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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
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