Essential Intrapartum and Newborn Care (EINC).pptx

CTTO

1. Essential Intrapartum and Newborn Care (EINC)

2. Essential Intrapartum and Newborn Care (EINC) The Essential Newborn Care protocol is a simple, concise and straightforward guideline that is backed by solid research evidence It emphasizes a core sequence of four actions that are performed step-by-step. It can be enforced immediately in all health care settings.

3. 82,000 Filipino children die annually, most could have been prevented The Philippines is one of the 42 countries that account for 90% of global under-five mortality

4. Majority of newborns die due to stressful events or conditions during labor , delivery and the immediate postpartum period.

5. At perineal bulging Prepare for the Delivery Check temperature of the delivery room 25 - 28 o C Free of air drafts Notify appropriate staff Arrange needed supplies in linear fashion Check resuscitation equipment Wash hands with clean water and soap Double glove just before delivery

6. Four Core Steps of Essential Newborn Care Immediate and thorough drying Early skin-to-skin contact Properly timed cord clamping Non-separation of the newborn and mother for early initiation of breastfeeding

7. Within 1st 30 secs Immediate Thorough Drying Call out the time of birth Dry the newborn thoroughly for at least 30 seconds – Wipe the eyes, face, head, front and back, arms and legs Remove the wet cloth

8. Within 1st 30 secs Immediate Thorough Drying Do a quick check of breathing while drying Notes : – During the 1st secs : Do not ventilate unless the baby is floppy/limp and not breathing Do not suction unless the mouth/nose are blocked with secretions or other material

9. Within 1st 30 secs Immediate Thorough Drying Notes: Do not wipe off vernix Do not bathe the newborn Do not do footprinting No slapping No hanging upside - down No squeezing of chest

10. After 30 secs of drying Early Skin-to-Skin Contact If newborn is breathing or crying: Position the newborn prone on the mother’s abdomen or chest Cover the newborn’s back with a dry blanket Cover the newborn’s head with a bonnet

11. After 30 secs of drying Early Skin-to-Skin Contact Notes: Avoid any manipulation, e.g. routine suctioning that may cause trauma or infection Place identification band on ankle (not wrist) Skin to skin contact is doable even for cesarean section newborns

12. 1 - 3 mins Properly - timed cord clamping Remove the first set of gloves After the umbilical pulsations have stopped , clamp the cord using a sterile plastic clamp or tie at 2 cm from the umbilical base Clamp again at 5 cm from the base Cut the cord close to the plastic clamp

13. 1 - 3 mins Properly - timed cord clamping Notes: Do not milk the cord towards the baby After the 1st clamp, you may “strip” the cord of blood before applying the 2nd clamp Cut the cord close to the plastic clamp so that there is no need for a 2nd “trim” Do not apply any substance onto the cord

14. Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding Leave the newborn in skin-to-skin contact Observe for feeding cues, including tonguing, licking , rooting Point these out to the mother and encourage her to nudge the newborn towards the breast

15. Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding Counsel on positioning Newborn’s neck is not flexed nor twisted Newborn is facing the breast Newborn’s body is close to mother’s body Newborn’s whole body is supported

16. Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding Counsel on attachment and suckling Mouth wide open Lower lip turned outwards Baby’s chin touching breast Suckling is slow, deep with some pauses

17. Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding Notes : Minimize handling by health workers Do not give sugar water, formula or other prelacteals Do not give bottles or pacifiers Do not throw away colostrum

18. Within 90 mins Non-separation of Newborn from Mother for Early Breastfeeding Weighing, bathing, eye care, examinations, injections (hepatitis B, BCG) should be done after the first full breastfeed is completed Postpone washing until at least 6 hours

19. BreastFeeding

20. Anatomy of the Breast External structures of the human breast Nipple Areola Glands of Montgomery – oil and sweat secreting glands around the areola ; softens the nipple for protection; kills microorganisms Internal Structures o Fatty tissues o Connective tissues o Glandular tissues

21. Hormones involved Estrogen – duct system and increase fat deposition resulting in enlargement of the breast Progesterone – glandular tissue resulting in the development of alveoli of secretory cells in preparation for milk production

22. Physiology of Lactation 2 Key reflexes in lactation 1. prolactin reflex In breastfeeding, signals are sent to the hypothalamus → Anterior pituitary gland stimulation → prolactin secretion → stimulate acinar cells → milk production 2 . let down reflex-activated even without sucking of breast; the mere thought of the mother of the baby can bring about this reflex Simultaneously, the signals sent to the hypothalamus → stimulates posterior pituitary gland → release oxytocin → contraction of myoepithelial cells → letdown reflex

23. Advantages of Breastfeeding Breast milk provides the necessary nutrients in the proper quality and quantity to sustain the metabolic needs of the infant . Anti-infective properties of breast milk are universally proven and accepted. Prevents hypersensitivity or allergy Psychological advantages Helps in earlier involution of the uterus Has contraceptive effects Protective against Necrotizing Enterocolitis and otitis media (due to the presence of IgA ) Prevents dental carries Economical, safe, available, convenient and at the right temperature

24. Composition of Mature Human Milk and Cow’s Milk Composition Human Milk Cow’s Milk Water (ml/100ml) 87.1 87.2 Caloric Density 20 cal/oz 20 cal/oz Protein (g/100 ml) 1.1 3.5 Casein (% protein) 40 82 Whey proteins 60 18 Alpha lactalbumin 2.6 g/L 1.1 g/L Lactoferrin 1.7 traces Beta lactoglobulin --- 3.6 Lactose (g/ 100 ml) 6.8 4.9 Fat Balanced unsaturated and saturated More saturated FA Iron Efficient absorption  

25. Disadvantages of Breastfeeding Lack of freedom Dad may feel left out Siblings might be jealous Nursing in public may make you feel a little uneasy Diet restrictions Passing on infections Physical breast problems Inability to measure milk consumed Embarrassing leaks

26. Management of breastfeeding 1. Preparing for bf: for normal nipples, toughen the nipples to eliminate the chances of nipples being sore during bf -pull nipples gently in all directions -wear loose clothing for flat or inverted nipples: Hoffman maneuver - both thumbs on the side of the nipple, pull gently outwards Breast shells Breast pumps

27. Integrated Management of Childhood Illnesses (IMCI) –Breastfeeding: Recognizing good attachment and good positioning Signs of good attachment : Infant’s chin should touch the breast mouth should be wide open lower lip turn outward more areola showing above

28. Signs of good positioning infant’s head and body should be straight infant’s head and body facing breast infant’s body close to the mother mother is supporting infant’s entire body

29. Common Breast-Feeding Positions

30. Signs of effective sucking slow deep sucks may pause occasionally the mother should allow the baby to finish the feeding and let the infant release the breast itself infant is satisfied after the feeding if the mother wants to be released from the feeding, just hold back a little and allow air in between breast and infant’s mouth and the baby will just release

31. Thank you!