Essential Newborn Care
Essential newborn care (ENC) is a comprehensive strategy designed to improve the health of
newborns through interventions before conception, during pregnancy, at and soon after birth, and in the
postnatal period. This protocol will focus on the first few hours of life of the newborn with the manual
guiding the health workers and medical practitioners in providing evidence-based essential newborn care.
The guidelines are categorized into to the time bound and non-time bound and unnecessary procedures.
Time bound procedures should be routinely performed first which is immediate drying, skin to skin
contact followed by clamping of the cord after 1-3 minutes, non-separation of the newborn from the mother
and breastfeeding initiation.
Non-time bound interventions include immunizations, eye care, Vitamin K administration, weighing
and washing while unnecessary procedures include routine suctioning, routine separation of newborn for
observation, administration of prelacteals like glucose water or formula.
This protocol is needed since decline in neonatal mortality hasn’t improved since 2003. Almost
82,000 Filipino children die annually and most could have been prevented because the common causes of
death were Sepsis or pneumonia, Asphyxia and Preterm pregnancy. Also majority of newborns die due to
stressful events or conditions during labor, delivery and the immediate postpartum period. Thus, immediate
essential newborn practices are needed to save lives.
Immediate Newborn Care
Practices:
Time Band: At Perineal Bulging: Prepare For the Delivery
Check temperature of the delivery room
o 25 - 28 C o
o Free of air drafts
Notify appropriate staff
Arrange needed supplies in linear fashion
Check resuscitation equipment
Wash hands with clean water and soap
Double glove just before delivery
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 newborn thoroughly for at least 30 seconds
o Wipe the eyes, face, head, front and back, arms and legs
Remove the wet cloth
Do a quick check of breathing while drying
Notes:
o 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: 0 - 3 mins : Immediate, Thorough Drying
Notes:
Do not wipe off vernix
Do not bathe the newborn –
Do not do foot printing
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 infection
Place identification band on ankle (not wrist)
Skin to skin contact is doable even for cesarean section newborns
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 “strip” 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 2nd “trim”
Do not apply any substance onto the cord
Time Band: Within 90 mins : Non-separation of Newborn from Mother for Early Breastfeeding
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 neither flexed nor 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 colostrums
Time Band: Within 90 minutes : Non-separation of Newborn from Mother for Early Breastfeeding
Weighing, bathing, eye care, examinations, injections (hepatitis B, BCG) should be done after the first full
breastfeed is completed
Postpone washing until at least 6 hours
