Transcript Normal Newborn Care

Emergency Health and
Nutrition Training
Neonatal Health
What can we do in crisis situations?
Learning Objectives
• Understand the epidemiology
• Understand the main causes of neonatal mortality
• Define elements of essential neonatal care
• Understand and discuss best practices and
technologies for promoting neonatal health
• Use relevant data and information to develop
appropriate essential neonatal interventions
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WHY Neonatal Health in
Emergencies?
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Neonatal Mortality rate by country 2000
WHO 2006
Cause of Death Worldwide Among Children <5
Years, 2000-2003
Neonatal mortality as % of IMR 2000
WHO 2006
WHERE? The 10 African countries where newborns have
the highest risk of dying
Country
Neonatal mortality
Rank
1,000 live births)
(out of 46
46
Liberia
66
45
Côte d'Ivoire
65
44
Mali
57
43
Sierra Leone
56
42
Angola
54
41
Somalia
49
40
Guinea-Bissau
48
39
Central African Republic
48
38
Nigeria
48
37
Congo DR
47
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WHY NO EVIDENCE in Emergencies
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Surveillance : Mortality Form
No. of deaths
0-4 yrs
5+ yrs
males females males females
Total
Watery diarrhea
Bloody diarrhea
Suspected cholera
Respiratory tract disease
Measles
Malaria
Maternal death
Suspected meninigits
Other/unknown
Total by age and sex
Total <5 yrs
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Surveys : difficult to measure
NMR = Deaths /live births
Low prevalence
- Very high confidence interval,
- Higher sample size
Prevalence of wasting:
• 28.9% < -2 Z scores weight for height [CI:25.9-32.1]
• TFC 17.2% [3.9 - 46.4]
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As a proportion of U5MR
Recall period
Births and deaths within recall period
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What can we do in emergencies
1. Essential Neonatal Care
2. Evidence development/ data
collection
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Causes of death
• 2/3 of deaths in the first
month die within the first
week
• 2/3 of deaths in the first week
occur within 24hours of life
• Main causes of death differ
with NMR
• Major causes of neonatal
deaths (globally)
– Birth asphyxia: 23%
– Infections: 36%
– Preterm: 27%
Lancet: Neonatal Survival
Series March, 2005
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Causes of death
Preterm babies
– Preterm babies – are babies born before 37 weeks gestation
– Preterm and low birth weight babies are prone to
complications:
• Feeding difficulty
• low body temperature
• Breathing difficulty – respiratory distress syndrome &
apnoea
• Jaundice of prematurely
• Low glucose level
Low birth weight
– Babies born with a birth weight of less than 2500 grams
– Globally 18 million babies are estimated to be born with LBW
every year, ½ of this are estimated to be in South Asia.
– Low birth weight is associated with 60-80% of neonatal deaths
– LBW could be due to : poor growth in utero; preterm or born
to early; preterm with poor growth in utero
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Causes of death
Infections
• In very high mortality settings almost 50% of deaths
are due to severe infections
– Neonatal sepsis, pneumonia, diarrhea
– Neonatal tetanus
Birth Asphyxia
• Asphyxia is when the baby doesn’t begin or sustain
adequate breathing at birth
• 5-10% of all newborns need resuscitation at birth
• Nearly 1 million babies die each year because they
don’t breath normally at birth
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Essential Neonatal Care
Major cause
of death
Prevention
Curative
Birth
Asphyxia
-Identification and
management of
hypertension in pregnancy
and pre eclampsia
-Skilled attendance of
delivery
-Labor Surveillance
(Partograph)
- Emergency Obstetrics
Care (EmOC)
(management of
obstructed labor and
hemorrhage)
Initiation of breathing
and resuscitation of
the newborn
Emergency Obstetrics
and Neonatal Care
(EmONC)
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Essential Neonatal Care Interventions
Complications
-Treat infections
of Preterm Birth during pregnancy
(UTI, RTI)
-Antibiotics for
preterm premature
rupture membranes
(PROM)
-Corticosteroids for
preterm labour
-Initiation of breathing
and resuscitation of
the newborn
-Improved feeding
practice
-Kangaroo Mother
Care
-Early identification
and treatment of
complications –mainly
infections
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Essential Newborn Interventions
Neonatal
Infections
Sepsis
Pneumonia
Diarrhea
Tetanus
-Clean childbirth
-Cord care
-Hygienic baby care
-Early
identification
(PNC)
-Antibiotics
-Tetanus toxoid
immunization of
pregnant woman
-Skilled birth attendant
-Immediate and
exclusive breastfeeding
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Care for Low Birth Weight baby
•
•
•
•
Deliver in a warm room
Dry newborn thoroughly and wrap in dry, warm cloth
Keep out of draft and place on a warm surface
Give to mother as soon as possible
– Skin-to-skin contact first few hours after childbirth
– Promotes bonding
– Enables early breastfeeding
– breathing
• Delay bathing - Bathe when temperature is stable (after 24
hours)
• Feeding support (immediate/exclusive breastfeeding)
• Prevention of infection: cord care (dry, clean, uncovered),
treat eye infection, temperature monitoring, early detection
of infections
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Evidence development:
Surveillance and Survey
1) Community level
- Community based surveillance system
- Population based surveys
- Proportion of U5MR
2) Primary health facility level
• Facility based data
3) Hospital level
• Facility based data
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Essential drugs and medical equipments
Drugs – need to be in emergency health kits
– Ampicillin, Amoxicillin, Metronidazole, Nystatin, Cloxacillin,
Erythromycin
– Gentamicin, Penicillin G, Benzathine benzyl penicillin, Ceftriaxone
– Sulfadoxine – Pyrimethamine (SP)
– Isoniazid
– Nevirapine, Zidovudine (AZT), Co-trimexazole
– Sliver nitrate solution (1%), Tetracycline 1% ointment, Polyvidone
Iodine solution 2.5%
– Vitamin A, Vitamin K, Folic Acid
Equipments and supplies
– Newborn face masks, resuscitation bag
– Suctions apparatus (bulb, mucus extractors, mechanical suction)
– Thermometer (axillary) – as low as 35 °C
– Thermometer (rectal) – as low as 25 °C
– Fetal Stethoscope, baby weighing scale
– Delivery kit, gloves, syringe, needles
– Disinfectant solution, gauze, gentian violet
Other materials
Clean delivery kits, baby cups, wraps, soap, baby diaper
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Resources
1) The Lancet Series: Neonatal Survival March,
2005
2) WHO – Integrated Management of Pregnancy
and Childbirth: Managing Newborn Problems – a
guide for doctors, nurses, and midwives. World
Health Organization 2003
3) Opportunities for Africa’s Newborns: practical
data, policy and programmatic support for
newborn care in Africa. Joy Lawn and Kate
Kerber, eds. PMNCH, Cape Town, 2006
4) Save the Children: care of the newborn reference
manual
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