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FOR THE NEWBORN. AGENDA. BCA at a glance Lessons from Adult BCA Why focus on the newborn BCA for the newborn. BCA AT A GLANCE. 10 LESSONS FROM ADULT BCA. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. EATING THE ELEPHANT ONE BITE AT A TIME. Why focus on the newborn?. - PowerPoint PPT Presentation
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FOR THE NEWBORN
AGENDA
1. BCA at a glance2. Lessons from Adult BCA3. Why focus on the newborn4. BCA for the newborn
BCA AT A GLANCE
3
1.Healthcare Associated Infections
2.Antimicrobial Stewardship
3.BCA…for the newborn
10 LESSONS FROM ADULT BCA
1.
5
Doctor-centred
Empowered Nurse
2.
6
Simple Evidence-Based
Intervention Big Difference
3.
7
Curative Measures
Preventative Interventions
4.
8
Fiction Scientific Data
5.
9
Billing Data
Clinical Data
6.
10
Reactive Proactive
7.
11
Head Office generated
data
Frontline staff data collection
8.
12
Quality Assurance
Quality Improvement
9.
13
Competition Collaboration
10.EATING THE ELEPHANT ONE BITE AT A TIME
Why focus on the newborn?
INFANT MORTALITYIN RSA ( Stats SA, 2008)
16
Neonatal31%
Diarrhoea22%
LRTI17%
0thers30%
Determinants of Infant Mortality
NEONATAL DEATHSIN RSA ( Stats SA, 2008)
17
Prematu-rity
38%
Birth As-
phyxia25%
Sepsis25%
Congential Abnormalities13%
Determinants of Neonatal Deaths
DRIVERS OF MORBIDITY AND MORTALITY
• Neonatal Sepsis• Chronic Lung Disease• Necrotising Enterocolitis• Periventricular-Intraventricular
Haemorrhage• Retinopathy of Prematurity
FOR THE NEWBORN
3 MAJOR COMPONENTS
1.Screening bundle
2.Drivers of Mortality & Morbidity
3. Sepsis bundle
SCREENING BUNDLE
1. Antenatal steroid compliance2. HIV screening3. HIV PMTCT compliance4. Syphilis screening5. Early NCPAP compliance6. Cranial Ultrasound compliance7. Retinal exam compliance8. Caesarean section rate
PIH
NECCLD
ROP
DRIVERS OF
MORBIDITY &
MORTALITY
SEPSIS BUNDLE
• Early Bacterial Sepsis (EBS)Vertical transmissionWithin 72 hours of birth
• Late Onset Infections (LOI)Healthcare Associated InfectionBacteria, fungal or viralAfter 72 hours of birth
SEQUENCING
Data CollectionScreening bundle BundlesM & M
driversObstetric Sepsis
SurveillanceEBS ICP & CLABSI bundleLOI
ROP
RETINOPATHY OF PREMATURITY
ROP BUNDLE
1. Pulse oximetry on an infant receiving oxygen.
2. Saturation probe to be placed on the Right or Left hand.
3. Saturation aimed at 86-92%4. Monitor alarm to be set at 85
(low) and 93 (high).5. Fundoscopy screening done or
booked before discharge.
ROP
CHRONIC LUNG DISEASE
CLD BUNDLE
1. Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.
2. Neopuff use in neonatal resuscitation.
3. Gentle ventilation (NCPAP) vs (HFO) vs (CV).
4. Permissive hypercapnia of more than 45mmHg.
5. Administration of systemic steroids to the infant to prevent or treat CLD.
CLD
NECROTISING ENTEROCOLITIS
NEC BUNDLE
1. Breastmilk or pasteurised EBM as a modality of feeding.
2. Trophic feeds within 24 hours of birth.
3. Adherence to “volume per day” protocol.
4. Adherence to “frequency of feeds” protocol.
NEC
PERIVENTRICULAR-INTRAVENTRICULAR
HAEMORRHAGE
PIH BUNDLE
1. Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.
2. Delayed cord clamping for 45 seconds to a minute.
3. Neopuff use in neonatal resuscitation.
4. Maintain infant temperature to more than 36 degrees Celsius.
5. Developmental care: dim lights, low levels of noise and minimal handling.
PIH