PEDIATRICS

NRP: Essential Newborn

Care (Part 1)
Dr. Kurt Peter N. Rosell
07.17.24
○ Coagulation defects
○ Acidosis
Topic Outline
○ Delayed fetal to newborn circulatory adjustment
○ Hyaline membrane disease
● Essential Newborn Care ○ Brain hemorrhage- due to prolonged hypothermia
● If the baby is not breathing, STIMULATE by DRYING!
ESSENTIAL NEWBORN CARE ● Do not slap, shake or rub the baby
● Do not ventilate unless the baby is floppy/limp and not
Essential Newborn Care Protocol: IMMEDIATE Newborn Care breathing
Practices that Save Lives ● Do not suction unless the mouth/nose are blocked

Every Newborn Has Needs 2. Skin to Skin Contact

• To breathe normally ● General perception is that it is purely for mother-baby bonding
• To be warm ● Other benefits:
• To be protected ○ B - breastfeeding success
• To be fed ○ L - lymphoid tissue system stimulation
○ E - exposure to maternal skin flora
Providing Warmth: Check the Environment ○ S - sugar (protection from hypoglycemia) -
● Check temperature of the delivery room * ○ T - thermoregulation
○ Ideal temp: 25 - 28°C ● If breathing or crying:
● Check for air drafts - Ensure that doors and windows are closed ○ Position prone on the mother's abdomen or chest
during delivery. Air drafts can bring cold air into the delivery ○ Cover the newborn
room, potentially predisposing the baby to hypothermia. ■ Dry linen for back
● Turn fans and air conditioners off before the delivery ■ Bonnet for head
● Temperature Check
*non-mercury thermometer ○ Room: 25-28 °C
○ Baby: 36.5 - 37.5 °C
Levels of Newborn Care Required at Birth
3. Properly-Timed Cord Clamping

BENEFITS Relative Risk NNT

Term: less anemia 0.2 7

(0.06 - 0.6) (4.5 - 20.8)

Preterm: less anemia 0.49 3

(0.3 - 0.81) (1.6 - 29.6)

Preterm: less IVH 0.59 2

(0.35 - 0.92) (1.4 - 9.8)

No significant impact on incidence of Post-Partum Hemorrhage

Benefits:
● Reduction in anemia
○ By 80% in term newborns
○ By 51% in preterm newborns
● Reduction in brain hemorrhage by 41% in preterms
1. Immediate and Thorough Drying ● No significant impact on incidence of post-partum hemorrhage
● Dry the newborn thoroughly for at least 30 seconds - Have a ● When preparing for delivery, put on 2 pairs of gloves after
partner to time the drying (call out 30 seconds). Avoid mistaking thorough handwashing
lack of crying for lack of breathing; if the baby isn't crying, check ● Remove the first set of gloves
their chest. ● Palpate the umbilical cord
● Do a quick check of breathing while drying ● Wait 1-3 minutes or until cord pulsations have stopped.
● >95% of newborns breathe normally after birth
● Follow an organized sequence
● Wipe gently, do not wipe off the vernix
● Remove the wet cloth, replace with a dry one
● Immediate drying:
○ Stimulates breathing
○ Prevents hypothermia
● Hypothermia can lead to - Highest risk are preterm babies
○ Infection

1
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Care of the Cord
● Do not milk the cord towards the baby
● Observe for the oozing of blood. If blood oozes, place a second
tie between the skin and the clamp
● DRY cord care is currently recommended
○ Do not apply any substance onto the cord
● Do not use a binder or "bigkis"

4. Non-separation of Newborn from Mother for Early Breastfeeding

After birth, newborn is typically ready to breastfeed in 20-60mins

● Never leave the mother and baby unattended

● Monitor mother & baby every 15 mins in the first 1-2 hrs.
Assess warmth and breathing.
○ Warmth: check to see if feet are cold to touch if no
thermometer
○ Breathing: listen for grunting, look for chest
in-drawing and fast breathing

Early and Appropriate Breastfeeding Initiation

● Leave the newborn between the mother's breasts in continuous
skin-to-skin contact
● The baby may want to rest for 20-30 mins and even up to 120
minutes before showing signs of readiness to feed
● Eye care, weighing, bathing, examinations, injections including
the birth dose of the Hepatitis B vaccine should be done after
the first full breastfeed is completed
● Inform the mother and record all actions
● Postpone bathing until at least 6 hours

Four core steps is applicable when you have NSD

For cesarean deliveries (CSD), follow these steps:

1. Immediate and thorough drying
2. Properly-timed cord clamping
3. Early skin-to-skin contact (place baby on mother's chest)
4. Non-separation