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Essential Newborn Care: From Evidence to Practice, Cheat Sheet of Science education

Ateneo de Zamboanga University (ADZU)Science education

A comprehensive overview of essential newborn care practices that can save lives. It covers key objectives such as discussing the problem of child mortality with a focus on neonatal mortality, understanding preventive interventions, and discussing immediate newborn care practices that save lives. The document delves into topics like the causes of neonatal deaths, the importance of early breastfeeding initiation, proper cord clamping, skin-to-skin contact, and routine early care of normal newborn infants. It emphasizes evidence-based practices and highlights the need for proper training and implementation to reduce neonatal mortality rates, particularly in countries like the philippines that account for a significant portion of global under-five mortality. The detailed information and practical guidance presented in this document make it a valuable resource for healthcare professionals, policymakers, and researchers working to improve newborn health outcomes.

Typology: Cheat Sheet

2022/2023

Uploaded on 03/17/2024

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Essential Newborn Care: From Evidence to Practice
Objectives:
By the end of this session, the learner should
• be able to discuss the problem of child
mortality focusing on neonatal mortality
• know preventive interventions to address the
above
• be able to discuss the immediate newborn
care practices that save lives
The Philippines is one of 42 countries that account for
90% of global under-five mortality 82,000 Filipino
children die anually
<5-year-old and Neonatal Mortality
Causes of Under Five Deaths, 2008
Causes of Neonatal Deaths, 2008
Majority of newborns die due to stressful events or
conditions during labor, delivery and the immediate
postpartum period
What Can We Do to Save Newborn Lives?
Large NCR Hospital partially closed for cleanup
25 babies reportedly died due to infection
This was considered and handled as a
hospital infection control problem
Environmental cultures positive
How much colostrum did the cases receive?
Delaying Initiation of breastfeeding increases risk of
infection-related death
Nepal 2008 N = 22,838 breastfed babies
pf3
pf4
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Essential Newborn Care: From Evidence to Practice Objectives: By the end of this session, the learner should

  • be able to discuss the problem of child mortality focusing on neonatal mortality
  • know preventive interventions to address the above
  • be able to discuss the immediate newborn care practices that save lives The Philippines is one of 42 countries that account for 90% of global under-five mortality 82,000 Filipino children die anually < 5 - year-old and Neonatal Mortality Causes of Under Five Deaths, 2008 Causes of Neonatal Deaths, 2008 Majority of newborns die due to stressful events or conditions during labor, delivery and the immediate postpartum period What Can We Do to Save Newborn Lives? Large NCR Hospital partially closed for cleanup 25 babies reportedly died due to infection  This was considered and handled as a hospital infection control problem  Environmental cultures positive  How much colostrum did the cases receive? Delaying Initiation of breastfeeding increases risk of infection-related death Nepal 2008 N = 22,838 breastfed babies

Delaying Initiation of breastfeeding increases risk of infection-related death Ghana 2004 N = 10,947 breastfed infants Essential Newborn Care Protocol was developed to address these issues What Immediate Newborn Care Practices Save Lives? Antenatal Steroids  Betamethasone  12 mg IM q 24 hrs x 2 doses  May be the preferred drug – less PVL  Dexamethasone  6 mg IM q 12 hrs x 4 doses  Have dexamethasone available in the E-cart  No additional benefit to using higher or more frequent doses  Prednisone, methylprednisolone, cortisol are unreliable Every Newborn Has Needs  To breathe normally  To be warm  To be protected  To be fed Providing Warmth: Check the Environment  Check temperature of the delivery room*  Ideal temp: 25 – 28°C  Check for air drafts  Turn air conditioner off at time of delivery *non-mercury thermometer After a baby is born, what should be the first action performed? Drying should be the first action, IMMEDIATELY for a full 30 seconds unless the infant is both floppy/limp and apneic Immediate Thorough Drying  Immediate drying:  Stimulates Breathing  Prevents hypothermia  Hypothermia can lead to  Infection  Coagulation defects  Acidosis  Delayed fetal to newborn circulatory adjustment  Hyaline membrane disease  Brain hemorrhage  Dry the newborn thoroughly for at least 30 seconds  Do a quick check of breathing while drying  >95% of newborns breathe normally after birth  Follow an organized sequence  Wipe gently, do not wipe off the vernix  Remove the wet cloth, replace with a dry one

  • If baby not breathing, STIMULATE by DRYING!
  • Do not slap, shake or rub the baby  Do not ventilate unless the baby is floppy/limp and not breathing  Do not suction unless the mouth/nose are blocked by secretions Unnecessary Suctioning  Of the 455 who were already breathing  94.9% suctioned once  84.0% suctioned more than once  Likelihood of UNNECESSARY suctioning  With training in Neonatal Resuscitation – 2.5 times  With training in Pediatric Resuscitation – 2.2 times

Non-separation of Newborn from Mother for Early Breastfeeding  Weighing, bathing, eye care, examinations, injections should be done after the first full breastfeed is completed  Postpone bathing until at least 6 hours  Never leave the mother and baby unattended  Monitor mother and baby q15 minutes in the first 1-2 hrs. Assess breathing and warmth.  Breathing: listen for grunting, look for chest in-drawing and fast breathing  Warmth: check to see if feet are cold to touch if no thermometer Early and Appropriate Breastfeeding Initiation  Leave the newborn between the mother’s breasts in continuous skin-to-skin contact  The baby may want to rest for 20-30 mins and even up to 120 minutes before showing signs of readiness to feed  Health workers should not touch the newborn unless there is a medical indication  Do not give sugar water, formula or other prelacteals  Do not give bottles or pacifiers  Do not throw away colostrum  Let the baby feed for as long as he/she wants on both breasts  Help the mother and baby into a comfortable position  Observe the newborn  Once the newborn shows feeding cues, ask the mother to encourage her newborn to move toward the breast Support Continued and Exclusive Breastfeeding  After delivery, mother is moved onto a stretcher with her baby and transported to Recovery Room, mother-baby ward or private room  Breastfeeding support is continued  Counsel on attachment and suckling  Mouth wide open  Lower lip turned outwards  Baby’s chin touching breast  Suckling is slow, deep with some pauses Proper Breastfeeding Hold  Look for a quiet place  Find a most relaxed position for mother  Provide adequate back support  Support feet  Do not hunch shoulders  Do not “ scissor” the breast  Cradle Hold  Cross Cradle Hold  Underarm Hold  Football hold  Baby is held like a clutch bag  Nose further away from the breast  Baby’s trunk is secure beside mother’s trunk

 Breastfeeding after Caesarian  Side-Lying Position E.O. 51 and its rIRR: The DON ’ Ts DO NOT REQUEST or ACCEPT from Milk Companies or their representatives:  Gifts of any sort  Samples or products covered under the Milk Code  Posters, other promotional materials or direct promotions of products covered under the code within your Health Facility, Community, Barangays, Events, etc.  Sponsorships without permission from FDA  Endorsements of products covered by the Milk Code ROUTINE EARLY CARE OF NORMAL NEWBORN INFANTS

  • Deliver on mother’s abdomen
  • Dry thoroughly with dry warm cloth then remove all wet linen
  • Sterile cord clamping once pulsation stops
  • Place on uninterrupted skin to skin contact in prone position - Encourage breastfeeding once with feeding cues - After 60mins of skin-to-skin contact and adequate latching on: ✓ Vit K 1mg IM (0.5mg for preterms) ✓ Erythromycin ophthalmic ointment OU ✓ Hepa B 0.5ml IM ✓ Anthropometric measurements and record ✓ Initial P.E. and Maturity Scoring and record - Minimize handling of the newborn unless necessary - Room in with mother - Keep with mother on skin to skin contact and cover with warm dry blanket &bonnet - Encourage direct breastfeeding per demand - Keep normothermic at all times - Bathe only after the 6th^ hour of life - Watch out for difficulty of breathing, early jaundice, feeding difficulties - Refer accordingly