Perinatal care

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).

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.

Attention should be focused on the 5 key moments advocated by the World Health Organization (WHO) and other situations associated with care of newborns*.
1. Before contact with the patient.
2. After contact with the patient.
3. Before invasive procedures.
4. After contact with secretions and body fluids.
5. Whenever preparing materials or equipment that are or have been in contact with patients and after contact with areas close to the patient.
* Whenever entering or leaving the hospital unit or isolation area.

Hand hygiene with alcohol or alcohol at 70% concentration with 2% glycerin can replace handwashing with water and soap when there is no visible dirt, especially in procedures at low risk for infection or in emergency situations.
In this procedure it is important to ensure the solution is rubbed on all surfaces of the hands, the fingers, and the spaces between the fingers, leaving the hands to dry spontaneously.

Surgical hand antisepsis
I Rub the hands with water and antiseptic detergent solution, including all surfaces, spaces
between the fingers, and nails; also wash the forearms.
II Rinse with running water.
III Wipe with sterile compress.
Note: this procedure should take 3 to 5 minutes for the first surgery and 2 to 3 minutes for subsequent surgeries.

Simple handwashing (plain soap) or antiseptic handwashing (soap containing antiseptic)
I. Rub the hands with water and liquid soap or antiseptic detergent solution for approximately 15 seconds, including all the surfaces, spaces between the fingers, and nails. Also wash the forearms.
II. Rinse with running water.
III. Wipe with paper towel.

The hands constitute the main form of transmission of microorganisms during patient care. The skin is a possible reservoir for various microorganisms that can be transferred from one surface to another. The skin of the hands hosts two principal microorganism populations: those belonging to the resident microbiota and those belonging to transient microbiota. Transient microbiotas colonize the most superficial layer of the skin, which allows their mechanical removal by handwashing with water and soap, although they are eliminated more easily when an antiseptic solution is used.

To reduce transmission of respiratory viruses during rooming-in and after hospital discharge, provide guidance to health professionals and family members on the following precautions:
• health professionals: disinfect hands before and after contact with patients.
• isolate patients hospitalized with suspicion of respiratory infection, with precautions that include:
· hand washing before and after contact with patients and their personal items;
· use of gloves and apron for contact with patients;

To support countries in adapting their response to different COVID-19 scenarios, the World Health Organization (WHO) Department of Maternal, Newborn, Child and Adolescent Health and Ageing commissioned this scoping review of published and grey literature. The objective was to identify interventions implemented to maintain the provision and use of essential services for MNCAAH during disruptive events and to summarize lessons learned during these interventions.