NEWBORN CARE

(from Essential Intrapartum

and Newborn Care/EINC)
(Unang Yakap Integrated)

CN Level 2
AY 2019-2020
Outline:

NEWBORN CARE
(Unang Yakap Integrated)

1.Immediate Newborn Care

(the first 90 minutes)
2.Essential Newborn Care
(after the first 90 mins to 6 hour)
3.Care Prior to Discharge
Immediate NB Care
The First 90 minutes
 Immediate NB Care
The First 90 minutes

TIME BAND: At perineal bulging, with

presenting part visible

INTERVENTION: Prepare for the

delivery
ACTION:
•Ensure that delivery area is draft- free and between
25-28 degree celsius using a room thermometer.
•Wash hands with clean water and soap.
•Double glove just before delivery.
 Immediate NB Care
The First 90 minutes

TIME BAND: Within the 1st 30 secs

Call out the time of birth

INTERVENTION: Dry and provide warmth.

ACTION:
•Use a clean, dry cloth to thoroughly dry
the baby by wiping the eyes, face, head,
front and back, arms and legs.
•Remove the wet cloth.
•Do quick check of newborn's breathing
while drying.
 Immediate NB Care
The First 90 minutes

TIME BAND: If after 30 secs of thorough drying,

newborn is not breathing or is gasping

INTERVENTION: Re-position, suction and

Ventilate
ACTION: Clamp & cut cord
•Call for help.
•Transfer to a warm, firm surface.
•Inform the mother that the newborn has difficulty
breathing and that you will help the baby to breathe.
•Start resuscitation protocol.
 Immediate NB Care
The First 90 minutes

TIME BAND: If after 30 secs of thorough drying,

newborn is breathing or crying

INTERVENTION: Do skin-to-skin contact

ACTION:
•If baby is crying and breathing normally, avoid any
manipulation, such as routine suctioning, that may cause
trauma or introduce infection.
•Place the newborn prone on the mother's
abdomen or chest skin-to-skin.
 Immediate NB Care
The First 90 minutes

TIME BAND: If after 30 secs of thorough drying,

newborn is breathing or crying

INTERVENTION: Do skin-to-skin contact

ACTION:
•Turn the newborn's head to one side
•Cover newborn's back with a blanket and head with a
bonnet.
(Rationale: keeping temperature at optimal range of 36.4 to 37.2 C
to avoid metabolic acidosis, hypoxia & shock)
•Place identification band on ankle.
 Immediate NB Care
The First 90 minutes

TIME BAND: If after 30 secs of thorough drying,

newborn is breathing or crying

INTERVENTION: Do skin-to-skin contact

ACTION:

INTERVENTION (Mother)
Palpate the mother's abdomen.
Exclude a second baby. If no 2nd baby, inject oxytocin 10 IU
IM into the mother's arm or high. If there is a 2nd baby, get
help. Deliver the second newborn.
 Immediate NB Care
The First 90 minutes

TIME BAND: 1-3 minutes

INTERVENTION: Do non-immediate or
appropriately timed cord clamping.
ACTION:
•Remove the first set of gloves immediately
prior to touching or handling the cord.
•Clamp and cut the cord after cord pulsations
have stopped(typically at 1 to 3 minutes)
 Immediate NB Care
The First 90 minutes

TIME BAND: 1-3 minutes

INTERVENTION: Do non-immediate or appropriately timed

cord clamping.
ACTION:
•Apply sterile plastic clamp or tie at 2cm and the second
clamp at 5cm from the umbilical base.
•Cut close to the first clamp with sterile scissors.
•Observe for oozing blood. It should have 2 arteries & 1
vein
INTERVENTION (Mother)
 Immediate NB Care
The First 90 minutes

TIME BAND: Within 90 min of age

INTERVENTION: Provide support for initiation

of breastfeeding
ACTION:
•Leave the newborn on mother's chest in
skin-to-skin contact.
•Observe newbornfor feeding cues
•Counsel on positioning and attachment.
Look for signs of good attachment and
suckling.
 Immediate NB Care
The First 90 minutes

TIME BAND: Within 90 min of age

INTERVENTION for SMALL BABY OR TWIN

•For a visibly small newborn or a newborn
born> 1 month early:
ACTION:
•Skin-to-skin contact with her as much as
possible.
•Provide extra blankets to keep the baby
warm
 Immediate NB Care
The First 90 minutes

TIME BAND: Within 90 min of age

INTERVENTION for SMALL BABY

OR TWIN
•For a visibly small newborn or a
newborn born> 1 month early:
ACTION:
•If mother cannot provide skin-to-
skin contact, use warm blanket or
radiant warmer
 Immediate NB Care
The First 90 minutes

TIME BAND: Within 90 min of age

KANGAROO
MOTHER CARE
 Immediate NB Care
The First 90 minutes

TIME BAND: Within 90 min of age

KANGAROO
MOTHER CARE
 Immediate NB Care
The First 90 minutes

TIME BAND: Within 90 min of age

KANGAROO
MOTHER CARE
 Immediate NB Care
The First 90 minutes

TIME BAND: Within 90 min of age

INTERVENTION for SMALL BABY OR TWIN

•For a visibly small newborn or a newborn
born> 1 month early:
ACTION:
•Do not bathe the small baby. Ensure hygiene
by wiping with a damp cloth but only after 6
hours.
•Prepare a very small baby(1.5kg) or a baby
born>2 months early for referral
 Immediate NB Care
The First 90 minutes

TIME BAND: Within 90 min of age

INTERVENTION: Do eye care

ACTION:
•Administer erythromycin or tetracycline
oitment or 2.5% providone- iodine drops to
both eyes after newborn has located breast.
(Rationale: for treatment of gonorrheal
conjunctivitis)
•Do not wash away the eye antimicrobial.
ESSENTIAL NEWBORN CARE
(from 90 minutes to 6
hours)
 Essential NB Care
90 minutes to 6 hours

TIME BAND: From 90 Min- 6 Hrs

INTERVENTIONS: Rooming-in (keep NB in the room with the

mother)
• Check for birth injuries, malformations or defects.
• Weigh the newborn.
• Get the head, chest, abdominal circumference and
length.
• Give Vit K prophylaxis (AquaMEPHYTON), middle third
vastus lateralis or rectus femoris to prevent
hemorrhagic disease; 0.5 – 1mg single dose.
 Essential NB Care
90 minutes to 6 hours

TIME BAND: From 90 Min- 6 Hrs

INTERVENTIONS: Rooming-in (keep NB in the room with the

mother)

• Inject hepa B & BCG vaccine

• Get the vital signs
• Perform cord care
• Dress the newborn
CARE PRIOR TO DISCHARGE
(after the first 90 minutes)
 Prior to Discharge
After the first 90 minutes
TIME BAND: After the 90 minute of age, but
prior to discharge

INTERVENTIONS:
Support unrestricted per demand
breastfeeding, day and night
 Prior to Discharge
After the first 90 minutes
TIME BAND: After the 90 minute of age, but
prior to discharge

INTERVENTIONS:
Ensure warmth the baby
Washing and bathing
(hygiene)
A B c

E F
 Prior to Discharge
After the first 90 minutes
TIME BAND: After the 90 minute of age, but
prior to discharge

INTERVENTIONS:
Sleeping
Look for signs of serious illness,
jaundice & local infection
Discharge instructions
 HEALTH TEACHINGS
Signs of neonatal distress
–Changes in color or activity
–Grunting or “sighing sounds”
–Rapid breathing with chest retractions
–Facial grimacing
• Temperatur
e– Axillary method, skin sensor for continuous reading
– 36.4 to 37.2 C
•Respirations
– Irregular yet normal (periodic apnea)
– 30-60 cpm
•Pulse
– 120-160 bpm
– Apical pulse for a full minute
* V/S should be monitored q30mins for 2hrs until stable
• Monitoring of output
– Within 24 hrs – voiding
– Within 48 hrs – passage of stools
– Assess for abdominal distention, bowel
sounds,
hydration, fluid intake & temperature stability.
• Weighing of the NB
– Same time of the day
– 10% of weight loss is normal – 1st week
• result of limited intake, loss of excessive extracellular
fluid, & passage of meconium.
• regained by 2 weeks
• BREAST
MILK
- M ilk prod uced by the mother.
- Provides pr imary source of
nutritionf or the baby
before they are able to eat &
digest

•• 3 Stages of Human Milk:

•• cofostrurn
. · nal milk
·rranstt/0
•" Aature milk
COLOSTRUM
- yellowish or creamy fluid
- thicker than mature milk
- contains more protein,
fat-soluble vitamins &
minerals
- high level of IgA
- replaced by transitional
milk within 2-4 days after
birth
• TRANSITIONAL MILK produced from the end
of colostrums & production until
approximately 2 weeks postpartum.
- contains lactose, water-soluble vitamins,
elevated levels of fats, & more calories than
colostrum.
• MATURE MILK 10% solids (carbohydrates,
proteins, fats) for energy & growth; rest is
water, which is vital in maintaining
hydration.
• MATURE
 foremilk
MILK
hindmilk

F H
  estrogen & progesterone levels (after
delivery of the placenta)

Stimulates adenohypophysis to
produce Prolactin

Acts on acinar cells to produce milk

Stored in collecting tubules

MILK-SECRETION
MILK-SECRETION REFLEX

When infant sucks

Stimulates posterior pituitary

gland to produce Oxytocin

Causes contraction of smooth

muscles of collecting tubules

Breast milk is released

MILK EJECTION
REFLEX
B – best for baby
R – reduces incidence
of allergies
E – economical, no cost & waste
A – antibodies, greater immunity to infections
S – satisfies infant’s nutritional needs
T – temperature always correct & constant
F – fresh milk- never spoils
E – emotional bonding
E – easy once established/convenient
D – digested easily
I – inhibits ovulation
N – no mixing required
G – gastroenteritis greatly d
reduce
 Article Review

7 Surprising Superpowers of Breastmilk:

1. Breastmilk can potentially cure cancer.
2. Breastmilk can ‘sense’ when your baby is sick.
3. On hot days, your breastmilk automatically
becomes more ‘watery’.
4. Breastmilk can fight bacteria.
5. Breastmilk cures acne.
6. It’s a natural pain-relief medication.
7. It’s the perfect pre-term baby milk.

Source: https://sg.theasianparent.com/breast-milk-powers-benefits/ 2017

 Preparation of
• Breast
Avoid use of soap on nipples
• use of creams, nipple rolling, pulling & rubbing
to “toughen” nipples is not advisable.
• Women with flat or inverted nipples may find
breast shells (breast cups) useful.
Syringe method
 Assisting with first
feeding
• Within the first hr of birth
• Baby & mother are stable.
• Position mother & baby
- w/ infant’s head & body straight
- facing her breast, w/ infant’s nose opposite her nipple
- infant’s body close to her body
- supporting infant’s whole body, not just neck &
shoulders

• Assess infant’s response to feeding.

– WOF cyanosis & choking
– Cradle
– Football hold
– Cross-cradle hold
– Side lying position
 Breast-Feeding Positions

C1radl e hold

C·ross.-cradIe hoId

Foott>al hold

Lying down
Signs of Good Attachment
a.chin touching breast
b.mouth wide open
c.lower lip turned outward
d.more areola visible above than below the mouth
• By inserting finger into the corner of the
infant’s mouth between the gums
– Mother should remove breast
quickly before the
infant begins to suck again.
•Indent the breast tissue with a finger near
the infant’s mouth & remove infant when
suction is released.
Suckling effectively – slow deep sucks & sometimes
pausing

Duration – 10 min. & then increase the time of feeding

in each breast

Volume of breast milk/day– average 1 quart but some

women are producing more milk

Next breastfeeding – begin on the last breast for even

stimulation & emptying of the breast

Frequency – average of 8-12 times in 24hr period

 Common breast
problems:
• No milk
• Engorgement
• Nipple pain
• Nipple trauma
• Flat or inverted
nipples
• Plugged ducts
• Mastitis
 No Milk
• “galactogogues”- whole grains, dark
green leafy vegetables, (spinach, broccoli,
malunggay, camote tops), garlic, nuts/seeds
(almonds, fennel), ginger, papaya, mussels,
spices (cumin, anise, turmeric)
• warm compress
• lactation massage
• good attachment
• frequent BF
 Engorgemen
t
• Temporary swelling or fullness of the breast when
milk begins to “come in” or change from
colostrums to transitional breast milk.
• Usually occurs on the 2nd or 3rd day after birth.
• Result of accumulation of milk, enlarged lymph
glands & increased blood flow.
• May also be caused by milk retention if feedings are
delayed, too short, or infrequent.
 Engorgemen
t
Tx includes:
– application of heat
& cold
– massage & proper
breastfeeding
techniques
– a well-fitting bra
may be worn both
day & night to help
support breasts.
 Nipple pain
• Pain for a minute or less
• Usually peaks at the 3rd to 6th day & resolves
soon afterward.
 Nipple
• traumapain
sustained
• appear red, cracked, blistered, or bleeding
• Tx includes proper positioning, rotating used
nipples, application of small amount of BM in
affected nipples.
• Redness of breasts tissue, purulent
discharge, fever, mastitis or breast abscess
may require antibiotic treatment.
 Plugged ducts
• localized edema &
tenderness is present, & a
hard area may be
palpated
• tiny, white area may be
present on the nipple
• massage & proper
breastfeeding
•plugged duct may
progress to mastitis if not
treated promptly
 Mastitis
• Inflammation of breast tissue
• caused by blocked milk ducts or
milk excess
• Onset of flu-like symptoms: fever,
chills, body aches & headache.
• Localized breast pain,
tenderness, a hot reddened area on
breast; usually on upper outer
quadrant
 Mastitis
• Tx:
• antibiotics
• Analgesics
• Antipyretics
• Rest
• Warm compress
• Adequate fluid intake & balanced
diet
• Unable to nurse for medical
or
employment reasons
• Manual or breast pump
• Breasts need frequent
stimulation
Manual expression
 Breast
pumps
• Hand-held
• Electric or battery operated
• Not refrigerated – 3-4 hrs
• Refrigerated – up to 3 days
– Stored in a clean plastic container
• Freezer compartment inside the
refrigerator
for up to 2 weeks
• Self contained freezer unit of a refrigerator for
up to 3 to 4 months
• In a separate deep freeze unit at 0⁰F or less up
to 6mons.
• Bathing
• Cleansing of buttocks & perineal
area
• Diaper change
• Cord care
• BATHIN
G

SPONGE
BATH

WARM
WATER BATH
• Cleansing of buttocks &
perineal area
• Fresh water & cotton or mild
soap & water with diaper
changes.
• Keep clean & dry.
• Diaper change

DIAPER RASH
• Cord care

2 to 3 days -
brownish & falls
approximately 10th
-14th day.
END