I.

INTRODUCTION

 What is EINC? – Harvey Jamilla

Essential Intrapartum Newborn Care is a package of evidenced based practices recommended by
the DOH, PhilHealth and WHO as the standard of care by all births by skilled attendants in all
Government and Private Settings

 EINC is a series of time-bound and evidence-based interventions for newborn babies and
their mothers that ensure the best care for them, when it was developed and further studies
was made, WHO supported the Philippine government in promoting safe and effective health
care for mothers and babies including the development and implementation of the EINC
protocols.

 Development of EINC – Harvey Jamilla

 The ENC Protocol was developed by the Newborn Care Technical Working Group (TWG)
 The TWG conducted a systematic search and critical appraisal of foreign and local medical
and allied health literature on practices in the immediate newborn period.
 An evidence-based draft was then developed and reviewed by the Department of Health
(DOH)
 Organizations like UN, UNICEF, UNFPA and POGS reviewed the draft.

 Goals and Objectives – Ian Fabella

1. Guide health workers and medical practitioners in providing evidenced-based essential newborn
care.
 This is to ensure that newborn babies receive the best and quality newborn care that is based on
evidences and studies, and also to reduce the risk for complications such as hypothermia and
sepsis.
2. Define the roles and responsibilities of the different DOH Offices and other agencies in the
implementation of the Newborn Protocol.
 This goal is included in the Administrative Order No. 2009-0025. It aims to define the roles and
responsibilities of the people and agencies that are connected with the implementation of EINC to
provide a safe, organized and evidenced-based protocol to ensure the quality care for newborn.
One of its main goals is to promote evidence-based care eliminating stereotyped newborn care practices
such as unnecessary suctioning and bathing instead of carrying out a step-by-step time bound intervention
and to achieve the United Nations Millennium Development Goal 4 of Reducing Under 5 Child Mortality
(through reduction of neonatal deaths).

 Unang Yakap – Ian Fabella

Unang Yakap is a simple and evidence-based interventions that may help in ensuring the survival of
all newborns and young infant. This compasses interventions such as ensuring warmth, breastfeeding,
love and safety and infection control.

 The most important outcome of Unang Yakap is the promotion of breastfeeding. Since the baby
is placed closely to the mother’s breast he becomes familiar with the breast as the source of food.
According to Dr Teresita “Tetchie” Cadiz Brion, from an interview with UNICEF, the most
 important outcome of Unang Yakap is the promotion of breastfeeding. Since the baby is placed
closely to the mother’s breast he becomes familiar with the breast as the source of food. She
highlighted the importance of collaboration between and continuous training of all the health
workers and volunteers involved in the care of mothers and newborns. Even doctors who are non-
first liners from other specialties were trained for additional support.

II. INTERVENTIONS AND PROCESSES

 Introduction- Kyla Fernandez

Standard essential newborn care practices and guidelines are organized by time, beginning at the time of
perineal bulging until one week of life. In EINC, interventions are given emphasis that should be
provided from birth of the newborn until the first 6 hours of life ‘til the first week of life.

 This is to ensure and prevent risks and complications for newborns. In the Administrative Order
2009-0025, it mentioned the Ensure Quality Provision of Time-bound Intervention where the
aspect of newborn care in the Philippines has not met the International Standards, and should be
re-learned and re-taught by all healthcare providers. That is why they formulated the four-time
bound interventions of EINC.
 4-Time Bounded Interventions- Kyla Fernandez
1. Immediate thorough drying –
- Use a clean, dry cloth to thoroughly dry the newborn by wiping the eyes, face, head, front
and back, arms and legs.
- Do a quick check of newborn's breathing while drying
- Do not put the newborn on a cold or wet surface.
- Do not bathe the newborn earlier than 6 hours of life.
2. early skin-to-skin contact –
- Place the newborn prone on the mother's abdomen or chest, skin-to-skin.
- Cover the newborn's back with a blanket and head with a bonnet.
- Do not separate the newborn from the mother, as long as the newborn does not exhibit
severe chest in-drawing, gasping or apnea and the mother does not need urgent
medical/surgical stabilization e.g. emergency hysterectomy.
- Do not wipe off vernix if present.
3. properly-timed clamping and cutting of the cord after 1 to 3 minutes
- Clamp and cut the cord after cord pulsations have stopped (typically at 1 to 3 minutes).
Do not milk the cord towards the newborn.
- Put ties tightly around the cord at 2 em and 5 em from the newborn's abdomen.
- Cut between ties with sterile instrument.
- Observe for oozing blood.

After cord clamping, ensure 10 IU Oxytocin 1M is given to the mother.

4. non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in
- Leave the newborn on the mother's chest in skin-to-skin contact. Health workers should
not touch the newborn unless there is a medical indication.
 - Observe the newborn. Advice the mother to start feeding the newborn once the newborn
shows feeding cues (e.g. opening of mouth, tonguing, licking, rooting). Make verbal
suggestions to the mother to encourage her newborn to move toward the breast e.g.
nudging.
- Counsel on positioning and attachment. When the newborn is ready, advise the mother to
position and attach her newborn.
- Advise the mother not to throwaway the colostrum.

4.2. Objective: To prevent ophthalmia neonatorum through proper eye care

- Administer erythromycin or tetracycline ointment or 2.5% povidone-iodine drops to both

eyes after the newborn has located the breast.
- Do not wash away the eye antimicrobial.

 Non-intermediate Interventions – Kyla Fernandez

1. Give Vitamin K prophylaxis
- Inject a single dose of Vitamin K 1 mg 1M (if parents decline intramuscular injections,
offer oral vitamin K as a 2nd line).
2. Inject Hepatitis Band BCG vaccinations
- Inject hepatitis B vaccine 1M and BCG intradermally.
3. Examine the newborn. Check for birth injuries, malformations or defects.
- Look for possible birth injury and/or malformations.
4. Cord Care
- Explain to the mother that she should seek care if the umbilicus is red or draining pus.
- Teach the mother to treat local umbilical infection three times a day.
 Discontinued Newborn Care Practices in the Delivery Room – Kenneth Historillo

1. Manipulation such as routine suctioning of secretions if the baby is crying and breathing
normally.
- Doing so may cause trauma or introduce infection.
2. Putting the newborn on a cold or wet surface.
- The reason why this is discontinued it’s because of the risk and possibility for the
newborn to acquire hypothermia that’s why it was mentioned in the 4-Time bounded
interventions that immediate thorough drying is essential and is the first step to newborn
care.
3. Wiping or removal of vernix caseosa if present
- Vernix caseosa is a white, creamy, naturally occurring biofilm covering the skin of the
fetus during the last trimester of pregnancy. Vernix coating on the neonatal skin protects
the newborn skin and facilitates extra-uterine adaptation of skin in the first postnatal
week if not washed away after birth.
4. Foot printing
- In the first few minutes following delivery, the newborn’s feet are pressed into a common
inkpad and later pressed onto an identification sheet. Not only is this practice is usually
done by untrained personnel with variable results, but more importantly also increases the
risk of cross-contamination among the babies. In 1988, the American Academy of
Pedicatrics (AAP) and the American College of Obstetricians and Gynecologists
(ACOG) stated that “individual hospitals may want to continue the practice of
 footprinting or fingerprinting, but universal use of this practice is no longer
recommended.”
5. Bathing earlier than 6 hours of life
- The minimum time recommended falls between 6-8 hours after birth (WHO, AWHONN,
Save the Children). It is suggested that the bath be done with the parents involved so that
they can learn the process and limit separation. Additionally, it is important to get baby
back in a skin to skin position immediately after to minimize effects from the cold.

 Significance of EINC and Unang Yakap – Kenneth Historillo

- Dr. Teresita Brion explained that “The Unang Yakap or Essential Intrapartum Newborn
Care was really conceptualized in order to have early initiation of breastfeeding. So how
early is early? As early as delivery. The newborn is placed strategically on the mother’s
breast so he will be able to feed immediately when he is hungry. What’s good about
Unang Yakap is that it respects the readiness of the baby to breastfeed as manifested by
feeding cues”.
III. DATA AND STUDIES

1. First Slide – Harvey Jamilla

(read the slide first)
- In the Philippines, an estimated 82 000 of 2.4 million children die annually before their
fifth birthday with half occurring among newborns. While post-neonatal deaths decreased
between 1990 and 2005, neonatal mortality did not.
2. Second Slide – Ian Fabella
(read slide first)
- As what was mentioned, 82,000 of 2.4 million children dies annually before their fifth
birthday, this decreased from 52 per 1000 livebirths in 1998 to 32 per 1000 livebirths in
2003, the problem is that neonatal deaths decrease slowly. As a response, the Philippines
Department of Health (DOH), World Health Organization (WHO) and partners
developed and adopted a systems approach to improve newborn care practices.
3. Third Slide – Kenneth Historillo
(read slide first)
- These are the most common reasons for neonatal deaths according to the analysis and
data of DOH.
o Birth Asphyxia - happens when a baby's brain and other organs do not get enough oxygen
and nutrients before, during or right after birth. This can happen without anyone
knowing. Without oxygen and nutrients, cells cannot work properly.
o Complications of Prematurity - Premature births can happen suddenly, with no known
cause. Sometimes providers have to induce (start) labor early for medical reasons.
Women can also go into premature labor due to:
- Chronic health conditions, such as diabetes or infections.
- Drug or alcohol abuse.
- Multiple pregnancies, such as twins or triplets.
- Preeclampsia (high blood pressure during pregnancy).
 Severe Infection – with the initiation of skin-to-skin contact of the newborn and mother,
this will prevent infection and increases colonization with protective bacterial flora.
 4. Fourth and Fifth Slide – Kyla Fernandez
(self-explanatory)

IV. POLICIES AND LAWS

 Implementing Mechanism – Kyla Fernandez
- The signing of the Administrative Order 2009-0025 last Dec. 1, 2009 institutionalizes
policies and guidelines for government and private health facilities to adopt the
essential newborn care protocol. Advocacy and dissemination for a have been done
since its launch. Scale-up implementation in all health facilities and social marketing
are both in the pipeline to ensure that the policy is implemented all over the country.
- The Teams are strategically dispersed throughout the Province to ensure timely
access to obstetric and newborn emergency care by mothers. The Teams shall
provide the full maternal and newborn care, family planning, adolescent reproductive
health and STI and HIV service packages to the general population as well child
survival packages: Infant and Young Child Feeding (IYCF), Integrated Management
of Childhood Illnesses (IMCI), Expanded Program on Immunization (EPI), etc.
 Laws and Administrative Orders in line with the Implementation of EINC protocol –
Kyla Fernandez
(will explain directly on report)
 Maternal, Newborn and Child Health Nutrition (MNCHN) Strategy (In line with the
DOH Administrative Order 2008-0029) – Ian Fabella
- Administrative Order 2008-0029 entitled: “Implementing Health Reforms for the.
Rapid Reduction of Maternal and Neonatal Mortality”, requires that “every birth
delivery should be done by skilled birth attendants”. Thus, it may be manned by a
physician – obstetrician – gynecologist, pediatrician, family medicine specialist,
general practitioner, midwife and/or a nurse. The MNCH strategy was acquired by
the DOH and used it’s service delivery team for implementation of the EINC
Protocol.
 Mother-Baby Friendly Hospital Initiative (MBFHI) and Infant and Young Child Feeding
Strategy and Republic Act 10028 – Kenneth Historillo
- Mother-Baby Friendly Hospital Initiative - What is the main purpose of Baby-
Friendly Hospital Initiative? The Baby-friendly Hospital Initiative is a global effort to
implement practices that protect, promote and support breastfeeding. It aims to
ensure that all maternity facilities become centres of breastfeeding support.
- Infant and Young Child Feeding Strategy - What is the aim of infant and young child
feeding? The aim of this strategy is to improve – through optimal feeding – the
nutritional status, growth and development, health, and thus the survival of infants
and young children.
- RA 10028 - "An act providing incentives to all government and private health
institutions with rooming-in and breastfeeding practices and for other purposes".
- Moreover, the connection of these laws and policies with the EINC protocol is to
promote breastfeeding and proper nutrition for children as early as right after birth.
 That is why early skin-to-skin contact is initiated in the 4-time bounded interventions
to promote latching and nudging on to the mother’s breast.
 Partner Institutions – Harvey Jamilla
- These partner institutions are responsible in promoting the EINC Protocol and
guidelines as well as develop the newborn care strategies here in the Philippines.