Essential Intrapartum and

Newborn care
 Essential Intrapartum Newborn
Care (EINC)
⚫ Is a package of evidence-based practices
recommended by the department of Health(
DOH), Philippine Health Insurance Corporation
(PhilHealth) and the world health Organization as
a standard of care in all births by skilled
attendanst in all government and private settings.
⚫ To decrease newborn death at least by half.
Unang Yakap, or “First Embrace”

⚫ A campaign of the DOH in

cooperation with WHO

⚫ emerged, referring to the

immediate and uninterrupted
skin-to-skin contact between
mothers and newborns that
fosters a successful start to
breastfeeding.
 EINC protocol
⚫ Immediate and
thorough drying of
the newborn
– Immediate and
thorough drying
for 30 seconds to
one minute warms
the newborn and
stimulates
breathing.
 EINC protocol

⚫ Early skin-to-skin
contact between
mother and newborn
- Early skin to skin contact
between mother and
newborn, and delayed
washing for at least 6
hours prevents
hypothermia, infection,
and hypoglycemia.
 EINC protocol
⚫ Properly-timed cord
clamping and cutting
prevents anemia and
protects against brain
hemorrhage in
premature newborns.
⚫ Properly timed
cord-clamping means
waiting for the cord
pulsations to stop
(between 1-3 minutes).
 EINC protocol
⚫ Non-separation of newborn
and mother for early
breastfeeding – Continuous
non-separation of newborn
and mother for early
breastfeeding protects
infants from dying from
infection.

⚫ The first feed provides

colostrum.
IMMUNIZATION
 Immunization

WHAT: According to the World Health Organization

(WHO), immunization is the process whereby a person
is made immune or resistant to an infectious disease,
typically by the administration of a vaccine.
WHY: To control and eliminate life-threatening
infectious
diseases
WHEN: Starts after the baby completes his first
breastfeed and detaches from the breast while he is
with his mother and usually ends at 15 months. (Birth
to 15 Months)
 Immunization for Infants

1. BCG vaccine (Bacille Calmette-Guérin)

2. Hepatitis B vaccine
3. DPT-HepB-Hib(Pentavalent vaccine)
4. Oral polio vaccine
5. Anti-measles vaccine (AMV1)
6. Measles-mumps-rubella vaccine (AMV2/MMR)
7. Rotavirus vaccine
 BCG Vaccine

Disease Prevented:
• Tuberculosis (TB) which includes:
- TB Meningitis (an infection of the brain)
- Miliary TB (wide spread infection)

Recommended Age:
• At birth – 6 months old
•In case it was not given at birth, a baby can be vaccinated any time up
to five years of age
 BCG Vaccine

Dose:
• 0.05 mL dose: children under 1 year old
• 0.1 mL dose: recipients over one year

Route of administration:
• Intradermal

Site:
• Right deltoid region (arm)

No other vaccine should be given in the same limb as the BCG for
three months afterwards, because of the risk of lymphadenitis (an
enlarged lymph node that becomes infected)
 BCG Vaccine

Possible Risks of BCG Vaccine

•Koch’s phenomenon: an acute inflammatory
reaction within 2-4 days after vaccination; usually
indicates previous exposure to tuberculosis.
Nursing management: No management is needed.
 BCG Vaccine

Possible Risks of BCG Vaccine

•Deep abscess at vaccination site; almost invariably
due to subcutaneous or deeper injection.
Nursing management: Refer to the physician for
incision and drainage.
 BCG Vaccine

Possible Risks of BCG Vaccine

•Indolent ulceration: an ulcer which persists after 12
weeks from vaccination date
Nursing Management: Treat with INH powder
(isonicotinic acid hydrazide)

•Glandular enlargement: enlargement of lymph

glands draining the injection site
Nursing Management: If suppuration occurs, treat as deep abscess
 Hepatitis B Immunization

Disease Prevented:
• Hepatitis B infection beyond childhood, into their adult years.

Recommended Age:
• shortly after birth (monovalent HepB vaccine only)

Dose:
•0.5 ml
 Hepatitis B Immunization

Birth Dose:
❖Mother is HBsAg-negative:
•All medically stable infants ≥2,000 grams: 1 dose
within 24 hours of birth.
•Infants <2,000 grams: administer 1 dose at
chronological age 1 month or hospital discharge. (A
dose received by an infant <2,000 grams and <1 month
of age does not count towards the primary series.)
 Hepatitis B Immunization

Birth Dose:
❖Mother is HBsAg-positive:
•Administer HepB vaccine and hepatitis B immune
globulin (HBIG) (in separate limbs) within 12 hours of
birth, regardless of birth weight.
•For infants <2,000 grams, administer 3 additional
doses of vaccine (total of 4 doses) beginning at age 1
month.
 Hepatitis B Immunization

Birth Dose:
❖Mother’s HBsAg status is unknown:
•Administer HepB vaccine within 12 hours of birth,
regardless of birth weight.
•For infants <2,000 grams, administer HBIG in addition to
HepB vaccine (in separate limbs) within 12 hours of birth.
Administer 3 additional doses of vaccine (total of 4 doses)
beginning at age 1 month.
•Determine mother’s HBsAg status as soon as possible. If
mother is HBsAg-positive, administer HBIG to infants
≥2,000 grams as soon as possible, but no later than 7 days
of age.
 Hepatitis B Immunization

Route of Administration:
• Intramuscular

Site:
• Anterolateral thigh muscle
 Hepatitis B Immunization

Possible Risks of HepB Vaccine

• Side effects usually are mild, and can include a mild
fever and soreness or redness at the injection site.
Allergic reactions to the vaccine are rare.
Nursing Management: No treatment is necessary.
 When to Delay or Avoid HepB Immunization

⚫ Doctors delay giving the vaccine to babies who weigh less than 4
pounds, 7 ounces (2,000 grams) at birth whose mothers do not
have the virus in their blood. The baby will get the first dose at 1
month of age or when the baby is discharged from the hospital.
DPT-HepB-Hib (Pentavalent vaccine)

Disease Prevented:
• Diphteria
• Pertussis
• Tetanus
• Hepatitis B
• Hib (Haemophilus influenzae type b)

Recommended Age:
• First dose: 6 weeks
• Second dose: 10 weeks
• Third dose: 14 weeks
 DPT-HepB-Hib (Pentavalent vaccine)

Dose:
• 0.5 ml

Route of Administration:
• Intramuscular

Site:
• Anterolateral thigh muscle
 DPT-HepB-Hib (Pentavalent vaccine)

Possible Risks of Pentavalent Vaccine

•Fever that usually lasts for only 1 day. Fever beyond 24
hours is not due to the vaccine but to other causes.
Nursing Management: Advise parents to give
antipyretic.

•Local soreness at the injection site.

Nursing Management: Reassure parents that
soreness will disappear after 3-4 days.
 DPT-HepB-Hib (Pentavalent vaccine)

Possible Risks of Pentavalent Vaccine

•Abscess after a week or more usually indicates that the
injection was not deep enough or the needle was not sterile.
Nursing Management: Incision and drainage may be
necessary.

•Convulsions: although very rare, may occur in children

older than 3 months; caused by pertussis vaccine.
Nursing Management: Proper management of
convulsions; pertussis vaccine should not be given anymore.
 DPT-HepB-Hib (Pentavalent vaccine)

Reason why a child should not be given

pentavalent vaccine:
Although serious side effects have not been reported,
a child who has had a severe reaction to pentavalent
vaccine earlier should not be given another dose.
 Oral Polio Vaccine

Disease Prevented:
• Polio

Recommended Age:
• First Dose: 6 weeks
• Second Dose: 10 weeks
• Third Dose: 14 weeks
 Oral Polio Vaccine

Dose:
• 2 drops

Route of Administration:
• Oral

Site:
• Mouth

Possible Risk of Oral Polio Vaccine:

• None
 Anti-measles vaccine (AMV1)

Disease Prevented:
• Measles

Recommended Age:
• 9-11 months
• 6 months during outbreak

Dose:
• 0.5 ml
 Anti-measles Vaccine (AMV1)

Route of Administration:
• Subcutaneous

Site:
• Outer part of the upper arm

Possible Risk of Anti-measles Vaccine:

•Fever 5-7 days after vaccination in some children; sometimes,
there is a mild rash.
Nursing Management: Reassure parents and instruct them to
give antipyretic to the child.
Measles-mumps-rubella vaccine (AMV2/MMR)

Disease Prevented:
• Measles
• Mumps
• Rubella

Recommended Age:
• 12-15 months

Dose:
• 0.5 ml
Measles-mumps-rubella vaccine (AMV2/MMR)

Route of Administration:
• Subcutaneous

Site:
• Outer part of the upper arm

Possible Risks of (AMV2/MMR):

•Local soreness, fever, irritability, and malaise in some children.
Nursing Management: Reassure parents and instruct them to
give antipyretic to the child.
 Rotavirus Vaccine

Disease Prevented:
• Rotaviral enteritis

Recommended Age:
• First Dose: 6 weeks to 15 weeks
• Second Dose: 10 weeks up to a maximum of 32 weeks

Dose:
• 1.5 ml
 Rotavirus Vaccine

Route of Administration:
• Oral

Site:
• Mouth

Possible Risks of Rotavirus Vaccine:

•Some children develop mild vomiting and diarrhea, fever,
and irritability
Nursing Management: Reassure parents and instruct
them to give antipyretic and Oresol to the child.
 ccine Birth 1 mo 2 mos 3 mos 4 mos 6 mos 9 mos 11 mos 12 mos

BCG Summary
Given at birth – 6 months
accine

1st dose if
HepB
1st dose baby is
ccine <2000 g

PT-He 1st dose 2nd dose 3rd dose

B-Hib 6th week 10th week 14th week

Oral
1st dose 2nd dose 3rd dose
polio 6th week 10th week 14th week
ccine

MV1 Given 9 – 11 mos

MV2/M
Given 12
MR

taviru 1st dose 2nd dose

accine 6th week 10th week
 Vitamin K shot at birth

For the prevention of a now rare, but potentially

fatal, bleeding disorder called ‘vitamin K deficiency
bleeding’ (VKDB), also known as ‘hemorrhagic
disease of the newborn’ (HDN).

•Babies are at risk for VKDB for the first 6 months of

life.
 Vitamin K shot at birth

Dosage and Route of Administration

•IM Administration
• Term babies 1mg IM soon after birth
• Preterm babies <1000g, 0.5mg IM soon after birth

Oral Administration
• If parents do not consent to IM but consent to oral vitamin K, this
needs to be given in 3 separate doses:
• 2mg oral soon after birth
• 2mg oral at 3-7 days

• 2mg oral at 6 weeks

If the infant vomits or regurgitates within 1 hour of an oral dose, this dose should
be repeated.
 Nursing Responsibility
Nursing and medical staff must be familiar with the principles of
the administration of medications to an infant. These principles
include:
•Observation of standard precautions
•Aseptic techniques
•Correct drug/dose/time/route/patient practices.
•If more than one injection has to be given on the same limb:
> injection sites should be 2.5-5cm apart
•Drops of vaccine are straight from the dropper onto the child’s
tongue
> DO NOT let the dropper touch the tongue
•To prevent spitting or failed swallowing, stimulate the rooting or
sucking reflex of the young infant.

NOT recommended: to mix different vaccines in one syringe

 Crede’s Prophylaxis

• For the prevention of inflammatory eye disease/conjunctivitis

in newborns.
• Also called as Ocular Prophylaxis for Gonococcal
Ophthalmia Neonatorum.
- Ophthalmia neonatorum is conjunctivitis in infants during
the first month of life. It can be caused by infection with
Neisseria gonorrhoeae (N. gonorrhoeae), Chlamydia
trachomatis (C. trachomatis), or other bacteria or viruses.
 Crede’s Prophylaxis

Population: All newborn

Risk Assessment: Increased risk of newborns with a

maternal history of no prenatal care, sexually transmitted
infections, or substance abuse.

Preventive Intervention: Preventive medications

include:
• erythromycin 0.5% ophthalmic ointment
• silver nitrate 1.0% solution
• tetracycline 1.0% ointment.

All are considered equally effective; however, the latter two

are no longer available.
 Crede’s Prophylaxis

Time of Intervention: Within 24 hours after birth.

Rationale
Importance: It is important because gonococcal
ophthalmia neonatorum can result in corneal scarring,
ocular perforation, and blindness.

Note: Crede’s Prophylaxis is still performed even if the baby

is born through Cesarean section because gonorrhea and
chlamydia are physically able to infect the fetus even before
the fetus passes through the birth canal.
APGAR SCORE
 APGAR SCORE
⚫ Developed in 1952 by Dr.
Virginia Apgar
⚫ Professor of Anesthesiology
at Columbia University
College of Physicians and
Surgeons
⚫ Director of obstetric
Anesthesia at Presbyterian
Hospital
 APGAR SCORE
⚫ A scoring system doctors and nurses use to assess
newborns one minute and five minutes after they are
born
⚫ Medical professionals use this assessment to quickly
relay the status of a newborn's overall condition. Low
Apgar scores may indicate the baby needs special care,
such as extra help with their breathing
 APGAR SCORE
⚫ The APGAR SCORING system is divided
into five categories. Each category receives a
score of 0 to 2 points. At most, a child will
receive an overall score of 10.
ANTHROPOMETRIC
MEASUREMENT
 EQUIPMENT
1. BABY SCALE
 EQUIPMENT
⚫ 2. INFANTOMETER
 EQUIPMENT
⚫ TAPE MEASURE
 HEAD
CIRCUMFERENCE
⚫ Normal
Measurement: 33 to
35 cm (13 to 14 inches).
⚪ In vaginal delivery,
molding may reduce
head circumference (HC)
immediately after birth
but it will return to
normal size after two to
thee days.
⚪ The HC is actually the
occipitofrontal
circumference (OFC)
 HEAD
CIRCUMFERENCE
⚫ It is approximately equal to crown-rump length
(CRL) or sitting height which is about 31 to 35 cm in
term infants.
⚫ The HC is usually greater than chest circumference (CC)
by 2 cm. The head is one fourth of the total body length;
this is because the head of the newborn is
proportionately larger than the head of the adult
 CIRCUMFERENCE
⚫ 1ST 4 Months - HC incrreased by half an inch a
month
⚫ 1st 8 Months - HC increased one fourth inch a
month

⚫ Measure HC at the level of eyebrows to the most

prominent portion of the infant’s head with the use of
a tape measure
⚫ Measure it after birth, then after 48 hours because
molding and caput succedaneum may misshape the
head making the first measurement inaccurate
 HEAD
CIRCUMFERENCE
⚫ Take note of the following changes in the head
circumference:
⚪ At birth HC may be equal or greater than CC due to molding.
⚪ After 2 to 3 days, HC is greater than CC by 2 to 3 cm.
⚪ After six months, HC is equal to CC.
⚪ After 1 year, HC is less than CC.
 ABNORMAL
FINDINGS:
⚫ HC less than 32 cm is
indicative of
microcephaly in term
infants.
⚫ HC that is 4 cm and
greater than CC or more
than 37 cm is indicative
of neurologic
involvement such as
hydrocephalus
 CHEST
CIRCUMFERENCE
⚫ Normal CC range from
30.5 to 33cm (12 to 13
inches),
⚫ Usually 2 cm less than
HC. The CC is measured
at the level of the nipple
using a tape measure.
⚫ A CC less than 30 cm
indicates prematurity.
An enlarged heart may
make the left side of the
chest larger.
 ABDOMINAL
CIRCUMFERENCE
⚫ Abdominal
circumference (AC) is
approximately the
same as chest
circumference.
⚫ It is measured just
above the level of
the umbilicus. It is
no longer
recommended to
measure AC below
the level of the
 ABDOMINAL
CIRCUMFERENCE
⚫ AC is not routinely measured unless there is a suspicion
of abdominal distention due to obstruction in the
gastrointestinal tract. The neonate’s abdomen usually
enlarges after a feeding due to lax abdominal muscle.
 WEIGHT
⚫ Birth weight of full term
newborn infants ranger
from 6 to 8.5 lbs or
2700 to 4000 g.
(Average – 3500 g)
⚫ Birth weight should be
recorded immediately
after birth
 WEIGHT
⚫ Average Female Infant birth weight
⚪ 7 lbs

⚫ Average male Infant birth weight

⚪ 7.5 lbs

⚫ Average Filipino infants

⚪ 3000 grams
 WEIGHT
⚫ PHYSIOLOGICAL WEIGHT LOSS – Newborns loss about
10% (6 to 10 oz) of their birth weight during the first 3 to 4 days
of life due to:
⚪ Excretion of fluids through the lungs, urinary bladder and bowels
⚪ Passage of meconium
⚪ Withholding of calories and fluids immediately after birth
⚪ Minimal food intake because sucking is not yet established and
colostrum contains less calories than mature milk
 WEIGHT
⚫ Weight Gain
⚪ Generally, breastfeed infants regain their birth weight within
10 days and formula fed infants within 7 days.
⚪ Birth weight doubles at 5-6 months and triples at one year.
By 2 years of age, expected weight gain is four times the birth
weight.
⚪ Infants generally gain approximately 20 to 25 grams per day
or 150 to 210 g weekly during the first five months of life. And
about 15 grams (6 to 8 oz weekly) from 6 months to 1 year.
 COMPUTATION OF EXPECTED
WEIGHT GAIN

⚫ Term Infants = ( age in days – 10) X 20 + 3000 grams

⚪ 10 – term infants take 10 days to regain birth weight
⚪ 20 – a weight gain of 20 grams/day is expected during the
first 5 months

⚫ Pre-term infants = (age in days – 14) X 15

⚪ 14 – Pre-term infants takes 14 days to regain their birth
weight
⚪ 15 – amount of weight gain each day
 COMPUTATION OF EXPECTED
WEIGHT GAIN

⚫ Infants below 6 months old:

⚪ Weight in grams = age in months X 600 + birth weight

⚫ 6 months to 12 months :
⚪ Expected weight in pounds = Age in months + 10
⚪ Weight in grams = Age in months X 500 + birth weight
 COMPUTATION OF EXPECTED
WEIGHT GAIN

⚫ 1-6 YEARS:
⚪ Weight in kg = age in years X 2 + 8
⚫ 6- 12 YEARS:
⚪ Weight in kg = age in years X 7 -5 / 2
 Factors affecting birth
weight
⚫ Race, nutrition, intrauterine conditions and genetic
factors
⚫ Birth weight increases with each succeeding child in the
family
⚫ Plotting birth weight in a neonatal graph helps to
identify newborns at risk because of their small or too
large sixe
⚫ Weight should be compared with height and head
circumference to see any disproportion that indicates
risk conditions.
⚫ The infant should be weighed not wearing a diaper. If a
diaper is in place, subtract the weight of the diaper from
the total weight.
⚫ The same weighing scale should be used every time the
infant’s weight is measured to prevent inaccuracies.
⚫ If the infant is being weighed on a bed that has a built-in
scale:
⚪ It is important to remove any extra sheets, toys or diapers
⚪ When weighing the critically ill neonate, lift the intravenous
infusion lines, as well as other pieces of equipment such as
ventilator tubing, so they do not cause an inaccurately high
weigh
 Abnormal Findings
⚫ Birth weight less than 1000 grams for term infants is
considered extremely low birth weight
⚫ Birth weight less than 1500 grams in term infants is considered
very low birth weight
⚫ Birth weight less than 2500 grams for term infant is called
Small for Gestational Age (SGA) infant in term infants.
⚫ Birth weight more than 4000 grams is known as Large for
Gestational Age (LGA) infant. Infant may be born of a
diabetic mother. Weight loss of more than 10% of birth
weight.
 CONVERTING grams
to pounds and ounces
⚫ 1 lb = 45.59237 grams
⚫ 1 oz. = 28.349523 grams
⚫ 1000 g = 1 kg
 LENGTH

⚫ Newborn average head

to heel length is 45 to 55
cm (18 to 22 inches)
Average is 50 cm
⚫ Female infants
⚪ Generally 1/2 inch
shorter than male
infants
⚫ Average Female infant length
⚪ 19.6 inches or 49 cm
⚫ Average male infant length
⚪ 20 inches or 50 cm

⚫ Remember that similar to weight, the rate of growth

diminishes as the infant grows older. Total average
increase in length during the first year of life is 25 cm
distributed as follows:
⚪ From birth to 3 months – 9 cm
⚪ From 3 to 6 months – 8 cm
⚪ From 6 to 9 months – 5 cm
⚪ From 9 to 12 months – 3 cm
 FORMULA FOR EXPECTED HEIGHT

⚫ Height in cm = age in years X 5 + 80

⚫ Height in inches = age in years X 2 + 32 or

Height in inches = age in years X 2 ½ + 30
⚫ Measure newborn length from top of the head to heel
using a tape measure. Extending the neonate’s leg to its
fullest extension and then recording the length from
crown of head to heel is the most accurate way to
measure length. One person should hold the infant’s in
place while the other completes the measurements.

⚫ An adjunct to crown-heel measurement is the

crown-rump measurement. This particular assessment is
useful in determining anatomical abnormalities such as
dwarfism. A length of less than 47 cm is a sign of
prematurity.
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