Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy.
Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy.
Int J Gynaecol Obstet. 2023 Oct;163 Suppl 2:68-73. doi: 10.1002/ijgo.15116.
An integrated approach is lacking for the management of childbirth and newborn care, even though their codependence is critical for improving maternal and newborn outcomes. FIGO's Prep-for-Labor rapid triage methods for women arriving at a clinical facility are addressed in earlier papers in this Supplement, but do not include newborn care. Immediate postpartum rapid triage using established Apgar score helps determine whether standard of care can be followed on site with available staff/tools. If not, newborn transfer alone or with the mother to a higher-level center as soon as feasible may be required. Updated newborn management tools with special emphasis on pragmatic steps that are applicable for any clinical setting including low- and middle-income countries (LMICs) are presented in this article. Given that more than 80% of newborn care can be managed at the birthing facility, transfer to a higher-level center for care is required only in selected cases. Management steps for healthy newborns are described and the actions needed for those requiring resuscitation are summarized. The simple noninvasive kangaroo mother care approach-universally applicable for both term and preterm newborns-is associated with a significant reduction in morbidity and mortality. Kangaroo mother care involves continuous maternal skin-to skin contact from birth, exclusive breastfeeding, and home support after discharge. Hence, hypothermia, hypoglycemia, and acquired infections are frequently prevented. It is anticipated that implementing simple noninvasive management steps will have a substantial positive impact on improving maternal and newborn outcomes.
分娩和新生儿护理的管理缺乏综合方法,尽管两者密切相关对于改善母婴结局至关重要。FIGO 在本增刊的早期论文中介绍了针对到达临床医疗机构的妇女的分娩前快速分诊方法,但不包括新生儿护理。使用已建立的 Apgar 评分进行产后即刻快速分诊有助于确定是否可以在现场使用现有人员/工具来遵循标准护理。如果不行,则可能需要尽快将新生儿单独或与母亲转移到更高一级的中心。本文介绍了更新的新生儿管理工具,特别强调适用于包括低收入和中等收入国家 (LMICs) 在内的任何临床环境的实用步骤。鉴于超过 80%的新生儿护理可以在分娩设施中进行,仅在特定情况下才需要将其转移到更高一级的中心进行护理。本文描述了健康新生儿的管理步骤,并总结了需要复苏的新生儿所需的操作。简单的非侵入性袋鼠式母亲护理方法——普遍适用于足月和早产儿——与发病率和死亡率的显著降低相关。袋鼠式母亲护理包括从出生开始的持续母婴皮肤接触、纯母乳喂养以及出院后的家庭支持。因此,经常可以预防低体温、低血糖和获得性感染。预计实施简单的非侵入性管理步骤将对改善母婴结局产生重大积极影响。