Near 750,000 newborns lives could be saved every year with specific interventions for small and sick newborns.
In order to achieve SDG 3 (to ensure healthy lives and promote well-being for all at all ages) focus is needed in improving care for every newborn, mainly in those who are born small (from prematurity or intrauterine growth restriction) or become ill. These babies are at high risk of dying or becoming disabled; an estimated 1 million of survivors in this group survive with a long-term disability.
Approximately 80% of the 2.5 million newborn deaths globally every year, are in low-birth-weight (LBW); two thirds of deaths happen in those born prematurely. Care in facilities for newborns is needed for the most common conditions, such as complications from prematurity, intrapartum brain injury, severe bacterial infection, pathological jaundice, and congenital conditions.
deaths every year happen in low birth weight babies
deaths happen in premature babies (less than 37 completed weeks of gestation) every year globally
newborns require care in facilities every year around the world
What can be done?
Where is the improvement in care most needed?
Ninety-eight percent of neonatal deaths occur in low and middle-income countries, with 75% occurring in Southern Asia and sub-Saharan Africa. Of the 10 countries with the highest NMRs, eight are in Africa, where the majority have experienced a recent humanitarian crisis. In humanitarian settings, pregnant and post-partum women face enormous challenges to access care for themselves and for their newborns. These women are also at risk for malnutrition, sexual violence, poor mental health and unplanned pregnancies, as well as those related to births with no skilled attendants.
In high-income countries (HICs), the neonatal mortality rate is usually low, and most small newborns survive and thrive. In middle-income countries (MICs), the risk of disability for infants born between 28 and 32 weeks of gestation is nearly double that of HICs, due to deficiencies in the quality of care. In low-income countries (LICs), disability is uncommon since the smallest and sickest newborns, usually die due to lack of access to essential care or more advanced care when needed.
What is the care needed?
Most newborns can survive and thrive when good quality health care, including appropriate inpatient care, is available. In order to provide appropriate care for small and sick newborns, LMICs require improvements in inpatient care to reduce mortality and avoid long-term complications. High-quality inpatient care requires an adequate space, competent professionals in all areas, and equipment and supplies to deliver the care. All newborns require essential care, particularly at the time of birth and during the first days of life, whether in a health facility or at home. Most small and sick newborns require special inpatient care, which can only be provided in a health facility. Intensive care in a high-level facility is only required by a third of sick newborns. In addition, the linkages between obstetric and neonatal services need to be protected and strengthened. The Survive and Thrive report provides a list of in-patient interventions proven effective in preventing newborn mortality and disability, by each level of care.
Inpatient care for small and sick newborns must be mother-newborn dyad centered and available 24/7. The principles of family-centered care should be included in training health care staff, in order to enable health workers to interact proactively with family members from the beginning of the inpatient experience and help build their confidence and skills to continue care after discharge.
The Nurturing Care Framework for ECD
The Nurturing Care Framework for Early Childhood Development, launched by WHO, UNICEF and the World Bank Group, demonstrates that focusing on ECD is one of the wisest investments a country can make to boost economic growth. Nurturing care is the provision of a stable environment that promotes children’s health and nutrition and interactions that are responsive, emotionally supportive, and developmentally stimulating, while providing protection from threats.
Neurosensory development begins in-utero and is responsive to positive and negative influences in the external environment from the time of birth. Hence early life exposure to hostile environment, including stress is linked to decreased brain density, with longer term effects on learning outcomes, newborns who are small — preterm, have low birth weight or are small for their gestational age — and / or are sick — from infections, intrapartum related complications and pathological jaundice — are at heightened risk of neurodevelopmental delays and disabilities.
Traditional inpatient care facilities expose vulnerable newborns to excess sound and light conditions in the units, potential harm from unsafe oxygen use, separation of the mother-infant dyad, including parental stress and negative psychological effects, delayed feeding and difficulties breastfeeding that can persist after discharge. Of the 13 million preterm newborns who survive globally each year, an estimated 2.7% have moderate to severe impairments and 4.4% have mild neurodevelopmental impairments.
Nurturing care for small and sick newborns is possible. Several evidence-based interventions can create a healing physical and sensory environment. Some of these include Family Centered Care that allows for non-separation of the mother from her newborn; Kangaroo Care; the Baby-friendly hospital initiative that supports the mother for breastmilk feeding, and safety and security through infection prevention and control, judicious use of antibiotics, and safe oxygen use when needed.
Use of data for action
Countries are required to improve the measurement of the care of small and sick newborns, and their later development and health in order to achieve the goal of ending all preventable deaths by 2030.
It is of utmost importance to collect and analyze data on coverage and quality of care, including long-term outcomes in the most at-risk. In order to guide programs and investments, the continuous monitoring of data on quality of care is a key element for better results for newborns survival and thriving.
It is also important to establish good measurement for innovations implemented in LMICs for the care of high-risk newborns. Some examples are lower cost and less sophisticated technologies, such as bubble CPAP (continuous positive airway pressure), or innovative implementation approaches, such as task-shifting roles for various cadres of health workers.
Cost of care and return on investment
The Survive and Thrive report mentions that the increased investment by LMICs to improve access to inpatient quality care for small and sick newborns is currently at US$ 0.20 per person and US$ 1,700 per newborn death averted. The investment in health and development of all newborns, providing a good start in the life cycle, and in particular for the most at-risk, will potentially increase economic development in such countries.
ENAP and next steps
The Every Newborn Action Plan set out concrete goals regarding newborn mortality in general and the care for small and sick newborns specifically: “By 2025, at least 75% of newborns will be resuscitated if needed; will receive kangaroo mother care (KMC) and other supportive care; and will receive antibiotic therapy if needed. In addition, country-specific targets will be set for comprehensive neonatal intensive care.” Appropriate action needs to be taken globally so small and sick newborns can survive and thrive. With strategic partnerships and innovative approaches, the international community can transform all aspects of neonatal care, expanding coverage and enhancing impact.
As a new community of practice, the Care of the Small and Sick Newborn CoP (SSNB CoP), is an interactive platform that allows practitioners and experts to exchange ideas, share lessons learned, disseminate and discuss implementation research results and evidence in the area of newborn health.
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