Essential Newborn Care:

From Evidence to Practice

 Objectives
By the end of this session, the learner
should
• be able to discuss the problem of child
mortality focusing on neonatal mortality
• know preventive interventions to
address the above
• be able to discuss the immediate
newborn care practices that save lives
Healthy People 2020
• Aims to have a society where people live longer and healthier lives.
• Increase the number of individuals going to a single health care provider for care.
• Increase the number of adolescents getting yearly physical, dental, and vision
examinations and be involved in extracurricular activities at school.
• Increase the number of adolescents who have a positive adult role model to talk
to.
• Increase number of children with disabilities who receive adequate care.
From Millennium Development Goals to Sustainable
Development Goals

5 4
What is sustainable development?
• Meets the needs of the present without compromising
the ability of future generations to meet their own needs

• Calls for concerted efforts toward building an inclusive,

sustainable and resilient future for people and planet

• Relies on three interconnected elements that are crucial

to the well-being of individuals and societies: economic
growth, social inclusion and environmental protection

• Requires eradicating poverty in all its forms and

dimensions
• Apply to low-, middle- and
high-income countries alike

• Governments are expected to

take ownership and establish
national frameworks for
achieving the goals

• The clock already started on 1

January, 2016
Health and Nutrition in the UN 2030 Sustainable
Development Goals
Goals:

• 2: End hunger, achieve food security and improved

nutrition and promote sustainable agriculture
• 3: Ensure healthy lives and promote well-being for all
at all ages
 MDGs to SDGs - The unfinished business of
the MDGs – MDG 1, 4, and 5

MDGs SDGs
• 1 - Eradicate extreme poverty 2. End hunger, achieve food
and hunger security and improved nutrition
• 4 - Reduce child mortality and promote sustainable
agriculture
• 5 - Improve Maternal Health
and access to RH services 3. Ensure healthy lives and
promote well-being for all at all
ages
The Philippines is one of 42countries that
account for 90% of global under-five
mortality

82,000
Filipino children die annually
Most could have lived
Childhood morbidity
• Morbidity is defined as the number of people in a population who are
faced with a specific health problem at a particular point in time.
Factors that place children at risk for increased
morbidity include:
• • chronic illness
• • homelessness
• • low birth weight
• • poverty
• • adoption from a foreign country
• • time spent in day-care centers.
Childhood mortality
• Mortality refers to the number of deaths from a specific cause in a
given year.
• Infant mortality rates are the number of infant deaths during the first
year of life per 1,000 live births
<5 year old and Neonatal Mortality
80
70
60
50
40
Under Five MR
30
20
Neonatal MR
10
0
1988 1993 1998 2003 2008

• 1988-1998: 40%
• 1998-2008:  20%
• Neonatal mortality hasn’t improved
DHS 88, 93, 98, 03, 08
Under Five Year Old Deaths, 2008

Source: Child Health Epidemiology Reference Group (CHERG)

Global, Regional and National Causes of Child Mortality: a systematic analysis. The Lancet May 2010; 375: 1969-1987
 Majority of newborns die due to stressful events
or conditions during labor, delivery and the
immediate postpartum period
35

30
Number of deaths

25

20
3 out of 4 newborn deaths
occur in the 1st week of life
15

10

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Day of Life NDHS 2003, special tabulations

Neonatal Mortality is high
for Rich and Poor, NDHS 2008
25

20
20 19

15 15
15

10
10

0
Lowest Second Middle Fourth Highest

Wealth Quintile
What Can We Do to Save Newborn Lives?
Preventive Interventions
Breastfeeding 13%
Insecticide-treated materials 7%
Complementary Feeding 6%
Zinc 4%
Clean delivery 4%
Hib Vaccine 4%
Water sanitation, hygiene 3%
Antenatal Steroids 3%
Newborn temperature management 2%
Vitamin A 2%
Tetanus Toxoid 2%
Nevirapine and replacement feeding 2%
Antibiotics for premature rupture of membranes 1%
Measles vaccine 1%

Antimalarial intermittent preventive treatment in pregnancy <1%

The Lancet Child Survival Series.
Lancet 2003; 362: 65–71
 • This was considered and
handled as a hospital
Large NCR infection control problem
Hospital
partially  Environmental cultures
positive
closed for  How much colostrum
cleanup did the cases receive?

25 babies reportedly
died due to infection
Baguio General
Hospital, 1970’s
I:
Period II:
Neonates were not rooming-in
roomed-in with their
with their mother
mother

allowed formula
The hospital strongly promoted
breastfeeding policy
Many cases of neonatal sepsis
89% reduction of neonates with
clinical signs of sepsis

Clavano, J TropPed, 1982

Delaying Initiation of breastfeeding increases
risk of infection-related death
Nepal 2008 N = 22,838 breastfed babies
12
11
10
9
8
Relative Risk

7
6
5
4
3
2
1
0
<1 1-24 24-48 48-72 >72
Hours after Birth

Mullany LC, et al. JNutr, 2008; 138(3):599-603.

Delaying Initiation of breastfeeding increases
risk of infection-related death
Ghana 2004 N = 10,947 breastfed infants
12
11
10
9
8
Relative Risk

7
6
5
4
3
2
1
0
Within 1 h 1h-end Day Day 2 Day 3 After Day 3
1
Hours after Birth
 Random Clinical Control Trial of Low Birth Weight
Hospitalized Neonates comparing type of feeding vs.
percentage with serious illness
50
45
45
40
% With Serious Illness

35 33

30
25
20
16
14.3
15
10.5
10
5
0
Raw Expressed BF Pasteurized Raw Expressed BF Pasteurized Formula Only
Expressed BF + Formula Expressed BF +
Formula
 Is neonatal death a problem limited to
nationwide hospitals?

Nationwide home Nationwide

deliveries by non-
health professionals Hospitals

Newborn Sepsis Not Studied 6%

16.8/1000 16.0/1000
Newborn Mortality*
Live Births Live Births

Maternal Mortality 162/100,000 + 234/100,000

+ FPS 2006, § Sobel, Silvestre, Mantaring 2009 , ActaPaediatrica 2011 * Sobel, Oliveros, Nyunt-U 2009
Essential
Newborn Care
Protocol was
developed to
address these
issues