essential newborn care, careduring 1st-2hr of life
Care to the new born child within 1-2
hours of birth of a child
Dr Rakesh Kumar
Dept of pediatrics
- birth up to the 27th completed day
of 28 days)
Essential Newborn Care Course
- Covers essential interventions in the 1st
hours after birth until the first week of life
- Emphasizes the need for a package /bundle
Preterm Baby: A baby who is born before 37 weeks(259 days).
Low Birth Weight(LBW): A baby weighing <2.5 kg.
Very low birth weight (VLBW): wt. < 1.5 kg
Extremely low birth weight (ELBW): w < 1.0 kg
Neonate: A baby who is ≤ 4 weeks or 28 days.
Early Neonatal Period(< 7 days).
Late Neonatal Period(7-28 days).
Infant: A child who is less than 1 year or 365 days.
Millennium Development Goal
fourth Millennium Development
Goal (MDG 4) aims to reduce the 1990
mortality rate among under-five children
by two thirds.
Millennium Development Goals adopted
by the United Nations in 2000 aim to
decrease child deaths worldwide by 2015.
Key facts about neonatal
year nearly 41% of all under-five
child deaths are among newborn infants,
i.e. the neonatal period.
75%of all newborn deaths occur in the
first week of life.
In developing countries nearly half of all
mothers and newborns do not receive
skilled care during and immediately after
Key facts contd….
to two thirds of newborn deaths can
be prevented if known, effective health
measures are provided at birth and
during the first week of life.
Of the 8.2 million under-five child deaths
per year, about 3.3 million occur during
the neonatal period.
The majority - almost 3 million of these die within one week and almost 2 million
on their first day of life.
Key facts contd….
additional 3.3 million are stillborn.
A child’s risk of death in the first four
weeks of life is nearly 15 times greater
than any other time before his or her
Almost 3 million of all the babies who die
each year can be saved with low-tech,
Neonatal mortality :Birth
process was the antecedent cause of
2/3 of deaths due to infections
◦ Lack of hygiene at childbirth and during newborn
◦ Home deliveries without skilled birth attendants
asphyxia in developing countries
◦ 3% of newborns suffer mild to moderate birth
◦ Prompt resuscitation is often not initiated or
procedure is inadequate or incorrect
Neonatal mortality :
and newborn deaths
◦ Significant contribution to deaths in low birth
weight infants and preterm newborns
◦ Social, cultural and health practices delaying
care to the newborn
neonatorum is a common
cause of blindness
◦ An extremely important factor in newborn
◦ At least 2 out 3 childbirths in developing
countries occur at home
◦ Only half are attended by skilled birth attendants
◦ Strategies for improving newborn health should
Birth attendant, families and communities
Healthcare providers within the formal health system
Essential Newborn Care
childbirth and cord care
◦ Prevent newborn infection
◦ Prevent and manage newborn
and exclusive breastfeeding
◦ Started within 1 hour after childbirth
of breathing and resuscitation
◦ Early asphyxia identification and management
◦ Prevent and manage ophthalmia neonatorum
◦ At birth: bacille Calmette-Guerin (BCG)
vaccine, oral poliovirus vaccine (OPV) and
hepatitis B virus (HBV) vaccine (WHO)
and management of sick
Care of preterm and or low birth weight
Cleanliness to Prevent
of cleanliness essential in both
home and health facilities childbirths
Principles of cleanliness at childbirth
Nothing unclean introduced vaginally
Clean delivery surface
Cleanliness in cord clamping and cutting
Cleanliness for cord care
prevention/control measures at
Thermal Protection of neonate
◦ Normal temperature: 36.5–37.5°C
◦ Hypothermia: < 36.5°C
◦ Stabilization period: 1st 6–12 hours after birth
Large surface area
Poor thermal insulation
Small body mass to produce and conserve heat
Inability to change posture or adjust clothing to respond
to thermal stress
◦ Newborn left wet while waiting for delivery of
◦ Early bathing of newborn (within 24 hours)
Hypothermia prevention in
Deliver in a warm room
Dry newborn thoroughly
and wrap in dry, warm
Keep out of draft and place on a warm surface
Give to mother as soon as possible
◦ Skin-to-skin contact first few hours after childbirth
◦ Promotes bonding
◦ Enables early breastfeeding
warmth by feeling newborn’s feet every 15
Bathe when temperature is stable (after 24
Early & exclusive breast
contact between mother and newborn
◦ Enables breastfeeding
◦ Rooming-in policies in health facilities prevents
◦ No prelacteal feeds or other supplement
◦ Giving first breastfeed within one hour of birth
◦ Correct positioning to enable good attachment
of the newborn
◦ Breastfeeding on demand
◦ Psycho-social support to breastfeeding mother
Neonatal resuscitation if needed
breathing (> 30 breaths/min.) in most
◦ Gentle stimulation, if at all
of routine oro-nasal suctioning is
◦ Biologically plausible advantages – clear airway
◦ Potentially real disadvantages – cardiac arrhythmia
◦ Bulb suctioning preferred
resuscitation may be needed
Thick meconium staining
Vaginal breech deliveries
Eye Care To Prevent or
◦ Conjunctivitis with discharge during first 2 weeks
◦ Appears usually 2–5 days after birth
◦ Corneal damage if untreated
◦ Systemic progression if not managed
◦ N. gonorrhea
More severe and rapid development of complications
30–50% mother-newborn transmission rate
◦ C. trachomatis
Eye Care To Prevent or
◦ Clean eyes immediately
◦ 1% Silver nitrate solution
Not effective for chlamydia
◦ 2.5% Povidone-iodine solution
◦ 1% Tetracycline ointment
BCG vaccinations to all neonate.
Single dose of OPV at birth .
HBV vaccination as soon as possible.
delivery of the baby and in the
absence of any immediate problems,
essential newborn care begins with a
thorough general clinical assessment.
should be done on all infants soon
after birth to detect signs of illness and
First steps and appearance
Start by congratulating the mother on the
arrival of her new baby and ask if she has any
concerns. The mother is usually the first
person to notice any problems.
Ask about feeding and the passage of urine
and stools. The infant should pass meconium
(the first black, tarry stools) within 24 hours
General observation: inspect colour,
breathing, alertness and spontaneous
Well infants have a flexed, posture. Partially
flexed posture is found in hypotonia or
Examine skin for prematurity or
Skin: some common normal findings
caseosa: a cream/white cheesy material on the skin
at birth which cleans off easily with oil.
Lanugo; fine downy hairs seen on the back and shoulders
especially in preterm infants.
Milia: pinpoint whitish papules on nose and cheeks due to
blocked sebaceous glands.
Mongolian blue spots: grey/bluish pigment patches seen in
the lumbar area, buttocks and extremities in dark skinned
babies.They usually disappear by one year.
Capillary heamangiomas (“stork bite” naevi): red flat patches
which blanch with gentle pressure. Commonly occur on
upper eyelids, forehead and nape of the neck.
Erythema toxicum: small white/yellow papules or pustules on
a red base seen on face, trunk and limbs. Develop 1 – 3 days
after birth and usually disappear by one week
Clinical assessment- color
palor or plethora
the baby should be uniformly pink
◦ Blueness of the hands and feet (peripheral cyanosis)
may be due to cold extremeties.
◦ Blueness of the mucous membranes and tongue is
central cyanosis and is usually due to lung or heart
(ecchymosis) is common after birth trauma.
Unlike cyanosis, bruising does not blanch on gentle
Clinical assessment - jaundice
Jaundice is common in the first week of life
and may be missed in dark skinned babies
the tip of the nose or hold baby
up and gently tip forward and backward
to get the eyes to open.
mother to do the same at home in
the first week and report to hospital if
significant jaundice is observed.
After these general observations, examine the
infant starting with the head and moving
down the body.
Observe the size and shape of the head
(micro- or macrocephaly; cephalhaematoma)
Check the anterior and posterior
fontanelles and that the skull sutures feel
Form and position of ears (low set ears
occur in chromosomal abnormalities, e.g.
Eyes and face
eyes for ocular anomalies and
check for red reflex using the
ophthalmoscope (to exclude cataract)
the face for dysmorphic features
and normal movements
lips and palate for clefts
Cardiovascular and respiratory
femoral and radial pulses for volume, rate and rhythm.
aortic coarctation, femoral pulse is reduced, absent or not
synchronous with radial pulse.
child is sick, measure blood pressure.
the apex beat and listen to the heart sounds for murmurs.
the respiratory rate
◦ normal 30 – 40 breaths/min in term infants
◦ faster in preterms.
◦ > 60 / minute abnormal
for respiratory distress: nasal flaring, intercostal and
the umbilical cord for presence of 2
arteries and a vein. Abnormal components may
be a pointer to the presence of intra-abdominal
anomalies e.g. renal.
for umbilical abnormalities, e.g. hernia,
palpate the abdomen
◦ the liver may be palpable upto 2cm below
the costal margin
Spine and genitalia
The spine for dimples, tuft of hair (spina
bifida occulta) or cystic swellings (spina
Remove the diaper to examine the genitalia.
In boys, confirm that both testicles have
descended into the scrotum.
Designate the infant’s sex
Inspect the perineum and check anus for
position and patency (can be done by gently
checking rectal temperature)
hands. Note single palmar crease
in chromosome abnormalities.
the feet. Note effects of foetal
posture should be noted.
hips for dislocation
of limb movements occurs in
fractures and nerve injury
◦ normal 2.5 – 3.99kg
◦ normal 48 – 52cm
◦ normal 33 – 37cm