ASKEP BAYI BARU LAHIR

NORMAL
Asuhan bayi baru lahir normal
Partograf
Kemajuan persalinan:
1. Pembukaan serviks
2. Turunnya kepala
3. His
Keadaan janin:
1. Frekuensi Djj
2. Warna, jumlah, lama ketuban pecah
3. Mulase kepala
 Keadaan ibu:
1. Tensi, nadi dan suhu
2. Urin: volume, protein, aseton
3. Obat obatan dan cairan IV
4. Pemberian oksitoksin
IMMEDIATE ESSENTIAL NEWBORN CARE
The First 90 Minutes
Bayi baru lahir sehat.
Infant mortality rate indonesia masih paling tinggi
diantara negara negara Asia Tenggara.
Immediate Essential Newborn Care

Time band: 2nd stage of labor

At perineal bulging, with presenting part visible

Intervention:Prepare for the delivery

Action:
Ensure that delivery area is draft-free and room
temperature between 2528oC.
Wash hands with clean water and soap.

Double glove just before delivery.

Preparing to Meet the Babys Needs

Good care of the newborn begins with good

preparation
Ensure all delivery equipment and supplies, including
newborn resuscitation equipment, are available.
Line up materials for delivery according to
sequence of use
Prepare for Delivery
2 sets of sterile gloves
Two clean and warm towels or cloth
Self inflating bag and mask (normal and small
newborn)
Suction device
Sterile cord clamp or ties
Sterile forceps and scissors
Rolled up piece of cloth
Bonnet
Clean dry warm surface
Broken equipment is dangerous
Equipment must be checked
daily and well before a
delivery takes place.
Resuscitation equipment
should always be close to
the delivery area
Health workers must know
how to use the equipment.

D11

Phil. ENCC 10
STANDARD PRECAUTIONS A4

Always remember the importance of observing

precautions to help protect the mother and baby
and ourselves from infections with bacteria, viruses
including HIV
Immediate Essential Newborn Care
Deliver the baby in prone position on the mothers
abdomen, face turned to the side
Call out time of birth.
Dry the newborn thoroughly. Check the babys
breathing while drying. Remove wet cloth.
Place the newborn on the mothers abdomen in skin-
to-skin contact. Cover the back with a dry blanket.
Time: WITHIN THE 1ST 30 SECS

Intervention: Dry and provide warmth.

Action:
Use a clean, dry cloth to thoroughly dry the baby

by wiping the face, eyes, head, front and back of

the trunk, arms and legs.
Do a quick check of newborns breathing while

drying.
Remove the wet cloth.
Drying The Newborn

Stimulates the newborn to breathe normally

Minimizes heat loss
Drying the newborn
During the 1st 30 seconds of
drying/stimulation:
Do not suction unless mouth/nose are
obstructed with secretions or other
material
Do not ventilate unless the baby is floppy
and not breathing

Phil. ENCC 15
Do not remove the vernix!!!
Time band: If after 30 secs of drying, newborn
is breathing or crying
Intervention: Skin -to-skin (STS) contact
Action:
Avoid any manipulation, such as routine
suctioning.
Place the newborn prone on the mothers abdomen
or chest skin-to-skin.
Cover newborns back with a blanket and head with
a bonnet.
Place identification band on ankle
Immediate skin-to-skin contact
Immediate skin-to-skin contact
Skin-to-Skin Contact

Provides warmth
Improves bonding
Provides protection from infection by exposure of the
baby to good bacteria of the mother
Increases the blood sugar of the baby
Contributes to the overall success of breastfeeding
Skin-to-Skin Contact

Effect on Immunoprotection
Colonization with maternal skin flora

Stimulation of the mucosa-associated lymphoid tissue

system.
Ingestion of colostrum
Risks of Hypothermia

Hypothermia can lead to :

Infection
Coagulation defects
Acidosis
Delayed fetal to newborn circulatory
adjustment
Hyaline membrane disease
Brain hemorrhage.

[i] Tunell R. Hypothermia: epidemiology and prevention, in Improving Newborn Health in Developing
Countries, A. Costello and D. Manandhar, Editors. 2000, Imperial College Press: London, UK. p. 207-
220.
When should the cord be clamped after
birth?

A. When the cord pulsations stop

B. Between 1 and 3 minutes
C. Between 30 secs - 1 minute in preterms
D. All of the above are appropriate
Time band: If after 30 secs of drying, newborn is
NOT breathing or is gasping

Intervention: Re-position, suction and ventilate

Action:
Clamp and cut the cord immediately

Call for HELP

Transfer to a warm firm surface

Inform the mother

Start resuscitation protocol

Time Band: 1 3 minutes
Intervention: Delayed or non-immediate
cord clamping
Action:
Remove the first set of gloves immediately prior to
cord clamping.

Clamp and cut the cord after cord pulsations have

stopped ( at 1 to 3 minutes)
 Action: Initial Cord care

-Put ties tightly around the

cord at 2 cm & 5 cm from
the abdomen.
-Cut between ties with sterile
instrument.
-Observe for oozing blood.
Do not apply any
substance to the stump
Do not bind or bandage
the stump
Leave the stump
uncovered
Properly timed clamping of the
umbilical cord
Reduces the risk of anemia in both
term and preterm babies
Term babies: less anemia in the newborn
24-48 hrs after birth
RR 0.2 (95% CI 0.06, 0.6)
NNT 7, (4.5- 20.8)
Preterms: less infant anemia
RR 0.49 (95% CI 0.3, 0.81)
NNT 3 (1.6 - 29.6)
Properly timed clamping of the
umbilical cord

Preterms: less intraventricular hemorrhage

No significant impact on incidence of Post-partum

hemorhage

Ceriani Cernadas ,et al. 2006;Rabe H, et al. 2004; McDonald SJ, et al.
2008; Hutton EK, et al. 2007; Kugelman A, et al. 2007
Van Rheenen PF, et al. 2006 Van Rheenen PF & Brabin BJ. 2006
Washing should be delayed until after 6 hours

Washing exposes to hypothermia

The vernix is a protective barrier to bacteria such

as E. coli and Group B Strep

Washing removes the crawling reflex

[i] Tollin M, Bergsson G, Kai-Larsen Y, Lengqvist J, Sjovall J, Griffiths W, Skulavottir G, Haraldsson A, et al. Vernix Caseosa as a multicomponent defense
system based on polypeptides, lipids and their interactions. Cell Mol Life Sci 2005; 62:2390-2399
[ii] Righard L, Alade M. Effect of delivery room routines on success of first breastfeed. Lancet 1990; 336: 1105-07
Time: WITHIN 90 min of age

Intervention: Provide
breastfeeding support
for initiation of breastfeeding
Action:
Leave the baby on the mothers chest in skin-to-skin
contact.
Observe the newborn.
Place identification tag / bracelet on the babys
ankle
Maintain skin-to-skin contact

- uninterrupted
for at least 90
minutes after
birth and until
the first
thorough
breastfeed is
complete
Monitor the mother and baby during the first hour after
complete delivery of the placenta

Never leave the woman and newborn alone

Keep the mother and baby in the delivery room

Record findings, treatments and procedures in the labor

record
Monitor every 15 minutes:

Baby
Breathing

warmth
SKIN TO SKIN CONTACT & INITIATION OF
BREASTFEEDING

To begin with the

baby will want to
rest.
Rest period may take
from a few minutes
to 30 or 40 minutes
before the baby
shows feeding cues.
SIGNS OF READINESS TO BREASTFEED

Only once the

newborn shows
feeding cues (e.g.
opening of
mouth, tonguing,
licking, rooting),
make verbal
suggestions to the
mother to
encourage her
newborn to move
toward the breast
e.g. nudging.
Help the mother and baby into a
comfortable position
Initiation of breastfeeding

Health workers should not touch the newborn unless

there is a medical indication.
Do not give sugar water, formula or other
prelacteals.
Do not give bottles or pacifiers.
Do not throw away colostrum.
If the mother is HIV-positive, counsel the mother on
breastfeeding
The first breast feed

Check attachment and positioning when the

baby is feeding
Let the baby feed for as long as he wants
on both breasts
Keep the mother and baby together for as
long as possible after delivery
Delay tasks such as weighing,
immunizations, etc. until after the first feed
HIV and Immediate Newborn Care

If the mother has HIV/AIDS:

universal precautions must be followed as with any
other delivery and after care.
Her baby can have immediate skin-to-skin contact

Breastfeeding can begin when the baby is ready after

delivery
Do not give the baby any other food or drink

Good attachment and positioning are vital

If replacement feeding, prepare formula for the

mother for the first few feeds
Time: WITHIN 90 min of age
Intervention: Do eye care
Action:
Wipe the eyes

Apply an eye antimicrobial within 1 hour of birth:

1% silver nitrate drops or

2.5% povidone iodine drops or

1% tetracycline ointment or erythromycin eye drops

Do not wash away the eye antimicrobial

FROM 90 Min 6 HRS
II. ESSENTIAL NEWBORN
CARE
Time: FROM 90 Min 6 HRS

Intervention: Give Vitamin K prophylaxis

and Hepatitis B and BCG
vaccinations at birth
Action:
Wash hands.

Inject a single dose of Vitamin K 1 mg IM.

Inject Hepatitis B vaccine IM and BCG

intradermally.
Record.
Time: WITHIN 90 min of age

Interventions:
Examine the baby
Check for birth injuries, malformations
or defects
Action:
Thoroughly examine the baby.

Weigh the baby and record.

Look for possible birth injury and/or malformation

Time: WITHIN 90 min of age
Interventions: Cord care
Action:
Wash hands before and after cord care.
- Put nothing on the stump.
- Fold diaper below stump. Keep cord stump loosely
covered with clean clothes.
- If stump is soiled, wash it with clean water and
soap. Dry it thoroughly with clean cloth.
Time: WITHIN 90 min of age

Interventions: Provide additional care

for a small baby or
twin
Action:
If the newborn is delivered 2 months earlier or

weighs <1500 grams, refer to a hospital

Time: WITHIN 90 min of age

Interventions: Provide additional care

for a small baby or
twin
Action:
If the newborn is delivered 1 month early of is
visibly small (1501 2499g)
- Special support for breastfeeding

- Discharge planning
Unneccesary Procedures

Not routinely recommended for all neonates

1. Routine suctioning
2. Early bathing/washing
3. Foot printing
4. Giving sugar water, formula or other prelacteals
and use of bottles and pacifiers
5. Application of alcohol, medicines and other
susbstances on the cord stump and bandaging the
cord stump or abdomen
SUMMARY
Essential Newborn Care Protocol

Essential interventions in the first 90 minutes of life

and up to 7 days of life
Emphasizes a core sequence of actions, performed
methodically, step-by-step
Some time-bound but doable even by a single health
worker caring for both mother and newborn