Normal Newborn Care Advances in Maternal and Neonatal Health

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  • Normal Newborn CareAdvances in Maternal and Neonatal Health

    Normal Newborn Care

  • Session ObjectiveDefine essential elements of early newborn careDiscuss best practices and technologies for promoting newborn healthUse relevant data and information to develop appropriate essential newborn recommendations

    Normal Newborn Care

  • Newborn Deaths8.1 million infant deaths (1993)3.9 million (48%) newborn deaths2.8 million (67%) early newborn deathsMajor causes of newborn deathsBirth asphyxia: 21%Infections: 42% (tetanus, sepsis, meningitis, pneumonia, diarrhea)

    Normal Newborn Care

  • Newborn Deaths (continued)Birth process was the antecedent cause of 2/3 of deaths due to infectionsLack of hygiene at childbirth and during newborn periodHome deliveries without skilled birth attendantsBirth asphyxia in developing countries3% of newborns suffer mild to moderate birth asphyxiaPrompt resuscitation is often not initiated or procedure is inadequate or incorrect

    Normal Newborn Care

  • Newborn Deaths (continued)Hypothermia and newborn deathsSignificant contribution to deaths in low birth weight infants and preterm newbornsSocial, cultural and health practices delaying care to the newbornCountries with high STD prevalence and inconsistent prophylactic practicesOphthalmia neonatorum is a common cause of blindness

    Normal Newborn Care

  • Newborn Deaths (continued)Low birth weightAn extremely important factor in newborn mortalityPlace of childbirthAt least 2 out 3 childbirths in developing countries occur at homeOnly half are attended by skilled birth attendantsStrategies for improving newborn health should targetBirth attendant, families and communitiesHealthcare providers within the formal health system

    Normal Newborn Care

  • Essential Newborn Care InterventionsClean childbirth and cord carePrevent newborn infectionThermal protectionPrevent and manage newborn hypo/hyperthermiaEarly and exclusive breastfeedingStarted within 1 hour after childbirthInitiation of breathing and resuscitationEarly asphyxia identification and management

    Normal Newborn Care

  • Essential Newborn Care Interventions (continued)Eye carePrevent and manage ophthalmia neonatorumImmunizationAt birth: bacille Calmette-Guerin (BCG) vaccine, oral poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine (WHO)Identification and management of sick newbornCare of preterm and/or low birth weight newborn

    Normal Newborn Care

  • Cleanliness to Prevent InfectionPrinciples of cleanliness essential in both home and health facilities childbirthsPrinciples of cleanliness at childbirthClean handsClean perineumNothing unclean introduced vaginallyClean delivery surfaceCleanliness in cord clamping and cuttingCleanliness for cord careInfection prevention/control measures at healthcare facilities

    Normal Newborn Care

  • Thermal ProtectionNewborn physiology Normal temperature: 36.537.5CHypothermia: < 36.5CStabilization period: 1st 612 hours after birthLarge surface areaPoor thermal insulationSmall body mass to produce and conserve heatInability to change posture or adjust clothing to respond to thermal stress Increase hypothermiaNewborn left wet while waiting for delivery of placentaEarly bathing of newborn (within 24 hours)

    Normal Newborn Care

  • Hypothermia PreventionDeliver in a warm roomDry newborn thoroughly and wrap in dry, warm clothKeep out of draft and place on a warm surfaceGive to mother as soon as possibleSkin-to-skin contact first few hours after childbirthPromotes bondingEnables early breastfeedingCheck warmth by feeling newborns feet every 15 minutesBathe when temperature is stable (after 24 hours)

    Normal Newborn Care

  • Early and Exclusive BreastfeedingEarly contact between mother and newborn Enables breastfeedingRooming-in policies in health facilities prevents nosocomial infectionBest practicesNo prelacteal feeds or other supplementGiving first breastfeed within one hour of birthCorrect positioning to enable good attachment of the newbornBreastfeeding on demandPsycho-social support to breastfeeding motherWHO 1999.

    Normal Newborn Care

  • Breathing Initiation and ResuscitationSpontaneous breathing (> 30 breaths/min.) in most newbornsGentle stimulation, if at allEffectiveness of routine oro-nasal suctioning is unknownBiologically plausible advantages clear airwayPotentially real disadvantages cardiac arrhythmiaBulb suctioning preferred Newborn resuscitation may be neededFetal distressThick meconium stainingVaginal breech deliveriesPreterm Hamilton 1999.

    Normal Newborn Care

  • Eye Care To Prevent or Manage Ophthalmia NeonatorumOphthalmia neonatorumConjunctivitis with discharge during first 2 weeks of lifeAppears usually 25 days after birthCorneal damage if untreated Systemic progression if not managedEtiologyN. gonorrhea More severe and rapid development of complications3050% mother-newborn transmission rateC. trachomatis

    Normal Newborn Care

  • Eye Care To Prevent or Manage Ophthalmia Neonatorum (continued)ProphylaxisClean eyes immediately1% Silver nitrate solutionNot effective for chlamydia2.5% Povidone-iodine solution1% Tetracycline ointmentNot effective vs. some N. gonorrhea strainsCommon causes of prophylaxis failureGiving prophylaxis after first hourFlushing of eyes after silver nitrate applicationUsing old prophylactic solutions

    Normal Newborn Care

  • Efficacy of Prophylaxis for Conjunctivitis in ChinaObjective: To assess etiology of newborn conjunctivitis and evaluate the efficacy of regimens in ChinaDesign: November 1989 to October 1991 rotated regimens monthly: tetracycline, erythromycin, silver nitrate302 (6.7%) infants developed conjunctivitis, most S. aureus (26.2%) and chlamydia (22.5%)Silver nitrate, tetracycline: fewer cases than no prophylaxis (p < 0.05), erythromycin: not significantChen 1992.

    Normal Newborn Care

  • Prophylaxis for Conjunctivitis: Objective and DesignObjective: To compare efficacy in prevention of nongonococcal conjunctivitisDesign: Randomized control trial to compare erythromycin, silver nitrate, no prophylaxisExamined with test for leukocyte esterase and chlamydia trachomatis antibody probe 3048 hours postpartum, 1315 days later, and telephone contact up to 60 days of lifeMain outcome measured: conjunctivitis within 60 days of life and nasolacrimal duct patencyBell 1993.

    Normal Newborn Care

  • Prophylaxis for Conjunctivitis: Results and ConclusionResults: 630 infants109 with conjunctivitis Silver nitrate vs. no prophylaxis: Hazard ratio 0.61 (0.39-0.97)Chemical conjunctivitis with silver nitrate resolves within 48 hoursErythromycin vs. no prophylaxis: Hazard ratio 0.69 (not significant)Conclusion: Parental choice of prophylaxis, including no prophylaxis, is reasonable IF antenatal care and STD screeningBell 1993.

    Normal Newborn Care

  • Povidone-Iodine for Conjunctivitis: Objective and DesignObjective: To determine incidence and type of conjunctivitis after povidone-iodine in KenyaDesign: Rotate regimen weekly: erythromycin, silver nitrate, povidone iodineResults: Conjunctivitis: Chlamydia in 50.5%S. aureus in 39.7%More infections in silver nitrate than povidone-iodine, OR 1.76, p < 0.001More infections in erythromycin OR 1.38, p=0.001Isenberg, Apt and Wood 1995.

    Normal Newborn Care

  • Povidone-Iodine for Conjunctivitis: ConclusionPovidone-iodine:Is good prophylaxisHas wider antibacterial spectrumCauses greater reduction in colony-forming units and number of bacterial speciesIs active against virusesIs inexpensiveIsenberg, Apt and Wood 1995.

    Normal Newborn Care

  • ImmunizationBCG vaccinations in all population at high risk of tuberculosis infectionSingle dose of OPV at birth or in the two weeks after birthHBV vaccination as soon as possible where perinatal infections are common

    Normal Newborn Care

  • SummaryThe essential components of normal newborn care include:Clean delivery and cord careThermal protectionEarly and exclusive breastfeedingMonitoringEye careImmunization

    Normal Newborn Care

  • ReferencesBell TA et al. 1993. Randomized trial of silver nitrate, erythromycin and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis. Pediatrics 92: 755760.Chen J. 1992. Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin, and no prophylaxis. Pediatr Infect Dis J 11: 10261030.Child Health Research Project and Maternal and Neonatal Health Program. 1999. Reducing Perinatal and Neonatal Mortality. Report of a meeting in Baltimore, Maryland, 1012 May, 1999.Hamilton P. 1999. Care of the newborn in the delivery room. Br Med J 318: 14031406. Isenberg SJ, L Apt and M Wood. 1995. A controlled trial of povidone-iodine as prophylaxis against ophthalmitis neonatorum. N Engl J Med 332: 562566.World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. WHO: Geneva.

    Normal Newborn Care

    Note: In this presentation, the term newborn refers to a baby between birth and one month old.Newborn care is important because major causes of newborn death are birth asphyxia and infection. A skilled attendant at childbirth who can assess the newborn correctly, perform essential interventions and does not delay resuscitation if indicated, is crucial. The attendant should also be able to care for or transport a sick newborn if needed.WHO estimates that almost half of newborn mortality is associated with preterm or low birth weight babies (Child Health Research Project and Maternal and Neonatal Health Program 1999).Newborns are uniquely susceptible to hypothermia because they have a large body surface area, which helps heat loss;