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Giving birth to improved newborn care

(The Philippine Star) Updated March 02, 2010 12:00 AM

Essential Newborn Care (ENC) is a simple four-pronged intervention approach integrating the
following steps: immediate drying, uninterrupted skin-to-skin contact between mother and
newborn, delayed cord clamping and cutting, and early initiation of breastfeeding.

MANILA, Philippines - Heeding calls to improve newborn care, health experts and medical
professionals led by Department of Health (DOH) Secretary Francisco Duque III convened
recently at Hotel Sofitel to discuss the state of newborn care system in the country. Joining
Secretary Duque were executives from key health institutions in the country such as officials
from health maintenance companies as well as doctors,’ nurses,’ and midwives’ associations.

The occasion also formalized the launch of the Essential Newborn Care (ENC) protocol
endorsed by the World Health Organization, which offers an evidence-based strategic
intervention aimed at improving newborn care and helping curb neonatal mortality.

In a ceremony marking the start of the Unang Yakap campaign, which comprises the new ENC
protocol, Secretary Duque, WHO representative to the Philippines Dr. Soc Nyunt-U, Dr.
Marinus Gotink of UNICEF Philippines, DOH Assistant Secretary Nemesio Gako, and DOH
Undersecretary Dr. Mario Villaverde signed a giant covenant marker to reaffirm their
commitment in adopting the new protocol.

In her presentation, DOH National Disease Prevention director Dr. Yolanda Oliveros says that
82,000 Filipino children die annually, with half of newborn deaths occurring in the first two
days of life. “But the thing is, many of these deaths could have actually been prevented,” she
said, citing the Lancet 2003 study.

Dr. Oliveros also notes that there are at least four steps in newborn care intervention that need
to be undertaken immediately to lessen statistics on newborn deaths. These are: immediate and
thorough drying to stimulate breathing; early skin-to-skin contact; properly-timed clamping and
cutting; and non-separation of newborn from the mother for early breastfeeding initiation.
These interventions, in fact, form part of the new ENC protocol now being promulgated by the
DOH.

In her discussion of the minute-by-minute assessment of newborn care within the first hour of
life, Dr. Oliveros said that the usual practice of cord clamping in most Philippine hospitals is 12
seconds with 99 percent under one minute, whereas WHO standards require one to three
minutes or until pulsations stop. Ninety-seven percent of them also do drying after one minute,
when WHO standards say it should be done immediately.

Immediate skin-to-skin contact is not also being observed, adds Dr. Oliveros, with only 9.6%
doing it after five minutes when it should be done over 90 percent of the time. Other “bad
habits” include putting babies on a cold surface (12 percent), not drying the baby (2.5 percent),
not drying the head (6.2 percent), and washing or giving the baby a bath (84 percent of
hospitals do it within eight minutes), when it could actually be delayed until after six hours.
Under the newly-approved guidelines, transferring babies to a nursery is no longer necessary
— instead, newborns should be roomed in with their mothers immediately.

Separating the baby from the mother, weighing, and examining the newborn should also be
done at least after more than an hour, not in just after 10 minutes, which is the usual practice.
Other newborn interventions cited include rooming in babies with their mother and immediate
breastfeeding (within one hour after birth or as soon as baby shows signs).

Dr. Oliveros ended her presentation by saying a new set of newborn care protocol is needed
because there is now a wide variety of practices among health practitioners. There were also
reports of inappropriate care being given the newborns, as well as continuously skyrocketing
costs of health care.

The half-day event also included an overview of the status quo of newborn health care in the
Philippines, highlighting an assessment of the practices of 51 major hospitals in the country.
Dr. Jacinto Mantaring of the Philippine General Hospital — one of hospitals that have since
adopted the ENC protocol — explained the rationale for the resolution, underlining the urgent
need of the country to invest in newborn health care.

The protocol categorizes post-natal procedures into time-bound, non-time bound, and
unnecessary actions. Time-bound interventions include immediate drying, skin-to-skin contact,
cord clamping after one to three minutes, breastfeed initiation, and non-separation of mother
and the newborn.

Non-time-bound procedures are administration of vitamin K, washing, immunizations, and


weighing. The unnecessary procedures, as laid out in the guideline, are foot printing,
administration of prelacteals like glucose water, routine suctioning, and separating the newborn
from the mother for observations.

Today, the Philippines remains one of 42 countries that account for 90 percent of mortality for
children below five years. With the new ENC protocol, the government is hoping to reduce
neonatal deaths by six per 1,000 live births.

Source:

http://www.philstar.com/Article.aspx?articleId=554053&publicationSubCategoryId=80
The current practice of handling newborns contributes to the high incidence of
neonatal death and illnesses in the country. Doctors are introducing a new way of
caring for newborns in the first few minutes of life, which could cut by almost half
the number of newborn deaths estimated at 40,000 each year according to this
report.

Important points in the new program of the Department of Health (DOH) and World
Health Organization that should be imposed are as follows: 1) dry the newborn
immediately after birth (instead of washing) to prevent hypothermia and the risks
related to it, 2) initiate skin contact with the mother by placing the baby on the
mother’s chest or abdomen to provide warmth, increase the duration of
breastfeeding, and allow the “good bacteria” from the mother’s skin to infiltrate the
newborn, and 3) delay the cord clamping by two to three minutes after birth (or
wait until the umbilical cord has stopped pulsing) to increase the baby’s iron
reserves, reduce the risk of iron-deficiency anemia and improve blood circulation.
These are basically in line with the Essential Newborn Care (ENC) protocol. When I
read about this, I had mixed emotions. On one hand, I got disappointed for I know it
was not strictly observed when I gave birth to my 4 children. On the other hand, I
felt grateful that an effort is being directed towards its strict implementation. There
are only three hospitals in the Philippines currently subscribing to the ENC protocol
so far—Quirino Memorial Medical Center in Quezon City, and Fabella Memorial
Medical Center and Philippine General Hospital in Manila.

In all of my childbirth experiences, the umbilical cord was immediately cut before
the baby is placed on my tummy or my breast. Then my baby was only allowed to
‘kiss’ my nipple because we were not given long enough time for the baby to latch
on. They wash the baby and when they bring the baby to the room to be with me
(room-in as we always specify), I usually notice red spots are on my baby’s face.
They said that it is the result of the cotton rubbed on my baby’s face and will wear
away in time. True enough the spots were gone in few days. But with the ENC
protocol this should not happen to newborn babies in the future.

Most babies do not experience hypothermia even when washed immediately after
birth, but a lot end up staying in the nursery for days just to be heated by lamps.
Isn’

it because they were washed even before they get acclimatized in their new
environment? I am just wondering. When this happens initiation of breastfeeding is
delayed, making the situation worse for both mother and baby. Delaying the start of
breastfeeding by one day could make the newborn 2.6 times more prone to
infection as also mentioned in that report.

I am posting this to help spread the information about the ENC Protocol. To those
who are about to give birth, discuss this with your Obstetrician-Gynecologist (OB).
Know the hospital policy on this as suggested in my previous blog on childbirth
preparation. If they are not yet implementing the ENC protocol and you want it for
your child, ask if they will accommodate your request.

This is also a good chance for me to highlight the various practices beneficial to the
health and well-being of the child with less emphasis on cleanliness: (1) passing
through the birth canal to get in contact with microorganisms necessary to prime
his/her immune system and (2) allowing the child to play and get dirty as explained
in my previous blog on natural immunity builders, (3) skin contact with mother for
the good bacteria to infiltrate newborn, (4) delaying washing of the new born to
prevent hypothermia as washing removes the vernix or baby’s skin protection.
Apparently, too much emphasis on cleanliness is also detrimental to your child.

Director Honorata Catibog, head of the DOH task force on the rapid reduction of
maternal and neonatal mortality, describes the new program to implement the ENC
protocol as “paradigm shift”. I call it going back to basics...our natural survival
strategy.

Newborn care key to baby’s survival—DoH


By Dona Pazzibugan
Philippine Daily Inquirer
First Posted 08:48:00 11/25/2009

Filed Under: Health, Children

MANILA, Philippines—The current practice of handling newborns, like clamping and cutting
the umbilical cord and washing the baby right after birth, have been known to actually contribute
to the high incidence of neonatal deaths and illnesses in the country.

Doctors are introducing a new way of caring for newborns in the first few minutes of life, which
could cut by almost half the number of newborn deaths estimated at 40,000 each year.

“This is a paradigm shift,” was how Director Honorata Catibog, head of the Department of
Health (DoH) task force on the rapid reduction of maternal and neonatal mortality, described the
new program introduced by the DoH and the World Health Organization.
Proponents of the Essential Newborn Care (ENC) are changing the protocol currently observed
by childbirth practitioners.

The ENC protocol prioritizes drying the newborn and initiating skin contact with the mother
before clamping and cutting the umbilical cord. It prescribes a proper sequence of interventions
that even a single health worker could perform and calls for initiating breastfeeding within the
first hour of life.

“What should be done [immediately] after birth is to dry the baby because hypothermia can lead
to several risks,” Dr. Aleli Sudiacal of the DoH explained at a forum held at the Quirino
Memorial Medical Center in Quezon City Tuesday.
She said delaying the cord clamping two to three minutes after birth (or waiting until the
umbilical cord has stopped pulsing) has been shown to increase the baby’s iron reserves. It also
reduces the risk of iron-deficiency anemia and improves blood circulation.

Instead of immediately washing the newborn, the baby should be placed on the mother’s chest or
abdomen to provide warmth, increase the duration of breastfeeding, and allow the “good
bacteria” from the mother’s skin to infiltrate the newborn.

“Delaying the start of breastfeeding is harmful,” Sudiacal stressed. She said a delay of one day
could make the newborn 2.6 times more prone to infection.

“Washing should be delayed until after six hours because this exposes the newborn to
hypothermia and removes the vernix (skin covering) which is a natural protective barrier against
bacteria. Washing also removes the baby’s crawling reflex,” she said.

The ENC protocol is being practiced in three hospitals so far—Quirino Memorial Medical
Center in Quezon City, and Fabella Memorial Medical Center and Philippine General Hospital in
Manila.