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FOR THE NEWBORN

FOR THE NEWBORN. AGENDA. BCA at a glance Lessons from Adult BCA Why focus on the newborn BCA for the newborn. BCA AT A GLANCE. 10 LESSONS FROM ADULT BCA. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. EATING THE ELEPHANT ONE BITE AT A TIME. Why focus on the newborn?.

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FOR THE NEWBORN

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  1. FOR THE NEWBORN

  2. AGENDA • BCA at a glance • Lessons from Adult BCA • Why focus on the newborn • BCA for the newborn

  3. BCA AT A GLANCE

  4. 10 LESSONS FROM ADULT BCA

  5. 1.

  6. 2.

  7. 3.

  8. 4.

  9. 5.

  10. 6.

  11. 7.

  12. 8.

  13. 9.

  14. 10.EATING THE ELEPHANT ONE BITE AT A TIME

  15. Why focus on the newborn?

  16. INFANT MORTALITYIN RSA ( Stats SA, 2008)

  17. NEONATAL DEATHSIN RSA ( Stats SA, 2008)

  18. DRIVERS OF MORBIDITY AND MORTALITY • Neonatal Sepsis • Chronic Lung Disease • Necrotising Enterocolitis • Periventricular-Intraventricular Haemorrhage • Retinopathy of Prematurity

  19. FOR THE NEWBORN

  20. 3 MAJOR COMPONENTS

  21. SCREENING BUNDLE 1. Antenatal steroid compliance 2. HIV screening 3. HIV PMTCT compliance 4. Syphilis screening 5. Early NCPAP compliance 6. Cranial Ultrasound compliance 7. Retinal exam compliance 8. Caesarean section rate

  22. CLD NEC DRIVERS OF MORBIDITY & MORTALITY PIH ROP

  23. SEPSIS BUNDLE • Early Bacterial Sepsis (EBS) • Vertical transmission • Within 72 hours of birth • Late Onset Infections (LOI) • Healthcare Associated Infection • Bacteria, fungal or viral • After 72 hours of birth

  24. SEQUENCING

  25. RETINOPATHY OF PREMATURITY ROP

  26. ROP BUNDLE Pulse oximetry on an infant receiving oxygen. Saturation probe to be placed on the Right or Left hand. Saturation aimed at 86-92% Monitor alarm to be set at 85 (low) and 93 (high). Fundoscopy screening done or booked before discharge. ROP

  27. CHRONIC LUNG DISEASE

  28. CLD BUNDLE Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation. Neopuff use in neonatal resuscitation. Gentle ventilation (NCPAP) vs (HFO) vs (CV). Permissive hypercapnia of more than 45mmHg. Administration of systemic steroids to the infant to prevent or treat CLD. CLD

  29. NECROTISING ENTEROCOLITIS

  30. NEC BUNDLE Breastmilk or pasteurised EBM as a modality of feeding. Trophic feeds within 24 hours of birth. Adherence to “volume per day” protocol. Adherence to “frequency of feeds” protocol. NEC

  31. PERIVENTRICULAR-INTRAVENTRICULAR HAEMORRHAGE

  32. PIH BUNDLE Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation. Delayed cord clamping for 45 seconds to a minute. Neopuff use in neonatal resuscitation. Maintain infant temperature to more than 36 degrees Celsius. Developmental care: dim lights, low levels of noise and minimal handling. PIH

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