Neonatal Care and

Nutrition
San Sebastian College-Recoletos de Cavite
Bachelor of Science in Nursing - Level II
Presented by: Dr. Archie Guitche
Essential
Newborn Care
● Also known as
Unang Yakap by
DOH
● Series of time bound
chronologically
ordered, standard
procedures that a
baby receives at birth
Essential Newborn Care

● Series of time bound

chronologically ordered, standard
procedures that a baby receives at
birth

• Immediate drying → prevents

hypothermia
Essential
Newborn Care

• Uninterrupted skin-to-
skin contact → prevents
hypothermia, increases
colonization with protective
family bacteria and
improves breastfeeding
initiation and exclusivity.
Essential Newborn Care

• Delayed cord clamping

after 1 to 3 minutes →
decreases anemia in 1 out of
3 premature babies and
prevents brain hemorrhage in
1 out of 2; prevents anemia
in 1 out of 7 term babies.
Essential
Newborn Care

• Non-separation of
mother and baby.
Breastfeeding within first
hour of life prevents
19.1% of all neonatal
deaths.
Thermoregulation

• Newborns are prone to heat loss and hypothermia

• Optimal method for maintaining temperature in a stable neonate?
• Skin-to-skin contact

Mechanism Description
Convection Heat energy to cooler surrounding air
Conduction Heat to colder materials touching the infant
Radiation Transfer of heat to nearby cooler objects
Evaporation Losses from skin and lungs (respiration)
APGAR Scoring System

• Rapidly assess the need to resuscitate

• Changes in the score may reflect how well the infant is
responding to resuscitation
• There is NO consistent data on the significance of APGAR score
on preterm infants
• A low 1-minute score does not correlate with outcome. However,
the 5-minute score is a valid predictor of neonatal mortality.
Breastfeeding

● Nurses are prime healthcare professionals to teach women

about the benefits of breastfeeding and provide anticipatory
guidance for problems that may occur.
Breastfeeding

● You can also help create an atmosphere conducive to

breastfeeding success in healthcare facilities by implementing
steps, such as:
○ Educating all pregnant women about the benefits and
management of breastfeeding
○ Helping women initiate breastfeeding within half an hour
after birth
○ Not giving newborns pacifiers to quiet them as this can
reduce the sucking initiative
Breastfeeding

○ Assisting mothers to breastfeed and maintain lactation

even if they should be separated from their infant
○ Not giving newborns food or drink other than breast milk
unless medically indicated, so they are hungry to
breastfeed. Advise women they need not introduce solid
food until at least 4 months.
○ Supporting rooming-in (such as allowing mothers and
infants to remain together) 24 hours a day
Breastfeeding

○ Encouraging breastfeeding on demand

○ Fostering the establishment of breastfeeding support
groups and referring mothers to them on discharge from
the birthing center or hospital
Physiology of Breast Milk Production

● Breast milk is formed in the acinar or alveolar cells of the

mammary glands

● Prolactin acts on the acinar cells of the mammary glands to

stimulate the production of milk.
Physiology of Breast Milk Production

● Regardless of the gestational age of the infant, the mother

should be able to produce a sufficient quantity of breast milk
for the infant, providing she empties the breasts through
breastfeeding or expressing milk (manually or by using a
breast pump).
Physiology of Breast Milk Production

● Milk flows from the alveolar cells, where it is produced,

through small tubules to reservoirs for milk, the lactiferous
sinuses, located behind the nipple. This constantly forming
milk is called fore milk.
Physiology of Breast Milk Production

● As the infant sucks at the breast, oxytocin, released from the

posterior pituitary, causes the collecting sinuses of the
mammary glands to contract, forcing milk forward through the
nipples, making it available for the baby. This action is called a
let-down reflex.
Physiology of Breast Milk Production

● New milk, called hind milk, is formed after the let-down reflex.
Hind milk, which is higher in fat than fore milk, is the milk that
makes a breastfed infant grow most rapidly.

● The release of oxytocin has a second advantage in that, by

causing smooth muscle contraction, it helps contract the
uterus.
Advantages of Breastfeeding

To the mother:
• The release of oxytocin from the posterior pituitary gland aids
in uterine involution.
• Breastfeeding may serve a protective function in preventing
breast cancer and possibly ovarian cancer.
• A woman may return to her prepregnant weight sooner, and if
menstruation is delayed, this may serve as a temporary family
planning method.
Advantages of Breastfeeding

• Successful breastfeeding can have an empowering effect

because it is a skill only a woman can master.
• Breastfeeding reduces the cost of feeding and preparation
time for infant feeding.
• A long-term effect may include a decreased risk of hip
fractures and osteoporosis in the postmenopausal period for
the woman
Advantages of Breastfeeding

• Breastfeeding provides an excellent opportunity to enhance a

true symbiotic bond between mother and child. Although this
does readily occur with breastfeeding, a woman who holds her
baby to formula feed can form this bond as well.
Advantages of Breastfeeding

To the infant:
● Breast milk contains secretory immunoglobulin A (IgA), which
binds large molecules of foreign proteins, including viruses
and bacteria, thus keeping them from being absorbed from the
gastrointestinal tract.
● Lactoferrin is an iron-binding protein in breast milk that
interferes with the growth of pathogenic bacteria.
Advantages of Breastfeeding

To the infant:
● The enzyme lysozyme in breast milk apparently actively
destroys bacteria by lysing (dissolving) their cell membranes,
possibly increasing the effectiveness of antibodies.
● Macrophages, responsible for producing interferon (a protein
that protects against viruses), help interfere with virus growth.
Advantages of Breastfeeding

To the infant:
● Leukocytes in breast milk provide protection against common
respiratory infectious invaders.
● The presence of Lactobacillus bifidus in breast milk interferes
with the colonization of pathogenic bacteria in the
gastrointestinal tract, thus reducing the incidence of diarrhea
Advantages of Breastfeeding

To the infant:
● It is high in lactose, an easily digested sugar that provides
ready glucose for rapid brain growth.
● The protein in breast milk is easily digested, and the ratio of
cysteine to methionine (two amino acids) in breast milk favors
rapid brain growth in the early months.
Advantages of Breastfeeding

To the infant:
● Formation of the dental arch because babies suck differently
from a breast than from a bottle
● That may make breastfeeding the best preparation for forming
common speech sounds
Breastmilk Composition

• Fat globules bound by membranes rich in:

o phospholipids – cell growth & brain development
o cholesterol – facilitates myelination of the CNS
• Breast milk has MORE compared to Formula milk
o Exceptions:
■ Iron
■ Vit D
■ Vit K
Stages of Lactation

Colostrum

● Colostrum, a thin, watery, yellow fluid

composed of protein, sugar, fat, water,
minerals, vitamins, and maternal
antibodies, is secreted by the acinar
breast cells starting in the fourth
month of pregnancy.
Stages of Lactation

Colostrum

● For the first 3 or 4 days after birth,

colostrum production continues.

● Because it is high in protein and fairly low

in sugar and fat, colostrum is easy to
digest and capable of providing adequate
nutrition for a newborn.
Stages of Lactation

Transitional Milk

● Replaces colostrum on the

second to fourth day.
● Between colostrum & mature
milk
● Rising levels of macronutrients
Stages of Lactation

Mature Milk

• Day 10-14 of life

• Colostrum content + high fat & lactose
Mature Breastmilk

Breast Milk Timing of Release Consistency Content

At the start of High lactose,

Foremilk Watery
feeding high protein

As feeding
High fat (5x the
progresses until
Hind milk Creamy fat content of
towards the end of
milk)
feeding
Techniques of Breastfeeding

4 Signs of Good Latch:

● Baby’s mouth is wide open
● More dark skin (breast areola) can be seen above the baby’s
mouth than below
● Baby’s lower lip is exposed
● Baby’s chin is attached to the mother’s breast
4 Signs of Good Latching

1. Mouth wide open

○ Your baby’s mouth

should be open
wide before they
latch.
4 Signs of Good Latching

2. Lower lip is exposed

○ Your baby’s lips should be

flared out like a fish, not
turned inward towards your
breast. You should be able
to see your baby’s lips when
latched.
4 Signs of Good Latching

3. Chin touching the breast

○ Your baby’s chin should be

touching your breast. To
help, you can use a C-
shaped hand to support your
baby’s neck and head,
bringing the chin in contact
with the breast.
4 Signs of Good Latching

4. Lined up ear, shoulder, and

hip

○ You can achieve this by

gently pressing your baby’s
stomach against your body.
Once in position, you should
be able to visually trace a
line from your baby’s ear,
shoulder, and hip.
Techniques of Breastfeeding

Proper positioning of baby while breastfeeding:

● Supporting whole of baby’s body
● Ensure baby’s head, neck, and back are in same plane.
● Entire baby’s body should face mother
● Baby’s abdomen touches mother’s abdomen
Techniques of Breastfeeding

Signs of effective suckling:

● Your baby takes slow deep suckles, sometimes pausing
● You may be able to see or hear your baby swallowing after
one or two suckles
● Suckling is comfortable and pain free for you.
● Your baby finishes the feed, releases the breast and looks
contented and relaxed
● Your breast is softer after the feed
Breastfeeding Positions

Cradle Hold

The cradle hold is the most common

position and helps provide an enjoyable
feeding and bonding experience for both of
you.

● Sit somewhere with support to keep

your arm at the right height, like an
armed chair or couch. If needed, you
can use pillows to support your arm.
Breastfeeding Positions

Cradle Hold

• Position your little one in your lap with

their head in the crook of your arm.
• Keep your baby’s chest against yours so
they do not have to turn their head
toward your breast. If necessary, use
pillows to support your baby’s head.
Breastfeeding Positions

Cross-cradle Hold

● This position is useful when first learning

to breastfeed and is a great option for
small babies. It allows you to have good
control of your baby’s head while
helping your little one to latch on.
Breastfeeding Positions

Cross-cradle Hold

● Think of this as the reverse of the cradle

hold. To perform the cross-cradle hold,
position your baby in the opposite
direction of the cradle hold with their
head in your hand, rather than the crook
of your arm.
Breastfeeding Positions

Football Hold or Rugby Hold

● If you are dealing with engorged breasts

or sore nipples, this is a great position to
try. The football or rugby hold helps to
prevent plugged ducts by positioning
your baby to empty the bottom ducts –
it's a win for both of you!
Breastfeeding Positions

Football Hold or Rugby Hold

• While turned on your side, hold your

baby like a football or rugby ball along
your forearm, with your baby’s body on
your arm and face toward your breast.
• Position your baby’s legs under your
arm.
• Use your other hand to support your
breast
Breastfeeding Positions

Football Hold or Rugby Hold

• The football or rugby hold is also helpful

if you have undergone a Cesarean
section and can’t place your baby on
your stomach while nursing.
Breastfeeding Positions

Side lying Position

● If you and your baby are more comfortable

lying down, this is a great position to try.
• Lay on your side and place your baby on
their side, facing you, with their head at
your breast.
• Support your back with pillows and make
sure that your baby’s nose isn’t obstructed.
Contraindications to Breastfeeding

• An infant with galactosemia (such infants cannot digest the

lactose in milk)
• Herpes lesions on a mother’s nipples
• Maternal exposure to radioactive compounds (such as occurs
with thyroid testing)
• Mothers receiving antimetabolites or chemotherapeutic agents
• Mothers receiving prescribed medications that would be
harmful to an infant, such as lithium or methotrexate
• Women whose toxicology screens for substance abuse are
positive, who need to be evaluated on an individual
basis regarding recommendations to breastfeed
Contraindications to Breastfeeding

• Women with maternal active, untreated tuberculosis, who

need to be evaluated individually depending on the stage of
their disease
• Women who are positive for HIV, who are advised not to
breastfeed in the United States until further studies confirm the
risk of not breastfeeding outweighs the risk of breast milk
transmission of the virus.
• In developing countries, women who are HIV positive may be
advised to breastfeed because commercial formula is not
available.
Contraindications to Breastfeeding

Important points to remember:

● TB – after two weeks of treatment, mother no longer

considered infectious, may do direct breastfeeding. Prior to
this, expressed mother’s milk can be given
Contraindications to Breastfeeding

Important points to remember:

● HIV – not absolutely contraindicated. In times where no safer

alternative is available, HIV mother can breastfeed provided that:
1. Shortest duration possible
2. Exclusive breastfeeding (mixed feeding increases risk of AGE
which increases transmission rate because of damaged
intestinal villi)
Contraindications to Breastfeeding

• Cigarette smoking is not a contraindication to breastfeeding, but

women should be aware some nicotine is carried in breast milk.

• Nicotine has the potential to decrease a mother’s milk supply