Essentials of Newborn Care[1].DOH-WHO Protocol.pps Southern Tag [Compatibility Mode]

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Essential Newborn Care:The DOH/WHO ProtocolEssential Newborn Care:The DOH/WHO ProtocolMaria Asuncion Silvestre, FAAPConsultant, Essential Newborn Care

4 March 2010



OUTLINE OUTLINE Why do we need this Protocol? What are the four core, time-bound stepsof Essential Newborn Care?

How are these steps performed? What can I do to implement the Protocolin my area of practice?



<5 year old and Neonatal Mortality, 1988 to 2008 <5 year old and Neonatal Mortality, 1988 to 2008 <5 Yr Old mortality decreased 40% (1988-1998) Past 10 years, declined by 20% Slow decline since neonatal mortality hasnt improved

806070Under FiveMortality Rate0102030405060

1988 1993 1998 2003 2008NeonatalMRDHS 88, 93,98, 03, 08



82,000 Filipino children die annually,most could have been prevented

Source: CHERG estimates of under-five deaths, 2000-03

The Philippines is one of the 42 countries thataccount for 90% of global under-five mortality



Majority of newborns die due to stressful events orconditions during labor, delivery and the immediate

postpartum period.3outof4newborndeathsoccurintheweekoflifeofdeathsDayofLifeNumbero

NDHS 2003, special tabulations



WhatImmediate Newborn CarePractices will save lives?



Time Band: At perineal bulgingPrepare for the DeliveryTime Band: At perineal bulgingPrepare for the Delivery Check temperature of the delivery room 25-28 oC

Free of air drafts Notify appropriate staff Arrange needed supplies in linear fashion Check resuscitation equipment Wash hands with clean water and soap Double glove just before delivery



Four Core Steps ofEssential Newborn CareFour Core Steps ofEssential Newborn Care Immediate and thorough drying Early skin-to-skin contact

Properly timed cord clamping Non-separation of the newborn andmother for early initiation ofbreastfeeding



Time Band: Within 1st 30 secsImmediate Thorough DryingTime Band: Within 1st 30 secsImmediate Thorough Drying Call out the time of birth Dry the newborn thoroughly for at least 30

secondsseconds

Wipe the eyes, face, head, front and back, armsand legs Remove the wet cloth



Time Band: Within 1st 30 secsImmediate and Thorough DryingTime Band: Within 1st 30 secsImmediate and Thorough Drying Do a quick check of breathing while drying Notes:

During the 1st secs:D t til t l th bbi Do not ventilate unless the baby isfloppy/limp and not breathing Do not suction unless the mouth/nose areblocked with secretions or other material



Time Band 0 -3 mins:Immediate, Thorough DryingTime Band 0 -3 mins:Immediate, Thorough Drying Notes: Do not wipe off vernix

Do not bathe the newbornDo not bathe the newborn

Do not do footprinting No slapping No hanging upside -down No squeezing of chest



Time Band: After 30 secs of dryingEarly Skin-to-Skin ContactTime Band: After 30 secs of dryingEarly Skin-to-Skin Contact If newborn is breathing or crying: Position the newborn prone on the mothers

abdomen or chest Cover the newborns back with a dry blanket Cover the newborns head with a bonnet



Time Band: After 30 secs of dryingEarly Skin-to-Skin ContactTime Band: After 30 secs of dryingEarly Skin-to-Skin Contact Notes: Avoid any manipulation, e.g. routine

suctioning that may cause trauma or infectiongy

Place identification band on ankle (not wrist) Skin to skin contact is doable even forcesarean section newborns



Time Band: 1 -3 minsProperly -timed cord clampingTime Band: 1 -3 minsProperly -timed cord clamping Remove the first set of gloves After the umbilical pulsations have

stopped, clamp the cord using a sterilestopped, clamp the cord using a sterileplastic clamp or tie at 2 cm from theumbilical base

Clamp again at 5 cm from the base Cut the cord close to the plastic clamp



Time Band: 1 -3 minsProperly -timed cord clampingTime Band: 1 -3 minsProperly -timed cord clamping Notes: Do not milk the cord towards the baby

After the 1st clamp, you may strip the cordAfter the 1st clamp, you may strip the cordof blood before applying the 2nd clamp

Cut the cord close to the plastic clamp so thatthere is no need for a 2nd trim Do not apply any substance onto the cord



Time Band: Within 90 minsNon-separation of Newbornfrom Mother forEarly BreastfeedingTime Band: Within 90 minsNon-separation of Newborn

from Mother forEarly Breastfeeding Leave the newborn in skin-to-skin contact Observe for feeding cues, including tonguing,licking, rooting Point these out to the mother and encourageher to nudge the newborn towards the breast




from Mother forEarly Breastfeeding Counsel on positioning

Counsel on positioning

Newborns neck is not flexed nor twisted Newborn is facing the breast Newborns body is close to mothers body Newborns whole body is supported




from Mother forEarly Breastfeeding Counsel on attachment and suckling

Counsel on attachment and suckling

Mouth wide open Lower lip turned outwards Babys chin touching breast Suckling is slow, deep with some pauses





Time Band: Within 90 minutesNon-separation of Newbornfrom Mother forEarly BreastfeedingTime Band: Within 90 minutesNon-separation of Newborn

from Mother forEarly Breastfeeding Weighing, bathing, eye care, examinations,ij ti (h titi BBCG) h ldbinjections (hepatitis B, BCG) should be doneafter the first full breastfeed is completed

Postpone washing until at least 6 hours



Time Band: Within 90 minutesNon-separation of Newbornfrom Mother forEarly BreastfeedingTime Band: Within 90 minutesNon-separation of Newborn

from Mother forEarly Breastfeeding Weighing, bathing, eye care, examinations,ij ti h ldb d ft th fi tfinjections should be done after the first full llbreastfeed is completed

Postpone washing until at least 6 hours



The evidence is solid:

The following NewbornCare Practices will save

lives:

Immediate and

Thorough Drying

Thorough Drying

Early Skin-to-SkinContact

Properly Timed Cord

Clamping

Non-separation ofNewborn from Motherfor Early Breastfeeding



Delaying Initiation of breastfeedingincreases risk of infection-related death,

RR

Nepal 2008, 22,838 breastfed babies

8101214Mullany LC, et al. J Nutr, 2008;138(3):599-603.0246

8<1 1-24 24-48 48-72 >72Hours after Birth



Delaying Initiation of breastfeeding increasesrisk of infection-related death,Ghana 2004, 10,947 breastfed infants



ENC Time-Bound Interventions

Within 30SecondsObjective:

To stimulatebreathing,providewarmthAfter thoroughdryingObjective:To provide warmth,bonding, preventinfection &hypoglycemiaUp to 3 minutes

Post-deliveryObjective:To reduceanemia in term &preterm;IVH & transfusionsWithin 90 minutesOf ageObjective:To facilitate initiationof breastfeedingthrough sustainedcontact warmth hypoglycemia

-Put on doublegloves-Dry thoroughly-Remove wet cloth-Quick check ofNBs breathing-Suction only ifneeded-Put prone on chest/abdomen skin to skin-Cover w/ blanket,bonnet-Place identificationon ankle-Do not remove vernixIVH & transfusionsin preterm-Remove 1st set ofgloves-Clamp and cut cordafter cord pulsationsstop (1-3 mins)-Do not milk cord-Give oxytocin 10mgIM to mother

contact-Uninterrupted skin toskin contact



-Observe NB forfeeding cues-Counsel onpositioning &attachment-Do eye care, injectionsetc after 1st breastfeed



Training Video



Current State ofNewborn Care PracticesNewborn Care Practicesin Philippine HospitalsCurrent State ofNewborn Care PracticesNewborn Care Practicesin Philippine Hospitals



Variation in Sequence of Interventions

Sobel, Silvestre, Mantaring, Oliveros, 2009



EssentialNewborn CareProtocol wasguidelinedeveloped toaddress these

issues



Next Steps

Dissemination DOH Administrative Order2009-0025 on ENC signed2009 0025 on ENC signed

Unang Yakap campaignlaunched Dec 9, 2009 Implementation Monitoring



Scope of Application

Whole hierarchy of the DOH and itsattached agencies Public and private providers

Development partners involved in theMNCHN strategy All health practitioners involved in maternaland newborn care



ENC Implementation ENC Implementation The current state of maternal and newborn careneeds urgent action Evidence-based interventions are not practicedsufficiently.

ENC Protocol provides an evidence-based, lowstl tch l cka fi t ti thcost, low technology package of interventions that twill save tens of thousandsof lives.

Each of us, as individuals and as organizations, haveto look inward to find ways to implement ENC Join us to bring Unang Yakap to your membershipand every person they can influence.



How can I contribute toimplementing ENC?

Organize a multidisciplinary ENC Working Group

MDs: Obs, Pediatricians, Anesthesiologists Nurses, nursing assistants Midwives Administrators Infection control committeeInfection control committee

Conduct a situational analysis of your facility Revise hospital policies and standard operatingprocedures, forms, order sheets etc



How can I contribute toimplementing ENC?

Enable the environment for ENC

Disable the environment that hinders ENC Join us to bring Unang Yakap to yourmembership and every mother, fatherthat they can influence.



Documents

Essentials of Newborn Care[1].DOH-WHO Protocol.pps Southern Tag [Compatibility Mode]