EINC LECTURES (CLINICAL EXPOSURE) IV.

  Within 90 minutes of age

Topic 1: Unang Yakap Policies & Unnecessary Objective: Facilitate the NB early initiation of
Procedures: breastfeeding.
ADMINISTRATIVE ORDER NO. 2009-0025  Leave the NB on the mother’s chest in STS contact
ADOPTING NEW POLICIES AND PROTOCOL ON  Observe the NB. Advise the mother to start the
ESSENTIAL NB CARE feeding once the NB shows feeding cues.
A.  Ensure quality provision of time-bound  Counsel on positioning and attachment.
interventions
 Advise mother not to throw away colostrum.
I.  Within the first 30-seconds of age
 If the attachment or sucking is not good, try again
Objective:  Dry and provide warmth to be NB and and reassess.
prevent hypothermia.
 A small amount of breast milk may be expressed
 Put on double gloves just before delivery. before starting breastfeeding to soften nipple area
for easier attachment.
 Use clean, dry cloth to thoroughly dry the eyes,
face, head, arms and legs. Objective: To prevent opthalmia neonatorum through
proper eye care.
 Remove the wet cloth.
 Administer erythromycin or tetracycline ointment
 Do a quick check of NB breathing while drying.
to both eyes after the newborn has located the
 If the NB must be separated from her mother, put breast.
her on a warm surface, in a safe place close to the
 Do not wash away the eye antimicrobial.
mother.
B.  Non-Immediate Interventions
II.  After thorough drying
1. Give Vitamin K prophylaxis
Objective: Facilitate bonding between mother and her
NB through skin-to-skin contact to reduce infection and 2. Inject Hepa B and BCG immunization
hypoglycemia.
3. Examination for birth injuries, malformation and
 Place the NB prone on the mother’s abdomen or defects
chest, skin-to-skin.
4. Cord care
 Cover the NB’s back and head.
C.  Newborn resuscitation
 Place the ID band in the ankle.
 Start resuscitation if the NB is not breathing or is
 Do not separate the NB from the mother unless the gasping after 30 seconds of drying or before 30
NB exhibit chest in-drawing, gasping or apnea and seconds of drying if the NB is completely floppy and
mother does not need immediate medical/surgical not breathing.
intervention.
 Clamp and cut the cord immediately.
 Do not wipe off vernix if present.
 Call for help.
III.  While on skin to skin contact
 Keep NB wrapped or under a heat source.
Objective: Reduce the incidence of anemia in term NB
 Apply step-by-step resuscitation accordingly.
and intraventricular hemorrhage in pre-term NB by
delaying or non-immediate cord clamping. D. Unnecessary Procedures
 Remove first set of gloves  Routine Suctioning
 Clamp and cut the cord after cord pulsations have  Suctioning has no benefit if the amniotic
stopped. Do not milk the cord fluid is clear and especially with NB who
o Put ties around the cord at 2 cm and 5 cm breathe immediately after birth.
from the newborn’s abdomen.  A dirty bulb can become a source of
o Cut between ties with sterile instrument infection.

o Observe for oozing blood  Routine suctioning has been associated

with cardiac arrhythmia.
o Give 10 IU Oxytocin IM after cord clamping.
  Suctioning is indicated only if the WHAT IS NEWBORN SCREENING?
mouth/nose is blocked with
Newborn Screening (NBS) is a simple procedure to find
secretions or other materials.
out if your baby has a congenital metabolic disorder
 Early Bathing that may lead to mental retardation and even death if
left untreated.
 Drop in the body’s temperature leading to:
WHY IS IT IMPORTANT TO HAVE NEWBORN
 Increase risk of developing infections
SCREENING?
 Coagulation defects
Most babies with metabolic disorders look normal at
 Brain damage birth. One will never know that the baby has the
disorder until the onset of signs and symptoms and
 Removes the vernix which is more often ill effects are already irreversible.
protective against bacteria that cause neonatal
sepsis and removes the crawling reflex. WHEN IS NEWBORN SCREENING DONE?

3. Foot Printing Newborn Screening is ideally done on the 48th hour or

at least 24 hours from birth. Some disorders are not
 Has proven to be an inadequate technique for detected if the test is done earlier than 24 hours. The
newborn identification process. baby must be screened again after 2 weeks for more
 Better identification techniques are DNA accurate results.
Genotyping and Human Leukocyte Antigen Tests. HOW IS NEWBORN SCREENING DONE?
4.  Giving of sugar-water formula pre-lacteals and use Newborn screening is a simple procedure. Using the hell
feeding bottles and pacifier. prick method, a few drops are taken from the baby’s
 Delaying initiation to breastfeeding increase in the heel and blotted on a special absorbent filter card. The
chances of newborn deaths due to infection. blood is dried for 4 hours and sent to the Newborn
Screening Laboratory (NBS Lab).
 Giving pre-lacteals by bottle, newborn may develop
a learned preference for the bottle leading to nipple WHO WILL COLLECT THE SAMPLE FOR NEWBORN
confusion and inefficient suckling which can further SCREENING?
lead to failure in breastfeeding. A physician, a nurse, a midwife or medical technologist
 Pacifiers contributes to a vicious cycle of poor can do the newborn screening.
attachment, sore nipples and lactational WHERE IS NEWBORN SCREENING AVAILABLE?
insufficiency.
Newborn screening is available in practicing health
5.  Application of alcohol, etc. on cord stump and institutions (hospitals, lying-ins, Rural Health Units and
bandaging cord stump or abdomen. Health Centers). If babies are delivered at home, babies
 The devitalized tissue of the cord stump can be an may be brought to the nearest institution offering
excellent medium for bacterial growth, especially if newborn screening.
the stump is kept moist and unclean substances are WHEN IS THE NEWBORN SCREENING RESULTS
applied to it. AVAILABLE?
 Cleaning with alcohol and bandaging delays healing Newborn screening results are available within three
and falling off the stump. weeks after the NBS Lab receives and tests the samples
 The alcohol keeps the stump moist while bandaging sent by the institutions.  Results are released by NBS
prevents aeration which facilitates the drying Lab to the institutions and are released to your
process. attending birth attendants or physicians.  Parents may
seek the results from the institutions where samples are
Topic 2: Newborn Screening collected.
NEWBORN SCREENING: A negative screen mean that the result of the test is
normal, and the baby is not suffering from any of the
Republic Act No. 9288
disorders being screened.
AN ACT PROMULGATING A COMPREHENSIVE POLICY
In case of a positive screen, the NBS nurse coordinator
AND A NATIONAL SYSTEM FOR ENSURING NEWBORN
will immediately inform the coordinator of the
SCREENING.
institution where the sample was collected for recall of
This Act shall be known as the “Newborn Screening Act patients for confirmatory testing.
of 2004”.
WHAT SHOULD BE DONE WHEN A BABY HAS A PKU Severe Normal
POSITIVE NEWBORN SCREENING RESULT? (Phenylketonuria) Mental
Retardation
Babies with positive results should be referred at once
to the nearest hospital or specialist for confirmatory G6PD                     Severe Normal
test and further management.  Should there be no Anemia,
specialist in the area, the NBS secretariat office will Kernicterus
assist its attending physician.

DISORDERS INCLUDED IN THE NEWBORN SCREENING

Topics 3-5: Schedule of Immunization, Latch -on
PACKAGE?
Procedures and Care of the Cord
1. Congenital Hypothyroidism (CH)
SCHEDULE OF IMMUNIZATION FOR CHILDREN BELOW
CH results from lack or absence of thyroid hormone, 1 YEAR OLD
which is essential to growth of the brain and the body. If
Name Preventa Age Recommended
the disorder is not detected and hormone replacement
of ble
is not initiated within (4) weeks, the baby’s physical At M M M M Y
Vaccine Disease
growth will be stunted, and she/he may suffer from Bi on on on on e
mental retardation. rt th th th th ar
h
2. Congenital Adrenal Hyperplasia (CAH)
BCG TUBERC ü          
CAH is an endocrine disorder that causes severe salt
ULOSIS(T
lose, dehydration and abnormally high levels of male
B)
sex hormones in both boys and girls. If not detected or
treated early, babies may die within 7-14 days. HEPATIT HEPATITI ü          
IS B SB
3. Galactosemia (GAL)
PENTAV Diptheria   ü ü ü    
GAL is a condition in which the body is unable to
ALENT ,
process galactose, the sugar present in milk.
VACCIN Tetanus,
Accumulation of excessive galactose in the body can
E Pertussis
cause many problems, including liver damage, brain
(DPT- , Hepa B,
damage and cataracts.
Hep B- Haemop
4. Phenylketonuria (PKU) HiB) hilus
lnfluenza
PKU is a metabolic disorder in which the body cannot e Type B
properly use one of the building blocks of protein called
phenylalanine. ORAL Polio   ü ü ü    
POLIO
Excessive accumulation of phenylalanine in the body VACCIN
causes brain damage. E (OPV)
5. Glucose-6-Phosphate Dehydrogenase INACTIV Polio       ü    
Deficiency (G6PD Def) ATED
G6PD deficiency is a condition where the body lacks the POLIO
enzyme called G6PD. Babies with this deficiency may VACCIN
have hemolytic anemia resulting from exposure to E (IIPV)
certain drugs, foods and chemical. PNEUM Pneumoc   ü ü ü    
OCOCC occal
Disorder Screened Effect Effect if
AL Infection
Screened SCREENED
CONJUG s
and treated
ATE
CH (Congenital Severe Normal VACCIN
Hypothyroidism) Mental E (PCV)
Retardation
MEASLE Measles,         ü ü
CAH (Congenital Death Alive and S, Mumps,
Adrenal Hyperplasia Normal MUMPS and
, Rubella.
Gal (Galactosemia) Death or Alive and
RUBELL
Cataracts Normal
A
 (MMR)  

  CARE OF THE CORD

LATCH ON PROCEDURES  The umbilical cord pulsates for a moment after

an infant is born as a last flow of blood passes
The Unang Yakap or Essential Intrapartum Newborn
from the placenta into the infant.
Care was conceptualized in order to have early initiation
of breastfeeding.  As early as a newborn is delivered,  Two clamps are then applied to the cord about
he/she is placed strategically on the mother’s breast so 5 in. from the infant’s abdomen, and the cord is
he/she will be able to feed immediately when he/she is cut between the clamps.
hungry.
 Every time you handle a newborn, inspect the
With, Unang Yakap, the Delivery Room medical staff cord to be certain it is clamped securely
recognizes the readiness of the baby to go to the breast. because if it loosens before thrombosis
The baby is not forced to latch, instead nudge him obliterates the umbilical vessels, hemorrhage
gently towards his mother’s breast when feeding cues could result.
like tonguing, licking, and opening of the mouth are
 The number of cord vessels should be counted
noted. The mothers and health workers were taught to
immediately after the cord is cut because they
look out for those feeding cues when they encourage
are most visible before drying begins.
the baby to go to the breast. That is why it is very
important that the mother and baby should be kept  Until the cord falls off, at about 7 to 10 days of
together on skin-to-skin contact on the breast for that life, be certain diapers are folded below the
first full breastfeed. level of the umbilical cord to help keep the cord
dry.
Unang Yakap emphasizes the need to breastfeed within
the first 60-90 minutes. It is during the early stage of  Advise parents to keep the cord dry until it falls
breastfeeding when the protein and nutrient-rich off. Discourage the use of creams, lotions, and
colostrum is released. This gives the newborn baby oils near the cord because these tend to slow
protection against infections. drying and may invite infection.
The most important outcome of Unang Yakap is the  Remind them to use sponge baths until the cord
promotion of breastfeeding. Since the baby is placed falls off. Some healthcare agencies recommend
closely to the mother’s breast, he becomes familiar with that parents apply rubbing alcohol to the cord
the breast as the source of food. site once or twice a day to hasten drying. Most
agencies recommend using no products
Latching capability 
because any manipulation of the cord could
 Babies have many instinctive reflexes already in invite infection
place to help him/her latch. 
 After the cord falls off, a small, pink, granulating
A natural position  area about a quarter of an inch in diameter may
remain. This should also be left clean and dry
 The laid-back nursing position, also known as
until it has healed (about 24 to 48 more hours).
the reclining breastfeeding position is more
skin-to-skin friendly than other breastfeeding  For the first hour after birth, the stump of the
positions since the whole front of your baby will umbilical cord appears as a white, gelatinous
be flat against you. Your hands are also free in structure marked with the blue and red streaks
this position to caress your new-born baby. of the one umbilical vein and the two arteries.

What babies need for a good latch   Any child with a single umbilical artery needs
close needs and assessment for anomalies that
 Be sure to notice hunger signs before your baby
are frequently associated with the lack of an
gets over-hungry and anxious.
umbilical artery
 Take time to soothe your baby before a
 Always inspect the cord clamp to be certain it is
breastfeeding session.
secure. After the first hour of life, the cord will
 Make sure that your baby's body and neck are begin to dry, shrink, and turn brown as if it were
supported. the dead end of a vine.

 Chin movement is essential for good milk  By the second or third day, it will have turned
transfer. black.

 Your baby needs a big mouthful of the breast.

 Your baby needs to breathe.

 On day 6 to 10, it breaks free, leaving a
granulating area a few centimeters wide that
will heal during the following week.

 There should be no bleeding at the base of the

cord and it should not appear wet.

 A moist or odorous cord suggests infection,

requiring immediate antibiotic therapy to
prevent the infectious organisms from entering
the newborn’s bloodstream and causing
septicemia.

 Moistness at the base of the cord also may

indicate a patent urachus (a narrow opening
that connects the bladder and the umbilicus),
which requires surgical repair

 Inspect the base of the cord to be certain no

abdominal wall defect such as an umbilical
hernia is present.