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📚 University Exam Theory Answers — All 25 Topics

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1. School Health Services

• Screening: General health, anaemia, nutrition, visual acuity, hearing, dental, skin, physical disabilities, learning disorders, behaviour problems
• Immunization: As per national schedule; fixed-day activity
• Micronutrient management: Weekly IFA tablets + Vitamin A in needy cases
• Deworming: Biannually (siblings also covered)
• Capacity building and monitoring
• Mid-day meal

• Counselling, yoga/physical education, peer health educators
• Adolescent health education, health clubs/cabinets, first aid rooms

Key: A doctor from PHC/CHC visits one school per week based on screening reports.

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2. Perinatal Mortality Rate (PMR)

PMR = (Late foetal deaths ≥28 wks + Early neonatal deaths in 1st week) / Live births in same year × 1000

PMR = (Late foetal deaths + Early neonatal deaths) / (Live births + Late foetal deaths) × 1000

Babies >1000 g birth weight used as denominator (equivalent to 28 weeks gestation)

• It combines stillbirths + early neonatal deaths
• Same causes operate across both periods (anoxia, infection, prematurity)
• Better indicator of obstetric and perinatal care quality

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3. Newborn Care

• Airway - clear, resuscitation if needed
• Breathing - assess, stimulate
• Cord - delayed clamping (reduces anaemia)
• Dry - immediate drying, prevent hypothermia
• Exclusive breastfeeding - early initiation within 1 hour

• Dry immediately, rub to stimulate
• Warmth - skin-to-skin, head cover, delayed bathing
• Breastfeeding - exclusive, early
• Cord care - clean, delayed clamping
• Antibiotic eye drops, Vitamin K at birth
• Transfer to NBSU/SNCU if danger signs

• NBCC (Newborn Care Corner) - in every delivery room (mandatory)
• NBSU (Newborn Stabilization Unit) - at all FRUs/CHCs (4-bed unit)
• SNCU (Special Newborn Care Unit) - facilities with >3000 deliveries/year (12 beds minimum)

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4. Psychological Problems of Elderly

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5. Health Problems of Elderly

• Cardiovascular: Hypertension, IHD, heart failure
• Orthopaedic: Osteoarthritis, osteoporosis, fractures
• Diabetes mellitus
• Eyes: Cataract, glaucoma, presbyopia
• Respiratory: COPD, pneumonia
• Mental: Dementia, depression
• Sensory: Deafness, vision loss
• Kidney: Chronic kidney disease, incontinence

• Malnutrition, falls, pressure ulcers, polypharmacy
• Cancer incidence rises with age
• Urinary/faecal incontinence

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6. ICDS Scheme (Integrated Child Development Services)

1. Supplementary nutrition
2. Non-formal pre-school education
3. Immunization
4. Health checkup
5. Education and health education to mothers
6. Nutrition education + referral services

• Improve nutritional and health status of children 0-6 yrs
• Lay foundation for psychological, social and educational development
• Reduce mortality, morbidity, malnutrition
• Achieve effective co-ordination of policy and implementation between departments

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7. Healthy School Environment

• Adequate classroom space, lighting, ventilation
• Safe drinking water, sanitation (separate toilets for boys/girls)
• Playground, clean surroundings

• Positive teacher-student relationships
• Anti-bullying, anti-discrimination policies

• Stress-free learning environment
• Counselling services available

• First aid facility
• Safe school building (no structural hazards)
• Safe transportation

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8. Infant Mortality Rate (IMR)

IMR = Deaths of children <1 year of age in a year / Live births in same year × 1000

• Neonatal mortality rate (NMR): Deaths in first 28 days
  • Early NMR: 0-7 days
  • Late NMR: 7-28 days
• Post-neonatal mortality rate (PNMR): 28 days to 1 year

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9. Maternal Mortality (School Health Services in Q9 is a duplicate - answer is on Maternal Mortality)

MMR = Deaths due to complications of pregnancy/childbirth/puerperium in 1 year / Live births in same year × 100,000

• Direct obstetric death: From obstetric complications (haemorrhage, eclampsia, sepsis, obstructed labour, unsafe abortion)
• Indirect obstetric death: From pre-existing disease aggravated by pregnancy (e.g., heart disease, anaemia)
• Late maternal death: >42 days but <1 year after termination

1. Delay in deciding to seek care
2. Delay in reaching the facility
3. Delay in receiving adequate care

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10. Perinatal Mortality Rate

• Perinatal period: 28 weeks gestation → 7th day of life
• Includes: Stillbirths (≥28 wks) + Early neonatal deaths (0-7 days)
• Best indicator of: Quality of obstetric care + perinatal services
• ICD-10 criterion: Birth weight ≥1000 g (= 28 weeks)

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11. MCH Indicators (Maternal and Child Health)

• Maternal Mortality Ratio (MMR)
• Proportion of antenatal care coverage (ANC)
• Proportion of institutional deliveries
• Proportion of births attended by skilled birth attendants
• Contraceptive prevalence rate

• Infant Mortality Rate (IMR)
• Neonatal Mortality Rate (NMR)
• Under-5 Mortality Rate (U5MR)
• Perinatal Mortality Rate (PMR)
• Low Birth Weight rate (<2500 g)
• Malnutrition rates (stunting, wasting, underweight)
• Immunization coverage rates

• Proportion of exclusively breastfed infants
• Vitamin A supplementation coverage

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12. Dietary Advice to Antenatal Mother

• Protein: +23 g/day → tissue growth, fetal development (milk, eggs, pulses)
• Iron: 60 mg/day + folic acid 500 mcg/day (IFA tablets)
• Calcium: 1200 mg/day (milk, dairy, ragi)
• AVitamin A: Important for fetal development
• Calories: +350 kcal/day above normal
• Folate: 500 mcg/day; prevents neural tube defects

• 5-6 small meals instead of 3 large ones
• Avoid raw/undercooked meat, alcohol, excess caffeine
• Adequate hydration (8-10 glasses water/day)
• If vegetarian: extra protein from pulses + Vitamin B12 supplementation

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13. Postpartum Haemorrhage (PPH)

1. Oxytocin 10 IU IM within 1 minute of delivery (drug of choice)
2. Controlled cord traction (Brandt-Andrews method)
3. Uterine massage after placenta delivery

• HAEMOSTATS mnemonic: Haemorrhage → Assess → Establish IV access → Massage uterus → Oxytocin → Stat (further drugs: ergometrine, misoprostol, carboprost) → Transfuse → Apply B-Lynch suture/balloon → Surgery (hysterectomy last resort)

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14. Postpartum Care

• Breastfeeding: Encourage exclusive breastfeeding
• Emocional support: Screen for postnatal depression
• Nutrition: Iron-folic acid supplementation continued for 3 months
• Examination: Check uterus involution, lochia, perineum, BP
• Family planning: Counsel on contraception
• Immunization: Baby's vaccination, mother's Td booster
• Training: Newborn care, danger signs recognition
• Screening: Anaemia, infection, thrombosis

• Heavy bleeding, foul-smelling lochia
• High fever, breast abscess
• Severe headache, convulsions (eclampsia)
• Suicidal thoughts (puerperal psychosis)

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15. Rooming-in

• For mother: Promotes bonding, increases breastfeeding confidence, reduces anxiety
• For baby: Promotes breastfeeding (on demand), reduces formula use, regulates infant temperature/glucose
• Infection control: Reduces nosocomial (hospital-acquired) infections in nursery

• Baby kept within arm's reach (within 1 metre)
• 24-hour rooming-in preferred
• Encourages skin-to-skin contact (Kangaroo care)
• One of the "10 Steps to Successful Breastfeeding" (WHO/UNICEF)
• Essential criterion for Baby Friendly Hospital Initiative (BFHI)

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16. Apgar Score

• 7-10: Normal (good condition)
• 4-6: Moderate depression (needs stimulation/oxygen)
• 0-3: Severe depression (needs immediate resuscitation)

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17. Small for Gestational Age (SGA)

• SGA = small relative to gestational age (may be term but small)
• LBW = birth weight <2500 g (regardless of gestation)
• IUGR = Intrauterine growth restriction (process causing SGA)

• Symmetrical (Type I): Head + body both small; early insult (chromosomal, infections like TORCH); poor prognosis
• Asymmetrical (Type II): Head spared, body small (brain sparing); late insult (placental insufficiency, maternal malnutrition); better prognosis

• Maternal: Malnutrition, smoking, hypertension, anaemia, drugs
• Fetal: Chromosomal abnormalities, TORCH infections, multiple pregnancy
• Placental: Insufficiency, infarction

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18. Intranatal Care

• Clean delivery: Sterile gloves, clean surface, instruments
• Labour monitoring: Partograph (tracks labour progress)
• Emergency management: Manage complications - PPH, dystocia, eclampsia
• AMTSL: Active management of 3rd stage (oxytocin + controlled cord traction)
• Newborn: Immediate newborn care (ABCD - airway, breathing, cord, dry/warm)
• Referral: Timely referral if high-risk features

• Fetal heart rate (every 30 min)
• Cervical dilatation (alert/action line)
• Descent of presenting part
• Contractions, maternal vitals

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19. Kangaroo Mother Care (KMC)

1. Kangaroo position: Baby placed vertically on mother's chest, between breasts (skin-to-skin, 24 hrs/day as much as possible)
2. Support for breastfeeding: Exclusive breastmilk/breast feeding
3. Early discharge: With follow-up

• Warmth: Maintains temperature (replaces incubator)
• Apnea: Reduces apneic episodes
• Thriving: Better weight gain
• Crying: Reduced crying
• Health: Lower infection rates, mortality
• Bonding/Breastfeeding: Promotes both

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20. Juvenile Delinquency

• Truancy, running away from home
• Theft, vandalism, violence
• Substance abuse
• Sexual offences

• Individual: Low IQ, hyperactivity, poor impulse control
• Family: Broken homes, neglect, abuse, parental criminality, poverty
• Social: Peer pressure, bad company, slum environment
• School: Academic failure, bullying, school dropout

• Primary: Counselling, family support, education, youth clubs, sports
• Secondary: Early identification, child guidance clinics
• Tertiary: Juvenile justice system, rehabilitation, vocational training

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21. Feeding of Normal Infant

• Immunity: IgA, lactoferrin, lysozyme
• Nutrition: Perfect balance; easily digestible
• Digestion: Whey proteins > casein (easier to digest)
• Intelligence: Better neuro-development
• Allergy protection: Reduces eczema, asthma

• Frequency: 2 times/day (6-8 months) → 3 times (9-11 months) → 3-4 times (12-23 months) + snacks
• Texture: Puree → mashed → family food progressively

• Rice/ragi kanji, mashed dal, banana, egg yolk
• Avoid honey (<1 year - botulism risk), whole cow's milk (<1 year)

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22. Essential Antenatal Care

• 1st visit: <12 weeks (ideally at registration)
• 2nd visit: 14-26 weeks
• 3rd visit: 28-34 weeks
• 4th visit: 36 weeks onwards

• Tetanus toxoid: 2 doses (TT1 at 16 wks; TT2 4 wks later)
• Anaemia detection + IFA tablets (60 mg iron + 500 mcg folic acid)
• Nutrition counselling
• Blood tests: Hb, blood group, Rh typing, VDRL, HIV, blood glucose
• Investigations: Ultrasound (anomaly scan at 18-20 wks)
• Counselling: Danger signs, birth preparedness, breastfeeding

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23. IMNCI (Integrated Management of Neonatal and Childhood Illness)

• Malaria
• Acute Respiratory Infection (pneumonia)
• Persistent diarrhoea
• Nutrition (malnutrition, anaemia)
• Disease - measles, ear infection

1. Curative: Algorithm-based case management (classify → treat/refer)
2. Preventive: Immunization, nutrition counselling
3. Promotive: Growth monitoring, breastfeeding promotion

• Check for danger signs first (can't drink, vomiting everything, convulsions, very sleepy)
• Then assess for main symptoms
• Then check for malnutrition/anaemia
• Then check immunization status

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24. Baby Friendly Hospitals (BFHI)

1. Written breastfeeding policy
2. Train all staff
3. Inform all pregnant women about benefits of breastfeeding
4. Initiate breastfeeding within 1 hour of birth
5. Show mothers how to breastfeed and maintain lactation

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25. Risk Approach

• Low risk: No risk factors
• High risk: One or more risk factors present (needs extra care)
• Very high risk: Multiple or severe risk factors (needs referral)

• Age: <20 or >35 years
• Grand multipara: ≥5 deliveries
• Expectant height: <145 cm
• Delivery complications in past
• Previous caesarean/surgery
• Anaemia (Hb <7 g/dL)
• Stillbirth/neonatal death in past
• Twins/multiple pregnancy, prolonged infertility

• Concentrates resources where most needed
• Cost-effective
• Reduces maternal and child mortality

• Over-medicalisation of normal pregnancy
• May miss some high-risk cases without identifiable factors
• Creates anxiety in mothers labelled "high-risk"

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Exam Tips:

• Questions on PMR, IMR, MMR always need the formula + definition + causes
• ICDS, IMNCI, BFHI - always mention the year launched + key components
• Apgar score - draw the table; always mention 1 and 5 minute assessment
• KMC - mention 3 components + WHO recommendation
• PPH - mention the 4 T's + AMTSL (oxytocin is drug of choice)

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✅ Q1 — SCHOOL HEALTH SERVICES

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📌 Definition

• Protecting and promoting their health
• Preventing disease
• Early detection and correction of health defects
• Creating a health-conscious generation

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📌 Objectives

1. Assess and improve the health status of school children
2. Prevent and control communicable diseases
3. Detect and correct physical and mental defects early
4. Provide nutritional support
5. Develop health habits and health literacy in children
6. Ensure a healthy school environment

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📌 Components of School Health Services

1. Health Appraisal (Screening / Assessment)

Key exam point: Referral cards given to children needing priority services at district/sub-district hospitals.

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2. Preventive Services

• As per national immunization schedule
• Fixed-day activity at schools
• Coupled with health education

• IFA (Iron-Folic Acid) tablets - weekly supervised distribution
• Vitamin A - given in needy cases
• This prevents iron deficiency anaemia and vitamin deficiencies in school children

• Biannually (twice a year)
• Prior IEC (Information, Education, Communication)
• Siblings of students also covered (not just enrolled children)
• Drug used: Albendazole 400 mg single dose (National Deworming Day - February 10th)

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3. Curative Services

• Basic medicines provided at school to manage common ailments
• Common conditions treated: fever, diarrhoea, skin infections, eye infections
• Referral for conditions that need higher care

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4. Health Education

• Teaching children about personal hygiene, nutrition, sanitation
• Awareness about tobacco, alcohol, drugs
• Menstrual hygiene for adolescent girls
• Mid-day meal programme (supplementary nutrition + keeps children in school)

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📌 Essential vs Desirable Services

Essential (Must have at every school):

Desirable (Health Promoting Schools):

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📌 Mid-Day Meal (MDM) Programme

• Launched: 1995 (centrally sponsored)
• Provides: 450 kcal + 12 g protein (primary), 700 kcal + 20 g protein (upper primary) per day
• Benefits: Improves attendance, reduces dropout, improves nutrition
• Managed jointly by: Schools + Anganwadi workers

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📌 Adolescent Health Services (linked to school health)

• Reproductive and sexual health counselling
• Tetanus immunization
• Nutritional counselling (anaemia prevention)
• STI/HIV/RTI management
• VCTC referral linkages

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📌 Healthy School Environment (connected concept)

• Safe water supply + adequate sanitation
• Separate toilets for boys and girls
• Proper lighting and ventilation
• Clean surroundings + waste disposal
• Safe playground
• No tobacco/alcohol in school premises

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📌 Role of Different Personnel

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📌 School Health Record

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📌 Memory Trick

• Screening
• Health education
• Immunization
• Micronutrient supplementation
• Sanitation (healthy environment)
• Deworming
• Mid-day meal
• Referral and curative care

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📌 Exam-Worthy One-Liners

• School health services are delivered under NRHM via PHC/CHC doctors
• A doctor visits one school per week based on screening reports
• Deworming is done biannually with Albendazole on National Deworming Day (Feb 10)
• IFA tablets are distributed weekly under school health
• Mid-day meal provides 450 kcal and 12 g protein for primary school children
• 10 Steps of Breastfeeding (BFHI) vs 10 Steps of School Health - don't confuse!
• WHO concept of Health Promoting School = school that constantly strengthens its capacity as healthy setting for living, learning, working

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✅ Q2 — PERINATAL MORTALITY RATE (PMR)

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📌 Definition of Perinatal Period

• ICD-8 definition: From 28th week of gestation to the 7th day after birth
• ICD-10 (1993): Same period, but uses birth weight ≥1000 g as preferred criterion (equivalent to 28 weeks)

If birth weight not available → use gestational age ≥28 weeks If gestational age not available → use crown-heel length ≥35 cm Preferred criterion = Birth weight

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📌 What is Perinatal Mortality?

Easy way to remember: PMR = Deaths JUST BEFORE + JUST AFTER birth (combined)

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📌 Formulae (Very Important for Exam)

Formula 1 - WHO (Developing nations / less established vital records):

Formula 2 - WHO (Developed nations / well-established vital records):

Difference: Denominator - developing nations use only live births; developed nations add late foetal deaths to denominator too. This difference in denominator makes international comparisons difficult.

Formula 3 - For International Comparisons (WHO Expert Committee, 1970):

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📌 Why PMR is Used? (Importance)

1. Same causative factors operate in both the late foetal and early neonatal period (anoxia, trauma, infection, prematurity)
2. Difficult to distinguish between a late foetal death and a very early neonatal death in the field
3. PMR reflects the quality of obstetric + perinatal care together
4. It captures both preventable stillbirths and preventable early neonatal deaths
5. Better indicator of maternity and neonatal services than either rate alone

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📌 Components Explained Simply

PREGNANCY
    |
28 WEEKS ──────────────────────────────────
    |                                      |
 LATE FOETAL DEATH              BIRTH (Live born)
 (Stillbirth ≥28 wks)               |
    |                          0-7 DAYS = EARLY NEONATAL DEATH
    |                               |
    └─────────── PMR covers ────────┘
                both of these
                        |
                  7 DAYS TO 28 DAYS = LATE NEONATAL DEATH
                        |
                (NOT included in PMR)

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📌 Causes of Perinatal Mortality

Foetal (Antepartum) causes:

• Placental insufficiency
• Congenital malformations (chromosomal)
• TORCH infections (Toxoplasmosis, Rubella, CMV, Herpes)
• Diabetes in mother
• Hypertension / Pre-eclampsia
• Multiple pregnancy
• Cord accidents (prolapse, entanglement)

Intrapartum causes:

• Birth asphyxia (most common cause of early neonatal death)
• Birth trauma
• Obstructed labour
• Prematurity

Neonatal causes (first 7 days):

• Respiratory Distress Syndrome (RDS) in preterm
• Sepsis/infection
• Hypothermia
• Hypoglycaemia
• Haemorrhagic disease of newborn

Mnemonic for causes: "PATCH-B"

• Prematurity
• Asphyxia
• Trauma / birth injury
• Congenital malformations
• Hypothermia / Hypoglycaemia
• Bacterial infection / sepsis

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📌 Prevention of Perinatal Mortality

Antenatal (before birth):

• Regular ANC (4 visits minimum)
• Detection and management of high-risk pregnancies
• Treatment of anaemia, hypertension, diabetes
• Folic acid supplementation (prevents neural tube defects)
• Avoid smoking, alcohol, teratogens
• Ultrasonography for anomaly detection

Intranatal (during delivery):

• Skilled birth attendant at every delivery
• Partograph monitoring (detect prolonged labour)
• Institutional delivery
• Emergency obstetric care (EmOC)
• Timely caesarean section when indicated

Postnatal (after birth - first 7 days):

• Essential newborn care (dry, warm, breastfeed)
• Vitamin K at birth (prevents haemorrhagic disease)
• Neonatal resuscitation if asphyxiated
• Prevention of hypothermia (KMC, warm room)
• Early detection of sepsis, jaundice

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📌 PMR in India and Global Context

• India's PMR has been declining due to JSSK, JSY, PMSMA schemes
• Sustainable Development Goal (SDG): Reduce PMR to ≤12 per 1000 live births by 2030

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📌 Difference Between PMR, NMR, IMR

All expressed per 1000 live births (except MMR = per 100,000 live births)

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📌 MCH Indicators Linked to PMR

• Quality of obstetric services
• Quality of neonatal care
• Overall standard of health system

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📌 Memory Summary Table

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📌 Exam One-Liners

• PMR = Stillbirths (≥28 wks) + Early neonatal deaths (0-7 days) per 1000 live births
• Preferred criterion for perinatal period = birth weight ≥1000 g (ICD-10)
• Two WHO formulae differ in the denominator (live births vs live births + late foetal deaths)
• PMR is a good indicator of quality of obstetric AND neonatal services together
• Most common cause of early neonatal death = birth asphyxia
• Most common cause of perinatal mortality overall = prematurity

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✅ Q3 — NEWBORN CARE

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📌 Definition

Neonatal period = 0 to 28 days of life

• Early neonatal: 0-7 days (highest risk period)
• Late neonatal: 7-28 days

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📌 Why is Newborn Care Important?

• 75% of all under-5 deaths occur in the first year of life
• 50% of infant deaths occur in the first 28 days (neonatal period)
• 25-45% of neonatal deaths occur on the first day of life
• Most neonatal deaths are preventable with simple, low-cost interventions

The goal of essential newborn care = Reduce perinatal and neonatal mortality

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📌 Main Components of Essential Newborn Care

Remember the mnemonic: "Dr. ABCWIF"

• Dr = Dry and stimulate
• A = Airway (clear)
• B = Breathing (assess)
• C = Cord care (delayed clamping)
• W = Warmth (prevent hypothermia)
• I = Infection prevention
• F = Feeding (exclusive breastfeeding)

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📌 Step-by-Step Immediate Newborn Care (at Birth)

Step 1 - Dry and Stimulate

• Immediately dry the baby with a clean, warm towel
• Drying provides tactile stimulation to initiate breathing
• Remove the wet towel immediately (prevents heat loss)
• Place baby on mother's abdomen (skin-to-skin)

Step 2 - Assess the Baby (in 30 seconds)

1. Is baby term (≥37 weeks)?
2. Is baby breathing or crying?
3. Is baby pink (good colour)?

If YES to all three → routine care If NO to any → Neonatal Resuscitation (NRP)

Step 3 - Delayed Cord Clamping

• Delay clamping for 1-3 minutes after birth (or until cord stops pulsating)
• Benefits:
  • Transfers 80-100 mL extra blood from placenta to baby
  • Reduces iron deficiency anaemia
  • Reduces need for blood transfusion in preterm
  • WHO recommends delayed cord clamping for all births

Step 4 - Prevent Hypothermia (Warm Chain)

1. Warm delivery room (≥25°C)
2. Warm resuscitation table
3. Immediate drying
4. Skin-to-skin contact
5. Breastfeeding
6. Bathing postponed (at least 6 hours, WHO says 24 hours)
7. Appropriate clothing + head covering (babies lose 25% heat from head)
8. Mother and baby together (rooming-in)
9. Warm transportation if transfer needed
10. Training of health workers

Normal newborn temperature: 36.5°C - 37.5°C Hypothermia: <36.5°C (cold stress <36°C, moderate <32°C, severe <28°C)

Step 5 - Clear Airway

• Only suction if obvious obstruction (meconium, blood)
• Routine suctioning is NOT recommended (causes bradycardia, mucosal trauma)
• Position baby with neck slightly extended (sniffing position)

Step 6 - Breastfeeding

• Initiate within 1 hour of birth
• Colostrum (first milk) = liquid gold:
  • Rich in IgA (immunoglobulin A) - passive immunity
  • Rich in proteins, Vitamin A
  • Acts as first vaccine
  • Has laxative effect (clears meconium, reduces jaundice)
• NEVER discard colostrum

Step 7 - Cord Care

• Cut cord with sterile blade/scissors
• Apply nothing to cord (dry cord care - WHO recommendation)
  • Exception: In high-infection settings, apply 4% chlorhexidine gel to cord stump
• Keep cord stump clean and dry
• Cord falls off in 7-10 days
• Do NOT bandage or cover with cloth

Step 8 - Eye Care

• Apply 1% tetracycline eye ointment OR 1% silver nitrate in both eyes
• Prevents ophthalmia neonatorum (gonococcal/chlamydial eye infection from birth canal)

Step 9 - Vitamin K

• Give Vitamin K 1 mg IM (intramuscular) in the anterolateral thigh at birth
• Prevents Haemorrhagic Disease of Newborn (HDN) / Vitamin K Deficiency Bleeding (VKDB)
• Newborns have low Vitamin K because:
  • It doesn't cross placenta well
  • Gut flora not yet established
  • Breast milk has low Vitamin K

Step 10 - Weighing and Recording

• Weigh baby at birth
• Normal birth weight: 2500-4000 g
• LBW: <2500 g
• Record weight, time of birth, Apgar score

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📌 Neonatal Resuscitation

NRP Algorithm - "ABC of Resuscitation"

BIRTH
  |
DRY, WARM, STIMULATE (30 seconds)
  |
Breathing? Heart rate?
  |
BREATHING + HR >100 → Routine care + breastfeed
  |
NOT BREATHING → VENTILATE (bag-mask, 40-60 breaths/min)
  |
30 seconds of ventilation → Check HR
  |
HR >60 → Continue ventilation
HR <60 → ADD chest compressions (3:1 ratio)
  |
HR still <60 → Epinephrine (adrenaline) 0.1-0.3 mL/kg IV

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📌 Newborn Care Facilities (Levels of Care)

1. NBCC - Newborn Care Corner

• Mandatory in EVERY delivery room
• Provides immediate care to ALL newborns at birth
• Equipment: Radiant warmer, suction, oxygen, bag-mask, weighing scale
• ~20,336 NBCCs operational in India

2. NBSU - Newborn Stabilization Unit

• At all FRUs (First Referral Units) and CHCs
• For sick and LBW newborns needing short-term care
• 4-bed unit + 2 beds in postnatal ward for rooming-in
• ~2,421 NBSUs functional in India

3. SNCU - Special Newborn Care Unit

• At district hospitals with >3000 deliveries/year
• Provides all care EXCEPT assisted ventilation and major surgery
• Minimum 12 beds at district hospital
• Add 4 beds per 1000 extra deliveries above 3000
• ~844 SNCUs functional in India

4. NICU - Neonatal Intensive Care Unit

• At medical college hospitals
• Full-fledged care including ventilation and surgery

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📌 Danger Signs in Newborn (Refer Immediately)

• Feeding problem - not feeding/refusing breast
• Apnea or fast breathing (>60/min or <30/min)
• Seizures / convulsions
• Temperature abnormal (fever >38°C or hypothermia <36.5°C)
• Bulging fontanelle
• Cyanosis (bluish skin)

• Jaundice in first 24 hours (always pathological)
• Umbilical cord infection (redness, pus, smell)
• Abdominal distension
• Vomiting bile

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📌 Home-Based Newborn Care (HBNC)

For home deliveries: 7 visits (additional visit on day of birth)

• Breastfeeding (exclusive, on demand)
• Warmth (temperature, clothing)
• Cord care (dry, clean)
• Danger signs
• Immunization (BCG, OPV-0 at birth)

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📌 Immunization at Birth

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📌 Special Situations in Newborn Care

Low Birth Weight (LBW) Baby (<2500 g):

• Extra warmth (KMC - Kangaroo Mother Care)
• Expressed breast milk if can't suck
• Monitor blood glucose (risk of hypoglycaemia)
• Early referral if sick

Preterm Baby (<37 weeks):

• High risk of RDS (surfactant deficiency)
• High risk of hypothermia, hypoglycaemia, apnea, sepsis
• May need CPAP / surfactant therapy
• KMC very beneficial

Post-term Baby (>42 weeks):

• Risk of meconium aspiration syndrome
• Risk of hypoglycaemia (large placental aging)
• Watch for fetal distress signs

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📌 Summary Table - What to Do at Birth

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📌 Exam One-Liners

• 75% of under-5 deaths occur in 1st year; 50% of those in neonatal period
• Most neonatal deaths occur on day 1
• Delayed cord clamping = delay 1-3 minutes = transfers 80-100 mL extra blood
• Colostrum = first milk = rich in IgA = first vaccine, never discard
• Routine suctioning of airway is NOT recommended (WHO)
• Vitamin K 1 mg IM at birth prevents haemorrhagic disease of newborn
• Cord care = dry cord care (nothing applied); chlorhexidine in high-risk settings
• Normal temperature = 36.5-37.5°C; hypothermia = <36.5°C
• ASHA does 6 home visits (day 1, 3, 7, 14, 28, 42)
• NBCC = every delivery room (mandatory) | NBSU = FRU/CHC | SNCU = district hospital

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