BASIC NEW BORN CARE & RESUSCITATION PROGRAM AN OVERVIEW “AADIGURU” Early Intervention Centre Wright Town - Jabalpur.

BASIC NEW BORN CARE &BASIC NEW BORN CARE &

RESUSCITATION PROGRAMRESUSCITATION PROGRAM

AN OVERVIEWAN OVERVIEW

““AADIGURU” AADIGURU” Early Intervention CentreWright Town - Jabalpur

Worldwide distribution of child deaths

Each dot represents 5000 deaths Lancet 2003

India is epicenter of Childhood Mortality

9.7 million < 5 yrs deaths annually world over

India 2.1 million (21%)

1 million newborns die

1 million newborns die

annually in India

annually in India

Neonatal deaths and the Millennium Development Goal 4

Millennium Development Goal 4 can only be achieved if neonatal deaths are addressed - missing from current programmes

050

100

150

Glo

bal

mo

rtal

ity

pe

r 10

00

bir

ths

1960 1980 2000 2020Year

Under-5 mortality rate

Late neonatal mortality

Early neonatal mortality

Target for

MDG-4

Rank State Neonatal mortality

rate (per 1,000 live births)

1 Chattishgarh 51.1

2 Jharkhand 48.6

3 Uttar Pradesh 47.6

4 Assam 45.5

5 Orissa 45.4

6 Madhya Pradesh 44.9

7 Rajasthan 43.9

8 Andhra Pradesh 40.3

9 Bihar 39.8

10 West Bengal 37.6

The first days of life are the riskiest Up to 50% of all NB deaths are on the

first day of life(500,000 babies in India dying on their birth day)

75% of NB deaths are in the first week

Leading causes of NB death

Severe Infections (36%)

Pre-Term Births (25%)

Birth asphyxia (23%).

Other Neonatal Causes (6%)

Neonatal Tetanus (4%)

Source: WHO World Health Statistics 2007 (India)

What can be done to save these newborn

lives now?

Neonatal Resuscitation :6-42% Breastfeeding :55-87% Prevention and management of

hypothermia :18-42%

Kangaroo Mother Care (LBW):incidence of infection :51% (7-75%)

Post Neonatal interventions - efficacy for reducing all cause of neonatal mortality

Birth Asphyxia Major cause of “Mortality” and “Stillbirth”

Major cause of short and long term

morbidity

Substantially treatable

Estimated Deaths due to Birth Asphyxia in India is

3 lacs per year

1 milli

on children w

ho survive birth asphyxia each year g

o

1 milli

on children w

ho survive birth asphyxia each year g

o

onto suffer c

erebral palsy and other d

isabilities

onto suffer c

erebral palsy and other d

isabilities

Birth Asphyxia – Decreased 60%

Mortality in delivery room - Decreased by 40%

Courtesy: Keenan W J for providing the slide

In rural Gadchiroli India interventions by the

trained VHW in basic newborn resuscitation

reduced case fatality in severe asphyxia by nearly

50% and asphyxia specific mortality rate by 65%

in comparison to management by TBA alone*

*Bang AT. Management of birth asphyxia in home deliveries in rural

Gadchiroli: the effect of two types of birth attendants and of

resuscitation with mouth-to-mouth, tube-mask or bag-mask. J Perinat

2005; S82-91.

Aim to have one NRP trained person attending every delivery ( > 27 millions deliveries /year in India )

Joint venture of IAP-AAP-LDSC Johnson and Johnson, India has agreed to provide academic grant

to train More than > 200,000 health professionals and workers in private sector in next 4 years

IAP’s initiative NRP FIRST GOLDEN MINUTE PROJECT

NRP FGM is not restricted to resuscitation

only

IAP has adopted NSSK manual of GOI

“Basic New born Care and Resuscitation

Program” which focuses on Resuscitation,

Prevention of Infection, Thermal Protection,

Feeding and Transport of Newborn

Participants like you are....

Learned Experienced Responsible Catering to NB care daily

Science is ever evolving / keeping abreast is the need of the hour

A new programme on Basic Newborn Care and Resuscitation, has been launched nationally by GoI to address important interventions of care at birth

Navjaat Shishu Suraksha Karyakram (NSSK)

GOI and IAP have signed a MoU for training

If the all essential interventions in “The Lancet Newborn Survival series” reached 90% of Indian women and

babies then 36-67% of newborn deaths could be prevented

Additional cost of $1.39 per capita per year

If we train more than 90% health personnel

attending institutional deliveries (41%) in

essential interventions ,an estimated 15 –

30 % reduction in NMR can be expected

There will be greater impact in states with

higher neonatal mortality

Primary causes of neonatal deaths in India Birth

asphyxia29%

Immaturity*23%

Infections 14%

Congenital malformation

s9%

Miscellaneous

25%

* Birth weight <750 g, hyaline membrane disease, intraventicular hemorrage

1 milli

on children w

ho survive birth asphyxia each year g

o

1 milli

on children w

ho survive birth asphyxia each year g

o

onto suffer c

erebral palsy and other d

isabilities

onto suffer c

erebral palsy and other d

isabilities

Averting neonatal death is pivotal to Averting neonatal death is pivotal to reduce child mortalityreduce child mortality

IAP’s Initiative

For improving Child Survival, Neonatal resuscitation Program

(NRP) with emphasis on management of First minute after birth is crucial.

Approach followed

Government Sector – Named as Navjat Shishu

Surakhsha Karyakram (NSSK) in partnership with

GOI

Private Sector – Named as First Golden Minute

(FGM). Supported by J & J.

NSSK

Launched on 15 Sep, 09 at Jaipur by hon’ble minister of Health Mr Ghulam Nabi Azad

Besides NRP, NSSK also includes Essential Newborn Care

• Breast Feeding

• Thermal Control – KMC

• Prevention of Sepsis

IAP is playing Key Role

Eval

uatio

n

Doc

umen

ts

Journey so far… Delhi

Bihar

Orissa

Jharkhand

Rajasthan

Madhya Pradesh

Uttar Pradesh

J & K

Haryana

Now Uttarakhand

40%

94%

54%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre Post % change

Performance Evaluation - Overall

Performance Evaluation Overall show improvement in skill levels to 94% for health experts from their pre training levels of 40%.

Basic Steps in Neonatal Resuscitation

Rarely Needed

Needed lessfrequently

Always needed

1%

10%

100%

Meds

Intubation and Chest

compressions

Ventilation withbag and mask

Initial steps to stimulate the baby to breathe

Assessment of baby and routine care

Basic

Advanced

Not only a project..

But ……

….a mission

NRP FGM