Dr. Pradeep Dubey MD ( Ped .), DCH. Cons. Developmental & Neuro Ped .

1. BASIC NEW BORN CARE & RESUSCITATION PROGRAM AN OVERVIEW Dr. PradeepDubey MD (Ped.), DCH. Cons. Developmental & NeuroPed. “AADIGURU” Early Intervention Centre Wright Town - Jabalpur

2. India is epicenter of Childhood Mortality Worldwide distribution of child deaths Eachdotrepresents 5000 deaths Lancet 2003

3. Childhood MortalityState of World’s Children 2008 1 million newborns die annually in India • 9.7 million < 5 yrs deaths annually world over India 2.1 million (21%)

4. Neonatal deaths and the Millennium Development Goal 4 150 Under-5 mortality rate Early neonatal mortality Late neonatal mortality 100 Global mortality per 1000 births 50 Target for MDG-4 0 1960 1980 2000 2020 Year Millennium Development Goal 4 can only be achieved if neonatal deaths are addressed - missing from current programmes

5. WHERE? The 10 States in India where newborns have the highest risk of dying

6. WHEN do newborns die? The first days of life are the riskiest • Up to 50% of all NB deaths are on the first day of life (500,000 babies in India dying on their birth day) • 75% of NB deaths are in the first week

7. Leading causes of NB death • Severe Infections (36%) • Pre-Term Births (25%) • Birth asphyxia (23%). • Other Neonatal Causes (6%) • Neonatal Tetanus (4%) Source: WHO World Health Statistics 2007 (India)

8. What can be done to save these newborn lives now?

9. Neonatal Resuscitation :6-42% Breastfeeding :55-87% Prevention and management of hypothermia :18-42% Kangaroo Mother Care (LBW):incidence of infection :51% (7-75%) Post Neonatal interventions - efficacy for reducing all cause of neonatal mortality

10. WhyNewborn resuscitation is important?

11. Estimated Deaths due to Birth Asphyxia in India is 3 lacs per year Birth Asphyxia • Major cause of “Mortality” and “Stillbirth” • Major cause of short and long term morbidity • Substantially treatable

12. 1 million children who survive birth asphyxia each year go onto suffer cerebral palsy and other disabilities

14. Impact of NRP in China 10 Provinces 2007 Courtesy: Keenan W J for providing the slide • Birth Asphyxia – Decreased 60% • Mortality in delivery room - Decreased by 40%

15. Impact of NRP on asphyxia mortality • In rural Gadchiroli India interventions by the trained VHW in basic newborn resuscitation reduced case fatality in severe asphyxia by nearly 50% and asphyxia specific mortality rate by 65% in comparison to management by TBA alone* *Bang AT. Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitation with mouth-to-mouth, tube-mask or bag-mask. J Perinat 2005; S82-91.

16. IAP’s initiative NRP FIRST GOLDEN MINUTE PROJECT • Aim to have one NRP trained person attending every delivery ( > 27 millions deliveries /year in India ) • Joint venture of IAP-AAP-LDSC • Johnson and Johnson, India has agreed to provide academic grant to train More than > 200,000 health professionals and workers in private sector in next 4 years

17. NRP First Golden Minute Project • NRP FGM is not restricted to resuscitation only • IAP has adopted NSSK manual of GOI “Basic New born Care and Resuscitation Program” which focuses on Resuscitation, Prevention of Infection, Thermal Protection, Feeding and Transport of Newborn

18. Participants like you are.... • Learned • Experienced • Responsible • Catering to NB care daily • Science is ever evolving / keeping abreast is the need of the hour

19. New Child Health Initiative by GOI Navjaat Shishu Suraksha Karyakram (NSSK) GOI and IAP have signed a MoU for training A new programme on Basic Newborn Care and Resuscitation, has been launched nationally by GoI to address important interventions of care at birth

20. Lives can be saved now If the all essential interventions in “The LancetNewborn Survival series” reached 90% of Indian women and babies then 36-67% of newborn deaths could be prevented Additional cost of $1.39 per capita per year

21. Expected Outcomes If we train more than 90% health personnel attending institutional deliveries (41%) in essential interventions ,an estimated 15 – 30 % reduction in NMR can be expected There will be greater impact in states with higher neonatal mortality

22. Primary causes of neonatal deaths in India * Birth weight <750 g, hyaline membrane disease, intraventicular hemorrage

23. 1 million children who survive birth asphyxia each year go onto suffer cerebral palsy and other disabilities Averting neonatal death is pivotal to reduce child mortality

24. IAP’s Initiative Forimproving Child Survival, Neonatal resuscitation Program (NRP) with emphasis on management of First minute after birthis crucial.

25. Approach followed • Government Sector – Named as Navjat Shishu Surakhsha Karyakram (NSSK) in partnership with GOI • Private Sector – Named as First Golden Minute (FGM). Supported by J & J.

26. NSSK • Launched on 15 Sep, 09 at Jaipur by hon’ble minister of Health Mr Ghulam Nabi Azad • Besides NRP, NSSK also includes Essential Newborn Care • Breast Feeding • Thermal Control – KMC • Prevention of Sepsis • IAP is playing Key Role

27. Evaluation Documents

28. Journey so far… • Delhi • Bihar • Orissa • Jharkhand • Rajasthan • Madhya Pradesh • Uttar Pradesh • J & K • Haryana • Now Uttarakhand

29. Performance Evaluation Overall show improvement in skill levels to 94% for health experts from their pre training levels of 40%. Performance Evaluation - Overall

30. Basic Steps in Neonatal Resuscitation Assessment of baby and routine care Always needed 100% Initial steps to stimulate the baby to breathe Basic Ventilation with bag and mask Needed less frequently 10% Advanced Intubation and Chest compressions 1% Rarely Needed Meds

31. NRP FGM Not only a project.. But …… ….a mission

32. It’s a long road ahead... But Challenge is to ensure that every newborn counts THANK YOU