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7/27/2019 WHO NBH Guidlines Dakar 20130709
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ENGAP Consultation| Dakar, Senegal | 9 - 11 Jul y 20131 |
Current Guidelines on Newborn Health
of the
World Health Organization
Severin von XylanderWHO Department of Maternal, Newborn, Child and Adolescent Health (MCA)
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Outline
Focus on priority interventions
Types of guidelines
References materials and sources
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Ending preventable deaths Labour and childbirth care
Labour monitoring
Childbirth care
Essential newborn care
Birth: drying, skin-to-skin
First week: early/excl. BF,warmth, cord care, hygiene
Obstruction/Fetal distress: CS,vacuum
PT labour: corticosteroids,antibiotics for PPROM
Preterm/LBW: KangarooMother Care, BF support,immediate treatment of suspected infection
Suspected sepsis:Early antibiotic treatment
Not breathing atbirth: Resuscitation
CARE DURINGPREGNANCY
TREATMENTFOR
PREGNANCYCOMPLI-CATIONS
PRE-CONCEPTION
CARE
REPRODUCTIVECARE
The time around childbirth and the first day of life: acritical window of opportuni ty to prevent and managecomplications
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We can reduce the main causes of deathNewborn Survival Solutions 3 by 2
Preterm birth
1. Preterm labor management including antenatal corticosteroids*2. Care including Kangaroo mother care, essential newborn care
Birth complications (and intrapartum stillbirths)1. Prevention with obstetric care *2. Essential newborn care , and resuscitation*
Neonatal infections1. Prevention, essential newborn care especially breastfeeding,
Chlorhexidine where appropriate*2. Case management of neonatal sepsis *
1
2
3
* Prioritised by the UN Commission on Life Saving Commodities for Women and Children
Over two-thirds of newborn deaths preventable actionablenow without intensive care
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CRITICAL NEWBORN INTERVENTIONS
1. Management of pre-term birth2. Skilled care at birth3. Basic Emergency Obstetric Care4. Comprehensive Emergency Obstetric Care5. Basic Newborn Care6. Neonatal resuscitation7. Kangaroo mother care for premature and small babies
8. Treatment of severe infections9. Inpatient supportive care for sick and small newborns
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Types of WHO Guidelines
Rapid advice guidelines: response to a public health emergency
Standard guidelines guidance in relation to a change in practice or controversy in a
single clinical or policy area
Full guidelines complete coverage of a health topic or disease
Compilations of guidelines contains current recommendations from WHO and other
sources, but does not include any new recommendations
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ENGAP Consultation| Dakar, Senegal | 9 - 11 Jul y 20137 |
Guidance by Levels of Care
Primary Level(PCPNC)
Community:Preventive/Promotive, Follow-up
(Care of Newborn at Home)
1 st Referral Level(MCPC, Pocket Book)
2nd Referral Level(MNP)
Low rik> 37 wks
Risks34 - 36 wks
Risks< 34 wks
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Management of Preterm Birth
Birth preparednessDetection of complications and initialmanagementManagement of:
Use of antenatal corticos teroids Pre-ecclampsia/ecclampsia
Preterm labour
(Preterm) prelabour rupture of membranes (p)PROM
C-sectionsStandard guidelines in development
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Skilled Care at Birth
Routine and emergency care for womenand newborns during labour and delivery
Use of the partograph
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Emergency Obstetric Care
Basic EmOC: routine and emergency care for womenand newborns during pregnancy, labourand delivery, and postpartum
Comprehensive EmOC : Managing complications in pregnancy
and childbirth
Assist vaginal delivery
C-sections
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ENGAP Consultation| Dakar, Senegal | 9 - 11 Jul y 201311 |
Basic Newborn Care
Routine and emergency care for womenand newborns during labour and delivery,postpartumFocus on cleanliness, warmth, andfeeding Standard guidelines: Care of the newbornimmediately after birth
Immediate drying and additional stimulation
Cord clamping
Skin-to-skin contact in the first hour of life Initiation of breastfeeding
Vitamin K prophylaxis
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Cord Care
Daily chlorhexidine (4%) application to the umbilical cord stump duringthe first week of life is recommended for newborns who are born athome in settings with high neonatal mortality (neonatal mortality rate>30 per 1000).
Clean, dry cord care is recommended for newborns born in health
facilities, and at home in low neonatal mortality settings. Use of chlorhexidine in these situations may be considered only to replaceapplication of a harmful traditional substance such as cow dung to thecord stump.
(Strong situational recommendation, moderate quality evidence) Postnatalcare guidelines for the mother and the newborn, 2013 (under review byWHO GRC)
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Optimizing Health Worker Rolesfor Maternal and Newborn Health
Who to do what
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Newborn Health Recommendation
Only GRC recommendationsreleased after 2008
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Thank you