Neonatal mortality is one of the major contributors (almost two-third) to the Infant Mortality. To address the issues of higher neonatal and early neonatal mortality, Facility Based Newborn Care services at health facilities have been emphasized. Setting up of facilities for care of Sick Newborn such as New Born Baby Corners (NBCCs), New Born Stabilization Units (NBSUs) and Special New Born Care Units (SNCUs), at different levels is a thrust area under NHM.

New Born Care Corners (NBCC)

• New-born Care Corner (NBCC) is a designated space in the labour room & Obstetric OT which is situated in draught free area, with equipment 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.
• These are 1 bedded facility attached to the labour room and Operation Theatre (OT) for provision of essential newborn care. NBCC at each facility where deliveries are taking place should be established.

Newborn Stabilization Units (NBSUs)

• New-born Stabilization Units (NBSU) is 4-6 bedded unit established at the sub district level for managing sick and small new-borns that 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.
• NBSUs are established at Community Health Centres (CHC) /First Referral Units (FRUs). These are 4 bedded units with trained doctors and nurses for stabilization of sick newborns.

Special Newborn Care Units (SNCU)

• 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 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.
• States have been asked to set up at least one SNCU in each district. SNCU is 12-20 bedded unit and requires 4 trained doctors and 10-12 nurses for round the clock services.

A comprehensive “Facility Based Newborn Care Operational Guide- 2011, a guideline for planning and Implementation” have been published and disseminated in 2011 by Child Health Division, MoHFW, GOI to act as reference tool for the states to take necessary steps in implementation of same.

Mother Newborn Care Units (MNCU):

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 own newborn.

Mother Newborn Care Unit (MNCU) is a facility where sick and small newborn are cared for with their mothers 24 × 7 with all facilities of SNCU for sick newborn care and provision for post natal care to the mother. The mother is not a visitor but she has her bed next to her baby and is actively involved in providing care. MNCUs should be designed with all the provisions for mother’s stay combined with respectful medical and supportive care for the mothers and their preterm or LBW infants until discharge. While MNCUs are being established, mothers should be encouraged to visit SNCU frequently to provide KMC for long hours.

Services at different levels of facility based newborn care

Navjat Shishu Suraksha Karyakram (NSSK)

The Government of India has been implementing Navjat Sishu Suraksha Karyakaram (NSSK) since 2009. With advances in critical care and based on the evidence, the NSSK training package has now been revised with updated algorithm and improved training methodology. The revised training package is two days classroom and hands-on training. Training package includes a resource manual and Flip chart. NSSK aimed to train all health workers and doctors involved in delivery and newborn care.

The training package emphasizes the skill imparting techniques by the facilitators and ensures uniform messaging across all the levels. This revised training package is an enabling tool and helps healthcare providers to improve their clinical skills and practices and contribute to newborn survival and health in the country.

NSSK is a programme aimed to train health personnel in essential newborn care and resuscitation, has been launched to address care at birth issues i.e. Prevention of Hypothermia, Prevention of Infection, Early initiation of Breast feeding and Basic Newborn Resuscitation. Newborn care and resuscitation is an important starting-point for any neonatal program and is required to ensure the best possible start in life. The objective of this initiative is to have a trained health personal in Basic newborn care and resuscitation at every delivery point. The training is for 2 days and is expected to reduce neonatal mortality significantly in the country. The NSSK training module was revised in the year 2020.

Janani Shishu Suraksha Karyakram (JSSK)

Janani Shishu Suraksha Karyakram (JSSK) was launched on 1st June 2011and has provision for both pregnant women and sick new born till 1 year after birth. 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:

• Free and zero expense treatment
• Free drugs and consumables
• Free diagnostics & Diet
• Free provision of blood
• Free transport from home to health institutions
• Free transport between facilities in case of referral
• Drop back from institutions to home
• Exemption from all kinds of user charges

The initiative would further promote institutional delivery, eliminate out of pocket expenses which act as a barrier to seeking institutional care for mothers and sick infants and facilitate prompt referral through free transport.

Family Participatory Care:

Family Participatory Care provides a conceptual framework for nurturing care by the mother along with other family members including the father. The care provision should include KMC, feeding mother’s own milk and performing activities of daily routine like sponging, changing diaper and helping with monitoring the baby. To ensure zero separation along with provision of KMC for prolonged duration, establishment of Mother Newborn Care Unit (MNCU) is required.

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

• Skin to skin contact
• Exclusive breast feeding

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, Evidence suggests that prolonged KMC—over 8 hours per day—yields maximum benefits for the newborn. To achieve these benefits, family members can also be involved in providing KMC. GoI has implemented Family Participatory Care and KMC can be practiced inside the SNCU/MNCU.

Antenatal Corticosteroids (ANCs)

Preterm baby is defined as a baby who is born alive before 37 weeks of pregnancy are completed. India has the highest number of preterm births as well as neonatal deaths due to prematurity. The mortality rate mong preterm newborns increases with decreasing gestational age. It may be noted that even the moderate and late preterm neonates have an increased mortality risk as compared to those born at term gestation.

Extremely preterm babies require neonatal intensive care for survival. Most of the other preterm babies have a good chance of healthy survival with special newborn care envisaged at sub district, district and medical college hospitals, coupled with facility based kangaroo mother care and home based newborn care.

Preterm babies have numerous challenges including difficulty in feeding maintaining body temperature and increased susceptibility to infections. Other serious complications which can develop are necrotizing enterocolitis (death of intestinal tissue) and intraventricular hemorrhage (bleeding into the brain). However, the most common cause of death among preterm babies less than 34 weeks is Respiratory Distress Syndrome (RDS). This is an acute lung disease due to surfactant deficiency in the lungs which leads to atelectasis and subsequent failure of gas exchange. Fortunately, RDS can be largely prevented by administering injection Corticosteroids to the pregnant woman as soon as she is diagnosed with preterm labour. Injection Corticosteroids (such as Dexamethasone or Betamethasone) when administered to the pregnant woman antenatally, cross the placenta and reach the foetal lung and stimulate surfactant synthesis and maturation of other systems. If this foetus is now delivered prematurely, s/he will have a low risk of developing RDS and, therefore, much higher chance of surviving with supportive care.

Vitamin-K

Vitamin K Deficiency Bleeding (VKDB) previously known as Hemorrhagic Disease of the Newborn (HDN), is a well-known clinical entity for over 100 years. Vitamin K is required for the synthesis of coagulation factors that prevent and control bleeding. All neonates have low levels of Vitamin K owing to poor transport of Vitamin K across placenta, low Vitamin K content in breast milk, and because gut colonization that is critical for its synthesis takes a few days to establish.

Facility based newborn care training manual of MoHFW recommends that all newborns weighing more than 1000 gm should be given 1 mg of Vitamin K intramuscularly after birth (i.e. the first hour by which infant should be in skin-to-skin contact with the mother and breast feeding is initiated). For babies weighing less than 1000 gm, a dose of 0.5 mg is recommended.

Other Newborn Initiatives;

• National Newborn Week: National Newborn Week is being observed by the Ministry of Health and Family Welfare (MoHFW), Government of India from 15th through 21st November to reinforces the importance of newborn health as a key priority area and reiterates its commitment steered at the highest level.
• India Newborn Action Plan: India Newborn Action Plan (INAP) was launched in 2014 to make concerted efforts towards attainment of the goals of “Single Digit Neonatal Mortality Rate” and “Single Digit Stillbirth Rate”, by 2030.