IMMEDIATE NEWBORN CARE

Definition:

Care of all newborns includes immediate and thorough drying, skin to skin contact of

the newborn with the mother, cord clamping and cutting after the first minutes after birth,
early initiation of breastfeeding, and exclusive breastfeeding

Purpose:

Immediate care of the newborn helps identify whether the baby has a normal condition; has a

condition or problem requiring urgent, rapid treatment; or has a condition/malformation or
other problem that requires transfer to another facility or service.

Materials:

Lots of bibs
Burp cloths
Breast pump
Milk storage containers (here are some essential safety tips on storing breastmilk)
Nursing pillow
Nursing bras (if buying before baby is born, buy one cup size larger than your pregnant bra size)
Breast pads (disposable or washable)
Lotion for sore nipples

Direction: Score the following steps according to the rating scale:

3 – Excellent: With complete rationale, Proper execution, Correct delivery
2 – Satisfactory: One of the criteria is missing.
1 – Needs Practice: Two of the criteria is missing.
0 – Not Performed

Note: This procedure can be done by the Nurse Assisting the delivery. *Some steps can be
performed by the Nurse Handling the delivery
Procedure Rationale Rating Remarks
1. Prepare equipment. This provides comfort and
convenience for the healthcare
provider

2. Perform hand hygiene. Deters the spread of microorganism

3. Put on sterile gloves. This helps the healthcare provider to
have direct contact with body fluids
and avoids contamination
 Procedure
4. Call out the time of birth. E.g.This is an indicator that the labor is
“8:30am, Baby Boy/Girl OUT”
5. Lay the newborn on the
mother’s abdomen on top of the abdomen may modify the amount of
sterile linen.*
6. Use the dry cloth to thoroughly This prevents heat loss
dry the baby by wiping the
eyes, face, head, front and back,
arms and legs. *
7. Do a quick check of newborn’s
breathing while drying.
8. Remove the first set of gloves
immediately prior to cord
clamping. *
9. Clamp and cut the cord after
cord pulsations have stopped
(typically at 1 to 3 minutes) *
10. Put the cord clamp tightly
around the cord at 2 cm and 5
cm from the base of the
umbilical cord. *
11. An inch from the cord clamp,
use a straight forceps to
clamp the cord.*
Rationale Rating Remarks
complete
Placing the infant on the mother’s
blood infused as well as allowing the
parents a free, unobstructed view of
their new child.
- also helps to keep the baby warm
A newborn who does not breathe
spontaneously or who takes a few
quick, gasping breaths but is unable to
maintain respirations needs
resuscitation as an emergency
measure.
- If a baby is crying and breathing
normally, avoid any manipulation,
such as routine suctioning, that may
cause trauma or introduce infection.
Cut between ties with sterile
instrument
This allows your baby to receive extra
oxygenated blood from your placenta,
which has important health benefits
It is therefore recommended that
the clamping of the umbilical cord is
done at least five
centimeters from the abdominal wall.
If the umbilical cord is broad-based it
is also recommended to clamp at a
safe distance from the basis
cord clamping is generally necessary if
you're bleeding heavily after giving
birth, if the baby isn't breathing, or if
another concern makes prompt
medical attention necessary.
 Procedure
12. Cut the cord in between the
cord clamp and the straight
forceps. *
13. Place the newborn on
mother’s chest in skin-to-skin
contact. Use clean and dry
sheets wiping the newborn.
Never remove the vernix
caseosa.*
14. Cover the head with bonnet.
Provide extra blankets to
keep the baby warm.*
15. Assess the APGAR score,
auscultate for the heart rate,
observe for the rhythm. Note
for the respiration.*
16. Observe the newborn. Only
when the newborn shows
feeding cues (e.g. opening of
mouth, tonguing, licking, and
rooting).
17. Make verbal suggestions to
the mother to encourage her
newborn to move toward the
breast e.g. nudging.
18. Counsel on positioning and
attachment. When the baby is
ready, advise the mother to:
a. Make sure the newborn’s
neck is not flexed nor
twisted.
b. Make sure the newborn
Rationale Rating Remarks
It is cut so that the baby is no longer
attached to the placenta
Do not separate the newborn from
mother, as long as the newborn does
not exhibit severe chest in-drawing,
gasping or apnea and the mother does
not need urgent medical stabilization
Do not put the newborn on a cold or
wet surface and this prevents heat
loss
The Apgar score standardizes infant
assessment at birth and serves as a
baseline for future evaluations. A
newborn whose total score is less
than 4 is in serious danger of
respiratory or cardiovascular failure
and needs resuscitation. A score of 4
to 6 means that the infant’s condition
is guarded and the baby may need
clearing of the airway and
supplementary oxygen. A score of 7 to
10 indicates that the infant scored as
high as 70% to 90% of all infants at 1
to 5 minutes after birth or is adjusting
well to extrauterine life (10 is the
highest score possible)
This is to ensure that the newborn has
no complications and is ready for
breastfeed
This is an initiation for the infant to
breastfeed
Correct positioning and
attachment are the
most important thing for
successful breastfeeding. Attachment i
s also sometimes known as latching
on. When your baby is well positioned
 Procedure Rationale Rating Remarks
is facing the breast, with and attached, they will find it easier to
the newborn’s nose feed well and you will find it more
opposite her nipple and comfortable
chin touching the breast.
c. Hold the newborn’s body
close to her body.
d. Support the newborn’s
whole body, not just the
neck and shoulders.
e. Wait until her newborn’s
mouth is opened wide.
f. Move her newborn onto
her breast, aiming the
infant’s lower lip well
below the nipple
19. Look for signs of good Breastfeeding shouldn’t be painful for
attachment and suckling: the newborn
a. Mouth wide open
b. Lower lip turned
outwards
c. Baby’s chin touching
breast
d. Suckling is slow, deep
with some pauses.
20. Continue the skin-to-skin This is to ensure comfort and
contact while on prevention of heat loss
breastfeeding.
After a Complete Breastfeed
20. Weigh the baby and return the To document the actual weight of the
baby on the mother’s baby and to prevent heat loss
abdomen to continue the skin-
to-skin contact.
22. Crede’s prophylaxis. Do eye Erythromycin and povidone-iodine
care. Administer gentamicin both decrease the risk of neonatal
eye drops/ erythromycin or conjunctivitis
tetracycline ointment.
(Medication varies among
different institutions) or 2.5%
povidone-iodine drops to both
eyes after newborn has located
breast.
23. Give 0.1 mL (1 mg) Vitamin Injection of vitamin K at birth
K prophylaxis IM to right effectively prevents Vitamin K
vastus lateralis. deficiency bleeding or VKDB
24. Inject 0.5 mL Hepatitis B
Vaccine IM to left vastus
lateralis.
25. Take Vital signs and
measurements and record:
 Procedure Rationale Rating Remarks
a. Weight in kilograms.
b. Take temperature per
rectum.
c. Measure head
circumference in
centimeters.
d. Measure chest
circumference in
centimeters.
e. Measure length in
centimeters. From
sole/heel to calf to back
to neck to head.
26. Perform a quick, head to toe
assessment.

27. Put on diapers; fold the top of

the diaper below stump. Keep
cord stump loosely covered
with clean clothes.
28. Put identification tag on the
ankle or wrist.

29. Assist the mother in doing

Kangaroo Mother Care/ Skin-
to-Skin Contact.
a. Place the baby in upright
position between the
mother’s breasts, chest to
chest
b. Position the baby’s hips in
a ‘frog-leg’ position with the
arms also flexed.
c. Secure the baby in this
position with the support
binder.
d. Turn the baby’s head to
one side, slightly extended
e. Tie the cloth firmly
30. Do health teaching
breastfeeding, include health
teachings and stress its
importance.
31. Do after care of the
equipment used.

32. Dispose soiled materials.

 Procedure Rationale Rating Remarks
33. Performed hand hygiene.

34. Document date, time of

delivery, sex of the baby,
condition at birth, procedure
done and reaction of the
baby.

EINC Team. June 2012. MNCHN EINC Advocacy Partners Handbook for Safe and Quality
Care of Birthing Mothers and Newborns.

Pilliteri, A. (2014). Maternal & Child Health Nursing: Care of the Childbearing &Childrearing
Family (7th Ed.). Philadelphia, PA: Wolters Kluwer.

WHO. Department of Making Pregnancy Safer. Essential Newborn Care Course. Integrated Management
of Pregnancy and Childbirth. Regional Trainors’ Training Course, Manila, Philippines. January
2009.

INSTRUCTOR: __________________________ AVERAGE: _______________________

DATE : __________________________