Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
If the mother’s HIV status is positive:
• Take particular care not to suction the mouth and the nose unless it is absolutely
necessary.
• Consider swabbing the whole body of the baby with chlorhexidine (0.25%) swabs/wipes as
recommended by the Ministry of Health.
• Administer ARV prophylaxis (niverapine and AZT or others as recommended by the
Ministry of Health).
• Infant feeding options for mothers whose HIV status is positive include the following:
o exclusive breastfeeding, taking care to avoid problems such as engorged breasts
and sore nipples, until six months, followed by rapid switch to formula feeds and
complementary feeding with semi-solids.
o use of expressed breast milk (EBM) rendered safe by flash heating of the milk (see
below), continued with complementary feeds with semisolids from the age of six
months (see chapter 11 on breastfeeding).
o use of formula feeds with complementary feeds from birth with semi-solids from the
age of six months. Formula feeds are applicable when replacement feeding is
acceptable, feasible, affordable, sustainable, and safe (AFASS); avoidance of all
breastfeeding by HIV-infected women is recommended. (WHO, 2009)
• The actual type of feeding will depend on the mother’s choice. You as the health care
provider should ensure that she is given the counseling and support she needs.
• It is important to stress the dangers of “mixed” feeding (breast milk and formula).
Table 5. Key Steps for Immediate Care of the Newborn
(The order may be changed according to the local needs, except for steps 1-3.)
Step 1 Dry the baby and keep him/her warm by placing the baby on the mother’s
abdomen.
Step 2 Assess breathing. Make sure the baby is breathing well.
Step 3 If the baby does not breathe, clamp/tie and cut the cord immediately and start
resuscitation.
If the baby does cry/breathes well, clamp/tie and cut the cord after pulsations
stop or after 2-3 minutes.
Step 4 Place the infant in skin-to-skin contact on the mother’s chest and cover both with
clean linen and blanket as required. Carry out all the steps noted below up to #9,
preferably with the baby on the mother’s chest.
Step 5 Administer eye drops/eye ointment.
Step 6 Administer vitamin K1.
Step 7
Step 8
Step 9
Step 10
Note
Place the baby identification bands on the wrist and ankle.
Initiate breastfeeding within the first hour.
Select the appropriate method of feeding for the HIV-infected mother, based on
informed choice.
Weigh the infant when he/she is stable.
Record observations and treatment provided in the registers/appropriate
chart/cards.
Defer the bath for at least six hours.
Clean the newborn of an HIV-infected mother as recommended by the Ministry of
Health.
Integrated maternal and newborn care
Basic skills course
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