Resource Library

The Healthy Newborn Network (HNN) is an online community dedicated to addressing critical knowledge gaps in newborn health. HNN brings together partner organizations and individuals working in newborn health to share key resources, data, experiences, and lessons and helps increase global commitment to the advancement of newborn health. It also provides a platform for stakeholders to engage in discussions and working group activities on the vast range of newborn and maternal health topics.

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.

This policy brief provides maternal and newborn health stakeholders and decision-makers with an overview of the WHO Labour Care Guide (LCG) and its guiding principles, key advantages of making the shift from the WHO partograph to the WHO LCG, and what is required to ensure an enabling environment that will facilitate a sustainable introduction of the WHO LCG.

Highlights

• The WHO LCG provides a tool to effectively implement the WHO 2018 evidence-based recommendations for intrapartum care for a positive experience.
• The chief advantages of the WHO LCG over to the WHO modified partograph include improved respectful care, more accurate assessments of fetal well-being and labor progress, and other improvements in maternal and newborn health outcomes.
• Successful, sustained implementation of the WHO LCG requires adequate human resources with the necessary expertise and skills; infrastructure updates to support recommended practices; adequate equipment, supplies, and medicines; and a health information management system designed to document and monitor recommended practices.

How to Use

This policy brief provides maternal and newborn health stakeholders and decision-makers the background needed to advocate for the adoption of the WHO LCG. By clearly highlighting the WHO LCG’s advantages over use of the WHO modified partograph and breaking down the key characteristics of an enabling environment, stakeholders will be able to advocate for and effectively implement the new WHO intrapartum care recommendations to improve the experiences of care and health outcomes.

More than a third of maternal deaths and a substantial proportion of pregnancy-related, life-threatening conditions are due to complications that arise during labor, childbirth, or the immediate postpartum period. Improving quality of care around the time of birth is essential for reducing stillbirths and maternal and newborn deaths. This technical brief from MOMENTUM Country and Global Leadership reviews 26 new recommendations from the WHO’s 2018 recommendations on intrapartum care for a positive childbirth experience, and recommends policy and program considerations for countries adopting, adapting, and implementing the recommendations.

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.

The Quality of Care Network is currently led by 11 pathfinder countries already spearheading efforts to improve quality of care in health services: Bangladesh, Côte d’Ivoire, Ethiopia, Ghana, India, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania and Uganda. Under the leadership of the ministries of health in these countries, the Quality of Care Network supports the implementation of national plans for quality improvement.

The following is intended to assist decision-makers in analyzing a country’s current situation. This will assist in making a decision about whether to introduce/ scale up OB U/S services and ultimately in developing an implementation plan for introducing OB U/S.

Column 1 outlines factors that will need to be considered – Review the factors that are listed. As you review them, delete any that are not relevant to your country situation and add any factors you think need to be considered when introducing U/S into your country.

Column 2 provides checklists to guide a situational analysis as well as make decisions on how to introduce U/S – Review the items listed and check any boxes that apply to your country context. If necessary, add additional items to assist in developing an implementation plan.

Column 3 provides a space to outline action items/activities to introduction into the health system – Review the situational analysis/decisions made and then write action items/activities that will ensure a sustainable and efficient introduction.

While major progress has been made over the past two decades to improve mortality outcomes in women and newborn— major disparities remain in survival rates around the time of birth for mothers and infants born in high-, middle- and low-income countries. A significant gap continues to exist between actual and achievable health care outcomes, primarily because effective interventions are not implemented for every patient, every time. While access to and use of services for childbirth care has increased globally, and in some countries beyond expectations, the quality of care remains an impediment to accelerating the pace of reductions in preventable maternal and newborn mortality and stillbirths worldwide. The evidence for what to do to close the disparities gap has been known for years but there has been limited success in understanding how to implement these interventions.

This International Joint Statement was reviewed and endorsed by the Council of International Neonatal Nurses (COINN), the International Confederation of Midwives (ICM), the International Council of Nurses (ICN), the International Federation of Gynecology and Obstetrics (FIGO), and the International Pediatric Association (IPA).

The statement was developed by the United States Agency for International Development’s Applying Science to Strengthen and Improve Systems (ASSIST) with support from the Every Preemie-SCALE project, the American Academy of Pediatrics (AAP), the American College of Nurse-Midwives (ACNM), the American College of Obstetricians and Gynecologists (ACOG), Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and Save the Children’s Saving Newborn Lives project.