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Phil. ENCC 1
Care of the newborn at the time of
birth
Immediate Newborn Care
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Phil. ENCC 2
Care of the newborn at the time of birth
Immediate
Newborn
Care
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Phil. ENCC 3
Objectives
To describe and carry out the evidencebased routine care of a newborn baby atthe time of birth and prevent
complications.
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The birth of JojoD11
To keep Jojo
alive and
healthy,what are his
immediate
needs?
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Phil. ENCC 5
Basic Needs of a Baby at Birth
To breathe normally
To be warm
To be protected
To be fed
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Phil. ENCC 6
PREPARATIONS PRIORTO DELIVERY
Equipment for Child Birth:
yPCPNC Manual D11, L3
yNewborn Care Protocol p.31-32
Wash hands
Wear Gloves
Line up materials for deliveryaccording to sequence of use
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Broken equipment is dangerous!
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Broken equipment is dangerous!
Equipment must be checked daily andwell before a delivery takes place.
Resuscitation equipment should alwaysbe close to the delivery area
Health workers must know how to use theequipment. Restock after every delivery.
D11
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Phil. ENCC 9
Care of the Normal Newborn at Birth
Role Play
y Two participantsy Scenario: mother delivers a normal baby
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Phil. ENCC
Immediate Newborn Care *
Deliver the baby prone on the mothersabdomen
Call out time of birth.
Dry the newborn thoroughly. Remove wet cloth.
Check breathing (while drying)
Position the newborn on the mothers abdomen
in skin-to-skin contact. Cover the back with a dry
blanket.
y If this is not possible, place newborn in a warm,
safe place close to the mother.
Examine page 5 of DOHNewborn Care Protocol
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Phil. ENCC
Immediate Newborn Care *
Remove first set of gloves. Clamp and cut the cord.
Place the newborn on the mothers chest in
skin-to-skin contact Cover the babys head with a hat. Cover the
mother and baby with a warm cloth.
Initiate breastfeeding while maintaining
skin-to-skin contact.
Place identification band on ankle.
Examine page 5 of DOHNewborn Care Protocol
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Immediate Newborn Care *
If baby is not breathing, dry andstimulate.
If after 30 secs, and patient fails tobreath:
y suction, change gloves and cut cordquickly
y transfer to a firm, warm surface and startnewborn resuscitation K11
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Phil. ENCC 13
Specific Care of the Baby in the Immediate
Period after Delivery
A. Drying the newborn- Stimulates the newborn to breathe normally- Minimizes heat loss
Duration: ~ 30 seconds
Do not rub off vernix!
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Drying the baby immediately after birth
Babys need to
breath
normally
-02 to brain
-RR=30-60
90% of newborns do
not have problems
with their breathing
after birth.
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Phil. ENCC 15
Immediate Care of the Newborn
During the 1st 30 seconds of drying /
stimulation:
y Do not suction unless mouth/nose are
obstructed with secretions or othermaterial
y Do not ventilate unless apneic baby isfloppy
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Immediate Care of the Newborn
B. Skin-to-Skin Contact
-Provides warmth
-
Improves bonding-Provides protection from infection by
exposure of the baby to good bacteria ofthe mother
-Increases the blood sugar of the baby
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Keeping the baby warmImmediate skin-to-skin contact
use warm cover ifroom temp
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Immediate Care of the Newborn
C. Non-immediate clamping of the
umbilical cord
- Allows the newborn to get a free bloodtransfusion from the placenta
-Reduces the risk of anemia in both term and
preterm babies
-Reduces the risk of transfusions andintraventricular hemorrhage in preterms
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Phil. ENCC 19
Initial Cord Care (Non-immediate Cord Clamping)
Remove the first set of gloves. If not possible, wash
gloved hands.
Clamp and cut cord after cord pulsations stop (1-3
minutes)
y Put plastic clamp or tie tightly around cord at 2cm and the forceps5cm from babies abdomen.
y Cut between ties with a sterile instrument.
y Observe for oozing blood. If blood oozes, place a second tie
between the skin and first tie.
DO NOT apply any substance to stump.
DO NOT bind or bandage stump.
Leave stump uncovered.
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Phil. ENCC 20
After Cord Care
Exclude a second baby
Never leave the mother and baby
unattended
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D. Assessing the babyDuring the first hour after complete
delivery of the placenta, the baby (andthe mother) should be monitored every
15 minutes.After the cord is cut, examine baby:
assess the baby for any signs of illness,
e.g. chest in-drawing J2
If the baby is doing well, continue skin-to-skin contact and provision of warmthK 9
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E.Initiation ofBreastfeeding
Leave baby the newborn between themothers breasts in skin-to-skin contact.
To begin with the baby will want to rest.
Every baby is different and the rest
period may take from a few minutes to30 or 40 minutes before the babyshows signs of wanting to breastfeed.
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Phil. ENCC 23
Initiation ofBreastfeeding
Help the mother and baby into a comfortableposition
Observe the newborn. Only once the
newborn shows feeding cues (e.g. openingof mouth, tonguing, licking, rooting) K2,make verbal suggestions to the mother toencourage her newborn to move toward the
breast e.g. nudging.
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Skin-To-Skin Contact and Breastfeeding
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Signs of Readiness to Breastfeed: Feeding Cues
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Importance of first
breastfeedingofcolostrum
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Initiation ofBreastfeeding
Health workers should not touch the newborn unlessthere is a medical indication.
Do not give sugar water, formula or otherprelacteals.
Do not give bottles or pacifiers.
Do not throw away colostrum.
If the mother is HIV-positive, see G7G8 ofPCPNC forspecial counseling
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Standard precautions MUST be followed as with ANY otherdelivery and after care.
Her baby can have immediate skin-to-skin contact as any othermother and baby.
Breastfeeding can begin when the baby is ready after delivery.
DO NOT GIVE the baby any other food or drink.
Good attachment and positioning is vital to prevent breastproblems.
Ifreplacement feeding G8prepare formula for the mother forthe first few feeds to be given by cup NOT bottle. G8
If the Mother has HIV/AIDS
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Phil. ENCC 30
SPECIAL SITUATIONS
*What should be done if a baby does not feedin one hour after birth?
Help the mother to initiate breastfeeding
within 1 hour, when baby is ready K2 If the baby does not feed in 1 hour, examine
the baby (J2-J9).
If healthy, leave the baby with the mother to
try later. Assess in 3 hours, or earlier if the
baby is small (J4).
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SPECIAL SITUATIONS
*How can a baby be fed if the mother is ill ?
If the mother is ill and unable to breastfeed, helpher to express breast milk and feed the baby bycup (p.J6).
*What options are there for a mother who cannotbreastfeed at all?
If unable to initiate breastfeeding,
plan for alternative feeding method K5-K8
What difficulties do you encounter in the ff:
Breech delivery
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Phil. ENCC 32
The first breastfeed
To help a baby successfully breastfeed soon after
birth, we: position the newborn prone on the mothers
abdomen in skin-to-skin contact.
may transfer the newborn to a position between herbreasts so that the baby can feed when it is ready.
check the position and attachment when the baby isfeeding.
let the baby feed for as long as he/she wants onboth breasts.
keep the mother and baby together for as long aspossible after delivery,
delay tasks such as weighing, bathing injections etcuntil after breastfeeding has been started.
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Phil. ENCC 33
Monitoring of the Baby
The babys breathing and warmth should bemonitored by a health professional every 15minutes for the first hours after birth and deliveryof the placenta.
- Breathing: listen for grunting, look for chest in-drawing andfast breathing.
- Warmth: check to see if feet are cold to touch.
DO NOT leave the mother and baby alone duringthe first hour after delivery.
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Immediate Care of the Newborn
What is the immediate care of NB?
What practices interrupt the time the
mother and baby may spend togetherimmediately after birth?
What practices are necessary after birth
which can be postponed later?
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Bathing the Baby
Do not bath the baby before 6 hours
after birth
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Eye care
Wipe the eyes
Apply an eye antimicrobial within 1 hour of
birth
- 1% silver nitrate drops or
- 2.5% povidone iodine drops or
- 1% tetracycline ointment or
erythromycin eye drops
D19
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INJECTIONS
AdministerVitamin K IM upper outer
quadrant (vastus lateralis) of the thigh
y 0.5 mg preterm
y 1.0 mg term
AdministerBCG and Hepatitis B vaccine
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Summary
P
repare the delivery areay Keep delivery room warm, close windows
y Have resuscitation equipment near deliverybed
y Have clean warm towels/covers/cloths readyfor newborn baby at delivery
Standard precautions
y Use soap and warm water to wash andclean hands
y Double glove
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Phil. ENCC 40
Summary
Immediate Newborn Carey Dry baby with a clean cloth immediately after
delivery
y
Position the newborn prone in skin-to-skin contacton the mothers abdomen
y Remove first set of gloves
y Clamp/tie and cut cord using a sterile kit
y Keeping mother and baby in skin-to-skin contactfrom birth encourages early breastfeeding
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Dry the baby
Remove wet cloth
Keep baby warm
Check breathing
Is the baby gasping or not breathing?Clamp the cord
Perform Newborn
Resuscitation
* Place baby in skin-to-skin contact on mothers abdomen or chest
* Clamp the umbilical cord after pulsations stop at around 1-3 mins
* Encourage breastfeeding
* Do not separate the baby from the mother for at least 90 minutes
unless in respiratory distress or maternal emergency
* Do eye care, cord care
* Postpone bathing until after NB is at least 6 hours of age
Does baby have signs of illness?
Is the baby visibly small?
*After 90 minutes of age (after baby has detached from breast)
- examine the baby
- weigh the baby
- inject Vit. K, Hep B, BCG
Does the baby weigh
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Videos
Immediate Newborn Care
y UP-PGH
DOH UNICEF Breast Crawl
y Jose Fabella Memorial Hospital
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Phil ENCC