राष्ट्रीय स्वास्थ्य मिशन
National Health Mission
Facility Based Newborn Care (FBNC) along with Home Based Newborn Care (HBNC) and Home-Based Care for Young Child (HBYC) establishes a continuum of care to ensure that every newborn receives essential services right from the time of birth and first 48 hours at the health facility and then at home up to 15 months.
New-born Care Corner (NBCC) is a designated space in the labour room & Obstetric OT which is situated in draught free area, with equipments like radiant warmers, suction machines, self-inflating bag/AMBU bag including masks of size 0 &1, Oxygen availability etc. NBCC is established to provide support to newborns required resuscitation services and/or assistance at the time of birth by Navjat Sishu Suraksha Karyakaram (NSSK) trained staff.
New-born Care Corners provide services during care at birth i.e. Prevention of Infection, Provision of warmth, Resuscitation, Early initiation of breastfeeding, weighting of new-born, immunization services, identification and prompt referral at risk or sick new-borns.
New-born Stabilization Units (NBSU) is 4-6 bedded unit established at the sub district level for managing sick and small new-bornsthat are not so seriously sick and can be managed at first level of new-born care facility. Pre-referral stabilizing of sick & small new-born at NBSUs before transfer to SNCU/NICU essentially improves the outcome of these babies.
SNCU is a 12 bedded or larger unit located at district/Sub district hospitals and medical colleges with dedicated and adequately trained doctors, staff nurses and support staff to provide 24*7 comprehensive secondary level of new-born care to small and sick neonates. The SNCU should have Patient Care area, Ancillary area and step down or MNCU area within or in close proximity. The minimum recommended number of beds for and SNCU at all the district hospital is 12. However, if the district hospital conducts more than 3000 deliveries per year, 4 beds should be added for each 1000 additional deliveries.
SNCUs are providing the care for sick and small new-borni.e. Management of Low birth weight infants < 1800 g, Management of all sick new-borns except those requiring mechanical ventilation and major surgical interventions, follow-up services of all babies discharged from the unit and high – risk new-borns, immunization services and referral services. Operational cost budget is being provided to SNCUs for ensuring day to day services and management as per FBNC operational guideline.
Mother Newborn Care unit:
The aim of this initiative is ‘no separation’ of mother and baby including small and sick babies who require newborn care. The mother and newborn dyad are to be cared for together while mother is empowered to participate in developmentally supportive care to her ownnewborn.
Services at different levels of facility based newborn care:
|
|
Newborn care corner (at all Delivery Points) |
Newborn Stabilization units (FRUs/CHCs) |
Special Newborn Care Unit (Sub District/District) |
|
Care at birth
|
Resuscitation, provision of warmth, prevention of infection Early initiation of breastfeeding, weighing the newborn |
Resuscitation, provision of warmth Prevention of infection, early initiation of breastfeeding Weighing the newborn |
Resuscitation, provision of warmth, prevention of infection, early initiation of breastfeeding and weighing the newborn |
|
Care of normal newborn |
Breastfeeding/ feeding support |
Breastfeeding/ feeding support |
Breastfeeding/ feeding support |
|
Care of sick newborn
|
Identification and prompt referral of ‘at risk’ and ‘sick’ newborn |
Management of low birth weight infants ≥1800 grams with no other complication Phototherapy for newborns with hyper-bilirubinemia Management of newborn sepsis Stabilization and referral of sick newborns and those with very low birth weight(rooming in) Referral services |
Managing of low birth weight infants <1800grams Managing all sick newborns (except those requiring mechanical ventilation and major surgical interventions) Follow-up of all babies discharged from the unit and high risk newborns Referral services |
Kangaroo Mother Care:
Kangaroo Mother Care (KMC) is a simple method of care for low birth weight infants that includes early and prolonged skin-to-skin contact with the mother (or a substitute caregiver) and exclusive and frequent breastfeeding. This natural form of human care stabilizes body temperature, promotes breast feeding, prevents infection and other morbidities. This also leads to early discharge, better neurodevelopment and encourages bonding between mother and infant.
KMC is initiated in the hospital and continued at home until the infant needs it and for optimum care a regular follow-up should be ensured.
Kangaroo mother care has following components
KMC satisfies all five senses of the infant. The infant feels the mother’s warmth through skin-to-skin contact (touch), listens to her voice and heartbeat (hearing), sucks breast milk (taste) has eye contact with her (vision) and smells her odour (olfaction).
Though all LBW infants should be provided KMC but considering the huge burden at facilities, priority must be given to infants with birth weight less than 2000 grams.
Minimum duration of a KMC session should be one hour because frequent handling may be stressful for the infant. The duration of each KMC session should be gradually increased for as long as the mother can comfortably provide KMC. GoI has implemented Family Participatory Care and KMC can be practiced inside the SNCU/MNCU.
Janani Sishu Suraksha Karyakaram:
Under this initiative the infant up to one year should be entitled to free transport from home to the Government health facility, between facilities and also drop back home. The entitlements would include free drugs and consumables, free diagnostics, free blood wherever required. Entitlement for sick infants till one year after birth are as:
