EINC Flashcards
FOUR CORE STEPS IN IMMEDIATE NEWBORN CARE
Immediate & Thorough Drying
Skin-to-skin Contact
Cord
Properly timed cord-clamping
IMMEDIATE AND THOROUGH DRYING SHOULD BE FIRST ACTION IMMEDIATELY for a full __ seconds.
30 secs
Clerk observed that the child is still both floppy and limp during the first seconds of immediate and thorough drying, what should be done at this time? Be specific.
- Call for help
- Do additional rescucitative measures
AMBU BAG
ET Intubation
2 advantages of the 1st step of EENC
Stimulate breathing
Prevents hypothermia
Ayaw natin maging hypothermic sa baby. Saan nagli-lead ang hypothermia? Give at least 4. (7 yun)
Hypothermia can lead to:
- respiratory distress
- Infection
- Coagulopathy
- Metabolic acidosis
- Brain hemorrhage
- Delayed fetal to newborn circulatory adjustment
- Hyaline membrane disease
First step when drying the baby.
It’s no longer recommended to slap or shake the baby.
What to do instead?
Rub the back of baby and flick soles of feet 3x when baby
hasn’t cried yet
T/F:
When immediate and thorough drying the newborn, position the newborn in a supine position first.
F.
STEPS:
- Place newborn prone to allow any secretion to drain, Rub the back of baby and flick soles of feet 3x when baby
hasn’t cried yet - Then turn over newborn into supine position
- Dry thoroughly for at least 30 seconds
• Follow an organized sequence
Start with mouth and nose, eyes and face head trunk
arms legs - Stimulate and check breathing while drying
• Don’t ventilate unless baby is floppy/limp and not breathing.
• Don’t suction unless mouth/nose are blocked by secretions 5. Wipe gently - Do no wipe off the vernix
• Vernix Caseosa: cheesy like substance which gives the baby
warmth - Remove the wet cloth
• Wet cloths induce cold stress/heat loss resulting in pallor and apnea - Replace with a dry cloth
- Put on a cap/bonnet (baby’s head has the highest heat loss)
Dry thoroughly for 30 seconds following the sequence:
A. Mouth nose, eyes and face —> head —> arms —> trunk —> legs
B. Mouth nose, eyes and face —> head —> arms —> legs —> trunk
C. Mouth nose, eyes and face —> arms —> legs —> head —> trunk
D. Mouth nose, eyes & face —> head —> trunk —> arms—> legs
D. D. Mouth nose, eyes & face —> head —> trunk —> arms —> legs
Remember* sa babies, when it comes to surface area
head > trunk > extremities
So syempre uunahin mong iddry yung mas malaking surface area to prevent hypothermia
Suction only if…
mouth/nose are blocked by secretions
Ventilate only if…
baby is floppy/limp and not breathing.
When the clerk fails to remove wet cloth, what will be the complications?
Wet cloths induce cold stress/heat loss resulting in
(+) pallor
(+) apnea
Last step of Immediate & Thorough drying
Cap and bonet kasi syempre head pinakamalking surface area —> more prone to heat loss or cold stress
Benefits of Skin to Skin contact
Hint: During a time of pandemic, experiencing skin to skin is a blessing 😏
BLEST
Breastfeeding success Lymphoid tissue system stimulation Exposure to maternal skin flora - most important advantage of STS (Doc Kho) Sugar (Protection from hypoglycemia) Thermoregulation
Breastfeeding success leads to (Give at least 3)
Breastfeeding success
Reduces crying,improvesmother-babyinteraction,
keeps the baby warmer, & helps women breastfeed successfully.
Positively associated with breastfeeding status at 1 & 4 mos
of age; longer duration of breastfeeding
Improvesmaternalaffection&attachmentbehaviors ® Shortercryingtime
LymphoidTissueStimulation
ProtectionfromHypoglycemia
Thermoregulation
Check room temp and baby temp which should be ______ respectively
Check room temperature
Room: 25 - 28°C
Baby: 36.5 – 37.5°C
If baby’s head is already coming out, turn off AC
Benefits of properly timed cord clamping
3 yun
Lowers incidence of BAP
Blood transfusion in preterm infants
Anemia
Preterm Intraventricular hemorrhage
Clamp the cord ____ cm from the umbilical base and ____ cm from the base (____ cm from the first plastic clamp)
2 cm from base
5 cm from base (3 cm from clamp)
Cut the cord near the plastic clamp
During non-separation of newborn from mother:
Frequence and duration of monitoring
Q15 for the first 2 hours
The baby may rest fro _______ minutes up to ______ minutes before signs of readiness to feed
The baby may rest for 20-30 minutes up to 120 minutes before signs of readiness to feed
Enumerate Breastfeeding cues:
Eye movement under closed lids
Increased alertness, movements of arms and legs
Tossing, turning or wiggling
Mouthing, licking, tonguing movements § Rooting
Changes in facial expression
Squeaking noises or light fussing
T/F. During the 4th step of EINC, baby girl Gabi cried. This is now an early sign for breastfeeding/early feeding cue
F. CRYING IS A LATE SIGN OF HUNGER
After the first full breastfeeding episode:
What should be done?
- Eye care
- Weight
- PE
- Injections (last) BCG, hep B., Vit. K which prevents hemorrhagic disease of the newborn
Administration of Vit. K after the first full breastfeeding episode. Prevents Hemolytic Disease of the newborn. T/F.
Hemorrhagic Disease of the Newborn
II. Enumerate the 3 things in active management of the 3rd stage of labor
- Oxytocin 10 UI IM within 1 minutes after delivery of the baby
- Controlled cord traction with counter-traction on the uterus
- Gentle uterine massage
Think of pushing by uterus and Pulling by the clerk
PUSHING: Oxytocin, Counter traction, Uterine massage
PULLING: Traction on the uterus
When we do cord care, antibiotics are necessary. T/F.
No.
We can already bathe the newborn after 24 hours. T/F.
❌ Early bathing with removal of vernix (after 24 hours):
Vernix is a protective barrier to E. coli and Group B Strep ® Hinders crawling reflex
Can lead to hypothermia and its complications
Vernix is a protective barrier to ____ and ____
Removal of vernix also hinders what reflex?
E. Coli and Group B Strep
CRAWLING reflex
Incorrect suctioning leads to
Basically Delikado sa VS: ⬇️ RR, ⬇️ HR, ⬇️ O2
Trauma&Infection
From trans:
- BRADYCARDIA (Vagal-induced)
- Apnea
- Slower rise in O2 sat
- Mucosal trauma with possibly increasing risk for infection
Foot printing increases risk of
Cross contamination among babies
When a baby is born, there is a transition from fetal circulation ___ to ___ shunting) to adult circulation ___ to ___ shunting
When a baby is born, there is a transition from fetal circulation (R-L shunting) to adult circulation (L-R shunting)
This should be the only mode of feeding up to 6 months
EXCLUSIVE BREASTFEEDING
T/F
newborns breathe using abdominal muscles up until 18 months old
F. 12 months dapat
What should the clerk explain when the mommy verbalizes na “Wala pong nakukuhang milk si baby”
explain that first 3 days,
there’s only a few drops of milk because baby’s stomach is
small in diameter (size: calamansi)
Neonates sleep for___ and awake for___ hrs
20 hrs tulog
4 hrs awake
Explain the benefit of delaying cord clamping?
What could it improve?
IRON STATUS up to 6 MONTHS AFTER BIRTH
Delaying cord clamping allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to six months after birth.
Why is the risk of low blood sugar higher for babies born to mothers with gestational diabetes
What could help stabilize their sugar levels?
higher insulin levels in their blood.
Skin-to-skin care in the hours after birth can help stabilize the baby’s blood sugar levels. Kasi magllatch on
(+) Meconium Stained Amniotic Fluid
Baby is crying. Chest rising is observed.
It is advisable to do suctioning in this case to clear proximal airway from meconium.
Suctioning has NO proven benefit!
(From trans)
Suctioning should be done ONLY if chest is not rising with bag and mask ventilation and have visible secretions in the mouth and/or the nose that appear to obstruct upper airway.
Milking the cord TOWARD BABY increase ____ lvls
Milking the cord TOWARD PLACENT incrase ____ lvls
Toward baby - Hct
Toward placenta - Anemic
If blood oozes, what should be done?
place a second tie between the skin and the clamp
DRY cord care is recommended t or f?
DRY cord care is recommended
Do not apply any substance onto the cord
Don’t use a binder or “bigkis”
Harbors infection when it becomes moist
Giving sugar water is recommended for babies who have a hard time breastfeeding. T or F
False
Why is it not advisable to give bottles or pacifiers?
Newborn might develop a learned preference for the bottle leading to nipple confusion and insufficient suckling and further leads to breastfeeding failure.
Alternating ____ minutes breastfeeding per breast
30 minutes
COUNSEL ON POSITIONING:
Newborn neck is preferred to be flexed
T or F
F.
Newborn neck is not flexed or twisted
Counsel on attachment and suckling
Lower lip turned inwards
T or F
F. Lower lip turned outwards
Counsel on attachment and suckling
It is okay for the sucking to be slow, deep and with some pauses
T or F
T
Suckling is slow, deep with some pauses
Baby should not make noises while suckling. It is a sign that the baby is not receiving any milk.
Preferred Eye antibiotic for the baby
This is to avoid which disease?
ERYTHROMYCIN
GONOCOCCI, CHLAMYDIA —> Opthalmia Neonatorum; causes blindness
Before silver nitrate and betadine
Where is Vitamin K injected?
Anterolateral thigh
