2. AGENDA 1.BCA at a glance 2.Lessons from Adult BCA 3.Why focus on the newborn 4.BCA for the newborn

3. BCA AT A GLANCE 3 1.Healthcare Associated Infections 2.Antimicrobial Stewardship 3.BCA…for the newborn

4. 10 LESSONS FROM ADULT BCA

5. 1. 5

6. 2. 6

7. 3. 7

8. 4. 8

9. 5. 9

10. 6. 10

11. 7. 11

12. 8. 12

13. 9. 13

14. 10. EATING THE ELEPHANT ONE BITE AT A TIME

15. Why focus on the newborn?

16. INFANT MORTALITY IN RSA ( Stats SA, 2008) 16

17. NEONATAL DEATHS IN RSA ( Stats SA, 2008) 17

18. DRIVERS OF MORBIDITY AND MORTALITY Neonatal Sepsis Chronic Lung Disease Necrotising Enterocolitis Periventricular-Intraventricular Haemorrhage Retinopathy of Prematurity

20. 3 MAJOR COMPONENTS 1.Screening bundle 2.Drivers of Mortality & Morbidity 3. Sepsis bundle

21. SCREENING BUNDLE 1. Antenatal steroid compliance 2. HIV screening 3. HIV PMTCT compliance 4. Syphilis screening 5. Early NCPAP compliance 6. Cranial Ultrasound compliance 7. Retinal exam compliance 8. Caesarean section rate

22. PIH NEC CLD ROP DRIVERS OF MORBIDITY & MORTALITY

23. SEPSIS BUNDLE Early Bacterial Sepsis (EBS)  Vertical transmission  Within 72 hours of birth Late Onset Infections (LOI)  Healthcare Associated Infection  Bacteria, fungal or viral  After 72 hours of birth

24. SEQUENCING Data Collection Screening bundle Bundles M & M drivers Obstetric Sepsis Surveillance EBS ICP & CLABSI bundle LOI

25. ROP RETINOPATHY OF PREMATURITY

26. ROP BUNDLE 1.Pulse oximetry on an infant receiving oxygen. 2.Saturation probe to be placed on the Right or Left hand. 3.Saturation aimed at 86-92% 4.Monitor alarm to be set at 85 (low) and 93 (high). 5.Fundoscopy screening done or booked before discharge. ROP

27. CHRONIC LUNG DISEASE

28. CLD BUNDLE 1.Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation. 2.Neopuff use in neonatal resuscitation. 3.Gentle ventilation (NCPAP) vs (HFO) vs (CV). 4.Permissive hypercapnia of more than 45mmHg. 5.Administration of systemic steroids to the infant to prevent or treat CLD. CLD

29. NECROTISING ENTEROCOLITIS

30. NEC BUNDLE 1.Breastmilk or pasteurised EBM as a modality of feeding. 2.Trophic feeds within 24 hours of birth. 3.Adherence to “volume per day” protocol. 4.Adherence to “frequency of feeds” protocol. NEC

31. PERIVENTRICULAR-INTRAVENTRICULAR HAEMORRHAGE

32. PIH BUNDLE 1.Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation. 2.Delayed cord clamping for 45 seconds to a minute. 3.Neopuff use in neonatal resuscitation. 4.Maintain infant temperature to more than 36 degrees Celsius. 5.Developmental care: dim lights, low levels of noise and minimal handling. PIH