A paradigm shift in newborn care

MANILA, Philippines - We’ve seen it portrayed in movies. A baby is delivered. It is held upside down and spanked. The umbilical cord is clamped and cut, and the baby is whisked away to be washed and cleaned immediately. Wrong!

“Washing should be postponed until eight hours after birth,” said Dr. Aleli Sudiacal of the Department of Health (DOH) at a forum held recently at the Quirino Memorial Medical Center in Quezon City.

“Washing immediately after delivery exposes the baby to hypothermia. It also removes the vermix, a protective barrier against bacteria and infections,” Sudiacal said.  

Sepsis is regarded as the most common cause of deaths, accounting for 26 percent of neonatal fatality. Over 40,000 Filipino newborns die annually, with the majority dying in the first two days of their lives.

The common practices of newborn care are seen to have contributed to the high incidence of neonatal mortality as well as morbidity in the country.

Aware of the need to raise the quality of post-natal care in health facilities, the World Health Organization (WHO), in partnership with the DOH, is promoting a new approach where evidence-based components are integrated in post-natal care. Called the Essential Newborn Care (ENC), this simple set of proven intervention can save the lives of newborns.

The new protocol is to postpone washing and instead, dry the baby immediately, within the first 30 seconds, and initiate skin-to-skin contact with the mother before clamping the umbilical cord. Breastfeeding should also be initiated within the first hour of birth.

“It’s a major paradigm shift,” said Dr. Honorata Catibog, head of the DOH Task Force on the Rapid Reduction of Maternal and Neonatal Mortality.

“Delaying cutting the umbilical cord for two to three minutes after birth is said to increase the newborn’s iron reserves. It also reduces risk of anemia and increases blood circulation.” Sudiacal explained. “Placing the baby on the mother’s chest or between her breasts will give the baby warmth and increase the duration of breastfeeding.”

“Studies showed delayed breastfeeding by one day increases by 2.6-fold the risk of death due to infection,” said Dr. Asuncion Silvestre, head of the PGH Lactation Unit and Milk Bank. 

“Colostrum in the mother’s first milk is high in antibodies that fight infections. Early breastfeeding allows the colonization of good bacteria. It also enhances bonding between mother and baby,” Silvestre said.

Rooming-in is encouraged in place of the old practice of keeping the baby in the hospital nursery, away from its mother.

“Before, the focus was on pre-natal care, with the practice of at least four pre-natal visits. But essential newborn care actually starts even before the mother gets pregnant. It starts with the status of the health of the woman,” Silvestre said. “All pregnancies are considered at high risk. We advocate facility-based delivery attended by skilled health professionals.”

Since early this year, health workers from various government hospitals such as Davao Medical, Vicente Sotto in Cebu, Baguio General Hospital, Veterans Regional Hospital, Dr. Jose Fabella Memorial Hospital in Manila and Quirino Memorial Medical Center in Quezon City, underwent ENC training with WHO, adopting the implementation strategy known as Basic Emergency Obstetric and Newborn Care. 

“We practice the team approach involving doctor, nurse, and midwife,” said Dr. Bella Vitangcol who led the familiarization tour of the essential newborn care facilities at the Quirino Memorial Medical Center, a pioneer in newborn care.

The goal is to rapidly reduce maternal and neo-natal mortality by 2015.