Normal Newborn Care Advances in Maternal and Neonatal Health Session Objective Define essential elements of early newborn

n care Discuss best practices and technologies for promoting newborn health Use relevant data and information to develop appropriate essential newborn recommendations Newborn Deaths 8.1 million infant deaths (1993) 3.9 million (48%) newborn deaths 2.8 million (67%) early newborn deaths Major causes of newborn deaths Birth asphyxia: 21% Infections: 42% (tetanus, sepsis, meningitis, pneumonia, diarrhea) Birth process was the antecedent cause of 2/3 of deaths due to infections Lack of hygiene at childbirth and during newborn period Home deliveries without skilled birth attendants Birth asphyxia in developing countries 3% of newborns suffer mild to moderate birth asphyxia Prompt resuscitation is often not initiated or procedure is inadequate or incorrect Hypothermia and newborn deaths Significant contribution to deaths in low birth weight infants and preterm newborns Social, cultural and health practices delaying care to the newborn Countries with high STD prevalence and inconsistent prophylactic practices Ophthalmia neonatorum is a common cause of blindness Low birth weight An extremely important factor in newborn mortality Place of childbirth At least 2 out 3 childbirths in developing countries occur at home Only half are attended by skilled birth attendants Strategies for improving newborn health should target Birth attendant, families and communities Healthcare providers within the formal health system Essential Newborn Care Interventions Clean childbirth and cord care Prevent newborn infection Thermal protection Prevent and manage newborn hypo/hyperthermia Early and exclusive breastfeeding Started within 1 hour after childbirth Initiation of breathing and resuscitation Early asphyxia identification and management Eye care Prevent and manage ophthalmia neonatorum Immunization At birth: bacille Calmette-Guerin (BCG) vaccine, oral poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine (WHO) Identification and management of sick newborn Care of preterm and/or low birth weight newborn Cleanliness to Prevent Infection Principles of cleanliness essential in both home and health facilities childbirths Principles of cleanliness at childbirth

 Clean hands Clean perineum Nothing unclean introduced vaginally Clean delivery surface Cleanliness in cord clamping and cutting Cleanliness for cord care Infection prevention/control measures at healthcare facilities Thermal Protection Newborn physiology Normal temperature: 36.537.5C Hypothermia: < 36.5C Stabilization period: 1st 612 hours after birth Large surface area Poor thermal insulation Small body mass to produce and conserve heat Inability to change posture or adjust clothing to respond to thermal stress Increase hypothermia Newborn left wet while waiting for delivery of placenta Early bathing of newborn (within 24 hours) Hypothermia Prevention Deliver in a warm room Dry newborn thoroughly and wrap in dry, warm cloth Keep out of draft and place on a warm surface Give to mother as soon as possible Skin-to-skin contact first few hours after childbirth Promotes bonding Enables early breastfeeding Check warmth by feeling newborns feet every 15 minutes Bathe when temperature is stable (after 24 hours) Early and Exclusive Breastfeeding Early contact between mother and newborn Enables breastfeeding Rooming-in policies in health facilities prevents nosocomial infection Best practices No prelacteal feeds or other supplement Giving first breastfeed within one hour of birth Correct positioning to enable good attachment of the newborn Breastfeeding on demand Psycho-social support to breastfeeding mother Breathing Initiation and Resuscitation Spontaneous breathing (> 30 breaths/min.) in most newborns Gentle stimulation, if at all Effectiveness of routine oro-nasal suctioning is unknown Biologically plausible advantages clear airway Potentially real disadvantages cardiac arrhythmia Bulb suctioning preferred Newborn resuscitation may be needed Fetal distress Thick meconium staining Vaginal breech deliveries Preterm Eye Care To Prevent or Manage Ophthalmia Neonatorum Ophthalmia neonatorum

 Conjunctivitis with discharge during first 2 weeks of life Appears usually 25 days after birth Corneal damage if untreated Systemic progression if not managed Etiology N. gonorrhea More severe and rapid development of complications 3050% mother-newborn transmission rate C. trachomatis Prophylaxis Clean eyes immediately 1% Silver nitrate solution Not effective for chlamydia 2.5% Povidone-iodine solution 1% Tetracycline ointment Not effective vs. some N. gonorrhea strains Common causes of prophylaxis failure Giving prophylaxis after first hour Flushing of eyes after silver nitrate application Using old prophylactic solutions Immunization BCG vaccinations in all population at high risk of tuberculosis infection Single dose of OPV at birth or in the two weeks after birth HBV vaccination as soon as possible where perinatal infections are common Summary The essential components of normal newborn care include: Clean delivery and cord care Thermal protection Early and exclusive breastfeeding Monitoring Eye care Immunization