Mandated Newborn Procedures by the Midwife - Concept Map
Essential Newborn Care in the First Hours of Life (EINC/Unang Yakap Protocol)
Related concepts
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
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
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
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
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
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
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
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
Concept connections
- EINC/Unang Yakap Four Core StepsThermoregulation and Heat Loss PreventionEarly skin-to-skin contact and drying are primary thermoregulation mechanisms within EINC protocol
- EINC/Unang Yakap Four Core StepsNon-Separation for Early BreastfeedingFourth EINC step directly enables early breastfeeding and mother-baby bonding
- Immediate Newborn AssessmentAPGAR ScoreAPGAR is the primary scoring tool for newborn transition assessment at 1 and 5 minutes
- Immediate Newborn AssessmentDetect and Refer FrameworkAssessment findings (APGAR 0-3, abnormal vitals, anomalies) trigger detect-and-refer pathway
- Properly Timed Cord ClampingCord Care ManagementCorrect clamping timing precedes all subsequent cord care procedures
- Vitamin K1 ProphylaxisPharmacological Newborn ProphylaxisVitamin K1 is one of four mandated pharmacological interventions in first hours
- Eye ProphylaxisPharmacological Newborn ProphylaxisEye prophylaxis (erythromycin) prevents ophthalmia neonatorum; mandated for every newborn
- Newborn Screening RA 9288Newborn Screening ProgramsRA 9288 establishes mandatory expanded newborn screening using heel-prick at 24-72 hours
- Newborn Hearing Screening RA 9709Newborn Screening ProgramsRA 9709 mandates universal hearing screening using OAE/AABR before discharge
- Newborn Screening RA 9288Detect and Refer FrameworkPositive newborn screening results (CH, CAH, GAL, PKU, G6PD) require urgent referral for confirmatory testing
- Newborn Hearing Screening RA 9709Detect and Refer FrameworkHearing screening refer results trigger audiologist referral and early intervention by 6 months
- Do NOT Practices in EINCEINC/Unang Yakap Four Core StepsDo NOT practices define what must be avoided during standard EINC implementation
- Meconium Aspiration ManagementDetect and Refer FrameworkNon-vigorous meconium-stained baby requires immediate resuscitation and referral (do not suction, call help, bag-mask within golden minute)
- Recognize HypothermiaThermoregulation and Heat Loss PreventionHypothermia recognition (axillary temp <36.5°C) triggers corrective action and potential referral
- Congenital HypothyroidismNewborn Screening RA 9288CH is the classic high-yield newborn screening disorder; early thyroxine prevents intellectual disability
- Delayed BathingDo NOT Practices in EINCDelayed bathing (≥6 hours, ideally 24 hours) is mandated to prevent heat loss and preserve skin barrier
- Vitamin K1 ProphylaxisPrevent VKDBVitamin K1 IM injection (1 mg term, 0.5 mg preterm) within first hour prevents Vitamin K Deficiency Bleeding
- Eye ProphylaxisPrevent Ophthalmia NeonatorumErythromycin 0.5% ointment applied to both eyes prevents ophthalmia neonatorum caused by maternal STIs
- BCG and Hepatitis B Birth-DosePharmacological Newborn ProphylaxisImmunizations given within 24 hours of birth as mandated part of newborn care package
- Midwife's Responsibility for ScreeningNewborn Screening RA 9288Midwife is legally responsible for ensuring heel-prick collection, informing parents, and arranging follow-up
- Heel-Prick Collection TimingNewborn Screening RA 928824-72 hours is ideal timing; before 24 hours risks false negatives; repeat required if early collection
- Expanded Newborn Screening PanelNewborn Screening RA 9288Panel screens for preventable causes of intellectual disability: CH, CAH, GAL, PKU, G6PD, MSUD and others
- OAE and AABR Testing MethodsNewborn Hearing Screening RA 9709OAE (otoacoustic emissions) and AABR (automated auditory brainstem response) are two validated screening modalities
- Early Intervention Goal by 6 MonthsNewborn Hearing Screening RA 9709Detection of congenital hearing loss enables intervention by 6 months, preserving speech and language development
- Omphalitis Prevention and RecognitionCord Care ManagementMother education about danger signs (redness, foul discharge, swelling) enables early return and referral
- Vernix ProtectionDo NOT Practices in EINCDo NOT wipe off vernix; it provides natural skin protection and is absorbed gradually
- Routine Suctioning AvoidanceDo NOT Practices in EINCAvoid routine suctioning; only suction if baby not breathing or obvious airway obstruction
- Mother-Baby Non-SeparationEINC/Unang Yakap Four Core StepsNon-separation is fourth EINC core step; essential for breastfeeding initiation and bonding
- Golden Minute PriorityDetect and Refer FrameworkEstablishing breathing within first 60 seconds is the single highest priority, taking precedence over routine procedures
- Normal Vital Signs Reference RangesImmediate Newborn AssessmentKnowledge of normal RR (40-60), HR (120-160), temperature (36.5-37.5°C), weight (2500-4000g) guides assessment
Diagrams
Complete Concept Map: Mandated Newborn Procedures
Comprehensive mind map showing all mandated newborn procedures organized by category. Central concept is the newborn care framework with eight major branches: EINC/Unang Yakap core steps, immediate assessment, thermoregulation, pharmacological prophylaxis, cord care, newborn screening programs, detect-and-refer framework, and prohibited practices. This represents the complete scope of midwife-managed newborn care in the first hours and days of life.
Unang Yakap (EINC) Procedure Sequence in First Minutes of Life
Step-by-step flowchart showing the EINC/Unang Yakap protocol sequence. Shows critical decision point at birth (vigorous vs. non-vigorous), with pathway to immediate resuscitation and referral for non-breathing babies, and the complete four-step sequence for vigorous newborns: drying (30 seconds), skin-to-skin contact, properly-timed cord clamping (1-3 minutes after pulsations stop), and non-separation for early breastfeeding within 90 minutes.
Newborn Assessment and Vital Signs Monitoring Process
Comprehensive assessment flowchart showing the newborn evaluation process. Includes APGAR scoring at 1 and 5 minutes with decision points for intervention levels, assessment of all vital signs (RR, HR, temperature, weight) with normal ranges, recognition of abnormalities, and the head-to-toe physical examination. Shows when to refer based on abnormal findings, particularly for severe depression and hypothermia.
Newborn Screening and Immunization Schedule in First 24-72 Hours
Timeline-based flowchart showing all mandated prophylaxis, immunizations, and screening procedures from birth through 24-72 hours. Includes Vitamin K1 injection (dose based on baby's weight category), eye prophylaxis with erythromycin, BCG and Hepatitis B vaccines, newborn screening (RA 9288) with optimal timing and midwife's legal responsibilities, and newborn hearing screening (RA 9709) with referral pathway when equipment unavailable. Shows decision points for timing appropriateness and result interpretation.
Detect and Refer Framework for Newborn Complications
Decision tree showing the midwife's detect-and-refer framework for newborn complications. Shows pathway from normal care diverging at abnormality detection, then branching into five major categories: meconium aspiration in non-vigorous baby (requiring resuscitation), severe neonatal depression (APGAR 0-3), gross congenital anomalies, temperature instability (hypothermia management and refer if not correcting), and abnormal screening results (newborn screening positive and hearing screening refer). Each pathway shows specific actions, assessment criteria, and referral triggers appropriate to the midwife's scope as detector and referrer, not manager.
Cord Care: From Clamping to Separation
Complete cord care pathway from delivery through separation. Shows delayed clamping principles (waiting 1-3 minutes for pulsations to stop), sterile cutting technique, dry cord care protocol (keeping clean and dry, exposing to air, avoiding all routine antiseptics unless protocol-specified), parent education about normal timeline (5-15 days separation), and recognition of danger signs of omphalitis (redness, foul discharge, swelling) requiring immediate return and referral.
Distribution of Mandated Newborn Procedures by Category
Pie chart showing the relative emphasis and distribution of mandated newborn procedures across seven major categories. Pharmacological prophylaxis (22%) and EINC core steps (20%) represent the largest components, followed by assessment/vitals (18%), thermoregulation (15%), screening programs (12%), cord care (10%), and detect-and-refer framework (3%). This distribution reflects the PRC licensure exam's emphasis on concrete procedures and pharmacology while maintaining awareness of the midwife's detection and referral responsibilities.