Giving birth to improved newborn care
MANILA, Philippines - Heeding calls to improve newborn care, health experts and medical professionals led by Department of Health (DOH) Secretary Francisco Duque III convened recently at Hotel Sofitel to discuss the state of newborn care system in the country. Joining Secretary Duque were executives from key health institutions in the country such as officials from health maintenance companies as well as doctors,’ nurses,’ and midwives’ associations.
The occasion also formalized the launch of the Essential Newborn Care (ENC) protocol endorsed by the World Health Organization, which offers an evidence-based strategic intervention aimed at improving newborn care and helping curb neonatal mortality.
In a ceremony marking the start of the Unang Yakap campaign, which comprises the new ENC protocol, Secretary Duque, WHO representative to the Philippines Dr. Soc Nyunt-U, Dr. Marinus Gotink of UNICEF Philippines, DOH Assistant Secretary Nemesio Gako, and DOH Undersecretary Dr. Mario Villaverde signed a giant covenant marker to reaffirm their commitment in adopting the new protocol.
In her presentation, DOH National Disease Prevention director Dr. Yolanda Oliveros says that 82,000 Filipino children die annually, with half of newborn deaths occurring in the first two days of life. “But the thing is, many of these deaths could have actually been prevented,” she said, citing the Lancet 2003 study.
Dr. Oliveros also notes that there are at least four steps in newborn care intervention that need to be undertaken immediately to lessen statistics on newborn deaths. These are: immediate and thorough drying to stimulate breathing; early skin-to-skin contact; properly-timed clamping and cutting; and non-separation of newborn from the mother for early breastfeeding initiation. These interventions, in fact, form part of the new ENC protocol now being promulgated by the DOH.
In her discussion of the minute-by-minute assessment of newborn care within the first hour of life, Dr. Oliveros said that the usual practice of cord clamping in most Philippine hospitals is 12 seconds with 99 percent under one minute, whereas WHO standards require one to three minutes or until pulsations stop. Ninety-seven percent of them also do drying after one minute, when WHO standards say it should be done immediately.
Immediate skin-to-skin contact is not also being observed, adds Dr. Oliveros, with only 9.6% doing it after five minutes when it should be done over 90 percent of the time. Other “bad habits” include putting babies on a cold surface (12 percent), not drying the baby (2.5 percent), not drying the head (6.2 percent), and washing or giving the baby a bath (84 percent of hospitals do it within eight minutes), when it could actually be delayed until after six hours. Under the newly-approved guidelines, transferring babies to a nursery is no longer necessary — instead, newborns should be roomed in with their mothers immediately.
Separating the baby from the mother, weighing, and examining the newborn should also be done at least after more than an hour, not in just after 10 minutes, which is the usual practice. Other newborn interventions cited include rooming in babies with their mother and immediate breastfeeding (within one hour after birth or as soon as baby shows signs).
Dr. Oliveros ended her presentation by saying a new set of newborn care protocol is needed because there is now a wide variety of practices among health practitioners. There were also reports of inappropriate care being given the newborns, as well as continuously skyrocketing costs of health care.
The half-day event also included an overview of the status quo of newborn health care in the Philippines, highlighting an assessment of the practices of 51 major hospitals in the country. Dr. Jacinto Mantaring of the Philippine General Hospital — one of hospitals that have since adopted the ENC protocol — explained the rationale for the resolution, underlining the urgent need of the country to invest in newborn health care.
The protocol categorizes post-natal procedures into time-bound, non-time bound, and unnecessary actions. Time-bound interventions include immediate drying, skin-to-skin contact, cord clamping after one to three minutes, breastfeed initiation, and non-separation of mother and the newborn.
Non-time-bound procedures are administration of vitamin K, washing, immunizations, and weighing. The unnecessary procedures, as laid out in the guideline, are foot printing, administration of prelacteals like glucose water, routine suctioning, and separating the newborn from the mother for observations.
Today, the Philippines remains one of 42 countries that account for 90 percent of mortality for children below five years. With the new ENC protocol, the government is hoping to reduce neonatal deaths by six per 1,000 live births.
