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EINC

Doc Gaspar
Outline
Global Strategy for Newborn Health
Kangaroo Mother Care
Scale up of Early Essen<al Intrapartal
Newborn Care Prac<ces:
Uninterrupted First Hour: Unang Yakap
Lacta<on Management
Benets
Evidences
Protocols
Global Goal for the Mother and The
Newborn
Unified Strategy to save mother,
newborns and children
Targe<ng high-risk and low performing areas to fast
track aMainment of goals
Empowering mothers to u<lize life-saving packages
Developing incen<ve mechanisms to inuence
posi<ve behaviors from health providers and
consumers
MNCHN STRATEGY intermediate
results

Every delivery is Every mother


Every FACILITY-BASED and newborn
Every
pregnancy is and managed pair secures
pregnancy is
wanted, by skilled proper
adequately
planned and health postpartum
managed
supported professionals
M.D., R.N., R.M.
and postnatal
care
MNCHN Service Delivery Network
End-Referral facility (Provincial hospitals
etc): BEMONC services + BT, CS and Advance
cEmONC NB Resuscita<on; Operates 24 hrs, with OB/
End-referral Surgeon, pedia, nurse, MW, med tech

BEmONC FACILITY Normal vaginal delivery, imminent breech


District Hospitals and delivery, emergency drugs (an<bio<cs,
Rural Health Units with MgSO4, oxytocin, dexamethasone), ENC,
SBAs Basic NB resuscita<on, FP services
Private Lying in CLinics
Pregnancy tracking, birth planning, home
visits and follow-up, nutri<on package
Community Level
including breas`eeding support; IEC on
Service Provider: facility delivery and family planning;
Community Health Teams communica<on ac<vi<es targeted to
mothers and their families.
IMPORTANT REASONS WHY THE 1st
HOUR AFTER BIRTH SHOULD BE
UNDISTURBED:
FIRST EMBRACE / UNANG YAKAP

Immediate
Skin to skin
and thorough
contact
Drying

Non-
Appropriate separa<on of
Timed Cord mother and
Clamping Newborn for
Breas`eeding
LINEAR ARRANGEMENT OF
INSTRUMENTS
Resuscitation Equipment
A newbron-sized self-ina<ng bag
Infant masks sizes 0 and 1
A suc<on device (mechanical or electrical or mouth-
operated)
Oxygen Source
Stethoscope
A supply of warm towels and blankets
Skilled birth attendants must be prepared
Advanced resuscita<on 4% Babies who need
help to breathe
Bagmask ven<la<on 9%

All Babies
Immediate
Newborn Drying quick check of
Care breathing, skin-to-skin
contact with mother,
Breas`eeding ini<a<on
EFFECTIVE RESUSCITATION POSSIBLE IN
LOW RESOURCE SETTINGS
Training providers in neonatal resuscita<on may
prevent
30% of deaths of full term babies with
intrapartum-related events
5-10% of deaths due to preterm birth
FREQUENCY of VENTILATION

Count out loud to maintain a rate of 40-6- breaths/min


Observe CHEST RISE
Breathe 2-3**
How to ventilate
Squeeze bag with 2 ngers or whole hand, 2-3 <mes
Observe for rising of chest.
IF CHEST IS NOT RISING:
Reposi<on the head
Check mask seal
Squeeze bag harder with whole hand

Once good seal and chest rising, ven<late at 40 squeezes per


minute
Observe the chest while ven<la<ng:
Is it moving with the ven<la<on?
Is baby breathing spontaneously?
Guidelines on Basic Newborn Resuscitation
2012
NO suc<oning for babies who are breathing on their own,
amnio<c uid is clear
If not breathing, posi<ve pressure ven<la<on could be given,
NOT suc<oning
Suc<oning should be done only if ven<la<on is not adequate
and there are secre<ons
PREPARE FOR ALL DELIVERIES
RESUSCITATION AREA
FIRM, FLAT SURFACE
WARM
NEAR DELIVERY
TABLE
A step away

THE WRONG SET UP


RESUSCITATION AREA

The beMer alterna<ve area for newborn resuscita<on


RESUSCITATION AREA

The beMer alterna<ve area for newborn resuscita<on



Resuscitation equipment MUST be
checked daily
FUNCTIONAL
CLEAN
WITHIN EASY REACH OF
THE RESUSCITATION AREA
- availability/in stock
BASIC RESUSCITATION EQUIPMENT
The AMBU Bag
Within 30 seconds after delivery
With in 30 seconds after delivery

Call out the ti e of birth


deliver and place on mother's abdomen
Dryng should be the first action

Immediately for the full 30 seconds unless the


infant is both floppy /limp and apneic
Immediate and thorough Drying
Immediate dying :
1. stimulate breathing
2. Prevents hypothermia
hypothermia can lead to
1. Infection
2.coagulation defects
3.acidosis
4. Delayed fetal to newborn circulatory adjustment
5. Hyaline membrane disease
6. Brain hemorrhage
acidosis
Immediate and thorough drying
dry the newborn thoroughly for at least 30
seconds
Do a quick check of breathing while drying
>95%of newborn breathe normally after birth
Follow organized sequence
wipe gently , do not wipe off the vernix
remove the wet cloth, replace with a dry
one
If baby is not breathing stimulate by dying
do not slap , shake, or rub the baby
do not ventilate unless the baby is floppy or
limp and not breathing.
Do not suction unless the mouth or nose are
blocked
Early skin to skin contact
General perception is that it is purely for
mother_baby bonding
other benifits
1. Provides warm
2. Improves bonding
3. Provides protection from infection by
exposure of baby to good bacteria of the
mother
4. Increases the blood sugar of the baby
If breathing or crying
position prone on the mothers Abdomen or chest
cover the newborn with dry linen for back and
bonnet for head
Temperature check
room 25-28C
baby 36.5 to 37.5 C
Properly timed cord clamping
benifits
1. Allows the newborn to get a free blood
transfusion from the placenta
2. Reduces the risk of anemia in both term and
preterm babies
3. Reduces the need of transfusion and brain
hemorrhage
After the umbillical pulsations have stopped remove
first set of gloves
Put plastic clamp at two cm from the newborns
abdomen
Put forcept at 5 cm fro the newborns abdomen
Cut just Bove the clamp with sterile instrument
Do not milk the cord towards the baby
observe the oozingof blood. If the blood oozes,
place a second tie between the skin and the
clamp
Dry cord care is currently recommended.
Do not use a binder or bigkis.
Non - separation of newborn from mother for
early breastfeeding
1. Place the newborn on the mother's chest in the skin to skin
contact
2. Cover the baby's head with a hat . Cover the mother and the
baby with a warm cloth.
3. Initiate brestfeeding while maintaining skin to skin contact
4. Pace identification band on ankle.
5. Never leave the mother and the baby unattended
6. Monitor mother and the baby every 15 mins in the first 1-2hrs.
Assess warmth and breathing.
warmth : check to see if feet are cold to touch if no thermometer
breathing : listen for grunting , look for the chest indrawing and
fast breathing
7.
Signs of Readiness to Breastfeed
When the newborn shows feeding cues (ex . Opening of mouth ,
tonguing, licking, roo<ng) make verbal sugges<on to the mother to
encourage her newborn to move toward the breast
(ex. Nudging)
Routine nasal and oropharyngeal suctioning
ADVERSE EFFECTS IF INEXPENSIVE PERFORMED
1. Apnea (cessa<on of breathing)
2. Vagal induced bradycardia (slow heart rate)
3. Slower rise in oxygen satura<ons
4. Mucosal trauma with possibility an increased risk for infec<on
Active management of the 3rd stage of labor
Give oxytocin 10 mg IM to mother
aler excluding a second baby
Apply gentle trac<on to the cord
Gentle uterine massage
Kangaroo mother Care
What ?
Con<nous prolonged early skin to skin contact between a baby and a
mother or other adult
(upto 24 hr per day several week)
Provides warm , promotes feeding. Reduces infec<ons and link with
addi<onal suppor<ve care, if needed.
Who?
Preterm or low birthweight babies (ex. Less than 200 g as marker of
preterm birth less that 34 week)
Clinically stable ( not requiring recurent resusita<on

First embrace : Unang yakap
Should not be delayed beyond the rst cri<cal hour.
The rst hr. should fucos on babies breast feed , mother- baby and
family bonding.
Unless mother or baby needs medical assistance the WVMC protocols
should support this new beginnings for both NSD and caesarean birth.