enc part i

8/9/2019 ENC Part I

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8/9/2019 ENC Part I


o#t of / ne"borns die in t!e rst

"ee of life, s$ecicall t!e rst 2das of life.

3isting $erinatal conditions

$redis$ose t!e ne"born to anincreased ris of ding immediatelafter deliver.

Is the risk of dying less in the higher

economic brackets in the country?

4!e average neonatal mortalit in t!e

co#ntr is 1%51000 live birt!s. In t!e lo"est socio'economic 6#intile,

it is 2051000 live birt!s, "!ile in t!eleast $oor it is 1051000 live birt!s.

4!is s!o"s t!at being in t!e !ig!est

"ealt! 6#intile does not give one asignicant advantage beca#se t!eneonatal mortalit rate is not far fromt!e national average.

t!e neonatal mortalit rate in a rst

"orld co#ntr lie 7a$an is onl2./51000 live birt!s.

Globall, a$$ro3imatel 10 million

c!ildren die eac! ear. 4!is is t!e ancet !ild S#rvival Series

"!ic! looed at $reventiveinterventions to save c!ildren:s lives.

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8/9/2019 ENC Part I


Wit! 2 interventions "e can $revent

> million of t!e 10 million global #nderve deat!s.

*otice t!at t!e onl 2'digit g#re in

t!e table is breastfeeding at 1?, etnot eno#g! em$!asis is $laced onbreastfeeding as a life'savingintervention.

om$are t!is "it! t!e giving of

antibiotics for -@&= A as interns, "e"ere assigned jo#rnal re$orts or givendemerits for failing to order t!is int!e mot!er:s c!art, et it contrib#testo onl an estimated 1? red#ction inc!ild!ood mortalit.

Good n#trition t!ro#g! breastfeeding,

a$$ro$riate com$lementar feeding,s#$$lementation &@ fortication can

alread $revent 2.% million deat!s.

B fe" ears ago, a se$sis o#tbrea in

an *@ !os$ital became front'$agene"s des$ite t!e fact t!at all large!os$itals nation"ide !avee3$erienced being in t!e samesit#ation. Bt t!e end of t!e o#tbrea,a total of 2 term babies "!o "ereborn !ealt! s#cc#mbed to se$sis.

4!e fat!er of one of t!ese babies

"rote to t!e WH& in Geneva saingt!at !e saved mone so t!at !is "ifeco#ld deliver in a !os$ital, onl to!ave t!e bab die from infection.WH& referred t!e case to t!e &Cce of t!e WH& @e$resentative to t!eco#ntr and an investigating team

"as formed. W!en t!e team arrivedat t!e !os$ital, t!e o#tbrea "as

being treated as an infection control$roblem. 4!e rst t!ing t!e teamleader ased "as EHo" m#c!colostr#m did t!e cases receiveFBns"er *ot a dro$.

In ag#io General Hos$ital, babies

"ere ro#tinel removed from t!eirmot!ers at birt!, $laced in an#rser, and given infant form#la.

4!e gra$! at t!e bottom s!o"s t!e!ig! incidence of se$sis amongt!ese babies.

Dra. lavano instit#ted a ne"

regimen t!at allo"ed mot!ers andbabies to room toget!er, andenco#raged "omen to breastfeedon demand. 4!e res#lts "eredramatic t!e incidence of oralt!r#s!, diarr!ea, clinical se$sis,

and deat! "ere drasticall red#ced

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8/9/2019 ENC Part I


d#ring t!e intensication of t!ebreastfeeding $rogram.

4!is contrib#ted to t!e formation

of t!e ab (riendl Hos$italInitiative.

In t!e -!ili$$ines, Dra. lavano

contin#ed to advocate against t!e#se of infant form#las, "or t!atcontrib#ted to t!e 198> -!ili$$ine*ational =il ode, and t!e 1992@ooming'In and reastfeeding Bct.

4!is st#d "as done in *e$al

involving 2,000 breastfed babies. It looed at t!e ris of infection'

related deat! correlated "it! t!etime of initiation of breastfeeding+in !o#rs.

If breastfeeding is started "it!in

an !o#r after birt!, t!e ris of infection'related deat! is 1. If breastfeeding is started after 1!o#r b#t "it!in t!e 1st 2/ !o#rs,t!e ris do#bles to 2. If breastfeeding is started after das, t!ere is a fo#r'fold increasein t!e ris of infection'relateddeat!.

B similar st#d done in G!ana "it!

!alf t!e n#mber of babies alsos!o"s t!e same dose'res$onse

relations!i$ bet"een initiation of breastfeeding and ris of infection'related deat!. 4!is dose res$onsec#rve is ver strong evidence fort!e $rotective $ro$ert of breastfeeding.

4!is is a randomied controlled

trial t!at st#died t!e t$e of feeding received b lo" birt!"eig!t babies against t!e ris of serio#s illness.

4!e res#lt of t!e st#d "as

signicant in t!at it s!o"ed t!att*e less +reastmil, t*e +a+-recei.es/ t*e *i0*er t*e ris, o1 serious illness2

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8/9/2019 ENC Part I


In a baseline st#d of consec#tive

deliveries in %1 of t!e largest!os$itals in 9 regions in t!e-!ili$$ines, t!e incidences of neonatal se$sis, neonatal andmaternal mortalities "ereobtained. In t!at !os$ital st#d,t!e neonatal se$sis rate "as >?.

4!ere is no available data forse$sis rates in babies delivered at!ome.

*e"born mortalit "as 1>.851000

live birt!s in !ome deliveries vs1>51000 live birt!s in !os$itals.Does this mean that hospital

deliveries do not have anadvantage over home deliveries?

ven more glaring are t!e

statistics for maternal mortalit1>25100,000 deliveries if !ome'based vs. 2/5100,000 !os$italdeliveries.

4!ese g#res onl goes to s!o"

t!at "e need to instit#te meas#rest!at "ill allo" mot!ers andne"borns to benet from safe and6#alit care.

W*at Immediate Ne3+orn Care

Practices Sa.e Li.es

Im$lementation of t!e * $rotocol !ast!e $otential to avert a$$ro3imatel J0$ercent of ne"born deat!s t!at are d#eto $reventable ca#ses.

Giving antenatal steroids to

mot!ers "!o are in $reterm labor!as several benecial o#tcomes int!e neonate.

(oremost among t!ese is t!e

overall red#ction in neonatal deat!"it! an @@ of 0.>9.

4!ere is also a red#ction in t!e

incidences of res$irator distresssndrome and cerebroventric#lar!emorr!age.

ontrar to t!e notion t!at steroids

"ill s#$$ress t!e imm#ne sstem,t!ere is also a red#ction in se$sis

in t!e rst /8 !o#rs of t!ene"born:s life.

It lie"ise does not increase t!e

ris of deat!, c!orioamnionitis or$e#r$eral se$sis in t!e mot!er.

Betametasone is t*e 5re1erred

steroid beca#se it is associated "it!less $eriventric#lar le#omalacia, adisorder of t!e "!ite matter of t!ebrain. Ho"ever it is m#c! moree3$ensive and is not al"as readil

available.

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De3amet!asone is more available and

is easil obtainedK it s!o#ld al"as bein t!e 'cart of o#r facilit forimmediate access "!en a mot!ercomes in $reterm labor.

If a quick delivery is expected and

dexa can be given only once, can wedouble the dose and give 1 mg q1hours? St#dies !ave s!o"n t!at t!ere

is no additional benet to #sing !ig!eror more fre6#ent doses.

If a mother with asthma has been

taking oral steroids for 1 week, canwe defer the dexa? We s!o#ld stillgive it beca#se t!e absor$tion of ot!er forms of steroids is #nreliable.

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enc part i

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