Description
This is a presentation explains and touches topics like newborn deaths, Essential Newborn Care Interventions, protection, Monitoring, Eye care and Immunization.
Maternal and Newborn Healthcare Management
Newborn Deaths
?
8.1 million infant deaths (1993)
3.9 million (48%) newborn deaths 2.8 million (67%) early newborn deaths Major causes of newborn deaths
? ?
?
?
?
Birth asphyxia: 21% Infections: 42% (tetanus, sepsis, meningitis, pneumonia, diarrhea)
2
Newborn Deaths (continued)
?
Birth process was the antecedent cause of 2/3 of deaths due to infections
? ?
Lack of hygiene at childbirth and during newborn period Home deliveries without skilled birth attendants 3% of newborns suffer mild to moderate birth asphyxia Prompt resuscitation is often not initiated or procedure is inadequate or incorrect
?
Birth asphyxia in developing countries
? ?
3
Newborn Deaths (continued)
?
Hypothermia and newborn deaths
?
Significant contribution to deaths in low birth weight infants and preterm newborns Social, cultural and health practices delaying care to the newborn
?
?
Countries with high STD prevalence and inconsistent prophylactic practices
?
Ophthalmia neonatorum is a common cause of blindness
4
Newborn Deaths (continued)
?
Low birth weight
?
An extremely important factor in newborn mortality At least 2 out 3 childbirths in developing countries occur at home Only half are attended by skilled birth attendants Strategies for improving newborn health should target – Birth attendant, families and communities – Healthcare providers within the formal health system
?
Place of childbirth
?
? ?
5
Essential Newborn Care Interventions
?
Clean childbirth and cord care
?
Prevent newborn infection Prevent and manage newborn hypo/hyperthermia Started within 1 hour after childbirth Early asphyxia identification and management
?
Thermal protection
?
?
Early and exclusive breastfeeding
?
?
Initiation of breathing and resuscitation
?
6
Essential Newborn Care Interventions (continued)
?
Eye care
?
Prevent and manage ophthalmia neonatorum At birth: bacille Calmette-Guerin (BCG) vaccine, oral poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine (WHO)
?
Immunization
?
? ?
Identification and management of sick newborn Care of preterm and/or low birth weight newborn
7
Cleanliness to Prevent Infection
?
Principles of cleanliness essential in both home and health facilities childbirths
Principles of cleanliness at childbirth
? ? ? ? ? ?
?
Clean hands
Clean perineum
Nothing unclean introduced vaginally Clean delivery surface Cleanliness in cord clamping and cutting
Cleanliness for cord care
?
Infection prevention/control measures at healthcare facilities
8
Thermal Protection
?
Newborn physiology
Normal temperature: 36.5–37.5°C ? Hypothermia: < 36.5°C ? Stabilization period: 1st 6–12 hours after birth – Large surface area – Poor thermal insulation – Small body mass to produce and conserve heat – Inability to change posture or adjust clothing to respond to thermal stress Increase hypothermia
? ? ?
?
Newborn left wet while waiting for delivery of placenta Early bathing of newborn (within 24 hours)
9
Hypothermia Prevention
?
? ? ?
Deliver in a warm room
Dry newborn thoroughly and wrap in dry, warm cloth Keep out of draft and place on a warm surface Give to mother as soon as possible
? ? ?
Skin-to-skin contact first few hours after childbirth Promotes bonding Enables early breastfeeding
? ?
Check warmth by feeling newborn’s feet every 15 minutes Bathe when temperature is stable (after 24 hours)
10
Early and Exclusive Breastfeeding
?
Early contact between mother and newborn
?
Enables breastfeeding ? Rooming-in policies in health facilities prevents nosocomial infection ? Best practices
? ? ?
? ?
No prelacteal feeds or other supplement Giving first breastfeed within one hour of birth Correct positioning to enable good attachment of the newborn Breastfeeding on demand Psycho-social support to breastfeeding mother
11
Breathing Initiation and Resuscitation
?
Spontaneous breathing (> 30 breaths/min.) in most newborns
?
Gentle stimulation, if at all Biologically plausible advantages – clear airway
?
Effectiveness of routine oro-nasal suctioning is unknown
? ? ?
Potentially real disadvantages – cardiac arrhythmia
Bulb suctioning preferred Fetal distress
?
Newborn resuscitation may be needed
? ? ? ?
Thick meconium staining
Vaginal breech deliveries Preterm
12
Eye Care To Prevent or Manage Ophthalmia Neonatorum
?
Ophthalmia neonatorum
? ? ? ?
Conjunctivitis with discharge during first 2 weeks of life Appears usually 2–5 days after birth Corneal damage if untreated
Systemic progression if not managed
N. gonorrhea – More severe and rapid development of complications – 30–50% mother-newborn transmission rate C. trachomatis
?
Etiology
?
?
13
Eye Care To Prevent or Manage Ophthalmia Neonatorum (continued)
?
Prophylaxis
?
Clean eyes immediately ? 1% Silver nitrate solution – Not effective for chlamydia ? 2.5% Povidone-iodine solution ? 1% Tetracycline ointment – Not effective vs. some N. gonorrhea strains ? Common causes of prophylaxis failure
? ? ?
Giving prophylaxis after first hour Flushing of eyes after silver nitrate application Using old prophylactic solutions
14
Efficacy of Prophylaxis for Conjunctivitis in China
?
Objective: To assess etiology of newborn conjunctivitis and evaluate the efficacy of regimens in China
Design: November 1989 to October 1991 rotated regimens monthly: tetracycline, erythromycin, silver nitrate 302 (6.7%) infants developed conjunctivitis, most S. aureus (26.2%) and chlamydia (22.5%) Silver nitrate, tetracycline: fewer cases than no prophylaxis (p < 0.05), erythromycin: not significant
?
?
?
15
Prophylaxis for Conjunctivitis: Objective and Design
?
Objective: To compare efficacy in prevention of nongonococcal conjunctivitis
Design: Randomized control trial to compare erythromycin, silver nitrate, no prophylaxis
?
?
Examined with test for leukocyte esterase and chlamydia trachomatis antibody probe 30–48 hours postpartum, 13–15 days later, and telephone contact up to 60 days of life
?
Main outcome measured: conjunctivitis within 60 days of life and nasolacrimal duct patency
16
Prophylaxis for Conjunctivitis: Results and Conclusion
?
?
Results: 630 infants
109 with conjunctivitis
?
Silver nitrate vs. no prophylaxis: Hazard ratio 0.61 (0.390.97)
?
– Chemical conjunctivitis with silver nitrate resolves within 48 hours Erythromycin vs. no prophylaxis: Hazard ratio 0.69 (not significant)
?
Conclusion: Parental choice of prophylaxis, including no prophylaxis, is reasonable IF antenatal care and STD screening
17
Povidone-Iodine for Conjunctivitis: Objective and Design
?
? ?
Objective: To determine incidence and type of conjunctivitis after povidone-iodine in Kenya
Design: Rotate regimen weekly: erythromycin, silver nitrate, povidone iodine Results:
?
?
?
Conjunctivitis: – Chlamydia in 50.5% – S. aureus in 39.7% More infections in silver nitrate than povidone-iodine, OR 1.76, p < 0.001 More infections in erythromycin OR 1.38, p=0.001
18
Povidone-Iodine for Conjunctivitis: Conclusion
Povidone-iodine:
? ? ?
Is good prophylaxis Has wider antibacterial spectrum Causes greater reduction in colony-forming units and number of bacterial species Is active against viruses Is inexpensive
? ?
19
Immunization
?
BCG vaccinations in all population at high risk of tuberculosis infection
Single dose of OPV at birth or in the two weeks after birth HBV vaccination as soon as possible where perinatal infections are common
? ?
20
Summary
The essential components of normal newborn care include:
? ? ? ? ? ?
Clean delivery and cord care Thermal protection Early and exclusive breastfeeding Monitoring Eye care Immunization
21
References
Bell TA et al. 1993. Randomized trial of silver nitrate, erythromycin and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis. Pediatrics 92: 755–760. Chen J. 1992. Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin, and no prophylaxis. Pediatr Infect Dis J 11: 1026–1030. Child Health Research Project and Maternal and Neonatal Health Program. 1999. Reducing Perinatal and Neonatal Mortality. Report of a meeting in Baltimore, Maryland, 10–12 May, 1999. Hamilton P. 1999. Care of the newborn in the delivery room. Br Med J 318: 1403–1406. Isenberg SJ, L Apt and M Wood. 1995. A controlled trial of povidoneiodine as prophylaxis against ophthalmitis neonatorum. N Engl J Med 332: 562–566. World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. WHO: Geneva.
22
doc_211564698.ppt
This is a presentation explains and touches topics like newborn deaths, Essential Newborn Care Interventions, protection, Monitoring, Eye care and Immunization.
Maternal and Newborn Healthcare Management
Newborn Deaths
?
8.1 million infant deaths (1993)
3.9 million (48%) newborn deaths 2.8 million (67%) early newborn deaths Major causes of newborn deaths
? ?
?
?
?
Birth asphyxia: 21% Infections: 42% (tetanus, sepsis, meningitis, pneumonia, diarrhea)
2
Newborn Deaths (continued)
?
Birth process was the antecedent cause of 2/3 of deaths due to infections
? ?
Lack of hygiene at childbirth and during newborn period Home deliveries without skilled birth attendants 3% of newborns suffer mild to moderate birth asphyxia Prompt resuscitation is often not initiated or procedure is inadequate or incorrect
?
Birth asphyxia in developing countries
? ?
3
Newborn Deaths (continued)
?
Hypothermia and newborn deaths
?
Significant contribution to deaths in low birth weight infants and preterm newborns Social, cultural and health practices delaying care to the newborn
?
?
Countries with high STD prevalence and inconsistent prophylactic practices
?
Ophthalmia neonatorum is a common cause of blindness
4
Newborn Deaths (continued)
?
Low birth weight
?
An extremely important factor in newborn mortality At least 2 out 3 childbirths in developing countries occur at home Only half are attended by skilled birth attendants Strategies for improving newborn health should target – Birth attendant, families and communities – Healthcare providers within the formal health system
?
Place of childbirth
?
? ?
5
Essential Newborn Care Interventions
?
Clean childbirth and cord care
?
Prevent newborn infection Prevent and manage newborn hypo/hyperthermia Started within 1 hour after childbirth Early asphyxia identification and management
?
Thermal protection
?
?
Early and exclusive breastfeeding
?
?
Initiation of breathing and resuscitation
?
6
Essential Newborn Care Interventions (continued)
?
Eye care
?
Prevent and manage ophthalmia neonatorum At birth: bacille Calmette-Guerin (BCG) vaccine, oral poliovirus vaccine (OPV) and hepatitis B virus (HBV) vaccine (WHO)
?
Immunization
?
? ?
Identification and management of sick newborn Care of preterm and/or low birth weight newborn
7
Cleanliness to Prevent Infection
?
Principles of cleanliness essential in both home and health facilities childbirths
Principles of cleanliness at childbirth
? ? ? ? ? ?
?
Clean hands
Clean perineum
Nothing unclean introduced vaginally Clean delivery surface Cleanliness in cord clamping and cutting
Cleanliness for cord care
?
Infection prevention/control measures at healthcare facilities
8
Thermal Protection
?
Newborn physiology
Normal temperature: 36.5–37.5°C ? Hypothermia: < 36.5°C ? Stabilization period: 1st 6–12 hours after birth – Large surface area – Poor thermal insulation – Small body mass to produce and conserve heat – Inability to change posture or adjust clothing to respond to thermal stress Increase hypothermia
? ? ?
?
Newborn left wet while waiting for delivery of placenta Early bathing of newborn (within 24 hours)
9
Hypothermia Prevention
?
? ? ?
Deliver in a warm room
Dry newborn thoroughly and wrap in dry, warm cloth Keep out of draft and place on a warm surface Give to mother as soon as possible
? ? ?
Skin-to-skin contact first few hours after childbirth Promotes bonding Enables early breastfeeding
? ?
Check warmth by feeling newborn’s feet every 15 minutes Bathe when temperature is stable (after 24 hours)
10
Early and Exclusive Breastfeeding
?
Early contact between mother and newborn
?
Enables breastfeeding ? Rooming-in policies in health facilities prevents nosocomial infection ? Best practices
? ? ?
? ?
No prelacteal feeds or other supplement Giving first breastfeed within one hour of birth Correct positioning to enable good attachment of the newborn Breastfeeding on demand Psycho-social support to breastfeeding mother
11
Breathing Initiation and Resuscitation
?
Spontaneous breathing (> 30 breaths/min.) in most newborns
?
Gentle stimulation, if at all Biologically plausible advantages – clear airway
?
Effectiveness of routine oro-nasal suctioning is unknown
? ? ?
Potentially real disadvantages – cardiac arrhythmia
Bulb suctioning preferred Fetal distress
?
Newborn resuscitation may be needed
? ? ? ?
Thick meconium staining
Vaginal breech deliveries Preterm
12
Eye Care To Prevent or Manage Ophthalmia Neonatorum
?
Ophthalmia neonatorum
? ? ? ?
Conjunctivitis with discharge during first 2 weeks of life Appears usually 2–5 days after birth Corneal damage if untreated
Systemic progression if not managed
N. gonorrhea – More severe and rapid development of complications – 30–50% mother-newborn transmission rate C. trachomatis
?
Etiology
?
?
13
Eye Care To Prevent or Manage Ophthalmia Neonatorum (continued)
?
Prophylaxis
?
Clean eyes immediately ? 1% Silver nitrate solution – Not effective for chlamydia ? 2.5% Povidone-iodine solution ? 1% Tetracycline ointment – Not effective vs. some N. gonorrhea strains ? Common causes of prophylaxis failure
? ? ?
Giving prophylaxis after first hour Flushing of eyes after silver nitrate application Using old prophylactic solutions
14
Efficacy of Prophylaxis for Conjunctivitis in China
?
Objective: To assess etiology of newborn conjunctivitis and evaluate the efficacy of regimens in China
Design: November 1989 to October 1991 rotated regimens monthly: tetracycline, erythromycin, silver nitrate 302 (6.7%) infants developed conjunctivitis, most S. aureus (26.2%) and chlamydia (22.5%) Silver nitrate, tetracycline: fewer cases than no prophylaxis (p < 0.05), erythromycin: not significant
?
?
?
15
Prophylaxis for Conjunctivitis: Objective and Design
?
Objective: To compare efficacy in prevention of nongonococcal conjunctivitis
Design: Randomized control trial to compare erythromycin, silver nitrate, no prophylaxis
?
?
Examined with test for leukocyte esterase and chlamydia trachomatis antibody probe 30–48 hours postpartum, 13–15 days later, and telephone contact up to 60 days of life
?
Main outcome measured: conjunctivitis within 60 days of life and nasolacrimal duct patency
16
Prophylaxis for Conjunctivitis: Results and Conclusion
?
?
Results: 630 infants
109 with conjunctivitis
?
Silver nitrate vs. no prophylaxis: Hazard ratio 0.61 (0.390.97)
?
– Chemical conjunctivitis with silver nitrate resolves within 48 hours Erythromycin vs. no prophylaxis: Hazard ratio 0.69 (not significant)
?
Conclusion: Parental choice of prophylaxis, including no prophylaxis, is reasonable IF antenatal care and STD screening
17
Povidone-Iodine for Conjunctivitis: Objective and Design
?
? ?
Objective: To determine incidence and type of conjunctivitis after povidone-iodine in Kenya
Design: Rotate regimen weekly: erythromycin, silver nitrate, povidone iodine Results:
?
?
?
Conjunctivitis: – Chlamydia in 50.5% – S. aureus in 39.7% More infections in silver nitrate than povidone-iodine, OR 1.76, p < 0.001 More infections in erythromycin OR 1.38, p=0.001
18
Povidone-Iodine for Conjunctivitis: Conclusion
Povidone-iodine:
? ? ?
Is good prophylaxis Has wider antibacterial spectrum Causes greater reduction in colony-forming units and number of bacterial species Is active against viruses Is inexpensive
? ?
19
Immunization
?
BCG vaccinations in all population at high risk of tuberculosis infection
Single dose of OPV at birth or in the two weeks after birth HBV vaccination as soon as possible where perinatal infections are common
? ?
20
Summary
The essential components of normal newborn care include:
? ? ? ? ? ?
Clean delivery and cord care Thermal protection Early and exclusive breastfeeding Monitoring Eye care Immunization
21
References
Bell TA et al. 1993. Randomized trial of silver nitrate, erythromycin and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis. Pediatrics 92: 755–760. Chen J. 1992. Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin, and no prophylaxis. Pediatr Infect Dis J 11: 1026–1030. Child Health Research Project and Maternal and Neonatal Health Program. 1999. Reducing Perinatal and Neonatal Mortality. Report of a meeting in Baltimore, Maryland, 10–12 May, 1999. Hamilton P. 1999. Care of the newborn in the delivery room. Br Med J 318: 1403–1406. Isenberg SJ, L Apt and M Wood. 1995. A controlled trial of povidoneiodine as prophylaxis against ophthalmitis neonatorum. N Engl J Med 332: 562–566. World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. WHO: Geneva.
22
doc_211564698.ppt