Unang Yakap (Essential Newborn Care: Protocol for New Life)

Many initiatives, globally and locally, help save lives of pregnant women and children. Essential
Newborn Care (ENC) is one.
ENC is a simple cost-effective newborn care intervention that can improve neonatal as well as
maternal care. IT is 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; and

fills a gap for a package of bundled interventions in a guideline format.

The Unang Yakap 4&5, or "The First Embrace", is the campaign of the Philippines Department
of Health (DOH), in cooperation with WHO, to adopt and embrace the safe and quality care of
Essential Intrapartum and Newborn Care (EINC) for birthing mothers and their newborns.

The DOH, in 2009, began a hospital-based initiative to change childbirth practices to

EINC. This iniative called Scale up EINC Project, with support from WHO and the Joint
Programme on Maternal and Neonatal Health (JPMNH), was piloted in 11 hospitals. This
project is fondly referred as Unang Yakap 4&5.
Since 2010, selected DOH-retained hospitals were trained on EINC evidence-based
standards and consequently adopted them. EINC represents the highest standards for safe
and quality care for birthing mothers and healthy newborns with 48 hours of intrapartum
period and up to a week of life of the newborn.
Adoption of the EINC evidenced-based standards helps reduce maternal and newborn
morbidity and deaths. It also supports the Philippine Government commitment to the
United Nations Millenium Development Goals (MDG) 4 and 5 by year 2015.
Initial results of the Unang Yakap campaign were extremely positive. Admissions to the
neonatal intensive care units (NICUs) dropped, neonatal sepsis rates were reduced,
maternal and newborn deaths decreased and more satisfied mothers. Hence, more and
more hospitals and health professionals are embracing and providing EINC care.

The campaign employs Essential Newborn Care (ENC) Protocol as a strategy to improve the
health of the newborn through interventions before conception, during pregnancy, at and soon
after birth, and in the postnatal period.
The ENC Protocol provides an evidence-based, low cost, low technology package of
interventions that will save thousands of lives.

Based on health statistics, the Philippines is one of the 42 countries that account for
90% of under-five mortality worldwide.

82,000 Filipino children under five years old die every year.

37% of them are newborn.

Majority of them (3/4) die within the first two days of life. Mostly due to stressful events
or conditions during labor, delivery and immediate postpartum period.

The current practice of handling newborns, like clamping and cutting the umbilical cord and
washing the baby right after birth, have been known to actually contribute to the high incidence
of neonatal deaths and illnesses in the country. Thus the need for a paradigm shift from the
prevailing standard procedures into the new protocol.
Health Secretary Duque explained that the ENC Protocol involves focusing on the first hours of
life of the newborn with the manual guiding health workers in providing evidence-based
essential newborn care.

The guidelines categorize procedures into time-bound, non time-bound and unnecessary
procedures:

TIME BOUND PROCEDURES

Time bound procedures should be routinely performed first immediate drying, skin-to-skin
contact followed by clamping of the cord after one to three minutes or until pulsations have
stopped, non-separation of the newborn from the mother and breastfeeding initiation.

NON TIME-BOUND PROCEDURES

Non time-bound intervention should only be done after the first full breastfeed. These are
immunizations, eye care, Vitamin K administration and weighing. Washing must be postponed
by at least 6 hours as this will hinder the crawling reflex.

UNNECESSARY PROCEDURES
The so-called unnecessary procedures include routine suctioning, routine separation of newborns
for observations, administration of pre lacteals like glucose, water formula and footprinting.