WHAT IMMEDIATE NEWBORN CARE PRACTICES WILL SAVE LIVES ? Time Band: At perineal bulging Prepare for the Delivery Check temperature of the delivery room 25 - 28 o C Free of air draft Notify appropriate staff Arrange needed supplies in linear fashion Check resuscitation equipment Wash hands with clean water and soap Double glove just before delivery
± ±
Time Band: 1 - 3 mins: Properly - timed cord clamping Remove the first set of gloves After the umbilical pulsations have stopped, clamp the cord using a sterile plastic clamp or tie at 2 cm from the umbilical base Clamp again at 5 cm from the base Cut the cord close to the plastic clamp Notes: Do not milk the cord towards the baby After the 1st clamp, you may ³strip´ the cord of blood before applying the 2nd clamp Cut the cord close to the plastic clamp so that there is no need for a 2n d ³trim´ Do not apply any substance onto the cord
± ±
Four
Core Steps of Essential Newborn Care Immediate and thorough drying Early skin-to-skin contact Properly timed cord clamping Non-separation of the newborn and mother for early initiation of breastfeeding
Time Band: Within 1st 30 secs: Immediate Thorough Drying Call out the time of birth Dry the newbo n ewborn rn thoroughly for at least 30 second Wipe the eyes, face, head, front and back, arms and legs Remove the wet cloth Do a quick check of breathing while drying Notes: During the 1st secs: Do not ventilate unless the baby is floppy/limp and not breathing Do not suction unless the mouth/nose are blocked with secretions or other material
±
±
±
±
Time Band: Within 90 mins. Non-separation of Newborn from Mother for Early Breastfeeding B reastfeeding Leave the newborn in skin-to-skin contact Observe for feeding cues, including tonguing, licking, rooting Point these out to the mother and encourage her to nudge the newborn towards the breast Counsel on positioning Newborn¶s neck is not flexed n or twisted Newborn is facing the breast Newborn¶s body is close to mother¶s body Newborn¶s whole body is supported Counsel on attachment and suckling Mouth wide open Lower lip turned outwards Baby¶s chin touching breast Suckling is slow, deep with some pauses Notes: Minimize handling by health workers Do not give sugar water, formula or other prelacteals Do not give bottles or pacifiers Do not throw away colostrum Weighing, bathing, eye care, examinations, examinations, injections (hepatitis B, BCG) should be done after the first full breastfeed breastfeed is completed Postpone washing until at least 6 h ours
± ± ± ±
± ± ± ±
Time Band 0 - 3 mins: Immediate, Thorough Drying Notes: Do not wipe off vernix Do not bathe the newborn Do not do footprinting No slapping No hanging upside - down No squeezing of chest
± ± ± ± ± ±
± ± ± ±
Time Band: After 30 secs of drying Early Skin-to-Skin Contact If newborn is breathing or crying: Position the newborn prone on the mother¶s abdomen or chest Cover the newborn¶s back with a dry blanket Cover the newborn¶s head with a bonnet Notes: Avoid any manipulation, e.g. routine suctioning that may cause trauma or suctioning infection infection Place identification band on ankle (not wrist) Skin to skin contact is doable even for cesarean section newborns
±
± ±
±
± ±
Care of the Eyes It is part of the routine care of the newborn to give prophylactic eye treatment against gonorrhea conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed on the fetus from the vaginal canal during delivery. This practice was introduced by Crede, a German gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose.
Erythromycin or tetracycline Opthalmic Ointment:
1.
These ointments are the ones commonly used now for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis. 2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes. Vitamin K or Aquamephyton
Cord Care Instruction to the mother on cord care:
1. No tub bathing until cord falls off. Do not sponge bath to clean the baby. See to it that cord does not get wet by water or urine. 2. Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution which is 70% alcohol. 3. Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine. 4. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air. 5. If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten. 6. Report any unusual signs and symptoms which indicate infection. Foul odor in the cord Presence of discharge Redness around the cord The cord remains wet and does not fall off within 7 to 10 days Newborn fever y
The newborn has a sterile intestine at birth, hence, the newborn does not possess the intestinal bacteria that manufactures vitamin K which is necessary for the formation of clotting factors. This makes the n ewborn prone to bleeding. As a preventive measure, .5 (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the newborn¶s vastus lateralis (lateral anterior thigh) muscle.
y y y
y
