WHO-recommended newborn care cuts life-threatening infections by two thirds

A STUDY in Vietnam by the World Health Organization (WHO) shows that hospitals can reduce life-threatening infections in newborns by over two thirds and admissions to the neonatal intensive care unit (NICU) by one third by implementing Early Essential Newborn Care (EENC).

Published in EClinicalMedicine (The Lancet journal focussed on clinical and public health research), the study titled ‘Early Essential Newborn Care is associated with reduced adverse neonatal outcomes in a tertiary hospital in Da Nang, Vietnam: A pre-post intervention study’ presents evidence that EENC strengthens health workers’ skills and improves care. These lead to increased rates of skin-to-skin contact and exclusive breastfeeding, and significant reductions in hypothermia, sepsis and NICU admissions.

“A newborn dies every two minutes in this region, but full implementation of EENC could prevent up to half of these deaths,” explained Dr Howard Sobel, Coordinator for Reproductive, Maternal, Newborn, Child and Adolescent Health in WHO’s Western Pacific Region and co-author of the study.

Other studies in Asia have shown that health worker practices around birth are often outdated and harmful, leading to increased risks for babies of sepsis (a dangerous infection in the bloodstream), hypothermia (dangerously low body temperature) or death. Despite the availability of knowledge and tools, the quality of care can be compromised by the lack of clear policy guidelines, availability and allocation of staff, supportive work environments, and other issues.

EENC is a package of simple, evidence-based clinical care practices recommended by WHO. It focusses on improving the quality of care during and immediately after birth. Central to EENC is the “First Embrace” – a prolonged skin-to-skin cuddle between mother and baby, which allows proper warming, feeding and umbilical cord care. Key actions include: thorough drying; immediate skin-to-skin contact; clamping the cord after pulsations stop; cutting the cord with a sterile instrument; and initiating exclusive breastfeeding when the baby shows feeding cues, such as drooling, tonguing, rooting and biting of their hand.

Aside from the bond it fosters, the First Embrace helps transfer warmth, placental blood, protective bacteria, and through colostrum (the first breast milk) essential nutrients and immune cells to protect from infection. All babies can benefit, including those born preterm, sick or by caesarean section.

The Da Nang Hospital for Women and Children in central Vietnam, where about 14,000 babies are born every year, implemented EENC through on-the-job coaching of staff on appropriate childbirth and newborn care in 2014 and 2015. A quality improvement approach was subsequently implemented to address factors such as local policies, organisation of work spaces, health worker roles, sequencing of tasks, and availability of supplies and equipment.

“EENC has transformed the care that babies receive in our hospital. The package of procedures is practical, and it can be implemented anywhere,” said Dr Hoang Tran, Deputy Director, Da Nang Hospital for Women and Children. WHO