Neonatal Health

What can we do in crisis situations?

Emergency Health and Nutrition Training

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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

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WHY Neonatal Health in Emergencies?

Neonatal Mortality rate by country 2000 WHO 2006

Cause of Death Worldwide Among Children <5 Years, 2000-2003

Neonatal mortality as % of IMR 2000 WHO 2006

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WHERE? The 10 African countries where newborns have the highest risk of dying

Rank (out of 46 countries)

Country Neonatal mortality rate

(per 1,000 live births)

46 Liberia 66

45 Côte d'Ivoire 65

44 Mali 57

43 Sierra Leone 56

42 Angola 54

41 Somalia 49

40 Guinea-Bissau 48

39 Central African Republic 48

38 Nigeria 48

37 Congo DR 47

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WHY NO EVIDENCE in Emergencies

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Surveillance : Mortality Form

No. of deaths Totalmales females males females

Watery diarrheaBloody diarrheaSuspected choleraRespiratory tract diseaseMeaslesMalariaMaternal deathSuspected meninigitsOther/unknownTotal by age and sexTotal <5 yrs

0-4 yrs 5+ yrs

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Surveys : difficult to measure

NMR = Deaths /live birthsLow prevalence - Very high confidence interval, - Higher sample size

Prevalence of wasting: • 28.9% < -2 Z scores weight for height [CI:25.9-

32.1]

• TFC 17.2% [3.9 - 46.4]

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As a proportion of U5MR

Recall period

Births and deaths within recall period

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What can we do in emergencies

1. Essential Neonatal Care2. Evidence development/ data

collection

Lancet: Neonatal Survival Series March, 2005

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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%

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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

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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

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Essential Neonatal Care

Major cause of death

Prevention Curative

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)

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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

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Essential Newborn Interventions

Neonatal Infections

Sepsis PneumoniaDiarrhea 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

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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

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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

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Essential drugs and medical equipmentsDrugs – 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 materialsClean delivery kits, baby cups, wraps, soap, baby diaper

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Resources

1)The Lancet Series: Neonatal Survival March, 2005

2)WHO – Integrated Management of Pregnancy and Childbirth: Managing Newborn Problems – a guide for doctors, nurses, and midwives. World Health Organization 2003

3)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, 2006

4)Save the Children: care of the newborn reference manual