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AGENDA
1. BCA at a glance
2. Lessons from Adult BCA
3. Why focus on the newborn
4. BCA for the newborn
BCA AT A GLANCE
3
1.Healthcare Associated Infections
2.Antimicrobial Stewardship
3.BCA…for the newborn
INFANT MORTALITYIN RSA ( Stats SA, 2008)
16
Neonatal31%
Diarrhoea22%
LRTI17%
0thers30%
Determinants of Infant Mortality
NEONATAL DEATHSIN RSA ( Stats SA, 2008)
17
Prematu-rity
38%
Birth As-
phyxia25%
Sepsis25%
Congential Abnormalities13%
Determinants of Neonatal Deaths
DRIVERS OF MORBIDITY AND MORTALITY
• Neonatal Sepsis• Chronic Lung Disease• Necrotising Enterocolitis• Periventricular-Intraventricular
Haemorrhage• Retinopathy of Prematurity
SCREENING BUNDLE
1. Antenatal steroid compliance
2. HIV screening
3. HIV PMTCT compliance
4. Syphilis screening
5. Early NCPAP compliance
6. Cranial Ultrasound compliance
7. Retinal exam compliance
8. Caesarean section rate
SEPSIS BUNDLE
• Early Bacterial Sepsis (EBS)Vertical transmissionWithin 72 hours of birth
• Late Onset Infections (LOI)Healthcare Associated InfectionBacteria, fungal or viralAfter 72 hours of birth
SEQUENCING
Data CollectionScreening bundle BundlesM & M drivers Obstetric Sepsis
SurveillanceEBS ICP & CLABSI bundleLOI
ROP BUNDLE
1. Pulse oximetry on an infant receiving oxygen.
2. Saturation probe to be placed on the Right or Left hand.
3. Saturation aimed at 86-92%
4. Monitor alarm to be set at 85 (low) and 93 (high).
5. Fundoscopy screening done or booked before discharge.
ROP
CLD BUNDLE
1. Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.
2. Neopuff use in neonatal resuscitation.
3. Gentle ventilation (NCPAP) vs (HFO) vs (CV).
4. Permissive hypercapnia of more than 45mmHg.
5. Administration of systemic steroids to the infant to prevent or treat CLD.
CLD
NEC BUNDLE
1. Breastmilk or pasteurised EBM as a modality of feeding.
2. Trophic feeds within 24 hours of birth.
3. Adherence to “volume per day” protocol.
4. Adherence to “frequency of feeds” protocol.
NEC
PIH BUNDLE
1. Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.
2. Delayed cord clamping for 45 seconds to a minute.
3. Neopuff use in neonatal resuscitation.
4. Maintain infant temperature to more than 36 degrees Celsius.
5. Developmental care: dim lights, low levels of noise and minimal handling.
PIH
Recommended