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8/15/2019 MCNAP-Essential Newborn Care
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8/15/2019 MCNAP-Essential Newborn Care
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Causes and Timing of Child Mortality
Current State of Newborn Care Practices
Steps in Immediate Newborn Care
Standard Essential Newborn Care PracticeGuidelines
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Source: CE!G estimates ofunder"fi#e deaths$ %&&&"&'
The Philippines is one of the (% countries that account for
)&* of global under"fi#e mortality
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Home
deliveries by
non-healthprofessionals
(per 1000 livebirths)
Health facility
deliveries
(per 1000 livebirths)
P-value
Neonatal+eaths
,-./ ,-.& &./%
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Intervention Percentage andMedian Time
H! "tandards
Cord clamp
+rying
Immediate s0in"to"s0in contact
Put on cold surfaceNot dried
ead not dried1ashing
,% sec))* in 2, min
)3* at , min
).-* at 4 min
,%*%.4*
-.%*/(* at / min
5ntil pulsations stop6,"' mins7
,&&* immediately
8)&* 6e9cept thoseneeding resuscitation7
NoneNone
None8- hours
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Intervention Percentage andMedian Time
H! "tandards
reastfeeding
Separated from
mother1eighing
E9aminationepatitis #accine
Nursery!ooming in
-,.'* at ,& min
)%.)* at ,% min
,&&* at ,' min
34.3* at ,3 min-).(* at %& min
4%* at ,) min/'* 6,44 min7
1;in , hour 6but when
baby shows signs7
8, hour
8, hour
8, hour8, hour
NE<E!
Immediately with
mother
Sobel$ Sil#estre$ Mantaring$ et al %&&/
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#ction $ (%)
Suctioning
ag and mas0
Slapping bac0
IntubationChest compressions;Epinephrine
+rying===
%( 6)%.'*7
,% 6(-.,*7 at ,%& secs
3 6%-.)*7
% 63.3*7 at ' and - mins% 63.3*7 at ( mins
, 6'./*7
=== Should be first action$ immediately$ for full '& seconds$ unlessboth floppy;limp and apneic
Sobel$ Sil#estre$ Mantaring$ et al %&&/
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Immediate and Thorough +rying
Early S0in"to"S0in Contact
Properly Timed Cord Clamping
Non"separation of Newborn from Mother
for Early reastfeeding
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,. 1ithin the first '& seconds
,., !b,ective &ry and provide .armth to thene.born and prevent hypothermia
Put on double glo#es >ust before deli#ery
5se a clean$ dry cloth to T?!?5G@A dry thenewborn by wiping the eyes$ face$ head$ front andbac0$ arms and legs
!emo#e the wet cloth
+o a Buic0 chec0 of newborns breathing while
drying
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+o not put the newborn on a cold or wet surface
+o not bathe the newborn earlier than - hours of life
If the newborn must be separated from his;hermother$ put him;her on a warm surface$ in a safe
place close to the mother
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%. Dfter thorough drying
/1 !b,ective acilitate bonding bet.een the
mother and her ne.born through s2in-to-s2in
contact to reduce li2elihood of infection and
hypoglycemia Place the newborn prone on the mothers abdomen
or chest$ s0in"to"s0in
Co#er the newborns bac0 with a blan0et and head
with a bonnet
Place the identification band on the an0le
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+o not separate the newborn from the mother$ as
long as the newborn does not e9hibit se#ere chest
in"drawing$ gasping or apnea and the mother does
not need urgent medical;surgical stabiliation e.g.
emergency hysterectomy
+o not wipe off #erni9 if present
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Chec0 for multiple births as soon as newborn is
securely positioned on the mother. Palpate the
mothers abdomen to chec0 for a second baby or
multiple births. If there is a second baby 6or
more7$ get help. +eli#er the second newborn.
Manage li0e the first baby
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'. 1hile on s0in"to"s0in contact 6up to ' minutes
post"deli#ery7
31 !b,ective 'educe the incidence of anemia in
term ne.borns and intraventricular hemorrhage
in pre-term ne.borns by delaying or non-immediate cord clamping
!emo#e the first set of glo#es immediately prior to
cord clamping
Clamp and cut the cord after cord pulsations ha#e
stopped 6typically at , to ' minutes7. +o not mil0the cord towards the newborn
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a. put ties tightly around the cord at % cm and 4 cm
from the newborns abdomen
b. cut between ties with sterile instrument
c. obser#e the ooing blood
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(. 1ithin )& minutes of age
41 !b,ective acilitate the ne.born5s early
initiation to breastfeeding and transfer of
colostrum through support and initiation of
breastfeeding @ea#e the newborn on the mothers chest in s0in"to"
s0in contact. ealth wor0ers should not touch the
newborn unless there is a medical indication
?bser#e the newborn. Dd#ice the mother to start
feeding the newborn once the newborn shows feedingcues 6e.g. opening of mouth$ lic0ing$ rooting7. Ma0e
#erbal suggestions to the mother to encourage her
newborn to mo#e toward the breast e.g. nudging
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Counsel on positioning and attachment. 1hen the newborn
is ready$ ad#ise the mother to position and attach her
newborn
Dd#ise the mother not to throw away the colostrum
If the attachment or suc0ling is not good$ try again andreassess
D small amount of breastmil0 may be e9pressed before
starting breastfeeding to soften the nipple area so that it is
easier for the newborn to attach
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4/ !b,ective To prevent ophthalmia
neonatorum through proper eye care
Ddminister erythromycin or tetracycline ointment or
%.4* po#idone"iodine drops to both eyes after the
newborn has located the breast +o not wash away the eye antimicrobial
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,. Gi#e <itamin F prophyla9is
%. In>ect epatitis and CG #accinations
'. E9amine the newborn. Chec0 for birth
in>uries$ malformations or defects
(. Cord care
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,. Start resuscitation if the newborn is not
breathing or is gasping after '& seconds of
drying or before '& seconds of drying if
the newborn is completely floppy and notbreathing
%. Clamp and cut the cord immediately
'. Call for help
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(. Transfer the newborn to a dry$ clean
and warm surface. Feep the newborn
wrapped or under a heat source if
a#ailable4. Inform the mother that the newborn
needs help to breathe
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,. If the newborn is deli#ered % months
earlier or weighs 2,$4&& g$ refer to a
specialied hospital
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%. or a #isibly small newborn or a
newborn born 8, month early: Teach the mother how to 0eep the small newborn
warm in s0in"to"s0in contact #ia Fangaroo MotherCare
Pro#ide e9tra blan0ets for the mother and the
newborn$ plus bonnet$ mittens and soc0s for the
newborn
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If the mother cannot 0eep the newborn s0in"to"
s0in because of complications$ wrap the
newborn in a clean$ dry$ warm cloth and place
in a cot. Co#er with a blan0et. 5se a radiant
warmer if the room is not warm or the baby is
small
Gi#e special support for breastfeeding.
Encourage the mother to breastfeed e#ery %"'hours
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1eigh the newborn daily
1hen the mother and newborn are separated$or if the newborn is not suc0ing effecti#ely$ use
alternati#e feeding methods
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'. +ischarge Planning Plan to discharge when:
,. reastfeeding well and gaining weight adeBuately
for ' consecuti#e days
%. ody temperature between '-.4 and '3.4 C for '
consecuti#e days
'. Mother able and confident in caring for the newborn
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%. Early bathing;washing ypothermia which can lead to infection$
coagulation defects$ acidosis$ delayed fetal to
newborn circulatory ad>ustment$ hyaline membrane
disease$ brain hemorrhage
Infection H the #erni9 is a protecti#e barrier to
bacteria such as E. coli and Group B Strep so is
maternal bacterial coloniation
No crawling refle9
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'. ootprinting Pro#en to be an inadeBuate techniBue for newborn
identification purposes
etter identification techniBues such as +ND
genotyping and human leu0ocyte antigen tests
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D pacifier contributes to nipple confusion if these
are used before the newborn is offered the mothers
breast
This undermines the chances of successful
breastfeeding by contributing to a #icious cycle ofpoor attachment$ sore nipples and lactational
insufficiency
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4. Dpplication of alcohol$ medicine and
other substances on the cord stump and
bandaging the cord stump or abdomen
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,. Dd#ise the mother to return or go to the
hospital immediately if: Jaundice of the soles or any of the following are
present=
+ifficulty of feeding
Con#ulsions
Mo#ement only when stimulated
ast or slow or difficult breathing 6e.g. se#ere chest in"
drawing7 Temperature 8'3.4 C or 2'4.4 C
=rom @ancet %&&/$ new IMCI algorithm for Aoung Infant II study
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%. Dd#ise the mother to bring her newborn
to the health facility for routine chec0"up
at the following prescribed schedule:
Postnatal visit 1 at (/"3% hours of life Postnatal visit / at 3 days of life
Immuni6ation visit 1 at - wee0s of life
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'. Dd#ise additional follow"up #isits
appropriate to problems in the following: T.o days H if with breastfeeding difficulty$ @ow
irth 1eight in the first wee0 of life$ red umbilicus$
s0in infection$ eye infection$ thrush or other
problems
"even days H if @ow irth 1eight discharged more
than a wee0 of age and not gaining weight
adeBuately
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(. Dd#ise for Newborn Screening
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