Essential newborn care

Dr Hussain Bux korejoAssistant Professor paediatrics

LUMHS

Learning objectives

• Define essential elements of early newborn care.

• Discuss best practices and techniques for promoting newborn health.

• Use relevant data and information to develop appropriate essential newborn intervention.

Essential newborn care

• Newborn care is important because major causes of newborn death are preventable eg birth asphyxia and infection.

• A skilled attendant at childbirth who can assess the newborn correctly, perform essential interventions and does not delay resuscitation if indicated, is crucial.

• The attendant should also be able to care for or transport a sick newborn if needed.

4Normal Newborn Care

Newborn Deaths

• 8 million infant deaths • 3.9 million (48%)

newborn deaths• 2.8 million (67%) early

newborn deaths• Major causes of

newborn deaths– Birth asphyxia: 21%– Infections: 42%

(tetanus, sepsis, meningitis, pneumonia, diarrhea)

Causes of neonatal deaths

• Birth process is the cause of 2/3 of deaths due to infections;– Lack of hygiene at the time of childbirth and during

newborn period.– Home deliveries without skilled birth attendants.

• Birth asphyxia in developing countries:– 3% of newborns suffer mild to moderate birth

asphyxia– Prompt resuscitation is often not initiated or

procedure is inadequate or incorrect

Causes of neonatal deaths

• Hypothermia and newborn deaths– Significant contribution to deaths in low birth

weight infants and preterm newborns– Social, cultural and health practices delaying care

to the newborn• Ophthalmia neonatorum is a common cause of

blindness

Risk factors for neonatal deaths

• Low birth weight– An extremely important factor in newborn mortality

• Place of childbirth– At least 2 out of 3 childbirths in developing countries

conducted at home.– Only half are attended by skilled birth attendants– Strategies for improving newborn health should

target• Birth attendant, families and communities• Healthcare providers within the formal health system

8 Normal Newborn Care

Essential Newborn Care Interventions

• Clean childbirth and cord care– Prevent newborn infection

• Thermal protection– Prevent and manage newborn hypo/hyperthermia

• Early and exclusive breastfeeding– Started within 1 hour after childbirth

• Initiation of breathing and resuscitation– Early asphyxia identification and management

9 Normal Newborn Care

Essential Newborn Care Interventions (continued)

• Eye care– Prevent and manage ophthalmia neonatorum

• Immunization– At birth: bacille Calmette-Guerin (BCG) vaccine, oral

poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine (WHO)

• Identification and management of sick newborn• Care of preterm and/or low birth weight

newborn

How to do these intervention

All these interventions can be carried out under the umbrella of two health programs

ENCC : Care at the time Of Delivery Examination Of Newborn Routine Newborn Care Basic Neonatal Resuscitation IMNCI : Identification and management of sick newborn

ENCC 3 11

Care of the baby at the time of birth

(Until around 1 hour after birth)

ENCC 3 12

Objectives

• To describe and carry out the evidence based routine care of a newborn baby at the time of birth and prevent complications.

ENCC 3 13

The birth of Jojo

ENCC 3 14

Second Stage of Labour: Immediate newborn care

• Call out time of birth

• Deliver baby onto mothers abdomen or into her arms

• Dry baby with a warm, clean towel or piece of cloth.

• Wipe eyes.

• Assess the baby’s breathing while drying.– Make sure there is not a second baby– Change gloves

• Clamp and cut the umbilical cord

• Put the baby between mother’s breasts for skin-to-skin care

• Place an identity label on baby

• Cover mother and baby with warm cloth.

• Put a hat on the baby’s head.

• Encourage breastfeeding

ENCC 3 15

Drying the baby immediately after birth

ENCC 3 16

Immediate skin contact

ENCC 3 17

Keeping a newborn baby warm after delivery

• Provide a clean, warm, draught free room for delivery at 25-280C.

• After birth immediately dry baby with a clean, dry, warm cloth.

• Put baby on mother’s abdomen or a warm, clean, dry surface.

• Give baby to its mother for skin-to-skin contact.

• Put naked baby between mother’s naked breasts, cover them both (as

• long as immediate medical care is not needed by either).

• Cover baby’s head.

• Encourage breastfeeding as soon as possible after birth

• If mother and baby are separated wrap baby in warm covers and

• place in a cot, in a warm room.

• Use a radiant heater if the room is not warm or baby is small.

ENCC 3 18

Immediate cord care

• Change gloves. If not possible, wash gloved hands.

• Clamp and cut cord.

• Put ties tightly around cord at 2cm and 5cm from babies

abdomen.

• Cut between ties with a sterile instrument.

• 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

ENCC 3 19

Eye care at the time of birth

ENCC 3 20

ENCC 3 21

Summary• Universal precautions

– Use soap and warm water to wash and clean hands (protection)

– Wear gloves (Protection)

• Make sure delivery area is ready for mother and new baby:– Keep delivery room warm, close windows (warmth, protection)– Have resuscitation equipment near delivery bed (breathing)– Have clean warm towels/covers/cloths ready for newborn baby at delivery

(warmth)– Dry baby with a clean cloth immediately after delivery (warmth,

protection)– Have sterile kit to tie and cut cord (protection)– Help mother to wear clothes which make immediate skin contact easy

(warmth)– Keeping mother and baby in skin-to-skin contact from birth encourages

early breastfeeding (feeding)

22 Normal Newborn Care

Early and Exclusive Breastfeeding• Early contact between mother and newborn

– Enables breastfeeding– Rooming-in policies in health facilities prevents

nosocomial infection• Best practices

– No prelacteal feeds or other supplement– Giving first breastfeed within one hour of birth– Correct positioning to enable good attachment of the

newborn– Breastfeeding on demand– Psycho-social support to breastfeeding mother

WHO 1999.

23 Normal Newborn Care

Immunization

• BCG vaccinations .• Single dose of OPV at birth or in the two

weeks after birth• HBV vaccination as soon as possible where

perinatal infections are common.

24 Normal Newborn Care

Pearls

The essential components of normal newborn care include:

• Clean delivery and cord care• Thermal protection• Early and exclusive breastfeeding• Monitoring• Eye care• Immunization