1. World Health Organization
15 April, 2017
Essential Newborn Care
Dr P. Mongi
African Regional Meeting on Interventions for Impact for Essential Obstetric and Newborn Care: February 2011, Addis Ababa, Ethiopia

2. Presentation outline Some Facts and Figures on Newborn health
Essential Newborn Care
Definition of Essential Newborn Care
Key components of Essential Newborn Care
WHO Essential Newborn Care Course- ENCC & Resuscitation

3. Progress towards MDG 4
Total number of deaths of children < 5 dropped from million in 1990 to 8.8 million in (30%)
Neonatal mortality represents about 40% (3·575 million), most in the first week

5. 3·6 Neonatal Deaths: Where ?
Disclaimer: The designation employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dashed lines represent approximate border lines for which there may not yet be full agreement.
In Japan, 1 in 1000 babies die within 28 days of birth.
In India, 37 in 1000 babies die within 28 days of birth.
In Sierra Leone, 45 in 1000 babies die within 28 days of birth.
1 dot = 1'000 neonatal deaths

6. 3·6 Neonatal Deaths: Why ?
Under-nutrition contributes to one-third of child deaths
Prematurity is a complication to be dealt with starting in pregnancy
Birth asphyxia needs to be dealt with in the first minutes of life
CHERG Lancet 2010; 375: 1969–87

7. In Africa 1·2 Neonatal Deaths: Why?
Lower contribution to overall child mortality
Prematurity and birth asphyxia contribute equally
Neonatal deaths likely to increase as child deaths fall
CHERG Lancet 2010; 375: 1969–87

8. Causes of Newborn deaths in SS-Africa
Newborn deaths constitute 29% of under five mortality
The main causes for almost 90% of Newborn deaths are:
Infections- 32%
Prematurity and Low birth weight- 29%
Birth Asphyxia and birth trauma- 27%
ALL are preventable and treatable
MDG- 4 can only be achieved if neonatal deaths are addressed and this necessitates both maternal and child health interventions

9. When are the 1.2 million African newborn deaths occurring?
World Health Organization
When are the 1.2 million African newborn deaths occurring?
15 April, 2017
About a quarter
of neonatal
deaths are on
the day of birth
Birth and first week is key:
when most babies die yet
when coverage
of care is lowest for
mothers and babies
More than 70% of
neonatal
deaths are in
the first week
Data from DHS surveys in 47 countries, 10,048 neonatal deaths. A very high proportion of deaths occur in the first hours and days after birth. Prevention of these early neonatal deaths will require improvements in care at the time of birth and improvements in care in the early neonatal period.
Source: Lawn JE, Kerber K -Daily numbers of death in 20 African countries during first month of life - based on 20 DHS datasets (2000 to 2004) with 5,763 neonatal deaths

10. World Health Organization
Coverage of key Maternal and Child Survival Interventions, in WHO/AFRO 2008
15 April, 2017
The hours and days of highest risk have the lowest coverage of care
Source: WHO World Health Statistics 2010, UNICEF State of the World’s Children, 2010 10

11. Definition of Essential Newborn Care- ENC
WHO Working Group Meeting in 1994 in Trieste, Italy- ENC was defined as consisting of eight components
These elements remain, even if some have slightly changed in content, since.
The concept of ENC was further divided into Basic Care and Special Care
Basic Care -includes interventions for all infants to meet their physiological needs.
Special Care -required for a small group of newborns because of diseases acquired before, during or after birth and/or because they are born too soon/small
This was the basis for developing the essential practice guide of the Integrated Management of Pregnancy and Childbirth (IMPAC) series as well as the guide for doctors, nurses and midwives Managing Newborn Problems.
The WHO Essential Newborn Care Course is part of these IMPAC series

12. Essential Newborn Care-Components
World Health Organization
15 April, 2017
Cleanliness
Thermal protection
Early and exclusive breastfeeding
Initiation of breathing, resuscitation
Eye care
Immunization
Management of newborn illness
Care of the preterm and/or low birth weight newborn
The WHO definition stemms from a WHO Working Group Meeting in 1994 in Trieste, Italy. ENC was defined as consisting of eight components:
Cleanliness: clean delivery and clean cord care for the prevention of newborn infections
Thermal protection: prevention and/or management of neonatal hypothermia and hyperthermia
Early and exclusive breastfeeding: Breasfeeding should be started within an hour of birth. Feeding should be as frequent as the baby demands, without prelacteal feeds or other fluids and food. Knowledge about importance of breastfeedin should be disseminated among families and communities as well as health workers and managers (10 steps)
Initiation of breathing, resuscitation: "Helping Babies Breathe" …
These elements remain, even if some of these elements have slightly changed in content, sine. The concept of ENC was further divided into Basic Care and Special Care. Basic Care includes interventions for all infants to meet their physiological needs. Special Care is required for a small group of newborns because of diseases acquired before, during or after birth and/or because they are born too soon or too small. This was the basis for developing the essential practice guide of the Integrated Management of Pregnancy and Childbirth (IMPAC) series as well as the guide for doctors, nurses and midwives Managing Newborn Problems.

13. Integrated Management of Pregnancy and Childbirth (IMPAC)
World Health Organization
Integrated Management of Pregnancy and Childbirth (IMPAC)
15 April, 2017
Clinical guidelines
Programme guides
Education modules
Advocacy material
Tools for monitoring and evaluation

14. Essential Newborn Care Course
New layout
French version in print

15. The 5 modules in the ENCC 1. Care of the baby at the time of birth
Introduction to the PCPNC guide
Universal precaution
Care of the baby at birth
Keeping baby warm
2. Examination of the newborn baby
Breasting a newborn baby- ensuring a good start
Communication skills
Examination of the newborn
3. Care of the newborn baby until discharge
Resuscitation of the newborn baby
Routine care of the newborn baby
4. Special situations
Overcoming difficulties in breastfeeding
The small baby
Alternative methods of feeding a baby
5. Optional module
Giving an injection
Kangaroo mother care

16. The WHO Essential Newborn Care Course
World Health Organization
The WHO Essential Newborn Care Course
15 April, 2017
Five days course on essential and emergency newborn care
Any health facility dealing with mothers and newborns
For doctors, midwives and nurses

17. ENCC: State of Implementation
World Health Organization
ENCC: State of Implementation
15 April, 2017
Mali
Kenya
No WHO AFRO
Trained trainers available (8 countries)
Al least one core national ENC training conducted (7 countries)
4 districts Training started in periphery (3 countries)
7 or more district/provincial courses (2 countries)
By 2010 ENCC training has been introduced in 40 countries globally
AFRO-20
EMRO
SEARO
WPRO
Yoy will receive an updated slide

18. Effective Perinatal Care Package (EPCP)
Total 15 countries

19. Asphyxia &Resuscitation of the newborn baby
Asphyxia is failure to breath within one minute after delivery.
Good labour could prevent most birth asphyxia
This is treatable if births are attended by health worker skilled in neonatal resuscitation
One in 20 (5%) babies need help with breathing- resuscitation
Resuscitation must be anticipated at each delivery
Resuscitation skills are essential to the survival of babies

20. Training Newborn Resuscitation in the Context of Essential Newborn Care-1
Newborn resuscitation is a critical component of ENC, but one out of the eight components
The WHO ENCC training package contains a module on basic newborn resuscitation based on the 1998 guidelines currently updated
Countries may chose to replace that module by Helping Babies Breath (HBB)
The introduction of ENCC should trigger the review of the national neonatal resuscitation guidelines including by level of care

21. Training Newborn Resuscitation in the Context of Essential Newborn Care-2
Efforts to improving ENC should go hand in hand with efforts to improving good quality obstetric care to prevent adverse neonatal outcomes including reduced need for resuscitation
National Ministries of Health and professional bodies (e.g. midwife associations, paediatric societies should take ownership of these training initiatives, partners should align and coordinate their support
The impact of any training (ENCC and/or HBB) on change of practice in all eight ENCC components in maternity services should be documented or evaluated, including in the context of other efforts such as the Baby Friendly Hospital Initiative (BFHI)

22. Thank you