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5/22/2018 ENC Protocol
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Zenaida Dy Recidoro RN MPHChief Health Program Officer
Department of Health
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Source: CHERG estimates of under-five deaths,2000-03
The Philippines is one of the 42 countries that
account for 90% of global under-five mortality
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Day of Life
3 out of 4 newborn deaths occur
in the week of lifeNumberofd
eaths
NDHS 2003, special tabulations
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Check temperature of the delivery room 25 - 28 oC
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
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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
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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
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Do a quick check of breathing while drying
Notes: During the 1st secs:
Do not ventilate unless the baby is floppy/limpand not breathing
Do not suction unless the mouth/nose areblocked with secretions or other material
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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
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If newborn is breathing or crying: Position the newborn prone on the mothers abdomen or
chest
Cover the newborns back with a dry blanket
Cover the newborns head with a bonnet
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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
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Remove the first set of gloves
After the umbilical pulsations have stopped,
clamp the cord using a sterile plastic clamp or tieat 2 cm from the umbilical base
Clamp again at 5 cm from the base
Cut the cord close to the plastic clamp
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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
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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
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Counsel on positioning Newborns neck is not flexed nor twisted
Newborn is facing the breast
Newborns body is close to mothers body
Newborns whole body is supported
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Counsel on attachment and suckling Mouth wide open
Lower lip turned outwards
Babys chin touching breast
Suckling is slow, deep with some pauses
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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
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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
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Weighing, bathing, eye care, examinations,
injections should be done after the first full
breastfeed is completed
Postpone washing until at least 6 hours
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Within 30
Seconds
Objective:
To stimulate
breathing,
providewarmth
After thorough
drying
Objective:
To provide warmth,
bonding, prevent
infection &hypoglycemia
-Put on double
gloves
-Dry thoroughly-Remove wet cloth
-Quick check of
NBs breathing
-Suction only if
needed
-Put prone on chest/
abdomen skin to skin
-Cover w/ blanket,bonnet
-Place identification
on ankle
-Do not remove vernix
Up to 3 minutes
Post-delivery
Objective:
To reduce
anemia in term &
preterm;IVH & transfusions
in preterm
-Remove 1stset of
gloves
-Clamp and cut cordafter cord pulsations
stop (1-3 mins)
-Do not milk cord
-Give oxytocin 10mg
IM to mother
ENC Time-Bound Interventions
Within 90 minutes
Of age
Objective:
To facilitate initiation
of breastfeeding
through sustainedcontact
-Uninterrupted skin to
skin contact
-Observe NB forfeeding cues
-Counsel on
positioning &
attachment
-Do eye care, injections
etc after 1st breastfeed
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Whole hierarchy of the DOH and itsattached agencies
Public and private providers
Development partners involved in theMNCHN strategy
All health practitioners involved inmaternal and newborn care
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How can MCNAP contribute to
implementing EmONC? Organize a multidisciplinary EmONC Working
Group MDs: Obs, Pediatricians, Anesthesiologists Nurses, nursing assistants Midwives Administrators Infection control committee
Conduct a situational analysis of your facility
Contribute to the revision of hospital policies andstandard operating procedures, forms, ordersheets etc
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How can MCNAP contribute to
implementing EmONC?
Enable the environment for EmONC
Disable the environment that hindersEmONC
Join us to bring Unang Yakap to yourmembership and every mother, father
that you can influence.
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