High

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.

The definition of the word “substitute” implies something that has properties similar to those of another thing and may replace it with a lesser degree of quality, or an imitation of lesser quality than the original.
A human milk substitute is any food marketed as a partial or total substitute for breast milk, and the elements for its administration, whether or not they are suitable for that purpose.
The International Code of Marketing of Human Milk Substitutes applies to marketing strategies for the following milk substitute products:

The mortality burden associated with congenital defects (CD) is relevant globally and regionally. In 2016, the global prevalence of CD reached 82,890,000 cases. One out of five deaths within the first 28 days of life is due to CD. In addition to neonatal mortality due to CD, it contributes to fetal mortality.

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.

The International Code of Substitutes consists of a set of recommendations aimed at regulating the aggressive and improper marketing of human milk substitutes, bottles and teats, which compete with breastfeeding.
In 1981, the 34th World Health Assembly adopted the International Code of Marketing of Human Milk Substitutes as a minimum requirement to protect and promote adequate feeding of infants and young children.

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.

According to the evidence available, vaccination against Covid 19 disease during pregnancy is safe for both mother and baby.
It is important to discuss this with the health care professional that cares for that pregnancy to promote an informed decision about immunization.
Unvaccinated pregnant women are at increased risk of becoming seriously ill, needing intensive care, and even dying. When they get Covid, birth may be triggered prematurely.
It is very important to discuss vaccinations with the professional who is monitoring pregnancy.
 

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.

Sometimes, several vaccines must be administered simultaneously during pregnancy; such is the case of Tdap (tetanus and diphtheria toxoids with acellular pertussis vaccine) and influenza vaccine, for instance.
In studies that enrolled non-pregnant individuals to assess the safety of concurrent administration of Tdap and influenza vaccines, compared to their separate use, there was no evidence of increased risk of adverse events.