Comment
Every Newborn: the professional organisations’ perspective preterm or low birthweight (or both) infants receive kangaroo mother care, and that all newborn babies with possible infection receive appropriate antibiotic therapy within a short time after birth.1 Basic neonatal resuscitation and care in the so-called golden minute after birth reduces neonatal mortality in developing countries and is estimated to reduce full-term infant deaths by up to 30%.4 In countries challenged by social, economic, humanitarian, and health complexities, provision of interventions to every mother and newborn baby to improve survival will not be without difficulty. However, the international professional organisations of obstetricians and gynaecologists, midwives, paediatricians, neonatologists, and neonatal nurses working together are able to promote a high standard of maternal and newborn care and requisite education and training; strengthen input into health plans and policy development; and foster international liaisons. Our organisations are pleased that The Lancet has published the Every Newborn Series,5–9 to bring attention to actions that are needed to accelerate progress towards Millennium Development Goals 4 and 5. The papers in this Series emphasise the important links between the various professional organisations to achieve the objectives of the Every Newborn Action Plan. The lifecourse approach is emphasised, highlighting the continuum of care needed from woman to newborn baby to childhood; the need for workforce planning and task
www.thelancet.com Published online May 20, 2014 http://dx.doi.org/10.1016/S0140-6736(14)60692-9
Published Online May 20, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60692-9 See Online/Series http://dx.doi.org/10.1016/ S0140-6736(14)60458-X, http://dx.doi.org/10.1016/ S0140-6736(14)60496-7, http://dx.doi.org/10.1016/ S0140-6736(14)60792-3, http://dx.doi.org/10.1016/ S0140-6736(14)60582-1, and http://dx.doi.org/10.1016/ S0140-6736(14)60750-9
Jenny Matthews/Panos
The International Federation of Gynecology and Obstetrics, the International Confederation of Midwives, the International Pediatric Association, and the Council of International Neonatal Nurses recognise and support the Every Newborn Action Plan,1 which is situated in the continuum of care for reproductive, maternal, newborn, and child health. The Every Newborn Action Plan calls for acceleration in action at country, regional, and local levels to accelerate reduction in stillbirth, and in neonatal and maternal mortality rates. Although some progress has been made since the Lancet Series on neonatal survival was published a decade ago, neonatal deaths have fallen at a slower rate than expected, stillbirths at an even slower rate, and, although maternal mortality has also declined, the relevant Millennium Development Goals for 2015 will not be achieved. Every year, 40 million mothers still give birth without any help from a midwife or another health worker trained and equipped to save the life of the baby or mother.2 Many babies die every year because mothers do not get the good quality care they need during labour and birth. Obstetricians and midwives are at the forefront of caring for the pregnant woman and newborn baby during the antenatal, intranatal, and postnatal periods. Often the midwife is the sole health-care professional responsible for both mother and baby. The causes of stillbirths and newborn and maternal deaths are closely related, and the solutions are known. Ensuring that essential care is provided around labour, delivery, and immediately afterwards is critical to ending newborn deaths. Available, skilled, well equipped birth attendants to assist women and newborn babies during labour and birth are vital to their survival.3 Additionally, because 85% of neonatal deaths relate to preterm complications,1 birth asphyxia, and infection, paediatricians, neonatologists, and neonatal nurses are essential to the care of preterm and ill newborn babies. There is a shortage of all health-care professionals, which is an issue that must be addressed; but most significantly, because nurses and midwives are the most numerous health-care providers in many countries and are at the frontline of providing care, it is nurses and midwives with additional training in neonatal care that are needed to ensure that greater than 75% of all infants not breathing after birth receive bag and mask resuscitation, that all
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Comment
sharing; and the need for family planning to reduce the burden of death. The Series also highlights that to avoid 116 million deaths and 99 million survivors with disability by 2035, we must reduce the number of babies who are small for gestational age (10·4 million in south Asia and sub-Saharan Africa in 2010), and prevent stillbirths, newborn deaths, and long-term non-communicable disorders. Improvement of maternal and newborn care is therefore crucial to improving the life and health of the overall population. Professional organisations have the capacity to mobilise members to achieve the common aim of ending preventable deaths. *Karen New, Andreas Konstantopoulos, Sabaratnam Arulkumaran, Frances Day-Stirk Council of International Neonatal Nurses, Boston, MA 02131, USA (KN); International Pediatric Association, Elk Grove Village, IL, USA (AK); International Federation of Gynecology and Obstetrics, London, UK (SA); and International Confederation of Midwives, The Hague, Netherlands (FD-S) [email protected] We declare no competing interests. 1
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Save the Children. Surviving the first day: state of the world’s mothers 2013. London: Save the Children International, 2013. http://www.savethechildren. org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SOWM-FULLREPORT_2013.PDF (accessed April 8, 2014). WHO. Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM, FIGO. Geneva: World Health Organization, 2004. http://whqlibdoc.who.int/publications/2004/9241591692.pdf (accessed April 8, 2014). Wall SN, Lee ACC, Niermeyer S, et al. Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet 2009; 107 (suppl): S47–64. Darmstadt GL, Kinney MV, Chopra M, et al, for The Lancet Every Newborn Study Group. Who has been caring for the baby? Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S0140-6736(14)60458-X. Lawn JE, Blencowe H, Oza S, et al, for The Lancet Every Newborn Study Group. Progress, priorities, and potential beyond survival. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S01406736(14)60496-7. Bhutta ZA, Das JK, Bahl R, 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? Lancet 2014; published online May 20. http:// dx.doi.org/10.1016/S0140-6736(14)60792-3. Dickson KE, Simen-Kapeu A, Kinney MV, et al, for The Lancet Every Newborn Study Group. Health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S0140-6736(14)60582-1. Mason E, McDougall L, Lawn JE, et al, for The Lancet Every Newborn Study Group, on behalf of the Every Newborn Steering Committee. From evidence to action to deliver a healthy start for the next generation. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S01406736(14)60750-9.
WHO. Every newborn: an action plan to end preventable deaths. May 2, 2014. http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_21-en.pdf?ua=1 (accessed May 11, 2014).
www.thelancet.com Published online May 20, 2014 http://dx.doi.org/10.1016/S0140-6736(14)60692-9
Every Newborn: the professional organisations’ perspective preterm or low birthweight (or both) infants receive kangaroo mother care, and that all newborn babies with possible infection receive appropriate antibiotic therapy within a short time after birth.1 Basic neonatal resuscitation and care in the so-called golden minute after birth reduces neonatal mortality in developing countries and is estimated to reduce full-term infant deaths by up to 30%.4 In countries challenged by social, economic, humanitarian, and health complexities, provision of interventions to every mother and newborn baby to improve survival will not be without difficulty. However, the international professional organisations of obstetricians and gynaecologists, midwives, paediatricians, neonatologists, and neonatal nurses working together are able to promote a high standard of maternal and newborn care and requisite education and training; strengthen input into health plans and policy development; and foster international liaisons. Our organisations are pleased that The Lancet has published the Every Newborn Series,5–9 to bring attention to actions that are needed to accelerate progress towards Millennium Development Goals 4 and 5. The papers in this Series emphasise the important links between the various professional organisations to achieve the objectives of the Every Newborn Action Plan. The lifecourse approach is emphasised, highlighting the continuum of care needed from woman to newborn baby to childhood; the need for workforce planning and task
www.thelancet.com Published online May 20, 2014 http://dx.doi.org/10.1016/S0140-6736(14)60692-9
Published Online May 20, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60692-9 See Online/Series http://dx.doi.org/10.1016/ S0140-6736(14)60458-X, http://dx.doi.org/10.1016/ S0140-6736(14)60496-7, http://dx.doi.org/10.1016/ S0140-6736(14)60792-3, http://dx.doi.org/10.1016/ S0140-6736(14)60582-1, and http://dx.doi.org/10.1016/ S0140-6736(14)60750-9
Jenny Matthews/Panos
The International Federation of Gynecology and Obstetrics, the International Confederation of Midwives, the International Pediatric Association, and the Council of International Neonatal Nurses recognise and support the Every Newborn Action Plan,1 which is situated in the continuum of care for reproductive, maternal, newborn, and child health. The Every Newborn Action Plan calls for acceleration in action at country, regional, and local levels to accelerate reduction in stillbirth, and in neonatal and maternal mortality rates. Although some progress has been made since the Lancet Series on neonatal survival was published a decade ago, neonatal deaths have fallen at a slower rate than expected, stillbirths at an even slower rate, and, although maternal mortality has also declined, the relevant Millennium Development Goals for 2015 will not be achieved. Every year, 40 million mothers still give birth without any help from a midwife or another health worker trained and equipped to save the life of the baby or mother.2 Many babies die every year because mothers do not get the good quality care they need during labour and birth. Obstetricians and midwives are at the forefront of caring for the pregnant woman and newborn baby during the antenatal, intranatal, and postnatal periods. Often the midwife is the sole health-care professional responsible for both mother and baby. The causes of stillbirths and newborn and maternal deaths are closely related, and the solutions are known. Ensuring that essential care is provided around labour, delivery, and immediately afterwards is critical to ending newborn deaths. Available, skilled, well equipped birth attendants to assist women and newborn babies during labour and birth are vital to their survival.3 Additionally, because 85% of neonatal deaths relate to preterm complications,1 birth asphyxia, and infection, paediatricians, neonatologists, and neonatal nurses are essential to the care of preterm and ill newborn babies. There is a shortage of all health-care professionals, which is an issue that must be addressed; but most significantly, because nurses and midwives are the most numerous health-care providers in many countries and are at the frontline of providing care, it is nurses and midwives with additional training in neonatal care that are needed to ensure that greater than 75% of all infants not breathing after birth receive bag and mask resuscitation, that all
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Comment
sharing; and the need for family planning to reduce the burden of death. The Series also highlights that to avoid 116 million deaths and 99 million survivors with disability by 2035, we must reduce the number of babies who are small for gestational age (10·4 million in south Asia and sub-Saharan Africa in 2010), and prevent stillbirths, newborn deaths, and long-term non-communicable disorders. Improvement of maternal and newborn care is therefore crucial to improving the life and health of the overall population. Professional organisations have the capacity to mobilise members to achieve the common aim of ending preventable deaths. *Karen New, Andreas Konstantopoulos, Sabaratnam Arulkumaran, Frances Day-Stirk Council of International Neonatal Nurses, Boston, MA 02131, USA (KN); International Pediatric Association, Elk Grove Village, IL, USA (AK); International Federation of Gynecology and Obstetrics, London, UK (SA); and International Confederation of Midwives, The Hague, Netherlands (FD-S) [email protected] We declare no competing interests. 1
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Save the Children. Surviving the first day: state of the world’s mothers 2013. London: Save the Children International, 2013. http://www.savethechildren. org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SOWM-FULLREPORT_2013.PDF (accessed April 8, 2014). WHO. Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM, FIGO. Geneva: World Health Organization, 2004. http://whqlibdoc.who.int/publications/2004/9241591692.pdf (accessed April 8, 2014). Wall SN, Lee ACC, Niermeyer S, et al. Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet 2009; 107 (suppl): S47–64. Darmstadt GL, Kinney MV, Chopra M, et al, for The Lancet Every Newborn Study Group. Who has been caring for the baby? Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S0140-6736(14)60458-X. Lawn JE, Blencowe H, Oza S, et al, for The Lancet Every Newborn Study Group. Progress, priorities, and potential beyond survival. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S01406736(14)60496-7. Bhutta ZA, Das JK, Bahl R, 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? Lancet 2014; published online May 20. http:// dx.doi.org/10.1016/S0140-6736(14)60792-3. Dickson KE, Simen-Kapeu A, Kinney MV, et al, for The Lancet Every Newborn Study Group. Health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S0140-6736(14)60582-1. Mason E, McDougall L, Lawn JE, et al, for The Lancet Every Newborn Study Group, on behalf of the Every Newborn Steering Committee. From evidence to action to deliver a healthy start for the next generation. Lancet 2014; published online May 20. http://dx.doi.org/10.1016/S01406736(14)60750-9.
WHO. Every newborn: an action plan to end preventable deaths. May 2, 2014. http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_21-en.pdf?ua=1 (accessed May 11, 2014).
www.thelancet.com Published online May 20, 2014 http://dx.doi.org/10.1016/S0140-6736(14)60692-9
