New Frontiers in Newborn Health:

1. New Frontiers in Newborn Health: Stephen Wall, MD SM Senior Research Manager Saving Newborn Lives Save the Children

2. Prevent and improve care for low birth weight infants • Prevent LBW by controlling maternal antenatal infections (eg, IPT for malaria) • Mali • Adapt and expand use of KMC in facilities and community settings • Zimbabwe, Malawi, India • Test community-based KMC to reduce neonatal mortality • Bangladesh

3. Prevent and improve recognition and management of newborns’ infections • Identify primary agents of newborn infection in community settings • Bangladesh • Develop sensitive and specific diagnostic algorithms for community workers to identify sick neonates in community settings • Ghana, South Africa, Bangladesh, Pakistan, Bolivia, India

4. Test new methods to provide antibiotic coverage to sick newborns in community-based settings (eg, uniject gentamicin) • Bangladesh • Examine strategies to utilize existing community-based workers to identify and improve antibiotic coverage for sick newborns • Nepal

5. Prevent and improve management of birth asphyxia • Develop and evaluate cost-effective community models of care for prevention and management of birth asphyxia • Identify feasible and cost-effective roles for community health workers, first-line health workers, and traditional birth attendants in reducing birth asphyxia

6. Develop valid indicators and methods for collecting data for monitoring impact of programs on asphyxia-related outcomes (neonatal death, neonatal encephalopathy, stillbirths)

7. Causes of Neonatal Mortality Source: WHO 2001 estimates (based on data collected around 1999)

8. “Tip of the Iceberg” Neonatal mortality due to Birth Asphyxia NE with handicap due to BA Stillbirths due to Birth Asphyxia

9. Potential strategies to address birth asphyxia at community level • Birth preparedness • Predicting need for emergency care • Training TBAs • HBNC by CHWs • Birthing centers/maternity waiting homes • Neonatal resuscitation • Perinatal death audit, verbal/social autopsy

10. What do we need to know? • Burden of asphyxia-related neonatal mortality and morbidity (local and global) • How much improvement in overall neonatal mortality might be expected by birth asphyxia interventions?

11. What are existing health services and local capacities for BA interventions? • Where do deliveries take place and who attends? • Obstacles and opportunities for improved care at delivery (eg, geographic, cultural, financial, quality)? • New roles for existing cadres of workers to improve prevention and management of birth asphyxia?

12. What is the estimated effect of selected interventions? • Neonatal resuscitation • Efficacy established (mouth-to-mouth, tube-mask, bag-mask), but cost-effectiveness in local contexts not certain • Are there new (or improved) cost-effective technologies? • Who can perform basic resuscitation? • Feasibility, program costs, sustainability, potential for bringing to scale?

13. How can new interventions for birth asphyxia be integrated into existing and future health systems? • Home-based care for newborns • TBAs (where SBA not available) • Community midwives • Maternity waiting homes • Referral systems and links to emergency obstetric services • Improving quality of care by SBA and facilities (eg, skilled personnel, equipped facilities)

14. What is cost-effectiveness of interventions to prevent and manage birth asphyxia? • Per neonatal life saved?

15. Birth Asphyxia: Current SNL Research • RFA: community-based interventions to improve prevention & management of BA • 27 concept papers • 3 proposals • Collaboration with WHO to develop tool to measure BA mortality and morbidity in communities and facilities • Stillbirth global review: numbers, risk factors, interventions