Current Status + Progress
The first month of life: the most vulnerable period

Deaths in the first month of life, which are mostly preventable, represent 45 per cent of total deaths among children under five. As mortality among children under five declines globally, deaths among these children are more and more concentrated in the first days of life. This makes focus on newborn care critical than ever before. In 2015, an estimated 2.7 million children died in their first month of life; almost 1 million or 36 per cent died in the first day of life. Despite ongoing challenges, major progress has been made in improving neonatal survival. Neonatal mortality is on the decline globally. The world’s neonatal mortality rate fell from 36 deaths per 1,000 live births in 1990 to 19 per 1,000 live births in 2015, a 47 per cent decline. The result is a drop in neonatal deaths worldwide from 5.1 million in 1990 to 2.7 million in 2015.

The large majority of newborn deaths (80 per cent) are due to complications related to preterm birth, intrapartum events such as birth asphyxia, or infections such as sepsis or pneumonia. Thus, targeting the time around birth with proven high impact interventions and quality care for small and sick newborns may prevent up to 80 per cent of newborn deaths. The “Every Newborn Action Plan” (ENAP) calls for an increased focus on the time around birth with targeted high impact interventions as a strategy for reducing not only newborn deaths but also maternal deaths and stillbirths, generating a triple return in investment.

THE FIRST 28 DAYS

A large majority of newborn deaths could be prevented with proven interventions around the time of birth and improved care for small and sick newborns. Deaths in the first 28 days of life account for an increasing share of under-five deaths, and they are declining at a slower rate than child deaths overall. Research conducted as part of the Every Newborn Action Plan and the 2014 Every Newborn Lancet series demonstrated that two key packages of interventions could prevent the majority of neonatal deaths.

Care around the time of birth could avert more than 40 per cent of neonatal deaths. Key interventions include care by a skilled birth attendant, emergency obstetric care, immediate care for every newborn baby (including breastfeeding support and clean birth practices such as cord and thermal care) and newborn resuscitation.

Care for small and sick newborns could avert 30 per cent of neonatal deaths. Key interventions include kangaroo mother care, prevention or management of neonatal sepsis, addressing neonatal jaundice and preventing brain damage after birth-related oxygen deprivation.

SKILLED DELIVERY AND POSTNATAL CARE

Skilled care at birth and postnatal checkups are essential to the well-being of both mother and newborn. Quality skilled care at birth would ensure that the newborn receives essential newborn care including thermal and cord care, and immediate breastfeeding. It also increases access to emergency care in the event of life-threatening complications. A newborn who is not breathing at birth will die within minutes if not properly cared for.

However, globally, in 2015 one in four births were not delivered by a skilled health personnel (26 per cent). This proportion increased to about half of all birth in least developed countries. Newborns are most vulnerable during the first hours and days of life, yet this critical window is being missed.  Data indicate that in least developed countries, only about half (54 per cent) of newborns are weighed at birth and a similar proportion (53 per cent) initiate breastfeeding immediately after birth.

The postnatal period is the time following delivery until six weeks after birth, and health checks during this time – especially the first two days after delivery – are essential. The WHO recommends postnatal care within 24 hours of birth, regardless of where the baby is born. Mothers and newborns should receive at least three additional postnatal care visits by a skilled provider, ideally on day 3 (48–72 hours after birth), between day 7 and day 14, and again 6 weeks after birth.

Postnatal care for the baby is an important opportunity to check for danger signs, such as insufficient feeding, fast breathing (a breathing rate of more than 60 per minute), severe chest in-drawing, lethargy, fever, low body temperature, or jaundice. At the same time, mothers can receive advice on how to identify and respond to these symptoms, as well as the benefits of exclusive breastfeeding and immunization.

Given the critical importance of essential newborn care and postnatal care for the baby, household survey programs such as DHS and MICS have recently included indicators to track the coverage of this important component of care for mothers and newborns. In the limited number of countries with data, only about half of mothers and newborns receive postnatal care, with significant variations across countries. In many of these countries data on newborn care are still lacking.

 

Most neonatal deaths could be prevented through low-cost, low-tech interventions
Key interventions for reducing neonatal mortality and morbidity

Source:  Based on Darmstadt, G. L., et al., ‘Evidence-based, Cost-effective Interventions: How many newborns can we save?’, Lancet, vol. 365, no. 9463, 12 March 2005, pp. 977–988, with updates from: www.who.int/pmnch/topics/part_publications/essential_interventions_18_01_2012.pdf. As published in: UNICEF, Committing to Child Survival: A promise renewed – Progress report 2012, UNICEF New York, 2012

In many countries, a majority of mothers and newborns are missing out on the benefits of postnatal health checks
Percentage of live births who received a postnatal care visit within 2 days of delivery, and percentage of mothers and percentage of mothers who received a postnatal care visit within 2 days of delivery

Source: UNICEF global databases 2015 based on MICS and DHS

 

HOME VISITS FOR NEWBORN CARE

A key strategy for ensuring a continuum of care from pregnancy through early childhood is integrating interventions into community-based programs and linking them to other services within health systems. In addition to the key interventions described above, adequate nutrition for pregnant and nursing women is essential to the well-being of both mother and child. The World Health Organization (WHO) and UNICEF recommend that care be provided by a skilled attendant during and immediately after birth, irrespective of where the birth takes place. When appropriate, home visits can provide effective care to infants and increase newborn survival. This strategy has shown positive results in high-mortality settings by improving essential newborn care practices and reducing newborn mortality.

REFERENCES

Bhutta, Z.A., et al., for The Lancet Newborn Interventions Review Group and The Lancet Every Newborn Study Group, Can Available Interventions End Preventable Deaths in Mothers, Newborn Babies, and Stillbirths, and at What Cost?, The Lancet, published online 20 May 2014, accessed 26 August 2015.

Darmstadt, G. L., et al., Evidence-based, Cost-effective Interventions: How many newborns can we save?, Lancet, vol. 365, no. 9463, 12 March 2005, pp. 977–988, with updates. As published in: Committing to Child Survival: A promise renewed – Progress report 2012, UNICEF New York, 2012.

The Lancet Neonatal Survival Series, March 2005.

UNICEF, Committing to Child Survival: A promise renewed – Progress report 2013, UNICEF, New York 2013.

UNICEF’s Multiple Indicator Cluster Surveys, Rounds 4 and 5, UNICEF, New York, 2013.

UNICEF, The State of the World’s Children 2014, UNICEF, New York, 2014.

United Nations Inter-agency Group for Child Mortality Estimation (IGME), Levels and Trends in Child Mortality: Report 2013, UNICEF, New York, 2013.

WHO/UNICEF Joint Statement, Home Visits for the Newborn Child: A strategy to improve survival, WHO, Geneva, 2009.

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Although remarkable progress has been made in recent decades to reduce the number of child deaths worldwide, too many newborns die each year. These deaths occur despite the availability of affordable, high-impact, evidence-based solutions. Mortality among newborns fell by 47 per cent over the period 1990 to 2015, a smaller decrease compared to the reduction in under-five mortality of 53 per cent witnessed during the same period.

The global Every Newborn Action Plan was launched in 2014 with clear targets and strategies for reduction of neonatal deaths and still births.

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