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CARE OF THE LOW BIRTHWEIGHT BABIES /NEONATAL INTENSIVE CARE AGGREY WASUNNA Division Of Neonatal Medicine Department of Paediatrics & Child Health University of Nairobi ASADI V ACCRA GHANA NOV 9 - 11 2009
BACKGROUND • Under five mortality rates are declining while NMRs remain stagnant in Sub-Saharan Africa • Globally there are 130 million live births with 4 million neonatal deaths (NND) • 99% of the NND occur in developing countries • Low birthweight (LBW) babies account for about 80% of NND • Poor record keeping hampers improvement of care ASADI V ACCRA GHANA NOV 9 - 11 2009
CASE FOR CARE OF LBW BABIES • Reducing NMRs will help in achieving MDG4 • Care for the LBW babies has a huge impact in reducing NMRs • Lots of resources needed to care for LBW babies but availability follows the “Inverse Care Law” (Hart 1971) ASADI V ACCRA GHANA NOV 9 - 11 2009
COST EFFECTIVE MEASURES OF CARE • Appropriate resuscitation /respiratory care • Prevention of hypothermia • Feeding and prevention of hypoglycemia • Prevention of infections Is there a place for Neonatal Intensive Care? ASADI V ACCRA GHANA NOV 9 - 11 2009
Reduction (%) In All Cause Neonatal Mortality or Morbidity • Resuscitation of the Newborn 6 – 42% • Breastfeeding 55 – 87% • Prevention/Management of Hypothermia 18 – 42% • Kangaroo Mother Care ( LBW ) reduces incidence of infection by 7 – 75% • Community based Pneumonia case Management 18 – 35% Adapted from Darmstadt GL et al 2005;Lancet 365: 977 - 988 ASADI V ACCRA GHANA NOV 9 - 11 2009
APPROPRIATE RESUSCITATION /RESPIRATORY CARE • Perinatal asphyxia a major cause of neonatal morbidity and mortality especially among LBW babies • Appropriate neonatal resuscitation has been shown to prevent perinatal asphyxia ASADI V ACCRA GHANA NOV 9 - 11 2009
Adequate resuscitation requires • Birth preparedness • Presence of competent personnel • Presence of working basic equipment • Studies have shown that lower cadre health workers can be trained to provide adequate resuscitation • Treatment modalities of established perinatal asphyxia are often costly and need expertise ASADI V ACCRA GHANA NOV 9 - 11 2009
PREVENTION AND MANAGEMENT OF HYPOTHERMIA • Hypothermia is associated with complications resulting in neonatal morbidity and mortality • LBW babies most affected • Hypothermia can be prevented through • Warming the room, drying and wrapping the baby • Frequent feeding • Skin to skin care • Incubators /semi permeable plastic sheets • Kangaroo Mother Care (KMC) • Easy to implement • Reduces infection /severe illness • Promotes breastfeeding with better weight gain ASADI V ACCRA GHANA NOV 9 - 11 2009
APPROPRIATE FEEDING AND PREVENTION OF HYPOGLYCAEMIA • Hypoglycaemia is common among the LBW babies • The magnitude of the impact not clear due to the paucity of data in Developing countries • Early initiation and frequent feeds important • Breastmilk is ideal: promotes ketogenesis and has low insulinogenic effect ASADI V ACCRA GHANA NOV 9 - 11 2009
Fortification of breastmilk should be considered as appropriate • Vitamin and mineral supplementation are important for optimal growth ASADI V ACCRA GHANA NOV 9 - 11 2009
INFECTION CONTROL • Neonatal infections contribute about 8-80% of NND • LBW babies are particularly prone to getting infected • Neonatal infections can be reduced through • Avoiding overcrowding • Strict policy of clean hands ASADI V ACCRA GHANA NOV 9 - 11 2009
Colonising babies with maternal organisms • Promoting breastfeeding • KMC • Limiting use of antibiotics • Clean equipment ASADI V ACCRA GHANA NOV 9 - 11 2009
Monitoring bacterial culture and sensitivity • Visiting policy / parent education • Well trained staff ASADI V ACCRA GHANA NOV 9 - 11 2009
NEONATAL INTENSIVE CARE ASADI V ACCRA GHANA NOV 9 - 11 2009
NEONATAL INTENSIVE CARE • Expensive to set up • Running costs high • Has an overall low impact on LBW babies survival • Found mainly inLevel 6 teaching/referral hospitals ASADI V ACCRA GHANA NOV 9 - 11 2009
CONCLUSION • Care of LBW babies in resource restricted countries still depends on cost effective preventive measures • Prevention of perinatalasphyxia,Hypothermia, infection together with appropriate feeding have significant impact in reducing LBW morbidity/mortality • NICU is out of reach for most Sub-Saharan countries with little impact on NMRs ASADI V ACCRA GHANA NOV 9 - 11 2009
THANK YOU ASADI V ACCRA GHANA NOV 9 - 11 2009