Report - Peri ( ENC)Jlo

8/2/2019 Report - Peri ( ENC)Jlo

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Janette L. Ortega,RMT,RN


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Essential newborn care(ENC)

is a comprehensive strategy

designed to improve the health ofnewborns through interventionsbefore conception, during pregnancy,at and soon after birth, and in the

postnatal period.


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ENC comprises:

(a) Basic preventive newborn care such ascare before and during pregnancy, cleandelivery practices, temperaturemaintenance, eye and cord care, andearly and exclusive breastfeeding on

demand day and night;(b) Early detection of problems or danger

signs (with priority for sepsis and birthasphyxia) and appropriate referral and

care seeking.(c) Treatment of key problems such as

sepsis and birth asphyxia.


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82,000 Filipino children die annually,most could have been prevented

Source: CHERG estimates ofunder-five deaths, 2000-03

The Philippines is one of the 42 countries that account

for 90% of global under-five mortality


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Majority of newborns die due to stressfulevents or conditions during labor, delivery and

the immediate postpartum period


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What Immediate Newborn Care

Practices will save lives?


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Four Core Steps ofEssential Newborn Care

Immediate and thorough dryingof the newborn

Immediate and thorough dryingfor 30 seconds to one minutewarms the newborn andstimulates breathing.

Early skin-to-skin contact betweenmother and newborn

Early skin-to-skin contact betweenmother and newborn and delayedwashing for at least six hours preventshypothermia, infection andhypoglycemia.


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Four Core Steps ofEssential Newborn Care

Properly-timed cord clamping andcutting

Properly-timed cord clamping andcutting prevents anemia and protectsagainst brain hemorrhage inpremature newborns. Properly timedcord-clamping means waiting for thecord pulsations to stop (between 1 to

3 minutes).

Non-separation of newborn andmother for early breastfeeding

Continous non-separation ofnewborn and mother for earlybreastfeeding protects infants fromdying from infection. The first feedprovides colostrum, a substanceequivalent to the babies first

immunization in its protectiveproperties.


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Time Band: At perineal bulgingPrepare for the Delivery

Check temperature of the delivery room

25 - 28 o C

Free of air drafts

Notify appropriate staff Arrange needed supplies in linear fashion

Check resuscitation equipment

Wash hands with clean water and soap Double glove just before delivery


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Time Band: Within 1st 30 secsImmediate Thorough Drying

Call out the time of birth

Dry the newborn thoroughly for at least

30seconds

Wipe the eyes, face, head, front andback, arms and legs

Remove the wet cloth


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Time Band: Within 1st 30 secsImmediate and Thorough Drying

Do a quick check of breathing whiledrying

Notes:

During the 1st secs:

Do not ventilate unless the baby is

floppy/limp and not breathing

Do not suction unless the mouth/noseare blocked with secretions or othermaterial


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Time Band 0 - 3 mins:Immediate, Thorough Drying

Notes:

Do not wipe off vernix

Do not bathe the newborn

Do not do footprinting

No slapping

No hanging upside - down

No squeezing of chest

g


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me an : er secs o ry ngEarly Skin-to-Skin Contact b/w Mother &

Newborn

If newborn is breathing or crying: Position the newborn prone on themothers abdomen or chest

Cover the newborns back with a dry

blanketCover the newborns head with abonnet

Notes:

Avoid any manipulation, e.g. routinesuctioning that may cause trauma or infection

Place identification band on ankle (not wrist)

Skin to skin contact is doable even for

cesarean section newborns

Ti B d 1 3 i


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Time Band: 1 - 3 minsProperly - timed cord clamping and

cutting

Remove the first set of gloves

After the umbilical pulsations have

stopped, clamp the cord using a sterile

plastic clamp or tie at 2 cm from the

umbilical base

Clamp again at 5 cm from the base

Cut the cord close to the plastic clamp


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Time Band: 1 - 3 mins Properly -timed cord clamping & cutting

Notes:

Do not milk the cord towards the baby

After the 1st clamp, you may strip thecord of blood before applying the 2nd

clamp Cut the cord close to the plastic clampso that there is no need for a 2nd trim

Do not apply any substance onto thecord

Time Band Within 90 mins Non


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Time Band: Within 90 mins Non-separation of Newborn from Mother for

Early Breastfeeding

Leave the newborn in skin-to-skin contact Observe for feeding cues, including

tonguing, licking, and rooting

Point these out to the mother andencourage her to nudge the newborntowards the breast

Counsel on positioning

Newborns neck is not flexed nor twisted Newborn is facing the breast

Newborns body is close to mothersbody

Newborns whole body is supported

Time Band: Within 90 mins Non


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Early Breastfeeding

Counsel on attachment and suckling Mouth wide open

Lower lip turned outwards

Babys chin touching breast

Suckling is slow, deep with somepauses

Notes:

Minimize handling by health workers

Do not give sugar water, formula or other

prelacteals

Do not give bottles or pacifiers

- Do not throw away colostrum

Time Band: Within 90 mins Non


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Early Breastfeeding

Weighing, bathing, eye care,examinations, injections (hepatitis B,BCG) should be done after the first full

breastfeed is completed

Postpone washing until at least 6 hours


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Non-Immediate Interventionswithin 6 hoursafter birth and should never be made to compete with the

time-bound interventions

1. Give Vitamin K prophylaxis

2. Inject Hepatitis B and BCG vaccinations

3. Examine the newborn. Check for birthinjuries, malformations or defects

4. Cord care


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UNNECESSARY PROCEDURES 1. Routine suctioning

No benefit if the amniotic fluid is clear and especiallywith newborns who cry or breathe immediately afterbirth

Moreover, a dirty bulb can become a source ofinfection

Has been associated with cardiac arrhythmia

Indicated only if the mouth/nose is blocked withsecretions or other materials


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2. Early bathing/washing

Hypothermia which can lead to infection,

coagulation defects, acidosis, delayed fetal tonewborn circulatory adjustment, hyalinemembrane disease, brain hemorrhage

Infection the vernix is a protective barrier to

bacteria such as E. coliand Group B Strep; sois maternal bacterial colonization

No crawling reflex


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3. Foot printing

Proven to be an inadequate techniquefor newborn identification purposes

Better identification techniques such asDNA genotyping and human leukocyte

antigen tests


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4. Giving sugar water, formula or otherprelacteals and the use of bottles or

pacifiers Delayed initiation to breastfeeding hasbeen linked to a 2.6 fold increase in thechances of newborn deaths due to

infection

If the sugar water, formula or prelactealsare introduced using a bottle, the

newborn may develop a learnedpreference for the bottle leading tonipple confusion and inefficient sucklingwhich can further lead to failure in

breastfeeding


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A pacifier contributes to nipple confusionif these are used before the newborn is

offered the mothers breast This undermines the chances ofsuccessful breastfeeding by contributingto a vicious cycle of poor attachment,

sore nipples and lactational insufficiency

5. Application of alcohol, medicine and

other substances on the cord stump andbandaging the cord stump or abdome


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2. Advise the mother to bring her newbornto the health facility for routine check-upat the following prescribed schedule:

Postnatal visit 1: at 48-72 hours of life

Postnatal visit 2: at 7 days of life

Immunization visit 1: at 6 weeks of life

3. Advise additional follow-up visitsappropriate to problems in the following:

Two days if with breastfeeding difficulty,Low Birth Weight in the first week of life, red

umbilicus, skin infection, eye infection, thrushor other problems

Seven days if Low Birth Weight dischargedmore than a week of age and not gaining

weight adequately


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DISCHARGE INSTRUCTIONS

4. Advise for Newborn Screening


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Newborn Screening (NBS)

- is a simple procedure to find out if your

baby has a congenital metabolic disorderthat may lead to mental retardation andeven death if left untreated.

-ideally done on the 48th hour or at least24 hours from birth. Some disorders arenot detected if the test is done earlier

than 24 hours. The baby must bescreened again after 2 weeks for moreaccurate results.


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The goal of newborn screening is to give

all newborns a chance to live a normallife. It provides the opportunity for earlytreatment of diseases that are diagnosedbefore symptoms appear. Included in the

panel of disorders under the PhilippineNewborn Screening Program are:Congenital Hypothyroidism (CH),Congenital Adrenal Hyperplasia (CAH),

Glucose-6-Phosphate Dehydrogenase(G6PD) Deficiency, Galactosemia (Gal)and Phenylketonuria (PKU).


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Newborn screening is a simpleprocedure.Using the heel prick method, afew drops of blood are taken from thebaby's heel and blotted on a specialabsorbent filter card. The blood is driedfor 4 hours and sent to the Newborn

Screening Laboratory (NBS Lab).


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5. Advise Newborn Hearing Screening.

- Republic Act #9709:

It is an act establishing universal

hearing screening program for theprevention, early diagnosis andintervention of hearing loss.


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- When the baby is born, he/she issubjected to an OtoAcousticEmmission test (OAE). This is done by

placing a probe in the babys ear thatemits a sound that stimulates the haircells inside the ear. It is a simple and

painless procedure that can be doneamong infants. Ideally, testing should bedone 2 days after birth to reduce thechance of failing the test due to dirt in

the ear canal. If they do not pass theinitial OAE screening, they undergo anAuditory BrainstemResponse (ABR)

test

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