Essential Newborn Care Protocol
Essential Newborn Care Protocol
Essential Newborn Care Protocol
Note:
Do not ventilate unless baby is floppy/limp/not breathing
Do not suction unless the mouth/nose are blocked with
secretions or other material
Immediate Newborn Care
(First 90 minutes)
• Time band: if after first 30 seconds of drying, baby is
limp/floppy/not breathing
• Intervention: Re-position, suction and ventilate
• Action:
• Clamp and cut cord immediately
• Call for help
• Transfer to warm, firm surface
• Inform parents that baby has difficulty breathing and you will help the
baby to breathe
• Start resuscitation protocol
Notes for baby who is floppy/limp/not
breathing
Health worker not skilled at advanced resuscitation (or
skilled but not equipped with intubation needs):
Clear the mouth
Start bag/mask ventilation
Refer and transport
Health worker with advanced skills at resuscitation:
Intubate the baby and ventilate
Refer and transport as necessary
Immediate Newborn Care
(First 90 minutes)
• Time band: if after 30 seconds of drying the baby is breathing
or crying
• Intervention: Do skin-to-skin contact
• Action:
• Avoid any manipulation (such as routine suctioning) that may cause
trauma or introduce infection
Place baby prone in skin-to-skin contact on mother’s abdomen
Cover baby’s back with a blanket and head with a bonnet
Place identification band on ankle
Notes for the baby who is breathing/crying
Do not separate the baby from the mother as long as the
baby does not exhibit severe chest in-drawing, gasping or
apnea and the mother does not need urgent medical
stabilization (e.g. hysterectomy)
Do not put the baby on a cold or wet surface
Do not wipe off the vernix
Do not bathe the baby earlier than 6 hours of life
Do not do footprinting
Within first 90 minutes of life
Time band: 1-3 minutes
Intervention: delayed or non-immediate cord clamping
Action:
Remove first set of gloves immediately prior to cord clamping
Clamp and cut the cord after cord pulsations have stopped
Put ties around the cord at 2cm and 5cm from the baby’s abdomen
Cut between ties using sterile instrument
Observe for oozing of blood
Note:
Do not milk the cord towards the newborn
After cord clamping, ensure 10IU oxytocin IM is given to the mother
Within first 90 minutes of life
Time band: within 90 minutes of age
Intervention: Provide support for initiation of
breastfeeding
Action:
Remove the first set of gloves immediately prior to cord
clamping
Leave the baby on mother’s chest in SSC
Observe the baby. Only when the newborn shows feeding cues
(opening of mouth, tounging, licking, rooting), make verbal
suggestions to the mother to nudge her baby to move to the
breast
Counsel on positioning and attachment: when the bay is
ready, advise the mother to:
Make sure the baby’s neck is not flexed or twisted
Make sure the baby is facing the breast, with the baby’s nose
opposite her nipple and chin touching the breast
Hold newborn’s body close to her body
Support the baby’s whole body, not just the neck and shoulders
Wait until her newborn’s mouth is opened wide
Move her newborn onto her breast, aiming the infant’s lower
lip well below the nipple
Summary of interventions after drying the
baby and placing baby in SSC
Do delayed or non-immediate cord clamping
Remove 1st set of gloves immediately prior to cord clamping
Place ties around 2cm and 5cm from baby’s abdomen
Oxytocin 10 IU IM to mother after cord clamping
Provide support for initiation of breastfeeding
Provide additional care for a small baby or twin (KMC)
Prepare very small baby (<1.5kg) or a baby born >2 months early
for referral
Do eye care
Administer erythromycin/tetracycline/2.5% povidone-iodine after
baby has located the breast
After first 90 minutes
Does the baby have signs of illness?
Is the baby visibly small?
Keep baby in SSC; cover with extra blankets; prepare for
referral if <1.5kg
After 90 minutes of age (after baby has detached from
breast):
Examine baby
Weigh baby
Inject Vit. K, Hepa B and BCG
Room in and continue exclusive per demand
breastfeeding
After first 90 minutes
Time band: 90 minutes – 6 hours
Intervention:Vit. K prophylaxis, Hepa B andf BCG
Action:
Wash hands
Inject Vit. K 1mg IM
Inject Hepa B and BCG
After first 90 minutes
Intervention: examine the baby
Action:
Thoroughly examine the baby
Weigh the baby and record
After first 90 minutes
Intervention: check for birth injuries, malformations or
defects
Bumps on one or both sides of the head, bruises, swellling on
buttocks, abnormal position of legs after breech presentation
or asymmetrical arm movement, or arm that does not move
If present: explain to parents that this does not hurt the baby, is likely
to disappear in 1-2 weeks and does not need special treatment
Gently handle the limb that is not moving
Do not force legs into a different position
Look for malformations: cleft palate or lip, club foot, odd
looking or unusual appearance, open tissue on head, abdomen
or back
Cover open tissue with sterile gauze before referral
Refer for special treatment
After first 90 minutes
Intervention: cord care
Wash hands
Put nothing on the stump
Fold diaper below the stump. Keep cord stump loosely covered
with clean clothes
If stump is soiled, wash with clean water and soap, then dry
thoroughly with clean cloth
Explain to mother she should seek care if umbilicus is red or
draining pus
Teach the mother how to treat local umbilical infection 3x a
day
Home cord care
Mother should wash hands with clean water and soap
before handling the baby
Gently wash off pus and crusts with boiled and cooled
water and soap
Dry the area with clean cloth
Paint with gentian violet
Wash hands
If pus or redness worsens or does not improve in 2 days,
refer urgently to hospital
Schedule of routine visits
Postnatal visit 1: at 48-72 hours of life
Postnatal visit 2: 7 days of life
Immunization visit 1: at 6 weeks of life
Schedule additional follow-up visits depending on baby’s
problems:
After 2 days: if with breastfeeding difficulty, LBW in 1st week of
life, red umbilicus, skin infection, eye infection, thrush or other
problems
After 7 days: if LBW discharged >1 week of age and gaining
weight adequately
The ENC Protocol
DOH Administrative Order
December 2009
Objectives
In general, this policy aims to ensure provision of globally-
accepted evidence-based essential newborn care focusing
on the first week of life
Specifically, it aims to:
Guide health workers and medical practitioners in providing
evidence-based essential newborn care
Define the roles and responsibilities of the different DOH
office and other agencies in the implementation of ENC
Scope
This order shall apply to the whole hierarchy of the DOH
and its attached agencies, other public and private
providers of health care and development partners
implementing the Maternal, Newborn and Child Health
and Nutrition (MNCHN) strategy and to all health
practitioners involved in maternal and newborn care.
Implementing mechanism
Governance:
The LGU capacity is envisioned to be operational with
organization of service delivery teams
Community level: WHT
Facility level: BEmONC and CEmONC teams
Financing:
ENC shall be part of enhanced NSD and MCP packages of
PHIC
Regulation:
Integrated in PHIC Benchbook
Service delivery:
Integrated in BEmONC training programs
Roles and responsibilities
LGU:
Adopt and implement the policy
Ensure availability of budget support
Conduct orientation/trainings for private and public health
workers on maternal and newborn care policies including this
protocol
Monitoring and evaluation
Development partners:
Support implementation of maternal and newborn care policies
and activities
Coordinate and collaborate with DOH and the LGUs in the
conduct of maternal and newborn care practices