1 / 44

Regionalization of Neonatal Care

Regionalization of Neonatal Care. By Dr. Sawsan Hussein Daffa Consultant Neonatologist MCH – Jeddah Head of Scientific Committee of Perinatal Mortality in Jeddah Pegin / SA. Topics to be Discussed. Introduction World Health Statistics Report – Global Statistics.

nodin
Télécharger la présentation

Regionalization of Neonatal Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Regionalization of Neonatal Care By Dr. Sawsan Hussein Daffa Consultant Neonatologist MCH – Jeddah Head of Scientific Committee of Perinatal Mortality in Jeddah Pegin / SA

  2. Topics to be Discussed • Introduction • World Health Statistics Report – Global Statistics. • Perinatal and Neonatal care in Jeddah where are we? • Regionalization • Definition • Previous experience of regionalization all over the world in Saudi Arabia. • Globally. • Previous experience in Saudi Arabia. • Local experience in Jeddah region.

  3. Introduction Regionalization systems of perinatal care are recommended to ensure that each newborn infant is delivered and cared for in a facility appropriate for his or her health care needs and to facilitate the achievement of optimal outcomes.

  4. Introduction “continue” Uniform national standards should be developed for the capabilities of each level of care such as : • Definitions • Levels of neonatal care • Requirements for equipment • Personnel • Facilities and training • The organization of services including neonatal transport.

  5. Population-based data on patient outcomes, including mortality, specific morbidities, and long-term outcomes, should be obtained to provide level-specific standards for volume of patients requiring various categories of specialized care, including surgery.

  6. World Health Statistics Report • The perinatal mortality rate is five times higher in developing than in developed regions: 10 deaths per 1000 total births in developed regions; 50 per 1000 in developing regions and over 60 per 1000 in least developed countries. Over 130 million babies are born every year, and more than 10 million infants die before their fifth birthday, almost 8 million before their first.

  7. 4 million die in first 28 days of life. ¾ of deaths in first week. ¼ 1st 24 hours of life.

  8. Where do newborn babies die? 1.5 million (~40%of all newborn deaths) occur in 4 countries of South Asia 99% of newborn deaths are in low/middle income countries 66% in Africa and South Asia

  9. Newborns in developing countries are ten times more likely to die than newborns in industrialized countries Neonatal mortality rate (per 1,000 live births), by region (2004)

  10. PNMR In gulf Area (2008) 20 15 10 5 0

  11. Skilled Attendance at Delivery Saves Newborn Lives 100 50 Skilled attendant at delivery Neonatal deaths 80 40 60 30 Skilled attendant at delivery (%) Neonatal deaths per 1000 live births 40 20 20 10 0 0 Latin America Africa Asia Developed regions Caribbean WHO estimates, 2000

  12. Regionalization What? Organization of health care resources and delivery within a defined geographic area. Why? To provide risk appropriate care to a total population to achieve the best outcomes in the most cost efficient manner.

  13. Definition Prenatal regionalization refers to : A structured network between primary care providers in obstetrics and pediatrics and tertiary care consultants, which ensures referral and transport of women and infants to tertiary hospitals when necessary.

  14. PREVIOUS EXPERIENCE OF REGIONALIZATION

  15. Globally During the 1970s,in an effort to improve the outcome of high-risk pregnancies, a number of states (US, Canada, UK) developed systems of regionalized perinatal care. • Through the 1970s and early 1980s, perinatal regionalization was associated with decreased neonatal mortality.

  16. Continued ,, • In 1970 Canadian Neonatologist, paul sweyer first advocated regionalization of NN, PN care after observing that the NMR was higher in small hospital than larger hospitals with NICU. • A review of perinatal mortality in Colorado, 1971 to 1978, and its relationship to the regionalization of perinatal services Am J Obstet Gynecol. 1981 Dec.

  17. Continued ,, - In 1977 the march of dimes committee on perinatal health in U/S issued the guidelines for perinatal care in an integrated regional system. • Sinclair JC. Mortality and morbidity of 500- to 1,499-gram birth weight infants live-born to residents of a defined geographic region before and after neonatal intensive care. Pediatrics. 1982 May.

  18. Continued ,, • Sims DG, Wynn J, improved outcome for newborn babies and declined admission to a regional neonatal intensive care unit. Arch Dis Child. 1982 May. • Paneth, Susser M. Newborn intensive care and mortality in low-birth-weight infants: a population study. N Engl J Med. 1982 Jul. • In North Carolina the proportion of infants weighing <2000 g born in the hospital with level III neonatal services was associated with lower neonatal mortality. (AM J ObstetGynecol 2001;184;1302-7.)

  19. -The three levels of care were designated as: Level I (basic) units provide care for normal newborn infants but must have the personnel and equipment to perform neonatal resuscitation, evaluate healthy newborns and provide postnatal care, and stabilize newborn infants until transfer to an appropriate higher level facility. Level II (specialty) units can provide care to moderately ill infants with problems that are expected to resolve rapidly or who are convalescing after intensive care treatment. Level III (subspecialty) units provide comprehensive care for all critically ill newborn infants, including those who require surgical intervention.

  20. Perinatal regionalization was implemented in North Carolina in 1974. which was associated with decreased neonatal mortality for low birth-weight (<2500 g) infants.

  21. Local Experience In Jeddah Region Health care planning system in Saudi Arabia has different agencies that play important roles in providing health care to residents these agencies are:

  22. The Ministry of Health. • The Neonatal Guard. • The Ministry of Defense and Aviation. • The Ministry of Interior Mazrou et al. 1990.

  23. In addition, the private sector in Saudi Arabia plays an increasingly significant role in the Kingdom and coordinates with the referral network and the regulatory requirements of health sector as a whole.

  24. In 2008 the director of health affairs in Jeddah region made a committee called. Scientific Committee of Prenatal Mortality / Morbidity in Jeddah region

  25. Members - Dr. SawsanDaffa *Consultant Neonatologist *Chairman of Scientific Committee of Perinatal Mortality - Dr. Mai Abualseoud * Neonatology Consultant * Head of Pediatrician Department and NICU in KFMH - Jeddah. - Dr. Saad Al Saedi * Head of NICU in KAUH, KFRC – Jeddah. * Consultant Neonatologist. - Dr. Mansour Al Qurashi *Consultant Neonatologist * Head Section KAMC-WR – Jeddah. - Dr. Hassan Mohammad Ali * Consultant Neonatologist SGH – Jeddah.

  26. Members - Dr. SafinazSalama * Consultant Neonatologist - Dr. DiaaAyoub * Consultant Pediatrician, Erfan Hospital – Jeddah. - Dr. Armand Agababyan *Consultant Neonatologist , SulimanFakeeh Hospital - Dr. Mohammed Wahdain *Chairman of Peadiatris, PICU KAH, Oncology Center. - Dr. Ahmed Balkhair * Head of Information Technology in M.O.H

  27. AIM To improve Perinatal Mortality in Jeddah region :

  28. The Population in Jeddah

  29. Steps • Regionalization of Neonatal Care • Unification of: • Neonatal Terms. • Levels of Neonatal Care. • Neonatal database in Jeddah region. • Standard International guidelines for NICU.

  30. Definitions Pre-term Less than 37 completed weeks. Term From 37 completed weeks to less than 42 completed weeks. Post-term 42 completed weeks or more Perinatal period The perinatal period commences at 22 completed weeks ends seven completed days after birth. Neonatal period The neonatal period commence at birth and ends 28 completed days after birth.

  31. Birth Weight Low Birth Weight Less than 2500 g. Very Low Birth Weight Less than 1500 g. Extremely Low Birth Weight Less than 1000 g.

  32. Methods • Collect data from all hospitals. • Through faxes, Emails. • On site visits.

  33. Results

  34. Population density and distribution to districts of Jeddah

  35. Distribution of hospitals in Jeddah areas

  36. Number of Delivery in Jeddah

  37. Recommendations • Red hot line central office responsible for all neonatal units in Jeddah region with an online active internet connections. • Neonatal transport team. • Regionalization of NICU and develop networking and linkages between all centers.

  38. Recommendations 4. Consultation system in ministry of health to allow information sharing, determining priorities, improving qualities. 5. Rotation of experienced neonatologist between hospitals to update information and sharing skill with stimulus material. 6. Neonatal teaching programs at all levels and workshops (in situ). 7. Invest antenatal care education at all levels including schools, universities and higher education.

  39. Thank You

More Related