Mastering the Standards: Essential Newborn Care
Maria Asuncion A. Silvestre, FAAP
Asphyxia (31%), complications of prematurity (30%) and severe infections (19%)
account for the majority of newborn deaths in the Philippines. i,ii Three out of every 4
of these deaths in the newborn period, occur in the first week of life. Care in the
immediate period after birth thus cannot be overemphasized.
Every health worker should have a working knowledge of the Essential Newborn Care
(ENC) Protocol. iii Signed into an Administrative Order of the Department of Health
in 2009, ENC emphasizes a bundle or package of interventions for the newborn that
follows a core sequence of life-saving interventions.
In the immediate newborn care period, the four core steps are 1) immediate and
thorough drying, 2) early skin-to-skin contact, 3) properly-timed cord clamping an 4)
non-separation of the newborn from his/her mother to complete the first
breastfeeding. Breastfeeding is known to save lives. iv Data from large prospective
cohort studies have shown that delaying breastfeeding initiation after the first hours
increases the risk of infection-related death of newborns two- to four-fold. v,vi
Other essential but less ‘time-bound’ interventions like eye prophylaxis, vitamin K,
hepatitis B and BCG vaccinations should be postponed until after the newborn has
located the breast, manifested feeding cues and completed the first breastfeed. The
newborn should not be separated from his/her mother, if at all possible to complete
this breastfeed. Weighing, bathing and the complete neurophysical examination
should likewise be deferred to as not to compromise the first colostrum feeding.
i The Department of Health. The Philippine Child Survival Strategy. Jan 2008.
ii World Health Organization Western Pacific Region (WHO WPR) and United Nations Children’s Fund (UNICEF). WHO/UNICEF
Regional Child Survival Strategy. Accelerated and Sustained Action Towards MDG 4. 2006.
iii WHO. Newborn care until the first week of life: clinical practice pocket guide. World Health Organization 2009. Available at
http://www.wpro.who.int/philippines/PubDocs.htm
iv Pan American Health Organization, Quantifying the benefits of breastfeeding: a summary of the evidence. Leon-Cava, Lutter C,
Ross, J, Martin L, eds. Washington, D.C.: PAHO. June 2002.
v Edmond KM, Kirkwood BR, Amenga-Etego S, Owusu-Agyei S, Hurt LS. Effect of early infant feeding practices on infectionspecific neonatal mortality: an investigation of the causal links with observational data from rural Ghana. Am J Clin Nutr, 2007;
86(4):1126-31.
vi Mullany LC, Katz J, Yue ML, Khatry SK, LeClerq SC, Darmstadt GL, et al. Breast-Feeding patterns, time to initiation, and
mortality risk among newborns in Southern Nepal. J Nutr, 2008; 138(3):599-603.
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