#WorldPrematurity: Day #NurturingCare :

Nurturing Care ensures the best start in life & will help babies survive & thrive.

Simple, cost-effective ways to promote developmentally supportive care: gentle touch, skin-to-skin care, #kangaroocare, early #breastfeeding, age-appropriate stimulation and interaction, protection from noise and bright light, or nesting.

Zero separation maintains infant-parent unity and protects the family bond.

Empower fathers to participate in Nurturing Care and be included in the family unit in facilities.

Ensure communication between health providers and families on preterm babies’ special needs, and provide physical and emotional support to the family.

Partnership between health providers and parents is necessary to provide Nurturing Care, and improves outcomes for babies.

From Healthy Newborn Network. The positive impact of delayed cord clamping even on respiratory depressed babies.

Background

Experiments have shown improved cardiovascular stability in lambs if umbilical cord clamping is postponed until positive pressure ventilation is started. Studies on intact cord resuscitation on human term infants are sparse. The purpose of this study was to evaluate differences in clinical outcomes in non-breathing infants between groups, one where resuscitation is initiated with an intact umbilical cord (intervention group) and one group where cord clamping occurred prior to resuscitation (control group).

Methods

Randomized controlled trial, inclusion period April to August 2016 performed at a tertiary hospital in Kathmandu, Nepal. Late preterm and term infants born vaginally, non-breathing and in need of resuscitation according to the ‘Helping Babies Breathe’ algorithm were randomized to intact cord resuscitation or early cord clamping before resuscitation. Main outcome measures were saturation by pulse oximetry (SpO2), heart rate and Apgar at 1, 5 and 10 minutes after birth.

Results

At 10 minutes after birth, SpO2 (SD) was significantly higher in the intact cord group compared to the early cord clamping group, 90.4 (8.1) vs 85.4 (2.7) %, P < .001). In the intact cord group, 57 (44%) had SpO2 < 90% after 10 minutes, compared to 93 (100%) in the early cord clamping group, P < 0.001. SpO2 was also significantly higher in the intervention (intact cord) group at one and five minutes after birth. Heart rate was lower in the intervention (intact cord) group at one and five minutes and slightly higher at ten minutes, all significant findings. Apgar score was significantly higher at one, five and ten minutes. At 5 minutes, 23 (17%) had Apgar score < 7 in the intervention (intact cord) group compared to 26 (27%) in the early cord clamping group, P < .07. Newborn infants in the intervention (intact cord) group started to breathe and establish regular breathing earlier than in the early cord clamping group.

Conclusions

This study provides new and important information on the effects of resuscitation with an intact umbilical cord. The findings of improved SpO2 and higher Apgar score, and the absence of negative consequences encourages further studies with longer follow-up.

Click the link below to access the article.

https://www.healthynewbornnetwork.org/hnn-content/uploads/Intact-cord-resuscitation-versus-early-cord-clamping-in-the-treatment-of-depressed-newborn-infants-during-the-first-10-minutes-of-birth-a-randomized-control-trial.pdf

World Prematurity Day is an opportunity to call attention to the heavy burden of death and disability and the pain and suffering that preterm birth causes. It is also a chance to talk about solutions. The multitude of events organized around the globe on World Prematurity Day remain the heart of the effort. Each year, an increasing number of countries have observed World Prematurity Day by organizing national and local events, including public art installations, parliamentary hearings, health professional meetings, and marches.

Every year, 15 million babies are born prematurely – more than one in ten of all babies around the world. World Prematurity Day is a key moment to focus global attention on the leading cause of child deaths under age 5: complications from preterm birth,  which account for nearly 1 million deaths each year (UNICEF). Without a major push to reduce these deaths, we will not reach the global goal endorsed by 193 countries to end all preventable newborn and child deaths by 2030.

World Prematurity Day initiatives aim to increase awareness, reach and engagement around the world about the issues of premature birth, newborn health and survival. This can be accomplished through your participation in a variety of ways, such as organizing an activity or event, and sharing advocacy messages on social media.

Do you have a personal experience with #PretermBirth? Help us mark #WorldPrematurityDay by sharing your story: po.st/8AIv7b

This resource has just been released. One of NNASA’s board was a contributing author.

Click below to access the document.

This years’s theme is Born too Soon: Providing the right care, at the right time, in the right place. See the Message map above for key messages to include in your WPD advocacy and activities.

A neonatal research article from SA.

Background

Multi-drug resistant organisms are an increasingly important cause of neonatal sepsis.

Aim

This study aimed to review neonatal sepsis caused by multi-drug resistant Enterobacteriaceae (MDRE) in neonates in Johannesburg, South Africa.

Methods

This was a cross sectional retrospective review of MDRE in neonates admitted to a tertiary neonatal unit between 1 January 2013 and 31 December 2015.

Results

There were 465 infections in 291 neonates. 68.6% were very low birth weight (< 1500 g). The median age of infection was 14.0 days. Risk factors for MDRE included prematurity (p = 0.01), lower birth weight (p = 0.04), maternal HIV infection (p = 0.02) and oxygen on day 28 (p < 0.001). The most common isolate was Klebsiella pneumoniae (66.2%). Total MDRE isolates increased from 0.39 per 1000 neonatal admissions in 2013 to 1.4 per 1000 neonatal admissions in 2015 (p < 0.001). There was an increase in carbapenem-resistant Enterobacteriaceae (CRE) from 2.6% in 2013 to 8.9% in 2015 (p = 0.06). Most of the CRE were New Delhi metallo—β lactamase- (NDM) producers.

The all-cause mortality rate was 33.3%. Birth weight (p = 0.003), necrotising enterocolitis (p < 0.001) and mechanical ventilation (p = 0.007) were significantly associated with mortality. Serratia marcescens was isolated in 55.2% of neonates that died.

Conclusions

There was a significant increase in MDRE in neonatal sepsis during the study period, with the emergence of CRE. This confirms the urgent need to intensify antimicrobial stewardship efforts and address infection control and prevention in neonatal units in LMICs. Overuse of broad- spectrum antibiotics should be prevented.

Click the link below to view the article:

https://www.healthynewbornnetwork.org/hnn-content/uploads/A-review-of-multidrug-resistant-Enterobacteriaceae-in-a-neonatal-unit-in-Johannesburg-South-Africa.pdf

Background

Child rearing practices and family environment determine the health of newborn. Harmful newborn care practices are the risk factors for late onset neonatal sepsis. The objective was to identify newborn practices related to breastfeedingcord care, hygiene of newborn and thermal care practice at home of admitted neonates with diagnosis Late Onset Neonatal Sepsis in pediatric unit of B.P. Koirala Institute of Health Sciences tertiary center in eastern Nepal.

Methods

Descriptive cross sectional study was carried out from December 2014 to January 2015 using consecutive sampling. Semi structured, pretested questionnaire was used to interview 40 mothers. Data were analyzed using SPSS 20, descriptive and inferential statistics were used.

Results

Initiation of breastfeeding within one hour of delivery was practiced by only 40% of mother. Among neonates, 65% were given colostrum, 25% were given pre lacteal feed, and 45% were given formula milk and animal milk. Mustard oil was used to care umbilical cord by 72.5 %. Hand washing was practiced by 62.5 % before touching the baby. Application of kajal (52.5%) in eyes and use of mustard oil (95%) for massaging newborn was common. For thermal care, burning charcoal (75%) was mostly used. The study revealed association between newborn care and mother education, per capita income of family and family type (p =0.012, p= 0.012, p=0.039) respectively.

Conclusions

Majority of practices in breast feeding and thermal care were good however in cord care and newborn hygiene practices was poor which stresses the need for the promotion of health education program to mothers by health care facilities.

Click below to view article:

https://www.healthynewbornnetwork.org/hnn-content/uploads/Newborn-care-practices-at-home-among-mothers-of-neonates-admitted-with-sepsis.pdf

From Healthy Newborn Network:

How do we prevent and manage preterm birth? This tool can give us a structured approach. The preterm continuum of care matrix is a comprehensive listing of evidence-based services and interventions. Interventions for care of women in preterm labor and those targeting care of the preterm/LBW newborn are aligned with the 2015 WHO Recommendations on Interventions to Improve Preterm Birth Outcomes.

The matrix provides an organized framework for the large number of evidence-based interventions along the pathway to care for non-pregnant and pregnant women, and mothers and preterm or LBW newborns. It can be used to initiate dialogue and coordination among stakeholders supporting maternal, newborn and reproductive health programs at the country level, identify gaps on the pathway to care, and guide the prioritization of services in response to preterm birth.

Click below to access the matrix.

https://www.healthynewbornnetwork.org/hnn-content/uploads/Continuum-of-care-for-the-prevention-of-preterm-birth-management-of-preterm-labor-and-delivery-and-care-of-the-preterm-and-small-newborn.pdf

From Health Newborn network:

Out of nine pregnancies, Anna Bondo had suffered seven stillbirths, each one a crushing heartbreak. Every loss came as a result of premature labour, the 43-year-old told UNFPA. Last month, pregnant for the tenth time, Ms. Bondo once again went into an early labour. She immediately feared the worst.

“I was downhearted;’ she said. “I thought I was going to lose my baby again.”

At 35 weeks, the birth would be considered “late preterm“, which comes with a host of risks for the baby, including respiratory distress. Most late preterm babies survive – but equipped health facilities and trained staff are essential to support their care.

Yet Liberia struggles to provide sufficient maternal and newborn care services. The country has one of the highest maternal death rates in the world, and an extremely high infant mortality rate as well. A newborn has a 51 in 1,000 chance of dying in the first 28 days of life, according to 2017 data.

Quality health care can be especially hard for women to access outside the capital, such as in the largely rural Margibi County, where Ms. Bondo lives.

Reviving and surviving

But this time, Ms. Bondo was lucky.

She went to the C.H. Rennie Hospital, and was put into the capable hands of Dr. Susan Kimono, a Ugandan obstetrician and gynaecologist deployed to Margibi’s Kakata City.

Dr. Kimono delivered a tiny girl who struggled to breathe. She required special care in the hours after delivery.

“As expected, the baby was born underweight, weighing just 1.6 kg. We immediately moved the newborn to the Neonatal Unit for intensive care;’ Dr. Kimono explained.

The Neonatal Unit – supported by UNFPA and Maternal & Child health Advocacy International – provides critical care for premature and sick newborns.

Ms. Bondo named her baby Dorcas. Together, they spent three weeks in the hospital, and were discharged on 13 August, both in good health.

“My baby is alive and safe after 19 days spent under intensive care;’ Ms. Bondo said. “If it was not for the doctors and nurses, my baby would not be alive today:’

Spreading her knowledge

In addition to providing life-saving care to women and their newborns, Dr. Kimono also provides training to junior doctors, nurses and midwives, acting as a mentor and guide both in the hospital and in post-graduate institutions throughout Liberia.

“It is a blessing to have Dr. Kimono assigned with us at the C.H Rennie Hospital:’ Yarkpazuo Kollie, a doctor-in-training, told UNFPA. “I have been able to acquire more skills
in emergency obstetric care.”

The programme that brings teaching doctors like Dr. Kimono to Liberia is funded with support from Johnson&Johnson as part of a 5-year collaboration, from 201 5 to 2020, in Liberia, Haiti and Pakistan.

UNFPA also supports midwifery schools and provides maternal health equipment and supplies to health facilities, part of broader efforts with the Government of Liberia to strengthen maternal health systems in the country.

We trust your plans for WPD 2019 are well underway? Please share pictures from your day with other NNASA members via our Facebook site.

We hope the resources below will help you in your advocacy and awareness campaigns in your hospitals. Share with your colleagues, PRO officers and the public.

Background

World Prematurity Day is an opportunity to call attention to the heavy burden of death and disability and the pain and suffering that preterm birth causes. It is also a chance to talk about solutions. The multitude of events organized around the globe on World Prematurity Day remain the heart of the effort. Each year, an increasing number of countries have observed World Prematurity Day by organizing national and local events, including public art installations, parliamentary hearings, health professional meetings, and marches.

2019 Theme

We invite you to use the World Prematurity Day 2019 theme: “Born Too Soon: Providing the right care, at the right time, in the right place.” A message map with the benefits of family partnership in care for children, families, parents, health care professionals, policymakers and others is available below.

Born Too Soon: Providing the right care, at the right time, in the right place

Every year, 15 million babies are born prematurely – more than one in ten of all babies around the world. World Prematurity Day is a key moment to focus global attention on the leading cause of child deaths under age 5: complications from preterm birth,  which account for nearly 1 million deaths each year (UNICEF). Without a major push to reduce these deaths, we will not reach the global goal endorsed by 193 countries to end all preventable newborn and child deaths by 2030.

Share your World Prematurity Day experience and plans, download social media resources, and share social media links within your networks.

To assist your planning, global partners are developing a World Prematurity Day toolkit, including: