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How to save newborns from complications, death

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*UNICEF, WHO say 2.5m die yearly, 30m in dire need of treatment
*Early caffeine therapy has no negative effects on brain development

A new report by a global coalition that includes the United Nations Children Education Fund (UNICEF) and the World Health Organisation (WHO) has outlined how to save sick and premature newborns from complications and death.

According to the report, Survive and Thrive: Transforming care for every small and sick newborn, the lives of 2.5 million newborns lost yearly and that of another 30 million that are sick, premature and prone to major complications could be saved with specialized care.

The report, published yesterday, found that among the newborn babies most at risk of death and disability are those with complications from prematurity, brain injury during childbirth, severe bacterial infection or jaundice, and those with congenital conditions. Additionally, the financial and psychological toll on their families can have detrimental effects on their cognitive, linguistic and emotional development.

According to the report, without specialized treatment, many at-risk newborns would not survive their first month of life. In 2017, some 2.5 million newborns died, mostly from preventable causes. Almost two-thirds of babies who die were born premature. And even if they survive, these babies face chronic diseases or developmental delays. In addition, an estimated 1 million small and sick newborns survive with a long-term disability.

With nurturing care, these babies can live without major complications. The report shows that by 2030, in 81 countries, the lives of 2.9 million women, stillborns and newborns can be saved with smarter strategies. For example, if the same health team cares for both mother and baby through labour, birth and beyond, they can identify problems early on.

In addition, almost 68 per cent of newborn deaths could be averted by 2030 with simple fixes such as exclusive breastfeeding; skin-to-skin contact between the mother or father and the baby; medicines and essential equipment; and access to clean, well-equipped health facilities staffed by skilled health workers. Other measures like resuscitating a baby who cannot breathe properly, giving the mother an injection to prevent bleeding, or delaying the cutting of the umbilical cord could also save millions.

To save newborns, the report recommends:
*Providing round-the-clock inpatient care for newborns seven days a week.
*Training nurses to provide hands-on care working in partnership with families.
*Harnessing the power of parents and families by teaching them how to become expert caregivers and care for their babies, which can reduce stress, help babies gain weight and allow their brains to develop properly.
*Providing good quality of care should be a part of country policies, and a lifelong investment for those who are born small or sick.

*Counting and tracking every small and sick newborn allows managers to monitor progress and improve results.
*Allocating the necessary resources, as an additional investment of US$ 0.20 cents per person can save two of every three newborns in low- and middle-income countries by 2030.

According to the report, almost three decades ago, the Convention on the Rights of the Child guaranteed every newborn the right to the highest standard of health care, and it is time for countries around the world to make sure the legislative, medical, human and financial resources are in place to turn that right into a reality for every child.

Meanwhile, in neonatal intensive care units, or NICUs, premature babies born under 29 weeks are given a daily dose of caffeine to ensure the best possible start to life. A new study by University of Calgary, Alberta, Canada, researchers shows the earlier the dose of caffeine can be given, the better.

The findings are published in Pediatrics.“Caffeine is the most commonly used drug in the NICU after antibiotics,” says Dr. Abhay Lodha, MD, associate professor in the departments of Paediatrics and Community Health Sciences at the Cumming School of Medicine and staff neonatologist with Alberta Health Services (AHS). “It’s important that we understand the long-term effects of caffeine as a treatment and ensure these babies are not only surviving, but have quality of life down the road.”Born prematurely at 27 weeks at the Foothills Medical Centre, Kyle and Avril Strachan’s baby, Anna, was given caffeine to help her breathe and boost lung function.

“The doctors told us, with premature babies, their brain hasn’t developed quite enough to let them do all the things their bodies should be doing on its own, like breathing,” says mom Avril. “In the first few weeks, when Anna was feeding, she would slow down or even forget to breathe. This would cause her heart to slow and for her to not get enough oxygen.”

To help her breathe more easily, Anna needed a continuous positive airway pressure, or CPAP, machine to deliver constant airflow to her lungs.

A 2014 study by Lodha showed starting caffeine therapy within two days after birth shortened the amount of time babies needed to use ventilators. It also reduced the risk of bronchopulmonary dysplasia (BPD), a form of chronic lung disease caused by damage to the lungs from use of a ventilator. What was not known was how that dose of caffeine affected brain development.

Lodha collaborated with researchers from the Universities of British Columbia, Montreal, Toronto and Mount Sinai Hospital in Toronto to analyze data from 26 NICUs across Canada. They found early caffeine treatment has no long-term negative effects on neurodevelopment, and is actually associated with better cognitive scores, and reduced odds of cerebral palsy and hearing impairment.

The team examined data from follow-up assessments conducted at age 18 to 24 months. During these follow-ups, children were assessed for their cognitive, language and motor development using the Bayley Scales of Infant and Toddler Development, a standardized scoring system to assess developmental functioning in infants and toddlers.

“We look at how children are constructing their understanding, such as solving simple problems or figuring out three-dimensional objects and toys,” says Dr. Dianne Creighton, PhD, research assistant professor in the Department of Paediatrics and retired psychologist with AHS. “We also assess how the little ones are able to understand simple words, or recognize the name of a picture, as well as their motor skills like climbing, crawling, balance and co-ordination.”

Lodha says it is believed that caffeine may increase the growth of dendrites, the small branches of a neuron that receive signals from other neurons. “Caffeine may also improve better lung stretch and expansion, cardiac output and blood pressure in premature infants, which improves oxygen supply throughout the body and brain, reducing the duration of mechanical ventilation and the risk of chronic lung disease and injury on the developing brain.”

Now two years old, Anna has completed multiple follow-up assessments and is participating in dance classes, gymnastics lessons and swimming like a fish, says her mom Avril.

“She’s very mechanical. She likes to build things, take it apart and figure out how it works,” she says. “It’s wonderful to know that the caffeine treatment has no adverse effects and that if researchers are getting positive findings, it should continue to be the standard of care for premature babies. In that case, I think parents would have no hesitation in having caffeine as part of their child’s treatment.”


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