regional action plan for healthy newborns rhag 26 june 2013
TRANSCRIPT
The First Embrace:Action Plan for Healthy
Newborns in the Western Pacific Region (2014-2020)
Reproductive Health Affinity Group
26 June 2013
Dr Ornella Lincetto
Every 2 minutes, 1 newborn dies in the Western Pacific Region
209 000 neonatal deaths in the Western Pacific Region every year
1 represents 100 neonatal deaths WHO Global Health
Observatory, 2011
Newborns account for >50% of all under 5 deaths Cause of Deaths before 5 years of age
in the WHO Western Pacific Region (2010)
Source:WHO Global Health
Observatory 2010
(n= 467 000)
We must get it right from (24 hours around birth) the start: Age at death for Neonates (0-28 days)
0
5
10
15
20
25
30
35
0 1 2 3 4 5 6 7 8 9 1011 1213 14 1516 1718 19 2021 22 2324 2526 27 28
Days of life
Prop
orti
onal
mor
talit
y
What we do then affects the rest of the newborn's life
2 out of 3 newborn deaths occur in the 3 days of life
WHO, 2012
Proportion of births assisted by a skilled birth attendant (2005-2011)
Reproductive AgeAntenatal
period
Adolescent
School age
Preschool
Continuum of the Life Cycle
Intra-partumDeliveryImmediate Newborn•First Embrace•Care for LBW/Preterm•Care for Sick Newborn
Postneonatal
Lateneonatal
Enhancing overall efforts on maternal and child health by focusing on a weak link
You are Li Yu (mom) and baby girl Lin Lin’s health professional.
What practices do you do that protect or place Lin Lin at risk?
WHO Western Pacific Regional Office
After Lin Lin is born, you should call out the time (to mins and secs) of birth, then what?
After Lin Lin is born, you should call out the time (to mins and secs) of birth, then what?
Lin Lin Has Needs
• To breathe normally
• To be warm• To be protected• To be fed
Immediate Thorough Drying
• Stimulates Lin Lin to Breathe• Prevents hypothermia
• If Lin Lin gets cold, she could get: – Infection– Coagulation defects– Acidosis– Delayed fetal to newborn circulatory adjustment– Hyaline membrane disease– Brain hemorrhage
Tunell R., in Improving Newborn Health in Developing Countries, A. Costello and D. Manandhar, Editors. 2000, Imperial College Press: London, UK. p. 207-220;Tollin M,et al.. Cell Mol Life Sci 2005
During drying and stimulation, your rapid assessment shows Lin Lin is crying.
What is your next action?
FIRST, DO NO HARM
• Do NOT suction Lin Lin unless her mouth/nose are blocked by secretions
During drying and stimulation, your rapid assessment shows Lin Lin is crying.
What is your next action?
7 billionth babies
WHO Western Pacific Regional Office
Skin-to-Skin Contact
Separated from mother
Skin-to-Skin ContactContributes to:• Warmth• Bonding• Successful breastfeeding/colostrum feeding• Stimulate the mucosa-associated lymphoid tissue
system• Calmness• Protection from hypoglycemia• Colonization with maternal skin flora
Moore Cochrane Rev, 2012
Anderson Cochrane Rev, 2005
Brandtzaeg. Ann N Y Acad Sci, 2002
WHO Western Pacific Regional Office
Delayed cord clamping
Term babies have less • Anemia
– RR 0.2 (95% CI 0.06, 0.6)
Preterms have less• Anemia requiring transfusion
– RR 0.6 (95% CI 0.5, 0.8)
• Intraventricular hemorrhage – RR 0.6 (95% CI 0.4, 0.9)
• Necrotizing Enterocolitis – RR 0.6 (95% CI 0.4, 0.9)
Ceriani Cernadas, 2006Rabe, Coch Rev, 2012
WHO Western Pacific Regional Office
How long after birth is Lin Lin ready to breastfeed?
How long after birth is Lin Lin ready to breastfeed?
• Drooling • Mouth Opening• Tonguing, Licking, • Biting Hand
Feeding CuesLin Lin may want to rest for 20-30 mins and even up to 120 minutes before showing signs of readiness to feed
What is the approximate capacity of Lin Lin’s stomach (when she was born)?
A
BC
D
A
BC
D
What is the approximate capacity of Lin Lin’s stomach (when she was born)?
If this benefits babies,
Skin-to-Skin Contact Separated from mother
Why is this so common?
Immediate drying, delayed cord clamp
Immediate cord clamp, delayed drying, suction
No one intends to harm newborns; but many common
practices are harmful
Priority interventions of EENC
WHO, 2013
Vision: A healthy start for every newborn
Mission: To strengthen the health system to cultivate an enabling environment where skilled providers of newborn care value and practice Essential Early Newborn Care (EENC) at every birth.
Action Plan
To eliminate preventable newborn mortality by providing universal access to high quality Early Essential Newborn Care.
Target 1: At least 80% of facilities where births take place are fully implementing EENC by 2020 in all member states.
Target 2: At least 90% of deliveries in all sub-national areas attended by a skilled birth attendant by 2020 in all member states.
Target 3a: National NMR 10 per 1000 live births or less by 2020.Target 3b: Sub-national NMR 10 per 1000 live births or less by 2020.
Regional Goal
Framework of Strategic Actions
SA1. Ensure consistent adoption and implementation of Early Essential Newborn Care (EENC).
Operational objectives:
1.1. To ensure EENC has been incorporated into national and sub-national health agendas, plans, budgets and financing mechanisms
1.2. To enable providers of newborn care to practice EENC at every delivery by providing appropriate system support and training
1.3. To ensure EENC has been incorporated into clinical protocols, quality improvement cycles and
accreditation mechanisms
1.4. To scale up centres of excellence implementing EENC
SA2. Improve political and social support to ensure an enabling environment for Early Essential Newborn Care (EENC)
Operational objectives:
2.1. To mobilize political commitment and social support of key stakeholders for policies, programmes and
services for the implementation of EENC
2.2. To strengthen legislation, regulations, and enforcement to meet international standards to support implementation of EENC
SA3. Ensure availability, access, and use of skilled birth attendants and essential maternal and newborn commodities in a safe environment.
Operational objectives:
3.1. To ensure availability of a skilled birth attendant for every delivery
3.2. To ensure availability of equipment, supplies and essential medicines in safe environments in routine and emergency situations
SA4. Engage and mobilize community to increase demand.
Operational objectives:
4.1. To increase community demand for skilled birth attendance and the EENC
SA5. Improve the availability and quality of perinatal information.
Operational objectives:
5.1. To strengthen capacity of routine information systems collect accurate data on perinatal
health
5.2. Improve collection and use of data on perinatal health and practices through research, surveys, and audits
Let’s
give a
healthy start for every newborn