By Stephen Hodgins, MD
Senior technical advisor, Saving Newborn Lives, Save the Children
Breastfeeding and thermal care are particularly potent determinants of newborn survival. Yet both have received disproportionately little program attention. Save the Children’s Saving Newborn Lives program has published a pair of evidence briefs on early initiation of breastfeeding and thermal care of newborns, which present the epidemiologic argument for increased prioritization of these issues. The briefs address two key elements of “essential newborn care” – important routine care practices that should be provided to all babies regardless of whether they are born at home or in a facility.
Exclusive breastfeeding through 6 months of age, followed by continued breastfeeding supplemented with complementary feeds has long been promoted as a core child-survival intervention. The importance of early initiation of breastfeeding – within no more than one hour after birth – has received less attention but is a critical practice for increasing the probability of newborn survival, particularly for those born very small. The evidence shows that the longer the wait, the higher the risks. The brief recommends the following:
- In settings where many births occur at home: Different strategies may be pursued depending on the setting. Antenatal care is an important opportunity to reach women, to inform them of the important benefits of breastfeeding. Other opportunities including community health worker outreach and pregnant women’s groups. These contacts can also be used to distribute health education materials addressing breastfeeding and other aspects of essential newborn care.
- For facility births: A universally observed practice should be that babies be given to their mothers to initiate breastfeeding as early as is feasible. Quality improvement efforts focused on labor and delivery should include attention to ensuring early initiation (along with optimal thermal care practices, discussed below).
While hypothermia (low body temperature) may be a sign of systemic infection, it is also a consequence of care practices and an important risk condition for newborns. Risk of hypothermia is especially high for newborns due to their wet skin and the cooler environment immediately after delivery and in the first hours of life. Very small babies, having a high surface-area-to-body-mass ratio, are even more vulnerable to evaporative heat loss. At the same time, particularly during the first 12 hours after birth, newborns have limited ability to generate and conserve heat, especially if they’re preterm. The increased risk of heat loss at the very time when one is least able to generate and conserve heat is a risky combination. The evidence presented in this brief demonstrates that the thermal care components of essential newborn care are critically important to prevent hypothermia and lower mortality and morbidity risks.The brief recommends that for both home and facility births, we need to aim for the following:
- At birth: Immediate drying, promptly placing the baby skin-to-skin on the mother’s chest, covering and putting the baby to the breast. Any time it is necessary that the baby be exposed, this should be under a radiant heat lamp, maintaining the “warm chain.”
- Over the first day of life: Maximize time spent skin-to-skin, delay bathing, minimize time spent exposed.
- For very small newborns: Continue maximizing time spent skin-to-skin, with careful attention to avoid chilling, through the first week of life and beyond.