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The First Embrace:Action Plan for HealthyNewborns in the Western PacificRegion (2014-2020)Reproductive Health Affinity Gro...
Every 2 minutes, 1 newborn diesin the Western Pacific Region209 000 neonatal deaths in theWestern Pacific Region every yea...
Newborns account for >50% of all under 5 deathsCause of Deaths before 5 years of agein the WHO Western Pacific Region (201...
We must get it right from (24 hours around birth)the start: Age at death for Neonates (0-28 days)051015202530350 1 2 3 4 5...
Proportion of births assisted by a skilledbirth attendant (2005-2011)
ReproductiveAgeAntenatalperiodAdolescentSchoolagePreschoolContinuum of the Life CycleIntra-partumDeliveryImmediate Newborn...
You are Li Yu (mom) and baby girlLin Lin’s health professional.What practices do you do that protector place Lin Lin at ri...
After Lin Lin is born, you should call out the time(to mins and secs) of birth, then what?
After Lin Lin is born, you should call out the time(to mins and secs) of birth, then what?
Lin Lin Has Needs• To breathenormally• To be warm• To be protected• To be fed
Immediate Thorough Drying• Stimulates Lin Lin to Breathe• Prevents hypothermia• If Lin Lin gets cold, she could get:– Infe...
During drying and stimulation, your rapidassessment shows Lin Lin is crying.What is your next action?
FIRST, DO NO HARM• Do NOT suction LinLin unless hermouth/nose areblocked bysecretions
During drying and stimulation, your rapidassessment shows Lin Lin is crying.What is your next action?
7 billionth babiesSkin-to-Skin ContactSeparated from mother
Skin-to-Skin ContactContributes to:• Warmth• Bonding• Successful breastfeeding/colostrum feeding• Stimulate the mucosa-ass...
Delayed cord clampingTerm babies have less• Anemia– RR 0.2 (95% CI 0.06, 0.6)Preterms have less• Anemia requiring transfus...
How long after birth is Lin Lin ready tobreastfeed?
How long after birth is Lin Lin ready tobreastfeed?
• Drooling• Mouth Opening• Tonguing, Licking,• Biting HandFeeding CuesLin Lin may want to restfor 20-30 mins and evenup to...
What is the approximate capacity of LinLin’s stomach (when she was born)?ABCD
ABCDWhat is the approximate capacity of LinLin’s stomach (when she was born)?
If this benefitsbabies,Skin-to-Skin Contact Separated from motherWhy is this socommon?Immediate drying,delayed cord clampI...
No one intends to harmnewborns; but many commonpractices are harmful
Priority interventions of EENCWHO, 2013
Vision: A healthy start for everynewbornMission: To strengthen the healthsystem to cultivate an enablingenvironment where ...
To eliminate preventable newborn mortality byproviding universal access to high quality EarlyEssential Newborn Care.Target...
Framework of Strategic Actions
SA1. Ensure consistent adoptionand implementation of EarlyEssential Newborn Care (EENC).Operational objectives:1.1. To ens...
SA2. Improve political andsocial support to ensure anenabling environment for EarlyEssential Newborn Care(EENC)Operational...
SA3. Ensure availability, access,and use of skilled birth attendantsand essential maternal and newborncommodities in a saf...
SA4. Engage and mobilizecommunity to increase demand.Operational objectives:4.1. To increase community demand for skilledb...
SA5. Improve the availabilityand quality of perinatalinformation.Operational objectives:5.1. To strengthen capacity of rou...
Let’sgive ahealthy startfor everynewborn
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Regional action plan for healthy newborns rhag 26 june 2013

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  • Read the slide Emphasize that for every 2 preterm babies where cord clamping is delayed, one will be saved of a brain hemorrhage. Note Delayed cord clamping is completely safe for mothers as well as babies. 1) Ceriani Cernadas JM, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C, Casas O, Giordano D, Lardizabal J. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: A randomized, controlled trial. Pediatrics 2006; 17;e779-e786. 2)Rabe H, et al. Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No. CD003248. DOI: 10.1002/14651858.CD003248.pub2. 3) McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No. CD004074. DOI:10.1002/14651858.CD004074.pub2.4) Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates. Systematic review and meta-analysis of controlled trials. JAMA. 2007; 297:1241-1252.5) Kugelman A, et al. Immediate versus delayed umbilical cord clamping in premature neonates born <35 weeks: A prospective, randomized, controlled study. Amer J Perinatol. 2007. 24(5):307-315. 6) van Rheenen PF, et al. Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developing countries. Ann Trop Paediatr. 2006 Sep;26(3):157-67. 2006; 333:954-958. 7) van Rheenen PF, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ 2006; 333:954-958
  • Read the slide Emphasize that for every 2 preterm babies where cord clamping is delayed, one will be saved of a brain hemorrhage. Note Delayed cord clamping is completely safe for mothers as well as babies. 1) Ceriani Cernadas JM, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C, Casas O, Giordano D, Lardizabal J. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: A randomized, controlled trial. Pediatrics 2006; 17;e779-e786. 2)Rabe H, et al. Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No. CD003248. DOI: 10.1002/14651858.CD003248.pub2. 3) McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No. CD004074. DOI:10.1002/14651858.CD004074.pub2.4) Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates. Systematic review and meta-analysis of controlled trials. JAMA. 2007; 297:1241-1252.5) Kugelman A, et al. Immediate versus delayed umbilical cord clamping in premature neonates born <35 weeks: A prospective, randomized, controlled study. Amer J Perinatol. 2007. 24(5):307-315. 6) van Rheenen PF, et al. Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developing countries. Ann Trop Paediatr. 2006 Sep;26(3):157-67. 2006; 333:954-958. 7) van Rheenen PF, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ 2006; 333:954-958
  • Read the slide Emphasize that for every 2 preterm babies where cord clamping is delayed, one will be saved of a brain hemorrhage. Note Delayed cord clamping is completely safe for mothers as well as babies. 1) Ceriani Cernadas JM, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C, Casas O, Giordano D, Lardizabal J. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: A randomized, controlled trial. Pediatrics 2006; 17;e779-e786. 2)Rabe H, et al. Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No. CD003248. DOI: 10.1002/14651858.CD003248.pub2. 3) McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No. CD004074. DOI:10.1002/14651858.CD004074.pub2.4) Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates. Systematic review and meta-analysis of controlled trials. JAMA. 2007; 297:1241-1252.5) Kugelman A, et al. Immediate versus delayed umbilical cord clamping in premature neonates born <35 weeks: A prospective, randomized, controlled study. Amer J Perinatol. 2007. 24(5):307-315. 6) van Rheenen PF, et al. Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developing countries. Ann Trop Paediatr. 2006 Sep;26(3):157-67. 2006; 333:954-958. 7) van Rheenen PF, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ 2006; 333:954-958
  • Transcript of "Regional action plan for healthy newborns rhag 26 june 2013"

    1. 1. The First Embrace:Action Plan for HealthyNewborns in the Western PacificRegion (2014-2020)Reproductive Health Affinity Group26 June 2013Dr Ornella Lincetto
    2. 2. Every 2 minutes, 1 newborn diesin the Western Pacific Region209 000 neonatal deaths in theWestern Pacific Region every year1 represents 100 neonatal deathsWHO Global HealthObservatory, 2011
    3. 3. Newborns account for >50% of all under 5 deathsCause of Deaths before 5 years of agein the WHO Western Pacific Region (2010)Source:WHO Global HealthObservatory 2010(n= 467 000)
    4. 4. We must get it right from (24 hours around birth)the start: Age at death for Neonates (0-28 days)051015202530350 1 2 3 4 5 6 7 8 9 1011 1213 14 1516 1718 19 2021 22 2324 2526 27 28Days of lifeProportionalmortalityWhat we do then affects therest of the newborns life2 out of 3 newborn deathsoccur in the 3 days of lifeWHO, 2012
    5. 5. Proportion of births assisted by a skilledbirth attendant (2005-2011)
    6. 6. ReproductiveAgeAntenatalperiodAdolescentSchoolagePreschoolContinuum of the Life CycleIntra-partumDeliveryImmediate Newborn•First Embrace•Care for LBW/Preterm•Care for Sick NewbornPostneonatalLateneonatalEnhancing overall efforts on maternal andchild health by focusing on a weak link
    7. 7. You are Li Yu (mom) and baby girlLin Lin’s health professional.What practices do you do that protector place Lin Lin at risk?
    8. 8. After Lin Lin is born, you should call out the time(to mins and secs) of birth, then what?
    9. 9. After Lin Lin is born, you should call out the time(to mins and secs) of birth, then what?
    10. 10. Lin Lin Has Needs• To breathenormally• To be warm• To be protected• To be fed
    11. 11. Immediate Thorough Drying• Stimulates Lin Lin to Breathe• Prevents hypothermia• If Lin Lin gets cold, she could get:– Infection– Coagulation defects– Acidosis– Delayed fetal to newborn circulatory adjustment– Hyaline membrane disease– Brain hemorrhageTunell R., in Improving Newborn Health in Developing Countries, A. Costello and D. Manandhar, Editors.2000, Imperial College Press: London, UK. p. 207-220;Tollin M,et al.. Cell Mol Life Sci 2005
    12. 12. During drying and stimulation, your rapidassessment shows Lin Lin is crying.What is your next action?
    13. 13. FIRST, DO NO HARM• Do NOT suction LinLin unless hermouth/nose areblocked bysecretions
    14. 14. During drying and stimulation, your rapidassessment shows Lin Lin is crying.What is your next action?
    15. 15. 7 billionth babiesSkin-to-Skin ContactSeparated from mother
    16. 16. Skin-to-Skin ContactContributes to:• Warmth• Bonding• Successful breastfeeding/colostrum feeding• Stimulate the mucosa-associated lymphoid tissuesystem• Calmness• Protection from hypoglycemia• Colonization with maternal skin floraMoore Cochrane Rev, 2012Anderson Cochrane Rev, 2005Brandtzaeg. Ann N Y Acad Sci, 2002
    17. 17. Delayed cord clampingTerm babies have less• Anemia– RR 0.2 (95% CI 0.06, 0.6)Preterms have less• Anemia requiring transfusion– RR 0.6 (95% CI 0.5, 0.8)• Intraventricular hemorrhage– RR 0.6 (95% CI 0.4, 0.9)• Necrotizing Enterocolitis– RR 0.6 (95% CI 0.4, 0.9)Ceriani Cernadas, 2006Rabe, Coch Rev, 2012
    18. 18. How long after birth is Lin Lin ready tobreastfeed?
    19. 19. How long after birth is Lin Lin ready tobreastfeed?
    20. 20. • Drooling• Mouth Opening• Tonguing, Licking,• Biting HandFeeding CuesLin Lin may want to restfor 20-30 mins and evenup to 120 minutes beforeshowing signs ofreadiness to feed
    21. 21. What is the approximate capacity of LinLin’s stomach (when she was born)?ABCD
    22. 22. ABCDWhat is the approximate capacity of LinLin’s stomach (when she was born)?
    23. 23. If this benefitsbabies,Skin-to-Skin Contact Separated from motherWhy is this socommon?Immediate drying,delayed cord clampImmediate cord clamp,delayed drying,suction
    24. 24. No one intends to harmnewborns; but many commonpractices are harmful
    25. 25. Priority interventions of EENCWHO, 2013
    26. 26. Vision: A healthy start for everynewbornMission: To strengthen the healthsystem to cultivate an enablingenvironment where skilled providers ofnewborn care value and practiceEssential Early Newborn Care(EENC) at every birth.Action Plan
    27. 27. To eliminate preventable newborn mortality byproviding universal access to high quality EarlyEssential Newborn Care.Target 1: At least 80% of facilities where births take place arefully implementing EENC by 2020 in all member states.Target 2: At least 90% of deliveries in all sub-national areasattended by a skilled birth attendant by 2020 in all memberstates.Target 3a: National NMR 10 per 1000 live births or less by2020.Target 3b: Sub-national NMR 10 per 1000 live births or lessby 2020.Regional Goal
    28. 28. Framework of Strategic Actions
    29. 29. SA1. Ensure consistent adoptionand implementation of EarlyEssential Newborn Care (EENC).Operational objectives:1.1. To ensure EENC has been incorporated into nationaland sub-national health agendas, plans, budgets andfinancing mechanisms1.2. To enable providers of newborn care to practiceEENC at every delivery by providing appropriate systemsupport and training1.3. To ensure EENC has been incorporated into clinicalprotocols, quality improvement cycles andaccreditation mechanisms1.4. To scale up centres of excellence implementingEENC
    30. 30. SA2. Improve political andsocial support to ensure anenabling environment for EarlyEssential Newborn Care(EENC)Operational objectives:2.1. To mobilize political commitment and social supportof key stakeholders for policies, programmes andservices for the implementation of EENC2.2. To strengthen legislation, regulations, andenforcement to meet international standards to supportimplementation of EENC
    31. 31. SA3. Ensure availability, access,and use of skilled birth attendantsand essential maternal and newborncommodities in a safe environment.Operational objectives:3.1. To ensure availability of a skilled birth attendant forevery delivery3.2. To ensure availability of equipment, supplies andessential medicines in safe environments in routine andemergency situations
    32. 32. SA4. Engage and mobilizecommunity to increase demand.Operational objectives:4.1. To increase community demand for skilledbirth attendance and the EENC
    33. 33. SA5. Improve the availabilityand quality of perinatalinformation.Operational objectives:5.1. To strengthen capacity of routine informationsystems collect accurate data on perinatalhealth5.2. Improve collection and use of data onperinatal health and practices through research,surveys, and audits
    34. 34. Let’sgive ahealthy startfor everynewborn
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