report - peri ( enc)jlo
TRANSCRIPT
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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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Time Band: Within 90 mins Non-separation of Newborn from Mother for
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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Time Band: Within 90 mins Non-separation of Newborn from Mother for
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