Essential Newborn Care
African Regional Meeting on Interventions for
Impact for Essential Obstetric and Newborn Care: 2123 February 2011, Addis Ababa, Ethiopia
Presentation outline
• Some Facts and Figures on
Newborn health
• Essential Newborn Care
• Definition of Essential Newborn
Care
• Key components of Essential
Newborn Care
• WHO Essential Newborn Care
Course- ENCC & Resuscitation
Africa Regional Meeting on Interventions for Impact
on Essential Obstetrics and Newborn care, 21-23,
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2 Addis Ababa
Progress towards MDG 4
 Total number of
deaths of children <
5 dropped from 12.4
million in 1990 to
8.8 million in 2008
(30%)
 Neonatal mortality
represents about
40% (3·575 million),
most in the first
week
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3 Addis Ababa
Trends in Neonatal Mortality
120
100
80
60
40
20
Making Pregnancy Safer
th
|
5 | 7 MPS Orientation Workshop Geneva 21 – 25 June 2010
Africa Regional Meeting on Interventions for Impact
on Essential Obstetrics and Newborn care, 21-23,
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4 Addis Ababa
12
14
20
20
10
20
06
08
20
20
04
20
00
02
20
20
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
19
80
0
Sources:
WHO/MSM 1996
WHO/MPS 2006,
2007
WHO 2010
3·6 Neonatal Deaths: Why ?
 Under-nutrition contributes to
one-third of child deaths
 Prematurity is a complication to
be dealt with starting in
pregnancy
 Birth asphyxia needs to be
dealt with in the first minutes of
life
CHERG Lancet 2010; 375: 1969–87
Africa Regional Meeting on Interventions for Impact
on Essential Obstetrics and Newborn care, 21-23,
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6 Addis Ababa
In Africa 1·2 Neonatal Deaths: Why?
 Lower contribution to
overall child mortality
 Prematurity and birth
asphyxia contribute
equally
 Neonatal deaths likely
to increase as child
deaths fall
CHERG Lancet 2010; 375: 1969–87
Africa Regional Meeting on Interventions for Impact
on Essential Obstetrics and Newborn care, 21-23,
|
7 Addis Ababa
Causes of Newborn deaths in SS-Africa
Newborn deaths constitute 29% of under five mortality
The main causes for almost 90% of Newborn deaths are:
1. Infections- 32%
2. Prematurity and Low birth weight- 29%
3. Birth Asphyxia and birth trauma- 27%
ALL are preventable and treatable
MDG- 4 can only be achieved if neonatal deaths are addressed
and this necessitates both maternal and child health
interventions
Africa Regional Meeting on Interventions for Impact
on Essential Obstetrics and Newborn care, 21-23,
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When are the 1.2 million African newborn
About a quarter
deaths occurring?
of neonatal
deaths are on
the day of birth
30
Proportion of deaths
25
20
More than 70% of
neonatal
deaths are in
the first week
15
10
5
0
0
5
10
15
20
25
30
Days of life
Africa Regional Meeting on Interventions for Impact
on Essential Obstetrics and Newborn care, 21-23,
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9 Lawn
Source:
Kerber K -Daily numbers of death in 20 African countries during first month of life - based on 20 DHS datasets
AddisJE,
Ababa
(2000 to 2004) with 5,763 neonatal deaths
Coverage of key Maternal and Child Survival
Interventions, in WHO/AFRO 2008
Coverage (%)
100
75
50
71
44
46
The hours and
days of
highest risk
have the
lowest
coverage of
care
74
73
43
37
31
35
25
17
8
0
ANC 1 vis. ANC at least
Skilled
P ostnatal
Exclusive
DP T3
Vit. A Suppl Diarrhoea rec P neu Case to M alaria case ITN use in U5
4 vis.
attendant at care (within 2 breastfeeding vaccination
ORT
HW
Rec antimal
birth
days)
<6 months
Africa Regional Meeting on Interventions for Impact
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Source:
WHO World Health Statistics 2010, UNICEF State of the World’s Children, 2010
10 Addis Ababa
Definition of Essential Newborn Care- ENC
 WHO Working Group Meeting in 1994 in Trieste, Italy- ENC was defined as
consisting of eight components
 These elements remain, even if some have slightly changed in content, since.
 The concept of ENC was further divided into Basic Care and Special Care
 Basic Care -includes interventions for all infants to meet their physiological
needs.
 Special Care -required for a small group of newborns because of diseases
acquired before, during or after birth and/or because they are born too soon/small
 This was the basis for developing the essential practice guide of the Integrated
Management of Pregnancy and Childbirth (IMPAC) series as well as the guide
for doctors, nurses and midwives Managing Newborn Problems.
 The WHO Essential Newborn Care Course is part of these IMPAC series
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Essential Newborn Care-Components
1. Cleanliness
2. Thermal protection
3. Early and exclusive breastfeeding
4. Initiation of breathing, resuscitation
5. Eye care
6. Immunization
7. Management of newborn illness
8. Care of the preterm and/or low birth weight
newborn
Africa Regional Meeting on Interventions for Impact
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Integrated Management of Pregnancy and
Childbirth (IMPAC)
 Clinical guidelines
 Programme guides
 Education modules
 Advocacy material
 Tools for monitoring and
evaluation
Africa Regional Meeting on Interventions for Impact
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Essential Newborn Care Course
 New layout
 French version in print
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The 5 modules in the ENCC
1. Care of the baby at the time of birth
1.
2.
3.
4.
Introduction to the PCPNC guide
Universal precaution
Care of the baby at birth
Keeping baby warm
2. Examination of the newborn baby
3. Care of the newborn baby until
discharge
1. Resuscitation of the newborn baby
2. Routine care of the newborn baby
4. Special situations
1. Overcoming difficulties in
breastfeeding
2. The small baby
3. Alternative methods of feeding a
baby
1. Breasting a newborn baby- ensuring
a good start
2. Communication skills
5. Optional module
3. Examination of the newborn
1. Giving an injection
2. Kangaroo mother care
Africa Regional Meeting on Interventions for Impact
on Essential Obstetrics and Newborn care, 21-23,
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The WHO Essential Newborn Care Course
 Five days course on
essential and emergency
newborn care
 Any health facility dealing
with mothers and newborns
 For doctors, midwives and
nurses
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ENCC: State of Implementation
Mali
Kenya
No WHO AFRO
Trained trainers available (8 countries)
Al least one core national ENC training conducted (7 countries)
4 districts Training started in periphery (3 countries)
7 or more district/provincial courses (2 countries)
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 By 2010 ENCC
training has
been introduced
in 40 countries
globally
–
–
–
–
AFRO-20
EMRO
SEARO
WPRO
Asphyxia &Resuscitation of the newborn
baby
 Asphyxia is failure to breath within one minute after delivery.
 Good labour could prevent most birth asphyxia
 This is treatable if births are attended by health worker skilled in
neonatal resuscitation
 One in 20 (5%) babies need help with breathing- resuscitation
 Resuscitation must be anticipated at each delivery
 Resuscitation skills are essential to the survival of babies
Africa Regional Meeting on Interventions for Impact
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Training Newborn Resuscitation in the
Context of Essential Newborn Care-1
 Newborn resuscitation is a critical component of ENC, but
one out of the eight components
 The WHO ENCC training package contains a module on
basic newborn resuscitation based on the 1998 guidelines
currently updated
 Countries may chose to replace that module by Helping
Babies Breath (HBB)
 The introduction of ENCC should trigger the review of the
national neonatal resuscitation guidelines including by level of
care
Africa Regional Meeting on Interventions for Impact
on Essential Obstetrics and Newborn care, 21-23,
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Training Newborn Resuscitation in the
Context of Essential Newborn Care-2
 Efforts to improving ENC should go hand in hand with efforts to
improving good quality obstetric care to prevent adverse neonatal
outcomes including reduced need for resuscitation
 National Ministries of Health and professional bodies (e.g. midwife
associations, paediatric societies should take ownership of these
training initiatives, partners should align and coordinate their
support
 The impact of any training (ENCC and/or HBB) on change of
practice in all eight ENCC components in maternity services should
be documented or evaluated, including in the context of other
efforts such as the Baby Friendly Hospital Initiative (BFHI)
Africa Regional Meeting on Interventions for Impact
on Essential Obstetrics and Newborn care, 21-23,
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21 Addis Ababa
Thank you