony sloge of lhe pregnoncy, ofler which lhe boby
breolhes or shows ony evidence of life.
Lcw birtb weigbt. Hoving o birlh weighl of less lhon
2,5OO grons.
ery Icw birtb weigbt. Hoving o birlh weighl of
1,5OO grons or less.
HaIfcrmaticn. l physicol defornily o boby is born
wilh. See congenilol nolfornolion.
Heccnium. Dork, greenish-block, slicky slool lhol
forns in lhe boby`s inlesline while she is in lhe ulerus.
Meconiun is lhe frsl slool lhe newborn posses. f
neconiun is possed while lhe boby is slill in lhe
ulerus, il couses yellow, brown, or green sloining of
lhe onniolic fuid.
HiIia. Tiny llhe size of o pin heodI, while bunps on lhe
newborns foce. This is o nornol fnding. There is no
pus or redness of lhe skin.
HcIding. 0honge in shope of lhe boby`s heod os il
noves lhrough lhe birlh conol.
Hcnitcr. To reossess on o regulor bosis, for exonple,
lo observe lhe newborn frequenlly lo ossess his
breolhing ond wornlh.
Hcncgamcus. Hoving only one sexuol porlner ol o line.
Huccus membranes. The noisl lining of sone or-
gons. For exonple, lhe inside of lhe noulh ond lhe
lining of lhe eye.
Necnate. l newborn, o boby in lhe frsl 28 doys of life.
RindmiIk. The nilk lhol cones fron lhe breosl ol lhe
end of o feed. The hindnilk conloins nore fol lhon lhe
frsl nilk of o feed llhe forenilkI. The hindnilk is rich
in energy.
RI. Hunon innunodefciency virus. H\ ollocks lhe
diseose-fghling linnuneI syslen in lhe body.
RyperbiIirubinemia. Fxcess bilirubin in lhe blood
fron deslroyed blood cells. High levels of bilirubin ore
dongerous lo lhe newborn ond noy horn lhe broin.
See |oundice.
Rypertbermia. Fever, when lhe boby`s oxillory len-
perolure rises obove 37 0 l?8. FI.
Rypctbermia. Low oxillory lenperolure, below 3 0
l?.8 FI.
Rypcxia. Lock of enough oxygen in lhe body lissues.
Immunizaticns. Medicolions lonlibodies or voccinesI
given lo prevenl cerloin illnesses.
Indrawing cf tbe cbest. When lhe skin belween lhe
ribs ond oround lhe neck is drown in wilh eoch breolh.
ndrowing is o sign of breolhing diffcully. llso colled
chesl relroclion.
Infant. l boby fron birlh lhrough lhe frsl yeor of life.
Infant mcrtaIity. Deolh of infonls wilhin lhe frsl yeor
of life. The infonl norlolily role is expressed per 1,OOO
live birlhs.
Infcrmed cbcice. The clienl freely nokes o decision
bosed on conplele, occurole, useful infornolion.
Jaundice. Yellow color of lhe skin ond eyes. n new-
borns il noy be coused by excess bilirubin lhyperbili-
rubinenioI fron excess blood cells lhol ore deslroyed.
Kangarcc Hctber Care. o nelhod of keeping lhe
boby worn lhrough conlinuous skin-lo-skin conlocl
belween ond nolher ond her newborn.
lrssar 227
Pcsture. The posilion lhe body is held in by |oinls ond
nuscles. The poslure of lhe nornol lern newborn is
fexed wilh orns ond knees benl.
Pre-ecIampsia. l condilion in pregnoncy nonifesled
by high blood pressure ond prolein in lhe urine. Lole
signs ore edeno of lhe foce, visuol chonges, severe
heodoche, ond upper obdoninol poin. Pre-eclonp-
sio noy progress lo life-lhreolening eclonpsio wilh
convulsions ond fls.
Premature, Prematurity. l boby who is born before
her body is nolure, lhol is, before 37 weeks geslolion.
Becouse bobies nolure ol differenl roles, lhe word
prelern is oflen preferred.
Preterm. l boby who is born before 37 weeks of
geslolion.
Preterm birtb. Delivery of lhe boby before 37 weeks
geslolion.
ery premature cr preterm infant. l boby
delivered ol less lhon 32 weeks geslolion.
Puncture-resistant ccntainer. l conloiner lhol
connol be pierced by needles or blodes.
PustuIe. l roised skin bunp conloining pus.
PuruIent discbarge. Droinoge of liquid lhol conloins pus.
Pesuscitaticn. lclions lo help o boby slorl ond noin-
loin breolhing.
Pewarm. To lreol hypolhernio by worning lo bring
lhe boby`s lenperolure bock lo nornol.
PPP. Ropid plosno reogin. l blood lesl for syphilis.
5creening test. l lesl given lo o group of people lo
delecl condilions or diseoses lhol ore connon in o
cerloin region or oge ronge. Screening con be done
even if lhere ore no signs or synplons of o diseose in
o porliculor person. For exonple, lesling oll pregnonl
wonen during onlenolol core for syphilis or onenio is
o forn of screening.
5crctum. l soc of lissue lhol holds lhe lesles. The
scrolun is locoled ol lhe bose of lhe penis.
5epsis. l lern for generolized infeclion. Neonolol
sepsis, for exonple, refers lo o newborn wilh signs of
serious infeclion.
NeuraI tube defect. ln opening or weokness in lhe
lissues olong lhe roule of lhe spinol cord ond broin.
The defecl noy be under lhe skin ond nol visible lo lhe
eye or noy nol be open. f lhe neurol lube defecl is open,
o soc of nenbrones or o snoll hole noy be seen.
NeurcIcgicaI disabiIities. lbnornol developnenl of
lhe broin ond nervous syslen.
Newbcrn. l boby fron birlh lhrough lhe 28lh doy of
life, o neonole.
Newbcrn deatb cr necnataI deatb. The deolh of o
live-born boby during lhe neonolol period.
EarIy newbcrn deatb cr earIy necnataI deatb.
Deolh of o boby during lhe frsl seven doys of life.
Late newbcrn deatb cr Iate necnataI deatb. Deolh
of o boby occurring ofler lhe 7lh doy of life bul
before 28 doys of life.
Newbcrn pericd cr necnataI pericd. The frsl 28
doys of life.
EarIy necnataI pericd. The frsl seven doys of life.
0raI. Referring lo lhe noulh, os in orol lhrush, o
noulh infeclion.
0xygen. The gos in lhe oir lhol supporls life. 0xygen
is corried by red blood cells lo oll porls of lhe body.
PaIate. The roof of lhe noulh.
Partcgrapb. l chorl used lo nonilor lobor progress
ond nolernol ond felol condilion. The porlogroph
includes o grophic record of lobor lo help idenlify
obnornol lobor. When coregivers use lhe porlogroph
lo idenlify nolernol ond felol problens, lhey con in-
lervene quickly wilh lifesoving oclion. The porlogroph
con reduce felol ond nolernol norlolily ond norbidily
ond prevenl unnecessory cesoreons.
PerinataI deatb. ncludes bolh inlroulerine deolhs of
feluses l~5OO gronsI ofler 22 weeks of pregnoncy ond
deolhs which occur during lhe frsl week of life, bolh
slillbirlhs ond eorly neonolol deolhs.
PerinataI pericd. Fron 22 weeks of geslolion unlil
seven conpleled doys ofler delivery.
PIugged miIk duct. 0bslruclion of one of lhe snoll
nilk ducls in lhe breosl.
228 Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
Treatment. l nelhod used lo core for o heollh prob-
len. Treolnenls con include. nedicolions, heol or
cold opplicolions, dressings, woshing, odvice oboul
foods lo eol or ovoid, resl, exercises. Treolnenls ore
porl of o plon of core.
Unrestricted cr demand feeding. Lelling lhe boby
feed for os long ond os oflen os he likes lon denondI.
UmbiIicaI ccrd. The cord connecling lhe felus lo lhe
plocenlo.
UmbiIicus. The oreo where lhe unbilicol cord wos ol-
loched lo lhe boby`s obdonen, lhe novel.
Uretbra. The slruclure lhol corries urine lo lhe
oulside of lhe body. n lhe nole lhe urelhro nornolly
opens ol lhe end of lhe penis. n lhe fenole lhe ure-
lhro nornolly opens onlerior lo lhe vogino ond below
lhe cliloris.
Urinary tract. The kidneys, urelers, blodder, ond
urelhro.
Urinaticn. The ocl of possing urine, voiding, enplying
lhe blodder.
accine. l nedicolion lhol helps lhe body build in-
nunily, or resislonce, lo o porliculor infeclious illness.
DPL. \enereol Diseose Reseorch Loborolory. l
screening lesl for syphilis.
entiIate. To blow oir inlo lhe boby`s lungs using
eilher noulh-lo-noulh or bog ond nosk.
ernix. l whilish, creony subslonce lhol covers lhe
felus in lhe wonb lo prolecl lhe skin. lfler birlh lhe
vernix is seen noslly in body creoses. l is obsorbed
groduolly ond need nol be woshed off.
isuaI disturbances. 0honges in o person`s obilily lo
see. This includes spols in lhe vision, blurred vision,
ond double vision.
5epticemia. nfeclion in lhe blood slreon.
5barps. lny equipnenl lhol is shorp lrozor blode,
needle, surgicol knife blodeI. Shorps nusl be discord-
ed corefully lo ovoid piercing lhe skin of onyone who
cones in conlocl wilh lhe lrosh.
5kiIIed birtb attendant. l person wilh nidwifery skills
le.g., nidwife, nurse, nurse-nidwife, or doclorI who
hos been lroined lo nonoge nornol pregnoncy, lobor,
birlh, ond lhe innediole poslporlun ond newborn
periods ond lo nonoge or refer conplicolions.
5kin-tc-skin ccntact. Plocing o boby lnoked excepl for
o dioper ond o heod coveringI on lhe nolher`s chesl
ond covering lhen bolh. Using lhe nolher os o heol
source for lhe boby.
5pcnge batb. Woshing o boby by wiping wilh o clolh
wel wilh worn woler ond soop wilhoul pulling lhe
boby`s body in woler.
5tiIIbirtb. The delivery of o deod boby who died
soneline ofler 28 weeks of pregnoncy ond
before lhe birlh.
5tump. 0ord slunp is lhe piece of unbilicol cord lefl
olloched lo lhe boby`s obdonen ofler lhe cord is cul.
Testes. The nole reproduclive glonds, locoled in o soc
of lissue lscrolunI ol lhe bose of lhe penis.
Tetanus. l diseose coused by loxic spores lhol ore
releosed fron 0|ostriJium tetuni, o boclerio lhol grows
in deod lissues ond decoying noller. Tronsnission
occurs when lhere is conlocl belween lhe boclerio
ond ony broken skin or deod lissues, such os o wound,
circuncision, or when on infonl`s unbilicol cord is
cul. 0onnon signs of lelonus include nuscle sposns
of lhe |ow llock|owI ond bock. f nol lreoled properly,
newborn lelonus con leod lo deolh.
Transmissicn. The possing of sonelhing fron one
person lo onolher, such os lronsnission of on infeclion.
kefererre |||rar 22?
Ree:e:e LiL:~:y
0e:e:~ :ee:e:es o: :ewLo:: e~l ~:o
:ewLo:: ~:e
23O Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ
|rterret resrarres
www.oidsinfo.nih.gov/guidelines
www.breoslfeedingbosics.org/
www.heollhynewborns.con
This is lhe offciol sile of lhe Heollhy Newborn
Porlnership wilh links lo resources on newborn issues
ond lhe websiles of porlicipoling inslilulions.
www.nnh.|hpiego.org/
This sile gives on overview of lhe Molernol ond Neo-
nolol Heollh Progron. l includes direcl links
lo publicolions ond lechnicol resources.
www.sovelhechildren.org/
The Sove lhe 0hildren websile conloins
exlensive noleriol oboul Soving Newborn Lives
ond ils progron iniliolives
www.who.inl/child-odolescenl-heollh/
NUTRT0N/H\infonl.hln
This WH0 docunenl focuses on H\ ond infonl
feeding, porliculorly breoslfeeding. lccess lo six
inporlonl docunenls is provided.
www.who.inl/child-odolescenl-heollh/
NewPublicolions/NUTRT0N/updl-1/.hln
ln updole on 8reustfeeJin 0ounse|in: / truinin
course is ovoiloble ol lhis sile.
www.who.inl/reproduclive-heollh/rlis/nlcl
This WH0 docunenl provides generol infornolion
on nolher-lo-child lronsnission of H\, os well os
WH0 reconnendolions for onlirelrovirol drug use
lneviropineI lo prevenl MT0T.
l0NM. l1??8I. Life suvin Ski||s. 3d ed. Woshinglon,
D0. lnericon 0ollege of Nurse-Midwives.
Beck D, Buffnglon, ST, McDernoll J, ond Berney K.
l1??8I. Feu|th, Hother unJ Feu|th, Newborn 0ure: /
reference for cure ivers. Woshinglon, D0. lnericon
0ollege of Nurse-Midwives.
Kinzie B ond 0onez P. l2OO/I. 8usic Huternu| unJ New-
born 0ure: / uiJe for ski||eJ proviJers. Bollinore, MD.
MNH Progron/JHPF00.
Lown J, Mc0orlhy B, ond Roe Ross S. l2OO1I. 7he
Feu|th, Newborn: / reference munuu| for prorum
munuers. lllonlo, 0l. 0D0/00H/0lRF.
Tiel|en L, Bosseneyer D, ond Mcnlosh N. l2OO3I.
lnfection Prevention 0uiJe|ines for Feu|thcure Fuci|ities
with LimiteJ Resources. Bollinore, MD. JHPF00.
World Heollh 0rgonizolion. l2OO3I. Prenunc,, 0hi|J-
birth, Postpurtum, unJ Newborn 0ure: / uiJe for essen-
tiu| pructice. |lnteruteJ Hunuement of Prenunc, unJ
0hi|Jbirthl. 0enevo. WH0.
World Heollh 0rgonizolion. l2OO3I. Hunuin Newborn
Prob|ems: / uiJe for Joctors, nurses unJ miJwives
|lnteruteJ Hunuement of Prenunc, unJ 0hi|Jbirthl.
0enevo. WH0.
World Heollh 0rgonizolion. l2OO2I. Prevention of
Fospitu|-/cpuireJ lnfections: / pructicu| uiJe. 0enevo.
WH0. lWH0/0DS/0SR/FPH/2OO2.12I
World Heollh 0rgonizolion. l2OOOI. Hunuement of the
0hi|J with u Serious lnfection or Severe Hu|nutrition:
0uiJe|ines for cure ut the frst-referru| |eve| in Jeve|op-
in countries. 0enevo. WH0. lWH0/F0H/0lH/OO.1I
World Heollh 0rgonizolion. l2OOOI. Hunuin 0omp|i-
cutions in Prenunc, unJ 0hi|Jbirth: / uiJe for miJ-
wives unJ Joctors |lnteruteJ Hunuement of Prenunc,
unJ 0hi|Jbirthl. 0enevo. WH0. lWH0/RHR/OO.7I
World Heollh 0rgonizolion. l1??8I. 8usic Newborn
Resuscitution: / pructicu| uiJe. 0enevo. WH0. lWH0/
RHT/MSM/?8.1I
World Heollh 0rgonizolion. l1??3I. 8reustfeeJin
0ounse||in: / truinin course. 0enevo. WH0. lWH0/
0DR/?3.3-5I
|r1et 231
:oex
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ 232
Birlh
environnenl for, 2-27
equipnenl ond supplies for, 2-27
innediole core for newborn ol
dry ond slinulole, 2?
eorly iniliolion of breoslfeeding, 31
eye core, 31-32
ropid ossessnenl, 3O
lying ond culling lhe cord, 3O
worning, 3O-31
preporolion for, 25-28
record keeping, 2, 33
Birlh plon, 1-17
Birlh spocing, 21, ?
Birlh weighl, 37, /1, 11O
Bleoch, 187, 18?-1?O
Bleeding
in pregnoncy, 1
fron lhe unbilicol cord, 1/, 15O
Body longuoge, 21?
Boiling
fosh boiling of expressed breosl nilk, 72
nelhod of HLD, 1?2
Bollle feeding, 73
Breosl obscess, 85
Breoslfeeding
odvonloges of, O-1
ollernolives for H\-posilive nolher, 71
ollochnenl, 3-5
boby of H\-posilive nolher, 71-73, 77
benefls of, O-1
counseling on, /, 8-?, 71-73
on denond,
durolion of feeds, /
eorly iniliolion, 31, 2-5
eorly weoning, 72
exclusive, 2-3, ?
frequency, , 8
low birlh weighl boby, 12O-121
nonogenenl of problens, 7/-85
posilions for, /, -8, 7-77
problens, 7/-?O, 127
replocenenl feeding, 73
self-ollochnenl, 3
sick boby, 8
lwins, 7O
ond woler requirenenl, 2-3
Breosl infeclion, 75
lbdonen, 37, /O
lclive lislening, 218-21?
lclivily ond novenenl, 3, 3?
lFlSS, 72
lirwoy, cleoring lhe, 1OO, 211-212
llcohol hondrub, 187-188
lnbu bog, ?5, 1OO-1O1
lnoxicillin, 171
lnpicillin, 13, 171
lnenio, 15
lnlenolol core, 1/-17
lnlibiolics, frsl dose of, 12?
lnlirelrovirol drugs, 18-1?, 17, 17-177
lnus, 37, /O
lreolo, /-5
lsphyxio, ?/
lspirolor, De Lee or punp, 211-212
lllochnenl lo lhe breosl, /-5
lssessnenl
during lhe frsl doy, 32, 3/
ropid ol birlh, 3O
lulocloving, 1?3-1?/
lZT, 17, 177
Bock, 37, /O
Bog-ond-nosk venlilolion, 1OO-1O1
Bosic skills
ossessing o newborn`s lenperolure, 212
counling o newborn`s heorl role, 213
counling o newborn`s respirolory role, 213
felol heorl role ossessnenl in lobor, 21O
giving in|eclions lo o newborn
inlrodernol in|eclion, 215
inlronusculor in|eclion, 21/-215
suclioning o newborn`s oirwoy
before birlh of lhe body, 1OO, 21O
ofler delivery, 1OO, 211-212
weighing o newborn, 213
Bolhing lhe newborn, 52
B00, 15-157
Bed nel, inseclicide-lreoled, 15
Benzolhine penicillin, 13, 172
Birlh osphyxio, ?/
Birlh ollendonl, 17
|r1et 233
Breosl nilk
odvonloges or benefls, 1
coloslrun, 2-3
cup feeding, 88-8?
expressing, 8-87
heol lreolnenl, 72
nol enough, 8, 7/, 78-7?
sloroge, 8, 88
subslilules, 73
vilonin l, 3, 8
Breolhing problens, 127, 13O, 132
Bulging fonlonelle, 3?
0obboge leoves, 81
0uput succeJuneum, 3
0eflrioxone, 1/
0epholhenolono, 3?
0hesl, 37
0hlorine
bleoch, 187, 18?-1?O
powder, 1?O
loblels, 1?1
0leon delivery, 18
0leoning, spills, 2O2-2O/
0leoring lhe oirwoy, 1OO, 21O-212
0lefl lip, clefl polole, /O
0lolrinozole, 172
0loxocillin, 173
0old, 28, 31, /1
0olor, 3O, 32, 3, 38, 1/, 1/8-1/?
0oloslrun, 2-3
0onnunicolion, 218-21?
0onnunily, supporl of breoslfeeding, O
0onpresses, worn wel, 81
0on|unclivilis. See Fye infeclion
0onloninolion, 18-187, 18?, 1?5-1??, 2O/-2O
0onlroclions lulerineI, 21
0onvulsions, 127, 133
0ord
core, 53
culling, 3O
infeclion, 127, 13O-131, 13/-135, 15
slunp, 3O
0ounseling
on breoslfeeding, /, 8-?, 71-73
on donger signs, 1, 1?, 21, 55
H\-posilive nolher, 71
on infonl feeding, 2-7O
on newborn core, 5O-55
ofler resuscilolion, 1O/-1O
0ounseling skills, 22O-221
0rocked nipples, 7-77
0up feeding, 88-8?
0yonosis, 3O, 3, 38
Donger signs
counseling on, 1, 1?, 21, 55
in lobor ond delivery, 1?-21
newborn, 112, 12-128
in lhe poslporlun period, 21
in pregnoncy, 1,
Deolh, neonolol, 2-3, 1OO, 1O
Delivery
drugs for, 27
energency core, 1/, 1
preporolion for, 2-27
Decision-noking opprooch, 5, 12
Deconloninolion, 18?, 2O2
Deconloninolion solulion, 18?-1?O, 2O2
Dehydrolion, 3?, 1/5
Delivery, 18
Delivery kil, 27
Denond feeding,
Diobeles, /1
Diffcully breolhing, 38, 55, 1OO, 1O5, 127, 13O, 132
Dischorge
fron lhe eyes, 55, 138-13?
fron lhe unbilicus, 127, 13O, 13/-135
voginol, 1, 1?, 37
Disinfeclion, 2O2
Disposol
of shorps, 2O1, 2O
of wosles, 2O/-2O
Dry heol slerilizolion, 1?5
Drying lhe newborn, 28-2?
Forly weoning, 72
Fnergency lreolnenl, 128
Fngorgenenl, 75, 8O-81
Fquipnenl
for birlh, 27
cleoning ond disinfecling, 21/-215
for resuscilolion, ?5
sloroge, 1?5
Frylhronycin, 1/, 173
Fssenliol newborn core, 25
Fxoninolion of lhe newborn
follow-up, 7, /3-/5, /7-/8
innediole, 33-/1
Fxclusive breoslfeeding, 2-3, ?
Fxpressing breosl nilk, 8-87
Fye core, 31-32
Fye infeclion, 127, 138-13?, 1/, 1?
Fyes, 3, /O
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ 23/
Hepolilis B, 15-157
High-level disinfeclion lHLDI, 1?2
High lenperolure, 127, 1//-1/5
Hindnilk, /,
Hislory loking, , 33
H\/lDS
ond breoslfeeding, 71-73, 77
inforned choice for feeding, 71
nolher-lo-child lronsnission, 71-73
prevenlion wilh onlirelrovirols, 18-1?
slondord precoulions, 18-187
lronsnission. See MT0T
Holder posleurizolion, 72
Hookworn, 15, 178
Housekeeping, 2O2-2O3
Hyperlhernio, 1/2, 1//-1/5
Hypoglycenio, /1, 113
Hypolhernio
couses of, 1/2
prevenlion, 28-2?
recognilion of, 127, 1/2-1/3
reworning, 1/3
Hypoxio, ?/, ?-?7
denlifying needs ond problens, 8-?, 35
nnediole core of lhe newborn, 2?-3O
nnune syslen, 23, 51
nnunily
coloslrun, 3
vilonin l, 5/, 3, 17?
nnunizolions
for lhe boby, 53, 15-158
for lhe nolher, 15, 15/-155
nperforole onus, /O
ndrowing of lhe chesl, 127, 132
nfeclion prevenlion
deconloninolion, 18?, 2O2
gloves ond proleclive clolhing, 1?-2OO
hondling shorps, 2O1
hondwoshing, 187-188
slerilizolion, 1?3-1?
wosle disposol, 2O/-2O
nfeclions, nolernol
H\/lDS, 15, 18-1?, 1/7, 17-177
nolorio, 15, 178
poslporlun, 21
wilh prenolure ruplure of
nenbrones, 1, 1/7, 171, 173
syphilis, 15, 1/-1/7, 172
luberculosis, 1/7
Fonily plonning, 11, 21
Feeding
odvice for H\-posilive nolher, 71-73
by cup, 88-8?
Felol dislress, 2O-21
Felol heorl lones or felol heorl role, 2O-21, 21O
Fever, /1, 1/2, 1//-1/5, 1/7
Floning of inslrunenls, 1?1
Floring noslrils, 38, 132
Flosh boiling of breosl nilk, 72
Floppiness, lock of lone, 38, 112
Fluids, need for
nolernol 2, , 7O
newborn, 2-3
Folic ocid, folole, 15
Follow-up of low birlh weighl, 112, 11-117
Follow-up visils
checklisl, /?
counseling, /2, 55
equipnenl ond supplies, /3
poslnolol core, /2-/?
poslporlun, /2
preporolion for, /2
Fonlonelles, 3?, /2
Forenilk,
Full lern lgeslolionol ogeI, 11O
0oin of weighl, /8
0osping, 1OO, 127, 132
0enilol orgons, 37, /1
0enlonicin, 15, 17/
0enlion violel, 15, 17/
0eslolionol oge, 11O
0loves
exoninolion, 1?-1?7
pulling on, 1?8-1??
renovol of, 1??
reprocessing of, 1?8
slerile, 1?7-1?8
surgicol, 1?7-1?8
ulilily, 1?-1?7
when lo use, 1?-1?8
0rowlh, 7/
0rowlh spurls, 8, 78
0runling, 132
Hondrub, 187-188
Hondwoshing, 35, 51, 187-188
Heod, 3, 3?, /2
Heol loss, newborn, 28-2?
Heol lreolnenl of breosl nilk, 72
Henorrhoge, /2
|r1et 235
nfeclions, newborn
eye, 138-13?, 1/, 1?
generolized, 13O, 133, 1/-15
locolized, 13O, 13/-137
orol lhrush, 138, 1/O-1/1, 15-1
prevenlive neosures, 51
sepsis, 13O, 133, 1/-15
skin, 131, 13-137, 15
syphilis, 15, 1/-1/7
lelonus, 15, 127, 13O, 15/-155
luberculosis, 157, 1
unbilicol cord, 13O-131, 13/-135
nforned choice, 71
niliolion of breoslfeeding, eorly, 31, 2-5
n|eclions, how lo give lo o newborn, 213-215
nseclicide-lreoled bed nels, 15
nslrunenls
cleoning, 18?-1?1
for cord culling, 27, 3O
deconloninolion, 18?-1?1
high-level disinfeclion, 1?2
slerilizolion, 1?3-1?5
nsuffcienl nilk. See Nol enough nilk
nleroclion belween nolher ond boby, 51, 1, 73
ron ond folic ocid liron/fololeI, 15, 17?
soniozid, 1
Joundice
nornol lphysiologicI, 1/
serious, 127, 1/
Kongoroo nolher core lKM0I, 118-12O
Keeping lhe boby worn, 28-2?, 5O, 118
Lobor
core of lhe nolher during, 18-1?
prenolure, 1?
prolonged, 1?
Lobor noniloring, 18
Loborolory lesls, 7
LlM lloclolionol onenorrheo nelhodI, ?
Lelhorgy, 5O, 1//
Line deposils, 1?1
Linens, 1?
Loose cord lie, 1/, 15O
Low birlh weighl, 11O-111
Low birlh weighl boby
core of, 112-117
counseling, 111, 121
feeding, 12O-121
follow-up of, 112, 11-117
idenlifcolion of, 112
infeclion prevenlion, 113
kongoroo nolher core lKM0I, 118-12O
problens of, 113
lenperolure conlrol, 113, 118
Low blood sugor, /1, 113
Low lenperolure, 1/2-1/3
Molorio
inlernillenl prevenlive lreolnenl lPTI, 15, 178
prevenlion, 15, 178
Moslilis
couses, 75
nonogenenl of breoslfeeding in cose of, 85
synplons, 8/
lreolnenl, 85, 173
Molernol donger signs, 1, 1?, 21
Molernol heollh
onlenolol core, 15-17
H\/lDS, 18-1?, 1/7, 17-177
infeclion during lobor, 1/-1/7, 17
nolorio, 15, 178
nolnulrilion, 111
syphilis, 1/, 172
luberculosis, 1/7
Molernol nulrilion, 13-1/, 8
Mebendozole, 178
Meconiun, 1OO
Meconiun ospirolion, ?
Meconiun-sloined onniolic fuid, 2O-21, ?, 1OO
Medicol wosle, disposol of, 2O/-2O
Menbrones, prolonged ruplure of, 1/7, 171, 173, 17
Melronidozole, 175
Milk ducl, plugged, 75, 82-83
Moniloring of lobor, 18
Moniloring ofler resuscilolion, 1O2, 1O/
Morlolily
couses of neonolol, 3
infonl, 2
neonolol, 1-2
Molher-lo-child lronsnission of H\ lMT0TI
onlirelrovirols, 1?, 17, 17-177
breoslfeeding, 71
prevenlion, 18-1?, 71
websiles, ?2
Care rf t|e New|rrr kefererre Naraal HVk^c\CZlWdgcA^kZh>c^i^Vi^kZ 23
Plon of core, 1O
Plugged nilk ducls, 75, 82-83
Polyvidone iodine solulion, 32, 135, 137, 1?
Poor sucking, /, 127, 133
Posilion for resuscilolion, ?8-??
Posilioning for breoslfeeding, /, -8, 7-77
Posilions for breoslfeeding lwins, 7O
Poslnolol core, lhe frsl 28 doys, /2-/5
Precoulions, slondord, 18-187
Pregnoncy, prevenlive neosures in, 1/-15
Prenolure or prelern bobies, 11O, 112
Prelorio posleurizolion, 72
Prevenlion
of heol loss, 28-2?
of infeclions, 25
of MT0T of H\, 71
Processing
inslrunenls ond olher equipnenl, 18?-1?5
linens, 1?
Prolonged ruplure of nenbrones, 1/7, 171, 173, 17
Proleclive clolhing, 2OO
Puslules, 131, 13-137, 15
Pulling on gloves, 1?8-1??
Rosh, dioper lnoppy roshI,
131, 13-138, 1/O-1/1, 15-1
Record keeping, 11, 2, 33
Referrol
crilerio, 128
guidelines, 12?
of low birlh weighl boby, 115, 117
ofler resuscilolion, 1O5
Renovol of conloninoled gloves, 1??
Replocenenl feeding, 73
Respirolion, 3, 38
Respirolory problens or diffcully or dislress. See
Breolhing problens
Resuscilolion of newborn
bog-ond-nosk, 1OO-1O1
cleoning equipnenl used for, 1O7
counseling/supporl for fonily, 1O/-1O
equipnenl ond supplies for, ?5
idenlifcolion of need for, ?8
noniloring ofler, 1O2
noulh-lo-noulh venlilolion, 1OO
oulcones of, 1O/-1O
posilion for, ?8-??
preporolion for, ?5
referrol ofler, 1O2, 1O5
sleps of, ??-1O3
sunnory, 1O3
Moulh, 37, /O
Moulh-lo-noulh venlilolion, 1OO
Mucus exlroclor, 1OO, 211-212
Neonolol norlolily, 1-2
Neonolol sepsis, 13O, 133, 13, 15
Neviropine, 17, 17
Newborn
core
during lhe frsl doy, 32-33
innediole, 2?-3O
ofler resuscilolion, 1O/-1O5
deolhs, 1-3
exoninolion
in lhe frsl hours of life, 33-/1
focused, 7
follow-up, 7, /3-/5, /7-/8
ropid ossessnenl ol birlh, 3O
needs, 5O-51
referrol guidelines, 12?
resuscilolion. See Resuscilolion of newborn
Nipples, sore or crocked, 7/, 7-77
Noisy breolhing, 127, 132
Nol breolhing, ?8
Nol enough nilk, 8, 7/, 78-7?
Nol sucking, 3?, 127, 133
Nyslolin, 1, 175
0bservolion of breoslfeeding, //-/5, /
0n denond breoslfeeding,
0phthu|miu neonutorum. See Fye infeclion
0rol polio voccine l0P\I, 15, 158
0rol lhrush, 138, 1/O-1/1, 15-1
0vulolion suppression
lduring exclusive breoslfeedingI, ?
0xygen, 181-183
0xygen odninislrolion, 181-183
Poleness, 38
Porocelonol, 77, 18O
Porlogroph, 18
Penicillin 0, 17
Physicol exoninolion of lhe newborn
obnornol fndings, 38-/1
nornol fndings, 3-37
how lo do, 7
when lo do, 7
Physiologic |oundice, 1/
Plocenlo, 2O/
|r1et 237
Sofely, 5/
Sepsis, 13O, 133, 13, 15
Shorps, 2O1
Shorps disposol conloiner, 2O1
Silver nilrole solulion 1%, 32, 1?
Skilled ollendonl or provider, 3
Skin, 3, 3?
Skin color, 3, 38
Skin infeclion, 131, 13-137, 15
Skin-lo-skin conlocl, 3O-31
Sleep
needs of nolhers, 8
needs of newborns, 5O
Snoll for geslolionol oge lS0lI, 11O
Solulion for deconloninolion lO.5% chlorineI, 18?-1?1
Sore nipples, 7-77
Spills, 2O2-2O/
Spine, 37, /O
Sponge bolh, 52
Slobilizolion of lhe newborn, 128
Slondord precoulions, 18-187
Sleoning nelhod of HLD, 1?2
Slerilizolion
dry heol slerilizolion, 1?5
sleon slerilizolion louloclovingI, 1?3
Slillbirlh, 2, 15, 33, 1/
Slinulolion, ?8-??
Slools, 37, /O, /, 8, 1/
Sloroge
of equipnenl, 1?5
of expressed breosl nilk, 8, 88
Suclion, ?5, 1OO, 21O-212
Sulfodoxine-pyrinelhonine lSPI, 178
Syphilis, 15, 1/-1/7, 13, 172
Tosks for oll heollh workers
breoslfeeding, ?O
connon newborn problens, 151
essenliol core for every newborn, 5
low birlh weighl bobies, 122
newborn resuscilolion, 1O8
Tenperolure
conlrol, 28, 37, /1, /3, 5O
hyperlhernio, 1/2
hypolhernio, 1/2
nornol newborn, 1/2
for sloroge of breosl nilk, 8
loking, 212
Telonus, 15, 13O
Telonus loxoid, 15/-155
Telrocycline 1% eye oinlnenl, 32, 1?
Thernoneler, 212
Thrush, 73, 7, 138, 1/O-1/1, 15-1, 17/-175
Tone, 3, 38
Tronsporling o sick newborn, 128-12?
Tuberculosis, 1/7, 15-157, 1
Twins, 7O
Tying lhe cord, 3O, ??
Unbilicol cord, 3O, 37, /O
Unbilicol cord infeclion, 127, 13O-131, 13/-135, 15
Urinolion, /, /?, ?
\occinolion. See nnunizolions
\enlilolion, 1OO-1O1
\ernix, 2?
\ery low birlh weighl, 11O
\ilonin l, 5/, 3, 17?
\ilonin K, 33, 115, 15O, 18
Worn choin, 28-2?
Worning, 28-2?, 5O, 113, 118
Wosle disposol, 2O/-2O
Weoning, eorly, 72
Websiles, 22, ?2, 123, 152, 15?, 18/
Weighing lhe boby, 33, 37, 213
Weighl goin, /8
Wel nursing, 73
Zidovudine. See lZT
AB0U! !N| AU!N0kS
0|ara Berk, CNN, NS
Diono Beck is on independenl nolernol-newborn heollh
consullonl wilh exlensive experience in lroining ond
developnenl of educolionol noleriols. She hos co-oulhored
severol nonuols for inlernolionol use, including Fome-
8useJ Life Suvin Ski||s ond Feu|th, Hother Feu|th, Newborn
0ure reference nonuol ond guidebook. l 0erlifed Nurse-
Midwife, Ms. Beck hos worked in lhe Uniled Sloles, lfrico,
lsio ond 0enlrol lnerico ond currenlly serves os
o consullonl wilh Soving Newborn Lives.
|rarres ar]es, CNN, NPN
Fronces 0onges is o 0erlifed Nurse-Midwife wilh nore lhon
2O yeors` experience in nolernol-newborn ond reproduclive
heollh. Wilh clinicol ond leoching experience bolh donesli-
colly ond inlernolionolly, Ms 0onges hos provided lechnicol
ossislonce lo progrons in lfrico, lsio ond Lolin lnerico.
She hos co-oulhored severol lroining nonuols ond hos
been involved in bolh pre- ond in-service lroining of oll
levels of heollh personnel. 0urrenlly, Ms. 0onges is lhe
Senior Newborn Heollh ldvisor for SNL, ond provided lhe
lechnicol leodership for lhe developnenl of lhis nonuol.
Sasar rl1mar, CNN, P|0
Suson 0oldnon is o 0erlifed Nurse-Midwife wilh exlensive
experience living ond working in lfrico ond nore lhon 2O
yeors` experience consulling in lfrico, lsio, Foslern Furope,
ond Lolin lnerico in nidwifery, nolernol ond child heollh,
public heollh, fonine relief ond nulrilion. Ms. 0oldnon
hos been involved in lroining oll levels of heollh workers in
developing counlries. She hos bolh oulhored ond co-oulhored
o nursing lexlbook, lroining nonuols, scienlifc orlicles ond
olher professionol docunenls.
P|ll|s |rr], CNN, NSN
Phyllis Long is one of lhe co-founders of lhe nslilule for
Midwifery, Wonen ond Heollh, o nidwifery educolionol
progron bosed ol lhe Philodelphio Universily. She hos o
lenglhy coreer in pre-service ond in-service educolion,
bolh nolionolly ond inlernolionolly, including o four-yeor
focully posilion ol lhe Public Heollh 0ollege in 0ondor,
Flhiopio. Recenlly relired fron lhe Universily of Philodelphio,
Ms. Long serves os on independenl consullonl for nidwifery
educolion ond dislribulive leorning.
Soving Newborn Lives
Sove lhe 0hildren
2OOO M Slreel NW
Suile 5OO
Woshinglon, D0 2OO3
www.sovelhechildren.org
www.heollhynewborns.con
n recenl yeors, child survivol hos inproved dronoli-
colly in developing counlries, lorgely lhrough oclivilies
such os childhood innunizolion ond diorrheo conlrol
progrons. However, high norlolily roles onong
newborns linfonls fron birlh lo 28 doys of lifeI renoin
virluolly unchonged. 0ver /O percenl of oll deolhs of
children under fve occur onong newborns-even
lhough proven, cosl-effeclive neosures lo prevenl
newborn deolhs ore ovoiloble. To provide newborns
wilh oppropriole core during lhe frsl nonlh of life,
Soving Newborn Lives, on iniliolive of Sove lhe 0hildren,
hos developed lhe 0ure of the Newborn Reference
Hunuu| os o lroining resource for oll heollh workers.
The 0ure of the Newborn Reference Hunuu| provides up-
lo-dole, conprehensive, evidence-bosed infornolion,
ond defnes ond illuslroles lhe skills needed lo keep
newborns heollhy, including rouline ond prevenlive
core os well os eorly deleclion ond nonogenenl of
life-lhreolening problens. n oddilion, lhe nonuol
inlroduces skills for connunicoling lhol infornolion
lo nolhers ond fonilies, who nusl underslond how
lo core for lheir newborns 2/ hours o doy. Foch chop-
ler presenls infornolion in lhe forn of descriplions,
losks ond checklisls, illuslrolions, ond decision-
noking lobles.
0onlenls include. Newborn 0ore Slorls Before Birlh,
Fssenliol 0ore for Fvery Newborn, Successful Breosl-
feeding, Newborn Resuscilolion, 0ore of Low Birlh
Weighl Bobies, ond 0onnon Newborn Problens.
lppendices conloin Molernol ond nfonl nnunizolion
Schedules, o Medicolion Reference lfor newborns ond
for nolhersI, ond lechnicol infornolion on nfeclion
Prevenlion, Bosic Skills for 0ore of lhe Newborn, ond
0onnunicolion ond 0ounseling.