Neonatal nursing

1. Dr. Rajalakshmi Murugan (PhD)
Associate Professor
Department of Nursing
School of Nursing and Midwifery
Addis Ababa University
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Introduction of Neonatal Nursing

2. Neonatology
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 Branch of medicine dealing with
neonate ( newborn) neonatal period
is 4 weeks of infants life after birth.

3. Neonatal nursing
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 Neonatal nursing is a sub-specialty of nursing care for
newborn infants up to 28 days after birth. The term neonatal
comes from neo, "new", and natal, "pertaining to birth or
origin".

4. Neonatal Nursing Definition
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 Neonatal nursing is a specialty that focuses on
helping newborn infants through their first several
months of life. Neonatal nursing deals with
premature infants or infants who have birth
defects and infections or who had a low birth
weight. Most often, your work is done in the
Newborn Intensive Care Unit (NICU).

5. Neonatal Nursing
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• Neonatal nursing requires a high degree of skill, dedication
and emotional strength as they care for newborn infants
with a range of problems.
• These problems vary between prematurity, birth
defects, infection , cardiac malformations and surgical
issues.
• Neonatal nurses are a vital part of the neonatal care team
and are required to know basic newborn resuscitation, be
able to control the newborn's temperature and know how to
initiate cardiopulmonary and pulse oximetry monitoring.
• Most neonatal nurses care for infants from the time of birth
until they are discharged from the hospital.

6. Important Facts About Neonatal
Nurses/ quality
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 Neonatal nurse must have a Skills of Empathy,
service-minded, problem solving, critical thinking,
good judgment and decision making, reading
comprehension, excellent written and spoken
communication, good time management,
situational awarenessWork

7. Job responsibility
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• Clinical care -generally care for a number of patients
in the NICU.
• May also help deliver premature infants, operate
high-tech neonatal machines and oversee the
administration of intravenous (IV) medications.
• May help with the developmental areas of growth,
social and emotional health and well-being.
Providing education to families on how to prevent
further illness and manage ongoing health conditions
will be a large part of job.
• Nurse Educator
• Researcher
• Leadership and management

8. Global status of neonatal issue
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• Globally every year about 4 million children die in
the first 4 weeks of life. A similar number of
babies are still born. Most neonatal deaths (99 %)
occur in low income and middle-income countries
and about half of the deaths occur at home. It is
tragic that millions of newborn die every year
specially when their deaths are so easily
preventable.
• It is estimated that about 75% of neonatal deaths
could be avoided with simple, low cost tools that
already exist such as antibiotics for pneumonia
and sepsis, sterile blades to cut the umbilical
cords using knit caps and kangaroo care to keep

9. Ethiopia status
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• In Ethiopia, about 81,000 babies die every year in
the first four weeks of life. This accounts for 42% of
all deaths in children younger than five years of age.
The risk of death is highest in the first 24 hours of life
when more than half of deaths occur and about
three- quarters of all neonatal deaths occur within
the first week of life. Because a woman health is
very closely linked with that of her fetus and newborn
many of the cause of maternal death and ill health
also have high impact on the health and survival of
the neonate.

10. NMR
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 Ethiopia infant mortality rate from 1950 to 2023.
United Nations projections are also included
through the year 2100.
 The infant mortality rate for Ethiopia in 2022 was
31.019 deaths per 1000 live births, a 4.6%
decline from 2021.

11. NMR
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• The current infant mortality rate for Ethiopia in 2023
is 29.524 deaths per 1000 live births, a 4.82%
decline from 2022.
• The infant mortality rate for Ethiopia in 2022
was 31.019 deaths per 1000 live births, a 4.6%
decline from 2021.
• The infant mortality rate for Ethiopia in 2021
was 32.514 deaths per 1000 live births, a 4.4%
decline from 2020.
• The infant mortality rate for Ethiopia in 2020
was 34.010 deaths per 1000 live births, a 4.21%
decline from 2019.
• https://www.macrotrends.net ›

12. Essential newborn care includes:
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• Immediate care at birth (delayed cord clamping,
thorough drying, assessment of breathing, skin-to-
skin contact, early initiation of breastfeeding)
• Thermal care
• Resuscitation when needed
• Support for breast milk feeding
• Nurturing care
• Infection prevention
• Assessment of health problems
• Recognition and response to danger signs
• Timely and safe referral when needed

13. Common neonatal conditions
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 Preterm infants are born at less than 37 weeks
gestational age and low birth weight infants are
born with a birth weight below 2.5kg regardless of
gestational age.
 An estimated 15 million newborns are born
preterm and more than 20 million are born low
birth weight each year.

14. Common neonatal conditions
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• Congenital conditions can be defined as structural or
functional anomalies that occur during intrauterine life
and may be detected before birth, at birth or in some
cases only in later infancy. They vary in severity and
may or may not affect life expectancy.
• Of the 5 million children under-5 years who died in
2020, approximately 400,000 died from congenital
conditions, representing nearly 8% of total under-5
deaths globally. A large proportion of children with
congenital conditions (over 90%) are born in low- and
middle-income countries.
• A small proportion of these conditions are genetic i.e.
chromosomal abnormalities (e.g. Patau’s Syndrome or

15. Common neonatal conditions
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• A focus on these conditions is important now. The
proportion of deaths resulting from congenital
conditions is increasing and infectious causes of
under-5 mortality are falling. Public health
prevention measures (like food fortification) are
needed as well as ensuring that systems are in
place to detect, treat and provide the long-term
care that children born with these conditions may
require.

16. Common neonatal conditions
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• Neonatal infections are primarily bacterial in origin,
and include pneumonia, sepsis, and meningitis.
• Neonatal infections result in over 550 000 neonatal
deaths every year. Most of these deaths can be
averted by preventive measures, early diagnosis,
timely care-seeking, treatment with appropriate
antibiotics, and follow up. Early diagnosis requires
early recognition of clinical signs, symptoms and
syndromes. Possible serious bacterial infection
(PSBI) is the most important clinical syndrome in low
and middle income countries (LMICs). An estimated

17. Common neonatal conditions
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• Birth asphyxia, defined as the failure to establish
breathing at birth, accounts for an estimated 900,000
deaths each year and is one of the primary causes
of early neonatal mortality. The most common cause
of perinatal asphyxia is complications during
childbirth. Guidelines for neonatal resuscitation
emphasise the importance of drying, stimulating and
warming babies with birth asphyxia. Babies who still
have problems need help with breathing using a
bag-and-mask or equivalent device which is felt by
many to be the critical step in managing asphyxiated
babies.

18. Newborn and Child Health
initiatives in MOH Ethiopia
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 Newborn Health Packages
The neonatal period is one of the most crucial
phases in the survival and development of a
child. There are proven and cost effective
newborn survival interventions, such as clear
delivery practices, exclusive breastfeeding, early
detection of danger signs, and effective and
timely treatment of complications such as sepsis
and birth asphyxia.

19. Newborn and Child Health
initiatives in MOH Ethiopia
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 Community Based Newborn Care (CBNC)
 It uses the four C’s in implementing the intervention
package; 1) prenatal and postnatal Contact with the
mother and newborn; 2) Case-identification of newborns
with signs of possible severe bacterial infection; 3) Care,
or treatment that is appropriate and initiated as early as
possible; and 4) Completion of a full 7-day course of
appropriate antibiotics whether the child needs referral
or not.

20. The nine interventions under the CBNC
package include:
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 Early identification of pregnancy
 Provision of Focused Antenatal Care (ANC)
 Promotion of institutional delivery
 Safe and Clean delivery including provision of misoprostol in
case of home deliveries or deliveries at the health post level
 Provision of immediate newborn care, including application
of Chlorhexidine on cord
 Recognition of asphyxia, initial stimulation and resuscitation
of neonates
 Prevention and management of hypothermia
 Management of pre-term and/or low birth weight neonates
 Initiation of treatment for neonatal sepsis/very severe
conditions at community level followed by prompt referral to
health facilities.

21. Newborn Care Corner
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 A package of interventions that are delivered at the
delivery room by midwives and other health
professionals targeting the three main causes of
newborn mortality; prematurity, asphyxia and
infection.

22. Neonatal Intensive Care Unit
(NICU)
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 To further strengthen the health facilities in delivering quality
MNCH services through efficient and effective linkages
between health centers and health posts, facility-based
packages of interventions are being rolled out by the
Ministry of health.
 The implementation followed operational standards to
classify NICUs into three levels, i.e. Level I (Basic) for
district hospitals, Level II (Specialty) for regional hospitals
and Level III (Sub Specialty) for tertiary hospitals.
 Currently, there are 425 nurses from 90 hospitals that have
been trained in neonatal intensive care level II. Facilities are
also supported technically through provision of essential
equipment to strengthen neonatal intensive care services.