Early Essential Newborn Care

1. Early Essential Newborn Care

2. Objectives • Immediate Newborn Care • The First 90 minutes • Essential Newborn Care • From 90 min to 6 hours • Care Prior to Discharge • After the first 90 minutes • 4. Care After Discharge • Discharge to 7 days • Additional Care • Newborn Resuscitation

3. Case study: Baby Musonda Mrs Musonda is about to give birth to a term baby in a remote clinic. Her pregnancy and labour have been uncomplicated. The next video is about preparation: How will you prepare for the baby’s arrival? What basic equipment will you need?

4. Immediate Newborn Care • Clean cloths, towels, blanket, cord ties and blades • Wash hands • Check resuscitation equipment

5. Immediate Newborn Care • Clean cloths, towels, blanket, cord ties and blades (ref p37) • Wash hands with soap and water • Check resuscitation equipment • Check room temperature (ref p1-3)

6. Immediate Newborn Care • Baby of Musonda is born, appears a normal size for gestation. Which intervention should you do in the first 30 seconds? • Slap, blow, pour cold water on the baby • Hold the baby upside down • Suctioning of the mouth and nose of the baby routinely • Heavy suctioning of the back of the throat of baby • Dry baby with clean cloth, keep warm and check baby • (ref p1)

7. Immediate Newborn Care • Dry baby with a clean cloth, • keep warm, • examine.

8. What do you look for? • Breathing or crying YES • Good muscle tone YES • Colour pink YES • Breathing or crying NO • Good muscle tone NO • Colour pink NO Immediate Newborn Care Skin to skin contact Neonatal Resuscitation Ref. p2

9. Routine Care of the Newborn • Baby of Musonda is crying and active. There are some nasal secretions but the baby is comfortable. The midwife is attending to the mother and asks you when to cut the umbilical cord. • How long should you wait before cutting the cord? • How would you care for the cord?

10. Cord Care • Wait 3 minutes or until the cord stops pulsating before cutting the cord. (Ref. p4) • Wash hands • Put nothing on the cord stump; keep it dry • Fold the nappy (diaper) below the level of the stump • Keep cord stump loosely covered • If the stump is soiled, wash with clean water and soap. • (Ref. p8)

11. Immediate Newborn Care • Properly timed cord clamping

12. Routine Care of the Newborn The baby is now 2 minutes of age pink, crying and active. A warm cloth is placed over the baby on mother. It is cold outside. How will you keep this baby warm? What may happen if the baby becomes cold?

13. Routine Care of the Newborn • Which of the following should you do? • Keep baby with mother • Wash baby within 6hrs • Put newborn on cold/wet surface • Wipe off vernix • Footprinting

14. Immediate Newborn Care • Skin to skin contact

15. Provide Support for Breastfeeding The newborn is having skin to skin contact and starts to show feeding cues. How will you support this mother?

16. Immediate Newborn Care • Initiate breastfeeding

17. Immediate Newborn Care Practice immediate newborn care. “the first 90 mins” in turns as a group of three: 1) Health worker 2) Mother 3) Observer

18. Summary: Early Essential Newborn Care • Dry baby with a clean cloth, keep warm, examine • Properly time cord clamping • Wait for up to 3 mins or until pulsations stop. Keep umbilical cord clean and dry. • Maintain skin-to-skin contact • Give the baby to mother as soon as possible, place on chest or abdomen • Cover the baby to prevent heat loss • Breastfeeding • Initiate within the first hour

19. Summary: Early Essential Newborn Care • Further Management after the first hour of life: • Give vitamin K (phytomenadione), according to national guidelines 1 ampoule IM once • Apply antiseptic ointment or antibiotic eye drops (e.g. tetracycline) to both eyes once (prophylaxis), according to national guidelines • There is no need to bathe baby immediately after birth • (Ref. p. 46, p. 50)