Normal Newborn Care

Advances in Maternal and Neonatal Health

Session Objective

Define essential elements of early newborn care

Discuss best practices and technologies for promoting

newborn health

Use relevant data and information to develop appropriate

essential newborn recommendations

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Newborn Deaths

8.1 million infant deaths

(1993)

3.9 million (48%) newborn

deaths

2.8 million (67%) early

newborn deaths

Major causes of newborn

deaths

Birth asphyxia: 21%

Infections: 42% (tetanus,

sepsis, meningitis,
pneumonia, diarrhea)

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Newborn Deaths (continued)

Birth process was the antecedent cause of 2/3 of deaths due to

infections

Lack of hygiene at childbirth and during newborn period

Home deliveries without skilled birth attendants

Birth asphyxia in developing countries

3% of newborns suffer mild to moderate birth asphyxia

Prompt resuscitation is often not initiated or procedure is

inadequate or incorrect

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Newborn Deaths (continued)

Hypothermia and newborn deaths

Significant contribution to deaths in low birth weight

infants and preterm newborns

Social, cultural and health practices delaying care to the

newborn

Countries with high STD prevalence and inconsistent

prophylactic practices

Ophthalmia neonatorum is a common cause of blindness

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Newborn Deaths (continued)

Low birth weight

An extremely important factor in newborn mortality

Place of childbirth

At least 2 out 3 childbirths in developing countries occur at

home

Only half are attended by skilled birth attendants

Strategies for improving newborn health should target

Birth attendant, families and communities
Healthcare providers within the formal health system

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Essential Newborn Care Interventions

Clean childbirth and cord care

Thermal protection

Prevent and manage newborn hypo/hyperthermia

Early and exclusive breastfeeding

Prevent newborn infection

Started within 1 hour after childbirth

Initiation of breathing and resuscitation

Early asphyxia identification and management

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Essential Newborn Care

Interventions (continued)

Eye care

Prevent and manage ophthalmia neonatorum

Immunization

At birth: bacille Calmette-Guerin (BCG) vaccine, oral

poliovirus vaccine (OPV) and hepatitis B virus (HBV)
vaccine (WHO)

Identification and management of sick newborn

Care of preterm and/or low birth weight newborn

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Cleanliness to Prevent Infection

Principles of cleanliness essential in both home and health

facilities childbirths

Principles of cleanliness at childbirth

Clean hands

Clean perineum

Nothing unclean introduced vaginally

Clean delivery surface

Cleanliness in cord clamping and cutting

Cleanliness for cord care

Infection prevention/control measures at healthcare facilities

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Thermal Protection

Newborn physiology

Normal temperature: 36.537.5C

Hypothermia: < 36.5C
Stabilization period: 1st 612 hours after birth
Large surface area
Poor thermal insulation
Small body mass to produce and conserve heat
Inability to change posture or adjust clothing to
respond to thermal stress
Increase hypothermia

Newborn left wet while waiting for delivery of placenta

Early bathing of newborn (within 24 hours)

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Hypothermia Prevention

Deliver in a warm room

Dry newborn thoroughly and wrap in dry, warm cloth

Keep out of draft and place on a warm surface

Give to mother as soon as possible

Skin-to-skin contact first few hours after childbirth

Promotes bonding

Enables early breastfeeding

Check warmth by feeling newborns feet every 15 minutes

Bathe when temperature is stable (after 24 hours)

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Early and Exclusive Breastfeeding

Early contact between mother and newborn

Enables breastfeeding
Rooming-in policies in health facilities prevents
nosocomial infection
Best practices

WHO 1999.

No prelacteal feeds or other supplement

Giving first breastfeed within one hour of birth
Correct positioning to enable good attachment of the
newborn
Breastfeeding on demand
Psycho-social support to breastfeeding mother

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Breathing Initiation and Resuscitation

Spontaneous breathing (> 30 breaths/min.) in most newborns

Gentle stimulation, if at all

Effectiveness of routine oro-nasal suctioning is unknown

Biologically plausible advantages clear airway

Potentially real disadvantages cardiac arrhythmia

Bulb suctioning preferred

Newborn resuscitation may be needed

Fetal distress

Thick meconium staining

Vaginal breech deliveries

Preterm

Hamilton 1999.

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Eye Care To Prevent or Manage

Ophthalmia Neonatorum

Ophthalmia neonatorum

Conjunctivitis with discharge during first 2 weeks of life

Appears usually 25 days after birth

Corneal damage if untreated

Systemic progression if not managed

Etiology

N. gonorrhea
More severe and rapid development of complications
3050% mother-newborn transmission rate
C. trachomatis

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Eye Care To Prevent or Manage

Ophthalmia Neonatorum (continued)

Prophylaxis

Clean eyes immediately

1% Silver nitrate solution
Not effective for chlamydia
2.5% Povidone-iodine solution
1% Tetracycline ointment
Not effective vs. some N. gonorrhea strains
Common causes of prophylaxis failure

Giving prophylaxis after first hour

Flushing of eyes after silver nitrate application
Using old prophylactic solutions

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Efficacy of Prophylaxis for

Conjunctivitis in China

Objective: To assess etiology of newborn conjunctivitis and

evaluate the efficacy of regimens in China

Design: November 1989 to October 1991 rotated regimens

monthly: tetracycline, erythromycin, silver nitrate

302 (6.7%) infants developed conjunctivitis, most S. aureus

(26.2%) and chlamydia (22.5%)

Silver nitrate, tetracycline: fewer cases than no prophylaxis (p

< 0.05), erythromycin: not significant

Chen 1992.

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Prophylaxis for Conjunctivitis: Objective

and Design

Objective: To compare efficacy in prevention of

nongonococcal conjunctivitis

Design: Randomized control trial to compare erythromycin,

silver nitrate, no prophylaxis

Bell 1993.

Examined with test for leukocyte esterase and chlamydia

trachomatis antibody probe 3048 hours postpartum, 1315
days later, and telephone contact up to 60 days of life

Main outcome measured: conjunctivitis within 60 days of life

and nasolacrimal duct patency

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Prophylaxis for Conjunctivitis:

Results and Conclusion

Results: 630 infants

109 with conjunctivitis

Bell 1993.

Silver nitrate vs. no prophylaxis: Hazard ratio 0.61 (0.390.97)

Chemical conjunctivitis with silver nitrate resolves
within 48 hours
Erythromycin vs. no prophylaxis: Hazard ratio 0.69 (not
significant)

Conclusion: Parental choice of prophylaxis, including no

prophylaxis, is reasonable IF antenatal care and STD screening

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Povidone-Iodine for Conjunctivitis:

Objective and Design

Objective: To determine incidence and type of conjunctivitis

after povidone-iodine in Kenya

Design: Rotate regimen weekly: erythromycin, silver nitrate,

povidone iodine

Results:

Conjunctivitis:
Chlamydia in 50.5%
S. aureus in 39.7%
More infections in silver nitrate than povidone-iodine, OR
1.76, p < 0.001
More infections in erythromycin OR 1.38, p=0.001

Isenberg, Apt and Wood 1995.

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Povidone-Iodine for Conjunctivitis:

Conclusion
Povidone-iodine:

Is good prophylaxis

Has wider antibacterial spectrum

Causes greater reduction in colony-forming units and

number of bacterial species

Is active against viruses

Is inexpensive

Isenberg, Apt and Wood 1995.

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Immunization

BCG vaccinations in all population at high risk of tuberculosis

infection

Single dose of OPV at birth or in the two weeks after birth

HBV vaccination as soon as possible where perinatal

infections are common

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Summary
The essential components of normal newborn care include:

Clean delivery and cord care

Thermal protection

Early and exclusive breastfeeding

Monitoring

Eye care

Immunization

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References
Bell TA et al. 1993. Randomized trial of silver nitrate, erythromycin and no
eye prophylaxis for the prevention of conjunctivitis among newborns not at
risk for gonococcal ophthalmitis. Pediatrics 92: 755760.
Chen J. 1992. Prophylaxis of ophthalmia neonatorum: comparison of silver
nitrate, tetracycline, erythromycin, and no prophylaxis. Pediatr Infect Dis J
11: 10261030.
Child Health Research Project and Maternal and Neonatal Health Program.
1999. Reducing Perinatal and Neonatal Mortality. Report of a meeting in
Baltimore, Maryland, 1012 May, 1999.
Hamilton P. 1999. Care of the newborn in the delivery room. Br Med J 318:
14031406.
Isenberg SJ, L Apt and M Wood. 1995. A controlled trial of povidone-iodine
as prophylaxis against ophthalmitis neonatorum. N Engl J Med 332: 562
566.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical
Guide. WHO: Geneva.

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