(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.
Essential Newborn Care 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
- fills a gap for a package of bundled interventions in a guideline format
How was the ENC Protocol developed?
The ENC Protocol was developed the Newborn Care Technical Working Group (TWG) that conducted a systematic search and critical appraisal of foreign and local medical and allied health literature on practices in the immediate newborn period. An evidence-based draft was then developed and reviewed by the Department of Health (DOH), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), the Philippine Obstetrical and Gynecological Society (POGS), the Philippine Society of Newborn Medicine (PSNbM, a subspecialty society of the Philippine Pediatric Society, PPS), other health professional organizations/associations, Save the Children, the academe and other stakeholders.
Why is Unang Yakap important and adopted in birth delivery?
The wide variations in newborn care practices in health facilities, both government and private, and also the proper sequence or order of newborn care services need to be standardized.The standard set of practices of EINC are evidenced based to reduce maternal and newborn mortality rate.. based on current evidences that show reduction in neonatal mortality and morbidity. This is to achieve the United Nations Millennium Development Goal 4 of Reducing Under 5 Child Mortality (through reduction of neonatal deaths).t supports the national commitment to the United Nations Millenium Development Goals (MDG) 4 and 5.
What are the four (4) time-bound interventions involved in ENC?
At the heart of the protocol are four (4) time-bound interventions:
1) immediate and thorough drying,
2) early skin-to-skin contact followed by,
3) properly-timed clamping and cutting of the cord after 1 to 3 minutes, and
4) non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in.
What do these four (4) time-bound interventions do to the newborn?
1. Within the first 30 seconds, Immediate and thorough drying of the newborn prevents hypothermia which is extremely important to newborn survival
2. After thoroughly drying, Keeping the mother and baby in uninterrupted skin-to-skin contact prevents hypothermia, hypoglycemia and sepsis, increases colonization with protective bacterial flora and improved breastfeeding initiation and exclusivity
3. While on skin-to-skin contact (up to 3 minutes post-delivery), properly timed cord clamping and cutting until the umbilical cord pulsation stops decreases anemia in one out of every seven term babies and one out of every three preterm babies. It also prevents brain (intraventricular) hemorrhage in one of two preterm babies.
4. Within 90 minutes of age, breastfeeding initiation with the transfer of colostrums prevents an estimated 19.1% of all neonatal deaths.
What has the government done to ensure implementation of the Essential Newborn Care Protocol?
The signing of the Administrative Order 2009-0025 last Dec. 1, 2009 institutionalizes policies and guidelines for government and private health facilities to adopt the essential newborn care protocol. Advocacy and dissemination for a have been done since its launch. Scale-up implementation in all health facilities and social marketing are both in the pipeline to ensure that the policy is implemented all over the country.
What are the advantages of the of EINC?
- It strengthens health facility environment for breastfeeding initiation to take place few moments after delivery of the baby.
- It provides appropriate and timely emergency newborn care to newborns in need of resuscitation by early and accurate assessment of the infant’s adjustment of the outside world.
- It ensures access of newborns to affordable life-saving medicines to reduce deaths and morbidity.
- It also ensures inclusion of newborn care in the overall approach to the Maternal, Newborn, Child Health and Nutrition Strategy.
What are the life-saving medicines to reduce deaths and morbidity from the leading causes of newborn conditions?
- Erythromycin ophthalmic ointment
- Vaccines (Hepa B)
What newborn care practices in the delivery room should no longer be continued?
The following practices should never be done anymore to the newborn:
- Manipulation such as routine suctioning of secretions if the baby is crying and breathing normally. Doing so may cause trauma or introduce infection.
- Putting the newborn on a cold or wet surface.
- Wiping or removal of vernix caseosa if present
- Foot printing
- Bathing earlier than 6 hours of life
- Unnecessary separation of the newborn primarily for weighing, anthropometric measurements, intramuscular administration of vitamin K, Hepatitis B vaccine and BCG vaccine
- Transferring of the newborn to the nursery or neonatal intensive care unit without any indication.
Who are involved in Essential Newborn Care Protocol?
Healthcare professionals, either in government or in private facilities, involved in maternal and newborn care not limited to obstetrician-gynecologists, pediatricians/neonatologists, nurses, midwives, but also the hospital administration officials, anesthesiologists, hospital infection control officers, hospital PhilHealth/Quality officers, clinical nutritionists, clinical pharmacists, nursing attendants, health promotion and information officers.
What is the relationship of the ENC Protocol with regard to the Maternal, Newborn and Child Health Nutrition (MNCHN) Strategy?
The Maternal, Newborn, Child Health and Nutrition (MNCHN) Strategy is in line with the DOH Administrative Order 2008-0029 that seeks to rapidly reduce maternal and newborn morbidity and mortality. Foremost to this is the provision of Basic and Comprehensive Emergency Obstetric and Newborn Care (BEmONC and CEmONC) capability of health facilities to meet the UN MDGs 4 and 5. Newborn care has been incorporated in the provision of these service capabilities. The Administrative Order 2009-0025 formalized the adoption of policies and guidelines on essential newborn care.
What is the relationship of the ENC Protocol with regard to the Mother-Baby Friendly Hospital Initiative (MBFHI), Infant and Young Child Feeding Strategy, and the Republic Act 10028?
The ENC Protocol seeks to provide a firm foundation for an environment that complies with the “Ten (10) Steps to Successful Breastfeeding” of the Mother-Baby Friendly Hospital Initiative (MBFHI), breastfeeding initiation crucial to the IYCF WHO global strategy and in the implementation of the R.A. 10028.
At the community level, the local government up to the barangay officials, together with their health workers, nutrition scholars, community health teams and volunteers, mothers’ groups are likewise enjoined to ensure proper information is disseminated to pregnant women and women of the reproductive age group.