Immediate newborn care practices delay thermoregulation and breastfeeding initiation

Abstract

AimA deadly nosocomial outbreak in a Philippine hospital drew nationwide attention to neonatal sepsis. Together with specific infection control measures, interventions that protect newborns against infection-related mortality include drying, skin-to-skin contact, delayed cord clamping, breastfeeding initiation and delayed bathing. This evaluation characterized hospital care in the first hours of life with the intent to drive policy change, strategic planning and hospital reform.MethodsTrained physicians observed 481 consecutive deliveries in 51 hospitals using a standardized tool to record practices and timing of immediate newborn care procedures.ResultsDrying, weighing, eye care and vitamin K injections were performed in more than 90% of newborns. Only 9.6% were allowed skin-to-skin contact. Interventions were inappropriately sequenced, e.g. immediate cord clamping (median 12 sec), delayed drying (96.5%) and early bathing (90.0%). While 68.2% were put to the breast, they were separated two minutes later. Unnecessary suctioning was performed in 94.9%. Doctors trained in neonatal resuscitation were 2.5 (1.1–5.7) times more likely to unnecessarily suction vigorous newborns. Two per cent died and 5.7% developed sepsis/pneumonia.ConclusionsThis minute-by-minute observational assessment revealed that performance and timing of immediate newborn care interventions are below WHO standards and deprive newborns of basic protections against infection and death.

Early breastfeeding initiation and incidence of neonatal sepsis in Chipinge District Zimbabwe

“…8 Despite the proven causes of neonatal sepsis, scientific evidence still attribute delayed breastfeeding initiation ton infection occurrence in the first 7 to 28 days of life. 3 Immediate newborn care which encompasses early initiation of breastfeeding has been reported to be a major non cost effective intervention in averting neonatal morbidity related to infections, hypothermia neonatal dehydration.…”

“…On the same note, the vernix Casiosa acts as a barrier against Escherichia coli and facilitates the breast craw reflex for early initiation of breastfeeding. 8 …”

Healthy Birth Practice #6: Keep Mother and Baby Together— It’s Best for Mother, Baby, and Breastfeeding

“…Shorter intervals between birth and the start of skinto-skin care and longer times spent skin-to-skin after birth improved breastfeeding exclusivity and duration. No data show that results vary by mode of birth (since most studies on skin to skin are on Gabriel et al, 2010;Moore et al, 2012;Sobel et al, 2011;Takahashi et al, 2011). Immediate skin-toskin care enables colonization of the newborn to maternal flora (vs. hospital flora) to protect against infection and promotes breastfeeding (Sobel et al, 2011).…”

“…Following vaginal birth, direct skin-to-skin care for stable mothers and babies can begin immediately, prior to cord clamping, as a newborn is placed on the mother's abdomen, dried, and covered with a blanket (Baby-Friendly USA, 2011;Sobel et al, 2011;UNICEF, 2011;World Health Organization, UNICEF, 2009). Once the cord is clamped, the newborn then can be moved to the mother's chest.…”

“…Skin-to-skin care means placing dried, unclothed newborns on their mother's bare chest, with warmed light blankets or towels covering the newborn's back. All routine procedures such as maternal and newborn assessments can take place during skin-to-skin care or can be delayed until after the sensitive period immediately after birth (American Academy of Pediatrics Section on Breastfeeding, 2012; American College of Obstetrics and Gynecologists [ACOG] Committee on Obstetrics Practice, Committee on Health Care for Underserved, 2013;Sobel, Silvestre, Mantaring, Oliveros, & Nyunt-U, 2011). First impressions are important and perhaps none more so than the newborn's first moments of introduction to the world and the mother's to her child.…”