Essential Newborn Care 2013

Essential Newborn Care
Facilitator: Almera H. Garcenila RN,MAN
Objectives:
At the end of an hour lecture the participants will be able to:
1. apply the steps in the immediate newborn
care procedure,
2. apply the steps in resuscitation of newborn,
3. value human life.
Immediate Newborn Care (first 90 minutes)
Every Newborn Has Needs

To breathe normally
To be warm
To be protected To be fed
At the of the discussion, the learner will be able to:

1. To describe in sequence, the step-by-step
procedures that a health worker should perform to meet the immediate basic needs of every newborn.
Providing Warmth: Check the Environment Preparation for vaginal birth

1. Ensure privacy at the delivery area
Check temperature of the delivery
room
Ideal temp: 25 28C
Check for air drafts Turn air conditioner off at an
appropriate time before delivery

Preparation for vaginal birth
2. Prepare your needs: Lay out two pairs of surgical gloves to be worn by the health worker that does both perineal support and cord clamping. Two warm blankets A bonnet A sterile plastic clamp And a sterile pair of scissors

3. WASH YOUR HANDS following the prescribed 1-2-3-4-5 method. 4. Put both sets of gloves.
This is a double-gloving step.
5. Remember that more than 90% of newborn breath on their own without problems.
If the baby is crying or breathing normally, do not suction because routine suctioning is potentially harmful Suction only if the airway is obstructed.

During the 1st 3 minutes within birth, here are
the correct procedures prescribed by the EINC protocol:

Once the baby is out, call out the time of birth and sex of the baby.
After a baby is born, what should be the first action performed?
A
B C
Clamp and cut the cord
Dry the baby
Suction the babys mouth and nose
Do foot printing
After a baby is born, what should be the first action performed?
A
B C
Clamp and cut the cord
Dry the baby
Suction the babys mouth and nose
Do foot printing


Lay the newborn on the mothers abdomen. TOWEL-DRY THE BODY of the newborn. Dry the baby for at least 30 seconds. This will stimulate the baby to breathe.
Immediate Thorough Drying

Immediate drying:
Stimulates Breathing Prevents hypothermia
Hypothermia can lead to

Infection Coagulation defects Acidosis Delayed fetal to newborn circulatory adjustment Hyaline membrane disease Brain hemorrhage
Tunell R., in Improving Newborn Health in Developing Countries, A. Costello and D. Manandhar, Editors. 2000, Imperial College Press: London, UK. p. 207-220; TollinM,etal.. Cell Mol Life Sci 2005
Drying should be the first action,
IMMEDIATELY for a full 30 seconds

Drying may be interrupted if, after a few seconds, the newborn remains both floppy/limp and apneic
Immediate Thorough Drying

Dry the newborn thoroughly for at least 30
seconds
Follow an organized sequence
Wipe eyes, face, head Front and back Arms and legs
Wipe gently, do not wipe off the vernix Remove the wet cloth, replace with a dry one
Immediate, Thorough Drying

Do a quick check of breathing while
drying
90-95% of newborns breathe normally after birth
If a baby is not breathing;

Stimulate by drying thoroughly Do not slap the baby Do not shake the baby Do not rub the baby vigorously
Immediate, Thorough Drying

Do not suction unless the
mouth/nose are blocked by secretions

Do a quick check of the babys
breathing and tone

Do not ventilate unless the baby
is floppy/limp and not breathing

If after drying, the baby is limp
and not crying, support breathing by bag and mask ventilation. Continue to keep the baby warm.
Washing the Baby in the First 6 Hours is Protective.
TRUE
FALSE
Washing the Baby in the First 6 Hours is Protective.
TRUE
FALSE
Early Washing Can Lead To:

Hypothermia which can lead to
Infection, coagulation defects, acidosis, delayed fetal
to newborn circulatory adjustment, hyaline membrane disease, brain hemorrhage
Infection
The vernix is a protective barrier to bacteria such as
E.coli and Group B Strep; so is maternal bacterial colonization
No crawling reflex
Tunell R., Cell Mol Life Sci 2005; 62:2390-99; Righard L, Alade M. Lancet 1990; 336: 1105-07.
Summary:
Do not wash or bathe the baby within his first 6 hours of life. Washing could lead to hypothermia and infection.


Remove the wet cloth. Initiate skin-to-skin contact by placing the baby prone on the mothers abdomen.or between her breast. Use the second linen to cover the babys back and place the bonnet on the newborns head. Both to keep the infant warm.
During drying and stimulation of the baby, your rapid assessment shows that the baby is crying.
What is your next action?
A B
Suction the babys mouth and nose Clamp and cut the cord
C
D
Do skin-to-skin contact
Do early latching on
During drying and stimulation of the baby, your rapid assessment shows that the baby is crying.
What is your next action?
A B
Suction the babys mouth and nose Clamp and cut the cord
C
D
Do skin-to-skin contact
Do early latching on
Skin-to-Skin Contact
Generally perceived to be an intervention for
provision of warmth and bonding

Less well appreciated are its contributions to
Overall success of breastfeeding/colostrum feeding Stimulation of the mucosa-associated lymphoid tissue system Protection from hypoglycemia Colonization with maternal skin flora
Moore E, et al. Cochrane Rev. 2007 Jul 18;(3). Anderson GC, et al. Cochrane Rev 2003;(2). Brandtzaeg P. Ann N Y AcadSci 2002;964:1345
Early Skin-to-Skin Contact

If newborn is breathing
or crying:
Position the newborn prone on the mothers abdomen or chest Cover the newborns back with a dry blanket Cover the newborns head with a bonnet
Use a warm cover if
room temp <25C

During the 1st 3 minutes within birth, here are the
correct procedures prescribed by the EINC protocol:

Place the ID bands around the newborns ankle. Skin-to-skin contact is essential to provide warmth and
create the bond between mother and child. Increasing the chances of overall success of breastfeeding allows colonization with good bacteria. Protects the baby from low blood sugar levels. Wipe the soiled gloves with the wet cloth used to wipe the baby.
When should the cord be clamped after birth?
A
B C
When the cord pulsations stop
Between 1 and 3 minutes
Between 30 secs - 1 minute in preterms

All of the above are appropriate
When should the cord be clamped after birth?
A
B C
When the cord pulsations stop
Between 1 and 3 minutes
Between 30 secs - 1 minute in preterms

All of the above are appropriate
Properly-Timed Cord Clamping

When preparing for delivery,
don 2 pairs of gloves after thorough handwashing

Remove the first set of gloves
Palpate the umbilical cord

After cord pulsations have
stopped, clamp the cord using a sterile plastic clamp or tie at 2 cm from the umbilical base
Properly-Timed Cord Clamping

Clamp again at 5 cm from the base Cut the cord close to the plastic clamp
2cm
3cm
BABY
Properly-Timed Cord-Clamping
Do not milk the cord
towards the baby

After the 1st clamp,
you may strip the cord of blood before applying the 2nd clamp
Cut the cord close to
the plastic clamp so that there is no need for a 2nd trim
Care of the Cord

Do not use a binder or bigkis Do not apply any substance onto the cord Observe for the oozing of blood. If blood
oozes, place a second tie between the skin and the clamp


While maintaining skin-to skin contact Check on the mothers condition To deliver the placenta, ensure that the uterus is well contracted. With one hand apply controlled traction on the cord while the other hand is positioned at the area of the womans symphysis pubis to provide counter traction.


Proceed to cheek on heavy bleeding and
examine the mothers perineum, lower vagina and vulva for tears. Clean the mother and keep her comfortable Inspect the placenta
What is the approximate capacity of a newborns stomach?

A
C D
What is the approximate capacity of a newborns stomach?

A B
C D
How long after birth is a newborn ready to breastfeed?
A
B C
immediately
5-10 minutes
10-20 minutes
20-60 minutes
How long after birth is a newborn ready to breastfeed?
A
B C
immediately
5-10 minutes
10-20 minutes
20-60 minutes
Early and Appropriate Breastfeeding Initiation

Leave the newborn between the mothers
breasts in continuous skin-to-skin contact

The baby may want to rest for 20-30 mins
and even up to 120 mins before showing signs of readiness to feed

Health workers should not touch the newborn unless there is a medical indication
Do not give sugar water, formula or other
prelacteals
Do not give bottles or pacifiers Do not throw away colostrum Let the baby feed for as long as he/she wants on
both breasts

Help the mother and baby into a comfortable position
Observe the newborn Once the newborn shows feeding cues, ask the mother to encourage her newborn to move toward the breast
Support Continued and Exclusive Breastfeeding

After delivery, mother
is moved onto a stretcher with her baby and transported to Recovery Room, mother-baby ward or private room
Breastfeeding support
is continued

Counsel on positioning
Newborns neck is not flexed or twisted Newborn is facing the breast Newborn is close to
mothers body Newborns whole body is supported

Counsel on attachment and suckling
Mouth wide open Lower lip turned
outwards Babys chin touching breast Suckling is slow, deep with some pauses
Proper Breastfeeding Hold

Look for a quiet place
Find most relaxed position for mother

Provide adequate back support
Support feet
Do not hunch shoulders
Do not scissor the breast

Breastfeeding:
Counsel on positioning . The newborns neck should not be flexed nor twisted. The newborns whole body should be facing the mothers breast The newborns body should be close to the mothers body The newborns body should be supported
Underarm Hold
Football hold
Baby is held like a
clutch bag
Nose further away
from the breast

Babys trunk is secure
beside mothers trunk
Side-Lying Position
Side-Lying Position
E.O. 51 and its rIRR: The DONTs DO NOT REQUEST or ACCEPT

from Milk Companies or their representatives:
Gifts of any sort Samples or products covered under the Milk Code Posters, other promotional materials or direct
promotions of products covered under the code within your Health Facility, Community, Barangays, Events, etc. Sponsorships without permission from FDA Endorsements of products covered by the Milk Code

After the baby completes his first breastfeed and detaches from the breast, while he is with his mother, perform a thorough physical examination and check for birth injuries, malformations and defects. Carry out the eye care procedures.

Add the eye ointment, vitamin k, hepatitis B and vaccines. Let the infant remain in the mothers arms as she recovers from giving birth.

While the mother and the newborn are
together in the skin-to-skin contact the mother should be in semi-upright position so that the babys head is higher than the rest of the babys body.

Within the 1-2 hours after a vaginal
delivery, the mother and the baby should not be left unattended. Both mother and the baby are monitored for bleeding and breathing and other signs of problems.

When the mother is transferred from delivery table and transported to the room or ward, the newborn is the best positioned prone on the mothers chest with the head turned to one side . The baby may be washed but only after at least six hours.

The step-by-step method of essential intrapartum and newborn care is doable even for a cesarean section birth. The baby is first positioned in between the mothers thighs where drying is carried out. Next, the cord is palpated and once pulsations have stopped, it is clamped and cut as previously demonstrated.

The baby is then brought and assisted for skin to skin contact on the mothers chest. Non-separation of the mother and baby follows to allow for early initiation of breastfeeding.
Non-separation of Newborn from Mother for Early Breastfeeding

Weighing, bathing, eye care, examinations, injections should be done after the first full breastfeed is completed Postpone bathing until at least 6 hours
Non-separation of Newborn from Mother

Never leave the mother and baby unattended

To summarize here are the step-by-step methods outlined in the essential newborn care protocol according to w.h.o. Standards:
Drying for at least 30 secs with rapid assesment
of breathing and tone . Early skin-to-skin contact. Properly timed cord clamping. Non-separation of the newborn from mother for early breastfeeding initiation.
Essential Newborn Care (from 90 mins to 6 hours)

At the of the discussion, the learner will be able to: 1. To describe in sequence, the step-by-step procedures that a health worker should perform within 90 minutes to 6 hours after birth.

This time band covers the essential
interventions which should be done after the after the baby completes his first breastfeed.
Healthy newborns will typically complete the
first breastfeed within the first 1 to 2 hours of life.

After the newborn has completed the first
breastfeed, the health worker washes his/her hands. After the newborn has located the breast, preferably after the first breastfeed . With the baby beside or on the abdomen of the mother, the health worker provides Eye Care then does a thorough physical examination.

Possible birth injuries like: bumps on either or both sides of the head, abnormal positioning of legs after breech
presentation, and asymmetrical arm movements Likely to disappear in a week or two and do not need special treatment.

Malformations like: cleft palate or lip, club feet, or unusual appearance
Should be referred for evaluation and special
treatment if available.
If there is any open tissue over the spine or
exposed internal organs like intestines, cover the tissue with sterile gauze before referral.

The vaccines are prepared next. Prepare the eye ointment, Vitamin K,
Hepatitis B and BCG vaccines. The Vitamin K ampule, Hepatitis B and BCG vials must be prepared with separate sterile needles and syringes. Ensure vaccine safety and proper closing.

The recommended sites for administration
are the outer mid-thighs for the Vitamin K and Hepatitis B shots, and the right upper arm for the BCG shot. The mother must be counseled about the possible side effects f the vaccines. Close observation of her newborn must be advised.

After injections, newborns who are beside
or on their mother chest are more easily consolable. At this point, counsel the mother on dry cord care. Advise her to put nothing on the stump so that it dries and falls off in a few days.

Again do not put on any substance, medicine,
or bandage on the cord fold diaper below stump. Keep cord stump loosely covered with clean clothes. If umbilicus is red or draining pus or blood, seek care.

Small babies should be provided with
additional care. A small baby refers to a newborn delivered two months early or weighs less than 1.5 kilograms at birth. A very small baby refers to a newborn delivered two months early or weighs less than 1.5 kilograms at birth.

In summary: 1. Care of the newborn after the first 1-2 hours until 6 hours after birth has been done . 2. Routine procedures like eye care, examination, weighing and injections should be performed
after the newborn has completed his/her first breastfeed, preferably in the company of the babys mother. 3. Care of the small and very small baby or twin has also been done.
Basic Resuscitation of the Newborn

More than 95% of newborns in the Philippines
will require no assistance to breath at birth

Around 5% will require some assistance and
less than 1% will require advanced resuscitation

The learner will be able to learn about the;
Guidelines set for Basic Resuscitation set with
the Essential Newborn Care protocol

The equipment and supplies, and Monitoring needed when resuscitation is
required



Before every delivery, it is necessary to have the
following basic equipment and supplies ready:

A wall clock or watch with a second hand A dry, clean, flat surface with a light and heat
source near birthing area

At least 2 dry towels
A non-mercury thermometer

Before every delivery, it is necessary to have the following basic equipment and supplies ready: Electric suction machine with pressure gauge (with the suction pressure regulated between 80-100cm of water) Suction catheters Face masks for term and preterm newborns Oxygen source with flow meter


Newborn sized and self-inflating resuscitator
bag with an oxygen reservoir attached

It is important to test the bag for leaks. Place palm against the outlet of the self inflating bag and
squeeze the bag. There must be a ready return to the inflated state after squeezing.

For those with facilities and skilled personnel, in addition to the basic equipment and supplies, ready: Sterile gloves Disposable face mask Laryngoscope with blade size 0 and 1 ( make sure to check the batteries. Ensure that the light works and the bulb is not loose.)

For those with facilities and skilled personnel, in addition to the basic equipment and supplies, ready:

Endotracheal tubes Adhesive tape Scissors suction tubes
Check that all these equipment are readily available at all times. It must be routine to replace stock after each delivery.

After delivery, call out the time of birth and sex
of the baby.
Do a quick check of the babys breathing
efforts while drying for at least 30 seconds.

The normal respiratory rate of newborn is
between 30-60 breaths per minute.

If the newborn is not breathing or crying but
has tone, stimulate breathing by immediate and thorough drying.

Call for help and start bag and mask ventilation
if:
After 30 secs to 1 minute of drying, the baby
is still not breathing or is gasping. If necessary, immediately clamp and cut the cord.

Place the baby in a dry surface with a light and
heat source. It is important to keep warm.

Position the newborns head and neck so it is
slightly extended. If the newborn is still not crying and not breathing begin supporting the newborns breathing by using a manual resuscitator, or what is more commonly known as self-inflating bag.

Choose the appropriate sized faced mask and
attach to the manual resuscitator. Place mask over the newborns mouth and nose.
Ensure that the mask is tightly sealed. Hold the
mask down with one hand using the C shaped hold with thumb and index finger. The other finger should be resting along the line of the jaw, lifting the chin.
Squeezed the bag attached to the mask and
deliver manual breaths by using the count, Breath-two-three-, breath-two-three..for 30 seconds.

While giving supported breaths with the bag
and mask, observe for the chest rise. If there is no chest rise, check the following: The position of the baby's head The adequacy of the mask seal The airway for obstruction

and mask, observe for the chest rise. If there is no chest rise, check the following: That the bag resuscitator is intact If there is pneumothorax or air leak The need to deliver more pressure by squeezing the bag harder

Assess the airway for blockage or obstruction.
If the airway is blocked by thick material or profuse secretions, clear the blocked airway by using a large bore suction catheter connected to a suction machine with the suction pressure regulated to 80-100 centimeters water.

Insert the catheter 5cm into the mouth and
suck while withdrawing. Then insert 3cm into each nostril and suck while withdrawing. Repeat once if needed but take no more than 20 seconds at each time.
After making the necessary adjustments in
supporting breathing, resume delivery of manual breaths, observe good chest rise and reassess the newborn every 30 seconds until there is crying or breathing.

When the newborn starts to breathe at a rate
more 30 minute or starts to cry, has no chest indrawing, and the color is pink, put the newborn skin to skin on the mothers chest while continuing to monitor the newborns breathing and warmth.
The mother is in a semi-sitting position and
the newborns head is turned to one side.

Support the mother and explain the newborns
condition.
When the newborn does breathing or is
gasping but a rate less than 30 per minute, or breathes at more than 30 per minute but has severe chest in-drawing, continue bag and mask ventilation and reassessment every 30 seconds. Arrange for referral and transport.

Proceed to intubation if thee is skilled
personnel and equipment available.

If after 20 minutes of effective ventilation with
good chest rise observed and the newborn still does not cry and gasp, the baby is presumed dead.
Explain to the mother that the newborn did
not survive, as well as to the family of the newborn. Make a record of the event.

In summary:
The additional care for a small number of newborns that may require assistance to initiate or sustain adequate breathing after immediate and thorough drying. These steps in Basic Newborn Resuscitation are applicable from primary health care settings
through to tertiary settings. The equipment and supplies and monitoring during resuscitation process.
INTERVENTION:
ACTION: Start resuscitation if the newborn: is not breathing or is gasping after 30 seconds of drying or before 30 seconds of drying if the baby is completely floppy and not breathing. Clamp and cut the cord immediately, if necessary. Transfer the newborn to a dry, clean and warm surface. Keep the newborn wrapped or under a heat source if available. Inform the mother that the newborn needs help to breathe.
INTERVENTION:
INTERVENTION: Open airway ACTION: Position the head so it is slightly extended. Introduce the suction tube: - First, into the newborns mouth 5 cm from the lips and suck while withdrawing. - Second, 3 cm into each nostril and suck while withdrawing. - Repeat once, if necessary taking no more than a total of 20 secs. Note: - Do not suction mouth and nose prior to delivery of the shoulders of babies with meconium stained amniotic fluid.
INTERVENTION:
INTERVENTION: Ventilate, if still not breathing ACTION: Place mask to cover chin, mouth and nose to achieve a seal. Squeeze bag attached to the mask with 2 fingers or whole hand, according to bag size, 2 or 3 times. Observe rise of chest. If chest is not rising: - First, reposition babys head - If babys chest is still not rising - Check for adequate mask seal - If chest is still not rising, squeeze bag harder.
INTERVENTION:
If chest is rising, ventilate at 40 breaths per minute until newborn starts crying or breathing. Reassess at 30-second intervals.
INTERVENTION:
If baby still fails to improve, check the following: Failure To Improve Checklist - Face-mask seal tight? - Airway clear of secretions? - Head positioned properly? - Is contact with the soft tissue of the infants anterior neck being avoided? - Resuscitator working properly? - Adequate pressure being used? - Air distending the stomach? - Air leak (pneumothorax)?
INTERVENTION:
If baby starts crying or breathing >30
per minute and has no chest-in-drawing, stop ventilating:

- Put the newborn in skin-to-skin contact on mothers chest and continue care while monitoring breathing and warmth. - Explain the babys condition to the mother.
INTERVENTION:
If after 30 sec of effective bag/mask ventilation,
the newborn is gasping/ breathing <30 per min or > 30 per min but has severe chest in-drawing: - Continue bag/mask ventilation - Continue assessing at 30 sec intervals while transporting or Proceed to intubation per advanced resuscitation guidelines, if skilled personnel and equipment are available
INTERVENTION:
If after 20 minutes of effective ventilation, the newborn does not start to breathe or gasp at all, stop ventilating. - Explain to the mother that the baby is dead, give supportive care and record the event.
Notes: - While ventilating, refer and explain to the mother what happened, what you are doing and why. - Ventilate, if needed, during transport - Record the event on the referral form and labor record.
INTERVENTION:
B. Additional Care of a Small Baby (or Twin): If newborn is preterm, 1-2 months early or weighing 1500 2499 g (or visibly small where scale not available) AREA OF CONCERN: Warmth
ACTION: Ensure additional warmth for the small baby. - Ensure the room is maintained 25-28oC. - Teach the mother how to keep the small baby warm in skin-to-skin contact via Kangaroo Mother Care - Provide extra blankets for mother and baby, plus bonnet, mittens and socks for baby. Notes: - Do not bathe the small baby. Keep the baby clean by wiping with a damp cloth but only after 6 hours.
INTERVENTION:
AREA OF CONCERN: Feeding Support ACTION: Give special support for breastfeeding: - Encourage the mother to breastfeed every 2-3 hours. - Assess breastfeeding daily: positioning, attachment, suckling, duration and frequency of feeds, and baby satisfaction with the feed.
Weigh baby daily. When mother and newborn are separated, or if the baby is not sucking effectively, use alternative feeding methods. Refer to Dealing with Feeding Problems
INTERVENTION: AREA OF CONCERN: Kangaroo Mother Care (KMC) (Adapted from WHO. ENCC Jan 2009) ACTION: Start kangaroo mother care when: The baby is able to breathe on its own (no apneic episodes). The baby is free of life-threatening disease or malformations. Notes: - The ability to coordinate sucking and swallowing is not a pre-requisite to KMC. Other methods of feeding can be used until the baby can breastfeed. - KMC can begin after birth, after initial assessment and basic resuscitation, provided the baby and mother is stable. If kangaroo mother care is not doable, wrap the baby in a clean, dry, warm cloth and place in a crib. Cover with a blanket. Use a radiant warmer if room is not warm or baby small.
INTERVENTION:
If kangaroo mother care is not doable, wrap the baby in a clean, dry, warm cloth and place in a crib. Cover with a blanket. Use: a radiant warmer if room is not warm or baby small. Explain KMC to the mother: - continuous skin-to-skin contact - positioning her baby - attaching her baby for breastfeeding - expressing her milk - caring for her baby - continuing her daily activities - preparing a support binder
Position the baby for -
KMC: Place the baby in upright position between the mothers breasts, chest to chest Position the babys hips in a frog-leg position with the arms also flexed. Secure the baby in this position with the support binder Turn the babys head to one side, slightly extended Tie the cloth firmly
INTERVENTION:
Notes:
- KMC should last for as long as possible each day.
- If the mother needs to interrupt KMC for a short
period, the father, a relative or friend should take over.
INTERVENTION:
AREA OF CONCERN: Discharge Planning ACTION: Plan to discharge when: - Breastfeeding well and gaining weight adequately for 3 consecutive days - Body temperature between 36.5 and 37.5C for 3 consecutive days - Mother is able and confident in caring for baby
Life is not measured by the years that you live, but by the deeds that you do and the joy the you give Thanks.GOD bless youall
Maam Mimi

The learner will be able to learn about the;
Guidelines set for Basic Resuscitation set with
the Essential Newborn Care protocol

The equipment and supplies, and Monitoring needed when resuscitation is
required




A wall clock or watch with a second hand A dry, clean, flat surface with a light and heat
source near birthing area

At least 2 dry towels
A non-mercury thermometer

Before every delivery, it is necessary to have the following basic equipment and supplies ready: Electric suction machine with pressure gauge (with the suction pressure regulated between 80-100cm of water) Suction catheters Face masks for term and preterm newborns Oxygen source with flow meter


Newborn sized and self-inflating resuscitator
bag with an oxygen reservoir attached

It is important to test the bag for leaks. Place palm against the outlet of the self inflating bag and
squeeze the bag. There must be a ready return to the inflated state after squeezing.

For those with facilities and skilled personnel, in addition to the basic equipment and supplies, ready: Sterile gloves Disposable face mask Laryngoscope with blade size 0 and 1 ( make sure to check the batteries. Ensure that the light works and the bulb is not loose.)

For those with facilities and skilled personnel, in addition to the basic equipment and supplies, ready:

Un-cuffed endotracheal tubes Adhesive tape Scissors suction tubes
Check that all these equipment are readily available at all times. It must be routine to replace stock after each delivery.

After delivery, call out the time of birth and sex
of the baby.
Do a quick check of the babys breathing
efforts while drying for at least 30 seconds.

The normal respiratory rate of newborn is
between 30-60 breaths per minute.

If the newborn is not breathing or crying but
has tone, stimulate breathing by immediate and thorough drying.

Call for help and start bag and mask ventilation
if:
After 30 secs to 1 minute of drying, the baby
is still not breathing or is gasping. If necessary, immediately clamp and cut the cord.

Place the baby in a dry surface with a light and
heat source. It is important to keep warm.

Position the newborns head and neck so it is
slightly extended. If the newborn is still not crying and not breathing begin supporting the newborns breathing by using a manual resuscitator, or what is more commonly known as self-inflating bag.

Choose the appropriate sized faced mask and
attach to the manual resuscitator. Place mask over the newborns mouth and nose.
Ensure that the mask is tightly sealed. Hold the
mask down with one hand using the C shaped hold with thumb and index finger. The other finger should be resting along the line of the jaw, lifting the chin.
Squeezed the bag attached to the mask and
deliver manual breaths by using the count, Breath-two-three-, breath-two-three..for 30 seconds.

and mask, observe for the chest rise. If there is no chest rise, check the following: The position of the baby's head The adequacy of the mask seal The airway for obstruction

and mask, observe for the chest rise. If there is no chest rise, check the following: That the bag resuscitator is intact If there is pneumothorax or air leak The need to deliver more pressure by squeezing the bag harder

Assess the airway for blockage or obstruction.
If the airway is blocked by thick material or profuse secretions, clear the blocked airway by using a large bore suction catheter connected to a suction machine with the suction pressure regulated to 80-100 centimeters water.

Insert the catheter 5cm into the mouth and
suck while withdrawing. Then insert 3cm into each nostril and suck while withdrawing. Repeat once if needed but take no more than 20 seconds at each time.
After making the necessary adjustments in
supporting breathing, resume delivery of manual breaths, observe good chest rise and reassess the newborn every 30 seconds until there is crying or breathing.

When the newborn starts to breathe at a rate
more 30 minute or starts to cry, has no chest indrawing, and the color is pink, put the newborn skin to skin on the mothers chest while continuing to monitor the newborns breathing and warmth.
The mother is in a semi-sitting position and
the newborns head is turned to one side.

Support the mother and explain the newborns
condition.
When the newborn does breathing or is
gasping but a rate less than 30 per minute, or breathes at more than 30 per minute but has severe chest in-drawing, continue bag and mask ventilation and reassessment every 30 seconds. Arrange for referral and transport.

Proceed to intubation if thee is skilled
personnel and equipment available.

If after 20 minutes of effective ventilation with
good chest rise observed and the newborn still does not cry and gasp, the baby is presumed dead.
Explain to the mother that the newborn did
not survive, as well as to the family of the newborn. Make a record of the event.

In summary:
The additional care for a small number of newborns that may require assistance to initiate or sustain adequate breathing after immediate and thorough drying. These steps in Basic Newborn Resuscitation are applicable from primary health care settings
through to tertiary settings. The equipment and supplies and monitoring during resuscitation process.

Essential Newborn Care 2013

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Essential Newborn Care

Facilitator: Almera H. Garcenila RN,MAN

Immediate Newborn Care (first 90 minutes)

Every Newborn Has Needs

Immediate Newborn Care (first 90 minutes)

At the of the discussion, the learner will be able to:

Immediate Newborn Care (first 90 minutes)

Providing Warmth: Check the Environment Preparation for vaginal birth

Check temperature of the delivery

Check for air drafts Turn air conditioner off at an

appropriate time before delivery

Immediate Newborn Care (first 90 minutes)

Immediate Newborn Care (first 90 minutes)

Immediate Newborn Care (first 90 minutes)

the correct procedures prescribed by the EINC protocol:

After a baby is born, what should be the first action performed?

Clamp and cut the cord

Dry the baby

Suction the babys mouth and nose

After a baby is born, what should be the first action performed?

Clamp and cut the cord

Dry the baby

Suction the babys mouth and nose

Immediate Newborn Care (first 90 minutes)

the correct procedures prescribed by the EINC protocol:

Immediate Thorough Drying

Hypothermia can lead to

Drying should be the first action,

IMMEDIATELY for a full 30 seconds

Immediate Thorough Drying

Immediate, Thorough Drying

If a baby is not breathing;

Immediate, Thorough Drying

mouth/nose are blocked by secretions

breathing and tone

is floppy/limp and not breathing

Washing the Baby in the First 6 Hours is Protective.

Washing the Baby in the First 6 Hours is Protective.

Early Washing Can Lead To:

to newborn circulatory adjustment, hyaline membrane disease, brain hemorrhage

E.coli and Group B Strep; so is maternal bacterial colonization

Immediate Newborn Care (first 90 minutes)

Immediate Newborn Care (first 90 minutes)

the correct procedures prescribed by the EINC protocol:

What is your next action?

What is your next action?

provision of warmth and bonding

Early Skin-to-Skin Contact

Use a warm cover if

room temp <25C

Immediate Newborn Care (first 90 minutes)

correct procedures prescribed by the EINC protocol:

When should the cord be clamped after birth?

When the cord pulsations stop

Between 1 and 3 minutes

Between 30 secs - 1 minute in preterms

When should the cord be clamped after birth?

When the cord pulsations stop

Between 1 and 3 minutes

Between 30 secs - 1 minute in preterms

Properly-Timed Cord Clamping

don 2 pairs of gloves after thorough handwashing

Palpate the umbilical cord