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Small and Sick
WHO-UNICEF Expert and Country Consultation on Small and/or Sick Newborn Care Group
(2023) WHO-UNICEF Expert and Country Consultation on Small and/or Sick Newborn Care
Group. A comprehensive model for scaling up care for small and/or sick newborns at district
level–based on country experiences presented at a WHO-UNICEF expert consulta- tion. J Glob
Health 2023;11:03023 (Open Access)
Access Guideline - https://jogh.org/wp-content/uploads/2023/04/jogh-13-03023.pdf
British Association of Perinatal Medicine (2019). Improving Normothermia in Very Preterm
Infants. A quality Improvement Toolkit.
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Access Guideline - https://www.londonneonatalnetwork.org.uk/wp-content/uploads/2015/09/Toolkit-2009.pdf
WHO guideline on safe oxygen:
Access Guideline - https://www.healthynewbornnetwork.org/hnn-content/uploads/DNH_TechBrief_Oxygen_7.6.17-1.pdf
Nuturing Care WHO:
Access Guideline - https://apps.who.int/iris/bitstream/handle/10665/345297/9789240035201-eng.pdf
British Association of Perinatal Medicine (BAPM) (2021) - Advanced Neonatal Nurse Practitioner
Capabilities Framework
Access Guideline - https://www.bapm.org/resources/300-advanced-neonatal-nurse-practitioner-capabilities-framework
British Association of Perinatal Medicine BAPM - Identification and Management of Neonatal
Hypoglycaemia in the Full Term Infant (Birth – 72 hours)
Access Guidelines - https://www.bapm.org/resources/identification-and-management-of-neonatal-hypoglycaemia-in-the-full-term-infant-birth-72-hours
Resuscitation Council UK - Newborn resuscitation and support of transition of infants at birth Guidelines
Access Guideline - https://www.resus.org.uk/library/2021-resuscitation-guidelines/newborn-resuscitation-and-support-transition-infants-birth
WHO (2019). Guideline for Management of Neonatal Hypoglycemia.
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Access Guideline - https://platform.who.int/docs/default-source/mca-documents/policy-documents/operational-guidance/ARE-MN-62-01-OPERATIONALGUIDANCE-2015-eng-
The Royal Hospital for Women: Hypoglycemia – Monitoring and Management of High
Risk Neonates.
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Access Guideline - https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/Hypoglycaemianeonate_0.pdf
NHS: Care of the Newborn Hypglycaemia Retrieved from:
https://www.bsuh.nhs.uk/wp-content/uploads/sites/5/2016/09/Hypoglycaemia-2012.pdf
India: Neonatal Hypoglycemia Treatment Guidelines (2022)
Access Guideline - https://iapindia.org/pdf/X9ceMoHV2pAF6UR_STG-NEONATAL-HYPOGLYCEMIA.pdf
Eswatini: Neonatal Hypoglycemia.
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Access Guideline - https://www.unicef.org/eswatini/media/631/file/UNICEF-Sd-Neonatal-Guidelines-report-2018.pdf
USA Brigham and womens.org. Neonatal Glucose Assessment and Clinical Management.
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Access Guideline - https://www.brighamandwomens.org/assets/bwh/pediatric-newborn-medicine/pdfs/dpnm-hypoglycemia-revised-12-19-16.pdf
Belize: Neonatal clinical protocols.
Access Guideline - https://platform.who.int/docs/default-source/mca-documents/policy-documents/guideline/blz-mn-32-02-guideline-2018-eng-neonatal-clinical-guidelines-2018-2021.pdf
AAP: Neonatal Clinical Guidelines.
Access Guideline - https://publications.aap.org/aapbooks/book/563/Neonatal-Care-A-Compendium-of-AAP-Clinical
Royal Children’s Hospital Melbourne. Nursing Standards.
Access Guideline - https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Nursing_Assessment/
Kenya. Comprehensive Newborn Care Protocols Book November 2022
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Access Guideline - https://paediatrics.uonbi.ac.ke/sites/paediatrics.uonbi.ac.ke/files/2023-04/Comprehensive%20Newborn%20Care%20Protocols%20Book%20November%202022.pdf
Kenya. Basic Paediatric Protocols. Kenya Basic Paediatric protocol November 2022
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Access Guideline - https://paediatrics.uonbi.ac.ke/sites/paediatrics.uonbi.ac.ke/files/2023-04/Basic%20Paediatric%20protocol%205th%20edition%20FOR%20PRINT%2031st%20Oct%202022.pdf
Sweden. Neurodevelopmental guidelines
Access Guideline - https://cdnlinks.lww.com/permalink/mcn/a/mcn_43_2_2017_12_18_lockeridge_0040_sdc01.pdf
BMJ Mapping of NICU developmental care nursing interventions.
Access Guideline - https://bmjopen.bmj.com/content/bmjopen/12/1/e046807.full.pdf
Sidney Children’s Hospital Network. Developmentally Supportive Care for Newborn Infants Practice Guideline.
Access Guideline - https://www.schn.health.nsw.gov.au/_policies/pdf/2006-0027.pdf
Critical Care Medicine. Guidelines for Family-Centered Care in the Neonatal, Pediatric and Adult ICU.
Access Guideline - https://journals.lww.com/ccmjournal/Fulltext/2017/01000/Guidelines_for_Family_Centered_Care_in_the.12.aspx
UK. Guideline for Family-Centered Care in the Neonatal, Pediatric and Adult Intensive Care Unit.
Access Guideline - https://pearl.plymouth.ac.uk/bitstream/handle/10026.1/13043/PEARL%202017%20Davidson%20J%20et%20al.%20FCC%20Guidelines.pdf?sequence=1
Royal Children’s Hospital Melbourne. Neonatal and infant skin care.
Access Guideline - https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal___infant_skin_care/
BWH. Skin Care.
Canadian Pediatric Society. Discharge Planning of the preterm infant.
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Access Guideline - https://cps.ca/en/documents/position/discharge-planning-of-the-preterm-infant
AHRQ. Discharge checklist.
Access Guideline - https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_1_IDEAL_chklst_508.pdf
AAP. Discharge.
Access Guideline - https://downloads.aap.org/AAP/PDF/NPA%20discharge%20Guidelines%20Final.pdf
Scottish Neonatal Discharge Planning and Follow-Up Framework.
Access Guideline - https://www.perinatalnetwork.scot/neonatal/neonatal-discharge/
The Royal Children Hospital Melbourne Neonatal intravenous fluids.
Access Guideline - https://www.rch.org.au/clinicalguide/guideline_index/Neonatal_intravenous_fluids/
University of Iowa. Fluid management: NICU Handbook.
Access Guideline - https://uihc.org/childrens/educational-resources/fluid-management-nicu-handbook
HIE Supportive Care Management Guidelines.
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Access Guideline - https://fn3.sites.medinfo.ufl.edu/files/2015/10/HIE-Supportive-Care-Management-Guidelines-08-1-2015-final1.pdf
India. Neonatal Transport.
Access Guideline - https://www.ontop-in.org/ontop-pen/Week-12-13/Transport%20of%20sick%20NB%20.pdf
Canada. Neonatal Transport.
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Access Guideline - https://medicine.usask.ca/documents/cme/NeonatalTransportGuidelines.pdf
Every Premie. Safe Oxygen Recommendations.
Access Guideline - https://www.everypreemie.org/wp-content/uploads/2019/09/SafeOxygen_english_7.6.17.pdf
Royal Children’s Hospital Melbourne. Oxygen Delivery.
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Access Guideline - https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Oxygen_delivery/
NHS Ashford and St. Peter’s Hospital. Neonatal intensive Care Unit Clinical Guideline Oxygen.
Access Guideline - https://www.ashfordstpeters.net/Guidelines_Neonatal/Oxygen%20Guideline%20June%202015.pdf
Joint United Kingdom Blood Transfusion and Tissue Transplantation Service.
Access Guideline - https://www.transfusionguidelines.org/transfusion-handbook/10-effective-transfusion-in-paediatric-practice/10-2-neonatal-transfusion
UK. Exchange Transfusion.
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Access Guideline - https://www.rch.org.au/uploadedFiles/Main/Content/neonatal_rch/EXCHANGE_TRANSFUSION.pdf
AAP. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More weeks of Gestation.
Access Guideline - https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-
AAP. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More weeks of Gestation.
Access Guideline - https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of
NHS Northern Devon Healthcare. Exchange Transfusion Guideline for Neonates.
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Access Guideline - https://www.northdevonhealth.nhs.uk/wp-content/uploads/2018/10/Exchange-Transfusion-Guideline-for-Neonates.pdf
British Association of Perinatal Medicine (BAPM) (2021) - Advanced Neonatal Nurse Practitioner Capabilities Framework
Access Guideline - https://www.bapm.org/resources/300-advanced-neonatal-nurse-practitioner-capabilities-framework
British Association of Perinatal Medicine BAPM - Identification and Management of Neonatal Hypoglycaemia in the Full Term Infant (Birth – 72 hours)
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Access Guideline - https://www.bapm.org/resources/identification-and-management-of-neonatal-hypoglycaemia-in-the-full-term-infant-birth-72-hours
Resuscitation Council UK - Newborn resuscitation and support of transition of infants at birth Guidelines
Access Guideline - https://www.resus.org.uk/library/2021-resuscitation-guidelines/newborn-resuscitation-and-support-transition-infants-birth
Workforce
NHS (2015). Toolkit for High-Quality Neonatal Services.
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Access Guideline - https://www.londonneonatalnetwork.org.uk/wp-content/uploads/2015/09/Toolkit-2009.pdf
Faculty Guidelines Institute: Recommended NICU Standards.
Access Guideline - https://fgiguidelines.org/wp-content/uploads/2020/08/Recommended-NICU-Standards_2020-08-31.pdf
AAP Standards for Levels of Neonatal Care.
Access Guideline - https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2023-061957/191305/Standards-for-Levels-of-Neonatal-Care-II-III-and?autologincheck=redirected
KMC
American Academy of Pediatrics. Immediate Kangaroo Mother Care (iKMC) series.
Access Guideline - https://www.aap.org/en/aap-global/immediate-kangaroo-mother-care-ikmc/
World Health Organization (2023). Kangaroo mother care-Implementation strategy for scale-up
adaptable to different country context.
Access Guideline - https://www.who.int/publications/i/item/9789240071636
Kwazula Natal, South Africa (2021). KMC daily discharge scoring sheet.
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Access Guideline - http://www.kznhealth.gov.za/neonates/records/KMC%20score%20sheet.pdf
Kwazula Nata, South Africa (2021). KMC Follow Up.
Access Guideline - http://www.kznhealth.gov.za/neonates/records/KMC%20Follow%20Up.pdf
Kwazula Nata, South Africa (2021). KMC Unit Audit.
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Access Guideline - http://www.kznhealth.gov.za/neonates/ess-pack/KMC%20audit%20(Tool%209).pdf
Neonatal Feeding
Barlow, S. M., Poore, M. A., Zimmerman, E. A., Finan, D. S. (2010) Feeding Skills in the Preterm Infant.
Access Article - https://leader.pubs.asha.org/doi/10.1044/leader.FTR3.15072010.22
Kwazula Nata, South Africa (2021). Preterm oral feeding trasition checklist.
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Access Guideline - http://www.kznhealth.gov.za/neonates/records/Oral%20feeding%20transitionchecklist%202.pdf
British Association of Perinatal Medicine (2020). Optimising Early Maternal Breast Milk for
Preterm Infants. A quality Improvement toolkit.
Access Guideline - https://www.londonneonatalnetwork.org.uk/wp-content/uploads/2015/09/Toolkit-2009.pdf
EFCNI (2023). Toolkit for establishing and organizing human milk banks.
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Access Guideline - https://www.efcni.org/wp-content/uploads/2023/04/EFCNI_Toolkit_Human_Milkbank_en_web.pdf
Cue based care:
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Access Guideline - https://www.slhd.nsw.gov.au/RPA/neonatal/content/pdf/Nursing%20Guidelines/Cuebased_care.pdf
IFCDC-Recommendations for Best Practice for Feeding, Eating and Nutrition Delivery.
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Access Guideline - https://nicudesign.nd.edu/nicu-care-standards/ifcdc--recommendations-for-best-practices-for-feeding-eating-and-nutrition-delivery/
KC. NICU Feeding Protocol.
Access Guideline - https://kcprematurebabies.com/wp-content/uploads/2020/pdf/NICU%20FEEDING%20PROTOCOL.pdf
University of Iowa. Feeding.
Access Guideline - https://uihc.org/childrens/educational-resources/feeding-nicu-handbook
Brigham and Women Hospital: Enteral Nutrition.
Access Resource - https://www.brighamandwomens.org/assets/bwh/pediatric-newborn-medicine/pdfs/dpnm-enteral-nutrition-clinical-practice-guideline-final.pdf
NICU Design: feeding
Access Guideline - https://nicudesign.nd.edu/nicu-care-standards/ifcdc--recommendations-for-best-practices-for-feeding-eating-and-nutrition-delivery/
NHS Greater Glasgow. Enteral feeding of preterm infants.
Access Guideline - https://www.clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/neonatology/enteral-feeding-of-preterm-infants/
NHS. Risk Stratified approach to enteral feeding on NICU
Access Guideline - https://ashfordstpeters.net/Guidelines_Neonatal/Risk%20Stratified%20Approach%20to%20Enteral%20Feeding%20Mar%202023.pdf
Government of Western Australia. Enteral Feeding: Initiation and Progression.
Access Guideline - https://www.cahs.health.wa.gov.au/-/media/HSPs/CAHS/Documents/Health-Professionals/Neonatology-guidelines/Enteral-Feeding-Initiation-and-Progression.pdf
Other Guidelines
Essential Newborn Care (WHO)
High-quality universal newborn health care is the right of every newborn everywhere.
Babies have the right to be protected from injury and infection, to breathe normally, to be warm and to be fed. All newborns should have access to essential newborn care, which is the critical care for all babies in the first days after birth. Essential newborn care involves immediate care at the time of birth, and essential care during the entire newborn period. It is needed both in the health facility and at home.
WHO Human Resource Strategies To Improve Newborn Care in Health Facilities in Low and Middle-Income Countries
Every year, an estimated 15 million babies are born preterm – before 37 weeks of pregnancy. That is more than 1 in 10 live births. Approximately 1 million children die each year worldwide due to complications from their early birth. Those that survive often face a lifetime of ill-health including disability, learning difficulties, and visual and hearing problems. Half of the babies born at or below 32 weeks (2 months early) die in low-income settings, due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all these babies survive. Today, (November 2020) on World Prematurity Day, WHO launched a new Roadmap on human resource strategies to improve newborn care in health facilities in low- and middle-income countries, aimed at improving quality of care for newborns, including small and sick babies, and supporting countries to achieve the SDG target to reduce neonatal mortality to less than 12 per 1000 live births by 2030.
WHO Recommendations for Care of the Preterm or Low-Birth-Weight Infant
The recommendations in this guideline are intended to inform development of national and subnational health policies, clinical protocols and programmatic guides. The target audience includes national and subnational public health policy-makers, implementers and managers of maternal, newborn and child health programmes, health-care facility managers, supervisors/instructors for in-service training, health workers (including midwives, auxiliary nurse-midwives, nurses, paediatricians, neonatologists, general medical practitioners and community health workers), nongovernmental organizations, professional societies involved in the planning and management of maternal, newborn and child health services, academic staff involved in research and in the pre-service education and training of health workers, and those involved in the education of parents.
Zero Separation Statements
This campaign is supported by more than 140 national and international parent- and patient organisations, international healthcare professionals and medical societies including the World Health Organization (WHO). Download their statement for your communication to advocate a zero separation policy in neonatal care.
Ending Preventable Newborn Deaths and Stillbirths By 2030 (UNICEF)
UNICEF is committed to providing affordable, high-quality health care to mothers and newborns
before, during, and after pregnancy. To achieve this goal, UNICEF and partners have adopted
the Every Newborn Action Plan, which provides a roadmap for reducing newborn mortality and
stillbirths and improving maternal and newborn health by 2030. The updated targets and
milestones for 2020-2025 include ensuring that every pregnant woman has four or more
antenatal care contacts, every birth is attended by skilled health personnel, every woman and
newborn receives early routine postnatal care within two days, and every small and sick
newborn receives care. UNICEF is supporting countries in implementing these
recommendations and reaching these goals by providing essential packages of high-quality
maternal and newborn services, such as home visits, small and sick newborn care, and
kangaroo care. Four indicators have been identified to track progress towards these goals:
antenatal care, births attended by skilled health personnel, postnatal care within two days, and
care for small and sick newborns. Currently, data on these indicators are derived from
population-based household surveys, but efforts are underway to strengthen routine health
information systems to capture this information rapidly at the subnational level.
https://data.unicef.org/resources/ending-preventable-newborn-deaths-and-stillbirths-by-2030/
British Association of Perinatal Medicine (BAPM) (2021)
Advanced Neonatal Nurse Practitioner Capabilities Framework
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The purpose of this framework is to give a career pathway to ANNPs working in any level or unit or within the transport setting. This model makes clear how ANNPs can progress outside the limitations of the clinical rota by setting out a variety of career development pathways using the four pillars of advanced practice: clinical practice, leadership and management, education and research.
The framework sets out the capabilities expected under each of these pillars at the level of ANNP, Senior ANNP and Consultant Nurse.
https://www.bapm.org/resources/300-advanced-neonatal-nurse-practitioner-capabilities-framework
British Association of Perinatal Medicine BAPM
Identification and Management of Neonatal Hypoglycaemia in the Full Term Infant (Birth – 72 hours)
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Hypoglycaemia is a leading cause of term admission to neonatal units. In 2016 NHS Improvement and BAPM convened a working group to develop a Framework for Practice to address variation in practices in the definition of hypoglycaemia, the identification, management and admission thresholds of babies admitted to neonatal units for hypoglycaemia, and to promote safer practices that avoid unnecessary separation of mother and baby.
This update of the Framework is to ensure alignment of recommended clinical practice with the most up-to-date scientific evidence.
This document is aimed at all healthcare professionals involved in the care of infants born at term during the first 48 - 72 hours after birth.
The framework should be delivered in partnership with parents.
We welcome your comments on the update of this Framework for Practice.
Resuscitation Council UK
Newborn resuscitation and support of transition of infants at birth Guidelines
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Authors
Joe Fawke, Jonathan Wyllie, John Madar, Sean Ainsworth, Robert Tinnion, Rachel Chittick, Nicola Wenlock, Jonathan Cusack,
Victoria Monnelly, Andrew Lockey, Sue Hampshire, Published May 2021.
https://www.bapm.org/resources/300-advanced-neonatal-nurse-practitioner-capabilities-framework