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ESSENTIAL NEWBORN CARE

TUNJUNG WIBOWO
Introduction
 Newborn must adapt quickly to life
outside uterus at birth
 Newborn’s body must make change
 Breathing the first and most important
adaptation
 The care of newborn in the first hour,
days, weeks will determine their survival
and wellbeing
 Baby need basic care to survive
essential newborn care (ENC)
ENC at Birth and After Birth
1. Clean and safe delivery
2. Keep the baby warm
3. Initiation of spontaneous breathing (included
resuscitation)
4. Prevention of infection (included universal precaution)
5. Keep the baby warm (included late bathing, skin to
skin, head cap)
6. Cut and care the cord
7. Early initiation of breastfeeding (include breast crawl)
and Exclusive breastfeeding
8. Eye care
9. Vitamin K1
10. Hepatitis B immunization
11. Rooming in
12. Oral Polio vaccine before discharge in facilities
1. Clean and safe delivery
 Delivery at the health facilities
 Attended by trained-health worker
 Prepare the Birth Room
 Clean: prevent infection
 Warm: warm room, and close doors or windows to
prevent drafts.
 Light: The health worker must be able to see the
newborn to check color and breathing. If there is not
enough natural light, use candles, a lamp, or another
light source.
 Private: let the mother decide who will be present for
the birth. Provide as much privacy as possible. If
possible, allow her to have the support of the person
of her choice during the facility birth.
2. Keep the baby warm
 Heat loss may lead to hypothermia and the
risk of death.
 Body heat lose quickly if: wet, uncovered,
exposed to drafts, placed on or near a cool
surface
The Warm Chain
 Keep the birthplace warm, at least 25 °C (77 °F), and avoid drafts.
 Immediately after the birth, dry the baby. In the first 1-2 minutes, the
newborn may lose enough heat for his body temperature to fall 2 °C
 Keep the baby lying on the mother’s abdomen or chest for all care.
 Put the baby in skin-to-skin contact with the mother for at least 2
hours after birth.
 breastfeed the baby as soon as possible
 Wait for at least 6 hours and preferably 24, to bathe the baby. Wait
longer if: 1) the baby feels cold or the axillary temperature is below
36 °C (96.8 °F), 2) the environment is cold, 3) the newborn is low birth
weight, or 4) the baby is unwell.
 Dress the baby in light, loose, warm clothing. Baby needs at least 1-2
more layers than an adult in the same climate. cover the baby’s head
with a hat. Lastly, cover the baby with a light, warm cover or blanket.
 Keep the mother and baby together in a warm room and encourage
breastfeeding
 Keep the baby warm during transportation, if referred.
 Teach both health workers and families about the risks of
hypothermia and how to prevent it.
3. Initiation of spontaneous breathing
 Most babies breathe and cry at birth with no help
 If Baby not breathing well Decide if the Baby Needs
Resuscitation
Meconium-
stained?
Yes

Is the baby vigorous? *

No
Yes

Suction the mouth and


trachea

Continue with remainder of initial stepS


Suction the mouth and nose
Dry, stimulate and reposition

Vigorous is defined as baby with strong


respiratory efforts, good muscle tone and a
heart rate > 100 bpm
UNTUK
SINGLE
PROVIDER
5. Prevention of infection
 Wash your hands often. Handwashing is the easiest and most
effective way to prevent passing germs.
 Consider every person as possibly infectious.
 Use these three infection prevention steps to prepare equipment,
supplies, linens, and surfaces before the baby is born:
 Decontamination
 Cleaning
 High-level disinfection or sterilization
 Wear gloves when touching anything wet: broken skin, mucous
membranes, blood, or other body fluids.
 Protect yourself from splashes or spills of blood and amniotic fluid;
wear eye protection, shoes, a facemask, and an apron.
 Dispose of wastes safely (placentas, blood, needles, and other
sharp equipment such as blades or broken glass).
Frequency and survival of nosocomial pathogens on the health workers’ hands
Pathogen Type of Frequency of Survival on hands Survival on an
colonized hands inanimate object
Gram positive bacteria
S. aureus SSI, UTI, septicaemia, 10-78% ≥ 150 min 4 w – 7 mo
pneumonia
Enterococcus sp UTI 41% 60 min 5 d – 4 mo
Gram negative bacteria
E. coli UTI, CAUTI unknown 6-90 min 2 h -6 mo
P. aeruginosa Pneumonia 1-25% 30-80 min 6 h-16 mo
Acinetobacter 3-15% ≥ 150 min 3 d – 5 mo
S. marcescens Septicemia, UTI, SSI, 15-24% ≥ 30 min 3 d – 2 mo
pneumonia, meningitis
Klebsiella sp. UTI 17% Up to 2 h 2 h – 30 mo
Spore forming bacteria
C. difficile Diarrhea 14-59% unknown ≥ 24 h – 5 mo
Fungi
C. albicans Septicaemia, UTI, SSI 23-81% 1h 1-150 d
Viruses
Influenza, unknown 10-15 min 12-48 h
Parainfluenza
HAV unknown Several hours 2 h – 60 d
HCV 8-24% unknown unknown
Rhinovirus Up to 65% unknown 2 h- 7 d
Rotavirus 20-79% Up to 260 min 6-60 d
Cut and care the Cord
 Tie (or clamp) the cord securely in two places:
 Tie the first one two fingers away from the baby’s abdomen.
 Tie the second one four fingers away from the baby’s
abdomen.
 Cut the cord between the ties.
 Use a new razor blade, or a boiled one if it has been used
before, or sterile scissors.
 Use a small piece of cloth or gauze to cover the part of the
cord you are cutting so no blood splashes on you or on others.
 Be careful not to cut or injure the baby. Place your hand
between the cutting instrument and the baby.
 Do not put anything on the cord stump.
 Keep Clean and Dry
Early initiation of breastfeeding

 Giving opportunity to the baby to breasfed


right after delivery by putting the baby skin to
skin contact with the mother and leave the
baby in this skin to skin condition for at least
on hour or until he finish his first feeding.
The Breast Crawl
5 phases of behavior before breastfeeding

Keep the baby lying on the mother’s abdomen


1. During the first 30’:the baby is in a quite or rest alert stage.
He looks at his mother, adapting to the new environment,
2. During the 30’-40’after birth: the baby start
making sounds, sucking movements, putting his
hand to his mouth
3. At this stage the baby
begins to drool
4.The baby presses and kicks/push his feet on his
mother’s abdomen pushing him towards his mother’s
breast
5. Licking mother’s skin. Touching mother’s nipples with hisfinger.

Hitting head into mother’s chest


While looking to right and to left

finding nipples licking it, “tasting” it.


Benefit of Early Initiation of
Breastfeeding

 Reduces infant deaths worldwide


 Encourage Eksclusive breastfeeding
 Protects infants from early exposure
to bacteria and viruses
 Increases maternal oxytocin important
for:
 milk production and attachment
 Helps prevent maternal blood loss
PEDOMAN MENYUSUI
(WHO/UNICEF, Breast Feeding Promotion and Support, 2005)

 Mulai menyusui segera setelah lahir (dalam waktu satu jam).


 Jangan berikan makanan atau minuman lain kepada bayi
(misalnya air, madu, larutan air gula atau pengganti susu ibu)
kecuali diinstruksikan oleh dokter atas alasan-alasan medis;
sangat jarang ibu tidak memiliki air susu yang cukup
sehingga memerlukan susu tambahan (Enkin, et al, 2000).
 Berikan ASI eksklusif selama enam bulan pertama hidupnya
dan baru dianjurkan untuk memulai pemberian makanan
pendamping ASI setelah periode eksklusif tersebut.
 Berikan ASI pada bayi sesuai dorongan alamiahnya baik
siang maupun malam (8-10 kali atau lebih, dalam 24 jam)
selama bayi menginginkannya.
Eye care

 Give the newborn eye care


with an antimicrobial
medication, shortly after
breastfeeding (1 hour after
birth)
 Prevent neonatal
conjungtivitis
 antimicrobial medication
 Silver nitrate solution 1%, or
 Polyvidone-iodine solution
2.5%, or
 Tetracycline 1% eye ointment.
Diagnosis Banding Konjungtivitis neonatus
Anamnesis Pemeriksaan Pengecatan Diagnosis
Gram
1 • Ibu ada PMS • Kedua mata Diplokokus Gonokokus
• Tak ada antibiotikprofilaksis terserang gram negatif
mata • Jumlah nanah
• Timbul hr ke-1 atau lebih banyak
2 • Sekret mula-mula cair, kmdn • Kedua mata negatif klamidia
berganti nanah terserang
• Ibu ada PMS • Jumlah nanah
• Timbul hr ke-5 atau lebih sedikit sampai
sedang
3 • Timbul hr ke-3 atau lebih • Satu mata terserang Kokus gram Staphylococcus
• Jumlah nanah positif aureus
sedang berkelompok
4 • Mata ditetesi perak nitrat saat • Kedua mata negatif Iritasi perak
lahir terserang nitrat (tdk
• Timbul hr ke-1 atau 2 • Mata merah & perlu tx)
bengkak
• Nanah sedikit
Vitamin K
 After initiation breasfeeding
 Give Vit K 1
 Dose: 1mg
 Branded : 1 mg = 0.5 cc
 Generic : 1 mg = 0.1 cc
 Route: IM
BEBERAPA FAKTA TENTANG VITAMIN
K PADA BAYI BARU LAHIR
 Vit K diproduksi oleh flora normal usus
 Bayi baru lahir usus masih steril shg vit K
blm bisa terbentuk
 Pemberian vit K terbukti bisa mencegah
perdarahan pd BBL
Aims
 Prevent Vitamin K Deficiency Bleeding
 Reduce mortality and morbidity cause by VKDB

Type of Vit K
• Vitamin K1 (phytomenadione) : Vegetable, milk

• Vitamin K2 (menaquinone): produced by bacteri in the intestine


• Vitamin K3 (menadione) : syntetic Vit K. Not used anymore in
neonate since it can cause haemolytic anemia
Types of VKDB

Late VKDB Secondary Vit


Early VKDB Classic VKDB
lambat K deficiency
2 minggu-3 bulan
1-7 hari (terbanyak 3-5
Umur < 24 jam (terutama 2-12 Segala usia
hari)
minggu)
-Pemberian makanan
-Intake Vit. K -Obstruksi bilier
terlambat
inadekuat -Penyakit hati
Obat yang -Intake Vit. K inadekuat
Penyebab & -Kadar Vit. K -Malabsorbsi
diminum selama -Kadar Vit. K rendah
Faktor resiko rendah pada ASI -Intake kurang
kehamilan pada ASI
-Tidak dapat (nutrisi
-Tidak dapat profilaksis
profilaksis Vit. K parenteral)
Vit. K
< 5% pada
0,01-1% (tergantung
Frekuensi kelompok resiko
pola makan bayi)
tinggi
Sefalhematom, gastrointestinal
umbilikus, GIT, umbilikus, hidung, , kulit,
Lokasi
intrakranial, tempat suntikan, bekas intrakranial
perdarahan
intraabdominal, sirkumsisi, intrakranial
GIT, intratorakal
-Vit.K profilaksis
Penghentian/peng
(oral/im)
Pencegahan gantian obat
-Asupan Vit. K yang
penyebab
adekuat
Imunization
Hepatitis B
At least 1 hour after Vit K
Oral Polio Vaccine
When discharge
Mengapa Vaksin Hepatitis B harus
diberikan segera setelah lahir?
 Sebagian ibu hamil merupakan carrier Hepatitis B.
 Hampir separuh bayi dapat tertular Hepatitis B
pada saat lahir dari ibu pembawa virus.
 Penularan pada saat lahir hampir seluruhnya
berlanjut menjadi Hepatitis menahun, yang
kemudian dapat berlanjut menjadi sirosis hati dan
kanker hati primer
 Imunisasi Hepatitis B sedini mungkin akan
melindungi sekitar 75% bayi dari penularan
Hepatitis B.
Rooming In
 Care the baby together with the mother
 Prevent infection
 Encourage exclusive breasfeeding
KEUNTUNGAN RAWAT GABUNG

 Ibu ber-reaksi pada bayinya &


menyusui kapan saja ia lapar
 Bayi kurang menangis   susu botol
 Ibu lebih percaya diri untuk menyusui
 Menyusui berlangsung > lama
setelah ibu meninggalkan rumah sakit
THANKS