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AMTSL and ENC at birth

AMTSL and ENC at birth. Goldy Mazia & Indira Narayanan BASICS PPH Working Group Meeting Washington DC March 20,2008. Outline of Presentation. Burden of deaths in the early newborn period and the need to address it

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AMTSL and ENC at birth

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  1. AMTSL and ENC at birth Goldy Mazia & Indira Narayanan BASICS PPH Working Group Meeting Washington DC March 20,2008

  2. Outline of Presentation • Burden of deaths in the early newborn period and the need to address it • Key programmatic priorities for addressing newborn health and integration with maternal care • Linking AMTSL and ENC at birth

  3. 150 Under-5 mortality rate 100 Global mortality per 1000 births 50 0 1960 1980 2000 2020 Year Why Focus on Newborns? To achieve MDG 4 neonatal deaths must be addressed 1-60 mo. mortality < 1 mo. mortality (NMR) Present trend  MDG

  4. Direct Causes of Neonatal Mortality:Global Estimates The Lancet Series- Newborn Survival, 2005

  5. Up to 50% of neonatal deaths are in the first 24 hours 4 Million Newborn Deaths - When? 75% of neonatal deaths are in the first week – 3 million deaths Time when most babies die is when coverage of quality care is lowest

  6. Skilled Birth Attendants and NMR Source: WHO estimates 2000

  7. Mere presence of a skilled birth attendant is not sufficient Quality of care and an enabling or supportive environment are important • Skills/expertise (for both mother and baby) using rational, appropriate interventions • Supportive supervision of staff • Adequate appropriate drugs, equipment and supplies of suitable sizes and strengths with good maintenance • Appropriate referral center/system including appropriate transport Pre-service education must also improve

  8. Home to hospital continuum of care Pre-pregnancy to post partum Prevention to treatment - priority sepsis and asphyxia Where funds are limited: Prioritize key interventions with subsequent phasing in of other components Link with partners leveraging additional support Continuum of Care is Important Newborn health Maternal health Inf./Child health Adol. health School health

  9. Key Essential Newborn Care Components linked with maternal care

  10. Other Essential Interventions Family planning Special care for LBW Immunization Essential Maternal and Newborn Care Facility-Based Minimum Package • Minimum Package • Birth preparedness • Tetanus toxoid • Partograph • Infection prevention • Active mgt of 3rd • stage of labor • Newborn resuscitation • Cord care • Thermal care • Immediate & excl breastfeeding • Infection treatment Prophylactic Eye care Iron folate Adequate nutrition Basic EmOC Intermittent presumptive treatment for malaria Prevention of Mother-to-Child Transmission of HIV Iodine Syphilis detection and treatment Context-Specific Package

  11. USAID/BASICS/POPPHI: Integration of AMTSL and ENC 1.) Keep required items for mother & baby close by, load oxytocin in syringe 2.) Inform mother what is being planned at her level of understanding Receive and dry the baby, discard wet linen Baby cries well Place baby on mother’s abdomen Dry and cover with dry cloth Inform mother about baby & AMTSL; administer oxytocin Clamp cord when pulsations stop/2-3 min. after the birth Apply controlled cord traction + uterine massage Cry not heard Dry and wrap in fresh dry linen exposing chest. Keep warm. Assess breathing Not breathing/gasping/ breathing very slow Breathing well Cut cord; resuscitation and AMTSL or if no assistance, physiological management of 3rd stage Start AMTSL – Get help to observe baby Eye prophylaxis; tie the cord; warmth (skin-to-skin); initiate breastfeeding Monitoring + rest of routine care of mother & baby

  12. Integrating AMTSL and ENC at Birth: Challenges • It is at the same time of AMTSL that the newborn requires care immediately after birth • Integrated care may present as a “conflict of interests” where there is only one attendant • A trained second attendant should be available for AMTSL in case the newborn requires special attention (i.e. asphyxia requiring resuscitation).

  13. Care of the Newborn at Birth - Monitoring Assess the baby with the mother (as a part of AMTSL): • Every 15 minutes for first 2 hours • Every 30 minutes during the third hour • Every hour from hours 3 to 6 after birth Breathing • Regular breathing (30-50/min) • No difficulty (nasal flaring, grunting, chest in-drawing) Color • Lips and tongue, palms and soles should be pink • Blue palms and soles might mean the baby is cold Temperature • Normal axillary temperature is 36.50 to 37.50 C • Promote skin-to-skin to keep the baby warm Umbilical cord • Check for bleeding/oozing; retie if needed

  14. Dominican Republic- Clean Delivery Practices In 3 Hospitals

  15. Swaziland -Temperature maintenance at birth

  16. Swaziland - Breastfeeding in first hour (interviews of mothers)

  17. Through • Prioritization; phasing in of activities/interventions with continued expansion • Support to construct a strong, cost-effective, VISIBLE newborn strategy to link with maternal and child health programs • Addressing inequities, sustainability, scale and adequate coverage with adequate interventions Ultimate Goal is to Achieve the MDGs

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