NEW POLICIES AND PROTOCOL ON ESSENTIAL INTRAPARTAL NEWBORN

CARE
The Philippines is one of 42 nations that account for 90 percent of global under-five
mortality. An estimated 82,000 Filipino children die annually before their 5th birthday.
More than one third (37 percent) of these children are newborns less than 28 days old.
These newborns die mostly of preventable causes such as asphyxia (lack of oxygen to
the brain) or sepsis (severe infection). The highest number of newborn deaths occur in
the first two days of life. Factors and conditions surrounding labor, delivery, and the
immediate postpartum period have been seen as reasons. The Millennium
Development Goal (MDG) 4, in particular, aims for a reduction in under-five mortality by
two-thirds by 2015. Childhood death rates in the Philippines have shown a downward
trend, but the decline dangerously slowed down in the past 10 years because the
neonatal mortality rate has remained almost unchanged
On December 7, 2009, the DOH issued an administrative order to implement the ENC
protocol with the goal of rapidly reducing the number of newborn deaths in the
Philippines. The GENERAL OBJECTIVE: To ensure the provision of globally accepted
evidence-based essential newborn care focusing on the first week of life.
With AO 2009 - 0025, the whole hierarchy of the DOH and its attached agencies, public
and private providers of health care and development partners implementing the
Maternal, Newborn and Child Health and Nutrition Strategy and all health practitioners
of maternal and newborn care are enjoined to adopt the policies and protocol on
Essential Newborn Care. Implementation of the ENC protocol has the potential to avert
approximately 70 percent of newborn deaths that are due to preventable causes.
Causes of newborn deaths:
1. Birth asphyxia (31%)
2. Complications of prematurity (30%)
3. Severe infection (19%)

ESSENTIAL NEWBORN CARE comprises:

1. Basic preventive newborn care such as care before and during pregnancy, clean
delivery practices, temperature maintenance, eye and cord care, and early and
exclusive breastfeeding on demand day and night;
2. Early detection of problems or danger signs (with priority for sepsis and birth
asphyxia) and appropriate referral and care seeking; and
3. Treatment of key problems such as sepsis and birth asphyxia.
Note: The guidelines categorize procedures into time-bound, non time-bound and
unnecessary procedures:
• TIME BOUND PROCEDURES – should be routinely performed first: immediate
drying, skin-to-skin contact followed by clamping of the cord after 1 to 3 minutes, non-
separation of the newborn to the mother and breastfeeding initiation.
• NON-TIME-BOUND INTERVENTION – should only be done after the first full
breastfeed: immunizations, eye care, Vitamin K administration and weighing. Washing
must be postponed by at least 6 hours.
• UNNECESSARY PROCEDURES – include routine suctioning, routine separation of
newborns for observations, administration of prelacteals like glucose, water, formula
and foot printing.

EBN Package: FOUR-STEP Newborn Care Intervention

1. Immediate and thorough drying to stimulate breathing after delivery.
2. Provision of appropriate thermal care through mother and newborn skin-to-skin
contact maintaining a delivery room temperature of 25-28 degrees centigrade and
wrapping the newborn with clean, dry cloth.
3. Properly timed clamping and cutting of the umbilical cord, (1-3 minutes or until cord
pulsation stops.
4. Immediate latching on and initiation of breastfeeding within first hour after birth.

QUALITY PROVISION OF TIME-BOUND INTERVENTIONS

1. WITHIN THE FIRST 30 SECONDS: Dry and provide warmth to the newborn and
prevent
2. AFTER THOROUGH DRYING: Facilitate bonding between the mother and her
newborn through SKIN-TOSKIN contact “Unang Yakap” to reduce likelihood of infection
and hypoglycemia.
3. WHILE ON SKIN-TO-SKIN CONTACT (UP TO 3 MINUTES POST-DELIVERY):
Reduce the incidence of anemia in term newborns and intraventricular hemorrhage in
pre-term newborns by delaying or non-immediate cord clamping.
4. WITHIN 90 MINUTES OF AGE: Facilitate the newborn’s early initiation to
breastfeeding and transfer of colostrum through support and initiation of breastfeeding.
NON-IMMEDIATE INTERVENTION: given within 6 hours after birth and should never
be made to compete with the time-bound interventions.
1. Give Vitamin K prophylaxis
2. Hepatitis B and BCG vaccinations
3. Examine the newborn. Check for birth injuries, malformations or defects.
4. Cord care

NEWBORN RESUSCITATION
1. Start resuscitation if the newborn is not breathing or is gasping after 30 seconds of
drying or before 30 seconds of drying.
2. Clamp and cut the cord immediately.
3. Call for help.
4. Transfer the newborn to a dry, clean and warm surface. Keep the newborn wrapped
or under a heat source if available.

UNNECESSARY PROCEDURES
1. ROUTINE SUCTIONING – indicated only if the mouth/ nose is blocked with
secretions 2. EARLY BATHING/WASHING – causes drop in the body temperature
leading to increased risk of developing infections, coagulation defects and brain
hemorrhage
3. FOOTPRINTING – has proven to be an inadequate technique for newborn
identification purposes
4. Giving sugar water, formula or other prelacteals and the use of bottles or pacifiers.
5. Application of alcohol, medicine and other substances on the cord stump and
bandaging the cord stump or abdomen.

DISCHARGE INSTRUCTIONS
1. Advise the mother to return or to go to the hospital immediately for:
• Jaundice of the soles
• Difficulty feeding
• Convulsions
• Movement only when stimulated
• Fast or slow or difficult breathing
• Temperature >37.5 or

2. Advise the mother to bring her newborn to the health facility for routine check-up
• Postnatal visit 1: 48 to 72 hours of life
• Postnatal visit 2: 7 days of life
• Immunization visit 1: 6 weeks of life

3. Consider additional follow-up visits appropriate to other identified problems

4. Advise for Newborn screening