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Neonatal Services – Potential for the Pacific PMA Meeting 2013

Neonatal Services – Potential for the Pacific PMA Meeting 2013. Johan Morreau Pediatrician Rotorua Hospital. Background / Reflections. Prevention of Disability Improved Survival Basic functions of a Pediatric Service WHO Millenium Goals

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Neonatal Services – Potential for the Pacific PMA Meeting 2013

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  1. Neonatal Services – Potential for the PacificPMA Meeting 2013 Johan Morreau Pediatrician Rotorua Hospital

  2. Background / Reflections • Prevention of Disability • Improved Survival • Basic functions of a Pediatric Service • WHO Millenium Goals • The last 20 years in NZ have seen significant improvements in Level 2 care – largely nursing based improvements and enabling increased numbers of babies to be safely cared for in Level 2 units • This level of service is possible in the South Pacific

  3. How do I know ? • Western Samoa – 6/12 in 1983. Looked after pediatric department there. Ben -2 years old

  4. Personal Experience in NZ • 1984 – present ,General Pediatrician Rotorua Hospital which has a Level 2 neonatal service (1600-1800 deliveries annually) • Early 2000 + - designed the “Extended Neonatal Nurse” role and nursing based (no junior doctors) Level 2 neonatal system that has been implemented at North Shore Hospital, Auckland. • This was based on a similar system that I’d seen in action in Colorado, USA 1989

  5. Extended Neonatal Nurse Role • Neonatal Resuscitation • Assessment /Examination • Bubble CPAP • IVI fluids (including procedures) • NG feeding • Standing orders eg IV fluids, Antibiotics • Patient and family focussed nursing (not task)

  6. Rotorua

  7. Personal Experience via NZ -Vietnam Health Trust • 2001 – current - Binh Dinh Province , Vietnam – evolving / developing their Level 0 , 1 and 2 and 3 neonatal services • Significant improvements in care • Significant decrease in hospital perinatal mortality statistics (with increase in workload and inclusion of deaths following discharge) • 2003 % mortality 14.56 • 2013 % mortality 6.3 • ? Significant decrease in morbidity , disability

  8. Key Success Factors 1 1. Senior Medical and Nursing Administrators want it • Request from Peoples Committee = Government for assistance • Binh Dinh Department of Health commitment and Vision – Dr Hung Deputy Director,Department of Health • Medical Leadership of Hospital share the “vision”

  9. Photos

  10. Key Success Factors 2 Commitment to dedicated permanent staffing – medical and nursing (includes budget!) Commitment to Nurse Leadership and Nurse Educator roles Equipment Good infection Control System

  11. Key Success Factors 3 Educational , Advisory support available • NZ Vietnam Health Trust commitment - ongoing • NZ AID Support • NZ VSA Nurse Educators and midwives with 2 year attachments on site • Education experiences in NZ for Ministry of Health (to generate vision) plus staff

  12. Photos

  13. Neonatal Service linkage to Maternity Adjacent Facility Relationships • Sharing of skills • Clarification of responsibilities eg neonatal resuscitation • Audit / Quality activities together

  14. Vietnam equipment supplier appropriate for developing world KSE Medical, Hanoi • Reusable and cleanable bubble CPAP equipment • Syringe drivers • Phototherapy units • Resuscitation trays/ incubators • Pulse Oximetry • http://ksemedical.com/

  15. Equipment examples

  16. Vision for Pacific 1 • Commitment to staffing and facility from government , ministries(only worth starting if there is commitment at Government and Ministry level) • Maintain focus on nursing as a stable workforce supported by doctors • Education via NZAID, RACP, Neonatal nursing groups – facilitated by Pasifika Medical association • Equipment – AID funding

  17. Vision 2 • Level 2 Neonatal Units in place • 24 / 7 Nursing providing resuscitation service to maternity • Trained medical and nursing staffing in place • Maternity and Neonatal Services are planned and work very closely together • Primary care midwives are all competent neonatal resuscitators who have needed equipment and can stabilize baby’s for safe transfer • Step 1 - Capacity to care well for > 32/40 • Step 2 - Capacity to care well for > 28-30/40

  18. Vision 3 • Bubble CPAP based ventilation and IV fluids • NG Tube feeding of Expressed Breast Milk • Careful Antibiotic Use (Reduce resistant organisms) • Appropriate Phototherapy • Improved perinatal mortality/morbidity +++ • Audit

  19. Additionally – easy to do’s • Newborn Metabolic Screening

  20. Questions/Discussion

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