Regional-National Networks
for Newborn-Perinatal
Health
CAH-SEARO
South East Asia Regional
Neonatal Perinatal Database
Background…
Aim
To Establish A SEAR Network for generating
information on neonatal/perinatal health in the Region
Objectives
•To generate and disseminate prospectively
collected data on neonatal-perinatal morbidity and
mortality at the Network institutions
•To use the data generated for quality improvement
of newborn care
Methodology
 Identification of network institutions
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Nodal center: WHO CC, AIIMS, New Delhi
5 other Centers of Excellence in different countries
Country
Center
Principal Investigators
Bangladesh Bangabandhu Sheikh Mujib Medical
University, Dhaka
Indonesia
Gadjah Mada University, Yogyakarta
Prof. M. Shahidullah
Nepal
Tribhovan University, Kathmandu
Prof. Prakash Shreshtha
Sri Lanka
DeSoysa Hospital for Women,
University of Colombo, Colombo
Queen Sirikt National Institute of Child
Health, Bangkok
AIIMS, New Delhi
Dr. Ishani Rodrigo
Thailand
India
Dr. Ekawaty Haksari
Dr. Uraiwan Chotigaet
Dr V K Paul and Dr A K Deorari
Regional Network
Methodology
 Development of tools
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PIs’ meeting
Data collection
Quality assurance
Data check and feedback
Mid-term meeting of PIs
Data analysis and drafting the final
report
Salient findings from the
database
SEAR- NPD
IGME data
Lancet 2010
Referral centers vs. whole country data!
Gains
• Established a network of centers of
excellence in the Region
• Engagement of local collaborators and
colleagues to implement the program at
each center
• Generation of data –for planning new
research and for quality improvement
Recommended Next steps
• Network Institutions
 To create network of institutions in countries
 To use the data generated for quality
improvement of newborn care
• Nodal center: Role
 Facilitating each center to create the network
 Help in developing software and data tools
 Developing a common website for the network
Regional Network Meeting on
Strengthening Newborn Health care,
Education and Training Capacity,
22-25 March 2011,
AIIMS, New Delhi, India
Regional Network Meeting:
Objectives
• To strengthen the Regional Neonatal-Perinatal
Network and promote National Networks for
strengthening neonatal healthcare toward the
attainment of MDG 4
• To build collaboration and consensus on promoting
evidence based newborn heath care, education and
training in the member States and the Region
• To introduce technical updates on KMC and LBW
feeding and introduce Newborn Learning Resource
Materials for capacity building of health care providers
• To receive technical inputs the draft ‘Standard
Treatment Protocols for Management of Newborn
Problems in Small Hospitals’
Regional Meeting: Participation
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Bangladesh
Bhutan
India
Indonesia
Myanmar
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Maldives
Nepal
Sri Lanka
Timor Leste
Regional Network Meeting:
Recommendations
1. Regional-National Networks for NeonatalPerinatal Health to contribute to newborn
survival and health towards achievement of
MDG 4 in the Region
2. Develop National Networks for NeonatalPerinatal Health
3. Develop Standard Treatment Protocols for
managing common newborn conditions in
small hospitals.
Regional-National Networks:
Functions
• Provide Advocacy for Policy / Strategy,
increased investments
• Promote Database and Research
• Assist in Knowledge Management:
Dissemination of / Exchange of / sharing
of knowledge and experience
• Build Education and Training Capacity
• Support Quality assurance
Develop National Networks:
Attributes of National Coordination Center:
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Has proven capacity in academics, education, training and
research in newborn health - Handles a large volume of
deliveries and patient load with NICU offering tertiary level
newborn care
Has significant experience and has goodwill among
professional colleagues in the country
Has capacity to provide leadership - Has a team of experts
and human resource available
Has proven track record of collaboration and contribution to
national newborn programme
Has stated mission and vision to promote public health
approach for newborn health and has keen interest and
inclination to lead such initiatives
Facilitated by WHO
Support of the Government
Role of ‘National Coordination
Center’
• Engagement with Regional Network
• Assist / lead development of National
Network
• Coordinate the National Network
• Contribute to the technical functions of the
Network in the country
Partners in the Country
• Institutions: Phased approach
– Neonatal Units:
• Government
• Private
– District / Sub-district Hospitals
• Professional Associations:
– Doctors: Neonatology, Pediatrics, Perinatology, ObGy
– Nurses and Midwives
• Development Partners: UN agencies and others
Stewarded by Ministry of Health
Sustenance
• Government mandate
• Continued engagement with partners
• Resources Mobilization:
– Leverage existing opportunities: Government,
Agencies
– National Coordination Center to coordinate
with WHO and agencies for resource
mobilization
Standard Treatment Protocols
for common newborn
conditions in small hospitals
Application
Small Hospitals that:
• Provide in-patient care to newborns – not
necessarily in special care units
• Have MBBS doctors and nurses
• May or may not have Specialist Pediatrician
• Has necessary supplies and equipment
• Protocols would be applicable to higher level
facilities with relevant additionalities
Evidence based
Consistent with existing WHO Guidelines:
• Pocket Book (Blue)
• Pink Book (IMPAC series)
• Recent Guidelines and updates by WHO
Format
• Section 1. Flow Charts or Decision Making
charts on identified conditions:
– 1-2 pages
– Action oriented
– Linkages with other relevant flow charts when
applicable
• Section 2. Explanatory Notes for rationale of
recommended actions for each condition
• Section 3. Guidance notes on procedures
• Annexure: Guidance note on how to organize
the neonatal care services at the small hospital
Standard Treatment Protocols
• Dr Tunjung: Seizure,
Hypoglycemia
• Dr Samana: Sepsis,
Fluids, Anemia
• Dr Ekawaty: Sepsis,
LBW feeding
• Dr Niyasha: Jaundice,
sepsis, seizures
• Dr Shreshtha:
Breathing difficulty,
sepsis, jaundice
• Drs KIshwar,
Shahidullah: Sepsis,
Triage, post asphyxia
• Dr Azad Choudhary:
LBW feeding, Referral
Dr Virna: Jaundice,
Seizures,
Hypoglycemia
• Dr Aye Aye:
Hypoglycemia, LBW
feeding, post asphyxia
Follow up
• National Networks for Neonatal / Perinatal
Health: Progress
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Bangladesh
Myanmar
Nepal
Sri Lanka
• Standard Treatment Protocols for Newborn
Conditions: Peer Review complete
• Use of ICT for training healthcare providers