The Department of Health and

the World Health Organization

has launched a campaign called "
Unang Yakap", which aims to
promote ways to take care of
newborn and their mothers on
December 2009.

The campaign to spread the use

of Essential Newborn Care
Protocol
What is the Essential Newborn
Care Protocol?

Series of time bound chronologically

ordered, standard procedures that a
baby receives from birth Simple, to-
the-point, user-friendly, globally
accepted evidence-based protocol to
essential newborn care focusing on
the 1st week of life Double even by a
single health worker caring for both
mother and newborn
Philippines is one of the 42
countries accounting 90% of all
global deaths under 5 year old
children.

Highest number of newborn

deaths occur in the first 2 days of
life.

Essential Newborn Care

implementation has the potential
to avert approximately 70% of
newborns death.
Time- bound Interventions:

1. Immediate and thorough

drying of the newborn

2. Initiate skin to skin contact

between mother and newborn

3. Properly timed cord clamping

and cutting

4. Non- separation of newborn

and mother for early
breastfeeding
STEP 1

This stimulates the newborn's

breathing and also to keep them
from warm.
STEP 2

The newborn and the mother

must come in to physical contact.
Place the newborn prone on the
mother's abdomen or chest skin-
to-skin.

Benefits of skin-to-skin contact:

1. Promotes bonding between mother and

child
2. Colonization with maternal skin flora
3. Overall sucess of breastfeeding
4. Protection from hypoglycemiia
STEP 3

The umbilical cord of the

newborn is clamped for one to
three minutes, or when the cord
pulsation stops.

Benefits of proper cord clamping:

1. Prevents anemia
2. Prevents intraventricular
hemmorhages
Materials to prepare in clamping
and cutting the cord:

1. Cord clamp
2. Forcep (Kelly straight or curve)
3. Umbilical cord scissors or
Bandage scissors or Mayo scissors
4. Sterile gloves
5. Sterile Gauze
Palpates the cord
for a few minutes
after birth until
pulsation ceases.
The cord is clamped
with a cord clamp
approximately 1-2
inches from the
infants umbilicus
1 Kelly hemostats placed an inch from the cord clamp
You can place a
sterile gauze
beneath the cord
before cutting to
protect the newborn
with blood coming
from the cord
Then cut in
between aseptically.
Counts the vessels
of the cord and
describe the color
and characteristics
of the blood
vessels.
STEP 4

The mother and the newborn are

kept close and early breastfeeding
is implemented. Early
breastfeeding gives a newborn
substance called colostrum which
boost a newborn's immunity
against diseases.
Virginia Apgar, MD
Sept 1952

The time for judging

the five objective signs
were sixty seconds
after the complete
birth of the baby and
repeated after 5
minutes.
A: APPERANCE / Color

All infants are obviously cyanotic at birth

because of their high capacity for carrying
oxygen and their relatively low oxygen content
and saturation.

The disappearance of cyanosis depends

directly on two signs previously considered --
respiratory effort and heart rate.

Comparatively few infants were given a full

score of two for this sign, and many received
zero in spite of their excellent score for other
signs.
P:PULSE / Heart Rate

A heart rate of 100-140 was considered good and

given a score of two, a rate of under 100 received a
score of one, and if no heart beat could be seen, felt
or heard the score was zero.

If one attends the baby alone, it is easy to learn to

look briefly at the epigastrium or precordium for
visible heart beat.

Palpation of the cord about two inches from the

umbilicus is the most satisfactory method for
determining the heart rate quickly and avoids the
area of clamping or tying of the cord.
G: GRIMACE / Reflex Irritability

This term refers to response to some form of

stimulation. The usual testing method was
suctioning the oropharynx and nares with a
soft rubber catheter which called forth a
response of facial grimaces, sneezing or
coughing.

Although spontaneous micturition and

defecation are not a response to an applied
stimulus, they were considered to be favorable
signs if they occurred.
A: ACTIVITY / Muscle Tone

A completely flaccid infant received a zero

score, and one with good tone, and
spontaneously flexed arms and legs which
resisted extension were rated two points.
R: RESPIRATION

An infant who was apneic at 60 seconds after birth

received a score of zero, while one who breathed
and cried lustily received a two rating.

All other types of respiratory effort, such as

irregular, shallow ventilation were scored one.

An infant who had gasped once at thirty or forty-five

seconds after birth, and who then became apneic,
received a zero score, since he was apneic at the
time decided upon for evaluation.
What do Apgar scores mean?

Apgar scores of 0-3 are critically low,

especially in term and late-preterm
infants

Apgar scores of 4-6 are below normal,

and indicate that the baby likely requires
medical intervention

Apgar scores of 7+ are considered normal

HEAD CIRCUMFERENCE -

Normal measurement: 33 to 35 cm (13 to 14

inches). In vaginal delivery, molding may
reduce head circumference (HC) immediately
after birth but it will return to normal size
after two to three days.

The HC is actually the occipitofrontal

circumference (OFC).

The HC is usually greater than chest circumference (CC) by 2

cm. The head is one fourth of the total body length; this is
because the head of the newborn is proportionately larger
than the head of the adult
CHEST CIRCUMFERENCE-

Normal CC range from 30.5 to 33 (12 to

13 inches), usually 2 cm less than HC. The
CC is measured at the level of the nipple
using a tape measure.

A CC less than 30 cm indicates

prematurity. An enlarged heart may make
the left side of the chest larger.
ABDOMINAL CIRCUMFERENCE-

Abdominal circumference (AC) is

approximately the same as chest
circumference. It is measured just above
the level of the umbilicus.

It is no longer recommended to measure

AC below the level of the umbilicus
because a full bladder may interfere with
accurate measurement.
WEIGHT - Birth weight of full term
newborn infants range from 6 to 8.5 lbs.
or 2700 to 4000 g. Average is 3500 g. Birth
weight should be recorded immediately
after birth because weight loss occurs
rapidly in newborns.

The average female infant birth weight is

around 7 lbs. while that of male infant is
around 7.5 lbs. Boys is usually heavier
than girls by 100 g or 3 ounces. The
average birth weight of Filpino infants is
3000 grams.
Vitamin K and Hepa B administration:

Vitamin K: 1mg, IM Vastus Lateralis

Hepa B: 0.5ml, IM Vastus Lateralis

1. Position the infant supine with the knee slightly flexed

2. Use an alcohol swab to clean the injection site using circular
motion. Allow the site to air dry
3. Hold the syringe between thumb and forefinger in your dominant
hand as if holding a dart
4. With your nondominant hand, grasp the muscle body between the
thumb and fingers to stabilize it for injection
5. Position the needle at a 90 degree angle (perpendicular) to the
infant's skin
6. Pierce the skin with needle using a smooth rapid motion
7.Inject the medication slowly
8. Gently withdraw the needle and release the skin to its normal
position
9. Cover the injection site with a piece of gauze and apply pressure
until bleeding stops.
Administration of Crede's Prophylaxis:
it is done to prevent newborn form
aquiring Opthalmia Neonatorum
1. Open the newborn's eye by placing the thumb and
forefinger of your nondominant hand at the corner of each
eyelid and pressing gently on periorbital ridges.
2. Apply a 1-2 cm ribbon of antibiotic ointment on the
lower conjunctival sac from the inner cathus to the outer
canthus
3. Close the newborn's eye and repeat the procedure on
the other eye
4. Use a gauze pad to wipe excess ointment after 1 minute

Note: Do not touch the tube or ampule into the eye while
applying the ointment
THANK YOU!