Impact of Early Essential Newborn Care (EENC) on Maternal and Neonatal Outcomes in a Tertiary Care Hospital

Sheikh Zayed Medical College162 enrolled

Overview

This study was examine whether Early Essential Newborn Care (EENC), a simple package of care given immediately after birth, could improve the health of both mothers and newborns compared with the routine care currently provided in the hospital. EENC included drying the baby right after birth, placing the baby in direct skin-to-skin contact with the mother, delaying cord clamping until pulsations stop, keeping the baby warm, and helping breastfeeding start within the first hour. In the routine care group, babies were received the usual hospital care, which may include early cord clamping, placement under a radiant warmer, and later skin-to-skin contact and breastfeeding. A total of 162 mother-baby pairs were enrolled at Shaikh Zayed Hospital, Rahim Yar Khan, and randomly assigned to either the EENC group or the routine care group. The study was included women aged 18 to 40 years with singleton term pregnancies who deliver vaginally, and whose babies are expected to weigh at least 2500 grams. Mothers with serious medical or obstetric problems, and newborns with major abnormalities or medical conditions, were not included. The study was compared important newborn outcomes such as early breastfeeding, time to first breastfeeding, exclusive breastfeeding up to 7 days, low body temperature, low blood sugar in at-risk babies, admission to the neonatal intensive care unit, eye infection, and confirmed infection during the first week of life. Maternal outcomes such as the duration of the third stage of labor, blood loss after delivery, pain, and anxiety were also measured.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Enrollment

162

Conditions

Interventions

Early Essential Newborn CarePROCEDURE

Immediate drying within 5 seconds after birth, skin-to-skin contact within the first minute for at least 90 minutes, delayed cord clamping after pulsations cease, thermal protection with wrapping and head covering, and initiation of breastfeeding within the first hour. Routine postnatal care will follow after the initial EENC period.

Routine Postnatal CarePROCEDURE

Standard labor room care including immediate drying, placement under a radiant warmer for about 20 minutes, prompt cord clamping, birth measurements, routine immunization, later skin-to-skin contact after the third stage of labor, and subsequent breastfeeding initiation.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 40 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Female age ≥ 18 to 40 years. * Gestational age between 37 and 41+6 weeks at the time of delivery. * Singleton pregnancies confirmed by antenatal assessment. * Estimated fetal birth weight of 2500 grams or more, based on obstetric ultrasonography. * Mothers intending to remain admitted in the hospital for a minimum of 24 hours following delivery. * Delivery must be completed via the vaginal route. Exclusion Criteria: * Women who undergo emergency cesarean section. * Neonates presenting with congenital deformities. * Newborns with structural anomalies or medical conditions. * Mothers experiencing severe obstetric complications or having significant underlying medical illnesses. * Mothers with contraindications to breastfeeding due to medical conditions (e.g., HIV infection, syphilis, prior breast surgeries, mastitis, or breast abscess). * Women who decline or are unable to provide informed consent. * Mother-infant dyads transferred to another healthcare facility within 24 hours postpartum.

Outcomes

Primary Outcomes

Successful First Breastfeeding

Proportion of newborns with successful first breastfeeding, defined as an Infant Breastfeeding Assessment Tool score of 10 or more out of 12 during the first breastfeeding session after birth.

Time frame: assessed within 24 hours postpartum

Secondary Outcomes

Early Breastfeeding Initiation

Proportion of newborns who begin breastfeeding within 60 minutes after birth.

Time frame: Within the first 60 minutes after birth

Exclusive Breastfeeding Rate at Day 7

Proportion of infants receiving only breast milk, with no supplementary liquids or solid foods, from birth up to 7 days postpartum.

Time frame: From birth to day 7 postpartum

Incidence of Neonatal Hypothermia

Proportion of newborns with axillary temperature below 36.0°C at any time during the first 24 hours of life.

Time frame: Within the first 24 hours after birth

Admission to Neonatal Intensive Care Unit

Proportion of newborns admitted to the Neonatal Intensive Care Unit for any clinical indication.

Time frame: Within the first 24 hours after birth

Neonatal Infection

Proportion of newborns with neonatal infection defined by both clinical signs or symptoms suggestive of infection and microbiological confirmation by positive blood culture.

Time frame: Within the first 7 days of life

Postpartum Blood Loss

Amount of maternal blood loss in milliliters during the first 24 hours postpartum, measured by pad-weighing method, with 1 gram weight difference considered equal to 1 milliliter blood loss.

Time frame: Within the first 24 hours postpartum

Maternal Anxiety Score

Maternal anxiety assessed using the State-Trait Anxiety Inventory-State, with total score ranging from 20 to 80. Higher scores indicate greater anxiety.

Time frame: 120 minutes after delivery

Maternal Pain Score at 30 Minutes

Maternal pain intensity measured using the Visual Analog Scale, ranging from 0 to 10, with higher scores indicating greater pain

Time frame: 30 minutes after delivery

Maternal Pain Score at 2 Hours

Maternal pain intensity measured using the Visual Analog Scale, ranging from 0 to 10, with higher scores indicating greater pain.

Time frame: 2 hours after delivery