Our goal is healthy mother with healthy babies and reduction of neonate mortality

1. Newborn Health & Nutrition
Dr.Ayesha Babar Kawish
Head
Al-Shifa School of Public Health
aykawish@gmail.com

2. Newborn Health & Nutrition
• Neonate & mortality rate
Definition: Number of deaths during the first 28 completed days
of life per 1000 live births in a given year or other period.

3. Infant mortality rate for Pakistan
• The current infant mortality rate for Pakistan in 2023
is 55.777 deaths per 1000 live births, a 1.95% decline from
2022.
• Pakistan has a neonatal mortality rate (NMR) of 41 deaths per
1000 live births, one of the highest in the world, and an
under-5 child mortality rate (U5MR) of 67 deaths per 1000
live births.

4. Why Newborns matter
• A newborn infant, or neonate, is a child under 28 days of age. During
these first 28 days of life, the child is at highest risk of dying. The vast
majority of newborn deaths take place in developing countries where
access to health care is low.
• Promoting newborn survival requires building strong health services,
ensuring that every birth is attended by skilled personnel and making
hospital care available for emergencies. It is crucial that early essential
newborn care is provided, including immediate and prolonged skin-to-
skin contact and early and exclusive breastfeeding, to improve chances
of survival and to lay the foundations for a healthy life.

5. Newborn’s matter

6. Nutritional Goal
• To achieve normal growth and development

7. Objectives
• To describe evidence-based routine care of a newborn baby at and soon after
birth care

8. FOUR basic needs at birth
• Thermal protection
• Normal breathing
• Mother’s milk
• Protection from infection

9. basic needs at birth
• Care of normal baby at birth

10. Care at birth
• Care at birth Call out time of birth Receive the baby onto a warm clean towel
and place on mother’s chest Clamp and cut the umbilical cord Dry the baby
with a warm, clean towel or piece of cloth Assess baby’s breathing while
drying

11. Care at birth
• Dry the baby immediately after birth Care at birth…

12. Care at birth
• Wipe both eyes (separately) with sterile gauze pieces
• Put the baby between mother’s breasts for skin-to-skin
contact
• Place an identity label on the baby
• Cover mother and baby with warm cloth;
• put a cap on the baby’s head Initiate breastfeeding

13. Care at birth
• Care at birth… Immediate skin-to-skin contact & breastfeeding

14. Care at birth
• Ensuring warmth at the time of delivery: ‘Warm chain’

15. Care at birth
• Warm chain’: At delivery At delivery: Ensure the delivery
room is warm (25° C), with no draughts. Dry the baby
immediately; remove wet cloth Wrap the baby with clean dry
cloth Keep the baby skin-to-skin with mother

16. Care at birth
• Assess baby’s breathing at the time of drying: If the baby is
crying vigorously or breathing adequately, then no
intervention is needed if the baby is not breathing or gasping,
then skilled care in the form of positive pressure ventilation
etc. (i.e. RESUSCITATION) would be required Helping the
baby breath

17. Care at birth
• Keep the baby clothed and wrapped;
• cover the head Postpone bathing particularly for small babies Keep baby
close to the mother Use kangaroo care for stable LBW babies
• Show mother how to avoid hypothermia and to recognize Initiate
breastfeeding
• ‘Warm chain’: After delivery

18. Care at birth
• Baby shows feeding cues…

19. Care at birth
Prevention of infections:
‘Clean chain’At delivery: WHO five cleans Clean Hands of
attendants (washed with soap) Surface for delivery Cutting
instrument for cord(i.e. razor, blade) String to tie cord Cloth to
wrap baby and mother

20. Care at birth
Prevention of infections: ‘Clean chain’After delivery Hand washing
before handling the baby Exclusive breastfeeding Keep the cord clean
and dry; do not apply anything Use a clean cloth as a diaper/napkin
Hand wash after changing diaper/napkin

21. Care at birth
• Apply a sterile tie tightly around cord at 2 cm and 5 cm from the abdomen
• Cut between the ties with a sterile instrument Observe for oozing blood every
15 minutes;
• if blood oozes, place a second tie
• Do not apply any substance to the stump DO NOT bind or bandage stump
Leave stump uncovered Cord care

22. Care at birth
• Clean eyes immediately after birth with swab soaked in sterile water Use
separate swabs for each eye;
• clean from medial to lateral side Give prophylactic eye drops within 1 hour of
birth (as per hospital policy)
• Do not put anything else in baby’s eyes Eye care

23. Care at birth
• Do not leave the mother and baby alone in the first hour after birth
• Monitor three parameters every 15 minutes: Breathing: Grunting, chest in-
drawing, fast breathing (>60/min)
• Warmth: Check if the baby’s feet are cold (by using your hands)
• Color: Evaluate the color of trunk and extremities Monitoring the baby

24. Care at birth
• Special situations Mother has HIV/AIDS
• Follow universal precautions as with any other delivery Baby can have
immediate skin-to-skin contact as any other mother and baby Breastfeeding
can begin when the baby is ready
• If mother chooses replacement feeding, prepare formula for the first few feeds
All other care (including cord care and eye care) remain the same

25. Key messages
• Four basic needs at birth:
• warmth,
• normal breathing,
• breastfeeding, prevention of
• Infections
• Ensure warmth by skin to skin contact with mother’s chest/abdomen
Help the mother to initiate early breastfeeding Follow ‘WHO five
cleans’ to prevent infections

26. Transformative innovations in newborn care

27. Kangaroo Mother Care or KMC
• care for preterm infants through prolonged and continuous skin-to-skin
contact. It is initiated in the hospital and can be continued at home with
adequate support and follow-up.
• KMC:
• improves the health and well-being of infants born preterm or low birth
weight,
• promotes better bonding between mother and child,
• facilitates exclusive breastfeeding, which strengthens the baby’s immune
system, and
• provides effective thermal control, reducing the risk of hypothermia.
• Fathers can also provide skin-to-skin contact through KMC.

28. Exclusive breastfeeding
• where the infant only receives breast milk without any
additional food or drink, not even water, for the first 6 months.
• Exclusive breastfeeding protects your baby from common
childhood illnesses such as diarrhoea and pneumonia, and helps
with a quicker recovery if the infant falls ill.
• Exclusive breastfeeding also contributes to health and well-
being of mothers: helps to space children, reduces the risk of
ovarian and breast cancer, and is a secure and low-cost way of
feeding.

29. Does only normal deliveries need Care ?
• Early Essential Newborn Care (EENC) improves the condition of all
babies including those who are premature, sick or born by caesarian
section.

30. Where to get help?
Consult your healthcare provider to ensure you receive Early
Essential Newborn Care. It should be available everywhere for
every baby including low-birth weight, premature babies or
even babies born by caesarean section.

31. How do you baby is getting enough milk?
• At birth, a newborn’s stomach is only the size of your thumbnail and
requires a very small amount of milk per feed. As you keep
breastfeeding, their stomach grows and your milk supply will too.
• Your baby will let you know when he or she has had enough by
closing her or his mouth and taking no more breast milk.
• Try breastfeeding 8 to 12 times over the day and night, when the baby
shows early feeding cues.

32. How do we know baby needs mother feed?
Early signs that a baby is ready to breastfeed include drooling,
then mouth opening, licking and biting of their fingers or
hand. It can take several attempts before a baby is able to
breastfeed successfully. Health workers should give mothers
and babies time and space to try, and support them when
necessary.

33. When mother thinks her feed is not enough
what to advice ?
Worries about not producing enough milk are common. But,
with the right support, virtually every mother can produce
enough breast milk for her baby or babies' needs. It’s all about
supply and demand. The more you breastfeed, the more milk
you produce. So, rather than supplement with infant formula
(which will again reduce demand and therefore supply), try to
breastfeed more frequently.

34. Is breastfeeding better ?
• Absolutely! Breastfeeding has many immediate and long-
term benefits for mother and child:
• Protection from diarrhoea, pneumonia and other common
illnesses for the baby
• Lower risk of overweight, obesity, diabetes and leukemia in
childhood and adolescence
• Reduced risk of breast and ovarian cancer, diabetes and
postpartum depression for the mother

35. Care of a normal baby at birth (Until 1 hour after birth)

36. Tips and information
• Wipe the baby dry and clean and delay the first bath for at least 24 hours
• Keep the baby warm with one or two layers of clothes more than adults and keep
the head covered with a hat
• Have the baby tested for eye and hearing problems and for jaundice
• Keep the umbilical cord dry and, not applying anything on it, such as ointment
• Keep the baby and the mother together in the same room and allow the baby to
feed on demand
• When the baby is small, keep the baby in skin-to skin contact as much as possible
every day
• Wash hands with soap and water before handling the baby
• Know the danger signs and where to seek care, such as if the baby is not feeding
well, has fast breathing or a high temperature

37. Thankyou !