4th. Week

Congenital defects (CDs) are the second leading cause of neonatal mortality and a very important cause of disease and disability.
In Latin America and the Caribbean, there are more than 15 million births every year. According to estimates published in 2018, approximately 15 out of every 1,000 will be at risk of dying before their first birthday and 10 in 1,000 before their first month of life.
One in 5 of the deaths occurring within the first 28 days of life is due to some CD.

Here are the key issues concerning the vaccination of pregnant women, to be considered from the first antenatal visits:
Education. Conveying quality information can change one of the main barriers against vaccination, i.e., lack of knowledge about susceptibility to vaccine-preventable diseases, the morbidity caused by those diseases, and the risks and benefits of vaccines.

There is evidence about aspects that influence the population's acceptance of vaccines. These should be strategically considered by members of the health team and by those who manage resources for vaccination campaigns.
These aspects include:
Trust: In the efficacy and safety of vaccines and in the delivery system.
Indifference: Some people have a low perception of the risk of vaccine-preventable diseases, leading them to believe immunization is unnecessary. Indifference may be determined by underestimation of their benefit (efficacy or safety) or by knowledge gaps.

Having a written breastfeeding policy allows to:

- Make the various actors at the facilities agree to comply with practices that favor breastfeeding.
- Make the medical and nursing staff take ownership of the topic.
- Have recommendations applicable to specific environments.
- Monitor, evaluate and obtain data on breastfeeding practices and their effects, e.g., through audits.
- Exchange views within and outside the institution, involving more actors, sharing experiences and facilitating the replication of good practices.

The development of the breastfeeding policy varies broadly; it should include breastfeeding experts and avoid commercial links with products and companies regulated by the International Code of Human Milk Substitutes.

A committee including high-level representation from all stakeholders may be appointed to develop the policy. Once the necessary agreements are reached, the committee should continue to monitor the proper implementation of the policy.

Standards and policies to strengthen breastfeeding at birthing facilities should be written. This feature is important to sustain unanimity of criteria in practices.

Furthermore, the policy should consider the 10 steps set forth by the World Health Organization for successful breastfeeding, i.e.

- available for consultation by all personnel

- visibly displayed in all areas of the hospital

- written in the language(s) most frequently understood by patients and staff.

Early learning is any opportunity for an infant, toddler or older child to interact with a person, place or object in their surroundings. Such interactions contribute to brain development and lay the foundation for later learning.
Activities that support early learning in the newborn period include making eye contact, smiling, talking, singing, and gently massaging the infant. Responding in a timely manner or anticipating the infant's cues also promotes early learning.

Early learning is defined as any opportunity for an infant, toddler, or older child to interact with a person, place or object around them. Such (positive or negative) interactions, or lack thereof, contribute to brain development and lay the foundation for later learning.
Infants and children should engage in early learning activities with their fathers, mothers and other caregivers between 0 and 3 years after birth.
Activities that support early learning in the neonatal period include making eye contact, smiling, talking, singing, and gently massaging the infant.

Banked human milk is the alternative for feeding premature newborns because it allows them to receive a diet consisting of exclusive human milk when the baby’s own mother's milk is unavailable, scarce or contraindicated.

It should be noted that BHM is superior to artificial formula.

Human milk banks should have standards and procedures in place to ensure that they provide sustainability, safety, and appropriate clinical and ethical use.

Gentle full-body massages are recommended for full-term newborns for their potential growth and developmental benefits.

Gentle stroking and massage provide an opportunity to stimulate infants and interact with them.

Reactions to massage should be respected according to the principles of tender and sensitive care.