Conference abstract

Neonatal care: the concept of minimally-invasive approach in very low birth-weight babies in MSF settings: “doing less can be better”

Pan African Medical Journal - Conference Proceedings. 2018:9(17).13 Dec 2018.
doi: 10.11604/pamj-cp.2018.9.17.744

Contact the corresponding author
Keywords: Neonatal care, low- resource settings, context- adapted care
Poster

Neonatal care: the concept of minimally-invasive approach in very low birth-weight babies in MSF settings: “doing less can be better”

Hans-Joerg Lang1,&, Oluwakemi Ogundipe1, Kirrily de Polnay1, Andrea Marelli1, Julita Gil Cuesta1, Isabel Zuniga1

1Médecins Sans Frontières (MSF), Operational Centre Brussels (OCB), Brussels, Belgium

&Corresponding author
Hans-Joerg Lang, Médecins Sans Frontières (MSF), Operational Centre Brussels (OCB), Brussels, Belgium

Abstract

Introduction: worldwide around 30 - 40% of deaths in children occur in neonates with the principal causes of morbidity and mortality being sepsis, birth-asphyxia and prematurity. In 2016, MSF- OCB registered 7,272 exits from 10 neonatal units in low-resource settings with a mortality rate of approximately 13%. Birth-weight was a major factor determining the mortality risk of newborns. In some units, the care of extremely low birth-weight (ELBW) (< 1000 grams) and very low birth-weight (VLBW) (1000 - 1500 grams) newborns with significant morbidities is relatively invasive (e.g. prolonged use of intravenous medications and fluids) and human resource intensive. We suggest that by using a “minimally-invasive approach” in VLBW, appropriate care can be provided, while avoiding harm and using resources efficiently.

Methods: the unique needs of VLBW newborns were considered. In order to recommend a “minimally-invasive approach”, we reviewed literature and considered the capacities of both basic and more advanced emergency obstetric and neonatal care units.

Results: this approach can be operationalized by prioritizing interventions such as effective basic newborn resuscitation, early proactive introduction of enteral feeds, limited use of intravenous fluids, simplified antibiotic regimens for certain patient groups, minimal handling and bundling of care, earlier maternal interaction with the infant as well as efficient respiratory support.

Conclusion: for VLBW infants, minimally-invasive care translated into these clinical interventions could help to improve access to efficient neonatal care by allowing decentralized care in remote settings while leading to decongestion of overcrowded neonatal units. While using resources more efficiently, a less invasive approach to newborn care has the potential to improve the outcome of newborns managed in MSF-settings. In more advanced settings, this approach might also free up resources to focus on interventions with a potentially high impact on survival of VLBW-neonates (e.g. introduction of non-invasive respiratory support). This approach warrants further evaluation.