1. Doug Simkiss Associate Professor of Child Health Warwick Medical School The principles of good neonatal care and why neonatal resuscitation is important

2. Introduction Principles of good neonatal care Why neonatal resuscitation is important

3. Introduction - Reference texts Malawi National Reproductive Health Service Delivery Guidelines, 2007 Managing Complications in Pregnancy and Childbirth: a guide for midwives and doctors; Integrated Management of Pregnancy and Childbirth, WHO, 2007

4. Introduction - Reference texts Pregnancy, Childbirth, Postpartum and Newborn Care: a guide for essential practice; Integrated Management of Pregnancy and Childbirth, WHO, 2009

5. Principles of good neonatal care Most babies require only simple supportive care at and after delivery –Dry the baby with a clean towel –Give the baby to mother as soon as possible, for skin to skin contact on breast –Cover the baby with clean towel to prevent heat loss –Record time of birth –Clamp and cut the cord (K10)

7. Principles of good neonatal care –Assess infant using APGAR score –Encourage breast feeding within the first half hour, after maternal HIV status and choice of feeding clarified –Keep newborn warm (K9) –Perform eye care –Weigh and record weight –Undertake head to toe examination of newborn –Maintain infection prevention and control practices during care of baby

8. Principles of good neonatal care APLS video clips –Drying the baby –Kangaroo care

9. Ongoing care of normal newborn Behaviour of baby (crying, feeding, reactions to stimuli Colour (eye and skin) Respiration Cord (bleeding/infection) Elimination pattern

10. Ongoing care of normal newborn Fontanelle (bulging/sunken) Vital signs (temperature) Immunisations (BCG, polio 0) Keep the baby safe (J2)

11. Breast feeding (J4, J9)

12. Breast feeding

14. Introduction Principles of good neonatal care Why neonatal resuscitation is important

15. Neonatal resuscitation is important ‘each year approximately 10 million babies do not breathe immediately at birth, of which about 6 million require basic neonatal resuscitation…evidence from several observational studies shows that facility based basic neonatal resuscitation may avert 30% of intrapartum – related neonatal deaths ’

16. Neonatal resuscitation is important ‘Very few babies require advanced neonatal resuscitation (endotracheal intubation and drugs) and these newborns may not survive without neonatal intensive care.

17. Neonatal resuscitation is important ‘Of the 60 million non-facility births, most do not have access to resuscitation. Several trials have shown that a range of community health workers can perform neonatal resuscitation with an estimated effect of a 20% reduction in intrapartum- related neonatal deaths (based on expert opinion)’ 1.

18. Neonatal resuscitation is important ‘Universal application of basic resuscitation may save hundreds of thousands of newborn lives currently lost each year and contribute significantly to progress toward Millennium Development Goal 4’.

19. Neonatal resuscitation S.N.Wall et al. International Journal of Obstetrics and Gynaecology 107 (2009) S47-S64

20. Neonatal resuscitation For some babies, the need for resuscitation can be anticipated –Mother has a chronic illness –Mother has a previous stillbirth or foetal death –Mother has pre-eclampsia –In multiple pregnancies –In preterm delivery –In abnormal presentation of the foetus

21. Neonatal resuscitation –With a prolapsed cord –Where there is prolonged labour or rupture of membranes or meconium stained liquor However for many babies the need for resuscitation cannot be anticipated before delivery, therefore be prepared for resuscitation at every delivery

22. Neonatal resuscitation ‘Anticipate the need for resuscitation and have a plan to get assistance for every baby but especially if the mother has a history of eclampsia, bleeding, prolonged or obstructed labour, preterm birth or infection’ WHO guidelines 2007

23. Neonatal resuscitation S.N.Wall et al. International Journal of Obstetrics and Gynaecology 107 (2009) S47-S64

24. Neonatal resuscitation If these limited data were generalised for Africa, <¼ of babies born in facilities would have access to resuscitation and because only about half of births are in facilities, only 1/8 of babies who require resuscitation may receive this intervention.

25. Neonatal resuscitation We will look at practical aspects of resuscitation in detail this afternoon including –Helping babies breathe –Bag and mask ventilation

26. Neonatal resuscitation APLS video clips –Head position infant airway –Neonatal resuscitation by nurses

27. Conclusion Principles of good neonatal care Why neonatal resuscitation is important