Date and time F – ESSENTIAL NEWBORN CARE

D - Born an alive, baby male/female via NSD; attended by ______________

(continuous) (pinkish/ acrocyanotic/pale); (active/some flexion of extremities/limp); (loud cry/weak cry/no cry)
(with caput succedaneum/ without caput succedaneum); (with 1, 2 cord loops/s/ without cord loop)
(with thickly/thinly meconium-stained amniotic fluid/ clear amniotic fluid)
A - immediate drying done on mother's abdomen, skin to skin contact initiated
- properly timed umbilical cord clamped and cut aseptically by_____
- positioned prone on the mother's chest and covered with warmed linen, bonnet provided
- identification tag secured at right ankle
(time) - trans out with mother to recovery room per stretcher, skin to skin contact maintained
- monitored every 15 mins. then every hour until stable
- feeding cues observed, assisted latching on to the mother. Demonstrated proper attachment and positioning
- counseled mother on the following:
• feeding cues
• breast feeding per demand, observing proper attachment and positioning
• to report danger signs such as poor suck, cyanosis, fast breathing and vomiting
• the importance of newborn screening and hearing screening
• proper hand hygiene
• thermoregulation
(time) - routine newborn care done at mother's bedside
- physical examination done by Dr.______
- (clothed and swaddled/kangaroo Mother Care instructed to mother, KMC blouse provided)
R – (good/fair/poor suck); (active, not in distress/in distress) (AGA, LGA, SGA, LBW, PT)
(time) - Trans out to _____ ward, (cuddled by mother/in KMC with mother) per wheelchair.

(printed name, signature, BSN-)

Date and time F – ESSENTIAL NEWBORN CARE

D - Born an alive, baby male/female via NSD; attended by ______________
(continuous) (pinkish/ acrocyanotic/pale); (active/some flexion of extremities/limp); (loud cry/weak cry/no cry)
(with caput succedaneum/ without caput succedaneum); (with 1, 2 cord loops/s/ without cord loop)
(with thickly/thinly meconium-stained amniotic fluid/ clear amniotic fluid)
A - immediate drying done on mother's abdomen, skin to skin contact initiated
- properly timed umbilical cord clamped and cut aseptically by_____
- positioned prone on the mother's chest and covered with warmed linen, bonnet provided
- identification tag secured at right ankle
(time) - trans out with mother to recovery room per stretcher, skin to skin contact maintained
- monitored every 15 mins. then every hour until stable
- feeding cues observed. Assisted latching on to the mother. Demonstrated proper attachment and positioning
- counseled mother on the following:
• feeding cues
• breast feeding per demand, observing proper attachment and positioning
• to report danger signs such as poor suck, cyanosis, fast breathing and vomiting
• the importance of newborn screening and hearing screening
• proper hand hygiene
• thermoregulation
(time) - routine newborn care done at mother's bedside
- physical examination done by Dr.______
- (clothed and swaddled/kangaroo Mother Care instructed to mother, KMC blouse provided)
R – (good/fair/poor suck); (active, not in distress/in distress) (AGA, LGA, SGA, LBW, PT)
(time) - Trans out to _____ ward, (cuddled by mother/in KMC with mother) per wheelchair.

(printed name, signature, BSN-)

Prepared by: Tamayo, Teanu