Case Assignment on the Newborn Care using EENC

How was the ENC Protocol developed?

The ENC Protocol was developed the Newborn Care Technical Working Group (TWG) that
conducted a systematic search and critical appraisal of foreign and local medical and allied health
literature on practices in the immediate newborn period. An evidence-based draft was then developed and
reviewed by the Department of Health (DOH), United Nations Children’s Fund (UNICEF), United
Nations Population Fund (UNFPA), the Philippine Obstetrical and Gynecological Society (POGS), the
Philippine Society of Newborn Medicine (PSNbM, a subspecialty society of the Philippine Pediatric
Society, PPS), other health professional organizations/associations, Save the Children, the academe and
other stakeholders.

What has the government done to ensure implementation of the Essential Newborn Care
Protocol?
The signing of the Administrative Order 2009-0025 last Dec. 1, 2009 institutionalizes policies
and guidelines for government and private health facilities to adopt the essential newborn care protocol.
Advocacy and dissemination for a have been done since its launch. Scale-up implementation in all health
facilities and social marketing are both in the pipeline to ensure that the policy is implemented all over the
country.

Core Steps (First 90 minutes)

Immediate and thorough drying of the newborn

Immediate and thorough drying for 30 seconds to one minute warms the newborn and
stimulates breathing. Immediate and thorough drying of the newborn prevents hypothermia which
is extremely important to newborn survival. Evidence shows that breastfeeding in the first hour of
life prevents about 19% of newborn deaths.

Skin-to-skin
Means your full-term, healthy baby is placed belly-down, directly on your chest, right
after birth. Your care provider dries your baby off, puts a hat on him or her, covers him or her
with a warm blanket, and gets your baby settled on your chest. The first hours of snuggling skin-
to-skin let you and your baby get to know each other. Keeping the mother and baby in
uninterrupted skin-to-skin contact prevents hypothermia, hypoglycemia and sepsis, increases
colonization with protective bacterial flora and improved breastfeeding initiation and exclusivity

Properly timed cord clamping

Properly timed cord clamping and cutting done until the umbilical cord pulsation stops. It
decreases anemia in one out of every seven term babies and one out of every three preterm
babies. It also prevents brain (intraventricular) hemorrhage in one of two preterm babies.

Early breastfeeding and non-separation from the mother

Babies held skin-to-skin with their mothers cry less often, breathe easier, and stay
warmer than babies who are separated from their mothers. They also instinctively attach to the
breast and begin breastfeeding, usually within one hour of birth. The advantages of rooming-in
for mother and baby are also discussed. Breastfeeding initiation within the first hour of life
prevents an estimated 19.1% of all neonatal deaths.
 From 90 mins to 6 hours

Eye Care
As the baby’s head is born eyes are swabbed using sterile swab; one swab per wipe,
inwards to outwards and discarded to prevent transmission of infections like gonorrhea
(ophthalmic neonotorum).

PA (physician assistant)
A neonatal physician assistant specializes in the care and treatment of newborn,
premature or ill infants, they report on the progress of patients for the doctor to review. The
neonatal physician assistant advises parents or caregivers about the treatment and care of the
infant.
After the baby has detached from the breast:
 wash hands;
 thoroughly examine the baby;
 put an identification tag around the ankle; and
 Weigh the baby and record.
Explain to the mother that you will be examining her baby and checking for birth injuries and/or
malformations, especially those that need additional care or early referral.
`Check for breathing difficulties including:
 grunting,
 chest in-drawing, or
 Fast or slow respiratory rate.

Check the baby’s

 temperature – normal axillary temperature is of 36.5–37.5 °C;
 eyes for redness, swelling or pus draining; or
 Umbilical stump for oozing blood.
Check for abdominal distention.
 Look at the head, trunk and all limbs of the baby.
 Check for possible birth injuries, including:
 bumps on one or both sides of the head;
 bruises, swelling on the buttocks;
 abnormal position of legs (after breech extraction);
 asymmetrical arm movement; or
 Arm that does not move.

Vitamin K
Vitamin K is also administered to prevent hemorrhagic disease of the newborn because
the newborn has a sterile intestine at birth; hence, the newborn does not possess the intestinal
bacteria that manufacture vitamin K which is necessary for the formation of clotting factors.

Hepatitis B Vaccine
Hepatitis B Vaccine will administer at birth, intramuscularly at the Upper outer portion of
the thigh, Vastus Lateralis (R-L-R), An early start of Hepatitis B vaccine reduces the chance of
being infected and becoming a carrier. It prevents liver cirrhosis and liver cancer which are more
likely to develop if infected with Hepatitis B early in life.

Anthropometric measurements
Anthropometric measurements are a series of quantitative measurements of the muscle,
bone, and adipose tissue used to assess the composition of the body. The core elements of
anthropometry are height, weight, body mass index (BMI), body circumferences (waist, hip, and
limbs), and skinfold thickness.

Anthropometric measurements of neonates are an important clinical tool for diagnosis of

abnormally small or large neonates. As for the females, the average newborn weighed 3.11kg
with a range of 2.1kg to 4.2kg, measured 48.49cm in length with a range of 45.1cm to 51.7cm
and measured 34.16cm in head circumference with a range of 32.3 to 36.4. These values were
found to be statistically significant when compared with the WHO- MGR.
https://www.doh.gov.ph/book/export/html/1125
https://my.clevelandclinic.org/health/articles/15276-skin-to-skin-contact-for-you--baby
https://www.doh.gov.ph/faqs/What-do-these-four-time-bound-interventions-do-to-the-newborn
https://www.slideshare.net/iyumvaaimable/immediate-care-for-the-new-borns?from_action=save
https://www.ncbi.nlm.nih.gov/books/NBK537315/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949938/#:~:text=As%20for%20the%20females
%2C%20the,compared%20with%20the%20WHO%2D%20MGR.
https://study.com/articles/Neonatology_Physician_Assistant_Salary_and_Career_Information.ht
ml#:~:text=A%20neonatal%20physician%20assistant%20specializes,newborn%2C%20prematur
e%20or%20ill%20infants.&text=They%20report%20on%20the%20progress,and%20care%20of
%20the%20infant.