This document discusses guidelines for immediate newborn care procedures. It outlines that many newborn deaths occur within the first 24 hours of birth, but many lives could be saved through simple interventions. It then describes the Apgar scale used to assess a newborn's health at 1 and 5 minutes after birth. Key immediate newborn care procedures that are described include drying the baby, applying identification bands, promoting skin-to-skin contact and breastfeeding, assessing vital signs regularly in the first hour, and performing a full examination. The goals of immediate newborn care are also stated.

1. IMMEDIATE NEW BORN CARE
Labour Room Management
MUNEESWARI JEYACHANDRAN,
MSC NURSING

2. W.H.O Extract on New born Care
• Of the 3.1 million new born deaths
that occurred in 2010, a quarter to
half of them occurred within the first
24 hours after birth.
• The majority of mothers and
newborns in low and middle income
countries do not receive optimal care
during these periods.
• Studies have shown that many
newborn lives van be saved by the
use of interventions that require
simple technology. The majority of
these interventions can be effectively
provided by a single skilled birth
attendant caring for the mother and
the newborn.

3. Apgar Scale
• The Apgar scale is a simple, painless
and effective test used by midwives
and doctors to assess New born’s
health condition.
• Once carried out, the test will give an
Apgar score. This score will help to
decide if your baby needs any
immediate treatment during the first
moments of her life.
• At one minute, and again at five
minutes after birth, your midwife will
evaluate your baby's wellbeing. Each
factor is given a score between zero
and two, then the scores are added
up.

4. Acronym Score of 0 Score of 1 Score of 2
Skin Colour Appearances Blue all over
White at
extremities,
Body pink
Pink all over
Heart rate Pulse Absent Slow Fast
Reflex
response
Grimace
No response
to stimulation
Grimacing
when
stimulated
Crying and
coughing
Muscle tone Activity Limp
Some
bending or
Stretching of
limbs
Active
movement
Breathing Respiration Absent
Weak or
irregular
Good and
baby is crying
Apgar Scale

5. Interpreting Apgar scores
• If your baby scores between 8-10, he/she is
in good to excellent condition and will
usually need only routine care.
• If your baby scores between 5-7, he/she is
in fair condition but may require help with
breathing. Midwife may vigorously rub
baby's skin or give oxygen.
• If your baby scores below 5, he/she may be
placed on a sloping pad to give her the heat,
light and oxygen she needs. A paediatrician
to be called to offer extra help.

6. Things to remember while interpreting Apgar scores
• If your baby achieves a low score, the Apgar
test will be used again later and until your
baby is in a good and stable condition.
• There is some evidence that low scores at
the five-minute mark may be associated
with a greater risk of problems, such as
cerebral palsy.
• There is no clear evidence that Apgar scores
can predict future health problems of the
baby.
• The Apgar score is only one measure of
newborn's health. There will be further tests
and examinations over the coming weeks
which will ensure that your baby is healthy.

7. Newborn Care Kit
Newborn
Care kit
Disposal
cord
clamp
Clamp &
Scissors
Neonatal
I.D bands
O2 sats
monitor
Neonatal
History
Sheet
Warm
towel and
baby
blankets
Stethoscope Thermometer

8. Objectives of Immediate Neonate Care
• To observe and assist the neonate in adaption to “Extra Uterine
Life”.
• To provide a thermo-neural environment and support
thermoregulation.
• To promote parent-infant bonding and initiate chosen method of
feeding.
• To identify any abnormalities.
• To recognize clinical deterioration and respond accordingly.

9. Immediate Newborn care procedures
• At birth, make an immediate
assessment, of the infant. If stable
then immediately place the neonate
skin-to-skin on the mother’s chest. If
the infant is not stable or you are
unsure then transfer the infant to
the resuscitation cot and reassess
or initiate resuscitation as
appropriate.
• Signs of clinical and physiological
instability often precede a cardio-
respiratory arrest. In many cases
these events may be prevented if
the cause of deterioration is
recognised early and acted upon
before the neonate deteriorates
beyond the point of reversibility.

10. Resuscitation positions

11. Immediate Newborn care procedures
• Dry the neonate with a warm towel, then cover the
neonate with warm, dry blankets.
• To promote initial attachment between parents and
neonate. Skin-to-skin contact prevents heat loss by
conduction.2 This reduces the potential for heat loss
through evaporation and conduction and thus cold stress

12. Immediate Newborn care procedures
• Clamp and cut the umbilical cord within 2-3
minutes of normal birth.
• Earlier cord clamping may be required for
prompt treatment of the infant or for harvesting
of stem cells.
• Delaying cutting of the umbilical cord within 2- 3
minutes of birth of term infants does not appear
to increase the risk of PPH. It may be
advantageous to the infant by improving their
iron status for up to 6 months after birth, but has
a possible additional risk for jaundice requiring
phototherapy.
• Delayed cord clamping may be less optimal in
areas where treatment for jaundice is less
accessible.The increase in polycythaemia in
term infants from delayed cord clamping
appears benign.
• Delayed cord clamping may decrease the
likelihood of feto-maternal transfusion.

13. Immediate Newborn care procedures
• Apply a disposable umbilical cord clamp 1-2 centimetres
from the umbilicus. Check the security of the clamp and
then cut the cord on the distal side of the clamp with the
cord scissors.
• Ensure there is no bleeding from the site.
• Note: For babies who require umbilical vein catheterisation,
leave at least 4cm of cord between the umbilicus and the
cord clamp.

14. Immediate Newborn care procedures
• Assess the Apgar score at one minute
and five minutes post birth.
• Document the Apgar scores on the
Neonatal History sheet.
• The Apgar score is used to assess
adaptation to extra uterine life. It
measures heart rate, respiratory
effort, colour, muscle tone and reflex
response.
• The APGAR scores provide
information on the neonate’s early
transition.

15. Immediate Newborn care procedures
• Promote breastfeeding of the
neonate within the first hour of
life by supporting skin-to-skin
contact and encouraging the
mother to put the baby to the
breast.
• Feeding within the first hour of
life helps to prevent
hypoglycaemia and hyper-
bilirubinemia.

16. Immediate Newborn care procedures
• Apply two white identification (ID)
bands to the neonate’s ankle with the
mother’s UMRN number on it.
• When the neonate’s own UMRN
number has been issued, replace the
original (mother’s UMRN)
identification band5 for two neonatal ID
bands (listing the neonate’s details),
preferably one on each ankle.
• Confirm that the mother’s details on
the neonate’s identification bands
match.
• Be aware of Hospital guidelines to
prevent Abduction of babies.

17. Immediate Newborn care procedures
• For the first hour after birth: Perform an
assessment of the following every 15 minutes6
and document:
• Respirations (Normal rate 30-60)
• Listen for grunting, look for chest/rib recession,
tachypnoea,6 and patent airway/position.
• Heart rate (Normal 110-160)
• Colour (Normal – Pink)
• Check Sa02 on right hand/wrist if unsure)
• Tone/level of consciousness.
• Temperature (Normal 36.5 to 37.4)
• After the first hour (if within normal limits), repeat
assessment of respirations, HR, colour,
tone/level of consciousness hourly for the next
two hours.
• Inform the mother to notify midwifery staff
immediately of any changes in:
1. Colour
2. Tone
3. Respirations
4. Behaviour.

18. Immediate Newborn care procedures
• Perform and record in front of the mother /
partner:
1.The cephalocaudal examination.
2.neonate’s weight,6 length and head
circumference.
• Check for malformations and any issues
with the presenting part.

19. Do’s and Don’ts of a Newborn Care

20. SOURCE OF CONTENT
• Integrated Management of
Pregnancy and Childbirth - WHO
2nd Edition ( Somali context )
• Intrapartum care, Clinical guidelines
- UK’s National Collaborating Center
for Women’s and Children’s Health
• Maternal and Newborn Health
Toolkit - Maternal Health Division,
Ministry of Health & Family Welfare

21. THANK YOU..!!!