Table A1.

Analytic framework of newborn care recommendations.

Newborn Care around the Time of Birth/Health Facility Conditions	Newborn Care Practices at Home Following Delivery
Protection (Hygiene)
Standard precautions and cleanliness: Wash hands Wear gloves Protect yourself from blood and other body fluids during deliveries Practice safe disposal of sharps Practice safe waste disposal Deal with contaminated laundry Sterilize and clean contaminated equipment Sterilize gloves Change gloves (if possible) prior to cutting the cord. Have sterile kit to tie and cut cord (protection)	Wash your hands with soap and water before and after handling your baby, especially after touching her/his bottom. Wash hands before and after cord care. Put nothing on the stump. DO NOT apply any substances or medicine to stump. Wash baby’s bottom when soiled and dry it thoroughly. Practice safe disposal of infant feces and household waste.
Warmth (Temperature control)
Have clean warm towels/covers/cloths ready for newborn baby at delivery. Thoroughly dry the baby immediately. Discard wet cloth. Skin-to-skin contact: Leave the baby on the mother’s abdomen (before cord cut) or chest (after cord cut) after birth for at least 2 h. Cover the baby with a soft dry cloth. Help mother to wear clothes which make immediate skin contact easy.	Keep baby warm and covered. Avoid frequent bathing, changes in baby’s temperature. Newborns need more clothing than other children or adults. If cold, put a hat on the baby’s head. During cold nights, cover the baby with an extra blanket.
Breathing
Assess the newborn. Have resuscitation equipment near delivery bed. Keep equipment in good condition. Monitor the baby every 15 min after delivery.	Advise the mother to seek care for the baby as needed, to observe baby and note danger signs for care seeking, especially difficulty breathing, fast or slow breathing, grunting, or chest in-drawing.
Feeding
Encourage immediate breastfeeding. Keeping mother and baby in skin-to-skin contact from birth encourages early breastfeeding. Counsel the mother on breastfeeding. Help the mother to initiate within one hour. Assess breastfeeding. Encourage breastfeeding on demand, day and night, as long as the baby wants. → A baby needs to feed day and night, 8 or more times in 24 h from birth. Only on the first day may a full-term baby sleep many hours after a good feed. → A small baby should be encouraged to feed, day and night, at least 8 times in 24 h from birth. Teach correct positioning and attachment. Show the mother how to hold her baby. She should: → make sure the baby’s head and body are in a straight line → make sure the baby is facing the breast, the baby’s nose is opposite her nipple → hold the baby’s body close to her body → support the baby’s whole body, not just the neck and shoulders Show the mother how to help her baby to attach. She should: → touch her baby’s lips with her nipple → wait until her baby’s mouth is opened wide → move her baby quickly onto her breast, aiming the infant’s lower lip well below the nipple. Look for signs of good attachment and effective suckling (that is, slow, deep sucks, sometimes pausing). If the attachment or suckling is not good, try again. Then reassess	Advice for mother: Start breastfeeding within 1 hour of birth. The baby’s suck stimulates your milk production. The more the baby feeds, the more milk you will produce. Give your baby the first milk (colostrum). It is nutritious and has antibodies to help keep your baby healthy. At each feeding, let the baby feed and release your breast, and then offer your second breast. At the next feeding, alternate and begin with the second breast. Exclusive breastfeeding for the first 6 months. Seek care for problems around breast feeding. Immediately after birth, keep your baby in the bed with you, or within easy reach. At night, let your baby sleep with you, within easy reach. While breastfeeding, you should drink plenty of clean, safe water. You should eat more and healthier foods and rest when you can.
Danger signs	Care seeking and referral
Stopped feeding well, history of convulsions, fast breathing (breathing rate ≥ 60 per minute), severe chest in-drawing, no spontaneous movement, fever (temperature ≥ 37.5°C), low body temperature (temperature < 35.5°C), any jaundice in first 24 h of life, or yellow palms and soles at any age. The family should be encouraged to seek health care early if they identify any of the above danger signs in between postnatal care visits.	Return or go to the hospital immediately if the baby has: difficulty breathing, convulsions, fever or feels cold, bleeding, diarrhea, very small, just born, not feeding at all. Go to the Health Center as quickly as possible if the baby has: difficulty feeding, pus from eyes, skin pustules, yellow skin, a cord stump which is red or draining pus, feeds <5 times in 24 h. During transportation: Keep the baby warm by skin-to-skin contact with mother or someone else. Cover the baby with a blanket and cover her/his head with a cap. Protect the baby from direct sunshine. Encourage breastfeeding during the journey. If the baby does not breastfeed and journey is more than 3 h, consider giving expressed breast milk by cup.