1) The document discusses new developments in reducing newborn mortality over the past decade. Deaths have declined 28% since 2000, due in part to low-cost interventions like home-based neonatal care in India.
2) It also summarizes evidence for interventions to address the three main causes of newborn deaths: birth asphyxia (Helping Babies Breathe training), preterm/low birthweight babies (kangaroo mother care), and infections (chlorhexidine cord care and community case management).
3) Ongoing research aims to simplify antibiotic treatment regimens for neonatal infections and evaluate strategies for scaling up newborn health programs.
1. Neonatal resuscitation involves providing care to newborns who do not transition well from intrauterine to extrauterine life, with 1-3 per 1000 live births requiring interventions like chest compressions or medications.
2. Successful transition at birth depends on significant physiologic changes and within 30 seconds of birth most term newborns will begin breathing on their own.
3. The neonatal resuscitation program follows a standard flow diagram involving initial assessment, clearing the airway, establishing breathing and circulation, and administering any necessary drugs.
This document discusses neonatal resuscitation and the physiologic changes that occur at birth. It covers topics like fetal circulation, oxygenation, the transition at delivery, signs of a compromised newborn, resuscitative steps including providing warmth, clearing the airway, stimulation and ventilation. Positive pressure ventilation techniques like bag-mask ventilation are described. The importance of anticipating resuscitation needs, preparing appropriately, and understanding the heart rate response to determine next steps is emphasized. Maintaining normal body temperature and oxygen saturation targets are also addressed.
New Concepts of Newborn Resuscitation – the new national protocolMCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
This document provides guidance on various aspects of newborn resuscitation and care based on a review of evidence. It finds that:
1. A combination of interventions including maintaining the environment at 23-25°C, warm blankets, plastic wrapping without drying, use of a cap and thermal mattress can help reduce the risk of hypothermia in preterm newborns.
2. For non-vigorous newborns delivered through meconium-stained amniotic fluid, immediate direct laryngoscopy and suctioning is not recommended compared to immediate resuscitation without direct laryngoscopy, based on low-certainty evidence.
3. Routine intrapartum oropharyngeal and
This presentation is the analysis of current newborn care in India. It focuses on the Hospital birth scenario and Factors contributing to newborn death. It further highlights , how the Midwives can make a difference.
Hello guys, bringing to you the concept of golden hour of neonatology. As in trauma, the first hour of neonatal life is most precious and this ppt is an attempt to highlight a few key aspects of this resuscitative strategy in premature infants.
Neonatal resuscitation guidelines were updated with the following key changes:
- Delayed cord clamping for at least 30 seconds is recommended for both term and preterm infants who do not require resuscitation.
- For infants requiring resuscitation, there is insufficient evidence on optimal cord clamping approach.
- Use of 3-lead ECG is recommended over pulse oximetry for accurate heart rate measurement during resuscitation.
- For preterm infants under 35 weeks, resuscitation should use low oxygen (21-30%) and titrate to target saturation rather than high oxygen.
The document outlines the immediate care and resuscitation of newborn babies. It discusses definitions, objectives, care at birth and in the nursery. Procedures like clamping the umbilical cord and APGAR scoring for assessment are explained. For babies with low APGAR scores, the steps of providing positive pressure ventilation, oxygen and potential intubation are summarized. Maintaining warmth, clearing the airway through gentle suctioning and positioning the baby are also general measures described.
1. Neonatal resuscitation involves providing care to newborns who do not transition well from intrauterine to extrauterine life, with 1-3 per 1000 live births requiring interventions like chest compressions or medications.
2. Successful transition at birth depends on significant physiologic changes and within 30 seconds of birth most term newborns will begin breathing on their own.
3. The neonatal resuscitation program follows a standard flow diagram involving initial assessment, clearing the airway, establishing breathing and circulation, and administering any necessary drugs.
This document discusses neonatal resuscitation and the physiologic changes that occur at birth. It covers topics like fetal circulation, oxygenation, the transition at delivery, signs of a compromised newborn, resuscitative steps including providing warmth, clearing the airway, stimulation and ventilation. Positive pressure ventilation techniques like bag-mask ventilation are described. The importance of anticipating resuscitation needs, preparing appropriately, and understanding the heart rate response to determine next steps is emphasized. Maintaining normal body temperature and oxygen saturation targets are also addressed.
New Concepts of Newborn Resuscitation – the new national protocolMCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
This document provides guidance on various aspects of newborn resuscitation and care based on a review of evidence. It finds that:
1. A combination of interventions including maintaining the environment at 23-25°C, warm blankets, plastic wrapping without drying, use of a cap and thermal mattress can help reduce the risk of hypothermia in preterm newborns.
2. For non-vigorous newborns delivered through meconium-stained amniotic fluid, immediate direct laryngoscopy and suctioning is not recommended compared to immediate resuscitation without direct laryngoscopy, based on low-certainty evidence.
3. Routine intrapartum oropharyngeal and
This presentation is the analysis of current newborn care in India. It focuses on the Hospital birth scenario and Factors contributing to newborn death. It further highlights , how the Midwives can make a difference.
Hello guys, bringing to you the concept of golden hour of neonatology. As in trauma, the first hour of neonatal life is most precious and this ppt is an attempt to highlight a few key aspects of this resuscitative strategy in premature infants.
Neonatal resuscitation guidelines were updated with the following key changes:
- Delayed cord clamping for at least 30 seconds is recommended for both term and preterm infants who do not require resuscitation.
- For infants requiring resuscitation, there is insufficient evidence on optimal cord clamping approach.
- Use of 3-lead ECG is recommended over pulse oximetry for accurate heart rate measurement during resuscitation.
- For preterm infants under 35 weeks, resuscitation should use low oxygen (21-30%) and titrate to target saturation rather than high oxygen.
The document outlines the immediate care and resuscitation of newborn babies. It discusses definitions, objectives, care at birth and in the nursery. Procedures like clamping the umbilical cord and APGAR scoring for assessment are explained. For babies with low APGAR scores, the steps of providing positive pressure ventilation, oxygen and potential intubation are summarized. Maintaining warmth, clearing the airway through gentle suctioning and positioning the baby are also general measures described.
Neonatal resuscitation is a series of actions to assist newborn babies having difficulty transitioning from intrauterine to extrauterine life. Approximately 10% of newborns require some assistance to begin breathing, while less than 1% require extensive resuscitation. The main goals are to initiate breathing, maintain adequate perfusion and cardiac output, and restore normal temperature. Essential equipment includes suction, bag and mask ventilation, intubation equipment and medications. The ABCs of neonatal resuscitation are maintenance of temperature, establishment of an open airway, initiation of breathing, and maintenance of circulation.
The document summarizes a hospital's venous thromboembolism (VTE) prophylaxis program over 7 years. It shows that the program reduced hospital-acquired deep vein thrombosis and pulmonary embolism by over two-thirds, saving over $6 million in costs. Moving forward, the hospital aims to further improve prophylaxis practices by focusing on areas like daily ambulation and administering prophylaxis in the emergency department and throughout a patient's care. The goal is continuous quality improvement to help more patients and potentially achieve outcomes like preventing all hospital-acquired infections.
The Department of Health in the Philippines launched a new birth protocol called "Unang Yakap" or "First Embrace" to reduce newborn mortality and help achieve the country's goal of reducing childhood mortality by two-thirds. The protocol stresses immediate drying of newborns, delayed cord clamping, skin-to-skin contact with mothers, and early initiation of breastfeeding within 90 minutes of birth. It was developed in collaboration with the World Health Organization and will be part of normal delivery packages covered by Philippine health insurance to speed up its implementation nationwide.
This document discusses guidelines for immediate newborn care procedures. It outlines that many newborn deaths occur within the first 24 hours of birth, but many lives could be saved through simple interventions. It then describes the Apgar scale used to assess a newborn's health at 1 and 5 minutes after birth. Key immediate newborn care procedures that are described include drying the baby, applying identification bands, promoting skin-to-skin contact and breastfeeding, assessing vital signs regularly in the first hour, and performing a full examination. The goals of immediate newborn care are also stated.
Neonatal intensive care involves specialized care for ill or premature newborns. Conditions requiring intensive care include prematurity, low birthweight, and medical issues. Intensive care aims to stabilize infants and address physiological immaturities in organ systems like respiratory, cardiovascular, and gastrointestinal systems. Intensive care involves continuous monitoring, respiratory support like CPAP or ventilation, thermoregulation, fluid management, and nutrition until infants can maintain homeostasis independently. Surgery for conditions like gastroschisis requires optimizing all body systems before, during and after the operation.
Neonatal resuscitation is intervention provided to newborn babies who need help breathing or with circulation after birth. It involves clearing and drying the airway, maintaining body temperature, initiating breathing through tactile stimulation or positive pressure ventilation, and administering chest compressions and medications if needed to support circulation. Proper preparation includes anticipating need, having adequate equipment like a resuscitation table, masks, oxygen, and medications, and ensuring trained personnel are present. Ongoing assessment of breathing, heart rate, and color determine if further resuscitation measures are required.
This document summarizes guidelines from the 7th edition of the Neonatal Resuscitation Program published in 2015. It discusses the incidence of newborns requiring resuscitation, anticipation of resuscitation needs, changes to the NRP flow diagram, levels of evidence for recommendations, and specifics of resuscitation steps including ventilation, chest compressions, and use of medications. Key points include anticipating resuscitation needs based on risk factors, initiating PPV within 60 seconds if needed, using appropriate pressures and oxygen levels during PPV, and administering epinephrine IV if the heart rate is less than 60/minute despite adequate ventilation and chest compressions.
The document summarizes new additions and guidelines in neonatal resuscitation based on recent evidence. Key points include: recommending delayed cord clamping for term and preterm infants; maintaining normothermia between 36.5-37.5°C; using low oxygen (21-30%) for resuscitating preterm infants under 35 weeks; considering CPAP initially over intubation for respiratory distress in preterm infants; and structuring educational programs to teach resuscitation every 6 months for better performance and confidence.
Neonatal resuscitation is a set of interventions to assist newborns after birth with breathing, heart rate and circulation issues. The Neonatal Resuscitation Program provides guidelines for proper resuscitation procedures. The document outlines assessment steps, interventions for inadequate breathing or heart rate like positive pressure ventilation, intubation and chest compressions. It recommends use of pulse oximetry and targeting specific oxygen saturation ranges. Procedures are tailored based on gestational age and other risk factors. The latest guidelines emphasize thermoregulation and update certain practices based on recent evidence.
This document provides an overview of neonatal resuscitation, covering topics such as factors that increase resuscitation risk, initial resuscitation steps, positive pressure ventilation methods, endotracheal intubation, and post-resuscitation care. Approximately 10% of newborns require some life support, rising to 80% for infants under 1500 grams. Proper preparation, warming, positioning, stimulation and evaluation of respirations and heart rate are the initial steps of resuscitation if needed. Positive pressure ventilation, endotracheal intubation or medications may be required if the infant remains in distress. Ongoing observation and intensive care is provided as needed after resuscitation.
1. Newborn resuscitation is critical to prevent the 4 million newborn deaths that occur annually, nearly all due to preventable conditions like prematurity, infection, and perinatal hypoxia.
2. Proper newborn resuscitation follows the ABCs - clear the airway, establish breathing, and maintain circulation. It requires anticipating need at every birth and having equipment ready like a self-inflating bag, masks, and suction device.
3. Steps include drying, positioning, suctioning if needed, and tactile stimulation followed by ventilation if not breathing. If the heart rate is slow, initiate chest compressions and provide medications like epinephrine if needed. Maintaining
Neonatal intensive care nurses provide care for premature and sick newborns. An associate's or bachelor's degree in nursing is required along with certification from passing a national exam. These nurses can work in Level II-IV neonatal intensive units that care for babies with different needs. They may become specialists in areas like development. Ethical issues around access to care, costs, and outcomes must be considered. National organizations like AWHONN support neonatal nurses through advocacy, education and setting standards of practice.
Neonatal resuscitation involves assessing newborns at birth and providing interventions to babies having difficulty transitioning from intrauterine to extrauterine life. About 10% of newborns require some assistance to begin breathing, while less than 1% require extensive resuscitation including ventilation, chest compressions, or medications. The Apgar score is used to evaluate neonatal well-being at 1 and 5 minutes after birth. Babies requiring resuscitation are initially stabilized, including warming, positioning, and clearing airways. Oxygen supplementation and positive pressure ventilation may then be provided if needed based on heart rate and respiration assessment.
Presentation on NRP (Neonatal Resuscitation Program)Moninder Kaur
Approximately 10% of newborns require some assistance breathing at birth, while less than 1% require extensive resuscitation. The American Heart Association and American Academy of Pediatrics have updated neonatal resuscitation guidelines. Proper equipment, positioning, suctioning, stimulation, ventilation, chest compressions, and medications may be required to resuscitate non-vigorous or depressed newborns. Ongoing assessment of respiration, heart rate, and color determine if further intervention is needed.
This document provides guidance on newborn resuscitation and care. It discusses assessing babies at birth and performing resuscitation if needed using proper equipment. It emphasizes the importance of adequate ventilation over additional oxygen. It also covers keeping babies warm through skin-to-skin contact and kangaroo mother care to promote breastfeeding and prevent infections. The document stresses exclusive breastfeeding for six months and feeding on demand.
The document provides guidelines for newborn resuscitation from the 2015 AHA. It outlines the initial steps of providing warmth, clearing the airway if needed, drying and stimulating the baby. Positive pressure ventilation and chest compressions may be required if the heart rate is less than 100 or 60 beats per minute respectively. Medications like epinephrine may be used if the heart rate does not improve with ventilation and compressions. Post resuscitation care involves glucose administration and therapeutic hypothermia for babies with hypoxic-ischemic encephalopathy.
This document provides information on assessing and managing distressed newborns in the pre-hospital setting. It discusses the normal transition from fetal to neonatal circulation, potential complications including congenital heart defects and respiratory distress, and the steps of the neonatal resuscitation protocol. Specific situations such as meconium aspiration, hypothermia, hypoglycemia, seizures and diarrhea are reviewed. Paramedics are instructed to focus on establishing an airway, preventing heat loss, and following the inverted pyramid approach of tactile stimulation, oxygen, ventilation, chest compressions and medications as needed to support the newborn's transition to extrauterine life.
Pediatrics notes about "Neonatal Resuscitation". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
Neonatal intensive care has evolved significantly since the 1900s due to advances in technology, care protocols, and therapeutics. Preterm birth remains a major challenge, with preemies facing immature organ systems and higher risks of complications like sepsis, respiratory distress, brain injuries, and more. The first hour after preterm birth less than 32 weeks is critical, and protocols aim to stabilize infants during this "golden hour." Despite gains, prematurity continues to cause mortality and morbidity. New technologies and the question of how to care for the smallest infants pose ongoing challenges for neonatal intensive care.
Neonatal resuscitation involves a series of actions to assist newborns having difficulty transitioning from the womb to outside world. It has evolved over time from techniques like chest compressions to modern practices like providing positive pressure ventilation and supplemental oxygen. International guidelines developed by ILCOR provide evidence-based recommendations for newborn resuscitation. These guidelines are updated every 5 years based on the latest research findings. The goal of newborn resuscitation is to quickly establish breathing and a heart rate above 60 beats per minute through airway management, ventilation, chest compressions and medications if needed. Hypothermia prevention and treatment of hypoglycemia are also important aspects of newborn care after resuscitation.
This document discusses various ethical issues that arise in neonatal intensive care units. It begins by stating that the goal of NICU care should be survival with an acceptable quality of life, not just survival alone. It then discusses challenges around determining when not to initiate or continue intensive care for extremely premature newborns or those with severe conditions. The document also addresses ensuring parental autonomy while balancing medical facts, distributing limited resources fairly, and minimizing patient pain and suffering. Throughout, it emphasizes the importance of open communication with parents and shared decision-making.
this is some innovation in field of neonatal care in developing world. i invite all my pediatrician friends to add on their innovation slides to this show..
Neonatal resuscitation is a series of actions to assist newborn babies having difficulty transitioning from intrauterine to extrauterine life. Approximately 10% of newborns require some assistance to begin breathing, while less than 1% require extensive resuscitation. The main goals are to initiate breathing, maintain adequate perfusion and cardiac output, and restore normal temperature. Essential equipment includes suction, bag and mask ventilation, intubation equipment and medications. The ABCs of neonatal resuscitation are maintenance of temperature, establishment of an open airway, initiation of breathing, and maintenance of circulation.
The document summarizes a hospital's venous thromboembolism (VTE) prophylaxis program over 7 years. It shows that the program reduced hospital-acquired deep vein thrombosis and pulmonary embolism by over two-thirds, saving over $6 million in costs. Moving forward, the hospital aims to further improve prophylaxis practices by focusing on areas like daily ambulation and administering prophylaxis in the emergency department and throughout a patient's care. The goal is continuous quality improvement to help more patients and potentially achieve outcomes like preventing all hospital-acquired infections.
The Department of Health in the Philippines launched a new birth protocol called "Unang Yakap" or "First Embrace" to reduce newborn mortality and help achieve the country's goal of reducing childhood mortality by two-thirds. The protocol stresses immediate drying of newborns, delayed cord clamping, skin-to-skin contact with mothers, and early initiation of breastfeeding within 90 minutes of birth. It was developed in collaboration with the World Health Organization and will be part of normal delivery packages covered by Philippine health insurance to speed up its implementation nationwide.
This document discusses guidelines for immediate newborn care procedures. It outlines that many newborn deaths occur within the first 24 hours of birth, but many lives could be saved through simple interventions. It then describes the Apgar scale used to assess a newborn's health at 1 and 5 minutes after birth. Key immediate newborn care procedures that are described include drying the baby, applying identification bands, promoting skin-to-skin contact and breastfeeding, assessing vital signs regularly in the first hour, and performing a full examination. The goals of immediate newborn care are also stated.
Neonatal intensive care involves specialized care for ill or premature newborns. Conditions requiring intensive care include prematurity, low birthweight, and medical issues. Intensive care aims to stabilize infants and address physiological immaturities in organ systems like respiratory, cardiovascular, and gastrointestinal systems. Intensive care involves continuous monitoring, respiratory support like CPAP or ventilation, thermoregulation, fluid management, and nutrition until infants can maintain homeostasis independently. Surgery for conditions like gastroschisis requires optimizing all body systems before, during and after the operation.
Neonatal resuscitation is intervention provided to newborn babies who need help breathing or with circulation after birth. It involves clearing and drying the airway, maintaining body temperature, initiating breathing through tactile stimulation or positive pressure ventilation, and administering chest compressions and medications if needed to support circulation. Proper preparation includes anticipating need, having adequate equipment like a resuscitation table, masks, oxygen, and medications, and ensuring trained personnel are present. Ongoing assessment of breathing, heart rate, and color determine if further resuscitation measures are required.
This document summarizes guidelines from the 7th edition of the Neonatal Resuscitation Program published in 2015. It discusses the incidence of newborns requiring resuscitation, anticipation of resuscitation needs, changes to the NRP flow diagram, levels of evidence for recommendations, and specifics of resuscitation steps including ventilation, chest compressions, and use of medications. Key points include anticipating resuscitation needs based on risk factors, initiating PPV within 60 seconds if needed, using appropriate pressures and oxygen levels during PPV, and administering epinephrine IV if the heart rate is less than 60/minute despite adequate ventilation and chest compressions.
The document summarizes new additions and guidelines in neonatal resuscitation based on recent evidence. Key points include: recommending delayed cord clamping for term and preterm infants; maintaining normothermia between 36.5-37.5°C; using low oxygen (21-30%) for resuscitating preterm infants under 35 weeks; considering CPAP initially over intubation for respiratory distress in preterm infants; and structuring educational programs to teach resuscitation every 6 months for better performance and confidence.
Neonatal resuscitation is a set of interventions to assist newborns after birth with breathing, heart rate and circulation issues. The Neonatal Resuscitation Program provides guidelines for proper resuscitation procedures. The document outlines assessment steps, interventions for inadequate breathing or heart rate like positive pressure ventilation, intubation and chest compressions. It recommends use of pulse oximetry and targeting specific oxygen saturation ranges. Procedures are tailored based on gestational age and other risk factors. The latest guidelines emphasize thermoregulation and update certain practices based on recent evidence.
This document provides an overview of neonatal resuscitation, covering topics such as factors that increase resuscitation risk, initial resuscitation steps, positive pressure ventilation methods, endotracheal intubation, and post-resuscitation care. Approximately 10% of newborns require some life support, rising to 80% for infants under 1500 grams. Proper preparation, warming, positioning, stimulation and evaluation of respirations and heart rate are the initial steps of resuscitation if needed. Positive pressure ventilation, endotracheal intubation or medications may be required if the infant remains in distress. Ongoing observation and intensive care is provided as needed after resuscitation.
1. Newborn resuscitation is critical to prevent the 4 million newborn deaths that occur annually, nearly all due to preventable conditions like prematurity, infection, and perinatal hypoxia.
2. Proper newborn resuscitation follows the ABCs - clear the airway, establish breathing, and maintain circulation. It requires anticipating need at every birth and having equipment ready like a self-inflating bag, masks, and suction device.
3. Steps include drying, positioning, suctioning if needed, and tactile stimulation followed by ventilation if not breathing. If the heart rate is slow, initiate chest compressions and provide medications like epinephrine if needed. Maintaining
Neonatal intensive care nurses provide care for premature and sick newborns. An associate's or bachelor's degree in nursing is required along with certification from passing a national exam. These nurses can work in Level II-IV neonatal intensive units that care for babies with different needs. They may become specialists in areas like development. Ethical issues around access to care, costs, and outcomes must be considered. National organizations like AWHONN support neonatal nurses through advocacy, education and setting standards of practice.
Neonatal resuscitation involves assessing newborns at birth and providing interventions to babies having difficulty transitioning from intrauterine to extrauterine life. About 10% of newborns require some assistance to begin breathing, while less than 1% require extensive resuscitation including ventilation, chest compressions, or medications. The Apgar score is used to evaluate neonatal well-being at 1 and 5 minutes after birth. Babies requiring resuscitation are initially stabilized, including warming, positioning, and clearing airways. Oxygen supplementation and positive pressure ventilation may then be provided if needed based on heart rate and respiration assessment.
Presentation on NRP (Neonatal Resuscitation Program)Moninder Kaur
Approximately 10% of newborns require some assistance breathing at birth, while less than 1% require extensive resuscitation. The American Heart Association and American Academy of Pediatrics have updated neonatal resuscitation guidelines. Proper equipment, positioning, suctioning, stimulation, ventilation, chest compressions, and medications may be required to resuscitate non-vigorous or depressed newborns. Ongoing assessment of respiration, heart rate, and color determine if further intervention is needed.
This document provides guidance on newborn resuscitation and care. It discusses assessing babies at birth and performing resuscitation if needed using proper equipment. It emphasizes the importance of adequate ventilation over additional oxygen. It also covers keeping babies warm through skin-to-skin contact and kangaroo mother care to promote breastfeeding and prevent infections. The document stresses exclusive breastfeeding for six months and feeding on demand.
The document provides guidelines for newborn resuscitation from the 2015 AHA. It outlines the initial steps of providing warmth, clearing the airway if needed, drying and stimulating the baby. Positive pressure ventilation and chest compressions may be required if the heart rate is less than 100 or 60 beats per minute respectively. Medications like epinephrine may be used if the heart rate does not improve with ventilation and compressions. Post resuscitation care involves glucose administration and therapeutic hypothermia for babies with hypoxic-ischemic encephalopathy.
This document provides information on assessing and managing distressed newborns in the pre-hospital setting. It discusses the normal transition from fetal to neonatal circulation, potential complications including congenital heart defects and respiratory distress, and the steps of the neonatal resuscitation protocol. Specific situations such as meconium aspiration, hypothermia, hypoglycemia, seizures and diarrhea are reviewed. Paramedics are instructed to focus on establishing an airway, preventing heat loss, and following the inverted pyramid approach of tactile stimulation, oxygen, ventilation, chest compressions and medications as needed to support the newborn's transition to extrauterine life.
Pediatrics notes about "Neonatal Resuscitation". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
Neonatal intensive care has evolved significantly since the 1900s due to advances in technology, care protocols, and therapeutics. Preterm birth remains a major challenge, with preemies facing immature organ systems and higher risks of complications like sepsis, respiratory distress, brain injuries, and more. The first hour after preterm birth less than 32 weeks is critical, and protocols aim to stabilize infants during this "golden hour." Despite gains, prematurity continues to cause mortality and morbidity. New technologies and the question of how to care for the smallest infants pose ongoing challenges for neonatal intensive care.
Neonatal resuscitation involves a series of actions to assist newborns having difficulty transitioning from the womb to outside world. It has evolved over time from techniques like chest compressions to modern practices like providing positive pressure ventilation and supplemental oxygen. International guidelines developed by ILCOR provide evidence-based recommendations for newborn resuscitation. These guidelines are updated every 5 years based on the latest research findings. The goal of newborn resuscitation is to quickly establish breathing and a heart rate above 60 beats per minute through airway management, ventilation, chest compressions and medications if needed. Hypothermia prevention and treatment of hypoglycemia are also important aspects of newborn care after resuscitation.
This document discusses various ethical issues that arise in neonatal intensive care units. It begins by stating that the goal of NICU care should be survival with an acceptable quality of life, not just survival alone. It then discusses challenges around determining when not to initiate or continue intensive care for extremely premature newborns or those with severe conditions. The document also addresses ensuring parental autonomy while balancing medical facts, distributing limited resources fairly, and minimizing patient pain and suffering. Throughout, it emphasizes the importance of open communication with parents and shared decision-making.
this is some innovation in field of neonatal care in developing world. i invite all my pediatrician friends to add on their innovation slides to this show..
This document provides an overview of newborn resuscitation for EMS personnel. It discusses the physiology of transition from fetal to newborn life, initial care of the newborn including maintaining airway and temperature control, and assessment of respiration, heart rate and color. It describes providing positive pressure ventilation and chest compressions if needed. Medications like epinephrine may be administered through the umbilical vein. Specific conditions that could require resuscitation are reviewed. The key is providing minimal intervention as most newborns will respond to ventilation and warming, with chest compressions and epinephrine rarely needed.
This document provides information about a normal newborn, including circulatory changes at birth, lung changes, carbohydrate metabolism, temperature regulation, and essential newborn care. It discusses assessment of gestational age, physical examination of the newborn, and neonatal immunization in Singapore. The key points are circulatory adaptation to extrauterine life, lung fluid reabsorption, temperature regulation, glucose level changes, screening for malformations, danger signs, and the neonatal immunization schedule in Singapore.
This document provides information about newborn care, infections, and diseases. It discusses common newborn infections like group B streptococcal disease and listeriosis. It also covers signs of infection like fever, meningitis, and sepsis. Additionally, it mentions congenital infections babies can be born with like rubella, toxoplasmosis, and cytomegalovirus. The document emphasizes the importance of prenatal care and visiting a health facility if a newborn appears troubled to help prevent and treat infections early.
The document discusses the evolution of reproductive, maternal, newborn, child and adolescent health (RMNCH+A) programs in India from the 1950s to present. It outlines the key historical programs and approaches, including the shift from a family planning focus to a more integrated reproductive health approach. The current RMNCH+A strategy aims to reduce maternal and child mortality by emphasizing continuum of care across the lifecycle through high impact interventions at various levels of the health system.
This document provides information on essential newborn care including maintaining temperature, establishing breathing, vitamin K injection, breastfeeding initiation and daily routine care like warmth, feeding, bathing and observation. It discusses Apgar scoring and harmful traditional practices. Key aspects of care include cleanliness, warmth, breastfeeding and monitoring of vital signs and growth. Nursing diagnoses related to airway, thermoregulation and infection risk are also mentioned.
The document discusses care of the newborn in the first 24 hours of life and in the nursery. It covers immediate care including establishing airway and breathing, maintaining temperature, and APGAR scoring. It also discusses components of newborn care like identification, bathing, measurements, eye prophylaxis, vitamin K administration, and assessments.
Save the Children is focused on reducing newborn mortality globally. It has three main goals:
1. Getting newborn health on global and national agendas through research showing the major causes of newborn deaths and effective interventions.
2. Supporting country programs that have led to important declines in newborn mortality rates in places like Bangladesh, Bolivia, and Tanzania.
3. Continuing to scale up high-impact newborn interventions through health systems, strengthen implementation, and institutionalize newborn survival within countries and organizations.
Community-based newborn health packages that include pregnancy surveillance, antenatal counseling, delivery care by trained birth attendants, and postnatal home visits have been shown to significantly reduce newborn mortality rates by up to 62% in studies in South Asia. Specific high-impact interventions for newborns that are effective and feasible in low-resource settings include neonatal resuscitation, Kangaroo Mother Care for low birth weight babies, chlorhexidine cord cleansing, and community management of neonatal sepsis and infections. Further research is still needed to determine how to most effectively deliver and implement newborn intervention packages at large scale.
Newborn survival and perinatal health in resource-constrained settings in Asia and the Pacific: Applying Global Evidence to Priorities Beyond 2015
12 April 2013
This document provides a summary of the under five children's health situation in Bangladesh. It discusses the leading causes of under five mortality, including preterm birth, pneumonia, and diarrhea. It also reviews vaccination rates, treatment of common childhood illnesses, breastfeeding practices, vitamin A supplementation, and childhood nutrition status. Several ongoing government and non-government programs aimed at improving child health in Bangladesh are also outlined, including the National Nutrition Services and Expanded Programme on Immunization. The document concludes by noting that Bangladesh has made progress in reducing under-five mortality but more efforts are still needed.
Preterm Birth Interventions_James Litch_10.16.13CORE Group
Prevention of Preterm Birth and Complications outlines key definitions, numbers, and interventions related to preterm birth. It begins with defining preterm birth as babies born alive before 37 completed weeks of pregnancy. It then presents a strategic three-phase approach and discusses how preterm birth is connected to other maternal and child health outcomes. The document reviews evidenced-based interventions to manage preterm birth like antenatal corticosteroids and antibiotics for premature prelabor rupture of membranes. It also discusses interventions for caring for preterm newborns and ways to prevent preterm birth like birth spacing and treating infectious diseases.
This study examined newborn care practices in rural Nepal and factors associated with those practices. The study surveyed 296 mothers 4 months postpartum about cord care, breastfeeding, and thermal care of their newborns. The study found that only 25.7% practiced clean cord care while 51.35% initiated breastfeeding within 1 hour and 58.45% delayed bathing babies beyond 24 hours. Most deliveries (53.38%) occurred at home without assistance from skilled birth attendants. The study concluded that community interventions are needed to improve newborn care practices and reduce risks like unsafe cord care and early bathing.
This document provides background information on a proposed research study examining determinants of antenatal corticosteroid utilization among preterm births in Addis Ababa, Ethiopia. It discusses high preterm birth rates globally and in Ethiopia, complications of preterm birth like respiratory distress syndrome, and the recommendation and benefits of antenatal corticosteroid administration. While corticosteroid use is recommended, coverage remains low in low-and middle-income countries. The study aims to assess corticosteroid utilization and associated factors in Addis Ababa hospitals over 4 months in 2016. A literature review found mixed results on corticosteroid trials in developing nations and a range of utilization rates reported in other studies from the
This document discusses strategies to prevent kernicterus, a type of brain damage caused by severe neonatal jaundice. It identifies several key areas for improvement, including better lactation support, follow-up within 48 hours of discharge, and parent education. A systems-approach is recommended to optimize newborn jaundice management through improved identification of at-risk newborns, characterization of jaundice levels, and community surveillance to achieve safety standards and prevent future cases of kernicterus.
This document discusses normal versus abnormal modes of delivery, specifically focusing on cesarean section rates. It provides statistics on global and Lebanese cesarean section rates, noting that Lebanese rates have risen dramatically in recent decades to over 40% currently. The document explores various factors contributing to increasing cesarean rates, such as financial incentives, malpractice concerns, and lack of labor preparation. It also reviews potential adverse effects of cesarean section on infant health outcomes like respiratory issues, microbiome disturbance, and increased risk of obesity and metabolic disorders. Solutions proposed to reduce unnecessary cesarean sections include implementing national guidelines, improving prenatal education, and promoting vaginal birth after cesarean.
Care Seeking for Newborn Illness a Changing Paradigm_Steve Wall_4.25.13CORE Group
The document discusses evidence from community health worker programs in multiple countries that care seeking for newborn illness from qualified providers outside the home is higher than originally assumed, as cultural taboos can be overcome through community education. It also examines the roles of community health workers in improving newborn care practices through home visits and facilitating care seeking, finding that while practices and care seeking increased, timely care seeking could still be improved. Overall, the key lessons highlighted are that demand for care can be generated through community programs, but treatment also needs to be accessible, and strengthening monitoring and follow up of referrals is important.
The document discusses common bacterial infections in children. The most common bacterial infections in babies are skin, ear, and throat infections, while the most common viral infections are respiratory infections such as RSV. Over 44% of child deaths under age 5 occur during the neonatal period, with approximately 2.6 million neonatal deaths worldwide in 2015. Bacterial infections and sepsis are major causes of neonatal mortality. Prevention strategies discussed include immunization of mothers and children, breastfeeding, hygiene practices like chlorhexidine cord care, and education of health professionals in neonatal resuscitation. Prudent antibiotic use and stewardship programs are important to prevent antibiotic resistance.
Bacterial meningitis in infants under 90 days old remains a significant burden in the UK and Ireland, with approximately 250 cases reported annually. While mortality has decreased over time to around 12%, long-term neurological complications and disabilities persist in around 20-25% of survivors. Effective diagnosis relies on lumbar puncture since clinical signs are non-specific, but many infants do not receive timely lumbar punctures. There is a lack of evidence regarding optimal antibiotic treatment duration and adjunctive therapies. Two ongoing studies aim to better define the current disease burden and identify opportunities to improve outcomes through earlier recognition, management, and prevention.
This document summarizes challenges and opportunities in diagnosing and managing pneumonia in high-resource settings. It discusses how pneumonia is a common and costly condition in the US, with obstacles to identifying the pathogen. It also reviews chest imaging recommendations and severity scoring systems. Guidelines for outpatient and inpatient antibiotic treatment of pneumonia are presented. The document concludes by discussing quality improvement efforts to increase appropriate first-line antibiotic prescribing both in hospitals and communities.
Dr. Laxmi Shrikhande is a renowned fertility specialist in India. She has held many leadership positions in national obstetrics and gynecology organizations. Her credentials include being medical director of a fertility clinic, publishing numerous papers, delivering lectures, and conducting health programs for women. She has received several awards for her contributions to women's health.
The document discusses newborn screening (NBS), which tests newborns for certain disorders and conditions that can compromise development if undetected. While NBS successfully lowers infant mortality, it has not addressed the increase in disabilities. The document advocates beginning NBS programs in India to detect conditions like congenital hypothyroidism and prevent associated morbidities and financial burdens. NBS programs require epidemiological data, ethical and economical consideration, and availability of screening tests, treatment, and intervention timelines. The document encourages starting regional NBS centers in India to prevent childhood disabilities and mortality from treatable metabolic diseases.
This document discusses progress towards Millennium Development Goal 4 (MDG4) of reducing child mortality. While overall progress has been made, neonatal mortality rates have declined more slowly. Simple, low-cost interventions like kangaroo mother care, neonatal resuscitation, and breastfeeding can significantly reduce neonatal deaths. However, implementation faces barriers like lack of healthcare workers, cultural practices, financial barriers to care, and poor quality of services. Political will is needed to fully achieve MDG4 targets through strengthened health systems and addressing inequities between regions.
- LiST (Lives Saved Tool) is a mathematical model that estimates the impact of scaling up maternal, newborn and child health interventions in low-income countries.
- It uses country-specific health and demographic data as well as evidence-based effectiveness estimates for 68 interventions to predict changes in mortality rates.
- LiST has been used globally and in several countries for strategic planning, evaluating the impact of interventions, and estimating lives saved by health programs.
Lives Saved Analyses for Child Survival Projects: Using LiST to Estimate the ...jehill3
Lives Saved Analyses for Child Survival Projects: Using LiST to Estimate the Impact of Maternal, Newborn and Child Health Interventions
Debra Prosnitz, MPH; Rebecca Levine, MPH; James Ricca MD, MPH; and Ingrid Friberg, PhD
Core Group Spring Meeting Pre-Session, Monday April 26, 2010
The document summarizes the key aspects of the Indian Newborn Action Plan (INAP). It was launched in 2012 to accelerate the reduction of preventable newborn deaths and stillbirths in India by 2030. The goals are to achieve single digit neonatal and stillbirth rates by 2030. It discusses the current trends showing geographical and rural-urban differences. The major causes of neonatal deaths are also provided. The document then describes the 6 strategic intervention packages of INAP covering preconception to postnatal newborn care. It highlights targets and principles of integration, equity and quality. Monitoring and evaluation are important components to track progress of the plan.
Similar to What's New for Newborns_Claudia Morrissey & Allyison Moran_10.14.11 (20)
Presentation_Behar - Private Public Partnerships and CKDuCORE Group
The document summarizes statistics and information about the sugarcane agribusiness in Mexico, including:
- It produced over 6 million tons of sugar in 2017/2018 and generated nearly 500,000 direct jobs.
- It has a complex supply chain involving sugarcane suppliers, mills, transportation, and the food industry.
- It has a legal framework including laws governing sustainable development of sugarcane and labor relations in mills.
- The government has a National Sugarcane Agribusiness Program to increase productivity and competitiveness.
Presentation_World Vision - Private Public Partnerships and CKDuCORE Group
The Fields of Hope project by World Vision Mexico seeks to prevent and reduce child labor in the sugarcane and coffee sectors in the states of Veracruz and Oaxaca. It aims to benefit 1,520 children at risk of or engaged in child labor across 24 communities and 4 municipalities. The project takes an integral approach through advocacy, collaboration with the private sector, and sensitizing communities and workers, while also promoting access to education.
Presentation_Wesseling - Private Public Partnerships and CKDuCORE Group
This document discusses the epidemic of chronic kidney disease of unknown etiology (CKDu) affecting agricultural workers along the Pacific coast of Central America. It provides evidence that the disease has an occupational etiology related to heat stress and dehydration experienced by sugarcane and other field workers. Studies show physiological changes in workers consistent with heat stress and dehydration across work shifts. Longitudinal studies find declines in kidney function over harvest seasons among heat-exposed occupations. Intervention studies reducing heat stress through water, rest, and shade have shown reduced declines in kidney function. While some non-occupational factors may also contribute, the evidence strongly suggests that prolonged occupational heat stress is a primary driver of the CKDu epidemic.
Presentation_NCDs - Private Public Partnerships and CKDuCORE Group
Non-communicable diseases like cardiovascular disease, cancer, chronic respiratory disease, and diabetes are leading causes of death and disability globally but receive little focus from global health initiatives. While communicable diseases have declined in recent decades, deaths from non-communicable diseases have increased and pose growing health and economic challenges as treatments remain limited. Experts call for greater prioritization and resources for non-communicable diseases on the global health agenda.
Presentation_HRH2030 - Opportunities to optimize and integrate CHWCORE Group
This document summarizes a conference session on integrating and optimizing community health workers (CHWs) in health systems from global and local perspectives. The session included a fishbowl-style debate where attendees were invited to discuss questions about implementing the WHO CHW Guideline recommendations, important partnerships for training CHWs, priorities for managing and supporting newly recognized CHWs, considerations for optimizing the role of CHWs, and innovations needed to shape and sustain CHWs' roles by 2030.
Presentation_Save the Children - Building Partnerships to Provide Nurturing CareCORE Group
This document discusses the experiences of a mother giving birth to a preemie baby named Becky at 30 weeks gestation. Some key points include:
- Becky spent time in the NICU and the mother felt her discharge was rushed, leaving her unprepared to deal with feeding and breathing issues at home.
- Becky faced various developmental issues over time, including low muscle tone, sensory processing disorder, autism, ADHD, and scoliosis.
- The mother advocates for increased support for preemie babies and their families, including more parent education, counseling, early intervention services, and IEP supports over time.
Presentation_Video - Building Partnerships to provide nurturing careCORE Group
This 4 minute video provides an overview of the key events in the history of the United States from 1492 to the early 2000s. It touches on major milestones like the founding of colonies, the American Revolution, westward expansion, the Civil War, industrialization, both World Wars, the Cold War, and events of the early 21st century. The video presents a high-level chronological summary of major political, economic and social developments that shaped America over the past 500+ years.
Presentation_Perez - Building Partnerships to provide nurturing careCORE Group
This document provides information on empowering health workers and caregivers to deliver therapeutic early childhood development care at home. It discusses how 90% of brain development occurs before age 5 and the importance of nurturing care for young children. The document outlines capacity development for parents and caregivers, including guidance on conducting activities that integrate motor, social-emotional, and therapeutic skills into daily routines. It also stresses the importance of addressing caregiver stress and depression through psychosocial support groups to promote child development.
Presentation_Robb-McCord - Building Partnerships to provide nurturing careCORE Group
The document summarizes key points from a CORE Group meeting on nurturing care for preterm newborns. It discusses how nurturing care involves providing a stable, sensitive environment that meets children's health needs from birth to 3 years. The evidence review examines interventions like skin-to-skin contact, breastfeeding, managing pain and stress, sleep protection and stimulation. Country case studies from both high and low income nations are also being conducted to understand policies and guidelines supporting nurturing care concepts.
Presentation_Discussion - Norms Shifting InterventionsCORE Group
Participants in a small group discussed how to integrate norms-shifting interventions into current projects and programs. They considered what new partnerships would be needed when working to shift social norms and what evidence of the effectiveness of norms-shifting interventions should be collected, for whom, and how.
Presentation_Krieger - Norms Shifting InterventionsCORE Group
The document discusses the origins and theories of social norms. It notes that early theorists like Durkheim, Weber, and Ogburn contributed to understanding where norms come from and how they guide behavior. Parsons further explored how members of society are socialized to norms. Later, feminist anthropologists studied norms and social control, especially regarding gender. The document contrasts philosophical, psychological, and anthropological approaches to studying norms and culture. It argues that knowledge of cultural norms can help reduce unexpected outcomes in social science and shift narratives to achieve behavior change. The example of the Albania Family Planning Project shows how understanding local norms was key to successfully promoting contraceptive use.
Presentation_NSI - Norms Shifting InterventionsCORE Group
This document discusses the key attributes of norms-shifting interventions. It identifies several attributes that make an intervention effective at shifting social norms, including seeking community-level change, engaging people at multiple levels, correcting misperceptions around harmful behaviors, confronting power imbalances related to gender, creating safe spaces for critical reflection, rooting the issue within community values, accurately assessing norms, using organized diffusion, and creating positive new norms. The document provides examples and explanations for each of these attributes.
Presentation_Igras - Norms Shifting InterventionsCORE Group
This document discusses using theory to inform the work of a learning collaborative (LC) on norms-shifting interventions for adolescent reproductive health. It outlines several relevant theories, including social norm and behavior change theory and communication and behavior change theories. It also discusses the value of "bottom-up" program change theory developed from implementation experience. The LC aims to facilitate collaboration between organizations, build knowledge, and develop shared tools to guide effective social norm measurement and practice at scale. By working collaboratively, the LC can take a more experimental approach in this nascent field while still being informed by relevant theories.
Presentation_Petraglia - Norms Shifting InterventionsCORE Group
This document discusses a constructivist perspective on norms and normative change. Some key points of constructivism are that knowledge is constructed through social interaction and prior experiences, and meaning is negotiated through language. Constructivism acknowledges that individuals belong to multiple reference groups and can choose which norms to follow in a given situation. Normative change interventions cannot directly manage or control norms, but may be able to influence them by facilitating dialogue, clarifying language, and encouraging ethical persuasion rather than direct attribution. Norms and beliefs are also difficult to accurately measure.
Presentation_Sprinkel - Norms Shifting InterventionsCORE Group
This presentation provides an overview of CARE's Tipping Point initiative which aims to address child, early and forced marriage in Nepal and Bangladesh through community programming and evidence generation. In Phase 1 from 2013-2017, the project worked with adolescents, parents and leaders in 16 districts across the two countries. Norms influencing child marriage include excluding girls' voices, controlling girls' sexuality, and perceptions of risks/benefits of marriage timing. Phase 2 implements a randomized control trial to generate evidence on effective gender transformative programming and the value of social norms approaches. Challenges included discussing sexuality while successes included girls gaining greater freedom and mobility.
Presentation_Tura - Norms Shifting InterventionsCORE Group
This document discusses the Care Group approach used in an intervention in Nepal from 2005-2010. It aimed to shift social norms around maternal and child health issues through community groups. Formative research identified key norms and barriers. Community groups engaged women to reflect critically and root issues in community values. Evaluations found sustained impact on behaviors like breastfeeding years later. Challenges included focusing directly on norm drivers and unrealistic community health worker workloads. Further research on accurate norm assessment and evidence-based norm-shifting is still needed.
Presentation_Sacher - Norms Shifting InterventionsCORE Group
This document summarizes Cristina Bicchieri's theory of social norms, which is grounded in philosophy, game theory, and psychology. The key aspects of the theory include conditional preferences that depend on social expectations, personal normative beliefs about what should be done, and expectations about what others in one's reference network do and think should be done. The implications for practice highlighted in the document include providing a theory of change, identifying the nature of norms to design appropriate interventions, and using data and illustrative vignettes to measure norms and guide social change programs.
Innovative Financing Mechanisms and Effective Management of Risk for Partners...CORE Group
The document summarizes the Utkrisht Development Impact Bond in India, which aims to improve quality of care in private maternity facilities. It discusses how impact bonds can mobilize private capital for development by lowering investment risk. The Utkrisht bond provides funds for accrediting 360-440 private facilities over 3 years. Facilities receive quality improvement support and investors are repaid based on the number of facilities accredited. Early lessons show facilities are motivated to improve if it grows their business and they receive support meeting standards. The bond also provides a framework for continuously improving the project and managing risks between partners.
Presentation_Multisectoral Partnerships and Innovations for Early Childhood D...CORE Group
This document summarizes a discussion on multi-sectoral partnerships and innovation for early childhood development. It was presented by several experts, including Dr. Maureen Black from RTI International, Dr. Joy Noel Baumgartner from Duke University, Mohammed Ali from Catholic Relief Services, Dr. Chessa Lutter from RTI International, and Dr. Erin Milner from USAID. The discussion covered topics like the importance of early childhood development, the Nurturing Care Framework, metrics and measures for childhood development, partnerships for early childhood programs, and challenges and next steps.
Presentation_Jurczynska - Catalyzing Investments in RMNCAH at the Community L...CORE Group
The document describes an evidence-based advocacy model called the Family Planning – Sustainable Development Goals (FP-SDGs) model. The model allows users to quantify the impacts of different family planning scenarios on 13 Sustainable Development Goal indicators out to 2030 or 2050. Users input baseline data and create three future scenarios capturing various levels of ambition for family planning and other socioeconomic factors. The model then projects population figures and calculates outcomes for the SDG indicators. Results can support advocacy efforts to increase funding and prioritization of family planning programs and policies. Examples of the model's use in Malawi, Tanzania, and West Africa demonstrate its ability to quantify potential development impacts of expanding access to voluntary family planning.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
5. Global progress to MDG 4 MDG 4 target (32) Ref: Lawn, Kerber et al BJOG 2009 updated with data for 2008 from UN Child Mortality Group, WHO//CHERG and IHME (Rajaratnam J eta l 2010) 3.1 million neonatal deaths, 41% of under 5 deaths Links closely with maternal health and MDG 5 USA NMR is 4
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9. WHERE? Neonatal & maternal deaths 2.4 million neonatal deaths Approx 67% of global total 340,000 maternal deaths Approx 65% of global total Ref: Lawn JE et al BJOG sept 2009. Data sources: Estimates of maternal (2005) and neonatal (2008) deaths from WHO. Updated June 2010 Countries with the highest numbers of neonatal deaths are similar to those with high maternal deaths Ranking for numbers of neonatal deaths Ranking for numbers of maternal deaths India 1 1 Nigeria 2 2 Pakistan 3 8 China 4 13 DR Congo 5 3 Ethiopia 6 5 Bangladesh 7 6 Indonesia 8 7 Afghanistan 9 4 Tanzania 10 9
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12. WHEN? The first days are critical Up to 50% of neonatal deaths occur in the first 24 hours Source: Lawn JE et al Lancet 2005, Based on analysis of 47 DHS datasets (1995-2003), 10,048 neonatal deaths) 75% of neonatal deaths occur in the first week
13. WHY? Causes of newborn deaths Three killers account for 81% of all neonatal deaths 3.1 million Source: CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010 UNICEF, State of the World's Children, 2011. Almost all deaths are due to preventable conditions
15. Intervention Packages Source: Lancet Neonatal Survival Series, 2005 Skilled obstetric and immediate newborn care including resuscitation Emergency obstetric care to manage complications such as obstructed labor and hemorrhage Antibiotics for preterm rupture of membranes # Corticosteroids for preterm labor # Emergency newborn care for illness, especially sepsis management and care of very low birth weight babies Clinical care Folic acid # Counseling and preparation for newborn care and breastfeeding, emergency preparedness Healthy home care including breastfeeding promotion, hygienic cord/skin care, thermal care, promoting demand for quality care Extra care of low birth weight babies Case management for pneumonia Family-community Clean home delivery Simple early newborn care 4-visit antenatal package including tetanus immunization, detection & management of syphilis, other infections, pre-eclampsia, etc Malaria intermittent presumptive therapy* Detection and treatment of bacteriuria # Outreach services Postnatal care to support healthy practices Early detection and referral of complications Infancy Neonatal period Pre- pregnancy Pregnancy Birth Antenatal 7-14% Reduction of NMR Intrapartum 19-34% Reduction of NMR Postnatal 10-27% Reduction of NMR
17. Generate New Evidence: SNL 1 The 36 research studies supported under SNL 1 built awareness that simple solutions for 3 killers could be feasibly delivered and have impact in low resource settings. Evidence for Joint Statement on PNC Home Visits Evidence for Joint Statement on PNC Home Visits Prevention + Management in India Prevention + Management in Bangladesh Prevention alone in India Prevention + Referral using Government model in Pakistan Ankur 2001-2005 Home-based newborn care (HBNC) replicated in 7 rural, urban and tribal districts 51% NMR Reduction Projahnmo 2001-2006 HBNC replicated in Sylhet district 34% NMR Reduction Shivgarh 2003-2006 HBNC with community mobilization and BCC only 54% NMR Reduction Hala 2003-2005 HBNC through existing CHW system (preventative care w/referral) 28% NMR Reduction in pilot areas
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19. SNL 2 Research Examples Outcomes Description Influence Infection Management RCT in Pakistan Postnatal Care Package OR in Bangladesh Integration of newborn care RCT in Uganda MNC & HIV Care RCT in South Africa Simplified Antibiotic Trial Testing if simplified antibiotic regimens are effective treatment for sepsis Treatment failure To modify global policy PNC Operations Research Testing existing cadres providing home visits to improve practices Coverage & Practices To inform MOH & partners how to deliver PNC in existing system and scale up UNEST Testing community-based package using volunteers linked to the health system Coverage & Practices To inform MOH how to scale up newborn care through health extension volunteers GOODSTART Testing govrn’t CHWs providing peer counseling at home to improve practices NMR, Coverage & Practices First study looking at integration of HIV/AIDS and ENC/PNC packages by CHWs and urban poor
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21. Source: Wall et al. Int J Gyn and Obstetr 2009; 107: s47-s64. Birth Asphyxia
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25. Cochrane Database of Systemic Reviews 2011, Conde-Agudelo A et al “ Compared with conventional neonatal care, KMC was found to reduce mortality at discharge.” KMC reduced severe infections, hypothermia, severe illness, and length of hospital stay KMC: What’s the evidence?
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31. Translating Research & Data for Action Regional Opportunities for Africa’s Newborns ASADI Science in Action LAC Alliance Global Countdown to 2015 CHERG LiST UN Jt. Statement National Situation Analysis (15) Data Profiles
51. Thank you! Visit the Healthy Newborn Network www.healthynewbornnetwork.org
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Editor's Notes
4.6 M in 1990 Mmratio declined 34%
Institute for Health Metrics and Evaluation Why? set the stage. At the end of the last century, 3 independent events occurred that converged to create a Perfect storm , if you will, for newborn survival.
Dec 1999, Abhay Bang published the results from the SEARCH project in Gadchiroli, India in the Lancet. There was a nearly 50% reduction in NMR when package of newborn preventive and curative care services, including management of newborn sepsis, was provide in the home by frontline workers. These finding ran counter to conventional wisdom that held that little could be done given to save newborns in low-resource settings: the investments needed to establish NICUs and to train sub-specialist staff were out of reach. I remember being at a meeting at Johns Hopkins in 1999 when Dr. Bang presented his preliminary findings. You could have heard a pin drop in that room. The second event in this perfect storm was
Commitments and pledges were made.
Save the Children developed a proposal based on new findings from SEARCH and in 2000 Saving Newborn Lives became the “flagship” project for addressing newborn mortality and morbidity in low-resource settings Celebratory moment yet sobering that there continue to be so many needless deaths.
Worldwide over 60 million births take place at home without the help of a skilled attendant. This can range from 94% in Ethiopia to less that 30% in Malawi where they have “outlawed” deliveries that are not attended by skilled practitioners (MDs, nurses, midwives).
Among the poorest and most vulnerable Coverage of life-saving interventions is highly inequitable Graph produced by Countdown 2015. On the left you will see a graph of coverage of 8 essential maternal newborn interventions by wealth quintile. The poorest quintile has only 20% coverage while the wealthiest has70% coverage. So…… If all…
Back in 2000, it was not clear how to impact on newborn survival. What inspired Save the Children and the Gates Foundation to try was the experience of Dr. Abhay Bang in Gadchiroli India where he reduced mortality among newborns by 61%. But there was still a tremendous need for understanding how he got the results he did. So a focus of SNL’s work has been to work with research partners to generate new evidence.
This is a busy slide based on data from the Lance Neonatal Survival Series, 2005 What it depicts is a breakdown of evidence-based interventions according to how they are delivered. The categories are clinical care, those that can be provided in outreach settings, and those that focus on actions by families and at the community level. Across the bottom we see the interventions positioned along a time line from pre-pregnancy to infancy. We can then create intervention packages along the timeline, divided into those delivered in the antenatal, intrapartum and postnatal periods, and ascribe the amount of reduction that can be achieved by the packages. What becomes clear, is that the most important times we can intervene to impact newborn deaths are the intrapartum and postnatal periods. So we now understand to reach MDG 4 we will have to focus more attention and resources on reducing newborn deaths. We know what these babies are dying from. We have data suggesting when to deliver key interventions. And we can then ask, How are we doing?
Preventive packages: To improve newborn practices and care seeking Behavior change communication Community mobilization/empowerment to improve newborn practices Preventive + management packages: Behavior change (home visits, community mobilization) Home-based assessment of newborn Home-based management of complications (eg, infection
A core component of SNL’s work has been to drive the generation of new evidence of what works to improve newborn survival. Overview of SNL 1 Research: Adapted and tested interventions and models in different settings Improved SOTA approaches to reduce mortality from 3 major killers
Building on learning from SNL1, SNL 2 generates evidence to leverage impact at scale by: Addressing the priority ‘what’ and ‘how’ questions of importance to national stakeholders (eg, MOH). Implementation research with partners involved in national scale up. Research to show how newborn health can be integrated with existing programs/systems already at scale or going to scale.
For some babies, special care is needed to address babies with complications: For BA, HBB: To increase quality and coverage of neonatal resuscitation at first-level facilities by front-line health workers The HBB curriculum was developed by the American Academy of Pediatrics and is currently be rolled out across the developing world. Any pediatricians here? Are you involved in the HBB roll-out? CCM of infection based on Dr. Bang’s work and on results from the Projahnmo project in Bangladesh funded through SNL showing significant reductions in newborn deaths from sepsis. And for preterm/ LBW infants, Kangaroo Mother Care
There is also now a new Cochrane Review from 2011 on facility-based KMC that suggests benefits from KMC
Previous Cochrane review from 2003 had not shown a significant mortality benefit. But numbers were small, studies had different outcomes, and the interventions started at different points. The review was updated 3/2011: Conde-Agudelo A, Belizán JM,Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD002771. DOI: 10.1002/14651858.CD002771.pub2 Compared with conventional neonatal care, KMC was found to reduce mortality at discharge or 40 - 41 weeks’ postmenstrual age and at latest follow up. Typical RR .60 Also reduced: severe infection/sepsis, nosocomial infection/sepsis, hypothermia, severe illness, lower respiratory tract disease, length of hospital stay. In addition, KMC increased: weight, head circumference, and length gains frequency and duration of breastfeeding mother satisfaction with method of infant care some measures of maternal-infant attachment Profound results for such a simple intervention.
MCHIP Ethiopia is conducting a study – also as shown in this poster, it is being implemented in Malawi
The evidence on impact of clean delivery practices was considered of low quality given that Randomized Controlled Trials are not possible—we can’t randomize some mothers to experience dirty deliveries; clearly would be unethical. 30 published studies show that clean birth practices reduce neonatal mortality & morbidity from infection‐related causes, including tetanus. In 3 studies (1 RCT), a reduction in maternal sepsis was found. Although evidence is weak, the GRADE recommendation for clean practices at birth is strong as this is an accepted standard. Evidence from 3 studies including 1 RCT supports the role of CBKs in promoting clean birth practices, although in all cases there were co‐interventions. None of the studies in either review reported any adverse effects from interventions including a CBK, however, none explicitly stated that they had looked for negative effects.
Because infections present themselves not on the day of birth that in the days after, and families don’t always recognize the baby as sick until the infectin is very severe and typically don’t seek care for illnesses in very young babies, a community-based intervention is needed. Typically management of infections is part of a series of home-based postnatal care visits. June 2011 – Journal of health Population and Nutrition.
Need to Highlight SNL’s Role in this process 2) Can mention Situation Analysis result examples: Launch Tz sit analysis – Dept of Planning there and sent template to all districts for financial planning to include KMC and resus that year – need for technical support to continue to move forward – included in district budgets Every Death counts in South Africa led to Lancet South Africa series – led to agenda for new MOH
While the knowledge of what works is increasing, it only matters if it is applied on a wide scale. Critical to that is knowing how widely these interventions are being implemented.
The goal is to reduce mortality This required changing behaviors and use of services at scale This requires as an intermediate measure ensuring that health systems have integrated effective newborn health interventions The boxes at the bottom are how we see our inputs into the process. The box on the right is the most critical. Etc. This framework guides SNL’s evaluation strategy
Agreement on measurement of PNC coverage and content, newborn behaviors/practices, and facility care – national level – DHS and MICS4 and SPA and optional DHS newborn module Agreement on indicators to include on newborn at sub-national levels – ongoing process – looking at SNL data as well as other partners Next meeting – Oct 17, 18 – Todd Nitkin is member of group -
At least two newborn danger signs – including:
Kidal region with 4 districts not yet reached I clarified some questions on the Mali training tracker tool and asked the team to separate out the communes of Bamako as districts as this was confusing us (the previous listed 53 districts yet the 6 communes of Bamako are included when we say 59 districts). In terms of interpreting the information, I have also received further clarity. UNICEF has provided the funding for training and equipment for essential newborn care which has led to 2,042 health providers trained in 83% (880/1059) of Mali’s health areas. Specifically Regional trainers trained in 8 out of 8 Regions District level staff trained in 49 out of 59 districts (83%) CSCom staff trained in 39 out of 59 districts nationally (8 regions) or 39 out of 44 districts (6 regions) originally targeted by SNL at the start of SNL2 (89%). (Note: to count the 39, I included on the districts where more than 10 people have been trained within a district because the smaller numbers from 1-4 are usually the district level trainers)
This slide shows the quantity of data were are currently collecting from our countries. Some of the results we expect to report on are coming from less rigorous research so we look forward in next year or so to perform a lot of analysis!