Neonatal Health What can we do in crisis situations? Emergency Health and Nutrition Training

2 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

3 WHY Neonatal Health in Emergencies?

Neonatal Mortality rate by country 2000 WHO 2006

Cause of Death Worldwide Among Children <5 Years,

Neonatal mortality as % of IMR 2000 WHO 2006

7 WHERE? The 10 African countries where newborns have the highest risk of dying Rank (out of 46 countries) CountryNeonatal mortality rate (per 1,000 live births) 46 Liberia Côte d'Ivoire Mali Sierra Leone Angola Somalia Guinea-Bissau Central African Republic Nigeria Congo DR 47

8 WHY NO EVIDENCE in Emergencies

9 Surveillance : Mortality Form

10 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: ] TFC 17.2% [ ]

11 As a proportion of U5MR Recall period Births and deaths within recall period

12

13 What can we do in emergencies 1.Essential Neonatal Care 2.Evidence development/ data collection

Lancet: Neonatal Survival Series March, 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%

15 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

16 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 Causes of death

17 Essential Neonatal Care Major cause of death PreventionCurative 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)

18 Essential Neonatal Care Interventions Complications of Preterm Birth -Treat infections 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

19 Essential Newborn Interventions Neonatal Infections Sepsis Pneumonia Diarrhea Tetanus -Clean childbirth -Cord care -Hygienic baby care -Tetanus toxoid immunization of pregnant woman -Skilled birth attendant -Immediate and exclusive breastfeeding -Early identification (PNC) -Antibiotics

20 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

21 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

22 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

23 Resources 1)The Lancet Series: Neonatal Survival March, )WHO – Integrated Management of Pregnancy and Childbirth: Managing Newborn Problems – a guide for doctors, nurses, and midwives. World Health Organization )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, )Save the Children: care of the newborn reference manual