The First Embrace:Action Plan for Healthy

Newborns in the Western Pacific Region (2014-2020)

Reproductive Health Affinity Group

26 June 2013

Dr Ornella Lincetto

Every 2 minutes, 1 newborn dies in the Western Pacific Region

209 000 neonatal deaths in the Western Pacific Region every year

1 represents 100 neonatal deaths WHO Global Health

Observatory, 2011

Newborns account for >50% of all under 5 deaths Cause of Deaths before 5 years of age

in the WHO Western Pacific Region (2010)

Source:WHO Global Health

Observatory 2010

(n= 467 000)

We must get it right from (24 hours around birth) the start: Age at death for Neonates (0-28 days)

0

5

10

15

20

25

30

35

0 1 2 3 4 5 6 7 8 9 1011 1213 14 1516 1718 19 2021 22 2324 2526 27 28

Days of life

Prop

orti

onal

mor

talit

y

What we do then affects the rest of the newborn's life

2 out of 3 newborn deaths occur in the 3 days of life

WHO, 2012

Proportion of births assisted by a skilled birth attendant (2005-2011)

Reproductive AgeAntenatal

period

Adolescent

School age

Preschool

Continuum of the Life Cycle

Intra-partumDeliveryImmediate Newborn•First Embrace•Care for LBW/Preterm•Care for Sick Newborn

Postneonatal

Lateneonatal

Enhancing overall efforts on maternal and child health by focusing on a weak link

You are Li Yu (mom) and baby girl Lin Lin’s health professional.

What practices do you do that protect or place Lin Lin at risk?

WHO Western Pacific Regional Office

After Lin Lin is born, you should call out the time (to mins and secs) of birth, then what?

After Lin Lin is born, you should call out the time (to mins and secs) of birth, then what?

Lin Lin Has Needs

• To breathe normally

• To be warm• To be protected• To be fed

Immediate Thorough Drying

• Stimulates Lin Lin to Breathe• Prevents hypothermia

• If Lin Lin gets cold, she could get: – Infection– Coagulation defects– Acidosis– Delayed fetal to newborn circulatory adjustment– Hyaline membrane disease– Brain hemorrhage

Tunell R., in Improving Newborn Health in Developing Countries, A. Costello and D. Manandhar, Editors. 2000, Imperial College Press: London, UK. p. 207-220;Tollin M,et al.. Cell Mol Life Sci 2005

During drying and stimulation, your rapid assessment shows Lin Lin is crying.

What is your next action?

FIRST, DO NO HARM

• Do NOT suction Lin Lin unless her mouth/nose are blocked by secretions

During drying and stimulation, your rapid assessment shows Lin Lin is crying.

What is your next action?

7 billionth babies

WHO Western Pacific Regional Office

Skin-to-Skin Contact

Separated from mother

Skin-to-Skin ContactContributes to:• Warmth• Bonding• Successful breastfeeding/colostrum feeding• Stimulate the mucosa-associated lymphoid tissue

system• Calmness• Protection from hypoglycemia• Colonization with maternal skin flora

Moore Cochrane Rev, 2012

Anderson Cochrane Rev, 2005

Brandtzaeg. Ann N Y Acad Sci, 2002

WHO Western Pacific Regional Office

Delayed cord clamping

Term babies have less • Anemia

– RR 0.2 (95% CI 0.06, 0.6)

Preterms have less• Anemia requiring transfusion

– RR 0.6 (95% CI 0.5, 0.8)

• Intraventricular hemorrhage – RR 0.6 (95% CI 0.4, 0.9)

• Necrotizing Enterocolitis – RR 0.6 (95% CI 0.4, 0.9)

Ceriani Cernadas, 2006Rabe, Coch Rev, 2012

WHO Western Pacific Regional Office

How long after birth is Lin Lin ready to breastfeed?

How long after birth is Lin Lin ready to breastfeed?

• Drooling • Mouth Opening• Tonguing, Licking, • Biting Hand

Feeding CuesLin Lin may want to rest for 20-30 mins and even up to 120 minutes before showing signs of readiness to feed

What is the approximate capacity of Lin Lin’s stomach (when she was born)?

A

BC

D

A

BC

D

What is the approximate capacity of Lin Lin’s stomach (when she was born)?

If this benefits babies,

Skin-to-Skin Contact Separated from mother

Why is this so common?

Immediate drying, delayed cord clamp

Immediate cord clamp, delayed drying, suction

No one intends to harm newborns; but many common

practices are harmful

Priority interventions of EENC

WHO, 2013

Vision: A healthy start for every newborn

Mission: To strengthen the health system to cultivate an enabling environment where skilled providers of newborn care value and practice Essential Early Newborn Care (EENC) at every birth.

Action Plan

To eliminate preventable newborn mortality by providing universal access to high quality Early Essential Newborn Care.

Target 1: At least 80% of facilities where births take place are fully implementing EENC by 2020 in all member states.

Target 2: At least 90% of deliveries in all sub-national areas attended by a skilled birth attendant by 2020 in all member states.

Target 3a: National NMR 10 per 1000 live births or less by 2020.Target 3b: Sub-national NMR 10 per 1000 live births or less by 2020.

Regional Goal

Framework of Strategic Actions

SA1. Ensure consistent adoption and implementation of Early Essential Newborn Care (EENC).

Operational objectives:

1.1. To ensure EENC has been incorporated into national and sub-national health agendas, plans, budgets and financing mechanisms

1.2. To enable providers of newborn care to practice EENC at every delivery by providing appropriate system support and training

1.3. To ensure EENC has been incorporated into clinical protocols, quality improvement cycles and

accreditation mechanisms

1.4. To scale up centres of excellence implementing EENC

SA2. Improve political and social support to ensure an enabling environment for Early Essential Newborn Care (EENC)

Operational objectives:

2.1. To mobilize political commitment and social support of key stakeholders for policies, programmes and

services for the implementation of EENC

2.2. To strengthen legislation, regulations, and enforcement to meet international standards to support implementation of EENC

SA3. Ensure availability, access, and use of skilled birth attendants and essential maternal and newborn commodities in a safe environment.

Operational objectives:

3.1. To ensure availability of a skilled birth attendant for every delivery

3.2. To ensure availability of equipment, supplies and essential medicines in safe environments in routine and emergency situations

SA4. Engage and mobilize community to increase demand.

Operational objectives:

4.1. To increase community demand for skilled birth attendance and the EENC

SA5. Improve the availability and quality of perinatal information.

Operational objectives:

5.1. To strengthen capacity of routine information systems collect accurate data on perinatal

health

5.2. Improve collection and use of data on perinatal health and practices through research, surveys, and audits

Let’s

give a

healthy start for every newborn