1. CARE OF THE LOW BIRTHWEIGHT BABIES /NEONATAL INTENSIVE CARE AGGREY WASUNNA Division Of Neonatal Medicine Department of Paediatrics & Child Health University of Nairobi ASADI V ACCRA GHANA NOV 9 - 11 2009

3. BACKGROUND Under five mortality rates are declining while NMRs remain stagnant in Sub-Saharan Africa Globally there are 130 million live births with 4 million neonatal deaths (NND) 99% of the NND occur in developing countries Low birthweight (LBW) babies account for about 80% of NND Poor record keeping hampers improvement of care ASADI V ACCRA GHANA NOV 9 - 11 2009

4. CASE FOR CARE OF LBW BABIES Reducing NMRs will help in achieving MDG4 Care for the LBW babies has a huge impact in reducing NMRs Lots of resources needed to care for LBW babies but availability follows the “Inverse Care Law” (Hart 1971) ASADI V ACCRA GHANA NOV 9 - 11 2009

5. COST EFFECTIVE MEASURES OF CARE -Appropriate resuscitation /respiratory care -Prevention of hypothermia -Feeding and prevention of hypoglycemia -Prevention of infections Is there a place for Neonatal Intensive Care? ASADI V ACCRA GHANA NOV 9 - 11 2009

6. Reduction (%) In All Cause Neonatal Mortality or Morbidity Resuscitation of the Newborn 6 – 42% Breastfeeding 55 – 87% Prevention/Management of Hypothermia 18 – 42% Kangaroo Mother Care ( LBW ) reduces incidence of infection by 7 – 75% Community based Pneumonia case Management 18 – 35% Adapted from Darmstadt GL et al 2005;Lancet 365: 977 - 988 ASADI V ACCRA GHANA NOV 9 - 11 2009

7. APPROPRIATE RESUSCITATION /RESPIRATORY CARE Perinatal asphyxia a major cause of neonatal morbidity and mortality especially among LBW babies Appropriate neonatal resuscitation has been shown to prevent perinatal asphyxia ASADI V ACCRA GHANA NOV 9 - 11 2009

8. Adequate resuscitation requires  Birth preparedness  Presence of competent personnel  Presence of working basic equipment Studies have shown that lower cadre health workers can be trained to provide adequate resuscitation Treatment modalities of established perinatal asphyxia are often costly and need expertise ASADI V ACCRA GHANA NOV 9 - 11 2009

9. PREVENTION AND MANAGEMENT OF HYPOTHERMIA Hypothermia is associated with complications resulting in neonatal morbidity and mortality LBW babies most affected Hypothermia can be prevented through  Warming the room, drying and wrapping the baby  Frequent feeding  Skin to skin care  Incubators /semi permeable plastic sheets Kangaroo Mother Care (KMC)  Easy to implement  Reduces infection /severe illness  Promotes breastfeeding with better weight gain ASADI V ACCRA GHANA NOV 9 - 11 2009

10. APPROPRIATE FEEDING AND PREVENTION OF HYPOGLYCAEMIA Hypoglycaemia is common among the LBW babies The magnitude of the impact not clear due to the paucity of data in Developing countries Early initiation and frequent feeds important Breastmilk is ideal: promotes ketogenesis and has low insulinogenic effect ASADI V ACCRA GHANA NOV 9 - 11 2009

11. Fortification of breastmilk should be considered as appropriate Vitamin and mineral supplementation are important for optimal growth ASADI V ACCRA GHANA NOV 9 - 11 2009

12. INFECTION CONTROL Neonatal infections contribute about 8-80% of NND LBW babies are particularly prone to getting infected Neonatal infections can be reduced through  Avoiding overcrowding  Strict policy of clean hands ASADI V ACCRA GHANA NOV 9 - 11 2009

13. Colonising babies with maternal organisms Promoting breastfeeding KMC Limiting use of antibiotics Clean equipment ASADI V ACCRA GHANA NOV 9 - 11 2009

14. Monitoring bacterial culture and sensitivity Visiting policy / parent education Well trained staff ASADI V ACCRA GHANA NOV 9 - 11 2009

15. NEONATAL INTENSIVE CARE ASADI V ACCRA GHANA NOV 9 - 11 2009

16. NEONATAL INTENSIVE CARE Expensive to set up Running costs high Has an overall low impact on LBW babies survival Found mainly in Level 6 teaching/referral hospitals ASADI V ACCRA GHANA NOV 9 - 11 2009

18. CONCLUSION Care of LBW babies in resource restricted countries still depends on cost effective preventive measures Prevention of perinatal asphyxia,Hypothermia, infection together with appropriate feeding have significant impact in reducing LBW morbidity/mortality NICU is out of reach for most Sub-Saharan countries with little impact on NMRs ASADI V ACCRA GHANA NOV 9 - 11 2009

19. THANK YOU ASADI V ACCRA GHANA NOV 9 - 11 2009