4th. Week

Neural tube defects (NTDs) are the most common defects of the central nervous system, with a strong impact on infant morbidity and mortality.
These are some of the milestones that can be highlighted about their evolution:
- 70s: advances in medical/surgical therapies lead to a significant reduction of sequelae and disability.

According to the World Health Organization (WHO), every year, about 8 million children are born with a birth defect in the world. Congenital anomalies cause 10 per cent of all newborn deaths and many of the babies who survive are at risk of carrying a lifelong disability if they do not have timely access to high-quality care.

However, the burden of death and disability differs by place of birth and is disproportionately high in low- and middle-income countries.

Banked human milk (BHM) is the alternative of choice for feeding preterm infants (PTNB) as it provides the opportunity for them to receive a diet consisting of exclusive human milk when the milk of the baby’s own mother is unavailable, scarce or contraindicated.
In terms of its benefits, BHM is somewhat inferior to the mother's own, but superior to artificial formula.

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.

Nutritional interventions are important in the development of young children. However, they are not enough on their own. They must be accompanied by responsive care in the context of early learning opportunities.
A paradigmatic example of adequate nutrition and responsive care is the feeding of human milk on demand to newborns and infants.

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.