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  1. 1. Introduction
    1. 1.0 Overview
    2. 1.1 What is the Purpose of the Field Guide
    3. 1.2 Who is the Field Guide intended for?
    4. 1.3 How is the Field Guide organized?
  2. 2. Background
    1. 2.0 Overview
    2. 2.1 Humanitarian Settings Across the Globe
      1. 2.1.1 Challenges to Newborn Health Service Delivery
    3. 2.2 Newborn Health: Epidemiology
      1. 2.2.1 Global burden of newborn mortality
      2. 2.2.2 Principal causes of neonatal deaths
  3. 3. Newborn Health Services
    1. 3.0 Overview
    2. 3.1 General Principles and Considerations
      1. 3.1.1 The Continuum of Care Across the Lifecourse
      2. 3.1.2 Levels of Care
    3. 3.2 Essential Newborn Care
    4. 3.3 Newborn Care at Household/Community Level
      1. 3.3.1 During the Antenatal Period
      2. 3.3.2 Intrapartum and essential newborn care
      3. 3.3.3 Postnatal care
    5. 3.4 Newborn Care at Primary Care Facilities
      1. 3.4.1 Antenatal care
      2. 3.4.2 Intrapartum and essential newborn care
      3. 3.4.3 Postnatal care
    6. 3.5 Newborn Care at Hospitals
      1. 3.5.1 Antenatal care
      2. 3.5.2 Intrapartum and essential newborn care
      3. 3.5.3 Postnatal care
    7. 3.6 Additional Considerations for Preventing and Managing Principal Causes of Neonatal Deaths
      1. 3.6.1 Prematurity/Low Birth Weight (LBW)
      2. 3.6.2 Newborn Infections
      3. 3.6.3 Intrapartum Complications
  4. 4. Strategic Considerations
    1. 4.0 Overview
    2. 4.1 Mainstreaming newborn health in humanitarian coordination
      1. 4.1.1 Incorporate questions about newborn health services within a rapid health assessment
      2. 4.1.2 Advocate for the inclusion and prioritisation of newborn health in humanitarian response plans
    3. 4.2 Conducting a situational analysis
      1. 4.2.1 Examine national policies and protocols relevant to newborn health
      2. 4.2.2 Examine existing clinical guidelines, key messages/ BCC materials, tools and training materials
      3. 4.2.3 Assess resource availability: facilities, supplies and staff
    4. 4.3 Developing an inclusive and unified response strategy
      1. 4.3.1 Prioritizing newborn interventions
      2. 4.3.2 Update and distribute clinical guidelines and protocols
      3. 4.3.3 Develop and collate needs based staff training materials
      4. 4.3.4 Procure and distribute essential medicines and supplies
      5. 4.3.5 Ensure quality improvement and respectful care
      6. 4.3.6 Develop proposals to secure additional funding
    5. 4.4 Developing and implementing a monitoring and evaluation (M&E) plan
      1. 4.4.1 Compromised data flow and routine information systems
  5. 5. Program Implementation Considerations
    1. 5.0 Overview
    2. 5.1 Developing and disseminating key messages/behavior change communication (BCC) materials
    3. 5.2 Developing a referral system
      1. 5.2.1 When referral is not feasible
    4. 5.3 Home visits for mothers and babies
    5. 5.4 Procuring newborn care supply kits
    6. 5.5 Managing newborn deaths in crisis settings
      1. 5.5.1 Support for neonatal loss
      2. 5.5.2 Documenting neonatal loss
  6. 6. Annexes
    1. 6.1 Annex 1: Newborn health services summary tables by levels of care
      1. 6.1.1 Annex 1A
      2. 6.1.2 Annex 1B
      3. 6.1.3 Annex 1C
    2. 6.2 Annex 2: Doses of Common Drugs for Neonates
    3. 6.3 Annex 3: Advanced Care for Very Sick Newborns
    4. 6.4 Annex 4: Tools to Support Neonatal Referrals
      1. 6.4.1 Annex 4A: When to Refer a Newborn to the Hospital
      2. 6.4.2 Annex 4B: Job Aid: Transporting the Sick Newborn
      3. 6.4.3 Annex 4C: Sample Referral Note
    5. 6.5 Annex 5: Newborn Kits for Humanitarian Settings
    6. 6.6 Annex 6: Indicators
      1. 6.6.1 Annex 6A: Newborn Health Indicators for Routine Data Systems
      2. 6.6.2 Annex 6B: List of Indicators and Questions to Measure Facility Capacity to Provide Key Newborn Health Services
Newborn Field Guide

3.5 Newborn Care at Hospitals

Photo credits: Jhpiego

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:

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;[1]
    • 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.

Table 3.3: Management of Meningitis (Download as image)

Indication Intervention
Cyanosed (blue or purplish discoloration of the skin and/or mucous membranes)
  1. Administer oxygen by nasal prongs or nasal catheter
  2. Monitor oxygen levels with pulse oximetry
Severe respiratory distress
Diagnoses of respiratory distress syndrome
  1. Provide CPAPabbreviation
  2. Monitor oxygen levels with pulse oximetry
Drowsy, unconscious or convulsing Check blood glucose and if the glucose level:
  • is < 20mg/100ml, give IVabbreviation glucose
  • is > 20mg/100ml, feed immediately and increase feeding frequency
  • cannot be checked, assume hypoglycemia and treat with IVabbreviation glucose and initiate feeding
Presence of convulsions

Administer phenobarbital (loading dose for phenobarbital 20 mg/kg IVabbreviation)

If convulsions persist
  1. Give further doses of phenobarbital 10 mg/kg up to a maximum of 40 mg/kg.
  2. If needed, continue phenobarbital at a maintenance dose of 5 mg/kg per day
Additional recommendations
  1. Administer IVabbreviation/IM ampicillin and gentamicin dosage based on weight of baby for 7-10 days
  2. Continue to provide supportive care, reinforce hygienic practice, and closely monitor
  3. Administer vitamin K
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
  1. benzylpenicillin (injectable 5 million IU/vial)
  2. caffeine citrate (20mg/ml oral/injectable solution)
  3. cefotaxime (injectable 125mg/vial)
  4. ceftriaxone (injectable 250mg/vial)
  5. cloxacillin (injectable 250mg/vial)
  6. diazepam (injectable 5mg/ml)
  7. epinephrine (1:10000 solution: 1 mg/ml, vial 1 ml);
  8. glucose hyper, (50%, 50 ml vial)
  9. gentamicin doses (injectable 40mg/ml)
  10. IV/IM Phenobarbital Sodium (injection 200g/ml, vial 1 ml)
  11. sterile water for injections that require dilution
  12. dexamethazone (4mg Injections)
  13. surfactant doses (suspension for intratracheal instillations 25mg/ml or 80mg/ml)

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Notes


Abbreviations

  1. WHO. WHO Recommendations on Interventions to Improve Preterm Birth Outcomes. WHO, 2015. ↩︎