FREQUENT QUESTIONS

The daily application of chlorhexidine to the umbilical cord stump in the first postnatal week is a recommendation that depends on the settings.

The only scenario that supports its use is where traditionally noxious substances (e.g., animal manure) are used on the umbilical cord. In newborns with unhygienic cord care (defined as the use of noxious substances on the cord, such as dust, clay, mud, and animal manure), chlorhexidine reduced mortality.

Necrotizing enterocolitis (NEC) is one of the most serious morbidities in preterm infants (PTNB). It is an inflammatory disease of the bowel that can cause perforation of the gut and peritonitis. Its underlying cause would be multifactorial. Some theories blame intestinal mucosal injury, inflammation and the presence of abnormal gut colonization.

Feeding PTNBs with human milk (HM) seems to have a preponderant role in the reduction of NEC, even if the supply of HM is partial.

As efforts to improve the outcomes of neonatal survival are scaled up, there is an increased demand for access to safe and effective transport.

Improving the procedures related to neonatal transport and the quality of care in critical conditions requires evidence-based technical guidelines as a reference for agencies, facilities, and health professionals responsible for setting health system priorities and policies around newborn transport.

Regionalization poses the challenge of defining where to assign resources to intensive care, transport or prevention and primary care.

Neonatal transport should be seen in the context of regionalized perinatal care, which encompasses the care of the pregnant woman and her fetus, the mother-to-be and her baby.

Universal newborn hearing screening (UNHS) with otoacoustic emissions (OAE) or automated auditory brainstem evoked potentials (ABEP-A) testing is recommended for early detection of permanent bilateral hearing loss (PBHL). UNHS should be accompanied by diagnostic and treatment services for infants in whom hearing loss is detected.

Universal neonatal screening for eye anomalies is recommended. This should be accompanied by diagnostic and treatment services for infants in whom an abnormality is detected.

An estimated 1.14 million children aged 0-15 years are blind or have severe visual impairment due to eye conditions. The main causes of blindness are congenital and developmental cataracts, corneal scarring, congenital ocular anomalies, retinal dystrophies, glaucoma, and retinopathy of prematurity.

Before organizing a neonatal transport system, there needs to be planning and coordination at the national and regional levels to align transport goals and objectives with those of the health system as a whole.
The planning process includes:
• Alignment of the objectives aimed to improve health system outcomes and transportation priority cases (and cases excluded).
• Estimation of the demand for care for each health problem selected and per region (met and unmet needs).

After childbirth, it is usual for some mothers to suffer from depression or anxiety. This is due to multiple causes and, in no case should the woman going through these situations be judged. It usually appears as feelings of sadness, irritability, difficulty falling asleep or extreme tiredness.
It is very important to attend to the mother's mental health and social well-being. Referral to a specialist may be advisable.
It is also important to involve the father, sexual partner or other companions, both in the care of the child and in supporting the mother.

Delays in the neonatal transfer system can have an impact on mortality. The “three delays” model (Thaddeus and Maine, 1994) describes a conceptual framework for the factors and phases of delay that influence timely access to specialized emergency care. The model makes it possible to analyze delays in the process at each stage of neonatal transfers.
In most cases, neonates are transferred from a primary care center to a referral center, but it can also occur from the community, from a facility or from within the same center.

Safely transferring sick newborns to health facilities with the level of complexity required to treat their condition contributes to the reduction of neonatal morbidity and mortality rates. Reducing these rates is essential to achieve the global goals for child survival in the coming decades. Efforts to prevent the main causes of neonatal mortality must be complemented by the development of systems to care for sick newborns, including safe neonatal transport.