The document discusses evidence-based neonatal care, highlighting the significant risk of newborn deaths occurring within the first 28 days of life, primarily due to factors such as preterm birth and birth complications. It outlines the India Newborn Action Plan aimed at reducing neonatal mortality rates by 2030 and emphasizes the importance of quality antenatal care and skilled attendance at birth. Furthermore, it covers best practices for neonatal resuscitation, thermoregulation, and promotes innovations to enhance maternal and infant health.

1. EVIDENCE BASED NEONATAL CARE
DR NILIMA SONAWANE
Principal
Institute of Nursing Education, Sir J J Hospital
Campus , Mumbai ,Maharashtra, India

3. NEONATE
A neonate is a baby who is Birth to 4 weeks old
Period of transition from intra uterine to extra Uterine
world.

4. Newborns: improving survival and well-being
• Although the global number of newborns deaths declined from 5 million
in 1990 to 2.4 million in 2019, children face the greatest risk of death in
their first 28 days.
• In 2019, 47% of all under-5 deaths occurred in the newborn period with
about one third dying on the day of birth and close to three quarters dying
within the first week of life.
• Children who die within the first 28 days of birth suffer from conditions
and diseases associated with lack of quality care at birth or skilled care
and treatment immediately after birth and in the first days of life.
• Preterm birth, intrapartum-related complications (birth asphyxia or lack
of breathing at birth), infections and birth defects cause most neonatal
deaths.
• Women who receive midwife-led continuity of care (MLCC) provided by
professional midwives, educated and regulated to internationals
standards, are 16% less likely to lose their baby and 24% less likely to
experience pre-term birth.

9. INDIA NEWBORN ACTION PLAN (INAP)

The India Newborn Action Plan (INAP) was launched in
September 2014 with the aim of ending preventable
newborn deaths and stillbirths by 2030.
 The salient features are:
  INAP has set the goals for neonatal mortality and
stillbirths. The goal is to attain Single Digit Neonatal
Mortality and Stillbirth Rates by 2030.

  INAP is to be implemented within the existing
Reproductive, Maternal, Newborn, Child and Adolescent
health (RMNCH+A) framework of the National Health
Mission (NHM).

10. CAUSES OF NEWBORN DEATHS IN INDIA

11. Essential Antenatal care is a great evidence of
positive fetal outcome
 Early registration
 Tetanus toxoids immunization
 Management of Anemia &
Hypertension
 Maternal Nutrition
 Birth preparation
 Danger sign identification
and proper treatment

12. CLEAN CHAIN- CLEAN BIRTH PRACTICE
Skill attendance at birth
 The WHO six “cleans”
1. Clean hands of the attendant
2. Clean Delivery surface
3. Clean cord cutting instrument
4. Clean cord tie
5. Clean towels to dry the baby and then
wrap the baby
6. Clean cloth to wrap the mother
Timely Access to Emergency Obstetric care

13. Effects of Birthing Room Design on Maternal and Neonate
Outcomes
 The aesthetic nature of the birthing room
environment may alter the need for obstetrical
interventions.

14. DESIGNING SENSORY BIRTHING ROOM
The concept of sensory delivery
rooms was introduced in 2013.
These rooms offer programmable
calming lights, restful pictures
displayed on a wall , big screen,
and sound effects.
The physical healthcare
environment has significant
effects on health and well-being.
Research indicates that birthing
environments can impact women
during labor and birth.

15. In India successful natural birth center emerging under the
supervision of skill attendance & birthing expert
Birth Village Natural Birthing center
Kochi Kerala
Dai Maas Natural Biith and Wellness
centre , Mumbai

16. EBP-NEONATAL RESUSCITATION
It is the series of
actions used to assist
newborn babies who
have difficulties with
making the
physiological transition
from intra uterine to
extra uterine

17. SUCTIONING AT BIRTH
 The World Health Organization (WHO) now advises against
routine bulb suctioning of neonates in the minutes following
birth. If the baby is born through clear amniotic fluid and
begins breathing on their own shortly after birth, do
not suction.
 Evidence based clinical guidelines recommend not suctioning
a baby’s airways unless they are unresponsive, floppy and
require resuscitation.
 There is no benefit to this practice, and it can cause
bradycardia and apnea. Instead, wipe the baby’s mouth and
nose with a towel to clear excess secretions and stimulate
respiration.

18. SUCTIONING AT BIRTH
NP suctioning does improve certain aspects of infants'
respiratory status. There are presumed benefits to NP
suctioning. However, there are also potential risks. Nasal-
pharyngeal suctioning can produce bradycardia,
laryngospasm, cardiac dysrhythmias, and edema and
trauma to mucous membranes (Oberc, 1991), tachycardia,
emotional distress, bronchospasm, and cardiac arrest
(Young, 1988).
The latest research shows that babies who have their faces
wiped after birth have a clinical outcome that is exactly the
same as those who are suctioned, but without the
damaging risks.

19. THERMOREGULATION
Prevention of Hypothermia
Thermal care (including prompt
drying and covering at birth,
maximizing skin-to-skin
contact, delayed bathing,
maintaining “warm chain”)

20. Thermocol boxes prove lifesavers for the newborn

21. WARM CHAIN
 Warm delivery room 25 c
 Warm resuscitation
 Dry baby immediately
 Postpone bathing for 24 hrs
 Breast feeding
 Skin to skin contact
 Warm clothing
 Mother Baby together
 Professional Alertness
 Warm transportation

22. KANGAROO MOTHER CARE

23. HOMEBASED NEWBORN CARE HBNC
 Breast feeding
 Cord care
 Maintenance of
temperature
 Early detection of
pneumonia and sepsis
 Promoting Hygienic
practices
 Recognition of post partum
complications

24. EARLY INITIATION OF BREAST FEEDING
Prevention of Hypoglycemia

25. DELAYED CORD CLAMPING
"wait a minute" policy
No Risk
It decreases the risk of anemia
The benefits are even greater for preterm
babies
It is safe process
Placental transfusion for 45 s or milking the
cord for 15s s improves cardiovascular
adaptation, with better hemodynamic
stability
Decreased intra ventricular hemorrhages,
need for transfusion, and late-onset sepsis.

26. EVIDENCE BASED CLEAN CORD CARE PRACTICES
 Cleaning with Alcohol delay healing
 The effect of topical antimicrobials in reducing infections
is less clear.
 Hand washing
 washing cord with soap and water & keep it Dry
 Exposed to air or cover with loose cotton cloths
 No unnecessary use of Topical antimicrobials on cord
stump
 Recent studies have proven that salt is effective at
treating umbilical granulomas. It is thought that
the salt draws water out of the cells and causes the
granuloma to shrink.

27. BABY’S FIRST BATH: WHY SHOULD IT BE DELAYED?
Vernix
Boost Immunity
Better Temperature
Regulation
Better Blood Sugar
Regulation
Improved Bonding Time
Better Success with
Breastfeeding

28. HEALTH EDUCATION : KEY TO SUCCESS
Working with individual family and community
To improve maternal and newborn health

29. IMNCI PLUS ETAT
Emergency Triage Assessment and Treatment

30. 10 BRILLIANT TECHNOLOGICAL INNOVATIONS TO SAVE
MOMS AND BABIES

32. 10 BRILLIANT TECHNOLOGICAL INNOVATIONS TO SAVE
MOMS AND BABIES

33. 10 BRILLIANT TECHNOLOGICAL INNOVATIONS TO SAVE MOMS
AND BABIES

34. 10 BRILLIANT TECHNOLOGICAL INNOVATIONS TO SAVE
MOMS AND BABIES