1. The First Embrace:
Action Plan for Healthy
Newborns in the Western Pacific
Region (2014-2020)
Reproductive Health Affinity Group
26 June 2013
Dr Ornella Lincetto

2. Every 2 minutes, 1 newborn dies
in the Western Pacific Region
209 000 neonatal deaths in the
Western Pacific Region every year
1 represents 100 neonatal deaths
WHO Global Health
Observatory, 2011

3. Newborns account for >50% of all under 5 deaths
Cause of Deaths before 5 years of age
in the WHO Western Pacific Region (2010)
Source:WHO Global Health
Observatory 2010
(n= 467 000)

4. We must get it right from (24 hours around birth)
the start: Age at death for Neonates (0-28 days)
0
5
10
15
20
25
30
35
0 1 2 3 4 5 6 7 8 9 1011 1213 14 1516 1718 19 2021 22 2324 2526 27 28
Days of life
Proportionalmortality
What we do then affects the
rest of the newborn's life
2 out of 3 newborn deaths
occur in the 3 days of life
WHO, 2012

5. Proportion of births assisted by a skilled
birth attendant (2005-2011)

6. Reproductive
AgeAntenatal
period
Adolescent
School
age
Preschool
Continuum of the Life Cycle
Intra-partum
Delivery
Immediate Newborn
•First Embrace
•Care for LBW/Preterm
•Care for Sick Newborn
Post
neonatal
Late
neonatal
Enhancing overall efforts on maternal and
child health by focusing on a weak link

7. You are Li Yu (mom) and baby girl
Lin Lin’s health professional.
What practices do you do that protect
or place Lin Lin at risk?

8. After Lin Lin is born, you should call out the time
(to mins and secs) of birth, then what?

9. After Lin Lin is born, you should call out the time
(to mins and secs) of birth, then what?

10. Lin Lin Has Needs
• To breathe
normally
• To be warm
• To be protected
• To be fed

11. Immediate Thorough Drying
• Stimulates Lin Lin to Breathe
• Prevents hypothermia
• If Lin Lin gets cold, she could get:
– Infection
– Coagulation defects
– Acidosis
– Delayed fetal to newborn circulatory adjustment
– Hyaline membrane disease
– Brain hemorrhage
Tunell R., in Improving Newborn Health in Developing Countries, A. Costello and D. Manandhar, Editors.
2000, Imperial College Press: London, UK. p. 207-220;Tollin M,et al.. Cell Mol Life Sci 2005

12. During drying and stimulation, your rapid
assessment shows Lin Lin is crying.
What is your next action?

13. FIRST, DO NO HARM
• Do NOT suction Lin
Lin unless her
mouth/nose are
blocked by
secretions

14. During drying and stimulation, your rapid
assessment shows Lin Lin is crying.
What is your next action?

15. 7 billionth babies
Skin-to-Skin Contact
Separated from mother

16. Skin-to-Skin Contact
Contributes to:
• Warmth
• Bonding
• Successful breastfeeding/colostrum feeding
• Stimulate the mucosa-associated lymphoid tissue
system
• Calmness
• Protection from hypoglycemia
• Colonization with maternal skin flora
Moore Cochrane Rev, 2012
Anderson Cochrane Rev, 2005
Brandtzaeg. Ann N Y Acad Sci, 2002

17. Delayed cord clamping
Term babies have less
• Anemia
– RR 0.2 (95% CI 0.06, 0.6)
Preterms have less
• Anemia requiring transfusion
– RR 0.6 (95% CI 0.5, 0.8)
• Intraventricular hemorrhage
– RR 0.6 (95% CI 0.4, 0.9)
• Necrotizing Enterocolitis
– RR 0.6 (95% CI 0.4, 0.9)
Ceriani Cernadas, 2006
Rabe, Coch Rev, 2012

18. How long after birth is Lin Lin ready to
breastfeed?

19. How long after birth is Lin Lin ready to
breastfeed?

20. • Drooling
• Mouth Opening
• Tonguing, Licking,
• Biting Hand
Feeding Cues
Lin Lin may want to rest
for 20-30 mins and even
up to 120 minutes before
showing signs of
readiness to feed

21. What is the approximate capacity of Lin
Lin’s stomach (when she was born)?
A
B
C
D

22. A
B
C
D
What is the approximate capacity of Lin
Lin’s stomach (when she was born)?

23. If this benefits
babies,
Skin-to-Skin Contact Separated from mother
Why is this so
common?
Immediate drying,
delayed cord clamp
Immediate cord clamp,
delayed drying,
suction

24. No one intends to harm
newborns; but many common
practices are harmful

25. Priority interventions of EENC
WHO, 2013

26. Vision: A healthy start for every
newborn
Mission: To strengthen the health
system to cultivate an enabling
environment where skilled providers of
newborn care value and practice
Essential Early Newborn Care
(EENC) at every birth.
Action Plan

27. To eliminate preventable newborn mortality by
providing universal access to high quality Early
Essential Newborn Care.
Target 1: At least 80% of facilities where births take place are
fully implementing EENC by 2020 in all member states.
Target 2: At least 90% of deliveries in all sub-national areas
attended by a skilled birth attendant by 2020 in all member
states.
Target 3a: National NMR 10 per 1000 live births or less by
2020.
Target 3b: Sub-national NMR 10 per 1000 live births or less
by 2020.
Regional Goal

28. Framework of Strategic Actions

29. SA1. Ensure consistent adoption
and implementation of Early
Essential Newborn Care (EENC).
Operational objectives:
1.1. To ensure EENC has been incorporated into national
and sub-national health agendas, plans, budgets and
financing mechanisms
1.2. To enable providers of newborn care to practice
EENC at every delivery by providing appropriate system
support and training
1.3. To ensure EENC has been incorporated into clinical
protocols, quality improvement cycles and
accreditation mechanisms
1.4. To scale up centres of excellence implementing
EENC

30. SA2. Improve political and
social support to ensure an
enabling environment for Early
Essential Newborn Care
(EENC)
Operational objectives:
2.1. To mobilize political commitment and social support
of key stakeholders for policies, programmes and
services for the implementation of EENC
2.2. To strengthen legislation, regulations, and
enforcement to meet international standards to support
implementation of EENC

31. SA3. Ensure availability, access,
and use of skilled birth attendants
and essential maternal and newborn
commodities in a safe environment.
Operational objectives:
3.1. To ensure availability of a skilled birth attendant for
every delivery
3.2. To ensure availability of equipment, supplies and
essential medicines in safe environments in routine and
emergency situations

32. SA4. Engage and mobilize
community to increase demand.
Operational objectives:
4.1. To increase community demand for skilled
birth attendance and the EENC

33. SA5. Improve the availability
and quality of perinatal
information.
Operational objectives:
5.1. To strengthen capacity of routine information
systems collect accurate data on perinatal
health
5.2. Improve collection and use of data on
perinatal health and practices through research,
surveys, and audits

34. Let’s
give a
healthy start
for every
newborn