who nbh guidlines dakar 20130709

7/27/2019 WHO NBH Guidlines Dakar 20130709

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ENGAP Consultation| Dakar, Senegal | 9 - 11 Jul y 20131 |

Current Guidelines on Newborn Health

of the

World Health Organization

Severin von XylanderWHO Department of Maternal, Newborn, Child and Adolescent Health (MCA)


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Outline

Focus on priority interventions

Types of guidelines

References materials and sources


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Ending preventable deaths Labour and childbirth care

Labour monitoring

Childbirth care

Essential newborn care

Birth: drying, skin-to-skin

First week: early/excl. BF,warmth, cord care, hygiene

Obstruction/Fetal distress: CS,vacuum

PT labour: corticosteroids,antibiotics for PPROM

Preterm/LBW: KangarooMother Care, BF support,immediate treatment of suspected infection

Suspected sepsis:Early antibiotic treatment

Not breathing atbirth: Resuscitation

CARE DURINGPREGNANCY

TREATMENTFOR

PREGNANCYCOMPLI-CATIONS

PRE-CONCEPTION

CARE

REPRODUCTIVECARE

The time around childbirth and the first day of life: acritical window of opportuni ty to prevent and managecomplications


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We can reduce the main causes of deathNewborn Survival Solutions 3 by 2

Preterm birth

1. Preterm labor management including antenatal corticosteroids*2. Care including Kangaroo mother care, essential newborn care

Birth complications (and intrapartum stillbirths)1. Prevention with obstetric care *2. Essential newborn care , and resuscitation*

Neonatal infections1. Prevention, essential newborn care especially breastfeeding,

Chlorhexidine where appropriate*2. Case management of neonatal sepsis *

1

2

3

* Prioritised by the UN Commission on Life Saving Commodities for Women and Children

Over two-thirds of newborn deaths preventable actionablenow without intensive care


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CRITICAL NEWBORN INTERVENTIONS

1. Management of pre-term birth2. Skilled care at birth3. Basic Emergency Obstetric Care4. Comprehensive Emergency Obstetric Care5. Basic Newborn Care6. Neonatal resuscitation7. Kangaroo mother care for premature and small babies

8. Treatment of severe infections9. Inpatient supportive care for sick and small newborns


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Types of WHO Guidelines

Rapid advice guidelines: response to a public health emergency

Standard guidelines guidance in relation to a change in practice or controversy in a

single clinical or policy area

Full guidelines complete coverage of a health topic or disease

Compilations of guidelines contains current recommendations from WHO and other

sources, but does not include any new recommendations


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Guidance by Levels of Care

Primary Level(PCPNC)

Community:Preventive/Promotive, Follow-up

(Care of Newborn at Home)

1 st Referral Level(MCPC, Pocket Book)

2nd Referral Level(MNP)

Low rik> 37 wks

Risks34 - 36 wks

Risks< 34 wks


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Management of Preterm Birth

Birth preparednessDetection of complications and initialmanagementManagement of:

Use of antenatal corticos teroids Pre-ecclampsia/ecclampsia

Preterm labour

(Preterm) prelabour rupture of membranes (p)PROM

C-sectionsStandard guidelines in development


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Skilled Care at Birth

Routine and emergency care for womenand newborns during labour and delivery

Use of the partograph


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Emergency Obstetric Care

Basic EmOC: routine and emergency care for womenand newborns during pregnancy, labourand delivery, and postpartum

Comprehensive EmOC : Managing complications in pregnancy

and childbirth

Assist vaginal delivery

C-sections


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Basic Newborn Care

Routine and emergency care for womenand newborns during labour and delivery,postpartumFocus on cleanliness, warmth, andfeeding Standard guidelines: Care of the newbornimmediately after birth

Immediate drying and additional stimulation

Cord clamping

Skin-to-skin contact in the first hour of life Initiation of breastfeeding

Vitamin K prophylaxis


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Cord Care

Daily chlorhexidine (4%) application to the umbilical cord stump duringthe first week of life is recommended for newborns who are born athome in settings with high neonatal mortality (neonatal mortality rate>30 per 1000).

Clean, dry cord care is recommended for newborns born in health

facilities, and at home in low neonatal mortality settings. Use of chlorhexidine in these situations may be considered only to replaceapplication of a harmful traditional substance such as cow dung to thecord stump.

(Strong situational recommendation, moderate quality evidence) Postnatalcare guidelines for the mother and the newborn, 2013 (under review byWHO GRC)


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Optimizing Health Worker Rolesfor Maternal and Newborn Health

Who to do what


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Newborn Health Recommendation

Only GRC recommendationsreleased after 2008


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Thank you

who nbh guidlines dakar 20130709

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