Unang Yakap

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Essential Newborn Care (ENC) The ENC Protocol is a step-by-step guide for health workers and medical practitioners issued by the Department of Health for implementation under Administrative Order 2009-0025. What are these step-by-step interventions? Immediate drying Using a clean, dry cloth, thoroughly dry the baby, wiping the face, eyes, head, front and back, arms and legs. Uninterrupted skin-to-skin contact Aside from the warmth and immediate bonding between mother and child, it has been found that early skin-to-skin contact contributes to a host of medical benefits such as the overall success of breastfeeding/colostrum feeding, stimulation of the mucosaassociated lymphoid tissue system, and colonization with maternal skin flora that can protect the newborn from sepsis and other infectious disease and hypoglycemia. Proper cord clamping and cutting Waiting for up three minutes or until the pulsations stop is found to reduce to chances of anemia in full term and pre-term babies. Evidence also shows that delaying cord clamping has no significant impact on the mother. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in The earlier the baby breastfeeds, the lesser the risk of death. Keeping the baby latched on to the mother will not only benefit the baby (see skin-to-skin contact) but will also prevent doing unnecessary procedures like putting the newborn on a cold surface for examination (thereby exposing the baby to hypothermia), administering glucose water or formula and foot printing (which increases risk of contamination from ink pads) and washing (the WHO standard is to delay washing up to 6 hours; the vernix protects the newborn from infection). On the other hand, necessary actions such as eye care, vitamin K administration must be timed. Eye care must be done after the infant has located the mothers breast.

New Born Care Essential newborn care

The majority of babies are born healthy and at term. The care they receive during the first hours, days and weeks of life can determine whether they remain healthy. All babies need basic care to support their survival and wellbeing. This basic care is called essential newborn care (ENC) and it includes immediate care at birth, care during the first day and up to 28 days. Most babies breathe and cry at birth with no help. Remember that the baby has just come from the mothers uterus, an environment that was warm and quiet and where the amniotic fluid and walls of the uterus gently touched the baby. You too should be gentle with the baby and keep the baby warm. Skin-to-skin contact with the mother keeps her baby at the perfect temperature, so you should encourage and help the mother to keep the newborn baby warm in this way. The care you give the baby and mother immediately after birth is simple but important. In this study session you will learn about the steps of immediate care which should be given to all babies at birth. You will look at how to assess, classify and treat newborns for birth asphyxia and low birth weight as well as how to monitor the mothers condition closely in the minutes and hours after the birth.

The eight steps of essential newborn care

Before you look at the eight steps of essential newborn care (ENC) you need to remember the importance of the three cleans that you learned in Study Session 3 of the Labour and Delivery Care Module. These are clean hands, clean surface and clean equipment. Your equipment should include two clean dry towels, cord clamps, razor blade, cord tie, functional resuscitation equipment, vitamin K, syringe and needles, and tetracycline eye ointment.

Figure 2.1 Drying and wrapping the newborn baby. Step 1 Deliver the baby onto the mothers abdomen or a dry warm surface close to the mother. Continue to support and reassure the mother. Tell her the sex of the baby and congratulate her. Step 2 Dry the babys body with a dry warm towel as you try to stimulate breathing. Wrap the baby with another dry warm cloth and cover the head (Figure 2.1). Dry the baby well, including the head, immediately and then discard the wet cloth. Wipe the babys eyes. Rub up and down the babys back, using a clean, warm cloth. Drying often provides sufficient stimulation for breathing to start in mildly depressed newborn babies. Do your best not to remove the vernix (the creamy, white substance which may be on the skin) as it protects the skin and may help prevent infection. Then wrap the baby with another dry cloth and cover the head. Step 3 Assess breathing and colour; if not breathing, gasping or there are less than 30 breaths per minute, then resuscitate. You will remember that you learned how to manage a newborn baby with birth asphyxia in Study Session 7 of the Labour and Delivery Care Module. As you dry the baby, assess its breathing. If a baby is breathing normally, both sides of the chest will rise and fall equally at around 3060 times per minute. Thus, check if the baby is:

Breathing normally Having trouble breathing Breathing less than 30 breaths per minute, or Not breathing at all.

Resuscitation of a baby who is not breathing must start within one minute of birth. If the baby needs resuscitation, quickly clamp or tie and cut the cord, leaving a stump at least 10 cm long for now and then start resuscitation immediately. Functional resuscitation equipment should always be ready and close to the delivery area since you must start resuscitation within one minute of birth. It may sound as if you have a lot to do in one minute, but the steps described here are ones that you can take simultaneously. That is, while you are delivering the baby onto the mothers abdomen and drying the baby, you can assess breathing and colour and take urgent action if necessary.

Figure 2.2 Tying and cutting the cord. Step 4 Tie the cord two fingers length from the babys abdomen and make another tie two fingers from the first one (Figure 2.2). Cut the cord between the first and second tie. If the baby needs resuscitation, cut the cord immediately. If not, wait for 73 minutes before cutting the cord. 1. Tie the cord securely in two places:

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2.

Tie the first one two fingers away from the babys abdomen. Tie the second one four fingers away from the babys abdomen. Make sure that tie is well secured; the thread you use to tie the cord must be clean.

Cut the cord between the ties:

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3.

Use a new razor blade, or a boiled one if it has been used before, or sterile scissors. Use a small piece of cloth or gauze to cover the part of the cord you are cutting so no blood splashes on you or on others. Be careful not to cut or injure the baby. Either cut away from the baby or place your hand between the cutting instrument and the baby.

Do not put anything on the cord stump.

Step 5 Place the baby in skin-to-skin contact with the mother, cover with a warm cloth and initiate breastfeeding. The newborn loses heat in four ways (see Figure 2.3 below):

Evaporation: when amniotic fluid evaporates from the skin. Conduction: when the baby is placed naked on a cooler surface, such as the floor, table, weighing scales, cold bed. Convection: when the baby is exposed to cool surrounding air or to a draught from open doors and windows or a fan. Radiation: when the baby is near cool objects, walls, tables, cabinets, without actually being in contact with them.

Figure 2.3 The newborn can lose heat in four ways. (Source: WHO, 1997, Safe Motherhood: Thermal Protection of the Newborn, a Practical Guide, accessed fromhttp://whqlibdoc.who.int/ hq/ 1997/ WHO_RHT_MSM_97.2.pdf[Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]) The warmth of the mother passes easily to the baby and helps stabilise the babys temperature. 1. 2. 3. Put the baby on the mothers chest, between the breasts, for skin-to-skin warmth. Cover both mother and baby together with a warm cloth or blanket. Cover the babys head.

The first skin-to-skin contact should last uninterrupted for at least one hour after birth or until after the first breastfeed. The baby should not be bathed at birth because a bath can cool the baby dangerously. After 24 hours, the baby can have the first sponge bath, if the temperature is stabilised.

Figure 2.4 Initiating immediate breastfeeding. If everything is normal, the mother should immediately start breastfeeding. For optimal breastfeeding you should do the following: 1. 2. Help the mother begin breastfeeding within the first hour of birth (Figure 2.4). Help the mother at the first feed. Make sure the baby has a good position, attachment, and is sucking well. Do not limit the length of time the baby feeds; early and unlimited breastfeeding gives the newborn energy to stay warm, nutrition to grow, and antibodies to fight infection.

The steps to keep the newborn warm are called the warm chain. 1. 2. 3. 4. 5. 6. 7. 8. Warm the delivery room. Immediate drying. Skin-to-skin contact at birth. Breastfeeding. Bathing and weighing postponed. Appropriate clothing/bedding. Mother and baby together. Warm transportation for a baby that needs referral.

Step 6 Give eye care (while the baby is held by its mother).

Figure 2.5 Putting tetracycline eye ointment into the eyes of the newborn baby. Shortly after breastfeeding and within one hour of being born, give the newborn eye care with an antimicrobial medication. Eye care protects the baby from serious eye infection which can result in blindness or even death. The steps for giving the baby eye care are these: First, wash your hands, and then using tetracycline 1% eye ointment: 1. Hold one eye open and apply a rice grain size of ointment along the inside of the lower eyelid. Make sure not to let the medicine dropper or tube touch the babys eye or anything else (see Figure 2.5). Repeat this step to put medication into the other eye. Do not rinse out the eye medication. Wash your hands again.

2. 3. 4.

Step 7 Give the baby vitamin K, 1 mg by intramuscular injection (IM) on the outside of the upper thigh (while the baby is held by its mother). After following correct infection prevention steps, with the other hand stretch the skin on either side of the injection site and place the needle straight into the outside of the babys upper thigh (perpendicular to the skin). Then press the plunger to inject the medicine. You will be learning more about safe injection techniques in your practical skills training sessions. There is also a study session on routes of injection in the Immunization Module. Step 8 Weigh the baby. Weigh the baby an hour after birth or after the first breastfeed. If the baby weighs less than 1,500 gm you must refer the mother and baby urgently.

Naegele's Rule is a standard way of calculating the due date for a pregnancy. The rule estimates the expected date of delivery (EDD) by adding one year, subtracting three months, and adding seven days to the first day of a woman's last menstrual period (LMP). The result is approximately 280 days (40 weeks) from the LMP. Calculation The rule estimates the expected date of delivery (EDD) (also called EDC, for estimated date of confinement) from the first day of the woman's LMP by adding 1 year, subtracting three months and adding seven days to that date. The result is approximately 280 days (40 weeks) from the LMP. Example: LMP = 8 May 2009 +1 year = 8 May 2010 -3 months = 8 February 2010 +7 days = 15 February 2010 280 days past LMP is found by checking the day of the week of the LMP and adjusting the calculated date to land on the same day of the week. Using the example above, 8 May 2009 is a Friday. The calculated date (15 February) is a Monday; adjusting to the closest Friday produces 12 February, which is exactly 280 days past 8 May. The calculation method does not always result in a 280 days because not all calendar months are the same length, it does not account for leap years. Parikh's Formula is a calculation method that considers cycle duration. Naegele's Rule assumes an average cycle length of 28 days, which is not true for everyone. EDD is calculated using

Parikh's Formula by adding 9 months to LMP, subtracting 21 days, then adding duration of previous cycles.[1] In modern practice, calculators, reference cards, or sliding wheel calculators are used to add 280 days to LMP.

Computation of AOG
Doctors commonly use "pregnancy wheels" to calculate the date of birth from the lastmenstrual period (LMP). This uses "Naegele's Rule", or: Take the LMP date: add a year, subtract three months, then add seven days. This new date estimates due date. Ex: LMP = 8/1/2007 --- > Due date = 5/7/2008 (you'll notice the rule will fail because 2008 is a leap year - I subtracted 1 day because of February 29.) Age of gestation is simply the number of days that have past from the LMP from the current date. Naegele's rule estimates 280 days [40 weeks] of pregnancy from the LMP, (not 266 days, 38 weeks, since fertilization). 80% of all pregnancies fall within 10 days of this calculation. Confirmation of dates is done with ultrasound in the (ideally) first trimester - measuring the crown rump length, etc. Source(s): I am an M.D.