Midwife Licensure Exam Midwifery Pharmacology & Newborn Procedures — Mandated Newborn Procedures by the MidwifeConcept Map

Concept

EINC/Unang Yakap Four Core Steps

Sub Concepts

• Immediate drying (first 30 seconds)
• Early skin-to-skin contact
• Properly timed cord clamping (1-3 minutes)
• Non-separation for early breastfeeding (within 90 minutes)

Relationship To Central

Foundation of normal newborn care; time-bound sequence midwife must follow

Concept

Immediate Newborn Assessment

Sub Concepts

• APGAR Score (1 and 5 minutes)
• Breathing assessment
• Heart rate measurement
• Muscle tone evaluation
• Color and reflex irritability
• Vital signs (RR, HR, temperature, weight)

Relationship To Central

Critical evaluation of newborn transition and need for intervention

Concept

Thermoregulation and Heat Loss Prevention

Sub Concepts

• Warm chain maintenance
• Skin-to-skin contact (Kangaroo Mother Care)
• Delayed bathing (≥6 hours, ideally 24 hours)
• Environmental warmth (25-28°C room temperature)
• Recognition of hypothermia (axillary temp <36.5°C)

Relationship To Central

Essential procedure for newborn survival; prevents hypothermia complications

Concept

Pharmacological Newborn Prophylaxis

Sub Concepts

• Vitamin K1 prophylaxis (VKDB prevention)
• Eye prophylaxis (erythromycin ointment)
• BCG vaccination (within 24 hours)
• Hepatitis B birth-dose vaccine (within 24 hours)

Relationship To Central

Mandated pharmaceutical interventions to prevent serious newborn conditions

Concept

Cord Care Management

Sub Concepts

• Timing of clamping and cutting
• Dry cord care protocol
• Danger signs recognition (omphalitis)
• Normal separation timeline (5-15 days)

Relationship To Central

Standard procedure for umbilical stump management and infection prevention

Concept

Newborn Screening Programs (RA 9288 & RA 9709)

Sub Concepts

• Newborn Screening Act (RA 9288)
• Universal Newborn Hearing Screening (RA 9709)
• Heel-prick collection timing (24-72 hours)
• Expanded Newborn Screening panel disorders
• Hearing screening methods (OAE/AABR)

Relationship To Central

Statutory mandated screening procedures for early disease detection and intervention

Concept

Detect and Refer Framework

Sub Concepts

• Meconium aspiration (non-vigorous baby)
• Severe neonatal depression (APGAR 0-3)
• Congenital anomalies
• Temperature instability
• Positive newborn screening results
• Hearing screening refer results

Relationship To Central

Midwife's scope in identifying complications requiring specialist care

Concept

Do NOT Practices in EINC

Sub Concepts

• Do NOT suction routinely
• Do NOT bathe early
• Do NOT separate mother and baby
• Do NOT wipe off vernix
• Do NOT apply cord antiseptics (unless protocol requires)
• Do NOT delay cord clamping beyond 3 minutes

Relationship To Central

Critical procedures to avoid that may harm normal newborn transition

To

Thermoregulation and Heat Loss Prevention

From

EINC/Unang Yakap Four Core Steps

Strength

strong

Relationship

Early skin-to-skin contact and drying are primary thermoregulation mechanisms within EINC protocol

To

Non-Separation for Early Breastfeeding

From

EINC/Unang Yakap Four Core Steps

Strength

strong

Relationship

Fourth EINC step directly enables early breastfeeding and mother-baby bonding

To

APGAR Score

From

Immediate Newborn Assessment

Strength

strong

Relationship

APGAR is the primary scoring tool for newborn transition assessment at 1 and 5 minutes

To

Detect and Refer Framework

From

Immediate Newborn Assessment

Strength

strong

Relationship

Assessment findings (APGAR 0-3, abnormal vitals, anomalies) trigger detect-and-refer pathway

To

Cord Care Management

From

Properly Timed Cord Clamping

Strength

strong

Relationship

Correct clamping timing precedes all subsequent cord care procedures

To

Pharmacological Newborn Prophylaxis

From

Vitamin K1 Prophylaxis

Strength

strong

Relationship

Vitamin K1 is one of four mandated pharmacological interventions in first hours

To

Pharmacological Newborn Prophylaxis

From

Eye Prophylaxis

Strength

strong

Relationship

Eye prophylaxis (erythromycin) prevents ophthalmia neonatorum; mandated for every newborn

To

Newborn Screening Programs

From

Newborn Screening RA 9288

Strength

strong

Relationship

RA 9288 establishes mandatory expanded newborn screening using heel-prick at 24-72 hours

To

Newborn Screening Programs

From

Newborn Hearing Screening RA 9709

Strength

strong

Relationship

RA 9709 mandates universal hearing screening using OAE/AABR before discharge

To

Detect and Refer Framework

From

Newborn Screening RA 9288

Strength

strong

Relationship

Positive newborn screening results (CH, CAH, GAL, PKU, G6PD) require urgent referral for confirmatory testing

To

Detect and Refer Framework

From

Newborn Hearing Screening RA 9709

Strength

strong

Relationship

Hearing screening refer results trigger audiologist referral and early intervention by 6 months

To

EINC/Unang Yakap Four Core Steps

From

Do NOT Practices in EINC

Strength

strong

Relationship

Do NOT practices define what must be avoided during standard EINC implementation

To

Detect and Refer Framework

From

Meconium Aspiration Management

Strength

strong

Relationship

Non-vigorous meconium-stained baby requires immediate resuscitation and referral (do not suction, call help, bag-mask within golden minute)

To

Thermoregulation and Heat Loss Prevention

From

Recognize Hypothermia

Strength

strong

Relationship

Hypothermia recognition (axillary temp <36.5°C) triggers corrective action and potential referral

To

Newborn Screening RA 9288

From

Congenital Hypothyroidism

Strength

strong

Relationship

CH is the classic high-yield newborn screening disorder; early thyroxine prevents intellectual disability

To

Do NOT Practices in EINC

From

Delayed Bathing

Strength

moderate

Relationship

Delayed bathing (≥6 hours, ideally 24 hours) is mandated to prevent heat loss and preserve skin barrier

To

Prevent VKDB

From

Vitamin K1 Prophylaxis

Strength

strong

Relationship

Vitamin K1 IM injection (1 mg term, 0.5 mg preterm) within first hour prevents Vitamin K Deficiency Bleeding

To

Prevent Ophthalmia Neonatorum

From

Eye Prophylaxis

Strength

strong

Relationship

Erythromycin 0.5% ointment applied to both eyes prevents ophthalmia neonatorum caused by maternal STIs

To

Pharmacological Newborn Prophylaxis

From

BCG and Hepatitis B Birth-Dose

Strength

strong

Relationship

Immunizations given within 24 hours of birth as mandated part of newborn care package

To

Newborn Screening RA 9288

From

Midwife's Responsibility for Screening

Strength

strong

Relationship

Midwife is legally responsible for ensuring heel-prick collection, informing parents, and arranging follow-up

To

Newborn Screening RA 9288

From

Heel-Prick Collection Timing

Strength

strong

Relationship

24-72 hours is ideal timing; before 24 hours risks false negatives; repeat required if early collection

To

Newborn Screening RA 9288

From

Expanded Newborn Screening Panel

Strength

strong

Relationship

Panel screens for preventable causes of intellectual disability: CH, CAH, GAL, PKU, G6PD, MSUD and others

To

Newborn Hearing Screening RA 9709

From

OAE and AABR Testing Methods

Strength

strong

Relationship

OAE (otoacoustic emissions) and AABR (automated auditory brainstem response) are two validated screening modalities

To

Newborn Hearing Screening RA 9709

From

Early Intervention Goal by 6 Months

Strength

strong

Relationship

Detection of congenital hearing loss enables intervention by 6 months, preserving speech and language development

To

Cord Care Management

From

Omphalitis Prevention and Recognition

Strength

moderate

Relationship

Mother education about danger signs (redness, foul discharge, swelling) enables early return and referral

To

Do NOT Practices in EINC

From

Vernix Protection

Strength

moderate

Relationship

Do NOT wipe off vernix; it provides natural skin protection and is absorbed gradually

To

Do NOT Practices in EINC

From

Routine Suctioning Avoidance

Strength

strong

Relationship

Avoid routine suctioning; only suction if baby not breathing or obvious airway obstruction

To

EINC/Unang Yakap Four Core Steps

From

Mother-Baby Non-Separation

Strength

strong

Relationship

Non-separation is fourth EINC core step; essential for breastfeeding initiation and bonding

To

Detect and Refer Framework

From

Golden Minute Priority

Strength

strong

Relationship

Establishing breathing within first 60 seconds is the single highest priority, taking precedence over routine procedures

To

Immediate Newborn Assessment

From

Normal Vital Signs Reference Ranges

Strength

strong

Relationship

Knowledge of normal RR (40-60), HR (120-160), temperature (36.5-37.5°C), weight (2500-4000g) guides assessment