Essential Newborn Care Profile/Rationale of the Health Program The Child Survival Strategy published by the Department of Health

has emphasized the need to strengthen health services of children throughout the stages. The neonatal period has been identified as one of the most crucial phase in the survival and development of the child. The United Nations Millennium Development Goal Number 4 of reducing under five child mortality can be achieved by the Philippines however if the neonatal mortality rates are not addressed from its nonmoving trend of decline, MDG 4 might not be achieved.

Vision and Mission: None to mention as these are inclusive in the MNCHN Strategy and NOH 2011-2016 Goals: To reduce neonatal mortality rates by 2/3 from 1990 levels Objectives: 1. To provide evidence-based practices to ensure survival of the newborn from birth up to the first 28 days of life 2. To deliver time-bound core intervention in the immediate period after the delivery of the newborn 3. To strengthen health facility environment for breastfeeding initiation to take place and for breastfeeding to be continued from discharge up to 2 years of life 4. To provide appropriate and timely emergency newborn care to newborns in need of resuscitation 5. To ensure access of newborns to affordable life-saving medicines to reduce deaths and morbidity from leading causes of newborn conditions 6. To ensure inclusion of newborn care in the overall approach to the Maternal, Newborn, Child Health and Nutrition Strategy The Essential Newborn Care package is a four-step newborn care time-bound intervention undertaken to lessen newborn death. 1. Immediate and thorough drying to stimulate breathing after delivery of the baby 2. Provision of appropriate thermal care through mother and newborn skin-to skin contact maintaining a delivery room temperature of 25-28 degrees centigrade and wrapping the newborn with clean, dry cloth. 3. Properly timed clamping and cutting of the umbilical cord, (1-3 minutes or until cord pulsation stops) 4. Non-separation of the newborn and mother for early breast-feeding. Immediate latching on and initiation of breastfeeding within first hour after birth. Post-natal care required within 24 hours after birth also includes Cord care Breastfeeding Vitamin K injection Eye prophylaxis Delayed bathing until 6 hours of life BCG and first dose of Hepatitis B Immunization Newborn screening The Essential Newborn Care Package aims to reduce newborn mortality rate from 13 deaths (2006 FPS, NSO) to 10 per 1000 live births by 2015. Unang Yakap aims to save newborn lives. Stages of Labor The four stages of the childbirth process are based on changes in the uterus and cervix as labor progresses. The beginning and end of each stage are described below: First Stage of Labor Begins at the onset of labor and ends when the cervix is 100 percent effaced and completely dilated to 10 centimeters. Average length ranges for a first-time mother is from ten-to-fourteen hours and shorter for subsequent births. Read more in our Health Libarary The first stage of labor Cerival Effacement and Dilation Illustration of Cervical Effacement Second Stage of Labor Begins when the cervix is completely effaced and dilated and ends with the birth of the baby. Average length for a first time mother ranges from 1 to-2 hours and shorter for subsequent births. Read more in our Health Library The second stage of labor Third Stage of Labor Begins with the birth of the baby and ends with the delivery of the placenta. Average length for all vaginal deliveries ranges from five-to-fifteen minutes.

Fourth Stage of Labor Begins with delivery of the placenta and ends one-to-two hours after delivery. Stage 1: Early labor and active labor The first stage of labor occurs when the cervix opens (dilates) and thins out (effaces) to allow the baby to move into the birth canal. This is the longest of the three stages of labor. It's actually divided into two phases of its own early labor and active labor. Early labor During early labor, your cervix will begin to dilate. You'll feel mild to moderately strong contractions during early labor. They may last 30 to 90 seconds and come at regular intervals. As your cervix begins to open, you might notice a thick, stringy, blood-tinged discharge from your vagina. This is known as bloody show. How long it lasts: Early labor is unpredictable. It can last for hours or even days, especially for first-time moms. It's often much shorter for subsequent deliveries. What you can do: Until your contractions increase in frequency and intensity, it's up to you. For many women, early labor isn't particularly uncomfortable. You might feel like doing household chores, taking a walk or watching a movie or you might simply continue your daily activities. To promote comfort during early labor: Take a shower or bath Listen to relaxing music Have a gentle massage Try slow, deep breathing Change positions Drink water, juice or other clear liquids Eat light, healthy snacks Apply ice packs or heat to your lower back Active labor Now it's time for the real work to begin. During active labor, your cervix will dilate to 10 centimeters. Your contractions will get stronger, last longer and come closer together. Near the end of active labor, it might feel as though the contractions never completely disappear. You might feel increasing pressure in your back as well. If you haven't headed to your labor and delivery facility yet, now's the time. Don't be surprised if your initial excitement wanes as your labor progresses and the pain intensifies. Don't feel that you're giving up if you ask for pain medication or anesthesia. Your health care team will help you make the best choice for you and your baby. Remember, you're the only one who can judge your need for pain relief. How long it lasts: Active labor often lasts up to eight hours. For some women, active labor lasts hours longer. For others especially those who've had a previous vaginal delivery active labor is much shorter. What you can do: Look to your labor coach and health care team for encouragement and support. Try breathing and relaxation techniques to combat your growing discomfort. Use what you learned in childbirth class or ask your health care team for suggestions. To promote comfort during active labor:

Change positions Rock in a rocking chair Roll on a birthing ball Take a warm shower or bath Place a cool, damp cloth on your forehead Take a walk, stopping to breathe through contractions Have a gentle massage between contractions The last part of active labor often referred to as transition can be particularly intense. If you feel the urge to push but you're not fully dilated, your health care provider might ask you to hold back. Pushing too soon could cause your cervix to tear or swell, which might delay delivery or cause troublesome bleeding. Pant or blow your way through the contractions. Stage 2: The birth of your baby It's time! You'll deliver your baby during the second stage of labor. How long it lasts: It can take from a few minutes up to several hours or more to push your baby into the world. It often takes longer for first-time moms and women who've had an epidural. What you can do: Push! You might be encouraged to push with each contraction to speed the process. Or you might take it more slowly, letting nature do the work until you feel the urge to push. When you push, don't hold tension in your face. Bear down and concentrate on pushing where it counts. Experiment with different positions until you find one that feels best. You can push while squatting, sitting, kneeling even on your hands and knees.

At some point, you might be asked to push more gently or not at all. Slowing down gives your vaginal tissues time to stretch rather than tear. To stay motivated, you might ask to feel the baby's head between your legs or see it in a mirror. After your baby's head is delivered, his or her airway will be cleared and your health care provider will make sure the umbilical cord is free. The rest of your baby's body will follow shortly. Stage 3: Delivery of the placenta After your baby is born, you'll likely feel a great sense of relief. You might hold the baby in your arms or on your abdomen. Cherish the moment. But a lot is still happening. During the third stage of labor, your health care provider will deliver the placenta and make sure your bleeding is under control. How long it lasts: The placenta is typically delivered in about five to 10 minutes. In some cases, it may take up to 30 minutes. What you can do: Relax! By now your focus has likely shifted to your baby. You might be oblivious to what's going on around you. If you'd like, try breast-feeding your baby. You'll continue to have mild contractions. Your health care provider might massage your lower abdomen to encourage your uterus to contract and expel the placenta. You might be asked to push one more time to deliver the placenta, which usually comes out with a small gush of blood. Your health care provider will examine the placenta to make sure it's intact. Any remaining fragments must be removed from the uterus to prevent bleeding and infection. If you're interested, ask to see the placenta. Your health care provider will also determine whether you need stitches or other repair work. If you do, you'll receive an injection of local anesthetic in the area to be stitched if it's not numb already. You might also be given medication to encourage uterine contractions and minimize bleeding.

What is NewBorn Screening? Newborn Screening (NBS) is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation and even death if left untreated. The goal of newborn screening is to give all newborns a chance to live a normal life. It provides the opportunity for early treatment of diseases that are diagnosed before symptoms appear. Included in the panel of disorders under the Philippine Newborn Screening Program are: Congenital Hypothyroidism (CH), Congenital Adrenal Hyperplasia (CAH), Glucose-6Phosphate Dehydrogenase (G6PD) Deficiency, Galactosemia (Gal) and Phenylketonuria (PKU). Assessments for newborn babies: Each newborn baby is carefully checked at birth for signs of problems or complications. A complete physical assessment will be performed that includes every body system. Throughout the hospital stay, physicians, nurses, and other healthcare providers continually assess a baby for changes in health and for signs of problems or illness. Assessment may include:

Apgar scoring: The Apgar score is one of the first checks of your new baby's health. The Apgar score is assigned in the first few minutes after birth to help identify babies that have difficulty breathing or have a problem that needs further care. The baby is checked at one minute and five minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color. Each area can have a score of zero, one, or two, with ten points as the maximum. A total score of ten means a baby is in the best possible condition. Nearly all babies score between eight and ten, with one or two points taken off for blue hands and feet because of immature circulation. If a baby has a difficult time during delivery, this can lower the oxygen levels in the blood, which can lower the Apgar score. Apgar scores of three or less often mean a baby needs immediate attention and care. However, only 1.4 percent of babies have Apgar scores less than seven at five minutes after birth. Sign Score = 0 Absent Absent Score = 1 Below 100 per minute Weak, irregular, or gasping Score = 2 Above 100 per minute Good, crying

Heart Rate Respiratory Effort Muscle Tone

Flaccid

Some flexion of arms and legs

Well flexed, or active movements of extremities Good cry

Reflex/Irritability

No response

Grimace or weak cry

Color

Blue all over, or pale

Body pink, hands and feet blue

Pink all over

Birthweight and measurements: A baby's birthweight is an important indicator of health. The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). In general, small babies and very large babies are at greater risk for problems. Babies are weighed daily in the nursery to assess growth, fluid, and nutrition needs. Newborn babies may lose as much as 10 percent of their birthweight. This means that a baby weighing 7 pounds 3 ounces at birth might lose as much as 10 ounces in the first few days. Premature and sick babies may not begin to gain weight right away. Most hospitals use the metric system for weighing babies. This chart will help you convert grams to pounds.

Converting grams to pounds and ounces: 1 lb. = 453.59237 grams; 1 oz. = 28.349523 grams; 1000 grams = 1 Kg.

Pounds Ounces 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 2 907 936 964 992 1021 1049 1077 1106 1134 1162 1191 1219 1247 1276 1304 1332 3 4 5 6 7 8 9

1361 1814 2268 1389 1843 2296 1417 1871 2325 1446 1899 2353 1474 1928 2381 1503 1956 2410 1531 1984 2438 1559 2013 2466 1588 2041 2495 1616 2070 2523 1644 2098 2551 1673 2126 2580 1701 2155 2608 1729 2183 2637 1758 2211 2665 1786 2240 2693

2722 3175 3629 4082 2750 3203 3657 4111 2778 3232 3685 4139 2807 3260 3714 4167 2835 3289 3742 4196 2863 3317 3770 4224 2892 3345 3799 4252 2920 3374 3827 4281 2948 3402 3856 4309 2977 3430 3884 4337 3005 3459 3912 4366 3033 3487 3941 4394 3062 3515 3969 4423 3090 3544 3997 4451 3118 3572 4026 4479 3147 3600 4054 4508

Measurements: Other measurements are also taken of each baby. These include the following: o head circumference (the distance around the baby's head) - is normally about one-half the baby's body length plus 10 cm o abdominal circumference - the distance around the abdomen o length - the measurement from crown of head to the heel Physical examination: A complete physical examination is an important part of newborn care. Each body system is carefully examined for signs of health and normal function. The physician also looks for any signs of illness or birth defects. Physical examination of a newborn often includes the assessment of the following:

vital signs:

temperature - able to maintain stable body temperature 98.6 F (37 C) in normal room environment pulse - normally 120 to 160 beats per minute breathing rate - normally 30 to 60 breaths per minute o general appearance - physical activity, tone, posture, and level of consciousness o skin - color, texture, nails, presence of rashes o head and neck: appearance, shape, presence of molding (shaping of the head from passage through the birth canal) fontanels (the open "soft spots" between the bones of the baby's skull) clavicles (bones across the upper chest) o face - eyes, ears, nose, cheeks o mouth - palate, tongue, throat o lungs - breath sounds, breathing pattern o heart sounds and femoral (in the groin) pulses o abdomen - presence of masses or hernias o genitals and anus - for open passage of urine and stool o arms and legs - movement and development Gestational assessment: Assessing a baby's physical maturity is an important part of care. Maturity assessment is helpful in meeting a baby's needs if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than it appears by size, and may need different care than a premature baby. An examination called The Dubowitz/Ballard Examination for Gestational Age is often used. A baby's gestational age often can be closely estimated using this examination. The Dubowitz/Ballard Examination evaluates a baby's appearance, skin texture, motor function, and reflexes. The physical maturity part of the examination is done in the first two hours of birth. The neuromuscular maturity examination is completed within 24 hours after delivery. Information often used to help estimate babies' physical and neuromuscular maturity are shown below Physical maturity: The physical assessment part of the Dubowitz/Ballard Examination looks at physical characteristics that look different at different stages of a baby's gestational maturity. Babies who are physically mature usually have higher scores than premature babies. Points are given for each area of assessment, with a low of -1 or -2 for extreme immaturity to as much as 4 or 5 for postmaturity. Areas of assessment include the following: o skin textures (i.e., sticky, smooth, peeling). o lanugo (the soft downy hair on a baby's body) - is absent in immature babies, then appears with maturity, and then disappears again with postmaturity. o plantar creases - these creases on the soles of the feet range from absent to covering the entire foot, depending on the maturity. o breast - the thickness and size of breast tissue and areola (the darkened ring around each nipple) are assessed. o eyes and ears - eyes fused or open and amount of cartilage and stiffness of the ear tissue. o genitals, male - presence of testes and appearance of scrotum, from smooth to wrinkled. o genitals, female - appearance and size of the clitoris and the labia. Neuromuscular maturity: Six evaluations of the baby's neuromuscular system are performed. These include: o posture - how does the baby hold his/her arms and legs. o square window - how far the baby's hands can be flexed toward the wrist. o arm recoil - how far the baby's arms "spring back" to a flexed position. o popliteal angle - how far the baby's knees extend. o scarf sign - how far the elbows can be moved across the baby's chest. o heel to ear - how close the baby's feet can be moved to the ears. A score is assigned to each assessment area. Typically, the more neurologically mature the baby, the higher the score. When the physical assessment score and the neuromuscular score are added together, the gestational age can be estimated. Scores range from very low for immature babies (less than 26 to 28 weeks) to very high scores for mature and postmature babies. All of these examinations are important ways to learn about your baby's well-being at birth. By identifying any problems, your baby's physician can plan the best possible care.