Essential Intrapartum and Newborn Care (EINC) Bulletin 1

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The EINC Bulletin details the Scale Up activities put into the implementation of EINC in the country and likewise provides important insights/information in the dissemination of the program in the Philippines

Text of Essential Intrapartum and Newborn Care (EINC) Bulletin 1

EINC BullEtINVol 1 June 15, 2011

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news Are Newborn Care Practices Done Appropriately within the First Hour of Life?: A Survey on 51 of the Largest Hospitals in the Philippinesa Feature: THE QUIRINO MEMORIAL MEDICAL CENTER EXPERIENCE: Accepting the challenge of change EBM Notes:The JPMNH Scale Up Project

Documenting Essential Intrapartum Newborn Care (EINC) Practices for Safe & Quality Maternal & Newborn Care

Drop in Maternal and Newborn Deaths Marks 8th week of EINC in General Santosr. Orlando Marius Oco Jr, Chairperson of the Local Health Board of General Santos City said they were encouraged by the feedback that there has been a dramatic drop in the NICU admissions, decreasing rates of preterm and sepsis deaths and an overall decrease in maternal and newborn deaths after 8 weeks of implementation of the EINC Scale Up Project. Dr. Oco said this as he welcomed the participants, project staff, conveners and resource speakers of the orientation workshop on Essential Intrapartum and Newborn Care last May 25, 2011. Dr. Oco cited the recent world health report which seeks to make every mother and child count. The United Nation says that almost 11 million children under 5 years of age will die from causes that are largely preventable. Among them are 4 million babies who will not survive the first month of life. At the same time, more than half a million women will die during pregnancy or childbirth. The report says that reducing this toll in line with the Millennium Development Goals depends largely on every mother and every child having the right access to healthcare from pregnancy through childbirth, the neonatal period and childhood. The Health Board Chair said the City of General Santos was grateful that General Santos City Hospital had been identified by the Department of Health as the collaborating institution in the SOCCSKARGEN Region to implement the Essential Intrapartum and Newborn Care protocol in the area. More than 500 health professionals from General Santos City, Kidapawan, Sultan Kudarat, Tacurong, Polomolok etc braved the rains to attend the EINC orientation workshop heldABOVE: Health professionals in General Santos city attending the second round of EINC Orientation Workshop held last May.

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over 3 days at the Lagao Auditorium in General Santos City. He ended his welcome by reminding the health professions that we do not rest on our laurels or wallow in defeat, we will take honor in this opportunity to learn and serve and in this privilege to host this workshop. And with the warm salutation You are in the home of the Generals!!! Good day to all and Magandang Gensan!

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unang Yakap Embraces

News

8,962

Healthcare Professionals!r. Mianne Silvestre, EINC Team Convenor and WHO Consultant, reports that at least 8,962 healthcare professionals are now aware or knowledgeable in essential intrapartum and newborn care (EINC) practices. We believe this means that mothers and newborns will benefit from safer, quality care from these health facilities.

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Participants follow Dra Izza Flores lead in proper hand hygiene technique at EINC Training in General Santos City

EINC Scale Up, Oct to May 2011

n=8,962

We believe this means that mothers and newborns will benefit from safer, quality care from these health facilitiesFrom October to May 2011, we tripled our goals when requests for the EINC training course, spontaneously came from private hospitals (12%) and public hospitals in provinces outside NCR (6%). The biggest chunk of awareness still comes from those who attended lectures of our EINC team or talks provided at special forum (53%). But this number appears understated. Dr. Silvestre pointed out that it does not capture the number of readers or listeners who have heard the DOH National Center for Disease Prevention and Control Director Dr. Ed Janairo or Family Health Offices Dr. Anthony Calibo on radio and television talk about the benefits of adopting the EINC practices.

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MNCHN EINC BullEtINPolicy Brief Are Newborn Care Practices Done Properly within the First Hour of life?

A Survey on 51 of the Largest Hospitals in the Philippineshe Philippines is one of 42 countries accounting for 90 percent of all global deaths in children under 5 years of age with 82,000 Filipinos die before reaching their 5th birthday. There are also over 40,000 newborns who die annually. And if newborn mortality is not reduced by half, the goal of reducing childhood mortality by two thirds, which is part of the Millennium Development Goals, will not be met. In a study of consecutive deliveries in 51 of the largest hospitals in 9 regions in the Philippines, an assessment tool developed by the World Health Organization (WHO) as a standard in Newborn Care which included the evidence-based intervention, was used to evaluate the performance, timing of procedures and attendant capabilities in immediate newborn care. The Intrapartum/Newborn Practices assessment tools were developed through a collaboration between the Philippine General Hospital and World Health Organization (WHO) with Department of Health (DOH) inputs. In this cross sectional study in 2009 using a brief questionnaire and annual reports such as hospital births, deaths and sepsis cases, approximately 10 babies were consecutively included from each of the randomly selected 51 hospitals. These evidence-based interventions include immediate drying, skin-toskin contact followed by clamping of the cord and non-separation, and breastfeeding initiation. Necessary interventions like immunizations, eye care, vitamin K administration was also timed. Unnecessary procedures such as routine suctioning, routine separation of newborns for observation, giving of glucose water or formula and footprinting

by Louell L. Sala, MD

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Metacards activity determine the level of knowledge and awareness on newborn care practices among health professionals

(increasing risk of contamination from ink pads) was also identified. A total of 481 mother-newborn dyads were directly observed. The percentages and median times to the following included cord clamping (12 sec), drying (93.8% at 1 min), skin-to-skin contact (9.6% at 4 min) and any early contact with mother (61.1% at 5 min), washing (84.2% at 8 min), breastfeeding initiation (61.3% at 10 min), separation from mother (93.2% at 12 min), weighing (100% at 13 min), examination (75.7% at 17 min), transfer to a nursery (52.4% at 20 min), eye prophylaxis (99.8% at 20 min), injections of vitamin K/vaccines (95.6% at 22 min) and rooming-in (83.4% at 138 min). Only 1 of 26 apneic or gasping newborns was dried prior to other actions. It was found from the study that among the randomly selected 51 hospitals in the Philippines, performance and timing of evidence-based interventions

in immediate newborn care were below WHO essential newborn care standards. In these hospitals, their practices prevented Philippine newborns from benefiting from their mothers natural protection in the first hour of life and almost none in the study newborns benefited from the natural transfusion from delayed cord clamping. It should be known that any unnecessary delay and restriction on immediate thorough drying, early and sustained skin-to-skin contact, early latching, rooming in and full breastfeeding, compromised the newborns chance for maintenance of warmth and survival beyond the newborn period. Further, these interventions can be integral to hospital infection control practices as they directly reduce risk of neonatal sepsis. Note. The Acta Paediatrica article can be downloaded for free via this link: http:// onlinelibrary.wiley.com/doi/10.1111/ j.1651-2227.2011.02215.x/pdf

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of neonatal deaths. Overall, 82,000 Filipino children die annually (2008) before the age of five, 45 % of them neonates. Almost half of newborn deaths occur in the first 28 days, a quarter of them in the first two days of life. The three major causes are complications of prematurity (41%), sepsisand pneumonia (16%), asphyxia (15%)1. The study confirmed that currentpractices in Philippine hospitals fell below recommended WHO standards and robbed newborns of the natural protection offered by four recommended basic interventions: immediate and thorough drying, skin to skin contact, properly timed cord clamping and early initiation of breastfeeding. Cords were immediately clamped at a median of 12 seconds, far too soon. Less than 1 in 10 babies was placed in direct skin-to-skin contact with the mother. Many newborns were exposed to cold by not being dried immediately and thoroughly, and being put on cold surfaces. All were washed early and 80% were suctioned unnecessarily, according to the study. >>

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MEDICAlEXPERIENCEFeature

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ccepting the challenge of changeby Monica Feria

Barely one year after adopting the new Essential Newborn Care protocols, QMMC cut newborn deaths by half and achieved a 70% reduction in neonatal sepsis. Doing away with unnecessary procedures in the delivery room also saved the hospital a minimum of P3 million.

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he Quirino Memorial Medical Center (QMMC), formerly known as the labor hospital in Quezon City, was among 51 government-run hospitals included in a comprehensive study on prevailing newborn care practices in the Philippines starting November, 2008. In hindsight, Dr. Belle Vitangcol, head of QMMCs pediatrics department and lead ENC trainor, remembers this as the starting point of a whirlwind that in barely one years time would sweep away many traditional practices and attitudes in the delivery room, and usher in a radically different regimen