# Situation: A 25-year-old primigravida at 40 weeks' gestation is in labor at a birthing facility that follows the Department of Health (DOH) Essential Intrapartum and Newborn Care (EINC) protocol. Her companion of choice stays with her, and her labor has been uncomplicated. The nurse reviews the care given to healthy term newborns who cry and breathe well at birth. Which practice BEST follows the EINC protocol?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629580  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 25-year-old primigravida at 40 weeks' gestation is in labor at a birthing facility that follows the Department of Health (DOH) Essential Intrapartum and Newborn Care (EINC) protocol. Her companion of choice stays with her, and her labor has been uncomplicated.

The nurse reviews the care given to healthy term newborns who cry and breathe well at birth. Which practice BEST follows the EINC protocol?

## 보기

1. Leaving the cord stump clean and dry, with nothing applied to it **✔ 정답**
2. Wiping off all the vernix during drying so that the skin dries faster
3. Cutting the cord next to the clamp placed 5 cm from the umbilical base
4. Suctioning the mouth and nose of every baby born through meconium-stained fluid

**정답: 1**

## 해설

EINC recommends dry cord care: the stump is kept clean and dry, with no alcohol, povidone-iodine, or other substance and no trimming. For a baby who cries and breathes well, the mouth and nose are suctioned only if secretions block them, whatever the color of the fluid. The vernix is left on the skin, and the cord is clamped at 2 cm and 5 cm from the base and cut close to the 2-cm clamp.

## 심화 해설

The EINC practice that fits
The Department of Health (DOH) Essential Intrapartum and Newborn Care (EINC) protocol recommends dry cord care. The umbilical cord stump is kept clean and dry, with nothing applied to it: no alcohol, no povidone-iodine, and no other substance, and the stump is not trimmed. Leaving the cord stump clean and dry with nothing applied is the practice that best follows EINC.

Why dry cord care is recommended
In settings with clean births and good hygiene, applying antiseptics to the cord does not reduce infection and may delay separation of the stump. Keeping the stump exposed to air and dry helps it separate naturally. The mother is taught to fold the diaper below the stump, to wash it with clean water and dry it if it becomes soiled, and to watch for redness, swelling, foul smell, or discharge, which need prompt care.

Why the other practices do not follow EINC

| Practice | EINC position |
| --- | --- |
| Wiping off all the vernix | Harmful; the vernix is left on because it protects the skin |
| Cutting next to the 5-cm clamp | Wrong; clamps go at 2 cm and 5 cm from the base, and the cord is cut close to the 2-cm clamp |
| Suctioning every baby with meconium-stained fluid | Not routine; suction only if secretions block the airway |
| Dry cord care | Recommended |

Details that are often tested
Thorough drying removes wetness, blood, and meconium, but the vernix caseosa is left in place because it protects the skin and helps keep the newborn warm. Wiping it off is listed among harmful practices. When the cord is clamped, the first clamp is placed 2 cm from the umbilical base and the second 5 cm from the base, and the cord is cut close to the 2-cm clamp. Cutting next to the 5-cm clamp would leave a long stump. Watch out! For a baby who cries and breathes well, the color of the amniotic fluid does not change the rule: routine suction is not done even with meconium-stained fluid, because suction can cause injury and bradycardia and delays skin-to-skin contact.

Exam takeaway
In EINC, the cord stump is kept clean and dry with nothing applied, the vernix is left on, and suction is used only for a blocked airway. Key point! Many EINC items test practices that were once routine but are now considered unnecessary or harmful, so recognize which traditional practices have been dropped.

## 임상 시나리오

EINC Newborn Care PracticesHealthy term newborns who cry and breathe well
Use dry cord care: keep the stump clean and dry, with no alcohol, povidone-iodine, or other substance, and do not trim it.

Leave the vernix on during drying. Clamp at 2 cm and 5 cm from the base and cut close to the 2-cm clamp.

Suction the mouth and nose only if secretions block the airway, whatever the color of the fluid.

CautionTeach the mother to report redness, swelling, foul smell, or discharge around the stump.

## 핵심 개념

- **Dry cord care** — Keeping the umbilical cord stump clean and dry with nothing applied to it.
- **Vernix caseosa** — The white, creamy coating on the newborn's skin that protects it and helps retain warmth.
- **Meconium-stained fluid** — Amniotic fluid colored green or brown by fetal stool passed before birth.
- **Umbilical stump** — The remaining part of the cord after cutting, which dries and separates in the first weeks.

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