Coverage of the WHO’s four essential elements of newborn care and their association with neonatal survival in southern Nepal

Abstract Background Despite recent improvements in child survival, neonatal mortality continues to decline at a slower rate and now represents 47% of under-five deaths globally. The World Health Organization developed core indicators to better monitor the quality of maternal and newborn health services. One such indicator for newborn health is “the proportion of newborns who received all four elements of essential care”. The four elements are immediate and thorough drying, skin to skin contact, delayed cord clamping, and early initiation of breastfeeding. Although there is existing evidence demonstrating an association with decreased neonatal mortality for each element individually, the cumulative impact has not yet been examined. Methods This analysis uses data from a randomized trial to examine the impact of sunflower versus mustard seed oil massage on neonatal mortality and morbidity in the Sarlahi district in Southern Nepal from 2010 to 2017. The proportion of newborn infants receiving an intervention was the exposure and neonatal mortality was the outcome in this analysis. Neonatal mortality was defined as a death between three hours and less than 28 days of age. Associations between neonatal mortality and the essential elements were estimated by Cox proportion hazards models. The hazard ratios and corresponding 95% confidence intervals were reported. Results 28,121 mother-infant pairs and 753 neonatal deaths were included. The percent receiving the individual elements ranged from 19.5% (skin to skin contact) to 68.2% (delayed cord clamping). The majority of infants received one or two of the elements of essential care, with less than 1% receiving all four. Skin to skin contact and early initiation of breastfeeding were associated with lower risk of neonatal mortality (aHR = 0.64 [0.51, 0.81] and aHR = 0.72 [0.60, 0.87], respectively). The risk of mortality declined as the number of elements received increased; receipt of one element compared to zero was associated with a nearly 50% reduction in risk of mortality and receipt of all four elements resulted in a 72% decrease in risk of mortality. Conclusions The receipt of one or more of the four essential elements of newborn care was associated with improved neonatal survival. The more elements of care received, the more survival improved.

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Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03421-w ◽

2021 ◽

Vol 21 (S1) ◽

Cited By ~ 2

Author(s):

Tazeen Tahsina ◽

◽

Aniqa Tasnim Hossain ◽

Harriet Ruysen ◽

Ahmed Ehsanur Rahman ◽

...

Keyword(s):

Newborn Care ◽

Health Indicators ◽

Newborn Health ◽

Public Hospitals ◽

Maternal And Newborn Health ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Improve Measurement ◽

Immediate Newborn Care ◽

Skin To Skin

Abstract Background Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. “Every Newborn Birth Indicators Research Tracking in Hospitals” (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. Methods The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women’s exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. Results Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8–21.0). Survey-reported (53.2, 95% CI 39.4–66.8) and register-recorded results (85.9, 95% CI 58.1–99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5–93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3–73.5%) and drying (7.3–29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5–3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. Conclusions Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.

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A Pilot Study To Assess Thecurrent Practices Of Immediate Newborn Care For Term Newborns In Relation To Early Skin-To-Skin Contact And Delayed Cord Clamping Among Health Personnel Of Labour Room.

Nursing and Midwifery Research Journal, ◽

10.33698/nrf0223 ◽

2017 ◽

Author(s):

Banrikordor Khyriem, ◽

V Venkadalkshmi, ◽

Avinash Kaur Rana

Keyword(s):

Pilot Study ◽

Health Personnel ◽

Newborn Care ◽

Delayed Cord Clamping ◽

Skin Contact ◽

Cord Clamping ◽

Immediate Newborn Care ◽

Term Newborns ◽

Labour Room ◽

Skin To Skin

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Practices of obstetricians regarding early mother‐to‐newborn skin‐to‐skin contact, early initiation of breastfeeding and delayed cord clamping

The FASEB Journal ◽

10.1096/fasebj.24.1_supplement.556.6 ◽

2010 ◽

Vol 24 (S1) ◽

Author(s):

Khadija Begum ◽

Kathryn G. Dewey

Keyword(s):

Early Initiation ◽

Delayed Cord Clamping ◽

Early Initiation Of Breastfeeding ◽

Skin Contact ◽

Cord Clamping ◽

Skin To Skin ◽

Initiation Of Breastfeeding

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Pulse oximetry in newborns with delayed cord clamping and immediate skin-to-skin contact

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2013-305484 ◽

2014 ◽

Vol 99 (4) ◽

pp. F309-F314 ◽

Cited By ~ 48

Author(s):

Marrit Smit ◽

Jennifer A Dawson ◽

Angelina Ganzeboom ◽

Stuart B Hooper ◽

Jos van Roosmalen ◽

...

Keyword(s):

Pulse Oximetry ◽

Delayed Cord Clamping ◽

Skin Contact ◽

Cord Clamping ◽

Skin To Skin

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Center-Based Experiences Implementing Strategies to Reduce Risk of Horizontal Transmission of SARS-Cov-2: Potential for Compromise of Neonatal Microbiome Assemblage

10.1101/2021.01.07.21249418 ◽

2021 ◽

Author(s):

Joann Romano-Keeler ◽

Dana Fiszbein ◽

Jilei Zhang ◽

Joseph Horowitz ◽

Karen Hayani ◽

...

Keyword(s):

Neonatal Intensive Care ◽

Horizontal Transmission ◽

Perinatal Transmission ◽

Neonatal Intensive Care Units ◽

Delayed Cord Clamping ◽

Average Hospital ◽

Skin Contact ◽

Cord Clamping ◽

Hospital Stays ◽

Skin To Skin

Perinatal transmission of COVID-19 is poorly understood and many neonatal intensive care units' (NICU) policies minimize mother-infant contact to prevent transmission. We present our unit's approach and ways it may impact neonatal microbiome acquisition. We attending COVID-19 positive mothers' deliveries from March-August 2020. Delayed cord clamping and skin-to-skin were avoided and infants were admitted to the NICU. No parents' visits were allowed and discharge was arranged with COVID-19 negative family members. Maternal breast milk was restricted in the NICU. All twenty-one infants tested negative at 24 and 48 hours and had average hospital stays of nine days. 40% of mothers expressed breastmilk and 30% of infants were discharged with COVID-19 negative caregivers. Extended hospital stays, no skin-to-skin contact, limited maternal milk use, and discharge to caregivers outside primary residences, potentially affect the neonatal microbiome. Future studies are warranted to explore how ours and other centers'with similar policies influence this outcome.

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Predictors for timely initiation of breastfeeding after birth in the hospitals of Nepal- a prospective observational study

International Breastfeeding Journal ◽

10.1186/s13006-021-00431-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Rejina Gurung ◽

Avinash K. Sunny ◽

Prajwal Paudel ◽

Pratiksha Bhattarai ◽

Omkar Basnet ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Public Hospitals ◽

Obstetric Complication ◽

Timely Initiation ◽

Skin Contact ◽

Cord Clamping ◽

Skin To Skin ◽

Timely Initiation Of Breastfeeding ◽

Initiation Of Breastfeeding

Abstract Background Timely initiation of breastfeeding can reduce neonatal morbidities and mortality. We aimed to study predictors for timely initiation of breastfeeding (within 1 h of birth) among neonates born in hospitals of Nepal. Method A prospective observational study was conducted in four public hospitals between July and October 2018. All women admitted in the hospital for childbirth and who consented were included in the study. An independent researchers observed whether the neonates were placed in skin-to-skin contact, delay cord clamping and timely initiation of breastfeeding. Sociodemographic variables, obstetric and neonate information were extracted from the maternity register. We analysed predictors for timely initiation of breastfeeding with Pearson chi-square test and multivariate logistic regression. Results Among the 6488 woman-infant pair observed, breastfeeding was timely initiated in 49.5% neonates. The timely initiation of breastfeeding was found to be higher among neonates who were placed skin-to-skin contact (34.9% vs 19.9%, p - value < 0.001). The timely initiation of breastfeeding was higher if the cord clamping was delayed than early cord clamped neonates (44.5% vs 35.3%, p - value < 0.001). In multivariate analysis, a mother with no obstetric complication during admission had 57% higher odds of timely initiation of breastfeeding (aOR 1.57; 95% CI 1.33, 1.86). Multiparity was associated with less timely initiation of breastfeeding (aOR 1.56; 95% CI 1.35, 1.82). Similarly, there was more common practice of timely initiation of breastfeeding among low birthweight neonates (aOR 1.46; 95% CI 1.21, 1.76). Neonates who were placed skin-to-skin contact with mother had more than two-fold higher odds of timely breastfeeding (aOR 2.52; 95% CI 2.19, 2.89). Likewise, neonates who had their cord intact for 3 min had 37% higher odds of timely breastfeeding (aOR 1.37; 95% CI 1.21, 1.55). Conclusions The rate of timely initiation of breastfeeding practice is low in the health facilities of Nepal. Multiparity, no obstetric complication at admission, neonates placed in skin-to-skin contact and delay cord clamping were strong predictors for timely initiation of breastfeeding. Quality improvement intervention can improve skin-to-skin contact, delayed cord clamping and timely initiation of breastfeeding.

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Misalignment of global COVID-19 breastfeeding and newborn care guidelines with World Health Organization recommendations

BMJ Nutrition, Prevention & Health ◽

10.1136/bmjnph-2020-000184 ◽

2020 ◽

pp. bmjnph-2020-000184

Author(s):

Duong Vu Hoang ◽

Jennifer Cashin ◽

Karleen Gribble ◽

Kathleen Marinelli ◽

Roger Mathisen

Keyword(s):

Psychological Health ◽

Newborn Care ◽

Early Initiation ◽

Psychological Support ◽

World Health ◽

Early Initiation Of Breastfeeding ◽

Skin Contact ◽

Guidance Documents ◽

Skin To Skin ◽

Initiation Of Breastfeeding

IntroductionRecommendations for the clinical management of new mothers with suspected or confirmed COVID-19 and their infants are required. Guidance must weigh the risk posed by transmission of SARS-CoV-2 against the protection that maternal proximity and breastfeeding provide infants. Our aim was to review international COVID-19 guidance for maternal and newborn care, assessing alignment with WHO recommendations and the extent to which policy supported or undermined breastfeeding.MethodsGuidance documents from 33 countries on the care of infants whose mothers were suspected or confirmed as having COVID-19 were assessed for alignment with WHO recommendations regarding: (1) skin-to-skin contact; (2) early initiation of breastfeeding; (3); rooming-in; (4) direct breastfeeding; (5) provision of expressed breastmilk; (6) provision of donor human milk; (7) wet nursing; (8) provision of breastmilk substitutes; (9) psychological support for separated mothers; and (10) psychological support for separated infants.ResultsConsiderable inconsistency in recommendations were found. Recommendations against practices supportive of breastfeeding were common, even in countries with high infant mortality rates. None of the guidance documents reviewed recommended all aspects of WHO guidance. The presence of influential guidance conflicting with WHO recommendations and an undervaluing of the importance of maternal proximity and breastfeeding to infant health appeared to contribute to this poor alignment.ConclusionThose developing guidance in the COVID-19 pandemic and other infectious disease outbreaks need to appropriately consider the importance of skin-to-skin contact, early initiation of breastfeeding, rooming-in and breastfeeding to maternal and infant physical and psychological health. In weighing the value of recommendations of others in future guidance development, countries should consider past reliability and value placed on breastfeeding. Recommendations against maternal proximity and breastfeeding should not be made without compelling evidence that they are necessary, and less harmful than maintaining dyad integrity.

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Neonatal care practices in Buikwe District, Uganda: a qualitative study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03699-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marte Bodil Roed ◽

Ingunn Marie Stadskleiv Engebretsen ◽

Robert Mangeni

Keyword(s):

Health Workers ◽

Post Partum ◽

Newborn Care ◽

Neonatal Care ◽

Sub Saharan Africa ◽

Cord Clamping ◽

Care Practices ◽

Sub Saharan ◽

Skin To Skin ◽

User Perspectives

Abstract Background Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births. Methods The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis. Results The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care. Conclusions Continued focus on systemic strategies for further implementation of the UCG is recommended.

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Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-021431 ◽

2018 ◽

Vol 8 (12) ◽

pp. e021431 ◽

Cited By ~ 2

Author(s):

Maria Alexsandra Silva Menezes ◽

Ricardo Gurgel ◽

Sonia Duarte Azevedo Bittencourt ◽

Vanessa Eufrazino Pacheco ◽

Rosana Cipolotti ◽

...

Keyword(s):

Health Facility ◽

Breast Feeding ◽

Perinatal Care ◽

Newborn Care ◽

Health Facilities ◽

Cross Sectional ◽

Essential Newborn Care ◽

Skin Contact ◽

Postnatal Women ◽

Skin To Skin

ObjectivesTo assess the use of the WHO’s Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure.DesignA cross-sectional observational health facility assessment.SettingThis is a secondary analysis of the ‘Birth in Brazil’ study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (secondary and tertiary level of care).ParticipantsData on 23 894 postnatal women and their newborn babies were analysed.Main outcome measuresThe facility structure was assessed by evaluating the availability of medicines and equipment for perinatal care, a paediatrician on call 24/7, a neonatal intensive care unit (NICU) and kangaroo mother care. The use of each ENC item was assessed according to the health facility structure and the mothers’ sociodemographic characteristics.ResultsThe utilisation of ENC items is low in Brazil. The factors associated with failure in pregnant woman reference were: pregnant adolescents (ORadj1.17; 95% CI 1.06 to 1.29), ≤7 years of schooling (ORadj1.47; 95% CI 1.22 to 1.78), inadequate antenatal care (ORadj1.67; 95% CI 1.47 to 1.89). The non-use of corticosteroids was more frequently associated with the absence of an NICU (ORadj3.93; 95% CI 2.34 to 6,66), inadequate equipment and medicines (ORadj2.16; 95% CI 1.17 to 4.01). In caesarean deliveries, there was a less frequent use of a partograph (ORadj4,93; 95% CI 3.77 to 6.46), early skin-to-skin contact (ORadj3.07; 95% CI 3.37 to 4.90) and breast feeding in the first hour after birth (ORadj2.55; 95% CI 2.21 to 2.96).ConclusionsThe coverage of ENC technologies use is low throughout Brazil and shows regional differences. We found a positive effect of adequate structure at health facilities on antenatal corticosteroids use and on partograph use during labour. We found a negative effect of caesarean section on early skin-to-skin contact and early breast feeding.

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