Term

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.

Several vaccines can be safely administered during pregnancy. In 2014, the WHO Global Advisory Committee on Vaccine Safety conducted a comprehensive assessment of the existing scientific data on the safety of vaccines during pregnancy, concluding that:
- Pregnancy should not prevent pregnant women from receiving a vaccine.
- Although live or attenuated microbial vaccines, such as the MMR vaccine, might pose a theoretical risk to the fetus, no major vaccination-associated adverse outcomes have been reported.

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.