WHO has been made aware of multiple, recent reports of eye injury, including blindness, with the use of
chlorhexidine gluconate 7.1%, in nine countries in sub Saharan Africa.

Chlorhexidine gluconate (CHX), available as an aqueous solution or as a gel (delivering 4% chlorhexidine), is used in umbilical cord care, and is listed in the WHO Essential Medicines List. WHO recommends daily chlorhexidine (4%) application to the umbilical cord stump during the first week of life for newborns who are born at home in settings with high neonatal mortality (neonatal mortality rate>30 per 1000). Clean, dry cord care is recommended for newborns born in health facilities, and at home in low neonatal mortality settings. Use of chlorhexidine in these situations may be considered only to replace application of a harmful traditional substance such as cow dung to the cord stump. The use of CHX is being implemented in many countries (South Asia and sub-Saharan Africa) as part of a package of essential newborn interventions to reduce the incidence of omphalitis.

CHX causes serious harm if mistakenly applied to the eyes, resulting in severe eye injuries. Over forty
(40) cases of such incorrect administration are recorded, either as media reports, or in the literature,
since 2015. Injuries associated with both the liquid and gel (ointment) formulations have been reported
when CHX was mistaken for eye drops or ointments.
The present Alert is being issued to warn all stakeholders involved in the umbilical cord care
programmes about this potential misadministration and risk of serious injury with CHX. All healthcare
professionals, caregivers and others involved in its distribution, use and / or administration are advised
to take all necessary measures and precautions to ensure its correct use and administration.
Suggestions to National Neonatal and Reproductive Health Programmes and/or Regulators include the
following:
• Assess what products are part of the newborn package and select the optimal primary
container/dosage form for CHX or modify the design of the container to distinguish the product
from other medicines typically used for newborns.
• Update the product label with appropriate information on the safe use of the product.

• Develop more detailed instructions for users (flyers, posters, pictorials etc.) that are culturally
appropriate and easy to understand, to ensure correct use of the product.
• Train health care professionals who interact with mothers and/or provide the product to ensure
the full understanding of the indications and contraindications for use and application methods.

All stakeholders are advised to remain alert to incidents of eye injury with CHX in their settings and to
report these to their National Regulatory Authority (NRA). Member States are reminded that adverse
events associated with the use of any medicinal product should be reported to the National Regulatory
Authority.
For any questions relating to this alert please contact Dr S Pal (pals@who.int) or Dr J Simon
(simonjo@who.int).

i https://www.who.int/medicines/publications/essentialmedicines/en/
ii https://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ (page 3)

From 13 to 15 November this year, the International Babyfood Action Network will host the Third World Breastfeeding Conference and the First World Complementary Feeding Conference in Rio de Janeiro, Brazil. Additional activities are organized on 11 and 12 November. The languages used at the conference will be English, Spanish and Portuguese.
For more information about the conference, please see the conference website: http://www.enam.org.br/ingles/index.php.

The deadline for submitting proposals for activities (courses, workshops, meetings, roundtables, discussion groups or other events) during or before the conference is 10 March.
Proposals for activities and abstracts need to be categorized in one of the following subject areas (for detailed descriptions see the website):
Infant feeding and the global agenda
Infant feeding in the contemporary context
Ethics, rights and equity in infant feeding issues
Policies and practices to promote, protect and support breastfeeding and healthy complementary feeding
Training and education in breastfeeding and complementary feeding

The deadline for submitting abstracts is 10 May
Abstracts are divided into 2 types: 1) Reports of experiences and 2) Research papers. For details, see the website.

Our Gauteng branch is excited and ready for 2019! Well done ladies!

See the dates of their planned branch meetings below and pop them in your diary now.

  • 2 March
  • 25 May
  • 17 August
  • 16 November
Let us know if you have any suggested speakers, topics or new ideas.
Hope to see a lot of you there

30 million newborns require specialized or intensive care in a hospital every year. Small and sick #newborn survival is the biggest unfinished agenda for ending preventable child deaths. It is urgent, and possible, to close this survival gap meeting our SDG targets. Caring for small and sick babies is crucial for reducing deaths, disability, stunting, and long-term risk of non-communicable disease. Learn more: bit.ly/care4everynewborn #EWECisme #2018PMNCHlive #EveryNewborn

1.7 million newborn lives could be saved each year by investing in access to quality care for every newborn, everywhere, including in humanitarian settings. While essential newborn care would benefit small and sick newborns, adding special and intensive care services for them would reduce neonatal mortality by almost 50%. It would also promote child development and foster economic productivity. Learn more from report by @WHO @UNICEF & partners: bit.ly/care4everynewborn #EveryChildAlive #EveryNewborn #EWECisme #2018PMNCHlive

Ensuring zero separation of a mother and her baby and providing a positive environment increases a #newborn’s ability to thrive. Empowered parents and caregivers are crucial for short and long-term success, which in turn benefit individuals, communities and countries entirely. Learn more from @WHO and @UNICEF report: bit.ly/care4everynewborn #EveryChildAlive #EWECisme #EveryNewborn

A NNASA board member was a contributing author to the international Survive and Thrive: Transforming Care for Every Small and Sick Newborn Key Findings report- in particular aspects of the report focusing on the important role parents can play in optimizing outcomes for their newborn.

#EveryNewborn can and will thrive as productive members of our societies, provided they are given high-quality inpatient care at the right time and in the right place, including follow-up care, & parents are supported and empowered. Learn more: bit.ly/care4everynewborn @WHO @UNICEF @UN_EWEC #EWECisme #2018PMNCHlive #EveryChildAlive

Today, in New Delhi India,  the international Partner’s Forum (The partnership for Maternal Child and Woman’s Health) meeting has just opened. The meeting, hosted by the Government of India, brings together more than 1,200 partners dedicated to the Every Woman Every Child movement, including country policy makers, global experts and leaders in health and development, advocates and youth leaders. At the meeting the Survive and Thrive: Transforming care for every small and sick newborn  Key Findings report will be launched. The Council of International Neonatal Nurses (Of whom you are all members through NNASA) is a supporting organisation and one of our NNASA board members is a contributing author.

The objectives of the report include:

  • Increase visibility of stark inequalities in survival rates for sick and new born babies in high-, middle- and low-income settings;
  • Provide new evidence and data to inform programming and policy at national and sub-national levels, prioritizing provision of quality care for small and sick newborns, particularly in the most marginalized communities.
  • Encourage policy makers and donors to act and invest in health systems that provide quality intensive care for small and sick newborns,
  • Highlight the value of investment in quality care for sick and newborn babies as a key intervention to accelerate progress in ending preventable newborn deaths.

Find the press release and link to Key Findings report below (The full report is yet to be released)

Press release:

NEW DELHI/ GENEVA /NEW YORK, 13 December 2018: Nearly 30 million babies are born too soon, too small or become sick every year and need specialized care to survive, according to a new report by a global coalition that includes UNICEF and the World Health Organization (WHO).

“When it comes to babies and their mothers, the right care at the right time in the right place can make all the difference,” said Omar Abdi, UNICEF Deputy Executive Director. “Yet millions of small and sick babies and women are dying every year because they simply do not receive the quality care that is their right and our collective responsibility.”

The report, Survive and Thrive: Transforming care for every small and sick newborn, finds that among the newborn babies most at risk of death and disability are those with complications from prematurity, brain injury during childbirth, severe bacterial infection or jaundice, and those with congenital conditions. Additionally, the financial and psychological toll on their families can have detrimental effects on their cognitive, linguistic and emotional development.

“For every mother and baby, a healthy start from pregnancy through childbirth and the first months after birth is essential,” said Dr Soumya Swaminathan, Deputy Director General for Programmes at WHO. “Universal health coverage can ensure that everyone – including newborns – has access to the health services they need, without facing financial hardship. Progress on newborn health care is a win-win situation – it saves lives and is critical for early child development thus impacting on families, society, and future generations.”

Without specialized treatment, many at-risk newborns won’t survive their first month of life, according to the report. In 2017, some 2.5 million newborns died, mostly from preventable causes. Almost two-thirds of babies who die were born premature. And even if they survive, these babies face chronic diseases or developmental delays. In addition, an estimated 1 million small and sick newborns survive with a long-term disability.

With nurturing care, these babies can live without major complications. The report shows that by 2030, in 81 countries, the lives of 2.9 million women, stillborns and newborns can be saved with smarter strategies. For example, if the same health team cares for both mother and baby through labour, birth and beyond, they can identify problems early on.

In addition, almost 68 per cent of newborn deaths could be averted in 2030 with simple fixes such as exclusive breastfeeding; skin-to-skin contact between the mother or father and the baby; medicines and essential equipment; and access to clean, well-equipped health facilities staffed by skilled health workers. Other measures like resuscitating a baby who cannot breathe properly, giving the mother an injection to prevent bleeding, or delaying the cutting of the umbilical cord could also save millions.

According to the report, the world will not achieve the global target to achieve health for all unless it transforms care for every newborn. Without rapid progress, some countries will not meet this target for another 11 decades. To save newborns, the report recommends:

  • Providing round-the-clock inpatient care for newborns seven days a week.
  • Training nurses to provide hands-on care working in partnership with families.
  • Harnessing the power of parents and families by teaching them how to become expert caregivers and care for their babies, which can reduce stress, help babies gain weight and allow their brains to develop properly.
  • Providing good quality of care should be a part of country policies, and a lifelong investment for those who are born small or sick.
  • Counting and tracking every small and sick newborn allows managers to monitor progress and improve results.
  • Allocating the necessary resources, as an additional investment of US$ 0.20 cents per person can save 2 of every 3 newborns in low- and middle-income countries by 2030.

Almost three decades ago, the Convention on the Rights of the Child guaranteed every newborn the right to the highest standard of health care, and it is time for countries around the world to make sure the legislative, medical, human and financial resources are in place to turn that right into a reality for every child, the report says.

Key facts

  • Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.
  • Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015 (1).
  • Three-quarters of these deaths could be prevented with current, cost-effective interventions.
  • Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:
  • extremely preterm (less than 28 weeks)
  • very preterm (28 to 32 weeks)
  • moderate to late preterm (32 to 37 weeks).

Induction or caesarean birth should not be planned before 39 completed weeks unless medically indicated.

The problem

An estimated 15 million babies are born too early every year. That is more than 1 in 10 babies. Approximately 1 million children die each year due to complications of preterm birth (1). Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.

Globally, prematurity is the leading cause of death in children under the age of 5 years. And in almost all countries with reliable data, preterm birth rates are increasing.

Inequalities in survival rates around the world are stark. In low-income settings, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive. Suboptimal use of technology in middle-income settings is causing an increased burden of disability among preterm babies who survive the neonatal period.

The solution

More than three quarters of premature babies can be saved with feasible, cost-effective care, such as essential care during child birth and in the postnatal period for every mother and baby, provision of antenatal steroid injections (given to pregnant women at risk of preterm labour and under set criteria to strengthen the babies’ lungs), kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding) and antibiotics to treat newborn infections. For example, continuity of midwifery-led care in settings where there are effective midwifery services has been shown to reduce the risk of prematurity by around 24%.

Preventing deaths and complications from preterm birth starts with a healthy pregnancy. Quality care before, between and during pregnancies will ensure all women have a positive pregnancy experience. WHO’s antenatal care guidelines include key interventions to help prevent preterm birth, such as counselling on healthy diet and optimal nutrition, and tobacco and substance use; fetal measurements including use of ultrasound to help determine gestational age and detect multiple pregnancies; and a minimum of 8 contacts with health professionals throughout pregnancy to identify and manage other risk factors, such as infections. Better access to contraceptives and increased empowerment could also help reduce preterm births.

Why does preterm birth happen?

Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but some are due to early induction of labour or caesarean birth, whether for medical or non-medical reasons.

Common causes of preterm birth include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure; however, often no cause is identified. There could also be a genetic influence. Better understanding of the causes and mechanisms will advance the development of solutions to prevent preterm birth.

Where and when does preterm birth happen?

More than 60% of preterm births occur in Africa and South Asia, but preterm birth is truly a global problem. In the lower-income countries, on average, 12% of babies are born too early compared with 9% in higher-income countries. Within countries, poorer families are at higher risk.

The 10 countries with the greatest number of preterm births(2):

  • India: 3 519 100
  • China: 1 172 300
  • Nigeria: 773 600
  • Pakistan: 748 100
  • Indonesia: 675 700
  • United States of America: 517 400
  • Bangladesh: 424 100
  • Philippines: 348 900
  • Democratic Republic of the Congo: 341 400
  • Brazil: 279 300

The 10 countries with the highest rates of preterm birth per 100 live births (2):

  • Malawi: 18.1 preterm births per 100 births
  • Comoros: 16.7
  • Congo: 16.7
  • Zimbabwe: 16.6
  • Equatorial Guinea: 16.5
  • Mozambique: 16.4
  • Gabon: 16.3
  • Pakistan: 15.8
  • Indonesia: 15.5
  • Mauritania: 15.4

Of 65 countries with reliable trend data, all but three show an increase in preterm birth rates over the past 20 years. Possible reasons for this include better measurement, increases in maternal age and underlying maternal health problems such as diabetes and high blood pressure, greater use of infertility treatments leading to increased rates of multiple pregnancies, and changes in obstetric practices such as more caesarean births before term.

There is a dramatic difference in survival of premature babies depending on where they are born. For example, more than 90% of extremely preterm babies (less than 28 weeks) born in low-income countries die within the first few days of life; yet less than 10% of extremely preterm babies die in high-income settings.