Are Newborn Care Practices Done Properly within the First Hour of Life? A Survey on 51 of the Largest Hospitals in the Philippines

The Philippines is one of 42 countries accounting for 90 percent of all global deaths in children under 5 years of age with 82,000 Filipinos die before reaching their 5th birthday. There are also over 40,000 newborns who die annually. And if newborn mortality is not reduced by half, the goal of reducing childhood mortality by two thirds, which is part of the Millennium Development Goals, will not be met.

In a study of consecutive deliveries in 51 of the largest hospitals in 9 regions in the Philippines, an assessment tool developed by the World Health Organization (WHO) as a standard in Newborn Care which included the evidence-based intervention, was used to evaluate the performance, timing of procedures and attendant capabilities in immediate newborn care.

The Intrapartum/Newborn Practices assessment tools were developed through a collaboration between the Philippine General Hospital and World Health Organization(WHO) with Department of Health (DOH) inputs. In this cross – sectional study in 2009 using a brief questionnaire and annual reports such as hospital births, deaths and sepsis cases, approximately 10 babies were consecutively included from each of the randomly selected 51 hospitals.

These evidence-based interventions include immediate drying, skin-to-skin contact followed by clamping of the cord and non-separation, and breastfeeding initiation. Necessary interventions like immunizations, eye care, vitamin K administration was also timed. Unnecessary procedures such as “routine” suctioning, “routine” separation of newborns for “observation”, giving of glucose water or formula and footprinting (increasing risk of contamination from ink pads) was also identified.

A total of 481 mother-newborn dyads were directly observed. The percentages and median times to the following included cord clamping (12 sec), drying (93.8% at 1 min), skin-to-skin contact (9.6% at 4 min) and any early contact with mother (61.1% at 5 min), washing (84.2% at 8 min), breastfeeding initiation (61.3% at 10 min), separation from mother (93.2% at 12 min), weighing (100% at 13 min), examination (75.7% at 17 min), transfer to a nursery (52.4% at 20 min), eye prophylaxis (99.8% at 20 min), injections of vitamin K/vaccines (95.6% at 22 min) and rooming-in (83.4% at 138 min). Only 1 of 26 apneic or gasping newborns was dried prior to other actions.

It was found from the study that among the randomly selected 51 hospitals in the Philippines, performance and timing of evidence-based interventions in immediate newborn care were below WHO essential newborn care standards. In these hospitals, their practices prevented Philippine newborns from benefiting from their mothers’ natural protection in the first hour of life and almost none in the study newborns benefited from the natural transfusion from delayed cord clamping. It should be known that any unnecessary delay and restriction on immediate thorough dring, early and sustained skin-to-skin contact, early latching, rooming in and full breastfeeding, compromised the newborns’ chance for maintenance of warmth and survival beyond the newborn period. Further, these interventions can be integral to hospital infection control practices as they directly reduce risk of neonatal sepsis.