QUESTIO

N:
DO YOU HAVE IDEA
HOW TO ASSESS
NEWBORN’S HEALTH
RIGHT AFTER BIRTH?
G ro u p 4
APGAR
SCORE
G ro u p 4
 APGAR SCORE

• Developed by Dr. Virginia Apgar in 1952

• Appearance (skin color), Pulse (heart rate),

Grimace response (reflexes), Activity (muscle
tone), and Respiration (breathing eff ort).

• At 1 minute and 5 minutes after birth,

newborns are observed and rated according
to APGAR SCORE.
 APGAR ASSESSMENT

COLOR HEART RATE REFLEX

IRRITABILITY
• All infanes appear
cyanotic at the • Stethoscope is the best 1. Response to a suction
moment of birth. way to determine heart catheter in the nostrils
rate
• Acrocyanosis 2. Response to having
(cyanosis of the • May also be obtained by the soles of the feet
hands and feet) is so observing and flicked
common in newborns counting the
that a score of 1 in pulsations of the
this category can be umbilical cord at the
thought of as normal. abdomen if the cord is
still uncut.
 APGAR ASSESSMENT

MUSCLE TONE RESPIRATORY

EFFORT
• Tested by • Are counted by observing
observing their chest movements.
resistance to any • A mature newborn usually
eff ort to extend cries and aerates the lungs
their extremities spontaneously at about 30
seconds after birth.

• By 1 minute, they are

maintaining regular,
although rapid,
respirations.
AGPAR ASSESSMENT
 INTERPRETING THE
APGAR SCORE

NORMAL RESULTS ABNORMAL RESULTS

• 4-6: May require
• 7-10: some medical
Generally healthy assistance, such as
newborn, no oxygen or stimulation.
immediate medical • 0-3: Indicates serious
intervention distress, immediate
needed. medical intervention
required.
 LET S PRACTICE!

You are collecting the 1 minute APGAR of a

male newborn. You note the HR is 140
bpm. The baby cry is strongest regular
and body is pink with slightly blue hands.
There is some flexion of arms and legs.
While assessing the newborn moves and
cries. What is your patient's APGAR Score?
 LET S PRACTICE!

You are collecting the 1 minute APPEARANCE 1

APGAR of a male newborn. You PULSE 2
note the HR is 140 bpm. The
GRIMACE 2
baby cry is strongest regular
and body is pink with slightly ACTIVITY 1
blue hands. There is some RESPIRATORY 2
flexion of arms and legs. While
APGAR SCORE 8
assessing the newborn moves
and cries. What is your
patient's APGAR Score?
EINC
 ESSENTIAL INTRAPARTUM
NEWBORN CARE (EINC)
• EINC stands for Essential Intrapartum
Newborn Care. It is a series of time-bound and
evidence-based interventions recommended by
the Department of Health (DOH) to improve the
health and survival of newborns and their
mothers

• EINC focuses on 4 time-bound interventions

such as immediate and thorough drying of the
baby, early skin-to-skin contact with the mother,
proper cord clamping, and early breastfeeding
initiation.
 DOH: UNANG YAKAP
• “Unang Yakap” is the campaign of the Department
of Health (DOH), in cooperation with the World
Health Organization (WHO), launched in 2009, to
adopt the Essential Intrapartum Newborn Care (EINC)
in the Philippines.

• It is the Filipino term for Essential Newborn Care. It

emphasizes the importance of immediate skin-to-skin
contact between the mother and newborn after birth.
This practice helps regulate the baby's body
temperature, promotes bonding, and facilitates
successful breastfeeding.
 FLOW
DIAGRAM
FOR EINC
 ESSENTIAL NEWBORN CARE

IMMEDIATE SKIN-TO-SKIN
DRYING CONTACT

DELIVER
Y NON-
SEPERATION PROPER CORD
OF THE BABY CLAMPING AND
FROM THE CUTTING
MOTHER
AND
BREASTFEEDING
INITIATION

Source: DOH: UNANG

 IMMEDIATE AND THOROUGH
DRYING OF THE NEWBORN
• Within the fi rst 30 METHOD
seconds/
• Use clean and
immediately after
birth dry cloth
1.Do NOT put • Wiped gently but
newborn on cold or
thoroughly
wet surface
2.Do NOT bathe the • FOCUS:
newborn earlier baby’s head,
than 6 hours of life chest, and back
IMMEDIATE AND THOROUGH
DRYING OF THE NEWBORN
• BENEFITS

1. Helps maintain baby’s body temperature

2. Encourages early breastfeeding

3. Prevention of Hypothermia

4. Promotes Early Bonding

5. Stimulation of the Respiratory System

 EARLY SKIN-TO-SKIN CONTACT
BETWEEN THE MOTHER AND THE
NEWBORN

• Skin-to-skin contact is usually referred to as the

practice where a baby is dried and laid
directly on the mother’s bare chest after
birth, both of them covered in a warm blanket
and left for at least an hour or until after the
first feed.

• Skin-to-skin contact is important in neonatal

units where it is often known as ‘kangaroo
care’.
 EARLY SKIN-TO-SKIN CONTACT
BETWEEN THE MOTHER AND THE
NEWBORN
METHODS

1.Place the newborn prone on the mother’s

abdomen or chest skin-to-skin.
2.Cover newborn’s back with a blanket and head
with a bonnet.
3.Left for at least an hour or until after the
first feed.
 EARLY SKIN-TO-SKIN CONTACT
BETWEEN THE MOTHER AND THE
NEWBORN
BENEFITS
• Helps the baby transition from the womb,
stabilizes breathing, and eases stress.
• Helps with postnatal anxiety and
depression, and releases oxytocin, which
can reduce the risk of excessive bed-wetting.
• Helps promote breastfeeding and lead to
exclusive breastfeeding.
 PROPERLY TIMED CORD
CLAMPING AND CUTTING

• Cutting the umbilical cord marks the

newborn's establishment of independent
breathing and separation from placental
support.

• This action initiates physiological changes

crucial for the newborn’s adjustment to life
outside the womb.
 PROPERLY TIMED CORD
CLAMPING
PHYSIOLOGIC INDIVIDUALIZED
CLAMPING APPROACH
Delaying the cutting of The timing of cord
the umbilical cord until the clamping should be
pulsation ceases allows for individualized based on the
maximum blood transfer infant's maturity and the
from the placenta to the parent's preference. Late
newborn. This can increase clamping may increase the
risk of polycythemia and
the infant's blood volume,
hyperbilirubinemia in
particularly red blood cells
susceptible newborns,
and white blood cells.
especially preterm infants.
 PROPERLY TIMED CORD
cutting
• The cord is clamped using two hemostats, positioned
8 to 10 inches from the newborn’s umbilicus.

• A partner or support person often has the opportunity to

cut the cord between the clamps, adding a personal
touch to the birth process.

• Afterward, an umbilical clamp is applied to secure the

cord stump. This is often equipped with an alarm system
in hospital settings to prevent newborn abduction.
 PROPERLY TIMED CORD
CLAMPING AND CUTTING
COLOR BLOOD VESSEL
SAMPLING COUNT
A blood sample may be The number of vessels
taken from the cord for in the cord is counted to
various purposes, ensure there are three
including blood typing, (two arteries and one
testing for fetal acidosis, vein).
and cord blood banking.
 POSITIONING DURING
Delayed Clamping
• Holding the infant at the uterine level
during delayed clamping ensures optimal
blood transfer from the placenta.

• Holding the infant higher than the uterus

or clamping immediately can reduce the
amount of blood received by the newborn.
 NON-SEPARATION OF BABY
FROM MOTHER AND
BREASTFEEDING INITIATION

Continuous non-separation of the mother and the

baby is likely to benefit both of them. It will not only
prevent exposure of the baby to potentially
hazardous NICU environments but will also relieve
the mother's anxiety and help her bond early
with her baby and helps to initiate breastfeeding
within 90 minutes of the baby's age.
 INITIAL
MEDICATION
VITAMIN K EYE CARE
ADMINISTRATION ADMINISTRATION

Administer Administer 1%
intramuscular vitamin K silver nitrate or
(1 mg) to prevent antibiotic eye drops
hemorrhagic disease of to prevent
the newborn. conjunctivitis.
 MONITORING FOR ANY
COMPLICATIONS AND PREPARE
FOR NEXT STEPS
1. Assess for Birth Injuries or
Complications: Examine the baby for any
signs of birth trauma or abnormalities.
2. Check for refl exes: Grasp, Moro, and suck
reflexes.
3. Look for any visible anomalies: Cleft lip,
deformities, etc.
 MONITORING FOR ANY
COMPLICATIONS AND PREPARE
FOR NEXT STEPS

4. Monitor closely for any signs of

distress or complications (e.g., respiratory
distress, hypoglycemia).

5. Prepare for transfer (if required),

especially in case of complications such as
severe asphyxia or birth defects requiring
neonatal intensive care.
 DISCHARGE/
FOLLOW-UP

If both the mother and the baby are stable,

• Provide the family with care instructions.
• Educate on breastfeeding, temperature regulation,
and signs of illness.
• Arrange follow-up care
• If complications arise, arrange for further
treatment in a neonatal care facility.
 ESSENTIAL NEWBORN
CARE FROM 90 MINS TO 6
HOURS OF LIFE
 ESSENTIAL NEWBORN
CARE FROM 90 MINS TO 6
HOURS OF LIFE
 ESSENTIAL NEWBORN
CARE FROM 90 MINS TO 6
HOURS OF LIFE
 ESSENTIAL NEWBORN
CARE FROM 90 MINS TO 6
HOURS OF LIFE
INTERVENTION ACTION

Skin to skin contact with the mother Deliver onto the mother's abdomen, dry baby
with a clean cloth, remove wet cloth and
cover the baby with a dry clean cloth to
prevent heat loss
Timing of cord clamping Wait for up to 3 mins or until pulsations stop.
Keep umbilical cord clean and dry. Before
handling the cord, remove your first glove
(double gloved hands)
Breastfeeding Initiate within the first hour once baby has
feeding cues.
Explain to the mother her baby is ready to
breastfeed when she sees feeding cues
 ESSENTIAL NEWBORN
CARE FROM 90 MINS TO 6
HOURS OF LIFE

• Give vitamin K prophylaxis

• Inject hepatitis B and BCG vaccinations

• Dry cord care

• Provide additional care for a small baby (or twin)

THAT IN ALL
THINGS,
GOD MAY BE
GLORIFIED!