care of the low birthweight babies /neonatal intensive care aggrey wasunna division of neonatal...
TRANSCRIPT
ASADI V ACCRA GHANA NOV 9 - 11 2009
CARE OF THE LOW BIRTHWEIGHT BABIES /NEONATAL INTENSIVE CARE
AGGREY WASUNNADivision Of Neonatal Medicine
Department of Paediatrics & Child HealthUniversity of Nairobi
ASADI V ACCRA GHANA NOV 9 - 11 2009
ASADI V ACCRA GHANA NOV 9 - 11 2009
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
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
COST EFFECTIVE MEASURES OF CARE
- Appropriate resuscitation /respiratory care- Prevention of hypothermia- Feeding and prevention of hypoglycemia- Prevention of infectionsIs there a place for Neonatal Intensive Care?
ASADI V ACCRA GHANA NOV 9 - 11 2009
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
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
• 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
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
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
• 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
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
• Colonising babies with maternal organisms• Promoting breastfeeding• KMC• Limiting use of antibiotics • Clean equipment
ASADI V ACCRA GHANA NOV 9 - 11 2009
• Monitoring bacterial culture and sensitivity• Visiting policy / parent education• Well trained staff
ASADI V ACCRA GHANA NOV 9 - 11 2009
NEONATAL INTENSIVE CARE
ASADI V ACCRA GHANA NOV 9 - 11 2009
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
ASADI V ACCRA GHANA NOV 9 - 11 2009
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
THANK YOU