1. 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
Time Band: Within 1st 30 secs
Immediate Thorough Drying
• Call out the time of birth

2. • Dry the newborn thoroughly for at least 30
seconds
– Wipe the eyes, face, head, front and back, arms
and legs
• Remove the wet cloth
Time Band: Within 1st 30 secs
Immediate and 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
Time Band 0 - 3 mins:
Immediate, Thorough Drying
• Notes:
– Do not wipe off vernix
– Do not bathe the newborn
– Do not do footprinting

3. – No slapping
– No hanging upside - down
– No squeezing of chest
Time Band: 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
Time Band: 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

4. Time Band: 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
Time Band: 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
Time Band: Within 90 mins
Non-separation of Newborn

5. 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
Time Band: 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

6. Time Band: 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
Time Band: Within 90 mins
Non-separation of Newborn
from Mother for
Early Breastfeeding
• Notes:

7. – 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
Time Band: Within 90 minutes
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
 To establish, maintain and support respirations.
 To provide warmth and prevent hypothermia.
 To ensure safety, prevent injury and infection.
 To identify actual or potential problems that may require immediate attention.
Establish respiration and maintain clear airway
The most important need for the newborn immediately after birth is a clear airway to enable the
newborn to breathe effectively since the placenta has ceased to function as an organ of gas
exchange. It is in the maintenance of adequate oxygen supply through effective respiration that
the survival of the newborn greatly depends.
Newborns are obligatory nose breathers. The reflex response to nasal obstruction, opening the
mouth to maintain airway, is not present in most newborns until 3 weeks after birth.
To establish and maintain respirations:
1. Wipe mouth and nose of secretions after delivery of the
head.
2. Suction secretions from mouth and nose.
 Compress bulb syringe before inserting

8.  Suction mouth first, then, the nose
 Insert bulb syringe in one side of the mouth
3. A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously, or if the cry is
weak.
 Do not slap the buttocks rather rub the soles of the feet.
 Stimulate to cry after secretions are removed.
 The normal infant cry is loud and husky. Observe for the following abnormal cry:
 High, pitched cry – indicates hypoglycemia, increased intracranial pressure.
 Weak cry – prematurity
 Hoarse cry – laryngeal stridor
4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant
in a position that would promote drainage of secretions.
 Trendelenburg position – head lower than the body
 Side lying position – If trendelenburg position is contraindicated, place infant in side lyingposition to permit
drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling
back to supine position.
5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction.
Newborns are obligatory nose breathers until they are about 3 weeks old.
Care of the Eyes
It is part of the routine care of the newborn to give prophylactic eye treatment against gonorrhea
conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed
on the fetus from the vaginal canal during delivery. This practice was introduced by Crede, a
German gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic ointments
are the drugs used for this purpose.
Erythromycin or tetracycline Opthalmic Ointment:
1. These ointments are the ones commonly used now a days for eye prophylaxis because they do not cause eye
irritation and are more effective against Chlamydial conjunctivitis.
2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes.
Vitamin K or Aquamephyton
The newborn has a sterile intestine at birth, hence, the newborn does not possess the intestinal
bacteria that manufactures vitamin K which is necessary for the formation of clotting factors.
This makes the newborn prone to bleeding. As a preventive measure, .5 (preterm) and 1 mg (full
term) Vitamin K or aquamephyton is injected IM in the newborn’s vastus lateralis (lateral
anterior thigh) muscle.
Care of the cord
The cord is clamped and cut approximately within 30
seconds after birth. In the delivery room, the cord is
clamped twice about 8 inches from the abdomen and cut in
between. When the newborn is brought to the nursery,
another clamp is applied ½ to 1 inch from the abdomen and
the cord is cut at second time. The cord and the area around
it are cleansed with antiseptic solution. The manner of cord
care depends on hospital protocol. What is important is that
the principles are followed. Cord clamp maybe removed
after 48 hours when the cord has dried. The cord stump usually dries and fall within 7 to 10 days
leaving a granulating area that heals on the next 7 to 10 days.
Instruction to the mother on cord care:

9. 1. No tub bathing until cord falls off. Do not sponge bath to clean the baby. See to it that cord does not get wet by
water or urine.
2. Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution
which is 70% alcohol.
3. Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper
soaks with urine.
4. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and separates more
rapidly if it is exposed to air.
5. If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten.
6. Report any unusual signs and symptoms which indicates infection.
 Foul odor in the cord
 Presence of discharge
 Redness around the cord
 The cord remains wet and does not fall off within 7 to 10 days
 Newborn fever
THE APGAR SCORING SYSTEM
The APGAR Scoring System was developed by Dr.
Virginia Apgar as a method of assessing the newborn’s
adjustment to extrauterine life. It is taken at one minute and
five minutes after birth. With depressed infants, repeat the
scoring every five minutes as needed. The one
minute score indicates the necessity for resuscitation. The
five minute scoreis more reliable in predicting mortality
and neurologic deficits. The most important is the heart
rate, then the respiratory rate, the muscle tone, reflex
irritability and color follows in decreasing order. A heart
rate below 100 signifies an asphyxiated baby and a heart
rate above 160 signifies distress.
ASSESS 0 1 2
HEART RATE Absent Below 100 Above 100
RESPIRATION Absent Slow Good crying
MUCLE TONE Flaccid Some flexion Active motion

10. REFLEX IRRITABILITY No response Grimace Vigorous cry
COLOR Blue all over Body pink, Pink all over
Extremities blue
Score:
 7 – 10 Good adjustment, vigorous
 Moderately depressed infant, needs airway clearance
 Severely depressed infant, in need of resuscitation.
ASSESSING THE AVERAGE NEWBORN
Head Circumference 34 – 35 cm
Temperature 97.6 – 98.6 F axillary
Chest Circumference 32 – 33 cm
Heart Rate 120 – 140 bpm
Respirations 30 – 60 bpm
Weight 2.5 to 3.4 kg
Length 46 to 54 cm