xylander: models of care for managing preterm birth and premature babies

7/28/2019 Xylander: Models of Care for Managing Preterm Birth and Premature Babies

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Global Newborn Conference 2013, Johannesburg | 16 Apri l 20131|

Models of Care for

Managing Preterm Birth and PrematureBabies

Severin von Xylander

WHO Department of Maternal, Newborn, Child and Adolescent Health (MCA)

The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this presentation andthey do not necessarily represent the decisions, policy or views of the World Health Organization.


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Rationale

Transpose Born Too Soon (BTS)recommendations in the existingimplementation framework of the MNCH

continuum of care

Identify health system requirements by

level of care


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Objective

Ensuring women at risk for preterm birth andprematurely born babies get the right care, at

the right time, by the right team and in the right

place

What should be provided?

When should it be provided?

Who should provide it?

Where should it be provided

What is needed (commodities)?


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Models of Care

Defines the way in which health services should be delivered

Outlines evidence-based practice throughout the continuum of careat different levels of care

Identifies and guides implementation during pregnancy andchildbirth and care for the preterm

Based on existing evidence and guidelines, intervention outcomesand consultation with key stakeholders at global level

Includes guidance on interventions (what), provider competencies(who) and health service delivery level (where)


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What: Interventions

Antenatal and delivery care for all pregnant women

Essential newborn care for all babies

Additional care for women at risk of preterm birth

Additional care for preterm babies


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Key Elements

Second referral level tertiary level Operational categorization by gestational age and

birth weight groups

Decision Trees for Preterm Labour and Preterm Birth Health systems requirements: Human Resources,

supplies, medicine & technologies

Simplified Reporting Categories

(Dimension of productivity / benchmarking)

Minimum level of services


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Operational GA & BW Categories

Gestational Age(completed weeks)

Birth Weight Ranges (g) * Level of Care

37>2500 Community / home

34-


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Additional Interventions for Women at Risk of Preterm

Labour and Preterm Babies

WOMEN AT RISK OF PRETERM LABOUR

Gestation(CompletedWeeks)

HEALTH SYSTEM

DELIVERY LEVEL

Comm

unity

Prim

ary

1stre

ferral

2nd re

ferral

Guidance on medical indications for induction of labour or

caesarean section


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Decision Tree:

Pregnant Women / Preterm Labour


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Decision Tree:

Admission after Delivery at Primary Level

Provide essential newborn care & basic resuscitation

Record gestational age from the maternal record, measure birth weight, and assessfeeding ability & ability to maintain temperature

34-1.8-2kg

Infant can suck & swallow & breastfeedeffectively

Maintain temperature in normal range 36-37C

Refer to 1st level facility for

Feeding support for baby & KMC iffeeding difficulty and/or temperature

instability


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Human Resources' Competencies

Community

(Does not include outreach by

health professionals, includes

family care and community

health workers)

Primary (including outreach,

target level for normal birth

and minimum additional

support needed)

1st Level Referral Facility 2nd Level Referral Facility

As transitory or emergency

measure: CHW present at birth or

as soon as possible after birth with

competencies in:

Identifying preterm/low birth weight

babies

Examining and assessing for dangersigns and referring if necessary

Counselling on essential newborn

care & special care for small babies, if

referral not possible

Promotion of ANC

Advising women to seek care for

danger signs in pregnancy

Health professionals trained to

proficiency in skills to:

Manage normal labour and delivery

Recognize & initiate treatment of

complications

Essential newborn care including

basic neonatal resuscitation Basic emergency obstetric and

newborn care

Outpatient management of sick

newborns

Follow-up care of preterm babies

Doctors competent in newborn care

(24 hour presence or on call)

Nurses/midwives competent in

newborn care (24 hour presence or

on call)

Comprehensive emergency obstetric

and newborn care

Doctors and nurses/midwives with

specialized competency in the care

of high risk pregnancies & preterm

newborns present 24 hours a day

(shifts)

Obstetricians

Paediatricians with neonatal skills orneonatologists

Nurses with neonatal nursing skills

Access to individuals within specific

clinical & diagnostic sub-specialities

or professionals with competencies

in maternal & newborn care:

anaesthesiology, surgery,

ophthalmology, intensive care,

cardiology, radiology, laboratory

services, audiology, nutrition &

pharmacy

Data collection system for obstetric

& newborn statistics


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Routine Data for Decision Making

Birth weight and gestational age for all births Live births (including singleton and multiple births with nolower limit in weight or gestation including proportion


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Productivity and Service Levels

It is proposed to include: a population-based / territorial approach for services, based on

size of population, expected number of cases and distance

Minimum level of service to maintain quality of services, e.g. xxnumber of incubators and step down cods

Avenue:

Detailed descriptions of the factors to consider

Benchmarking (Case studies)


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Conditions, complications, interventions

Gestational Age (Completed Weeks)


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Where: Levels of Care

Primary Level

(PCPNC)

Community:

Preventive/Promotive, Follow-up(Care of Newborn at Home)

1st Referral Level

(MCPC, Pocket Book)

2nd Referral Level(MNP)

Low rik> 37 wks

Risks34 - 36 wks

Risks< 34 wks


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Thank you

xylander: models of care for managing preterm birth and premature babies

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