5. Components of essential newborn care
1. Neonatal resuscitation
2. Provision of warmth
3. Infection prevention
4. Initiation of breastfeeding within an hour of birth & exclusive
breastfeeding
5. Screening for congenital anomalies
6. Newborn weighing
GOI guidelines MOHFW
7. Step 1
Deliver the baby onto the
mother’s abdomen or a dry
warm surface close to the
mother
Step 2
Dry the baby’s body with a dry
warm towel & wrap the baby
with another dry warm cloth
and cover the head
Eight steps of essential new born care
11. Step 3 Step 3
Assess breathing and colour
If not breathing, gasping or
<30 breaths per minute,
then resuscitate
Resuscitation must start
within one minute of birth
Golden 1 minute of
resuscitation
Eight steps of essential new born care
13. Step 4
Cord care
Step 5
Care of the eyes
Eight steps of essential new born care
Clamp and cut cord with a sterile
instrument. Do not apply any
substance to the stump. Leave
stump uncovered and dry
Use sterile normal saline soaked
swabs.
14. Eight steps of essential new born care
Warm the delivery room
Immediate drying
Skin-to-skin contact at birth
Breastfeeding
Bathing and weighing postponed
Appropriate clothing/bedding
Mother and baby together
Warm transportation for a baby that
needs referral
Step 6
Warm chain
15. Eight steps of essential new born care
Step 7
Give the baby vitamin K
1 mg i.m.
Step 8
Weigh the baby
16. Sign Score 0 1 2
Heart rate Absent Slow (below 100) Over 100
Respiratory effort Absent Slow irregular Good cry
Muscle tone Flaccid Some flexion of
extremities
Active movements
Reflex response No response Grimace Cry
Colour Blue, pale Body pink,
extremities blue
Completely pink
Total score 0-3 4-6 7-10
Severe depression Mild depression No depression
APGAR Score
18. Neonatal examination
1. Body size
2. Body temperature
3. Skin
4. Cardio-respiratory
activities
5. Neuro-behavioural
activity
6. Head and face
7. Abdomen
8. Limbs and joints
9. Spine
10.External genitalia
20. 1. Phenylketonuria
2. Neonatal hypothyroidism
3. Coomb’s test
4. Sickle cell or other hemoglobinopathies
5. Congenital dislocation of hip
Neonatal screening
22. 1. Abnormal breathing patterns
2. Unable to suck or sucking poorly
3. Fever or hypothermia
4. Lethargy or Convulsions
5. Jaundice
6. Pallor/ bleeding/ Cyanosis
7. Repeated vomiting and distended abdomen
8. Red swollen eyelids / pus discharge from the eyes
MOHFW- RCH manual
New born danger signs
23. 1. Birth weight <2.5 kg
2. Twins
3. Birth order 5 or more
4. Artificial feeding
5. Weight below 70% of expected wt.
6. Failure to gain wt. during 3 successive months
7. Children with PEM, diarrhoea
8. Working mother/ one parent
At-risk infants
25. Low Birth Weight
Preterm
• <37 completed weeks
of gestation
• Developed countries
Small-for-date (SFD) /
Intra Uterine Growth
Restriction (IUGR)
• <10th percentile for
gestational age
• Developing countries
25
26. 1. Malnutrition
2. Anemia
3. Hypertension
4. Infections
5. Unregulated fertility
Maternal factors
6. Smoking
7. Short maternal stature
8. Close birth spacing
9. Low economic status
10.Heavy physical work
28. LBW initiates a vicious cycle of malnutrition
across the life cycle
LBW gives our children a disadvantaged start to life
29. • Regular antenatal care
• Controlling infections
• Detection and management of
medical illness
Direct
Intervention
Measures
• Family Planning
• Improve nutritional status of
adolescent girls
• Socioeconomic improvement
• Improve sanitation
• Avoidance of smoking
• Maternity leave with full wages
for working women
Indirect
Measures
Prevention of LBW
30. Thermal Protection of LBW babies
Well wrapped baby
Radiant warmer
30
Skin-to-skin contact
Kangaroo Mother Care
33. Optimal Infant and Young Child Feeding (IYCF)
practices
1. Initiation of breastfeeding within one hour of birth
2. Exclusive breastfeeding for the first six months of life
3. Timely introduction of complementary foods at 6-8 months
4. Age appropriate complementary feeding for children 6-23 months
5. Active feeding for children during and after illness
34. Breastfeeding
• World Breastfeeding week- 1st week of August
• Gold standard feeding option
• Breastfeed “on cues”
• Breastfeeding support
• Baby friendly hospital initiatives
(BFHI)
36. 1. Sore nipple
2. Breast engorgement
3. Poor milk supply
4. Poor weight gain
If attachment is not good, check for correct positioning
Check for baby’s sucking :
If not sucking well, then look for ulcers or white patches in the
mouth
Effects of poor attachment
38. Complementary Feeding
• Appropriately thick homogenous foods made from locally available foods
introduced at six completed months to all babies while continuing
breastfeeding
Complementary foods must be:
• Timely
• Adequate
• Appropriate
• Safe
• Properly fed
