The debate today for the evolution of newborn care in developing world countries benefits from a century of developed world experience.
Many recent reports on neonatal mortality in developing countries rightly place considerable emphasis on what can be achieved with simple basic interventions. These reports talk about the significant reductions in neonatal mortality in the UK from 1950 to 1970 without the benefit of expensive technology. There are however many factors that contributed to the lower perinatal, neonatal and maternal mortality rates; increased wealth and education, antenatal care and more sophisticated diagnostic techniques, well organised delivery rooms with skillful resuscitation techniques as well as risk identification and efficient transport of critical newborns. It cannot be assumed that similar results can be obtained in developing countries where financial and human resources are the problems.
It is critically important to get the basic elements of maternal and newborn care right. It is also important to recognise that premature birth is the leading direct cause of neonatal deaths worldwide, and, in addition, low birth weight is a significant underlying cause in over 60% of all neonatal deaths. Early neonatal deaths (perinatal, first 7 days of life) account for 75% of all cases. For many of these babies basic interventions and Kangaroo Mother Care is not enough, they need more advanced specialist care. For more information about Kangaroo Mother Care click here.
For developing countries with limited resources for neonatal care, decisions have to be made on what strategies are to have priority. Solutions need to be suitable for each country and embedded in their overall strategy to save newborn lives. Solutions may be a mix of basic interventions and subject to resources more advanced neonatal care at regional hospitals.
Models of care are already being developed in some developing countries to meet a range of needs. For example, under the three levels of care model; the first level provides for normal pregnancies and healthy newborn babies; the second level for pregnancies at moderate risk; and at the third level are regional hospitals with neonatal intensive care units. Bringing all the high-risk infants together at the third level enables the necessary expertise to develop, so that each baby can have the best chance of survival.
There is no doubt that basic interventions are critical to saving newborns and moving the development of maternal and neonatal care forward in some of the poorest countries in the world. The development of more specialist care and Neonatal Intensive Care Units (NICUs) is also essential to saving newborn lives, as the experience of a century of neonatal care in the UK has shown.
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