Helping Babies Survive - resus.org.au · Helping Babies Survive . Susan Niermeyer MD, ... • Care...
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Helping Babies Survive Susan Niermeyer MD, MPH University of Colorado Aurora, Colorado, USA
Transcript of Helping Babies Survive - resus.org.au · Helping Babies Survive . Susan Niermeyer MD, ... • Care...
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Helping Babies Survive
Susan Niermeyer MD, MPH
University of Colorado Aurora, Colorado, USA
Presenter
Presentation Notes
Thanks to Prof. Morley, and my colleagues in Neonatal ILCOR – Prof Helen Lily and Dr. Lindsay Mildenhall, for the opportunity to talk about global newborn survival. This is not the mainstream world of CPR and cardiac arrest – rather it is ventilatory support to prevent and reverse asphyxia, prevention of hypothermia, prevention of sepsis and shock. The great advantage to neonatal resuscitation is the very high rate of successful outcomes with basic interventions. Extending the capacity to achieve those successful outcomes to resource-limited areas of the world is now the focus to end preventable deaths.
Helping Babies Survive – the big picture objectives
• Understand the importance of newborn survival to global child survival
• Know when, where, and why newborns die • Describe the Every Newborn Action Plan goals
to reduce stillbirth, newborn, maternal death • Identify successful interventions and
challenges to improving newborn survival
Under-5 child mortality 45% of deaths occur in the neonatal period
2.7 million neonatal deaths and 2.6 million stillbirths per year worldwide
WHO, Levels and Trends in Child Mortality, 2015
Presenter
Presentation Notes
Globally neonatal mortality is the largest contributor to under-5 child mortality. Nearly half of under-5 child deaths occur in the first 28 days of life. This amounts to nearly 3 million neonatal deaths each year and not even counted in child mortality figures – another estimated 2.6 million stillbirths – approximately 45% of those occurring during the intrapartum period.
Vision for Every Newborn Action Plan A world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children thrive and reach their full potential
Lawn JE Lancet 2014 www.thelancet.com/series/everynewborn
When newborns are dying time of highest risk the same for newborns, stillbirths, women
Birth is the time of greatest risk of death and disability Triple return on investment
1.2 million intrapartum stillbirths
>1 million neonatal deaths
~113,000 maternal deaths
75% neonatal deaths
Birth day
Where newborns are dying
1 2
Countries with highest neonatal mortality rates
Central African Republic (40.9) Mali (41.5) Pakistan (42.2) DR Congo (43.5) Lesotho (45.3) Angola (45.4) Guinea Bissau (45.7) Somalia (45.7) Sierra Leone (49.5)
Countries with highest numbers of neonatal deaths
1. India (779,000) 2. Nigeria (267,000) 3. Pakistan (202,400) 4. China (157,400) 5. DR Congo (118,100) 6. Ethiopia (87,800) 7. Bangladesh (75,900) 8. Indonesia (72,400) 9. Angola (41,200) 10. Kenya (40,000)
Lawn JE Lancet 2014 www.thelancet.com/series/everynewborn
Why newborns are dying 3 major causes of neonatal mortality
Severe Infections
Intrapartum-related complications
Complications from low weight and preterm birth
Presenter
Presentation Notes
So to that end, Helping Babies Survive directly targets the 3 major causes of neonatal mortality. First, intrapartum-related complications (asphyxia) – in its simplest definition, a baby who fails to breathe or sustain effective breathing at birth. Until recently, in resource-limited settings, there were few interventions for asphyxia, because resuscitation was really equated with intensive care. Complications from low birthweight and preterm birth- taken together now represent the leading cause of neonatal death (hypothermia, inadequate feeding) Third, severe infections, often resulting in late neonatal mortality, represent a clear target for prevention as well as treatment. So, many of these causes of neonatal death can be addressed with available interventions and are preventable.
Ending preventable newborn and child deaths
Source: Lancet Every Newborn series, paper 2
From 2.9 to 0.8 million neonatal deaths About 29 countries will have to more than double their rates of progress
Sub national equity goals should also be set
A Promise Renewed target:
National U5MR of 20 or less
Every Newborn target: National NMR of 10 or less
Presenter
Presentation Notes
US neonatal mortality rate 3/1000 and IMR 6-7/1000, with MS and AB 8/1000
Source: Lancet Every Newborn series, paper 2
From 2.6 to 1.1 million stillbirths Aligned with NMR target
Sub national equity goals should also be set
Every Newborn target National stillbirth rate of 10 or less
Ending preventable stillbirths
Lancet GH Sept 2013 : The Lancet Global Health 2013; 1:e176-e177 (DOI:10.1016/S2214-109X(13)70059-7)
Global average MMR of 70 per 100,000 With different targets for different countries
Ending preventable maternal deaths
Preterm birth • Antenatal corticosteroids, preterm labor management • Care including essential newborn care + Kangaroo mother
care
Birth complications
(and intrapartum stillbirths)
• Prevention by skilled attendance and obstetrics • Care including essential newborn care + resuscitation
Neonatal infections
• Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate
• Case management of neonatal sepsis with antibiotics
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* Prioritised by the UN Commission on Life Saving Commodities for Women and Children
71% of newborn deaths preventable actionable now without intensive care
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The three main causes of newborn deaths all have effective and feasible interventions = 3 by 2
Presenter
Presentation Notes
We know how to reduce the main causes of neonatal death We have the knowledge and tools to reduce at least two-thirds of these deaths. In 2012, PMNCH issued its consensus on essential interventions for RMNCH – those commodities and services proven to save lives of women and children. In 2013, we have heard from the UN Commission on Life-Saving Commodities for Women and Children, which highlight the importance of greater advocacy and action on corticosteroids, chlorohexidine, injectable antibiotics and resuscitation equipment to prevent newborn deaths. We need to work together, across all constituencies, to deliver these solutions at scale and drive greater public demand for essential newborn care. Risk factors for preterm birth Lifestyle – smoking, alcohol, work, environmental smoke exposure For each of the main causes of death there are prevention and management evidence based solutions. This slides shows examples of some of these solutions.
Helping Babies Breathe 2nd Edition Action Plan
Helping Babies Breathe
• Action Plan • Facilitator Flip Chart • Learner Workbook • Neonatal Simulator • Bag and Mask • Suction Device
Presenter
Presentation Notes
The full educational package includes the Action Plan, a Facilitator Flip Chart which amplifies every step of the Action Plan for the learner and serves as an instructor manual for the facilitator, and the Learner Workbook, which serves as a guide to skills practice, case scenarios, and group discussion to identify potential barriers to implementation and ways to overcome them. All materials are freely available from the AAP digital resource center or in print format, and can be not only translated but adapted to conform to specifics of national guidelines. At the core of the educational program is a set of training and clinical devices – a water-filled neonatal simulator that has the weight and tone of a baby who needs resuscitation and shows the 3 cardinal evaluation signs of crying, breathing, and heart rate. A simplified ventilation bag and mask, and a re-usable bulb suction both can be disassembled and highly disinfected. User feedback has recently prompted development of an upright ventilation bag which facilitates a mask seal and even easier cleaning. Education and clinical equipment are delivered simultaneously so learning can be immediately put into practice. The simulator is made available at cost in LMIC to make it available in delivery facilities for ongoing practice (more on that later).
Continuation of learning in the clinical setting
The Formula for Survival patient survival is the product of three important factors
Søreide E et al. Resuscitation 2013;84:1487-93
Medical Science
Educational Efficiency
Local Implementation
Survival
Presenter
Presentation Notes
So, if we think of neonatal survival as the product of three important factors – in Helping Babies Survive, we can deliver the best medical science with improved educational efficiency - but what about the third factor of implementation?
Are all babies dried thoroughly immediately after birth?
Do all babies have the airway cleared for visible secretions or obstruction only?
Is umbilical cord clamping delayed for at least 1 minute?
Are all babies placed skin-to-skin with the mother after drying?
Do all babies who do not breathe after stimulation receive bag and mask ventilation by 1 minute?
Is equipment prepared and checked before every delivery?
Using the Action Plan to create change
Presenter
Presentation Notes
The Action Plan can be used to define important process and outcome measures. Observations point out the gaps in care and the team decides on what steps need emphasis and practice
Msemo G et al. Pediatrics 2013; 131:e353
Tanzania: change in survival
Intrapartum stillbirth
24 hr mortality
Impact of training, practice, quality improvement - Nepal
KC A et al. Pediatrics 2016; 137 (6):e2 0150117
intrapartum stillbirth 1st day mortality
12 10 8 6 4 2 0
Mor
talit
y pe
r 100
0 bi
rths
Helping Babies Breathe implementation in over 80 countries
Essential Care for Every Baby
Presenter
Presentation Notes
In addition to the Action Plan, Flipchart and Provider Guide, there is a new element – the Parent Guide.
Essential Care for Every Baby Parent Guide
Ethiopia Field Testing with WHO – Addis Abbaba, May 2014
Essential Care for Small Babies
Presenter
Presentation Notes
Essential Care for Small Babies is the third educational module; it develops the concept of the well, small baby – one without breathing problems, but with a requirement for special care in order to remain healthy.
Helping Babies Survive addressing 3 major causes of neonatal mortality
Severe Infections
Intrapartum-related complications
Complications from preterm birth
HBB: Basic resuscitation
ECSB: Continuous skin-to-skin care Alternative feeding methods Hygiene Recognition of problems
ECEB: Hygiene, cord care Skin-to-skin contact Exclusive breastfeeding Recognition of danger signs, antibiotic treatment
Lawn et al http://www.nature.com/pr/journal/
In low income countries the major challenge is still survival BUT in middle income countries scaling up more complex neonatal care must
DO NO HARM
Beyond newborn survival where you are born predicts your survival and risk of disability
Challenges to sick newborn care
Challenges to sick newborn care
Clinical services • feeding • thermal support • Infection prevention/mgt • oxygen/respiratory care Facility design and function Management and finance Data systems Referral, transport, communication
Every Newborn Action Plan changing the landscape for newborn health
Every Newborn
Action Plan World Health
Assembly 2014
Every Newborn Progress Reports
2015 & 2016
National Newborn Action Plans 2014: 2 countries 2016: 17 countries
Presenter
Presentation Notes
Either new national plan or strengthened NB in national RMNCH Plans Afghanistan Angola Bangladesh Burma Cameroon China Ethiopia Ghana India Indonesia Kenya Nepal Philippines Tanzania Uganda Vietnam Zimbabwe
Helping Babies Survive
www.everynewborn.org hbs.aap.org
Presenter
Presentation Notes
Our common goal of ending preventable death.
