KZN Neonatal Programme

Welcome to the KZN neonatal programme website.

We trust you will find all the support and resources here that you need to offer optimal neonatal care in your facility.

Please contact Ruth e-Provincial Neonatal Coordinator at ruth.davidge@kznhealth.gov.za for any questions or support required in neonatal care.

Premature birth is now the leading cause, globally, of U5M. 15 million babies are born too soon every year. 1 million of these don’t reach their 5th birthday.

750 thousand (2/3rds) could be saved with simple inexpensive interventions like breast feeding, antibiotics and skin to skin care.

Reducing premature births and neonatal mortality have thus become global priorities.

The Every Newborn Action Plan (ENAP) has set a global neonatal mortality (NMR) target of 10/1000 births for every nation to achieve by 2035.

South Africa has made great progress in reducing Under-5 mortality (U5M) from 65,000 deaths in 2007 to 35,000 deaths in 2012. Unfortunately, in line with the global situation, neonatal mortality has remained relatively unchanged at over 12/1000 since 2000! This means that of the approximately 1 million babies born each year in the public sector over 12 000 die in the first month. That’s 33 every day! Most of these babies die on the first day or the first week of their life making the neonatal period –the first month of life-the most vulnerable period our lives.

The National Perinatal Mortality Committee (NaPeMCo) has launched the HHAPI-NeSS plan:    

 

Improve the Health System for mothers and babies

  • Ensure 24-hour access to functioning emergency obstetric and neonatal care (both basic and comprehensive). Dedicated ambulances, maternal waiting homes, KMC sites in all hospitals etc. 
  • Ensure accessible and appropriate contraceptive services for all women which are integrated into all levels of health care and are available on site for women post-miscarriage and postpartum women
Improving skills and skills of Health Care providers in maternal and neonatal care
  • Train all health care workers involved in maternity and neonatal care in the ESMOE-EOST programme and in managing immature infant -SA INC
  • Train all health care workers who deal with pregnant women in HIV advice, counselling, testing and support (ACTS), initiation of HAART, monitoring of HAART
Reduce deaths due to Asphyxia
  • Ensure that labour is monitored appropriately by a skilled birth attendant
  • Ensure all birth attendants are skilled at a minimum in neonatal bag and mask ventilation
  • Ensure that the m is used to monitor labour and the fetus and mother are monitored according to the prescribed norms ensuring proper data interpretation.

The above are in support of the Neonatal Survival Strategy.

Figure 5.2
The above table reflects the impact of neonatal morbidity and mortality and the interventions that are required at multiple levels. These have been grouped into an Essential Package of Care (EPOC) or Quality Improvement Toolkit for Newborn Health.

Most of the programmes in EPOC are familiar:

  1. Improved antenatal care through Basic Antenatal Care (BANC) program.

  2. Promotion of Breastfeeding through the Mother-Baby Friendly Initiative (MBFI)

  3. Effective neonatal resuscitation through the Helping Babies Breath (HBB) and Essential Steps in the Management of Obstetric Emergencies (ESMOE) programmes,

  4. Improved care for premature babies through Kangaroo Mother Care (KMC)

  5. Training for health workers caring for neonates-The Management of Sick and small Neonates Program (MSSN)-In  KZN known as the Kwa-Zulu Initiative for Newborn care (KINC)

  6. Increasing administration of antenatal steroids to prevent to the development of hyaline membrane disease

  7. The roll out of Nasal Continuous Positive airways Pressure (nCPAP) to district hospitals to support respiratory management and prevent the need for ventilation.

The Campaign to Accelerate Reduction in Maternal and Neonatal Mortality in Africa (CARMA) has also highlighted many of these interventions.

The following pie chart represents the approximate reduction in neonatal mortality that could be achieved if these key programmes were fully implemented.

KZN Implementation

n 2015 a system of accreditation of paediatric services was launched based on the clinical governance framework reflected in the diagram alongside. Three rounds subsequently occurred-Neonatal, Paediatric Inpatients and Ambulatory services ending in 2018. These provided a baseline of the existing services and standards of care in the Province.

Starting with Neonates these accreditation tools have been adapted to include and extend all the requirements of the National EPOC.

These tools are aimed at empowering hospitals to:

  • Know the expected standards of care

  • Equip them with the necessary tools and knowledge to be able to implement them

  • Assess their own progress in implementation and improved outcomes

In KZN the Essential Package of care includes et al:

  1. Standardised clinical records and management checklists

  2. Norms for infrastructure, equipment, staffing, consumables and pharmaceuticals

  3. Systems for monitoring

    1. Admissions, discharges, deaths, transfers

    2. Medical and nursing handovers and task allocation, in-service training and skills development

    3. Equipment maintenance, procurement processes and support services eg maintenance and cleaning

  4. Audit tools

  5. Reports

The implementation of this package of care and achievement of implementation goals will be monitored and reported through the Neonatal Implementation Dashboard at Facility, District and Provincial level. It will be supported through mentoring visits from regional outreach consultants and the DCST teams.