Internal Medicine

Essential newborn care (ENC)


Care that every newborn baby needs regardless of where it is born or its size.

Sequence of care

Preparation for birth

  • Warm & drought free delivery room
  • Pre-heated radiant warmer
  • 2x clean warm towels
  • Asepsis:
    • Hand washing, sterilised gloves
    • Sterilized delivery kit
  • Functional bag & mask

Immediate newborn care

First 60-minutes of birth

  • Record time of birth
  • Rule out meconium
  • If meconium present, or baby not crying:
    • Suction before drying
  • Put baby on mother’s abdomen. Check for breathing and dry the baby
  • Remove wet towel and ensure skin-to-skin contact. Cover baby with dry & warm towel
  • Ensure cord-cutting (within 1-3 minutes)
  • Rule out major malformations & birth injury
  • Support mother in initiating breastfeeding (within 30 minutes)
  • Place identity tag on baby

Early newborn care

60 min – 6 hours

  • Weigh the baby (ensure proper function prior)
  • Administer Vitamin K IM (1 mg)
  • Examine for vital signs& ruole out danger signs
  • Vaccinate:
    • BCG
    • OPV-0
    • HepB- birth dose
  • Rooming-in with mother

Care prior to discharge

6 hours – 48 hours

  • Continue monitoring
  • Ensure successful establiishment of breastfeeding & rule out any feeding difficulty
  • Counsel mother for exclusive breastfeeding
  • Continue to keep baby warm

Care at discharge

Discharge criteria

  • Screening tests done
  • Nutritional supplements started
  • Immunization completed
  • Weight gain is consistent
  • Baby is feeding well
  • Absence of danger signs
  • Treatment completed (if any)

Danger signs

  • History of difficulty in feeding
  • Movement only when stimulated
  • Temperature below 35·5°C or 37·5°C or more
  • Respiratory rate over 60 breaths per minute
  • Severe chest indrawing
  • History of convulsions


  • DO NOT:
    • Suction (unless nose/mouth is blocked)
    • Separate newborn from mother
    • Place newborn on wet/cold surface
    • Wipe off vernix
    • Bathe the baby (till discharge)
    • Feed anything other than breastmilk
    • Discharge (if baby is not feeling well)


Within 3-7 days of discharge


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