ESSENTIAL

INTRAPARTAL
NEWBORN
CARE
The DOH/WHO Protocol
DENVER M. OFICIAR
Introduction:
In March 2015, the World Health Organization (WHO) Regional Office for the Western Pacific launches the “First Embrace” campaign for
Early Essential Newborn Care (EENC). The campaign seeks to engage with the general public, health workers, policy-makers and civil society to
promote the recommendations in the Action Plan for Healthy Newborn Infants 2014-2020. The “First Embrace” refers to sustained skin-to-skin
contact immediately after birth transferring life-saving warmth, encouraging exclusive breastfeeding and promoting the natural bond between
mother and child.
Giving appropriate and immediate support on the health and nutrition of a newborn is significant in avoiding newborn complications that
may result to death. There are many traditional beliefs and practices on newborn care, and it should be examined if it would benefit or harm the
baby. On December 2009, Francisco Duque, Secretary of Department of Health, signed Administrative Order 2009-0025. This administrative order
mandates the implementation of the Essential Intrapartum Newborn Care (EINC) Protocol and creates the Unang Yakap Campaign. This campaign
aims to promote ways to take care of newborn children and their mother. Unang Yakap campaign or EINC protocol should be followed in order to
ensure the health of both the mother and the baby.
Unang Yakap is a simple and evidence-based intervention that may help in ensuring the survival of all newborns and young infant. This
compasses interventions such as ensuring warmth, breastfeeding, love and safety and infection control. This protocol is now practiced in birthing
centers and hospitals. Clear instructions that EINC protocol will be performed immediately after the delivery must be given by the mother prior
to giving birth.
Prioritizing the health of a newborn baby is vital for their growth and development. It is important that a mother should include the EINC
protocols or the Unang Yakap Campaign in their birth plans since it would benefit both the mother and her baby. Also, newborn babies should
undergo newborn screening and hear screening in order to treat and prevent complications that may arise in the future. A baby must receive the
essential newborn care health services including immunization in the health facility. Proper care and support should be given with newborns to
ensure their survival.

Learning Objectives:
At the end of the discussion, the students will be able to:
1. Identify the purpose of Essential Intrapartal Newborn Care.
2. Describe the steps of Essential Intrapartal Newborn Care.
3. Perform the steps of Essential Intrapartal Newborn Care accurately and in order.

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What is the Essential Newborn Care Protocol?
• Series of time bound chronologically ordered, standard
procedures that a baby receives from birth.
• Simple, to-the-point, user-friendly, globally accepted
evidence-based protocol to essential newborn care focusing
on the 1st week of life.
• Doable even by a single health worker caring for both
mother and newborn.

How is the Newborn Care Protocol organized?

• By time bands.
• With cross references to sections of the WHO PCPNC
Manual (2006).
• With algorithms that represent clinical pathways.

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I. Immediate Essential Newborn Care -The First 90 Minutes
Time band: 2nd stage of labor
▪ At perineal bulging, with presenting part visible
Intervention: Prepare for the delivery
Action:
▪ Ensure that delivery area is draft-free and room temperature between 25–28oC.
▪ Wash hands with clean water and soap.
▪ Double glove just before delivery
▪ Ensure all delivery equipment and supplies, including newborn resuscitation equipment, are available.
▪ Line up materials for delivery according to sequence of use.

What to prepare before delivery:

▪ 2 sets of sterile gloves
▪ Two clean and warm towels or cloth
▪ Self-inflating bag and mask (normal and small newborn)
▪ Suction device
▪ Sterile cord clamp or ties
▪ Sterile forceps and scissors
▪ Rolled up piece of cloth
▪ Bonnet
▪ Clean dry warm surface

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 • Always remember the importance of observing standard precautions to help protect the
mother and baby and ourselves from infections with bacteria, viruses including HIV.
During Delivery:
• Deliver the baby in prone position on the mother’s abdomen, face turned to the side
• Call out time of birth.
• Dry the newborn thoroughly. Check the baby’s breathing while drying. Remove wet cloth.
• Place the newborn on the mother’s abdomen in skin-to-skin contact. Cover the back with a dry blanket.

Time: WITHIN THE 1ST 30 SECS

Intervention: Dry and provide warmth.
Action:
• Use a clean, dry cloth to thoroughly dry the baby by wiping the face,
eyes, head, and front and back of the trunk, arms and legs.
• Do a quick check of newborn’s breathing while drying.
• Remove the wet cloth.

During the 1st 30 seconds of drying/stimulation:

– Do not suction unless mouth/nose are obstructed with secretions or
other material.
– Do not ventilate unless the baby is floppy and not breathing.

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 Time band: If after 30 secs of drying, newborn is breathing or
crying
Intervention: Skin -to-skin (STS) contact
Action:
• Avoid any manipulation, such as routine
suctioning.
• Place the newborn prone on the mother’s abdomen
or chest skin-to-skin.
• Cover newborn’s back with a blanket and head with a
bonnet.
• Place identification band on ankle

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 Time band: If after 30 secs of drying, newborn is NOT breathing or is gasping
Intervention: Re-position, suction and ventilate
Action:
• Clamp and cut the cord immediately
• Call for HELP
• Transfer to a warm firm surface
• Inform the mother
• Start resuscitation protocol

Time band: 1 – 3 minutes

Intervention: Delayed or non-immediate cord clamping
Action:
• Remove the first set of gloves immediately prior to cord clamping.
• Clamp and cut the cord after cord pulsations have stopped ( at 1 to 3
minutes)

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 Time: WITHIN 90 min of age
Intervention: Provide breastfeeding support for initiation of breastfeeding
Action:
• Leave the baby on the mother’s chest in skin-to-skin contact.
• Observe the newborn.
• Place identification tag / bracelet on the baby’s ankle

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 VITAL SIGNS NORMAL VALUES
TEMPERATURE Axilla: 36.5°C- 37°C ( 97.9°F-98°F)
HEART RATE Apical: 120-140 bpm
RESPIRATIONS 30-60 breaths/ min
BLOOD PRESSURE Oscillometric: 64/41 mmHg in arm and calf

(Oscillometric: Most noninvasive blood pressure monitors use the Oscillometric technique. The cuff is placed on the patient's arm, and the cuff
bladder is inflated with air until the external pressure exceeds the intra-arterial systolic pressure and arterial flow past the cuff ceases. The cuff
bladder pressure is slowly released.)
SKIN TO SKIN CONTACT & INITIATION OF BREASTFEEDING
• To begin with, the baby will want to rest.
• Rest period may take from a few minutes to 30 or 40 minutes before
the baby shows feeding cues.

SIGNS OF READINESS TO BREASTFEED

-Only once the new born shows feeding cues (e.g. opening of
mouth, tonguing, licking, rooting), make verbal suggestions to the
mother to encourage her new born to move toward the breast e.g.
nudging.

Initiation of breastfeeding
• Health workers should not touch the newborn unless there is a
medical indication.
• Do not give sugar water, formula or other pre-lacteals.
• Do not give bottles or pacifiers.
• Do not throw away colostrum.
• If the mother is HIV-positive, counsel the mother on breastfeeding.

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The first breast feed
– Check attachment and positioning when the baby is feeding.
– Let the baby feed for as long as he wants on both breasts.
– Keep the mother and baby together for as long as possible after delivery.
– Delay tasks such as weighing, immunizations, etc. until after the first feed.

Time: WITHIN 90 min of age

Intervention: Do eye care
Action:
• Wipe the eyes
• Apply an eye antimicrobial within 1 hour of birth:
– 1% silver nitrate drops or
– 2.5% povidone iodine drops or
– 1% tetracycline ointment or erythromycin eye drops
• Do not wash away the eye antimicrobial.

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1. What are the benefits of immediate skin-to-skin contact?
A. Provides warmth
B. Increases overall duration of exclusive breastfeeding
C. Allows colonization with good bacteria
D. All of the above

2. When should the cord be clamped after birth?

A. When the cord pulsations stop
B. Between 1 and 3 minutes
C. Between 30 secs - 1 minute in preterm
D. All of the above are appropriate

II. Essential Newborn Care - From 90 Min – 6 HRS

Time: FROM 90 Min – 6 HRS

Intervention: Give Vitamin K prophylaxis and Hepatitis B and BCG
vaccinations at birth
Action:
• Wash hands.
• Inject a single dose of Vitamin K 1 mg IM.
• Inject Hepatitis B vaccine IM and BCG intradermal.
• Record.

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 Time: WITHIN 90 min of age
Intervention:
● Examine the baby
● Check for birth injuries, malformations or defects
Action:
● Thoroughly examine the baby.
● Weigh the baby and record.
● Look for possible birth injury and/or malformation

Time: WITHIN 90 min of age

Intervention: Cord care
Action:
● Wash hands before and after cord care.
● Put nothing on the stump.
● Fold diaper below stump. Keep cord stump loosely
covered with clean clothes.
● If stump is soiled, wash it with clean water and
soap. Dry it thoroughly with clean cloth.

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 Time: WITHIN 90 min of age
Intervention: Provide additional care for a small baby or twin
Action:
• If the newborn is delivered 2 months earlier or weighs <1500 grams, refer to a hospital
• If the newborn is delivered 1 month early of is visibly small (1501 – 2499g)
• KMC
• Special support for breastfeeding
• Discharge planning

Unnecessary Procedures
Not routinely recommended for all neonates:
1. Routine suctioning. 2. Early bathing/washing.

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3. Foot printing. 4. Giving sugar water, formula or other prelacteals and use of bottles and pacifiers.

5. Application of alcohol, medicines and other substances

on the cord stump and bandaging the cord stump or abdomen.

SUMMARY

Essential Newborn Care Protocol

• Essential interventions in the first 90 minutes of life and up to 7 days of life.
• Emphasizes a core sequence of actions, performed methodically, step-by-step.
• Time-bound but doable even by a single health worker caring for both mother and newborn.

Immediate Newborn Care

First 90 Minutes of Life
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 • Call out time of birth.
• Deliver the baby prone on the mother’s abdomen
• Dry the newborn thoroughly. Check breathing while drying.
• Remove wet cloth.
• Position the newborn on the mother’s abdomen in skin-to-skin contact. Cover the back with a dry
blanket.
• Remove first set of gloves.
• Clamp and cut the cord when pulsations have stopped ( 1-3 minutes)
• Place the newborn on the mother’s chest in skin-to-skin contact
• Cover the baby’s head with a hat. Cover the mother and baby with a warm cloth.
• Initiate breastfeeding while maintaining skin-to-skin contact.
• Place identification band on ankle.
• Do eye care

References:
Balita, C. E. (2015). Ultimate Learning Guide to Nursing Review (3rd ed.). Ultimate Learning Series.

Janus de Leon. (2011, November 5). Unang Yakap Training (Essential Newborn Care) Training. YouTube.
https://www.youtube.com/watch?v=AjcoR2tozyQ&t=101s

Ricci, S. (2020). Essentials of Maternity, Newborn, and Women’s Health (5th ed.). LWW.

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 Silvestre, M. A. (2010, March 4). Essential Newborn Care: The DOH/WHO Protocol. Http://Www.Ppsstc.Com/.
http://www.ppsstc.com/files/Essentials%20of%20Newborn%20Care%5B1%5D.DOH-WHO%20Protocol.PPS%20Southern%20Tag%20%5BCo
mpatibility%20Mode%5D.pdf

WHO EINC Briefer. (2011). Essential Intrapartum and Newborn Care (EINC): Saving mothers' and newborns' lives by translating evidence to
practice.

World Health Organization. (2009). Newborn Care Unit until the First Week of Life.

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