Early Essential Intrapartum and Newborn Care,

Newborn Screening, Basic Emergency Obstetric

and Newborn Care and Comprehensive Emergency
Obstetric and Newborn Care

SESSION 19
Early Essential Intrapartum and Newborn Care
-practices are evidenced-based standards for safe and quality care of
birthing mothers and their newborns, within the 48 hours of Intrapartum
period (labor and delivery) and a week of life for the newborn.

－ A series of time bound, chronologically-ordered, standard procedures

that a baby receives at birth.
－ Can prevent at least half of newborn death without additional cost to
both families and hospitals.
 Four time-bound interventions:
1. Immediate and thorough drying of the newborn
－Immediate and thorough drying for 30 sec to
one-minute warms the newborn and stimulate
breathing.
－ Use a clean, dry cloth to thoroughly dry the baby by
wiping the eyes, face, head, front and back, arms and
legs.
2. Early skin to skin contacts between mother and the
newborn
－Place the newborn prone on the mother's abdomen
or chest skin-to-skin.
－ Cover newborns back with a blanket and head with a
bonnet. Place identification.
This prevents:
Hypothermia Infection
Hypoglycemia
Four time-bound interventions:
3. Properly timed cord clamping and cutting
－Clamp and cut the cord after cord pulsations have
stopped (typically at 1 to 3 minutes)
－ Put ties tightly around the cord at 2 cm using cord
clamp and 5 cm from the newborn's abdomen.
－Cut between ties with sterile instrument.
This prevents:
Anemia
✓ Protects against brain hemorrhage in premature
newborn
Four time-bound interventions:
4. Non-separation of baby from mother
Time bound: Within 90 minutes of age
－Continuous non-separation for early
breastfeeding which protects the infants from
infection.
Early Essential Newborn Care within 90
minutes to 6 hours of life
Nursing Intervention:
－Give a single dose of Vitamin K 1mg (IM route)
- Inject hepatitis B and BCG vaccinations at birth
- Record.
－Thoroughly examine the baby. Weigh the baby
and record.
－Check for birth injuries, malformations or defects.
After the 90 minutes of age Nursing
Intervention:
－Support unrestricted, per demand exclusive
breastfeeding, day and night
－Keep the newborn in the room with his/her
mother, in her bed or within easy reach.
－Do not separate them(rooming-in).
Care Prior to Discharge:
- Ensure warmth of the baby
- Ensure the room is warm(>250 C and draft-free).
- Explain to the mother that keeping baby warm
is important for the baby to remain healthy
- Keep the baby in skin-to-skin contact with the
mother as much as possible.
- Dress the baby or wrap in soft dry clean cloth.
- Cover the head with a cap for the first few days,
especially if baby is small.
Newborn Screening
is a public health program designed to screen
infants shortly after birth for a list of conditions that
are treatable but not clinically evident in newborn
period.

Goal:
－Early Detection of children at increased risk for
selected metabolic or genetic diseases so that
medical treatment can
be promptly initiated to avert metabolic crises and
prevent irreversible neurological and developmental
sequelae.
Newborn Screening
Components of NBS:
A. Education: Professionals, parents and
policy makers
B. Screening: Collection activities,
Specimen delivery, Laboratory testing and
Result reporting
C. Early Follow-up:
D. Diagnosis:
E. Management: Medical management,
Long term follow-up, Specimen mgt
F. Evaluation:
Newborn Screening
Cardinal Principles of Screening:
- The disorder has a relatively high incidence so that
the cost per diagnosed individual is reasonable
- An effective and not overly expensive treatment is
available.
- A relatively inexpensive screening test that is
suitable for high volume testing (preferably
automatable)
- The screening test has a very high sensitivity
(very low false negatives) and high specificity
(low false positives which require expensive
follow-up)
Newborn Screening
Criteria:

- Disorder produces irreversible damage

before onset of symptoms
- Treatment is effective if begun early
- Natural history of disorder is known

Specimen Collection:
- Blood specimen is obtained from heel of
infant should be obtained from medial or
lateral side of the heel
Newborn Screening
Timing of Collection:
－Normal Term Newborn: Before nursery
discharge or 3rd day of life whichever is earlier.
－Preterm or LBW:2 weeks of age or at
discharge whichever is earlier.
- Newborn who is to receive blood transfusion,
One specimen collected before transfusion &
second specimen 2 days after transfusion
Newborn Screening

Results available:
- Seven (7) working days from the time the newborn screening samples
are received
- Laboratory result indicating an increased risk or of heritable disorder (+)
shall be immediately released, within 24 hours followed by confirmatory
testing can be immediately done

Secondary Test:
- An abnormal finding on newborn screening test is not diagnostic of a
disorder
- Additional test should be performed to substantiate the original finding
- Also, the original specimen is retested for the analysis that is abnormal.
 Newborn Screening
DISORDER EFFETS EFFECT IF TREATMENT
SCRENED SCREENED SCREENED &
TREATED
CH (Congenital Severe Mental Normal Hormones
Hypothyroidism) Retardation
CAH (Congenital Death Alive and Hormones
adrenal Normal
Hyperplasia)
GAL Death or Alive & Normal Diet Restriction
(Galactosemia) cataracts
G6PD Severe Anemia, Normal Avoidance of
Deficiency Kernicterus Triggering
factors
 BASIC EMERGENCY OBSTETRIC &
NEWBORN CARE
STRATEGIES TO REDUCE MATERNAL MORTALITY

- Access to skilled birth attendance

- Access to EmONC
The three delays Model EmONC

Identifying and Receipt of adequate

Decision to seek
reaching health and appropriate
care
facility treatment

Complications Recovery/Death
STANDARDS FOR EmONC COVERAGE
World Health Organization's recommended
minimum:
5 health facilities providing EmONC per 500,000
population (4 basic and 1 comprehensive)

-Coverage of EmONC facilities in Kenya:

1.2/500.000
population
Services should be available every day, all day
·Equitable distribution of facilities and services
Basic Emergency Obstetric and Newborn Care
It refers to lifesaving services for emergency maternal
and newborn conditions/complications being provided
by a
health facility or professional
－consist of the core district hospital. For geographically
isolated/disadvantaged areas/ densely populated areas,
the
designated BeMONC facilities are the following:
Rural Health Unit,
Barangay Health Station,
VLying-in Clinics and Birthing Homes.
Accessibilty within 1 hour from residence or referring
facility within the ILHZ(Inter-local Health Zones)
Basic Emergency Obstetric and Newborn Care
Shall operate within 24 hours with 6 signal obstetric function.
Shall have access to communication and transportation facilities to
mobilize referrals.
Staff composition
（1)Medical Doctor
（1)Registered Nurse,
（1)Registered Midwife.
Comprehensive Emergency Obstetrics and Newborn Care facility
- Refers to lifesaving services for emergency maternal and newborn
conditions/complications as in Basic Emergency
Obstetric and Newborn Care plus the provision of surgical delivery and
blood bank services and other specialized
obstetric interventions.
Basic Emergency Obstetric and Newborn Care
Signal Functions
1:Administer Parenteral Antibiotics
- Puerperal sepsis accounts for 8% of global maternal deaths and 33% of
maternal death
- Effectively managed with injectable antibiotics
- IV Penicillin G 2MU every 6 hours
- Plus, Gentamicin 5 mg/kg body weight IV every 24 hours
- Plus, Metronidazole 500mg IV every 8 hours

2:Administer Uterotonic Drugs

-Postpartum hemorrhage accounts for 15% of global maternal deaths
Up to 33% of maternal deaths
-Effectively managed through active management of third stage of
labor
-IM oxytocin within 1 minute of delivery
Basic Emergency Obstetric and Newborn Care
Signal Functions

3.Administer Parenteral Anticonvulsants

- Severe pre-eclampsia and eclampsia account for 10% of global annual
maternal deaths.
- The Philippine Health Statistics 2000 (PHS) revealed that 25 percent of
all maternal deaths are due to hypertension,.*
- Effectively managed through use of parenteral anticonvulsants
Basic Emergency Obstetric and Newborn Care
Signal Functions

4:Manually Remove Placenta

－Retained placenta: A major cause of postpartum hemorrhage and
puerperal sepsis -both leading causes of
maternal mortality
－Managed through manual removal of the placenta; requires
elbow-length sterile gloves
5:Remove Retained Products of Conception
- complications from abortion account for 15% of global annual
maternal deaths.
- Managed effectively through manual vacuum aspiration or medical
evacuation using misoprostol
- Post abortion care provides an opportunity to prevent further
unplanned pregnancy by promoting contraceptive use.
Basic Emergency Obstetric and Newborn Care
Signal Functions

6:Perform Assisted Vaginal Delivery

－Obstructed labor accounts for 6% of maternal deaths.
－Assisted vaginal delivery, using forceps or vacuum extraction, when
done appropriately, can avert unnecessary
hospital referral and caesarian delivery.

7:Perform Basic Neonatal Resuscitation

- Perinatal asphyxia is a leading cause of child mortality, accounting for
11% of global under-five deaths annually.*
- Severe forms are associated with serious long-term complications.
- Effective newborn resuscitation can reduce morbidity and mortality
associated with perinatal asphyxia
Basic Emergency Obstetric and Newborn Care
Signal Functions

8:Perform Caesarean Delivery

- Caesarean section is a life-saving procedure required when vaginal
delivery places the life or health of the mother
or baby at risk.
- It is the first of two additional signal functions required in facilities
designated to provide CEmONC.

9:Provide Blood Transfusion

- Blood transfusion is a life-saving procedure for women suffering from
postpartum hemorrhage-the leading single cause of maternal mortality.
- Facilities providing CEmONC are required to provide blood transfusion.