Essential newborn care Dr Hussain Bux korejo Assistant 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.

Newborn Deaths 8 million infant deaths 4/15/2017 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) Newborn care is important because major causes of newborn death are 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. Normal Newborn Care

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

Essential Newborn Care Interventions 4/15/2017 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 Normal Newborn Care

Essential Newborn Care Interventions (continued) 4/15/2017 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 Normal Newborn Care

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

Care of the baby at the time of birth M1-S3_Care_baby_at_time_birth.ppt Care of the baby at the time of birth (Until around 1 hour after birth) ENCC 3

M1-S3_Care_baby_at_time_birth.ppt 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

The birth of Jojo ENCC 3

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

Drying the baby immediately after birth ENCC 3

Immediate skin contact ENCC 3

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

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

Eye care at the time of birth ENCC 3

ENCC 3

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) ENCC 3

Early and Exclusive Breastfeeding 4/15/2017 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. Normal Newborn Care

Immunization BCG vaccinations . 4/15/2017 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. Normal Newborn Care

Pearls The essential components of normal newborn care include: 4/15/2017 Pearls The essential components of normal newborn care include: Clean delivery and cord care Thermal protection Early and exclusive breastfeeding Monitoring Eye care Immunization Normal Newborn Care