MCNAP-Essential Newborn Care

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



Source: CE!G estimates ofunder"fi#e deaths$ %&&&"&'

The Philippines is one of the (% countries that account for

)&* of global under"fi#e mortality





Home

deliveries by

non-healthprofessionals

(per 1000 livebirths)

Health facility

deliveries

(per 1000 livebirths)

P-value

Neonatal+eaths

,-./ ,-.& &./%





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



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 %&&/



#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 %&&/



Immediate and Thorough +rying

Early S0in"to"S0in Contact

Properly Timed Cord Clamping

Non"separation of Newborn from Mother

for Early reastfeeding





,. 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



+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



%. 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



+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



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



'. 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



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



(. 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



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



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



,. Gi#e <itamin F prophyla9is

%. In>ect epatitis and CG #accinations

'. E9amine the newborn. Chec0 for birth

in>uries$ malformations or defects

(. Cord care



,. 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



(. 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



,. If the newborn is deli#ered % months

earlier or weighs 2,$4&& g$ refer to a

specialied hospital



%. 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



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



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



'. +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





%. 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



'. ootprinting Pro#en to be an inadeBuate techniBue for newborn

identification purposes

etter identification techniBues such as +ND

genotyping and human leu0ocyte antigen tests





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



4. Dpplication of alcohol$ medicine and

other substances on the cord stump and

bandaging the cord stump or abdomen



,. 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



%. 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



'. 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



(. Dd#ise for Newborn Screening



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MCNAP-Essential Newborn Care