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