Essential New Born Care

1. EssEntial nEwborn
CarE PRESENTED BY
ANJALI SHUKLA
M.SC NURSING( Obs & Gynae)

2. HEALTHY NEWBORN
A healthy infant born at term b/w 38-42wks should
have average birth weight , cries immediately
following birth, establishes independent rhythmic
respiration & quickly adapts to the changed
environment
ESSENTIAL NEWBORN CARE
Basic care to support survival and wellbeing is called ENC
• It includes immediate care at birth, care during the first day
and up to 28 days

3. IndiaWorld
Neonatal
deaths37% 55%
Under
five deaths
Neonatal Deaths
Neonatal deaths are a major contributing factor to U5
mortality in India
Source:
2007 UNICEF

4. Major causes of U5 mortality
Pneumonia
19%
Neonatal
45%
Others
8%
injuries
2%
Malaria
1%
Measles
4%
HIV/AIDS
1%
Diarrhoea
20%
Asphyxia, 23
Neonatal
Tetanus, 4
Congenital
anomaly, 4
Diarrhoea, 2
Others, 6
Sepsis, 36
Small/Very
Small at birth,
21
Causes of Neonatal
Deaths
WHO 2016,

5. PrEParinG For birtH
WASH YOUR HANDS
ESSENTIAL
• A draught free, warm room - temperature 250
C +
• A clean, dry and warm delivery surface
• A radiant heater
• Two clean, warm towels/cloths: to dry, wrap or cover the newborn
baby.
• A folded piece of cloth
• A suction device
• A newborn size self inflating bag, masks
• Laryngoscope
• Oxygen
• Medications
• A CLOCK

6. Essential Newborn Care Interventions
(Soon after the delivery of the baby)
Initial care
• It should be placed on a clean dry or warm linen with the head slightly downwards (150
). It
facilitate the drainage of the mucus accumulated in the trachea bronchial tree by gravity.
• The time of baby’s birth and the sex are noted and recorded soon.
Clearing the airway :
• Wiping of the baby’s face and fluid from the nose and mouth.
• Suctioning the oral and nasal passage with a soft rubber bulb syringe or mucus sucker.(if
needed)
• The airway should be cleared with the aid of a mucus extractor or soft suction catheter
• Clear oropharynx prior to nasopharynx

7. Importance of suctioning:
• Several natural mechanisms help with this:
• As the fetal chest passes through the birth canal it is
compressed, squeezing excess fluid out of the lungs
prior to the baby taking its first breath.
• After several seconds in this "partly delivered"
position, fluid can be seen streaming out of the
babys nose and mouth.

8. Clamping and cutting the cord:
• The cord is clamped by two kocher’s forceps , the near
one is placed 5cm away from the umbilicus and is cut
in between .
• Two separate cord ligatures are applied with sterile
cotton thread 1 cm apart. 2.5 cm away from the navel
squeezing the cord with fingers prior to applying
ligeratures or plastic cord clamp.
Delay cord clamping:
for 2-3 minutes or till cessation of the cord pulsation
facilitates transfer of 80-100ml blood from the
compressed placenta to a baby when placed below the
level of uterus.
Early cord clamping :
Should be done in cases of Rh – incompatibility or
babies born asphyxiated one of a diabetic mother.

9. Identification :
Quick check is to any gross abnormality and dry or
wraped in warm towel When the babies are born in
the hospital , it is essential to identifiable. The
identification tape is tied both on the wrist of the
baby and the mother

10. . APGAR SCORE MONITORING:
After the baby is seen making respiratory effort , the midwife
can proceed to dry the infant in order to avoid evaporative
heat loss .
• At 1 min , after the baby’s birth the midwife will assess the
baby’s general condition and will repeat this for 5 min.
It Involves 5 indicators :
• Activity
• Pulse
• Grimace
• Appearance
• Respirations TOTAL SCORE = 10
NO DEPRESSION: 7-10
MILD DEPRESSION: 4-6
SEVERE DEPRESSION : 0-3

12. PREVENTION OF HEAT LOSS:
• It is important to keep the baby warm. This is initated by wiping off
and drying the baby.
• Bodily contact with the mother
• Radiant warmer or 200 watt bulb
• Warmed blanket
• The wet towel removed before wrapping the baby in warm blankets ,
skin to skin contact with mother to conserve heat .
• Prior to transferring the baby to the ward must carry out a gross
examination of the baby for any congenital defect.
• Vitamin K 1mg IM given as a prophylaxis against bleeding .
erythromycin or Gentamicin eye ointment is applied as prophylaxis
with in 1 hour of birth.

13. Newborn can lose heat in four ways

14. Keeping a newborn baby warm
after delivery
Method of heat loss Prevention
Evaporation: Wet baby Immediately after birth dry
baby with a clean, warm,
dry cloth
Conduction: Cold surface
e.g weighing scale etc.
Put the baby on the
mother’s abdomen or on
a warm surface
Convection: Cold draught Provide a warm, draught
free room for delivery at
≥25o
C
Radiation: Cold metallic
surroundings
Keep the room warm

15. Universal Precautions & cleanliness
• Wash hands.
• Wear gloves.
• Protect yourself from blood and other body fluids
during deliveries.
• Practice safe sharps disposal.
• Practice safe waste disposal.
• Deal with contaminated laundry.
• Sterilize and clean contaminated equipment.

16. ‘‘Five cleans’ to prevent infectionFive cleans’ to prevent infection

17. Kangaroo Mother Care

18. CARE IN NURSERY:
ADMISSION IN NURSERY
• Common indications of the new born in the nursery are : prematurity ,
respiratory distress, poor perfusion or presence of cyanosis , malformation and
need for O2therapy.
Components of Routine Nursing Care
• A nthropometric Measurements
• B athing – Oil bath/ warm water bath
• C ord Care
• D ressing/ Wrapping - mummified
• E ye prophylaxis
• F oot printing / Identification & Feeding
• G et APGAR score – 1 & 5 mins
• H R, RR, Temp
• I njection of Vitamin K & Imuunization
• R outine medication
• V ital sign
• W eight

19. Bathing –
• complete warm water bath
• From cleanest to dirties part
• Do not remove vernix caseosa vigorously
Cord care
It is kept exposed to air and allowed to dry to promote early detachment.
• Topical antiseptic like triple dye and Neosporin powder may be applied to reduce
bacteria colonization .
CORD BLOOD COLLECTION
Make sure cord blood is collected for analysis and sent to laboratory for checking of
Rh Blood type, Hematocrit & possible cord blood gases.

20. • Eye prophylaxis – eyes are kept clean wool soaked with sterile normal saline as a
prophylaxis against opthalmia neonatrum.
• Immunization and vaccines at birth time
Screening of the new born – screening test like glucose screening and detect
hypoglycaemia specially for infants of diabetic mothers, bilirubin screening .
• Feeding – the frequency, duration and volume of each feed is important for
newborn’s growth and development usually it is 8-12 times per day.
• Weight – The weight is loss of 7-10% in the first week of life . weight gain
generally begins by the second week. Average daily weight gain is 20-30 g/day . the
infant weighted should be daily.
• Vital sign- RR , HR, axillary temp. Are recorded every 6-8 hours in baby’s chart
.each urine and stool output is recorded . most of the newborn pass urine by 24
hour and meconium by 48 hours of life.

21. Anthropometric Measurement-
LENGTH:
• (from top of head to the heel with the leg fully extended)
• Average range: 18-22 inches (46-56 cm)
Head circumference:
Head circumference (repeat after molding and caput succedaneum are resolved).
Average range: 33 to 35 cm (13-14 inches) Normally, 2 cm larger than chest
circumference Place tape measure above eyebrows and stretch around fullest part of
occipital at posterior fontanel.
Chest circumference (at the nipple line):
• Average range: 30-33 cm (12-13 inches) Normally, 2 cm smaller than head
circumference Stretch tape measure around scapulae and over nipple line.

22. Warm Chain
• Warm delivery room
• Immediate drying
• Skin to skin contact at birth
• Breastfeeding
• Bathing and weighing postponed
• Appropriate clothing
• Mother and baby together
• Warm transportation

23. Prevention of infections: ‘cleanPrevention of infections: ‘clean
chain’chain’
At delivery: WHO five cleans
Clean
1. Hands of attendants (washed with soap)
2. Surface for delivery
3. Cutting instrument for cord(i.e. razor, blade)
4. String to tie cord
5. Cloth to wrap baby and mother

24. Prevention of infections: ‘cleanPrevention of infections: ‘clean
chain’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

25. DanGer siGn in neW
Born

26. Ask the mother
• Do you or baby have any problems?
• Has infant passed stool with in 24 hours ( lubricated per rectal
thermometer and suspect obstruction )
• Failure to pass urine? ( 48hrs) – delayed passage or obstrctive
uropathy etc
• Causes of vomiting ( ingestion of meconium , systemic illness)
• Causes of Diarrhea ( mother ingestion of drugs, infection by non
breast feed baby, metabolic disorder
• Have you started breast feeding infant?
• Do you have any pain while breast feeding?

27. Examine the Baby
• Count breaths in one minute (grunt, central cynosis)
Central cynosis- ( cardiac and pulmonary disease)
Peripheral cynosis- ( cold)
• Look for severe chest indrawing
• Look at umbilicus. Is it red or draining pus?
• Look for skin pustules. Are there 10 or more
pustules or a big boil?
• TEF( tracheo- esophageal fistula) – excessive
drooling , choking )

28. CENTRAL PERIPHERAL
CYNOSIS

29. Examine the baby
• Measure axillary Temperature (if not possible, feel
for fever or low body temperature)
• See if young infant is lethargic and poor sucking
• Look for jaundice. Are the face, abdomen or soles
yellow?
• Look for malformations
• Capillary refill time (CRT) ( indicates tissue
perfusion)
• Abnormal weight loss pattern

30. Follow-up
• Schedule postnatal visit within first week on day 3
and day 7 of delivery. Also visit on day 14, 21 and
28 if baby is LBW.
• Assess for growth and development and signs of
illnesses
• Health education of parents done
• Assessed at least once every month for 3 months
and subsequently 3 monthly till 1 year.

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

32. SUMMARY
• Basic care to support survival & wellbeing is ENC
• Ventilation must be initiated within 1st
min of life
• Help to initiate breast feeding within 1st
hr of birth
• Identify and refer neonates requiring special care
• Take all precautions to prevent infection,
hypothermia and counsel mother for the same
• Counsel mother for Danger signs, immunization &
follow-up

33. QUeStionS
Q. 1-Which of the following is the most common
cause of neonatal death in India:
• (A) Birth asphyxia
• (B) Sepsis
• (C) Low birth weight
• (D) Congenital anomaly

34. Q2. After birth, how long it can take to achieve
an oxygen saturation of 90% in normal term
newborn
• (A) 1 minute
• (B) 2 minutes
• (C) 5 minutes
• (D) 10 minutes

35. Q3. As per neonatal resuscitation program
India, need for resuscitation at birth is
decided by assessing following risk factor/s
at birth-
• (A) Gestational maturity
• (B) Breathing
• (C) Muscle tone
• (D) All of the above

36. Q4. All of the following statements are true
about kangaroo mother care except
• (A)Especially useful for low birth weight
babies
• (B) Risk of apnea is increased
• (C) Decreased risk of infection
• (D) Can be practiced by other family members