Evolution of Newborn Care in Low- and Middle-Income Countries

What is the newborn period defined as? Early newborn period? Late newborn period?

• first 4 weeks/28 days of life

• first week

• 2nd-4th week

What are the two types of stillbirths (SBs)?

1. early or macerated/antepartum (20 weeks or earlier)

2. fresh/intrapartum (during labor and delivery)

Perinatal mortality rate

# of stillbirths + early neonatal deaths per 1000 total births

Neonatal mortality rate

# of deaths among the newborns (1st 28 days) per 1000 live births

What are the top three causes of neonatal deaths?

1. preterm birth complications

2. intrapartum related events

3. infections (sepsis, pneumonia, diarrhea, and other infections)

When do newborn babies die?

1. 75% of deaths are in first week

2. 36% are in first 24 hrs

What three things improved newborn outcomes in high income countries?

1. public health approaches

2. improved individual neonatal care (e.g. feeding, warmth, hygiene, antibiotics, resuscitation, hospital births, and c-sections)

3. neonatal intensive care introduction and scale up

What are the characteristics of Essential Newborn Care (ENC)?

• clean, safe delivery practices, including hand hygiene

• temperature maintenance

• basic resuscitation to initiate respiration

• early skin-to-skin contact

• breastfeeding

• clean cord care

• eye care

• extra care for low-birth weight/preterm babies

• postnatal visit (within 48 hrs and by end of 1st week)

• identification and referral for danger signs

What did ENC programs not include?

home based treatment of infections

What extra care is recommended for low birth weight/preterm babies?

• kangaroo mother care

• longer skin-to-skin contact with proper positioning

What was the result of the ENAP (every newborn action plan) initiative?

countries developing budgeted national strategies for newborn care with specific costed plans to implement activities to decrease newborn mortality and stillbirth rates

What are the six WHO health system building blocks?

1. health service delivery

2. health workforce

3. health information systems (data: indicators)

4. access to essential medicines

5. health systems financing

6. leadership and governance

What are the classifications for preterm, late preterm, moderate preterm, very preterm, extremely preterm, viable (LMICs), viable (HIC), and previable?

• preterm: <37 weeks

• late preterm: 34-37 weeks

• very preterm: 28-32 weeks

• extremely preterm: <28 weeks

• viable (LMIC): 24 weeks

• viable (HIC): 22 weeks

• previable: <20 weeks

Point of care quality improvement (POCQI)

advocacy, motivation, additional training/refresher courses, and facilitation are required for quality improvement

What challenges were posed to quality improvement in terms of supervision?

• supervision was not always in the job description of hospital/facility staff

• self learning and mentoring cultures limited in some centers in LMICs

• supervisors, even if physicians, were in government offices at times with limited clinical skills and poor motivation for visits to peripheral centers

• supervision was often started long after training, resulting in decreased skills

PDSA cycle for quality improvement

plan —→ do —→ study —→ act