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Priorities in neonatal care in developing countries
1Department of Neonatology 1 Kandang Kerbau Hospital, Singapore.
Insights
Developing countries need to prioritize neonatal care with limited resources. Essential steps include collecting perinatal data, training staff in resuscitation, preventing infections, and implementing simple interventions like warming devices and nasal continuous positive airway pressure (nCPAP).
Area of Science:
- Neonatal Medicine
- Public Health
- Perinatology
Background:
- Developed countries have reduced perinatal and neonatal mortality through advanced neonatal care, technology, and improved understanding of newborn pathophysiology.
- Organized delivery room care, skillful resuscitation, risk identification, and infant transport (including in utero transfer) contribute to lower mortality rates.
- Developing countries face resource limitations, hindering the attainment of similar outcomes and necessitating a prioritized approach to neonatal care.
Purpose of the Study:
- To highlight the challenges and propose essential strategies for improving neonatal care in resource-limited developing countries.
- To emphasize the importance of data collection, standardized terminology, and trained personnel for effective perinatal health planning.
- To outline key interventions for reducing neonatal mortality, focusing on preventable causes like infections and birth asphyxia.
Main Methods:
- Review and synthesis of established neonatal care practices and their applicability in resource-constrained settings.
- Emphasis on data collection for problem definition, monitoring, auditing, and evaluation of perinatal health.
- Recommendations for standardized terminology, staff training, infection control, and essential interventions.
Main Results:
- Prioritization of neonatal care is crucial in developing countries due to resource constraints.
- Collecting minimum meaningful perinatal data is essential for defining problems and planning health strategies.
- Key interventions include skilled resuscitation, infection prevention (hand hygiene, aseptic techniques, isolation), maintaining body temperature, blood glucose monitoring, antenatal steroids, and utilizing devices like nasal continuous positive airway pressure (nCPAP).
Conclusions:
- Effective neonatal care in developing countries requires strategic prioritization of resources and interventions.
- Standardized data collection and terminology are vital for comparative studies and effective health planning.
- Preventing nosocomial infections and ensuring skilled resuscitation are paramount to reducing neonatal mortality and morbidity.
Abstract:
Lower perinatal and neonatal mortality have been achieved in the developed countries following advancement of neonatal care, introduction of high technologies, and better knowledge of pathophysiology of the newborn infants. Other contributing factors are organised delivery room care with skillful resuscitative techniques as well as risk identification and efficient transport of the sick infants including in utero transfer of the fetus, etc. It cannot be assumed that similar results can be attained in developing countries where financial and human resources are the problems. With limited resources, it is necessary to prioritize neonatal care in the developing countries. It is essential to collect minimum meaningful perinatal data to define the problems of each individual country. This is crucial for monitoring, auditing, evaluation, and planning of perinatal health care of the country. The definition and terminology in perinatology should also be uniform and standardised for comparative studies. Paediatricians should be well trained in resuscitation and stabilisation of the newborn infants. Resuscitation should begin in the delivery room and a resuscitation team should be formed. This is the best way to curtail complication and morbidity of asphyxiated births. Nosocomial infections have been the leading cause of neonatal deaths. It is of paramount importance to prevent infections in the nursery. Staff working in the nursery should pay attention to usage of sterilised equipment, isolation of infected babies and aseptic procedures. Paediatricians should avoid indiscriminate use of antibiotics. Most important of all, hand-washing before examination of the baby is mandatory and should be strictly adhered to. Other simpler measures include warming devices for maintenance of body temperature of the newborn babies, blood glucose monitoring, and antenatal steroid for mothers in premature labour. In countries where neonatal jaundice is prevalent, effective management to prevent kernicterus is essential. Simple assisted ventilatory device such as nasal continuous positive airway pressure (nCPAP) is also useful.