Post on 21-Dec-2015
description
Implementing the Every Newborn Action Plan
Towards ending preventable maternal and newborn mortality
Bernadette Daelmans Department of Maternal, Newborn, Child and Adolescent Health
Building a movement
x World Health
Assembly
The end of MDGs brings new clarity about what is left behind on the agenda – newborns, stillbirths, adolescents
Every Newborn Series 5 papers
6 comments
55 authors from 18+ countries
60+ partner organisations
Every Newborn Action Plan Based on the evidence from the Series Co-led by WHO and UNICEF Consultation >60 country governments >80 organisations, >1000 individuals World Health Assembly 2014 resolution Launched June 2014
Now to action in many countries…
Main funders: Bill & Melinda Gates Foundation, USAID, Children’s Investment Fund Foundation
@joylawn
Towards ending preventable maternal and
newborn mortality
By 2030 in EVERY COUNTRY: MMR reduction of at least 2/3 from 2010 and MMR less than 140 NMR of less than 12 per 1000 live births Still births less that 12 per 1000 total births
In 2013 : 289.000 maternal deaths 2.9 million newborn deaths 2.6 million stillbirths
More than 3.0 million babies and women could be saved each year
Addressing the main causes of mortality
Causes of maternal mortality Causes of newborn mortality
Care around the time of birth: a triple return on investment
Source: Special analysis detailed in The Lancet Every Newborn Series, launched 19 May 2014
Almost 3 million babies and women could be saved each year through investing in quality care around the time of birth.
Strategic objectives
Address all major causes of maternal and newborn mortality, morbidity and related disabilities as well as stillbirths;
Invest in and improve quality care for women and newborns, especially around the time of childbirth;
Address inequities in access to and quality of reproductive, maternal, perinatal and newborn health care services;
Harness the power of parents, families and communities; empower women and girls
Ensure universal coverage of essential interventions for reproductive, maternal and newborn health care
Improve metrics globally and nationally and ensure accountability
5 things to do differently
Integrated Plans Integrated service
delivery, continuum of care, coordination
Implementation & Innovation
Address health system bottlenecks, Every Mother Every Newborn initiative
Indicators & metrics Targets in post 2015
Measurement of progress and impact
Intentional leadership
development Especially in countries with highest burden
Investment for impact
Governance, community participation, partner
alignment
WHO recommendations for maternal, perinatal and newborn care
http://www.who.int/maternal_child_adolescent/documents/mnca-recommendations/en/
Resuscitation: what is new?
No routine suctioning even before ventilation, only for babies born through meconium-stained amniotic fluid who do not start breathing on their own
Preference of bulb syringe in the absence of mechanical equipment
Start Positive Pressure Ventilation within 1 minute
Preference of self-inflating bag
Measurement of heart rate after 60 seconds
Recommendation to stop resuscitation after 10 min, if no detectable heart rate
Cord care
Daily chlorhexidine (4%) application to the umbilical cord stump during the first week of life is recommended for newborns who are born at home in settings with high neonatal mortality (30 or more neonatal deaths per 1000 live births).
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 replace application of a harmful traditional substance such as cow dung, to the cord stump.
Facility stay after childbirth
After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
J. Lawn et al. Lancet 2014; 384: 189–205
Timing and number of postnatal contacts
Healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
If birth is at home, the first postnatal contact should be as early as possible within 24 hours of birth.
At least three additional postnatal contacts are recommended for all mothers and newborns: on day 3 (48–72 hours), between days 7–14, and 6 weeks after birth.
Home visits in the first week after birth are recommended for care of the mother and newborn.
Assessment of the newborn
The newborn should be referred for further evaluation if any of the signs is present:
1. stopped feeding well, 2. history of convulsions, 3. fast breathing (breathing rate ≥60 per minute), 4. severe chest in-drawing, 5. no spontaneous movement, 6. fever (temperature >37.5 °C), 7. low body temperature (temperature <35.5 °C), 8. any jaundice in first 24 hours of life, or yellow palms and
soles at any age.
Care for low birth weight babies
Feeding of low birth weight infants
LBW and VLBW infants should be fed mother's own breast milk. If the mother is not able to breastfeed, donor milk should be given
LBW should be put to the breast as soon as clinically stable after birth
LBW should be exclusively breastfed on demand for 6 months
LBW infants who can not be breastfed, but can swallow should be fed by cup and spoon (or cup with beak), based on hunger cues, but at least every 3 hours
http://www.who.int/maternal_child_adolescent/documents/infant_feeding_low_bw/en/
Forthcoming WHO recommendations
Antenatal corticosteroids for management of preterm labour and birth for women at risk of preterm birth from 24 weeks to 34 weeks of gestation
when the following conditions are met: gestational age assessment can be accurately undertaken preterm birth is considered imminent there is no clinical evidence of maternal infection adequate childbirth care is available (including the core functions of emergency
obstetric care) the preterm newborn can receive adequate care if needed (including resuscitation,
thermal care, feeding support, infection treatment and safe oxygen use).
Kangaroo mother care for neonates weighing ≤2000g at birth as soon as they are clinically stable;
care should be provided as continuously as possible
New evidence towards updated guidelines
Young infants 7 – 59 days old with fast breathing as a single sign, who are identified through home visits or spontaneously brought for care at outpatient clinics can be safely and effectively treated with oral amoxicillin for 7 days by appropriately trained health care provider.
Young infants 0 – 59 days old with any sign of clinical severe infection who are not critically ill, who are identified through home visits or spontaneously brought for care at outpatient clinics and whose caregivers cannot or do not accept hospitalization
Option 1: IM gentamicin 5-7.5 mg/kg once daily for 7 days and twice daily oral amoxicillin, 50 mg/kg per dose for 7 days. Close follow up is essential
Option 2: IM gentamicin 5-7.5 mg/kg once daily for 2 days and twice daily oral amoxicillin, 50 mg/kg per dose for 7 days. Close follow up is essential. A careful assessment on day 4 is mandatory.
Also see: AFRINEST and SATT studies, Lancet Global Health, published online April 2, 2015
Three main streams of activities are ensuring the action plan leads to real change in countries:
1. Country implementation: identifying and responding to technical support needs, supporting translation of evidence into action, including Every Mother Every Newborn quality improvement initiative.
2. Data and metrics: improving and institutionalizing metrics to track coverage and impact based on the goals and targets of the ENAP and five strategic objectives.
3. Advocacy: strengthening maternal and newborn health advocacy efforts globally and in countries, building a movement for change.
Every Newborn action now:
Research as cross cutting
www.lancet.com/series/everynewborn #EveryNewborn
An Action Plan To End Preventable Deaths
EVERY NEWBORN We are still building a
movement…
BE PART OF THE ACTION
For more information
visit www.everynewborn.org