Essential Newborn Care (ENC)

a simple, cost-effective newborn care intervention that

can improve neonatal as well as maternal care.
an evidence-based intervention that :
emphasizes a core sequence of actions, performed
methodically (step-by-step)
is organized so that essential time bound interventions are
not interrupted
fills a gap for a package of bundled interventions in a
guideline format
a series of time bound, chronologically-ordered,
standard procedures that a baby receives at birth

Unang Yakap
A campaign that seeks to engage national and
local sectors, public and private health sectors,
individuals and organizations, mothers,
fathers and families, to embrace the Essential
Newborn Care Protocol to ensure a bright and
healthy future for our newborns.
Rationale
Every year approximately 40,000 Filipino
neonates die, mostly from preventable causes.
The majority die within the rst week.
The high mortality and morbidity rates in
newborns are directly related to inappropriate
hospital and community practices currently
employed throughout the Philippines.
TIME BAND: At perineal bulging
INTERVENTION: Prepare for the delivery
Check temperature of the delivery room
25-28C
Free if air drafts
Notify appropriate staff
Arrange needed supplies in a linear fashion
Check resuscitation equipment
Wash hands with clean water and soap
Double glove just before delivery
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
TIME BAND: Within the 1
st
30 seconds
INTERVENTION: Immediate and
thorough drying
Call out 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
Within the 1
st
30 seconds: Immediate
and thorough drying
Do a quick check of breathing while drying

**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

If after 30 seconds of drying, newborn
is not breathing or is gasping
Intervention: Reposition, suction and
ventilate
Action:
Clamp and cut cord immediately
Call for help
Transfer to a warm, firm surface
Inform the mother that the mother has difficulty
breathing and that you will help the baby breathe
Start resuscitation protocol

TIME BAND: After 30 seconds of drying
INTERVENTION: Early Skin to Skin
Contact
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
Place identification band on ankle (not wrist)

Do not separate the newborn from mother
Do not put the newborn on a cold or wet
surface.
Do not wipe off vernix if present.
Do not bathe the newborn earlier than 6
hours of life.
If the newborn must be separated from
his/her mother, put him/her on a warm
surface, in a safe place close to the mother
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

Notes
Do not milk the cord towards the baby; After the
first clamp- you may strip the cord of blood before
applying the 2
nd
clamp
Cut the cord close to the plastic clamp so that
there is no need for a 2
nd
trim
Do not apply any substance to the cord


Time Band: With 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 out these to the mother and encourage
her to nudge the newborn towards the breast

Time Band: With 90 mins
Non separation of Newborn from
Mother for Early Breastfeeding
Counsel on positioning
Newborns neck is not flexed nor twisted
Newborn is facing the brest
Newborns body is close to mothers body
Newborns whole body is supported
Time Band: With 90 mins
Non separation of Newborn from
Mother for Early Breastfeeding
Counsel on attachment and suckling
Mouth wide open
Lower lip turned outwards
Babys chin touching the breast
Suckling is slow, deep with some pauses


Notes
Minimize handling by healthworkers
Do not give sugar water, formula or other
prelacteals
Do not give bottles or pacifiers
Do not throw away colostrum

Time Band: With 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