Resource Library

NEST360 is an international alliance united to end preventable newborn deaths in African hospitals. The alliance works to deliver a package of technologies and services that enable local governments to save newborn lives, improve newborn outcomes, and empower the medical workforce for the future. There are a number of resources available to support clinicians, engineers and administrators to implement an evidence-based model for sustainable, high-quality hospital-based newborn care in limited resource settings, including clinical and technical resources, technology resources, implementation resources, and COVID-19 related resources.

Summary

Implementation of KMC is central to achievement of the SDGs for the survival, health and well-being of preterm or LBW infants, both well and sick, through its successful scale-up at all levels of facility care and in the community. Based on the new evidence on successful scale-up of KMC in programmatic settings from several countries, complemented by the joint wisdom and experience of global stakeholders, this implementation strategy is intended to guide the way forward for universal coverage of KMC for all preterm or LBW infants, both well and sick. This implementation strategy is meant to inspire a renewed vision in which mothers and infants are kept and cared for together from birth, and where parents and families play a central role in the care of their infants, thus humanizing health care.

Highlights

Achieving KMC implementation at scale requires:

• A system-wide perspective and structural changes to place mothers and infants at the center of care by keeping and caring for them together after birth
• A commitment by political and program leadership to implement KMC as the foundation of small and/or sick newborn care
• A dedicated budget for implementing KMC as part of small and/or sick newborn care in national maternal, newborn and child health programs
• Developing and implementing a monitoring and evaluation framework to track progress.

How to Use

KMC has been shown to be an essential intervention superior to standard radiant warmer/incubator care in all settings. All countries, irrespective of their income setting and resource availability, should adapt this strategy to their health system contexts to realize the full impact of KMC in improving the survival, health and well-being of mothers and preterm or LBW infants alike.

Summary

The purpose of this document is to put forward the joint position and vision of an expert, global, multi-stakeholder working group on implementing KMC for all preterm or LBW infants as the foundation for small and/or sick newborn care within maternal, newborn and child health programs, and spur collaborative global action. Reversing the long-standing inequities in health care will require prolonged efforts; the scale-up of KMC as an essential service for all mothers and their preterm or LBW infants as a critical component of universal health coverage can serve as the key starting point.

Highlights

• Kangaroo mother care (KMC) is an intervention that enables the mother to take a central role in her own and her newborn’s care, thereby ensuring the power stays with the mother, and health workers support and respond to the mother’s and newborn’s needs.
• It humanizes maternal and newborn care by empowering and involving those who care most for the infant, rather than focusing predominantly on technological solutions.
• KMC can serve as a starting point for broader health-system redesign and service delivery transformation for maternal and newborn care, and a model of what can be accomplished when relevant stakeholders are empowered to play the roles naturally entrusted to them in the care of their newborns.

How to Use

Operationalizing this concept can serve as a strong foundation of highly efficient health systems that are rooted in the communities they serve and focus not only on preventing and treating illness but also on improving well-being and quality of life.

Summary

Born too soon: decade of action on preterm birth looks to the future, setting an ambitious agenda to reduce the burden of preterm birth by addressing factors outside of the health system that affect preterm birth; and, within health systems, by providing high-quality, respectful care for women and babies so that they can survive and thrive, no matter where they are born. 

Highlights

• Of every 10 babies born, 1 is preterm – and every 40 seconds, 1 of those babies dies
• Preterm birth rates have not changed in the past decade in any region of the world
• The impacts of conflict, climate change, COVID-19 are increasing risks for women and babies everywhere
• Action is needed urgently to improve the prevention of preterm birth, alongside better care for affected babies and their families

How to Use

This report is intended to inspire and support country-led action: politicians, policy-makers and leaders of all stakeholder groups are its primary audience. However, leadership “from the top” often emerges in response to a unified call to action by a broad-based coalition of committed advocates “from the bottom”.

Despite some progress over the last 10 years, the survival, health, growth and neurodevelopment of preterm and LBW infants remains concerning in many countries. These new guidelines, developed by a global group of content experts in collaboration with the WHO, encapsulate the latest research into recommendations for evidence-based care of preterm and LBW infants, and strongly advocating for family-centered care that puts caregivers at the center of caring and making decisions for their infants.

Key Highlights

• These new guidelines include 25 new recommendations (11 are new and 14 are updated) for three areas: 1) Preventive and promotive care, 2) Care for Complications and 3) Family Involvement and Support.
• There are 11 strong recommendations for all preterm or LBW infants and 14 recommendations that are conditional on particular contexts or conditions. New strong recommendations include immediate KMC for all LBW babies, caffeine for apnea and extubation, family involvement, and home visits. Updated strong recommendations include: providing KMC at home or in the health facility for 8-24 hours/day, using mother’s own milk, early initiation of enteral feeding, duration of exclusive breastfeeding to six months, iron supplementation and CPAP for RDS.
• The new guidelines include one new good practice statement around ensuring that parental leave and entitlements address the special needs of caregivers of preterm and LBW infants.

What does this means for health programming?

These guidelines should be used to inform the development of national and subnational health policies, clinical protocols and programmatic guides. Implementation considerations can be found in the guide, and a full implementation guide is also forthcoming.

Each year around the world, 2.4 million newborns die in the first month of life and up to 30 million newborns require some level of inpatient care. The majority of these small and sick newborns are born with low birth weight or prematurely, leaving them and their mothers highly vulnerable and requiring specialized care.

The project aims to document the approaches taken, barriers and enablers, and lessons learned for establishing and strengthening inpatient newborn care services as part of a network of newborn care, as viewed by stakeholders in the delineated geographies.

Each year around the world, 2.4 million newborns die in the first month of life and up to 30 million newborns require some level of inpatient care. The majority of these small and sick newborns are born with low birth weight or prematurely, leaving them and their mothers highly vulnerable and in need of specialized care. The neoLENS project aims to document the approaches taken, barriers and enablers, and lessons learned for establishing and strengthening inpatient newborn care services within a network of newborn care, as viewed by stakeholders in Ethiopia, India, Malawi and Rwanda. PATH identified and documented experiences and perceptions of key stakeholders/informants on what it took/takes to establish, scale up, and strengthen inpatient newborn care services. As part of the data collection process and in the final case study, we focused on recording and documenting the objectives and processes in each setting, as well as the evolution for how they reached their current state.

Immerse yourself in a multimedia experience where you can virtually “walk through” an existing unit in Malawi that provides care for small and sick newborns. This virtual experience offers a realistic glimpse into the newborn care unit and its practices. In the virtual experience, health care providers give a commentary on how to successfully establish and scale the care of small and sick newborns.

The NEST360 and UNICEF Implementation Toolkit for Small and Sick Newborn Care brings together readings, tools and learning to provide a one-stop shop for implementers to act, use, share and learn. Information in support of WHO norms and standards from more than 300 implementers around the world is systematically organized in this open access online toolkit to enable implementation and reach every newborn.

The Every Newborn Action Plan (ENAP) service delivery and readiness targets were recently updated and published in a report ‘Ending Preventable Newborn Deaths and Stillbirths by 2030: Coverage targets 2020-2025’. The ENAP service coverage targets include national and subnational targets for use by program managers.

“Kangaroo mother care,” a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (<2.0 kg) when initiated after stabilization, but the majority of deaths occur before stabilization. The safety and efficacy of kangaroo mother care initiated soon after birth among infants with low birth weight are uncertain.

The results of this new clinical trial published in May 2021 provide evidence in support of starting KMC immediately after birth, a clear message that keeping mothers and babies together helps babies to survive and thrive.

Key Findings

• Starting KMC immediately after birth in newborns with birthweight of 1000 grams to 1799 grams has the potential to save up to 150,000 more lives each year (a further increase in survival of 25%), compared with the current recommendation of starting it only once a baby is stable.
• Mother-Newborn Intensive Care Units will be critical to support the mother, or a surrogate, in providing this immediate, ongoing skin-to-skin contact from birth.

Understanding of the lifesaving benefits of KMC for babies born early or small and its continued importance during the COVID-19 pandemic are further strengthened with this new evidence on the benefits of starting the intervention immediately after birth. Among preterm or low birthweight infants, KMC has been shown to reduce infant deaths by as much as 40%, hypothermia by more than 70%, and severe infections by 65%.