The Components of
Essential Newborn Care
Indira Narayanan, Mandy Rose, Dilberth Cordero,
Silvana Faillace, and Tina Sanghvi
Essential newborn care (ENC) is a comprehensive strategy designed to improve the health of newborns through
interventions before conception, during pregnancy, at and soon after birth, and in the postnatal period. This brief
describes the components of ENC, criteria for prioritizing them, and strategies used in operationalizing them.
Implementation of ENC will have a positive impact on neonatal and infant mortality.
Indira Narayanan, Mandy Rose, Dilberth Cordero, Silvana Faillace, and Tina Sanghvi. The Components of Essential
Newborn Care. Published by the Basics Support for Institutionalizing Child Survival Project (BASICS II) for the United
States Agency for International Development. Arlington, Virginia, June 2004.
Photo Credit: BASICS II
BASICS II is a global child survival project funded by the Office of Health and Nutrition of the Bureau for Global
Health of the U.S. Agency for International Development (USAID). BASICS II is conducted by the Partnership for
Child Health Care, Inc., under contract no. HRN-C-00-99-00007-00. Partners are the Academy for Educational
Development, John Snow, Inc., and Management Sciences for Health. Subcontractors include Emory University, The
Johns Hopkins University, The Manoff Group, Inc., the Program for Appropriate Technology in Health, Save the
Children Federation, Inc., and TSL.
This document does not represent the views or opinion of USAID. It may be reproduced if credit is
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The Components of Essential
Indira Narayanan, Mandy Rose, Dilberth Cordero,
Silvana Faillace, and Tina Sanghvi
These issues need to be addressed in an
are provided during the perinatal and
neonatal periods (Figure 1) is critical to appropriate manner at the facility and community
ensuring the health of mother and baby. levels to ensure a continuum of care.
Maternal health and newborn health are
inextricably linked; this brief primarily addresses Components
the needs of the newborn infant and some selected The components of ENC are summarized in
maternal issues that influence birth outcome. Figure 2 and described in greater detail in Table 1.
Essential newborn care (ENC) is a Depending on their mandates, private voluntary
comprehensive strategy designed to improve the and other organizations may facilitate or provide
health of newborns through interventions before ENC services or simply promote them through
conception, during pregnancy, at and soon after communication and social mobilization strategies.
birth, and in the postnatal period.
Essential Newborn Care
(a) Basic preventive newborn care Figure 1. Definition of the Perinatal and Neonatal Periods
such as care before and during
pregnancy, clean delivery Perinatal period
maintenance, eye and cord care, Early Late
and early and exclusive neonatal neonatal
breastfeeding on demand day
(b) Early detection of problems or
danger signs (with priority for
sepsis and birth asphyxia) and 22 weeks
Birth 6 completed 27 completed
appropriate referral and care- days days
seeking. This may also be a part
of (a) and (c); and
Pregnancy Newborn period
(c) Treatment of key problems such
as sepsis and birth asphyxia.
The Components of Essential Newborn Care 3
Figure 2. Essential Newborn Care Components: The “What”
Maternal issues Close Baby issues
Promotion or provision of services link Promotion or provision of services
Preventive maternal components Preventive baby components
(Essential obstetric care) (Essential newborn care)
1. Essential preventive care 1. Essential preventive care
2. Recognition of danger signs and referral 2. Recognition of danger signs and referral
Management of complications Management of complications
(Emergency obstetric care) (Essential newborn care)
1. Recognition of danger signs and referral 1. Recognition of danger signs and referral
2. Treatment of problems 2. Treatment of problems (with priority
given to sepsis and birth asphyxia)
Before conception Pregnancy At birth Postnatal period
Prioritization of Components ■ Likelihood for sustainability and for taking to
Table 1 outlines a large number of components scale;
for optimal newborn health. However, it may not ■ Acceptability with and interest of partners,
be feasible to implement all components including the Ministry of Health, after
simultaneously. Components should be prioritized suitable advocacy;
according to local needs, and implemented in a ■ Existing programs into which newborn health
phased manner or by linking with suitable components and strategies can be linked;
partners. Criteria for selection of components to ■ Proportion of facility and home deliveries,
be implemented in initial and subsequent phases and available care providers; and
include: ■ Existing infrastructure and quality of
■ Existing infant and neonatal mortality rates.
Generally, as infant mortality decreases,
neonatal mortality as a proportion of infant
Implementation of Essential Newborn Care
In general, it is easier to select ENC interventions
mortality increases. With lower infant
to implement (the “what”) than to operationalize
mortality rates, countries and organizations
them (the “how”). Some approaches that have
are more likely to be ready to implement an
been used include:
increased number of components for
improving newborn health; ■ Advocacy (at all levels and at every stage);
■ Resources that are available or that can be ■ Situational analysis of key issues within the
leveraged; country or area;
4 The Components of Essential Newborn Care
Table 1. Improving Newborn Health: The Essential Newborn Care Components
Before At and Soon after Birth (Up to
Conception Antenatal Period about Six Hours) Postnatal Period
■ Adequate care of ■ At least four visits with an emphasis on goal- ■ Skilled birth attendant following clean ■ Consultation(s) with mother and baby early in the first week, at
the female child, oriented or focused antenatal care. delivery practices and supported by least once before day 3, and followed up as required.
including nutrition, ■ Tetanus toxoid. an enabling environment (skills, ■ Continued essential preventive newborn care, including
education, and ■ Iron and folate. supplies, and suitable referral support for exclusive breastfeeding on demand, temperature
health care. ■ Adequate nutritious diet. facilities). maintenance, cord care, etc.
■ Immunization, ■ Extra rest. ■ Application of principles of the ■ Continued application of inputs for PMTCT activities, including
including tetanus ■ Consumption of iodized salt by the family. prevention of mother-to-child feeding and other support such as antiretroviral therapy,
toxoid. ■ In areas where malaria is endemic: transmission (PMTCT) of HIV/AIDS counseling, and nutrition.
■ Folate – Mother (later with the baby) sleeps under strategy to the baby and the care ■ Postnatal vitamin A for the mother and continued use of iron
supplementation. an insecticide-treated bednet; and provider. and folate and intermittent therapy for malaria (where malaria
■ Birth spacing. – Mother takes intermittent presumptive ■ Detection of problems and is endemic), according to recommendations of the Ministry of
■ Prevention of therapy. emergencies in the mother and Health.
sexually ■ Detection and treatment of STIs such as syphilis appropriate referral and care-seeking. ■ Counseling for nutrition, family planning, and prevention and
transmitted and gonorrhea. ■ Treatment of problems in the mother. treatment of STIs.
infections (STIs). ■ Interventions for HIV/AIDS, including voluntary ■ Essential preventive care of the baby: ■ Detection of danger signs and appropriate referral and care-
■ Avoidance of counseling and testing. – Cleanliness and prevention of seeking.* The first four or five signs are more commonly used,
substance abuse, ■ Birth preparedness: infection; especially in the community:
including – Determination of place of delivery with the – Temperature maintenance; – Poor sucking or not sucking;
avoidance of health care provider; – Eye care; – Inactivity or lethargy—often denoted by families as
smoking and – If home delivery: (a) adequate linen, washed – Cord care; “loose-limbed” in several languages;
alcohol use. and sun-dried—at least five pieces of cloth – Early initiation of breastfeeding – Fever or hypothermia;
for delivery (may include a plastic sheet for (within one hour) without pre- – Respiratory distress;
the mother); (b) clean new blade kept in its lacteal feeds, and advice for – Convulsions;
wrapper until the moment of use; and (c) subsequent, frequent exclusive – Vomiting;
clean cord ties. All these items should be breastfeeding on demand day and – Abdominal distension;
kept in a clean container; night; and – Severe umbilical infection (redness or swelling of the skin
– Setting aside of or arrangements to get – Extra care for the low birthweight surrounding the base of the cord or a foul smell); a slight
money for going to a facility for planned baby. pus discharge may often be considered a minor infection
delivery or for emergencies in the mother ■ Resuscitation at site of babies who do that can be treated locally;
and baby; and not breathe properly at birth. – Jaundice reaching the palms and soles;
– Identification of the facility and ■ Detection and referral and appropriate – Extensive pustules or skin infection; and
transportation to be used in case of an care-seeking for babies with danger – Swollen eyelids with pus discharge.
emergency. signs. ■ Detection of minor problems, local treatment where necessary,
■ Early detection of problems or emergencies in and follow-up including referral, if needed, for:
the mother and appropriate referral to and care- – Conjunctivitis;
seeking at a suitable facility. – Minor umbilical infection;
■ Treatment of problems in the mother. – Pyoderma or skin infection;
– Thrush; and
*Organizations or programs have selected different signs and varying numbers of signs; however, the fewer the danger signs, the easier it is for health workers to recall them
The Components of Essential Newborn Care
and inform families if they occur. This prioritization of danger signs is useful, particularly for those working at peripheral centers and in communities.
■ Use of existing programs, resources, and care communities, facilities, and public and private
providers; sectors for a continuum of care; and
■ Collaboration, coordination, and consensus- ■ Monitoring and evaluation as part of an ENC
building with partners; program, with emphasis on the use of data to
■ Health system strengthening: identify gaps and implement adaptations.
– Competency-based capacity-building;
– Improvement of pre-service education; Conclusion
– Supervision; In brief, key strategies to improve newborn health
– Drugs and supplies; and an include:
– Improved referral/counter-referral system.
■ Prioritization of ENC interventions according
■ Community-based interventions:
to local requirements, with gradual phasing-in
– Capacity-building of community health
of interventions not initially included;
workers and volunteers including
■ Integration of ENC with existing maternal
traditional birth attendants;
and child survival programs in a way that
– Supervision of community health workers
maintains clear visibility of newborn health
issues in order to attain the necessary impact
– Provision of supplies; and
on neonatal morbidity and mortality; and
– Social mobilization including
■ Implementation that addresses at inception
participation from community-based
key issues such as sustainability and scale.
■ Multi-channel communication for appropriate
Strategies like these will have a greater impact
behavior at all levels, including targeting of
on neonatal mortality rates and, in turn, on infant
policymakers, community leaders, and care
mortality rates, which will represent an important
providers at facility and community levels.
step toward achieving the Millennium
■ Linkage with or coordination between groups,
strategies, and sites, such as a link between
Acknowledgment. The authors wish to thank the BASICS II Strategic Experience Transfer (SET) team for their assistance in
preparing this document.
6 The Components of Essential Newborn Care
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