https://doi.org/10.33698/NRF0223 Banrikordor Khyriem, V Venkadalkshmi, Avinash Kaur Rana
Abstract : Introduction : Immediate newborn care is the care provided to a newborn baby immediately after delivery and it is of immense importance for the healthy life of a baby. Early skin-to- skin contact and delayed cord clamping are important components of immediate newborn care. Organizations like WHO and American Academy of Pediatrics have provided recommendations regarding immediate newborn care of a term baby.
Objective : To assess the current practices of immediate newborn care for term newborns in relation to early skin-to-skin contact and delayed cord clamping among health personnel of Labour Room in a tertiary care hospital in North India.
Methodology : Tools used were questionnaire for demographic and experience profile of health personnel and an observation checklist with stepwise items of immediate newborn care in relation to early skin-to-skin contact and delayed cord clamping. A total of 45 health personnel filled the questionnaires and 13 full term deliveries were observed by using the observation checklist.
Results : Out of the 13 deliveries, warm and dry linens were kept ready and mother was provided with clean gown in all the deliveries. Breastfeeding was initiated within 1 hour of birth in 92.31% of the deliveries. Delayed cord clamping was done in 30.76% while early skin-to-skin contact was not done in any of the deliveries.
Conclusion : There is inadequate practice of delayed cord clamping and early skin-to-skin contact. Standardization of immediate newborn care practices in relation to early skin-to- skin contact and delayed cord clamping by developing protocol and educating health personnel can bring about the improvement in immediate newborn care.
Keywords
Current practices, Immediate newborn care, early skin-to-skin contact, delayed cord clamping
Correspondence at
V Venkadalakshmi
Lecturer
National Institute of Nursing Education (NINE) PGIMER, Chandigarh.
Introduction
Immediate newborn care is the early management of the newborn immediately following birth in the delivery room or nursery1. Early skin-to-skin contact and delayed cord clamping are important components of immediate newborn care for term newborns. Early skin-to-skin contact can be achieved by putting the newborn baby naked in prone position on the mother’s naked chest or abdomen immediately following delivery with the baby’s back covered by warm linen. All routine procedure such as maternal and newborn assessments can take place during skin-to- skin care or can be delayed.2 Delayed cord clamping is achieved by clamping and cutting the umbilical cord at or after 60 seconds after delivery3.
Many organizations have given recommendations regarding immediate newborn care. World Health Organization (WHO) recommends that while initiating simultaneous essential newborn care, cord clamping should be performed after 1-3 minutes after birth. WHO does not recommend early cord clamping, that is, clamping the cord less than 1 minute after birth except if the baby is asphyxiated or the baby needs to be resuscitated. WHO also recommends that newborns without complications should be kept with their mother for early skin-to-skin contact for the first hour of birth as it helps in preventing hypothermia and promote breastfeeding.3
The American Heart Association and the American Academy of Pediatrics in 2015 recommends that newborn infants who do not require resuscitation should stay with the mother for routine care which includes: drying the infant, placing the infant skin-to- skin contact with the mother, covering the baby and mother with dry linen to maintain a normal temperature.4 The All India Institute of Medical Science (AIIMS) protocol in 2014 recommends that immediately after the birth, the infant must be placed on the mother’s abdomen to ensure early skin-to- skin contact. This will help in maintaining the temperature of the newborn, promoting early breastfeeding and also help in decreasing the pain and bleeding of the mother. The protocol also recommends that delayed cord clamping for nearly 2 minutes should be done as it helps in allowing flow of additional amount of blood from the placenta to the infant.5 The American Congress of Obstetricians and Gynecologists (ACOG) in 2017 recommends in vigorous term and preterm infants, cord clamping should be delayed for at least 30-60 seconds after birth.6 Early skin-to-skin contact and delayed cord clamping that have been highlighted in various recommendations and proven to be beneficial to the newborn. Mahmood I et al showed that early skin-to-skin contact shorten the time of initiation of breastfeeding and improve the rate of success of first breastfeeding.7 Srivastava S et al concluded in their study that early skin- to-skin contact helps in preventing hypothermia.8 Chaparro C et al observed that infants who had delayed cord clamping had higher levels of serum ferritin. Mean corpuscular volume and total body iron than infants who did not have delayed cord clamping.9 Though, care of all term newborns should include immediate and thorough drying, skin-to-skin contact of the newborn with the mother, cutting and clamping the cord at or after the first minute of birth, early initiation of breastfeeding, and exclusive breastfeeding10, many health care settings including tertiary care centres do not follow these recommendations due to various reasons. Many newborn care practices that are being followed commonly in health settings, like weighing, giving injection vitamin K delay thermoregulation and breastfeeding initiation. This is not beneficial for the newborns11.Observational studies help in uncovering practices which are not in accordance with recommendations which may not benefit the newborns11. This study aims to observe the current practices of immediate newborn care in relation to early skin-to-skin contact and delayed cod clamping in Labour room of a tertiary care hospital, North India. These data will be used to develop an immediate newborn care protocol for term newborns.
Objective
To assess the current practices of health personnel while providing immediate newborn care for term newborns in relation to early skin-to-skin contact and delayed cord clamping.
Materials and Methods
An observational approach was used to assess the current practice of immediate newborn care for term newborns in relation to early skin-to-skin contact and delayed cord clamping in Labour room of a tertiary care hospital, North India. The Labour room consists of observation room, delivery room with 2 delivery tables, nursery and post natal unit. There are about 4000 deliveries conducted annually. Ethical clearance for conducting the study has been given by the Institute Ethics committee, PGIMER, Chandigarh. In the current study, the deliveries are being conducted by the residents of obstetrics and gynaecology department while the immediate newborn care for term newborns is being provided by the nurses. The tools used were questionnaire to collect the demographic and experience profile of the health personnel and an observation checklist which include sequence of steps of immediate newborn care in relation to delayed cord clamping and early skin-to- skin contact. A total of 45 health personnel filled the questionnaires and 13 full term deliveries were observed during July 2016 using the observation checklist. The inclusion criteria include newborns of gestational age 37-42 weeks. Exclusion criteria include term newborns who need resuscitation, multiple deliveries, newborns who are born to mothers with severe bleeding, eclampsia, cardiac problems.
Results Table 1: Demographic Characteristics of
|
Table 1 describes the demographic characteristics of health personnel. Among them 93.3% were females, 53.3% were B.Sc Nursing, 66.7% sister grade II, 22.2% Junior Residents, 6.7% Senior Residents and 4.4% sister grade I.
Table 2 depicts the experience profile of health personnel. The mean experience of the health personnel in PGIMER was 3.72±4.61 years with a range 0.7-22 years. The mean experience in labour room was 2.8±2.86 years with a range of 0.5 -22 years while the mean total experience of the health personnel was 4.75±4.78 years with a range of 0.1-14 years . The average number of deliveries attended by the health personnel per week was 19.62±8.33 with a range of 4-40
Health Personnel
N=45
Table 2: Experience Profile of Health Personnel
N=45
| Variables | Mean±SD | Range |
| Experience (In years) | ||
| In PGIMER | 3.72±4.61 | 0.7-22 |
| In Labour room | 2.8±2.86 | 0.5-22 |
| Total | 4.75±4.78 | 0.1-14 |
| Average number of deliveries attended per week | 19.62±8.33 | 4-40 |
Table 3 depicts the current practices regarding immediate term newborn care in relation to early skin-to-skin contact and delayed cord clamping. Mother provided with gown and warm and dry linens kept ready in all the deliveries. Breastfeeding initiated on or before first hour of life in 92.31% of the deliveries. Just born baby placed on mother’s tummy was done in 61.53% of the deliveries. Clamp and cut the cord at or after 60 seconds from birth was done in 30.76% of the deliveries. Nurse calls out time of delivery in 23.07% of the deliveries. The rest of the steps for maintaining skin to skin contact for one hours after birth were not done in any of the deliveries.
Table 3: Assessment of current practices of immediate term newborn care
N=13
| Steps | n(%) |
| Mother explained about skin-to-skin contact | – |
| Mother provided with gown | 13(100) |
| Warm and dry linens kept ready | 13(100) |
| Cap and socks are kept ready | – |
| Nurse calls out time of delivery | 3(23.07) |
| Just born baby placed on mother’s tummy | 8(61.53) |
| Back of the baby dried with warm linen | – |
| Wet cloth removed | – |
| Baby covered with warm cloth | – |
| Cap and socks are applied to the baby | – |
| Skin-to-skin contact continued while mother is still on delivery table | – |
| Nurse calls out time to clamp and cut the cord | – |
| Clamp and cut the cord at or after 60 seconds from birth | 4(30.76) |
| Baby and mother covered with warm linen | – |
| Mother assisted to get down from delivery table | – |
| Mother transferred to post natal unit while skin-to-skin contact continued | – |
| Mother’s gown changed and clean dress provided | – |
| Skin-to-skin contact not broken in between first hour of birth | – |
| Baby’s axillary temperature checked at 1 hour | – |
| Breastfeeding initiated on or before first hour of life | 12(92.31) |
Discussion
Immediate newborn care is of great importance to the health of the newborn and the promotion of essential newborn care practices helps in improving newborn health outcomes. Early skin-to-skin contact and delayed cord clamping are important components of immediate newborn care. The newborn care practices recommended by various organizations like WHO in relation to early skin-to-skin contact and delayed cord clamping may not be implemented in health settings even in tertiary care centres due to various reasons. Observing current practices helps in uncovering practices which are not in accordance with these recommendations and the reasons for it.11 Since, the current study is a pilot project, full term deliveries were observed using an observation checklist and these data collected will help in developing an immediate newborn care protocol for term newborns. Through the observation, it was found that some good practices were being done such as mother was provided with gown and warm and dry linens were kept ready in all the deliveries, breastfeeding was initiated on or before first hour of life in 92.31% of the deliveries which is much higher than the result observed in a study conducted by Callaghan-Koru J et al in their settings, where, 56.7% newborns were breastfed within the first hour.12 It was also observed that just born baby was placed on mother’s abdomen in 61.53% of the deliveries which is higher than the findings by Callaghan-Koru J et al who observed that keeping the newborn on the mother’s chest immediately after delivery was done in 21.5%.
The current study showed that clamping and cutting the cord at or after 60 seconds from birth was done in 30.76% of the deliveries which is lower than the findings of a study conducted by Blouin B et al who observed that cord clamping at or after 1 minute after birth was done in 39.3%.13 Nurse calls out time of delivery was done in 23.07% of the deliveries. The rest of the steps including early skin-to-skin contact were not done in any of the deliveries which was similar to the finding of a quality improvement initiative conducted by Sharma K et al in another tertiary care centre in North India, where the practice of skin-to-skin contact immediately after delivery was at 0%.14 In present study early skin-to-skin contact was not done in any of the deliveries and delayed cord clamping was done in some deliveries because they are not in routine practice of the Labour room.
The study concludes that the steps in the current practice of immediate newborn care in labour room are not in accordance with the steps recommended by various organizations and there is inadequate practice of important steps that is early skin- to-skin contact and delayed cord clamping which in turn can impact the health outcome of the newborn. By developing protocol about immediate newborn care in relation to early skin-to-skin contact and delayed cord clamping and educating health personnel about it, the practices can be standardized can bring about improvement in immediate newborn care.
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