1. Essential newborn care
Dr Hussain Bux korejo
Assistant Professor paediatrics
LUMHS

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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. 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

9. Essential Newborn Care Interventions (continued)
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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

10. 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

11. 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

12. 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

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 C.
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)
ENCC 3

22. 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

23. 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

24. 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