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  1. 1. Introduction
    1. 1.0 Overview
    2. 1.1 What is the Purpose of the Field Guide
    3. 1.2 Who is the Field Guide intended for?
    4. 1.3 How is the Field Guide organized?
  2. 2. Background
    1. 2.0 Overview
    2. 2.1 Humanitarian Settings Across the Globe
      1. 2.1.1 Challenges to Newborn Health Service Delivery
    3. 2.2 Newborn Health: Epidemiology
      1. 2.2.1 Global burden of newborn mortality
      2. 2.2.2 Principal causes of neonatal deaths
  3. 3. Newborn Health Services
    1. 3.0 Overview
    2. 3.1 General Principles and Considerations
      1. 3.1.1 The Continuum of Care Across the Lifecourse
      2. 3.1.2 Levels of Care
    3. 3.2 Essential Newborn Care
    4. 3.3 Newborn Care at Household/Community Level
      1. 3.3.1 During the Antenatal Period
      2. 3.3.2 Intrapartum and essential newborn care
      3. 3.3.3 Postnatal care
    5. 3.4 Newborn Care at Primary Care Facilities
      1. 3.4.1 Antenatal care
      2. 3.4.2 Intrapartum and essential newborn care
      3. 3.4.3 Postnatal care
    6. 3.5 Newborn Care at Hospitals
      1. 3.5.1 Antenatal care
      2. 3.5.2 Intrapartum and essential newborn care
      3. 3.5.3 Postnatal care
    7. 3.6 Additional Considerations for Preventing and Managing Principal Causes of Neonatal Deaths
      1. 3.6.1 Prematurity/Low Birth Weight (LBW)
      2. 3.6.2 Newborn Infections
      3. 3.6.3 Intrapartum Complications
  4. 4. Strategic Considerations
    1. 4.0 Overview
    2. 4.1 Mainstreaming newborn health in humanitarian coordination
      1. 4.1.1 Incorporate questions about newborn health services within a rapid health assessment
      2. 4.1.2 Advocate for the inclusion and prioritisation of newborn health in humanitarian response plans
    3. 4.2 Conducting a situational analysis
      1. 4.2.1 Examine national policies and protocols relevant to newborn health
      2. 4.2.2 Examine existing clinical guidelines, key messages/ BCC materials, tools and training materials
      3. 4.2.3 Assess resource availability: facilities, supplies and staff
    4. 4.3 Developing an inclusive and unified response strategy
      1. 4.3.1 Prioritizing newborn interventions
      2. 4.3.2 Update and distribute clinical guidelines and protocols
      3. 4.3.3 Develop and collate needs based staff training materials
      4. 4.3.4 Procure and distribute essential medicines and supplies
      5. 4.3.5 Ensure quality improvement and respectful care
      6. 4.3.6 Develop proposals to secure additional funding
    5. 4.4 Developing and implementing a monitoring and evaluation (M&E) plan
      1. 4.4.1 Compromised data flow and routine information systems
  5. 5. Program Implementation Considerations
    1. 5.0 Overview
    2. 5.1 Developing and disseminating key messages/behavior change communication (BCC) materials
    3. 5.2 Developing a referral system
      1. 5.2.1 When referral is not feasible
    4. 5.3 Home visits for mothers and babies
    5. 5.4 Procuring newborn care supply kits
    6. 5.5 Managing newborn deaths in crisis settings
      1. 5.5.1 Support for neonatal loss
      2. 5.5.2 Documenting neonatal loss
  6. 6. Annexes
    1. 6.1 Annex 1: Newborn health services summary tables by levels of care
      1. 6.1.1 Annex 1A
      2. 6.1.2 Annex 1B
      3. 6.1.3 Annex 1C
    2. 6.2 Annex 2: Doses of Common Drugs for Neonates
    3. 6.3 Annex 3: Advanced Care for Very Sick Newborns
    4. 6.4 Annex 4: Tools to Support Neonatal Referrals
      1. 6.4.1 Annex 4A: When to Refer a Newborn to the Hospital
      2. 6.4.2 Annex 4B: Job Aid: Transporting the Sick Newborn
      3. 6.4.3 Annex 4C: Sample Referral Note
    5. 6.5 Annex 5: Newborn Kits for Humanitarian Settings
    6. 6.6 Annex 6: Indicators
      1. 6.6.1 Annex 6A: Newborn Health Indicators for Routine Data Systems
      2. 6.6.2 Annex 6B: List of Indicators and Questions to Measure Facility Capacity to Provide Key Newborn Health Services
    7. 6.7 Annex 7: READY: Maternal and Newborn Health During Infectious Disease Outbreaks: Operational Guidance for Humanitarian and Fragile Settings
  7. 7. In Practice
    1. 7.1 Uganda
      1. 7.1.1 Recommendations
    2. 7.2 Kenya
      1. 7.2.1 Recommendations
    3. 7.3 Ethiopia
      1. 7.3.1 Recommendations
    4. 7.4 South Sudan
Newborn Field Guide

3.1 General Principles and Considerations

3.1.1 The Continuum of Care Across the Lifecourse

Neonatal services are part of a continuum of care that is comprised of two dimensions—the lifecourse and levels of care (Figure 3.1). This results in a matrix of integrated packages involving different types of care at different levels. More specifically, neonatal services are part of maternal and newborn care across a spectrum of SRMNCAHabbreviation services that begin before pregnancy and continue through labor and birth, the immediate postnatal period, the extended postnatal period, childhood and adolescence. Integrated service delivery extends from household to health facility and/or hospital and back home, along with a health system continuum of care.

The neonatal period merits special attention within humanitarian settings, when health services and systems may be interrupted and emergency support is brought in through national and international mechanisms. The newborn health services described in this Field Guide should be provided by governmental and non-governmental channels during a crisis response.

Although each humanitarian crisis presents different issues and challenges to responders, the life-saving interventions and commodities presented in this chapter have been defined according to WHOabbreviation approved standards for newborn care and, when systematically implemented, will improve MNHabbreviation outcomes in humanitarian settings. These recommendations should be adapted to local needs and used to improve guidelines already in place outlining minimum care and supply requirements for MNHabbreviation care in crisis and displaced settings.

Figure 3.1: Package of interventions across the continuum of care

Source: Lawn J, Sadoo S, Strategies through the lifecourse to improve maternal, newborn, child, and adolescent health, Oxford Textbook of Global Health of Women, Newborns, Children, and Adolescents, Oxford University Press, 2018.

3.1.2 Levels of Care

In humanitarian settings, staff working at all levels should deliver integrated maternal and newborn services across the continuum of care. This includes appropriate referral and follow-up across these three levels:

Hospitals and health facilities

These may include district, provincial, and national referral hospitals and temporary field hospitals. Inpatient referral care is provided by midwives, nurses and physicians with pharmacy and laboratory support services. Hospitals have the ability to provide more advanced MNHabbreviation care, such as CEmONC and advanced neonatal respiratory and feeding support.

Outpatient and outreach services

These facilities include existing host community primary care facilities, and other clinics operating out of permanent structures, which can be supplemented with temporary clinics in camp settings and mobile clinics. Some facilities at this level may be designated and equipped to deliver BEmONC services. Services are typically delivered by midlevel staff such as nurses and midwives, with support for referral to hospital if needed, and connections to community structures after discharge.

Family and community care

Evidence from low– and middle-income settings suggests dialogue and engagement of CHWs and men in promoting maternal and newborn health can improve care seeking behavior and home behaviors. Care at the household and community level is provided to women and babies in their homes or in camp settings by CHWabbreviation or other lay community members, TBAs, outreach workers or other trained health workers. These workers may be linked to a health post or primary care facility. The care is mainly promotive and preventive, with outreach.