3.5.1 Antenatal care
Follow measures recommended under Section 3.3.1 and Section 3.4.1.
For pre-term and/or LBW babies
- Monitor labor closely.
- Prepare the delivery room for anticipated complications such as hypothermia and asphyxia.
3.5.2 Intrapartum and essential newborn care
In addition to following the guidance provided in Section 3.2, Section 3.3.2 and Section 3.4.2:
- If there are signs of maternal or fetal distress, follow guidelines for providing BEmONC or CEmONC services.info
- If the newborn, including pre-term and/or LBWabbreviation babies, does not start breathing spontaneously or is not stable, follow the steps of the Newborn Resuscitation Flowchart (Figure 3.3) until breathing is established.
3.5.3 Postnatal care
During the immediate postnatal period (within the first hour of birth)
Follow the same guidance detailed in section Section 3.2 and Section 3.4.3 with accommodations for complications such as assisted delivery or birth by cesarean section.
In case of intrapartum complications during birth
- Provide advanced care for respiratory distress syndrome such as CPAPabbreviation support with ability to monitor oxygen saturation levels.
- In addition to respiratory issues, the newborn may have other complications such as convulsions or hypoglycemia. Convulsions can be due to perinatal asphyxia, hypoglycemia or infection. If the newborn is convulsing:
- Provide IVabbreviation phenobarbital.
- Check glucose for hypoglycemia (<45 mg/dl or 2.5 mmol/l) and treat with glucose by IVabbreviation or nasogastric tube as indicated.
- Once newborn is breathing well and is stable, follow ENCabbreviation measures outlined in Section 3.3.3 and Section 3.4.3.
Identify small and/or sick newborns, including preterm and low birth weight (LBWabbreviation) babies immediately after birth and provide special careinfo
- If the baby is unstable requiring frequent ventilatory support, and a functional, clean incubator is available, use the incubator until the baby is stable enough to transition to KMCabbreviation (See Box 3.2 for KMCabbreviation).
- If the mother is not available to perform STSabbreviation or KMCabbreviation, enlist the support of another caregiver.
During the first week of life (second hour following birth up to seven days)
In addition to the measures recommended for pre-term and/or LBWabbreviation babies in Section 3.4.3:
- If intensive care equipment is available, provide incubator care for preterm babies not yet stable enough for STSabbreviation/KMCabbreviation.
- Provide advanced care for respiratory distress:
- employ therapeutic use of surfactant for intubated and ventilated infants with respiratory distress syndrome;
- provide CPAPabbreviation and monitor oxygen saturation levels and vital signs;
- prevent and treat apnea of prematurity with caffeine (Section 3.6.1).
- Monitor and manage newborns with jaundice with phototherapy or exchange blood transfusion based on bilirubin cut-off points (Box 3.10).
For babies exhibiting danger signs or indicators of neonatal infections
- In addition to guidance in Section 3.4.3, provide case management of neonatal infections including sepsis, meningitis and pneumonia.
- For pneumonia and sepsis, continue the regimen recommended in Section 3.4.3 for 10 days.
- If meningitis is suspected or diagnosed, continue antibiotic treatment for 21 days. In addition to antibiotics, see Table 3.3 for management.
|Cyanosed (blue or purplish discoloration of the skin and/or mucous membranes)||
|Severe respiratory distress|
|Diagnoses of respiratory distress syndrome||
|Drowsy, unconscious or convulsing||
Check blood glucose and if the glucose level:
|Presence of convulsions||
Administer phenobarbital (loading dose for phenobarbital 20 mg/kg IVabbreviation)
|If convulsions persist||
Note: If ampicillin is not available, benzylpenicillin can be used. If meningitis is suspected, or the baby is not improving on the initial antibiotic, consider using a broader spectrum cephalosporin such as ceftriaxone or cloxacillin.
Cloxacillin is also indicated if there is a high suspicion for staphylococcus infections
See Section 3.6 for further information about managing prematurity, infections and intrapartum complications.
See Box 3.12 for a checklist of minimum supplies at the hospital level. For advanced care in the hospital setting, see Annex 3 on advanced newborn care. Consult WHOabbreviation and UNICEFabbreviation 2019 manual on Management of the sick young infant up to 2 Months.
Newborn Care Supply Kits include the medicines, commodities and supplies to support safe births and newborn survival in the immediate postnatal period. The Newborn Care Supply Kits are complementary to the Inter-agency Reproductive Health Kits in Crisis Situations, which contain only some newborn health items and are managed by UNFPAabbreviation. If needed, please see the Newborn Care Supply Kits for Humanitarian Settings Manual for further information and information on how to procure the kits (see Section 5.4 for further information).
Box 3.12: Medicines for inclusion at the hospital level, depending on local capacity, include
- benzylpenicillin (injectable 5 million IU/vial)
- caffeine citrate (20mg/ml oral/injectable solution)
- cefotaxime (injectable 125mg/vial)
- ceftriaxone (injectable 250mg/vial)
- cloxacillin (injectable 250mg/vial)
- diazepam (injectable 5mg/ml)
- epinephrine (1:10000 solution: 1 mg/ml, vial 1 ml);
- glucose hyper, (50%, 50 ml vial)
- gentamicin doses (injectable 40mg/ml)
- IV/IM Phenobarbital Sodium (injection 200g/ml, vial 1 ml)
- sterile water for injections that require dilution
- dexamethazone (4mg Injections)
- surfactant doses (suspension for intratracheal instillations 25mg/ml or 80mg/ml)