CARE OF THE LOW BIRTHWEIGHT BABIES /NEONATAL INTENSIVE CARE AGGREY WASUNNA Division Of Neonatal...

ASADI V ACCRA GHANA NOV 9 - 11 2009

CARE OF THE LOW BIRTHWEIGHT BABIES /NEONATAL INTENSIVE CARE

AGGREY WASUNNADivision Of Neonatal Medicine

Department of Paediatrics & Child HealthUniversity of Nairobi

ASADI V ACCRA GHANA NOV 9 - 11 2009

ASADI V ACCRA GHANA NOV 9 - 11 2009

BACKGROUND

• Under five mortality rates are declining while NMRs remain stagnant in Sub-Saharan Africa

• Globally there are 130 million live births with 4 million neonatal deaths (NND)

• 99% of the NND occur in developing countries• Low birthweight (LBW) babies account for

about 80% of NND• Poor record keeping hampers improvement of

care

ASADI V ACCRA GHANA NOV 9 - 11 2009

CASE FOR CARE OF LBW BABIES

• Reducing NMRs will help in achieving MDG4• Care for the LBW babies has a huge impact in

reducing NMRs• Lots of resources needed to care for LBW

babies but availability follows the “Inverse Care Law” (Hart 1971)

ASADI V ACCRA GHANA NOV 9 - 11 2009

COST EFFECTIVE MEASURES OF CARE

- Appropriate resuscitation /respiratory care- Prevention of hypothermia- Feeding and prevention of hypoglycemia- Prevention of infectionsIs there a place for Neonatal Intensive Care?

ASADI V ACCRA GHANA NOV 9 - 11 2009

Reduction (%) In All Cause Neonatal Mortality or Morbidity

• Resuscitation of the Newborn 6 – 42%• Breastfeeding 55 – 87%• Prevention/Management of Hypothermia 18 – 42%• Kangaroo Mother Care ( LBW ) reduces incidence of infection by 7 – 75%• Community based Pneumonia case Management 18 – 35%

Adapted from Darmstadt GL et al 2005;Lancet 365: 977 - 988

ASADI V ACCRA GHANA NOV 9 - 11 2009

APPROPRIATE RESUSCITATION /RESPIRATORY CARE

• Perinatal asphyxia a major cause of neonatal morbidity and mortality especially among LBW babies

• Appropriate neonatal resuscitation has been shown to prevent perinatal asphyxia

ASADI V ACCRA GHANA NOV 9 - 11 2009

• Adequate resuscitation requires Birth preparedness Presence of competent personnel Presence of working basic equipment

• Studies have shown that lower cadre health workers can be trained to provide adequate resuscitation

• Treatment modalities of established perinatal asphyxia are often costly and need expertise

ASADI V ACCRA GHANA NOV 9 - 11 2009

PREVENTION AND MANAGEMENT OF HYPOTHERMIA

• Hypothermia is associated with complications resulting in neonatal morbidity and mortality

• LBW babies most affected• Hypothermia can be prevented through

Warming the room, drying and wrapping the baby Frequent feeding Skin to skin care Incubators /semi permeable plastic sheets

• Kangaroo Mother Care (KMC) Easy to implement Reduces infection /severe illness Promotes breastfeeding with better weight gain

ASADI V ACCRA GHANA NOV 9 - 11 2009

APPROPRIATE FEEDING AND PREVENTION OF HYPOGLYCAEMIA

• Hypoglycaemia is common among the LBW babies

• The magnitude of the impact not clear due to the paucity of data in Developing countries

• Early initiation and frequent feeds important• Breastmilk is ideal: promotes ketogenesis and

has low insulinogenic effect

ASADI V ACCRA GHANA NOV 9 - 11 2009

• Fortification of breastmilk should be considered as appropriate

• Vitamin and mineral supplementation are important for optimal growth

ASADI V ACCRA GHANA NOV 9 - 11 2009

INFECTION CONTROL

• Neonatal infections contribute about 8-80% of NND

• LBW babies are particularly prone to getting infected

• Neonatal infections can be reduced through Avoiding overcrowding Strict policy of clean hands

ASADI V ACCRA GHANA NOV 9 - 11 2009

• Colonising babies with maternal organisms• Promoting breastfeeding• KMC• Limiting use of antibiotics • Clean equipment

ASADI V ACCRA GHANA NOV 9 - 11 2009

• Monitoring bacterial culture and sensitivity• Visiting policy / parent education• Well trained staff

ASADI V ACCRA GHANA NOV 9 - 11 2009

NEONATAL INTENSIVE CARE

ASADI V ACCRA GHANA NOV 9 - 11 2009

NEONATAL INTENSIVE CARE

• Expensive to set up• Running costs high• Has an overall low impact on LBW babies

survival• Found mainly in Level 6 teaching/referral

hospitals

ASADI V ACCRA GHANA NOV 9 - 11 2009

ASADI V ACCRA GHANA NOV 9 - 11 2009

CONCLUSION

• Care of LBW babies in resource restricted countries still depends on cost effective preventive measures

• Prevention of perinatal asphyxia,Hypothermia, infection together with appropriate feeding have significant impact in reducing LBW morbidity/mortality

• NICU is out of reach for most Sub-Saharan countries with little impact on NMRs

ASADI V ACCRA GHANA NOV 9 - 11 2009

THANK YOU