FOR THE NEWBORN

AGENDA

1. BCA at a glance

2. Lessons from Adult BCA

3. Why focus on the newborn

4. BCA for the newborn

BCA AT A GLANCE

3

1.Healthcare Associated Infections

2.Antimicrobial Stewardship

3.BCA…for the newborn

10 LESSONS FROM ADULT BCA

1.

5

Doctor-

centred

Empowered Nurse

2.

6

Simple Evidence-Based Intervent

ion

Big Differen

ce

3.

7

Curative

Measures

Preventative Interventions

4.

8

Fiction

Scientific Data

5.

9

Billing Data

Clinical Data

6.

10

Reactive

Proactiv

e

7.

11

Head Office genera

ted data

Frontline

staff data

collection

8.

12

Quality Assura

nce

Quality Improvement

9.

13

Competition

Collaboration

10.EATING THE ELEPHANT ONE BITE AT A TIME

Why focus on the newborn?

INFANT MORTALITYIN RSA ( Stats SA, 2008)

16

Neonatal31%

Diarrhoea22%

LRTI17%

0thers30%

Determinants of Infant Mortality

NEONATAL DEATHSIN RSA ( Stats SA, 2008)

17

Prematu-rity

38%

Birth As-

phyxia25%

Sepsis25%

Congential Abnormalities13%

Determinants of Neonatal Deaths

DRIVERS OF MORBIDITY AND MORTALITY

• Neonatal Sepsis• Chronic Lung Disease• Necrotising Enterocolitis• Periventricular-Intraventricular

Haemorrhage• Retinopathy of Prematurity

FOR THE NEWBORN

3 MAJOR COMPONENTS

1.Screening bundle

2.Drivers of Mortality & Morbidity

3. Sepsis bundle

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

PIH

NECCLD

ROP

DRIVERS OF

MORBIDITY &

MORTALITY

SEPSIS BUNDLE

• Early Bacterial Sepsis (EBS)Vertical transmissionWithin 72 hours of birth

• Late Onset Infections (LOI)Healthcare Associated InfectionBacteria, fungal or viralAfter 72 hours of birth

SEQUENCING

Data CollectionScreening bundle BundlesM & M drivers Obstetric Sepsis

SurveillanceEBS ICP & CLABSI bundleLOI

ROP

RETINOPATHY OF PREMATURITY

ROP BUNDLE

1. Pulse oximetry on an infant receiving oxygen.

2. Saturation probe to be placed on the Right or Left hand.

3. Saturation aimed at 86-92%

4. Monitor alarm to be set at 85 (low) and 93 (high).

5. Fundoscopy screening done or booked before discharge.

ROP

CHRONIC LUNG DISEASE

CLD BUNDLE

1. Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.

2. Neopuff use in neonatal resuscitation.

3. Gentle ventilation (NCPAP) vs (HFO) vs (CV).

4. Permissive hypercapnia of more than 45mmHg.

5. Administration of systemic steroids to the infant to prevent or treat CLD.

CLD

NECROTISING ENTEROCOLITIS

NEC BUNDLE

1. Breastmilk or pasteurised EBM as a modality of feeding.

2. Trophic feeds within 24 hours of birth.

3. Adherence to “volume per day” protocol.

4. Adherence to “frequency of feeds” protocol.

NEC

PERIVENTRICULAR-INTRAVENTRICULAR

HAEMORRHAGE

PIH BUNDLE

1. Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.

2. Delayed cord clamping for 45 seconds to a minute.

3. Neopuff use in neonatal resuscitation.

4. Maintain infant temperature to more than 36 degrees Celsius.

5. Developmental care: dim lights, low levels of noise and minimal handling.

PIH