Professional Documents
Culture Documents
Severin von Xylander WHO Department of Maternal, Newborn, Child and Adolescent Health (MCA)
The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this presentation and they do not necessarily represent the decisions, policy or views of the World Health Organization.
Rationale Transpose Born Too Soon (BTS) recommendations in the existing implementation framework of the MNCH continuum of care Identify health system requirements by level of care
2 | Global Newborn Conference 2013, Johannesburg | 16 April 2013
Objective
Ensuring women at risk for preterm birth and prematurely born babies get the right care, at the right time, by the right team and in the right place What should be provided? When should it be provided? Who should provide it? Where should it be provided What is needed (commodities)?
3 | Global Newborn Conference 2013, Johannesburg | 16 April 2013
Models of Care
Defines the way in which health services should be delivered Outlines evidence-based practice throughout the continuum of care at different levels of care Identifies and guides implementation during pregnancy and childbirth and care for the preterm Based on existing evidence and guidelines, intervention outcomes and consultation with key stakeholders at global level Includes guidance on interventions (what), provider competencies (who) and health service delivery level (where)
What: Interventions
Antenatal and delivery care for all pregnant women Essential newborn care for all babies Additional care for women at risk of preterm birth Additional care for preterm babies
Key Elements
Second referral level tertiary level Operational categorization by gestational age and birth weight groups Decision Trees for Preterm Labour and Preterm Birth Health systems requirements: Human Resources, supplies, medicine & technologies Simplified Reporting Categories (Dimension of productivity / benchmarking) Minimum level of services
6 | Global Newborn Conference 2013, Johannesburg | 16 April 2013
First (primary level) community / home Referral-level /small hospital (secondary level) Second referral-level / regional hospital (tertiary level)
* These are practical birth weight ranges that roughly correspond to the expected birth weight in the at proposed ranges of gestational age and to facilitate decision making and statistical reporting if gestational age is not known
Additional Interventions for Women at Risk of Preterm Labour and Preterm Babies
Gestation (Completed Weeks)
Guidance on medical indications for induction of labour or caesarean section Tocolytics to slow down preterm labour, provide for corticosteroid effect and allow transfer if appropriate (KEY)
<37 <34 X
Primary
X X
Community with follow-up if: Weight >1.8-2kg Infant can suck & swallow & breastfeed effectively Maintain temperature in normal range 3637C
Refer to 1st level facility for Feeding support for baby & KMC if feeding difficulty and/or temperature instability
Thermal protection provided during transfer with skin to skin Reliable transport is available Infection control measures in place Contact made to referral centre
Primary (including outreach, target level for normal birth and minimum additional support needed)
Health professionals trained to proficiency in skills to: Manage normal labour and delivery Recognize & initiate treatment of complications Essential newborn care including basic neonatal resuscitation Basic emergency obstetric and newborn care Outpatient management of sick newborns Follow-up care of preterm babies
Doctors competent in newborn care (24 hour presence or on call) Nurses/midwives competent in newborn care (24 hour presence or on call) Comprehensive emergency obstetric and newborn care
Doctors and nurses/midwives with specialized competency in the care of high risk pregnancies & preterm newborns present 24 hours a day (shifts) Obstetricians Paediatricians with neonatal skills or neonatologists Nurses with neonatal nursing skills Access to individuals within specific clinical & diagnostic sub-specialities or professionals with competencies in maternal & newborn care: anaesthesiology, surgery, ophthalmology, intensive care, cardiology, radiology, laboratory services, audiology, nutrition & pharmacy Data collection system for obstetric & newborn statistics
Avenue:
Detailed descriptions of the factors to consider Benchmarking (Case studies)
<28
28 800 - 1500
29
30
31
32
33
34
35
36 1950 - 3300
37 2150 - 3450
38 2350 - 3600
39 2500 - 3700
40 2600 - 3800
41 2650 - 3850
900 - 1600 1000 - 1750 1150 - 1950 1250 - 2150 1400 - 2450 1550 - 2750 1700 - 3050
Recommendations for management of common childhood conditions: evidence for technical update of pocket book recommendations: newborn conditions, dysentery, pneumonia, oxygen use and delivery., common causes of fever, severe acute manutrition and supportive care (2012). Guidelines on optimal feeding of low-birth-weight infants in low- and middle-income countries (2011). Guidelines on basic newborn resuscitation (2012).
*In the community and health systems level including: Promotion of antenatal and skilled delivery for all women, counselling on birth preparedness and emergency/complication readiness planning, smoking cessation and exposure to other pollutants, reduction of violence against women, monitoring and referral of women with danger sighs/complications,
counselling on essential newborn care, referral for danger signs and very LBW if born at home
Levels of Care: 1 Primary care (normal maternity care with basic emergency obstetric care available) First referral-level care (Comprehensive emergency obstetric care available + ANCS, KMC and 2 feeding support) 3 Second referral-level care (Leve 2 + specialized services)
Risks 34 - 36 wks
1st Referral Level (MCPC, Pocket Book) Primary Level (PCPNC) Community: Preventive/Promotive, Follow-up (Care of Newborn at Home)
Thank you