Essential Newborn

Assessment & Care

By
Kabale Siragi
MBChB
 Learning Objectives
• Definition of ENAC
• Components of ENAC
• How to provide ENAC
• Algorithm of neonatal resuscitation
• Prevention of Hypothermia in neonates
 ENC: Definition
• Majority of babies born healthy and at term
• Care during first hours, days and weeks of life
determine whether they remain healthy
• Basic care to support survival and wellbeing
is called ENC
• It includes immediate care at birth, care
during the first day and up to 28 days
 Major causes of U5 mortality
Neonatal
45% Measles Others, 6
4% Diarrhoea, 2
Malaria
1%
Neonatal
Others
8% Tetanus, 4
injuries
2% Congenital
HIV/AIDS anomaly, 4
1% Sepsis, 36
Pneum onia
Diarrhoea
19%
20% Small/Very
Small at birth,
21

Asphyxia, 23

WHO 2008, CHERG (Nov 2006)

Causes of Neonatal
Deaths
India: When and why do neonates die ?

Week 1 73.3%
Day U5
Day1 39.5% Child
2 6.7% Asphyxia deaths
3 10.2% Prematurity

4 5.6%
1st day 20%
5 5.6% By 3rd
day
25%
6 2.7%

7 3.0%
Tetanus
Sepsis /
By 7th
day
37%
pneumonia
Week 2 13.8%
By 28th
day
50%
Week 3 8.7%

Week 4 4.2%

0% 10% 20% 30% 40% 50% 60% 70% 80%

 Four basic needs of ALL
newborns
• To breath normally
• To be protected
• To be warm
• To be fed
Immediate care for the new born;
Airway- Clean nose & mouth
Thermoregulation 4.Gross assessment
APGAR 5.ID, Bonding -Safety against
 Essential Newborn Care
Interventions
• Clean childbirth and cord care
– Prevent newborn infection
• Thermal protection
– Prevent & manage newborn hypo/hyperthermia
• Early and exclusive breastfeeding
– Started within 1 hour after childbirth
• Initiation of breathing and resuscitation
– Early asphyxia identification and management
Universal Precautions & cleanliness
• Wash hands.
• Wear gloves.
• Protect yourself from blood and other
body fluids during deliveries.
• Practice safe sharps disposal.
• Practice safe waste disposal.
• Deal with contaminated laundry.
• Sterilize and clean contaminated
equipment.
 PREPARING FOR BIRTH
WASH YOUR HANDS
ESSENTIAL
• A draught free, warm room - temperature 250C +
• A clean, dry and warm delivery surface
• A radiant heater
• Two clean, warm towels/cloths: to dry, wrap or
cover the newborn baby.
• A folded piece of cloth
• A suction device
• A newborn size self inflating bag, masks
• Laryngoscope
• Oxygen
• Disposables
• Medications
• A CLOCK
 Assessment of the baby at the
time of birth
APGAR
• This is a modern waySCORE
of assessing
newborns within the first minute an 5th
minute after birth. APGAR score was
introduced by Virginia Apgar in 1952 to
quantitatively evaluate the new born’s
condition after birth. It scores between 0-2
in each of the different categories are
assigned at 1 and 5 minutes of life. A-
appearance P-Pulse G-Grimace A-Activity
R-Response. Assess all the systems head
 Routine Care
• Call out time of birth
• Place baby on mother’s abdomen
• Dry baby with warm clean sheet
• Wipe mouth and nose with clean cloth
• Assess baby’s breathing while drying
• Clamp cord after 1-3 min, cut with sterile
instrument, put sterile tie
• Put identity label on the baby
 Routine Care
• Examine for malformations/ birth injury
• Initiate breast feeding within 1 hour
• Record baby’s weight
• Give Inj Vit K 1mg IM ( 0.5 mg for preterm)
• Cover baby’s head with cloth.
• Cover mother and baby with warm cloth
 Resuscitation
• All babies must be assessed for need of
resuscitation at birth
• At least 1 person skilled in providing
resuscitation must be present
• Ventilation must start within 1 minute of
birth
• First golden minute
 Resuscitation Flow Diagram
Note the time
Birth Receive baby in
dry, warm linen Routine care
• Dry baby on mother’s abdomen Assess
• Provide warmth (skin to
ment
skincare)
Is baby crying/ YES • Assure open airway if needed
breathing
• Cut cord in 1-2 min
• Ongoing evaluation of neonate
No
• Cut cord immediately and place
under radiant warmer
• Provide initial steps (Dry, Yes
position, clear airway, tactile A
Stimulus)

Labored
Gasping/Apnea or No
30 sec breathing/Cy Evluation
HR<100 anosis
Yes
Yes
Insure open airway, O2,
Initiate PPV Monitoring, Consider B
60 sec using air/O2 shifting to SCNU
 Initiate PPV
using air/O2

Heart Rate after 5 No Baby breathing well and

infl ations: <100 heart rate>100 bpm Evaluation
bpm?
Yes
Look for Chest Rise; if Not PPV <1 Yes Observational
• Reduce leaks min care
• Ensure open airway
• Consider increasing pressure
No

If Heart rate < 60 bpm and chest rising Baby breathing Post-
• Continue PPV, add 100% oxygen well and resuscitation
• Start chest compressions: 3:1 heart rate>100 care
bpm

C
If HR not detectable or <60bpm
Give Adrenaline
Where do babies go from delivery
room?
A) Refer if:
• Birth weight <1500 gms, <34 weeks
• Major congenital malformation
• Severe birth injury
• Respiratory distress
• PPV >1 minutes or needing chest
compression or drugs
B) Observational care:

• Birth weight 1500-1800 gm

• Babies needing IPPV <1 minutes and vigorous

 Immediate cord care
• Clamp and cut cord with a sterile
instrument.
• Tie the cord between 2 to 3 cms
from the base and cut the
remaining cord.
• Observe for oozing blood.
• DO NOT apply any substance to
stump.
• DO NOT bind or bandage stump.
• Leave stump uncovered.
Newborn can lose heat in four ways
 Keeping a newborn baby warm
after delivery
Method of heat loss Prevention

Evaporation: Wet baby Immediately after birth dry

baby with a clean, warm,
dry cloth
Conduction: Cold surface Put the baby on the
e.g weighing scale etc. mother’s abdomen or on
a warm surface
Convection: Cold draught Provide a warm, draught
free room for delivery at
≥25oC
Radiation: Cold metallic Keep the room warm
surroundings
Kangaroo mother care
 KMC
• Skin to skin contact, any family member can do
• Not less than 1 hour at a time
• useful for LBW
• Provide warmth, promote BF,
• Protects from infection
• Emotional bonding
• Physiological stability, reduces apnea
• Multimodal stimulation
 Warm chain
• Warm delivery room
• Immediate drying
• Skin to skin contact at birth
• Breastfeeding
• Bathing and weighing postponed
• Appropriate clothing
• Mother and baby together
• Warm transportation
 Breastfeeding
• Help mother to initiate breastfeeding within
first hour of birth
• Help mother at first feed
• Ensure
- Good position
- Good attachment
- Effective suckling
 Examine the baby
• Count breaths in one minute
• Look for severe chest indrawing
• Look and listen for grunting
• Look at umbilicus. Is it red or draining pus?
• Look for skin pustules. Are there 10 or more
pustules or a big boil?
 Examine the baby
• Measure axillary temperature (if not possible,
feel for fever or low body temperature)
• See if young infant is lethargic
• Look for jaundice. Are the face, abdomen or
soles yellow?
• Look for malformations
 Assess Breastfeeding
If infant has not fed in previous hour, ask mother to
put her infant to breast. Observe the breastfeed
for 4 minutes.
• Is the infant able to attach?
To check attachment, look for:
- Chin touching breast
- Mouth wide open
- Lower lip turned outward
- More areola above than below the mouth
 Assess Breastfeeding (contd)
• If not well attached, help mother to position so
that baby attaches well.
• Is the infant suckling effectively (that is, slow
deep sucks, sometimes pausing)?
• If not sucking well, then look for:
- ulcers or white patches in mouth (thrush)
• If there is difficulty or pain while feeding, then
look for
- Engorged breasts or breast abcess
- Flat or inverted, or sore nipples
 Cord Care
• Umbilical cord is important portal of entry for
pathogenic organism.
• Instruct mother not to apply anything on
cord and keep it dry.
• Umbilical stump must be inspected after 2-4
hours of clamping.
• Bleeding may occur at this time due to
shrinkage of cord and loosening of ligature
 Skin and Eye Care
• Babies are not bathed routinely in hospital to
prevent complications like hypothermia and
infection,
• May be sponged with lukewarm water.
• No routine eye care is required
 Counsel the mother
• Keep baby warm
• Breastfeed frequently and exclusively
• Advise mother to wash hands with soap and
water after using toilet and after cleaning
bottom of baby.
• Advise mother regarding danger signs and
care seeking.
 Immunization
• The baby should receive
-BCG
-Polio-0
-Hepatitis B (HB-1) - if included in immunization
schedule
 Follow-up
• Schedule postnatal visit within first week on
day 3 and day 7 of delivery. Also visit on day
14, 21 and 28 if baby is LBW.
• Assess for growth and development and signs
of illnesses
• Health education of parents done
• Assessed at least once every month for 3
months and subsequently 3 monthly till 1 year.
 SUMMARY
• Basic care to support survival & wellbeing is ENAC
• Ventilation must be initiated within 1st min of life
• Help to initiate breast feeding within 1st hr of birth
• Identify and refer neonates requiring special care
• Take all precautions to prevent infection,
hypothermia and counsel mother for the same
• Counsel mother for Danger signs, immunization &
follow-up
 Questions
Q. 1-Which of the following is the most common
cause of neonatal death in uganda:
• (A) Birth asphyxia
• (B) Sepsis
• (C) Low birth weight
• (D) Congenital anomaly
Q2. After birth, how long it can take to achieve
an oxygen saturation of 90% in normal term
newborn
• (A) 1 minute
• (B) 2 minutes
• (C) 5 minutes
• (D) 10 minutes
Q3. As per neonatal resuscitation program
Uganda, need for resuscitation at birth is
decided by assessing following risk factor/s at
birth-
• (A) Gestational maturity
• (B) Breathing
• (C) Muscle tone
• (D) All of the above
Q4. All of the following statements are true
about kangaroo mother care except

• (A)Especially useful for low birth weight babies

• (B) Risk of apnea is increased
• (C) Decreased risk of infection
• (D) Can be practiced by other family members
Q5. Most consistent clinical finding of early
onset neonatal sepsis is?
• (A) Apnea
• (B)Tachypnea
• (C) Fever
• (D) Seizure
Q6. Presence of all of the following features
suggest good attachment of infant to mother’s
breast except:
A.Mouth widely open
B.Lower lip curled out
C.Chin touches the breast
D.Lower areola visible more than upper
 Answer
• Q1: B
• Q2: D
• Q3: B
• Q4: B
• Q5: B
• Q6: D

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