QuestionsQuestions (DOH ADMINISTRATIVE ORDER NO. 2009-0025)
AO No. 2009-0025 adopts evidence-based essential newborn care policies and protocols with emphasis on interventions from birth until the first 6 hours of life (and brief mention up to the first week). It applies to the entire DOH hierarchy, attached agencies, other public and private health providers, development partners implementing MNCHN strategy, and all health practitioners involved in maternal and newborn care.
It aims to ensure globally accepted evidence-based essential newborn care focusing on the first week of life. Specifically: (1) guide health workers in providing evidence-based care, and (2) define roles and responsibilities of DOH offices and other agencies in implementing the newborn protocol.
They are: (1) evidence-based interventions; (2) integrated service delivery (mother and newborn as a unit); (3) human rights-based approach; (4) life-cycle based intervention (continuum of care, not single-disease focus); and (5) multi-sectoral collaboration.
Put on double gloves just before delivery; use a clean dry cloth to thoroughly dry the newborn by wiping eyes, face, head, front/back, arms/legs; remove the wet cloth; do a quick check of breathing while drying; do not place on cold or wet surface; do not bathe earlier than 6 hours; if separation is necessary, place on a warm safe surface close to the mother.
Skin-to-skin contact is placing the naked newborn prone on the mother’s bare chest; it is critical for successful breastfeeding. The AO requires placement on the mother’s abdomen/chest, covers the newborn’s back and head, and specifically states: do not wipe off vernix if present.
It requires delaying or non-immediate cord clamping: clamp and cut the cord after cord pulsations have stopped (typically 1 to 3 minutes), and do not milk the cord toward the newborn. It also prescribes tying tightly around the cord at specified distances and cutting between ties with sterile instruments, with observation for oozing blood.
Ensure that 10 IU Oxytocin IM is given to the mother, and follow other protocols per PCPNC.
Within 90 minutes of age, it requires leaving the newborn on the mother’s chest in skin-to-skin contact, health workers should not touch unless medical indication; counsel the mother to start feeding when feeding cues appear; advise positioning and attachment when ready; advise not to throw away colostrum; and support if attachment/suckling is not good.
Administer erythromycin or tetracycline ointment or 2.5% povidone-iodine drops to both eyes after the newborn has located the breast; do not wash away the eye antimicrobial.
Give Vitamin K prophylaxis: inject 1 mg IM; if parents decline IM, offer oral Vitamin K as the second line. Also inject Hepatitis B vaccine IM and BCG intradermally, examine the newborn (weigh, record, look for birth injuries/malformations), and perform cord care counseling/proper handling.
Suctioning is indicated only if the mouth/nose is blocked with secretions/materials. The AO discourages routine suctioning, noting virtually all healthy newborns were suctioned unnecessarily and that dirty bulbs can be infection sources and may be associated with cardiac arrhythmia.
It discourages early bathing/washing before the WHO-recommended timeframe of at least 6 hours after birth. It explains that early bathing causes temperature drop increasing infection risk and other complications, removes vernix (protective barrier), and removes the crawling reflex.
It lists: (1) routine suctioning; (2) early bathing/washing; (3) footprinting as inadequate for newborn identification; (4) giving sugar water/formula/prelacteals and use of bottles/pacifiers before breastfeeding is established; and (5) application of alcohol/medicine/substances on the cord stump and bandaging the cord stump/abdomen.
Discharge is planned when breastfeeding is well and weight gain is adequate for 3 consecutive days; temperature is 36.5–37.5°C for 3 consecutive days; and the mother is able and confident in caring for the newborn. Return/go to hospital immediately if jaundice of soles or specified danger signs occur (feeding difficulty, convulsions, movement only when stimulated, fast/slow/difficult breathing with severe chest-in-drawing, temperature >37.5°C or <35.5°C).
Postnatal visit 1 at 48–72 hours; postnatal visit 2 at 7 days; immunization visit 1 at 6 weeks. It also provides additional follow-ups for problems such as breastfeeding difficulty, low birth weight, red umbilicus, infections, thrush, and weight gain issues.
Implementation uses the MNCHN service delivery network and referral system with Service Delivery Teams: community level (Community/Women’s Health Teams) and facility level (BEmONC and CEmONC Teams, itinerant teams, social hygiene clinic teams). These teams provide integrated services including maternal and newborn care and child survival packages like IYCF, IMCI, and EPI.
Implementation is stated to be a driver for health facilities’ accreditation and for professionals to qualify for PhilHealth benefits, as newborn care policies are integrated into enhanced Normal Spontaneous Deliveries (NSD) and Maternal Care Packages (MCP) of PhilHealth. Funding sources include national/local levels and public/private sectors for supplies and capability-building.
It takes effect immediately upon posting and publication in the DOH intranet of fifteen (15) days after filing with the UP Law Center.