31 March 2014

ENDING NEWBORN DEATHS

Ensuring Every Baby Survives.
Save the Children, the noted children’s aid organization, has just published a comprehensive review of global newborn mortality and issued a call to action.  The United Nations Millenium Development Goals included a projected 50% reduction in newborn mortality by 2015.  Although a few countries have already achieved this reduction, most countries, including all of Sub-Saharan Africa, have lagged behind. Save the Children’s projected action plan includes eight essential health worker supported interventions around birth.  They are:
1.      Skilled care at birth and emergency obstetric care (including assisted vaginal delivery and caesarean section if needed) ensuring timely care for women and babies with complications

2.     Management of pre-term birth (including antenatal corticosteroids for mothers with threatened preterm labor, to reduce breathing and other problems in preterm babies.

3.     Basic newborn care (focus on cleanliness, including cord care, warmth and support for immediate breastfeeding, recognition of danger signs and care seeking)

4.     Neonatal resuscitation for babies who do not breathe spontaneously at birth

5.     Kangaroo mother care (skin –to-skin breastfeeding support especially for premature and small babies

6.     Treatment of severe newborn infections (focus on early identification and use of antibiotics

7.     Inpatient supportive care for sick and small newborns (focus on IV fluids/feeding support and safe oxygen use).

8.     Prevention of mother-to-child transmission of HIV (during pregnancy, labor and the immediate newborn period).

Several recent innovations can be easily and inexpensively carried out by health workers in rural settings.  They are:

1.     Corticosteroids given to mothers  going into premature labor help the baby’s lungs to mature
2.     Simple bag and mask devices are effective in helping newborn babies breathe

3.     Kangaroo Mother Care was originally developed to cope with situations where incubators were not available to keep a premature baby warm, but has been shown to have beneficial long-term effects even where intensive care is available.

4.     The antiseptic chlorhexidine in gel form has been shown to be the preferred agent in initial umbilical cord care.

The Save the Children Report emphasizes that applying these techniques and developments at full scale is impossible without health systems that can reach all mothers and babies.  “Only a health worker who  supports births and is up to date with training and techniques can make sure they are used properly.  Only a strong health system can deliver these human resources, products and techniques to every community and every birth.”
Save the children is to be congratulated for producing this comprehensive and compelling report.

Submitted by Roger Boe MD

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