CORE Group Global Health Practitioner Conference 2019

1. CORE Group Meeting
MAY 7, 2019
Every Preemie—SCALE
SCALING, CATALYZING, ADVOCATING, LEARNING, EVIDENCE-DRIVEN

2. ENSURE THEY THRIVE
Nurturing care for small and sick newborns from
birth to 3 years – evidence review and synthesis

3. Why Inpatient Newborn Care?
Adapted from: Lawn JE, Davidge R, Paul VK, et al. Born too soon: care for the preterm baby

4. Nurturing Care
• Nurturing Care for Early Childhood Development. A
framework for helping children survive and thrive to
transform health and human potential—launched by
WHO, UNICEF, the World Bank Group and other partners in
2018 at the World Health Assembly
• Nurturing care defined as “a stable environment that is
sensitive to children’s health and nutritional needs,
with protection from threats, opportunities for early
learning, and interactions that are responsive,
emotionally supportive, and developmentally
stimulating”
• Developmentally supportive care improves
outcomes for newborns by placing them in a
nurturing, family-centred environment with
respect, minimal stimulation, and maximum
information-sharing between providers and
families.
• Pertains to all newborns, infants and children from 0 – 3
years

5. Reviewing the evidence
The evidence review and synthesis process includes two
components:
• A review of reviews from peer reviewed literature which
sought evidence about core elements of nurturing care
for in-facility small and sick newborns and post-
discharge care at the community level;
• Country case studies in high-, middle- and low-income
countries (Nepal, India, Philippines, Colombia, US,
Sweden, Rwanda and/or South Africa)
• A search for grey literature specific to case study countries
including policies, procedures, guidelines, laws and acts which
support the concepts of nurturing care.
Elements of developmentally supportive care

6. Evidence for key interventions—some highlights
INTERVENTION FINDINGS
Skin-to-skin/Kangaroo Care • Skin-to-skin/KC has positive and protective effects, particularly in LBW newborns, including mortality reduction,
prevention of sepsis, hypothermia and hypoglycaemia, reduced hospital readmission, exclusive breastfeeding and
improved biophysiological parameters.
• Involving fathers in skin-to-skin confers benefits for the whole family.
Nutrition
(breastmilk feeding and
breastfeeding)
• Early exposure to breastmilk confers benefit to preterm infants. Evidence is emerging that human milk has a positive
impact on preterm infants’ neurodevelopmental outcomes in the shorter- and longer-term through to adulthood.
• Targeting education and mass media campaigns to the local context and involving the wider community can enhance
breastfeeding practices.
Sensory environment • The sensory environment can provide both negative (light and noise) and positive (touch/massage) sensory stimulation.
• Cycled lighting appears safe and confers some short-term benefits (shorter length of stay).
• Reducing noise appears to confer benefit in enhancing quiet sleep states and physiologically stability.
• Early intervention, as simple and low cost as holding/touching, and parent involvement are important for positive
neurodevelopmental outcomes.
Reducing stress and pain • Assessment and management of pain is still poorly undertaken with reports that pain management (pharmacological or
non-pharmacological) is only undertaken about 50% of the time for painful procedures in neonatal units.
• Skin-to-skin confers benefit over sweet solution in preterm newborns. Skin-to-skin undertaken with any provider confers
benefit.
Supportive positioning • Positioning has short- and long-term benefits for development and for cognitive function.
• Positioning interventions that promote stability and reduce stress may have an impact on the cortex development in
preterm infants and should be encouraged.

7. INTERVENTION FINDINGS
Protecting and promoting sleep • Clustering of care and procedures (e.g. diaper change, eye care, repositioning of monitoring
device leads) is recommended to ensure complete sleep cycles and reduce stress-induced
physiological instability.
Protecting skin • Current evidence does not support the use of emollients for reducing invasive infection or
mortality in preterm infants in inpatient settings in any country defined by high, middle or
low income.
Age-appropriate stimulation and interactions
with health professionals, parents/
families/carers
• In the clinical context, the focus should be on interactions and activities that promote
maternal/parent - newborn contact and reduce stress for families while in hospital and
post discharge.
• Activities and care-giving that support positive interactions in the newborn inpatient and
early infancy period confers some benefit for cognitive function up to pre-school age.
Partnering with parents and families • Collaborating with parents, improved communication and involvement in decision-making
results in improved outcomes for both parents and neonates.
• Engaging parents early with good communication, education, participation in care giving and
decision-making benefits short term outcomes for newborns such as breastfeeding, growth,
readiness for discharge, distress and stress; and for parents: reduced stress, increased
confidence and positive parent-infant interactions.
Follow up and screening • In development

8. COUNTRY CASE STUDIES