Essential Intrapartum and Newborn Care

Essential Intrapartum and Newborn Care (EINC)

• Globally accepted, evidence-based protocol for essential newborn care
• Focuses on the first week of life

Intended Learning Outcomes

• Students can determine the basic concepts of newborn care based on World Health Organization standards, including practices that should no longer be continued.
• Students can discuss the purposes of the four time-bound interventions in newborn care immediately after birth.
• Students can determine the nursing responsibilities related to essential newborn care in the first 90 minutes of life.

What is EINC?

• It's the Department of Health's commitment to ensure deliveries are attended by skilled professionals in well-equipped and accessible facilities.
• Approximately 40,000 Filipino neonates die annually, mostly from preventable causes.
• Neonatal deaths often occur within the first week of life.
• High mortality and morbidity rates are directly linked to inappropriate hospital and community practices.
• Newborn care is separate from maternal care.

Essential Newborn Care (ENC) Protocol

• A series of time-bound, chronologically-ordered standard procedures for newborns at birth.
• Four time-bound interventions are key:
  • Immediate and thorough drying of the newborn: Prevents hypothermia, crucial for survival. Technique involves using a clean, dry cloth to wipe the eyes, face, head, front, back, arms, and legs thoroughly.
  • Early skin-to-skin contact: Prevents hypothermia, hypoglycemia, and sepsis. Increases colonization with protective bacterial flora and improves breastfeeding initiation and exclusivity. Technique involves placing the newborn prone on the mother's abdomen or chest skin-to-skin.
  • Properly timed cord clamping and cutting: Decreases anemia in premature babies and prevents brain hemorrhage. Technique involves clamping the cord after pulsations have stopped (usually 1-3 minutes), tying it tightly around the cord at 2 cm and 5 cm from the newborn's abdomen, and cutting between the ties with a sterile instrument. Observe for oozing blood. Do not milk the cord towards the newborn.
  • Breastfeeding initiation within the first hour of life: Prevents neonatal deaths due to infection. First feed provides colostrum. Technique involves observing newborns for feeding cues. Verbal suggestions for the mother to encourage the newborn to move toward the breast.

Crede's Prophylaxis

• Newborn eye treatment to prevent ophthalmia neonatorum (severe eye infection).
• Approved ophthalmic agents include 1% silver nitrate, 0.5% erythromycin, 1% tetracycline, and 2.5% Povidone-iodine drops.

Hepatitis B Vaccine

• All newborns receive a first vaccination within 12 hours of birth.
• Infants of mothers who are positive for HBsAg (hepatitis B surface antigen) also receive hepatitis B immune globulin (HBIG) at birth.
• Vaccine dosage is 0.5 ml.
• Injection site is right lateral anterior thigh or vastus lateralis.
• Route is intramuscular (IM).

Bacille Calmette-Guérin (BCG) Vaccine

• 0.05 mL of BCG vaccine.
• Injection site is right deltoid.
• Route is intradermal (ID).

Newborn Examination

• Weighing the newborn
• Thorough examination for deformities or abnormalities
• Anthropometric measurements
• Bowel patency check
• Checking of vital signs

Weight Measurement

• Newborn is weighed nude and without a blanket.
• Helps determine maturity and establishes a baseline for future weight measurements, comparing maturity.

Thorough exam for abnormalities

• Checks for possible birth injuries.
• Looks for malformations.

Head Circumference Measurement

• Measure around the occiput process, just above the baby's eyebrows.
• Measures are conducted using a tape measure.

Chest Circumference Measurement

• Measured using a tape measure just above the baby's nipple line after inspiration.

Abdominal Circumference Measurement

• Measured just above the umbilicus using a tape measure.

Length Measurement

• NB's legs fully extended with toes pointing upwards.
• Measuring distance from heel to the top of the head using a length board.

Bowel Patency

• Checking bowel patency by inserting a rectal thermometer 1.5-2cm into the anus.

Vital Signs

• Checking of Respiratory rate, Pulse Rate and Cardiac Rate.

Assessments for Well-being

• APGAR Scoring
  • Apgar scoring evaluates the newborn and checks for possible difficulties to adapt to extrauterine life. It is performed twice (at 1 and 5 minutes).
  • Proponent: Dr. Virginia Apgar
  • Used to determine the prognosis of a newborn.

Harmful Practices to Avoid

• Washing before 6 hours of life
• Routine suctioning
• Routine separation and cohorting of babies.

Practices in the Delivery Room to Avoid

• Routine suctioning of secretions
• Putting the newborn on a cold or wet surface.
• Removal of vernix caseosa
• Foot printing and bathing before 6 hours of life
• Unnecessary separation of the newborn
• Transferring the newborn to nursery or NICU without indication

Vitamin K Prophylaxis

• Single dose of 0.5 to 1.0 mg of vitamin K administered intramuscularly within the first to sixth hour of life to prevent bleeding problems.
• Possible adverse reactions may include local irritation.

Nursing Responsibilities

• Administering the IM injection into the vastus lateralis muscle.
• Monitoring and assessing for signs of bleeding (e.g., black, tarry stools, hematuria).
• Monitoring hemoglobin and hematocrit levels, and bleeding from any open wounds or the base of the cord.