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Implementing the Every Newborn Action Plan

Towards ending preventable maternal and

newborn mortality
Bernadette Daelmans
Department of Maternal, Newborn, Child and Adolescent Health

Building a movement


The end of MDGs brings new clarity about what is left

behind on the agenda newborns, stillbirths, adolescents

Every Newborn Series

5 papers
55 authors from 18+ countries
60+ partner organisations
Main funders: Bill & Melinda Gates Foundation, USAID, Childrens Investment Fund Foundation

Every Newborn Action Plan

Based on the evidence from the Series
Co-led by WHO and UNICEF
Consultation >60 country governments
>80 organisations, >1000 individuals
World Health Assembly 2014 resolution
Launched June 2014

Now to action in many countries


Towards ending preventable maternal and

newborn mortality
In 2013 :

289.000 maternal deaths

2.9 million newborn deaths
2.6 million stillbirths

More than 3.0 million babies and

women could be saved each year


MMR reduction of at least 2/3 from
2010 and MMR less than 140
NMR of less than 12 per 1000 live births
Still births less that 12 per 1000 total

Addressing the main causes of mortality

Causes of maternal mortality

Causes of newborn mortality

Care around the time of birth:

a triple return on investment

Source: Special analysis detailed in The Lancet Every Newborn Series, launched 19 May 2014

Almost 3 million babies and women could be saved each year through
investing in quality care around the time of birth.

Strategic objectives
Address all major causes of maternal and newborn mortality, morbidity
and related disabilities as well as stillbirths;
Invest in and improve quality care for women and newborns,
especially around the time of childbirth;
Address inequities in access to and quality of reproductive, maternal,
perinatal and newborn health care services;
Harness the power of parents, families and communities; empower
women and girls
Ensure universal coverage of essential interventions for reproductive,
maternal and newborn health care
Improve metrics globally and nationally and ensure accountability

5 things to do differently
Especially in countries
with highest burden

Integrated Plans
Integrated service
delivery, continuum of
care, coordination

Implementation &
Address health system
bottlenecks, Every Mother
Every Newborn initiative

Investment for
Governance, community
participation, partner

Indicators & metrics

Targets in post 2015
Measurement of progress
and impact

WHO recommendations for maternal, perinatal

and newborn care

Resuscitation: what is new?

No routine suctioning even before ventilation, only for babies born
through meconium-stained amniotic fluid who do not start
breathing on their own
Preference of bulb syringe in the absence of mechanical
Start Positive Pressure Ventilation within 1 minute
Preference of self-inflating bag
Measurement of heart rate after 60 seconds
Recommendation to stop resuscitation after 10 min,
if no detectable heart rate

Cord care
Daily chlorhexidine (4%) application to the umbilical cord stump
during the first week of life is recommended for newborns who
are born at home in settings with high neonatal mortality (30 or
more neonatal deaths per 1000 live births).
Clean, dry cord care is recommended
for newborns born in health facilities and
at home in low neonatal mortality settings.
Use of chlorhexidine in these situations
may be considered only to replace application
of a harmful traditional substance such as
cow dung, to the cord stump.

Facility stay after childbirth

After an uncomplicated
vaginal birth in a health
facility, healthy mothers
and newborns should
receive care in the facility
for at least 24 hours after

J. Lawn et al. Lancet 2014; 384: 189


Timing and number

of postnatal contacts
Healthy mothers and newborns should receive care in the facility for
at least 24 hours after birth.
If birth is at home, the first postnatal contact should be as early as
possible within 24 hours of birth.
At least three additional postnatal contacts are recommended for all
mothers and newborns:
on day 3 (4872 hours),
between days 714, and
6 weeks after birth.
Home visits in the first week after birth are recommended for care of
the mother and newborn.

Assessment of the newborn

The newborn should be referred for further evaluation if any of
the signs is present:

stopped feeding well,

history of convulsions,
fast breathing (breathing rate 60 per minute),
severe chest in-drawing,
no spontaneous movement,
fever (temperature >37.5 C),
low body temperature (temperature <35.5 C),
any jaundice in first 24 hours of life, or yellow palms and
soles at any age.

Care for low birth weight babies

Feeding of low birth weight infants

LBW and VLBW infants should be fed mother's own
breast milk. If the mother is not able to breastfeed,
donor milk should be given
LBW should be put to the breast as soon as clinically
stable after birth
LBW should be exclusively breastfed on demand for 6
LBW infants who can not be breastfed, but can swallow
should be fed by cup and spoon (or cup with beak),
based on hunger cues, but at least every 3 hours

Forthcoming WHO recommendations

Antenatal corticosteroids for management of preterm labour and
for women at risk of preterm birth from 24 weeks to 34 weeks of gestation
when the following conditions are met:
gestational age assessment can be accurately undertaken
preterm birth is considered imminent
there is no clinical evidence of maternal infection
adequate childbirth care is available (including the core functions of emergency
obstetric care)
the preterm newborn can receive adequate care if needed (including resuscitation,
thermal care, feeding support, infection treatment and safe oxygen use).

Kangaroo mother care

for neonates weighing 2000g at birth as soon as they are clinically stable;
care should be provided as continuously as possible

New evidence towards updated guidelines

Young infants 7 59 days old with fast breathing as a single sign, who
are identified through home visits or spontaneously brought for care at outpatient
clinics can be safely and effectively treated with oral amoxicillin for 7 days

by appropriately trained health care provider.

Young infants 0 59 days old with any sign of clinical severe infection
who are not critically ill, who are identified through home visits or
spontaneously brought for care at outpatient clinics and whose caregivers
cannot or do not accept hospitalization
Option 1: IM gentamicin 5-7.5 mg/kg once daily for 7 days and twice daily oral
amoxicillin, 50 mg/kg per dose for 7 days. Close follow up is essential
Option 2: IM gentamicin 5-7.5 mg/kg once daily for 2 days and twice daily oral
amoxicillin, 50 mg/kg per dose for 7 days. Close follow up is essential. A careful
assessment on day 4 is mandatory.
Also see: AFRINEST and SATT studies, Lancet Global Health, published online April 2, 2015

Every Newborn action now:

Three main streams of activities are ensuring the
action plan leads to real change in countries:

Country implementation: identifying and

responding to technical support needs,
supporting translation of evidence into action,
including Every Mother Every Newborn quality
improvement initiative.


Data and metrics: improving and

institutionalizing metrics to track coverage and
impact based on the goals and targets of the
ENAP and five strategic objectives.


Advocacy: strengthening maternal and newborn

health advocacy efforts globally and in countries,
building a movement for change.

Research as cross cutting

We are still building a


An Action Plan To End Preventable Deaths

For more information